Characteristics of Childhood Experiences in Women with Remitted Major Depression

Research into the relationships between psychiatric disorders and childhood adversities (e.g. neglect, physical abuse, sexual abuse) has been limited by the use of self-report assessments, which may provide incomplete or biased information. The Childhood Experience of Care and Abuse (CECA; Bifulco, Brown, & Harris, 1994) is a rigorous semi-structured interview, but is limited in utility because of its length. The goal of this project was to more efficiently classify detailed reports of childhood events gathered from the CECA. An exploratory factor analysis was performed using a sample of women (N=142) with remitted, recurrent major depression. One definable factor was found, Noxious Environment, which accounted for a large proportion of the variance in the CECA. This suggests that the development of a briefer CECA rating method is warranted. Additional exploratory analyses indicated that childhood experiences might be significantly influenced by the composition of the household and any caregiver transitions that occur. These findings suggest the CECA can be condensed, making it less time-consuming and burdensome to score and thus more widely usable in research settings. Additionally, these findings reinforce the advantages of using the CECA over self-report measures of adverse experiences by allowing for changes in ratings over time and accounting for changes in household composition

The Role of Positive Life Events on Treatment Outcome during Acute and Maintenance Interpersonal Psychotherapy for Recurrent Major Depressive Disorder

Major Depressive Disorder (MDD) is a highly recurrent and potentially chronic disorder. While much research has focused on the role of severe life events as important risk factors for depression onset, less is known about the relationship between positive life events and MDD. The purpose of the current study was to examine the relationship between positive life events and recovery from an acute episode of depression and maintenance of recovery in the context of Interpersonal Psychotherapy (IPT) treatment in women with recurrent MDD. One hundred thirty-one women who were enrolled in the "Maintenance Psychotherapy in Recurrent Depression" study (MH 49115 E. Frank, PI) entered into maintenance treatment and received at least one Life Events and Difficulties Schedule interview (LEDS; Brown & Harris, 1978). To simultaneously account for both positivity and threat, event ratings were divided into four mutually exclusive categories: provoking, severe, neutral, and positive. A Cox proportional hazards model with each of the four categories of life events included as time-dependent covariates was used to test the cumulative effects of life events on 1) time to remission during the acute treatment phase and 2) time to recurrence during the maintenance phase. Contrary to the hypotheses, there was no relationship between the cumulative experience of positive life events and remission from MDD during the acute treatment phase, nor was there a significant relationship between the cumulative experience of positive life events and episode recurrence. However, the cumulative experience of "neutral" life events was significantly related to episode recurrence, even when controlling for demographic and clinical variables, including personality pathology. This finding suggests that the cumulative effects of seemingly benign "neutral" events may disrupt therapy processes and trigger episode recurrence. Future work is needed to further elucidate the nature of these neutral life events and how they may be related to stress reactivity or stress generation in patients at high risk for MDD recurrence. This may help to clarify the mechanisms by which life events contribute to depression and how best to target these areas in therapy