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J Affect Disord. 2015 Nov 15;187:241-4. doi: 10.1016/j.jad.2015.08.026. Epub 2015 Aug 19.

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

Author information

1
National Institutes of Health, National Institute of Mental Health, Experimental Therapeutics and Pathophysiology Branch, Building 10/CRC, 10 Center Dr., Bethesda, MD 20892, USA. Electronic address: mark.niciu@nih.gov.
2
Yale University Department of Psychiatry/Connecticut Mental Health Center, Abraham Ribicoff Research Facilities, 34 Park St., 3rd floor, New Haven, CT 06519, USA; Clinical Neuroscience Division, Veterans Affairs National Center for PTSD, Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
3
Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave., West Haven, CT 06516, USA.
4
Yale University Department of Psychiatry/Connecticut Mental Health Center, Abraham Ribicoff Research Facilities, 34 Park St., 3rd floor, New Haven, CT 06519, USA.
5
Yale Child Study Center, 230 South Frontage Rd., New Haven, CT 06519, USA.

Abstract

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 (rs=-0.39, padjusted=0.05). Complementary general linear model analysis revealed enhanced CBT efficacy in patients with a history of early life parental loss or separation [F(1,35)=6.65, p=0.01].

LIMITATIONS:

Small sample size, Treatment-naïve 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.

KEYWORDS:

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

PMID:
26363143
PMCID:
PMC4814568
DOI:
10.1016/j.jad.2015.08.026
[Indexed for MEDLINE]
Free PMC Article
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