Childhood Maltreatment and Cognitive Functioning in Patients with Major Depression
Author: Dr. Trisha Chakrabarty
Editors: Dr. Wegdan Rashad, Dr. Sagar Parikh, and Mr. Andrew Kcomt
Your childhood experiences influence how you view yourself, others and the world. It’s not surprising then that the presence of emotional, physical and/or sexual abuse in childhood (collectively called ‘childhood maltreatment’) is one of the strongest risk factors for developing depression later in life.
Childhood maltreatment, however, impacts more than one’s emotional well-being over the long-term, as these stressful experiences also alter areas of the brain involved in memory, attention and problem solving. These functions fall under the broad umbrella of ‘cognition’: the process of acquiring, understanding and manipulating information about the world around us. Adults who experienced childhood maltreatment display more cognitive difficulties than their peers, even if they don’t suffer from a diagnosable mental health disorder.
Adults with depression also experience cognitive difficulties, which may remain even after symptoms of depression improve. These cognitive difficulties contribute to problems with social, school and work performance. It is therefore important for us to understand which patients with depression are more likely to have severe and long-lasting cognitive difficulties, in order to provide them with needed support. As childhood maltreatment is associated with long-lasting cognitive changes, we thought it possible that individuals with depression who have also experiencedchildhood maltreatment are at higher risk for more pronounced problems with cognition.
In our paper published last year, we aimed to answer two main questions: 1) in adults who are currently depressed, are experiences of childhood maltreatment associated with cognitive difficulties? and 2) do these same adults with childhood maltreatment continue to show cognitive difficulties, even after their depressive symptoms improve?
Study Groups and Plan
At the start of the CAN-BIND-1 study, 183 participants with current symptoms of major depression and 102 healthy comparison participants completed a detailed interview regarding childhood experiences of maltreatment and computerized cognitive tests. Participants with depression then received 16 weeks of treatment with the antidepressant escitalopram, with some participants who did not improve with the initial 8 weeks of escitalopram additionally receiving aripiprazole (a commonly used add-on medication in depression) from weeks 8 to 16. After these 16 weeks, all participants completed a standardized questionnaire with a clinician to assess symptom severity, and repeated the cognitive tests.
The results of the childhood maltreatment interview were used to classify participants into the following groups:
- Participants with depression and childhood maltreatment
- Participants with depression without childhood maltreatment
- Healthy participants with childhood maltreatment
- Healthy participants without childhood maltreatment
These groups were compared on specific cognitive measures, including memory (ability to remember words and shapes), processing speed (the speed at which one can understand and complete a mental task), complex attention (ability to focus on changing and complex information), cognitive flexibility (ability to mentally shift between different sets of information), working memory (ability to mentally hold and manipulate information) and ‘global’ cognition (an average of multiple different cognitive measures).
We found that approximately half of adult participants with depression (93 out of 183) experienced severe childhood maltreatment. In contrast, only 20% of healthy participants experienced severe childhood maltreatment.
Before starting antidepressant treatment, all participants with depression were experiencing moderate – severe depressive symptoms. Participants with depression and childhood maltreatment scored significantly lower than healthy participants without maltreatment in global cognition, memory, and processing speed scores. However, participants with depression and without childhood maltreatment did not differ from healthy participants without maltreatment in any cognitive measure.
After 16 weeks of antidepressant treatment, 49 participants with depression and childhood maltreatment and 50 participants with depression and without childhood maltreatment were in ‘remission’, meaning that they no longer had significant symptoms of depression. Remitted participants with depression and childhood maltreatment scored lower than healthy participants without maltreatment in memory and processing speed. Remitted participants with depression and without childhood maltreatment once again scored similarly to healthy participants without maltreatment in all cognitive measures.
Our findings suggest that in depression, it is the patients who have experienced childhood maltreatment who are at risk for more severe and persisting cognitive difficulties, even after other symptoms of depression improve. These individuals may benefit from more and longer term supports to help them succeed in their social and work pursuits.
Chakrabarty, T., Harkness, K. L., McInerney, S. J., Quilty, L. C., Milev, R. V., Kennedy, S. H., … & Lam, R. W. (2020). Childhood maltreatment and cognitive functioning in patients with major depressive disorder: a CAN-BIND-1 report. Psychological medicine, 50(15), 2536-2547.