Differential Psychological Treatment Effects in Patients With Late-Life Depression and a History of Childhood Maltreatment

•What is the primary question addressed by this study?Does childhood maltreatment affect the psychological treatment outcomes in late-life depression?•What is the main finding of this study?In older individuals with depression and childhood maltreatment, both specific and non-specific psychotherapy equally reduce depressive symptoms. However, in patients without childhood maltreatment, cognitive behavioral therapy for late-life-depression demonstrates greater efficacy over non-specific supportive psychotherapy.•What is the meaning of the finding?Practioners should consider a history of early trauma in their choice between specific and non-specific interventions. This is the first interventional study to assess the impact of childhood maltreatment (CM) on psychological treatment outcomes in patients with late-life depression (LLD). This is a secondary analysis of a multicenter, randomized controlled trial with 251 participants aged ≥60 years with moderate to severe depression. Participants were randomly assigned to cognitive behavioral therapy for late life depression (LLD-CBT) or to a supportive intervention (SUI). Treatment outcomes were measured by changes in the Geriatric Depression Scale (GDS). In the intention-to-treat sample (n = 229), both LLD-CBT (n = 115) and SUI (n = 114) significantly reduced depressive symptoms in patients with CM, with large effects at post-treatment (d = 0.95 [95% CI: 0.65 to 1.25] in LLD-CBT; d = 0.82 [95% CI: 0.52 to 1.12] in SUI). A significant treatment group*CM interaction (F(1,201.31) = 4.71; p = .031) indicated greater depressive symptom reduction in LLD-CBT compared to SUI at week 5 and post-treatment for patients without CM, but not at 6-month follow-up. Across both treatments, higher severity of the CM subtype ‘physical neglect’ was associated with a smaller depressive symptom reduction (F(1,207.16) = 5.37; p = .021). Specific and non-specific psychotherapy effectively reduced depressive symptoms in older individuals with depression and early trauma. For patients without early trauma, LLD-CBT may be preferable over SUI. Considering early trauma subtypes may contribute to develop personalized treatment approaches.