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. 2025 May 2:55:e127.
doi: 10.1017/S0033291725000984.

Childhood maltreatment's influence on the dynamic course of depression: symptom trajectories during inpatient treatment and after discharge

Janette Ratzsch  1   2   3 , Maike Richter  1   2   3   4 , Rogério Blitz  1   2   3 , Lejla Colic  1   2   3 , Lara Gutfleisch  1   2   3 , Janik Goltermann  4 , Marius Gruber  4   5   6 , Benjamin Straube  7   8 , Nina Alexander  7   8 , Hamidreza Jamalabadi  7   8 , Frederike Stein  7   8 , Katharina Brosch  7   8   9 , Florian Thomas-Odenthal  7   8 , Paula Usemann  7   8 , Lea Teutenberg  7   8 , Jonathan Repple  4   5   6 , Bernhard T Baune  10   11   12 , Martin Walter  1   2   3 , Igor Nenadić  7   8 , Tilo Kircher  7   8 , Udo Dannlowski  4 , Nils Opel  1   2   3   4
Affiliations

Childhood maltreatment's influence on the dynamic course of depression: symptom trajectories during inpatient treatment and after discharge

Janette Ratzsch et al. Psychol Med. .

Abstract

Background: Many studies have highlighted the detrimental effect of childhood maltreatment (CM) on depression severity and the course of illness in major depressive disorder (MDD). Yet our understanding of how CM influences the dynamic symptom change throughout a patient's trajectory remains limited. Hence, we investigated the impact of CM on depression severity in MDD with a focus on various treatment phases during inpatient treatment and after discharge (1 or 2 years later) and validated findings in a real-world setting.

Methods: We used longitudinal data from a cohort study sample (n = 567) and a clinical routine sample (n = 438). CM was measured with the Childhood Trauma Questionnaire (CTQ), and depression severity was assessed using Beck's Depression Inventory (BDI). The long-term clinical trajectory was assessed using the Life Chart Interview.

Results: Our analyses revealed that CM significantly increased depression severity before, during, and after inpatient therapy in both samples. Although CM was associated with higher depression severity at the beginning of inpatient treatment and lower remission rates upon discharge, no discernible impact of CM was evident on the relative change in symptoms over time during inpatient treatment. CM consistently predicted higher relapse rates and lower rates of full remission after discharge during long-term follow-up in both samples.

Conclusions: Our findings affirm the link between CM and the development of more severe and persistent clinical trajectories within real-world clinical settings. Furthermore, conventional psychiatric treatments may not lead to comparable outcomes for individuals with a history of CM, underscoring the necessity for tailored therapeutic interventions.

Keywords: childhood maltreatment; clinical routine samplelong-term course; major depressive disorder; relapse; symptom trajectories.

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Conflict of interest statement

The authors have no conflicts of interest to declare. MG has received remuneration from Janssen for consultancy services. JR received speaker’s honoraria from Janssen, Hexal, Neuraxpharm and Novartis.

Figures

Figure 1.
Figure 1.
Change in BDI values over time during inpatient treatment depending on the severity of CM. Note: CTQ = Childhood Maltreatment Questionnaire, BDI = Beck’s Depression Inventory. CTQ values are divided into three distinct groups to illustrate the absence of an interaction effect.
Figure 2.
Figure 2.
CTQ score by relapse during one-year follow-up interval in the CRS and two-year follow-up interval in the CoSS. Note: CTQ = Childhood Maltreatment Questionnaire, CRS = Clinical Routine Sample, CoSS = Cohort Study Sample.
Figure 3.
Figure 3.
CTQ score by achieving full remission during one-year follow-up interval in the CRS and two-year follow-up interval in the CoSS. Note: CTQ = Childhood Maltreatment Questionnaire, CRS = Clinical Routine Sample, CoSS = Cohort Study Sample.
See this image and copyright information in PMC

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