A history of early life parental loss or separation is associated with successful cognitive-behavioral therapy in major depressive disorder

作者：Niciu Mark J^*; Abdallah Chadi G; Fenton Lisa R; Fasula Madonna K; Black Anne; Anderson George M; Sanacora Gerard

来源：Journal of Affective Disorders, 2015, 187: 241-244.

DOI：10.1016/j.jad.2015.08.026

• Major depressive disorder
• Cognitive-behavioral therapy
• Parental loss
• Parental separation
• Hypothalamic-pituitary-adrenal axis
• Cortisol

Background: There is a clinical need for evidence-based psychotherapy response biomarkers in major depressive disorder (MDD). Based on previous studies, we hypothesized that lower 24-h urinary cortisol levels and a history of early life stress/trauma would predict an improved antidepressant response to cognitive-behavioral therapy (CBT).
Methods: 50 currently depressed MDD subjects were enrolled. 24-h urine was collected and measured for cortisol levels by radioimmunoassay (RIA). Subjects were also administered early life stress/trauma measures at baseline: Global Perceived Early-Life Stress (GPELS), The Early Life Trauma Inventory (ELTI) and Klein Loss Scale (KLS). The efficacy of a twelve-week course of once-weekly CBT was evaluated by the primary outcome measure, the 24-item Hamilton Depression Rating Scale (HDRS24), at baseline and every four weeks, and the Beck Depression Inventory at baseline and weekly thereafter. 42 subjects had at least one complete follow-up visit (>= 4 weeks of CBT), and 30 subjects completed the full 12-week course.
Results: Baseline 24-h urinary cortisol levels did not correlate with CBT's antidepressant response. Higher KLS scores, a measure of early life parental loss or separation, correlated with delta HDRS24 (r(s)=-0.39. P-adjusted=0.05). Complementary general linear model analysis revealed enhanced CBT efficacy in patients with a history of early life parental loss or separation [F-(1,F- 3.5)=6.65, p=0.01] .
Limitations: Small sample size, Treatment-naive population.
Conclusions: Early life parental separation or loss positively correlated with CBT's antidepressant efficacy in our sample and may warrant further study in larger clinical samples.

• 出版日期2015-11-15
• 单位NIH; 上海市精神卫生中心