From past to present: the connection of traumatic childhood experiences, recent stressful life events, and treatment expectations in depression.

Background

Depression is often linked to adverse experiences across the lifespan, including traumatic childhood experiences and recent stressful life events. These experiences may further amplify the pre-existing pessimistically biased future perspective in depression, also affecting treatment expectations for psychotherapy. More pessimistic treatment expectations, in turn, are associated with less favourable treatment outcomes. However, little is known about how traumatic childhood experiences and recent stressful life events affect treatment expectations in depression.

Objective

This analysis investigated the association between traumatic childhood experiences, recent stressful life events, and treatment expectations among patients with depression. We hypothesised direct associations of traumatic childhood experiences and stressful life events with more pessimistic treatment expectations, and a moderating effect of stressful life events on the association between traumatic childhood experiences and expectations.Method: Data from 55 day clinic patients with depression were analysed. At the beginning of treatment, patients completed the Childhood Trauma Questionnaire (CTQ), and an abuse score and a neglect score were computed. Furthermore, they completed the Social Readjustment Rating Scale (SRRS) to assess the burden of recent stressful life events. Treatment credibility and outcome expectations, both cognitive and affective, were assessed with the Credibility-Expectancy Questionnaire (CEQ).

Results

The path analysis showed that childhood abuse was associated with lower levels of cognitive outcome expectations. In contrast, childhood neglect was associated with higher cognitive outcome expectations and higher treatment credibility. Also, a higher burden of stressful life events was linked to higher cognitive outcome expectations. For affective outcome expectations, no significant association was observed with any of the predictors.

Conclusions

The findings highlight how traumatic childhood experiences and stressful life events are differentially associated with treatment expectations in depression. Thus, tailored interventions to foster positive and realistic treatment expectations are needed taking the patients' history of childhood trauma and recent stressful life events into account.