Childhood Trauma in Depressive Disorders

This chapter will discuss the role of childhood trauma in major depressive disorder (MDD). The chapter contributes with new understanding of the negative consequences of early life stress, as well as setting childhood trauma in a biological context of susceptibility and discussing novel long-term pathophysiological consequences in MDD. Childhood traumatic events are risk factors for developing MDD, in addition to a more severe clinical presentation over time (primarily an earlier age at onset and an increased risk of suicide attempt and comorbid illnesses). The importance of investigated childhood trauma in MDD is demonstrated by worse treatment response in individuals with childhood trauma than in non-traumatized individuals with MDD. Childhood trauma leads to alterations of affective regulation, impulse control, and cognitive functioning that might decrease the ability to cope with later stressors. Epigenetic factors may be involved in the neurobiological consequences of childhood trauma in MDD. Biological sequelae such as chronic inflammation, HPA axis abnormalities, sleep disturbances, or telomere shortening might be potential mediators of the negative effects of childhood trauma in MDD, including poorer physical health. The main clinical implication is to systematically assess childhood trauma in patients with MDD, or at least in those with a severe or instable illness course. The challenge for the next years will be to fill the gap between clinical and fundamental research and routine clinical practice. Recommendations for managing this specific population clearly need more attention.