Childhood Trauma Questionnaire-based child maltreatment profiles to predict efficacy of the Cognitive Behavioral Analysis System of Psychotherapy versus non-specific psychotherapy in adults with early-onset chronic depression: cluster analysis of data from a randomised controlled trial.

BACKGROUND

Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression.

METHODS

We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study.

FINDINGS

253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F

INTERPRETATION

CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health.

FUNDING

The German Research Foundation and the German Federal Ministry of Education and Research.

Informations de copyright

Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of interests SG has received book royalties from Elsevier. ME has received book royalties from Thieme. MHa has received book royalties from Springer, Hogrefe, Kohlhammer, Elsevier, and Beltz. JPK has received book royalties from Beltz, Elsevier, Hogrefe, and Springer, and honoraria for workshops and presentations from GAIA and Sympatient related to CBASP and other forms of psychological interventions including digital interventions. ES has received book royalties from Elsevier and Routledge/Taylor & Francis, and honoraria for workshops and presentations from Freiburger Institute for Scientific Psychotherapy and Lindauer Psychotherapy Weeks related to CBASP. FP has received honoraria for workshops and presentations Kirinus Munich, AWIP Ulm, and Lindauer Psychotherapy Weeks related to CBASP; is a member of the International Scientific Advisory Board of Sooma and the European Scientific Advisory Board of BrainsWay; has received speakers honoraria from Mag&More and the neuroCare Group; and has received support with equipment to his laboratory from neuroConn, Mag&More, and BrainsWay. All other authors declare no competing interests.