Childhood maltreatment and outcomes following electroconvulsive therapy in adults with depression.

IF 5.3 2区 医学 Q1 PSYCHIATRY Acta Psychiatrica Scandinavica Pub Date : 2024-09-05 DOI:10.1111/acps.13756
Ana Jelovac, Christopher Mohan, Emma Whooley, Anna Igoe, Cathal McCaffrey, Declan M McLoughlin
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Abstract

Objective: Childhood maltreatment is associated with less favourable treatment outcomes with pharmacotherapy and psychotherapy for depression. It is unknown whether this increased risk of treatment resistance in maltreated individuals extends to electroconvulsive therapy (ECT).

Methods: This retrospective cohort study included 501 consecutive adult referrals for an acute course of twice-weekly ECT for unipolar or bipolar depression at an academic inpatient centre in Ireland between 2016 and 2024. Retrospectively reported physical and sexual childhood maltreatment were assessed on hospital admission. Response was defined as a score of 1 or 2 and remission was defined as a score of 1 on the Clinical Global Impression - Improvement scale 1-3 days after final ECT session. Logistic regression analyses were used to examine the associations between childhood maltreatment and ECT nonresponse and nonremission, adjusting for covariates. Mediation analyses were conducted to explore the role of psychiatric comorbidities, persistent depressive symptoms lasting 2 years or more in the current episode, and baseline depression severity.

Results: Compared to the group with no childhood maltreatment, the childhood maltreatment group had similar odds of ECT nonresponse (adjusted odds ratio = 1.47, 95% CI = 0.85-2.53) but significantly elevated odds of ECT nonremission (adjusted odds ratio = 3.75, 95% CI = 1.80-7.81). In a mediation analysis, presence of persistent depressive symptoms mediated 7.4% of the total effect of childhood maltreatment on ECT nonremission.

Conclusion: Individuals with exposure to childhood maltreatment may be less likely to achieve full remission following a course of ECT.

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儿童时期的虐待与成年抑郁症患者接受电休克治疗后的结果。
目的:儿童时期的虐待与抑郁症药物治疗和心理治疗的不良疗效有关。目前尚不清楚受虐待者治疗抵抗风险的增加是否也会影响到电休克疗法(ECT):这项回顾性队列研究纳入了2016年至2024年期间爱尔兰一家学术住院中心连续转诊的501名成人患者,这些患者因单相或双相抑郁症接受了每周两次的急性ECT治疗。入院时对回顾性报告的童年身体虐待和性虐待进行了评估。最后一次电疗疗程后1-3天,临床总体印象--改善量表得分达到1分即为应答,得分达到2分即为缓解。逻辑回归分析用于研究童年虐待与 ECT 无应答和无缓解之间的关系,并对协变量进行了调整。研究人员还进行了中介分析,以探讨精神疾病合并症、持续2年或更长时间的抑郁症状和基线抑郁严重程度的作用:与无童年虐待组相比,童年虐待组的电疗无反应几率相似(调整后的几率比=1.47,95% CI=0.85-2.53),但电疗无缓解几率显著升高(调整后的几率比=3.75,95% CI=1.80-7.81)。在中介分析中,持续抑郁症状的存在中介了儿童虐待对电疗无效总影响的7.4%:结论:受过童年虐待的人在接受电痉挛疗法治疗后完全缓解的可能性较小。
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来源期刊
Acta Psychiatrica Scandinavica
Acta Psychiatrica Scandinavica 医学-精神病学
CiteScore
11.20
自引率
3.00%
发文量
135
审稿时长
6-12 weeks
期刊介绍: Acta Psychiatrica Scandinavica acts as an international forum for the dissemination of information advancing the science and practice of psychiatry. In particular we focus on communicating frontline research to clinical psychiatrists and psychiatric researchers. Acta Psychiatrica Scandinavica has traditionally been and remains a journal focusing predominantly on clinical psychiatry, but translational psychiatry is a topic of growing importance to our readers. Therefore, the journal welcomes submission of manuscripts based on both clinical- and more translational (e.g. preclinical and epidemiological) research. When preparing manuscripts based on translational studies for submission to Acta Psychiatrica Scandinavica, the authors should place emphasis on the clinical significance of the research question and the findings. Manuscripts based solely on preclinical research (e.g. animal models) are normally not considered for publication in the Journal.
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