Childhood trauma and outcome trajectories in patients with longstanding eating disorders across 17 years

Background: A large proportion of patients with eating disorders (ED) report experiences of childhood trauma. Latent trajectory analysis in ED samples reveals the complexities in course and outcome and can explore the long-term impact of adverse experiences in childhood. Method: A total of 84 patients with longstanding ED were included. ED symptoms were assessed by the Eating Disorder Examination interview at discharge from inpatient treatment, and at 1-, 2-, 5-, and 17-year follow-up, respectively. Change over time was examined using growth mixture modeling, allowing the number of trajectories to emerge through the data. Prevalence of childhood trauma was assessed, and its relation to class membership was tested. Results: We identified four distinct classes: patients with (a) a continuous improvement in the entire follow-up period, and scores within normal range at the end, “continuous improvement” (54.8%); (b) a high symptom level at baseline and moderate decrease over time, “high and declining” (22.6%); (c) initial ED scores below clinical cut-off and stable symptoms throughout the course, “consistently low” (14.3%); and (d) with high scores initially, and a significant increase in symptoms over time, “high and increasing” (8.3%). A history of childhood sexual abuse (CSA) was overrepresented in classes with persistently high symptom levels and poor long-term outcome Discussion: Patients with longstanding ED displayed considerable diversity in trajectories of symptom change across 17 years. To improve long-term outcome, enhanced treatment of sequelae from CSA seems essential. Public Significance: Patients with longstanding eating disorders displayed four different trajectories of change in a 17-year follow-up study. Although there were significant changes over time, the majority of patients remained within similar symptom levels as they presented with at discharge from inpatient treatment. Exposure to childhood maltreatment was common within the sample. Childhood sexual abuse predicted poor long-term outcome, which highlights the importance of trauma informed care

Emotional Infant Face Processing in Women With Major Depression and Expecting Parents With Depressive Symptoms

Processing of emotional facial expressions is of great importance in interpersonal relationships. Aberrant engagement with facial expressions, particularly an engagement with sad faces, loss of engagement with happy faces, and enhanced memory of sadness has been found in depression. Since most studies used adult faces, we here examined if such biases also occur in processing of infant faces in those with depression or depressive symptoms. In study 1, we recruited 25 inpatient women with major depression and 25 matched controls. In study 2, we extracted a sample of expecting parents from the NorBaby study, where 29 reported elevated levels of depressive symptoms, and 29 were matched controls. In both studies, we assessed attentional bias with a dot-probe task using happy, sad and neutral infant faces, and facial memory bias with a recognition task using happy, sad, angry, afraid, surprised, disgusted and neutral infant and adult faces. Participants also completed the Ruminative Responses Scale and Becks Depression Inventory-II. In study 1, we found no group difference in either attention to or memory accuracy for emotional infant faces. Neither attention nor recognition was associated with rumination. In study 2, we found that the group with depressive symptoms disengaged more slowly than healthy controls from sad infant faces, and this was related to rumination. The results place emphasis on the importance of emotional self-relevant material when examining cognitive processing in depression. Together, these studies demonstrate that a mood-congruent attentional bias to infant faces is present in expecting parents with depressive symptoms, but not in inpatients with Major Depression Disorder who do not have younger children

Do self-criticism and somatic symptoms play a key role in chronic depression? Exploring the factor structure of Beck depression inventory-II in a sample of chronically depressed inpatients

Background: The factor structure of depression differs for different sub-samples. The purpose of this study was to explore the factor structure of Beck Depression Inventory-II in patients with chronic depression presenting for inpatient treatment. Methods: Using exploratory structural equation modeling (ESEM), we explored whether a two-factor solution or a bifactor solution provided best model fit for a sample of 377 patients. For the best fitting model stability was assessed with tests for invariance across primary diagnosis (persistent depressive disorder v. recurrent major depressive disorder), and presence of comorbidity. Results: A bifactor solution with one general factor and two specific factors provided best model fit. Invariance analyses provided support for measurement invariance and stability of the factor solution. Limitations: The naturalistic study design implies some uncertainty regarding possible systematic differences between the patients on demographic and clinical characteristics. Conclusion: The factor structure in our sample was best explained by a general depression factor, one specific factor pertaining to self-criticism, and one consisting of the somatic items fatigue, disturbance of sleep, and appetite. Clinicians could benefit from paying special attention to the subfactors identified, as these findings may have implications for treatment choice for patients with chronic depression

Comparing outcomes in chronic depression following inpatient psychotherapy for patients continuing versus discontinuing antidepressant medication

Research indicates that combination of psychotherapy and antidepressant medication (ADM) provides cumulative effects and thus outperforms monotherapy in treating chronic depression. In this quasi-experimental study, we explored symptom change for patients with chronic depression treated with ADM when presenting for a 12-week psychotherapeutic inpatient treatment programme. We compared outcomes through treatment and follow-up of patients who continued medication with those who discontinued. We also tested possible moderator effects of initial depression severity on change between the groups. Based on prior research, we hypothesized that combination treatment would yield better results (i.e., more reduction in depression). Patients (N = 112) were referred from general practitioners or local secondary health care. Outcome was measured by Beck Depression Inventory-II (BDI-II), and comparisons were carried out using multilevel modelling. Although 35 patients discontinued ADM during treatment, 77 continued. Both continuers and discontinuers had a significant treatment effect that was maintained at 1-year follow-up. There was no difference in outcome between continuers and discontinuers of ADM. Patients with severe depression had significantly more symptom improvement than patients with moderate depression, but depression severity did not affect outcomes across continuers and discontinuers of ADM differently. The results could indicate that patients had developed resistance and/or tolerance to the prophylactic effects of medication and that ADM did not contribute to the reduction of depressive symptoms. The findings may also indicate that psychotherapy alone in some instances can be a viable alternative to continued combined treatment. Clinicians should carefully assess benefits of patients' ongoing use of antidepressant medication when entering psychotherapy