Q&A: Childhood Maltreatment and Cognitive Functioning in Patients with Major Depression
After reading the lay summary on CAN-BIND paper entitled, “Childhood maltreatment and cognitive functioning in patients with major depression”, we invited our community advisory committee members to share questions they had on the study. Below are some of these questions posed and answers by the first author of the paper, Dr. Trisha Chakrabarty. Reviewed by Wegdan Abdelmoemin, Sagar Parikh, and Andrew Kcomt.
Q: How was the severity of childhood maltreatment measured?
A: Childhood maltreatment was assessed using the Childhood Experience of Care and Abuse interview. This is a semi-structured interview which assesses the type, duration and severity of different forms of maltreatment before the age of 18.
Q: Is it possible that psychotherapy may improve some of these cognitive measures?
A: There isn’t a lot of evidence to suggest that the types of psychotherapy that are commonly used to treat depression (such as cognitive behavioural therapy) impact the types of cognitive measures that were assessed in this study. Cognitive remediation (which involves practicing tasks aimed at improving memory, focus, etc.) has shown promise in improving cognition in depression.
Q: Did the participants with depression and childhood maltreatment show any improvement in cognitive measures after the treatment?
A: Participants with depression did not show significant improvement in cognitive measures after treatment, regardless of whether or not they experienced childhood maltreatment. This is consistent with past studies that have found that most antidepressants do not cause significant improvements in cognition. It also emphasizes the need to develop treatments that are specifically aimed at improving cognition.
Q: Have studies looked at the brain activity of individuals with depression and childhood maltreatment in regard to cognitive function? Are there identifiable differences in brain structure and/or brain activity in regions associated with these cognitive functions?
A: Studies have consistently found that individuals with childhood maltreatment show changes in the structure and activity of brain regions involved in emotion processing and cognition. We are currently examining the relationship between brain changes, cognition and childhood maltreatment in the individuals with depression who participated in the CAN-BIND-1 study.
Q: Do we know to what extent depression exacerbated existing cognitive difficulties? Were pre-/post-intervention scales used to measure the severity of cognitive impairments in both groups?
A: Both the healthy and patient groups completed cognitive testing at baseline and after 16 weeks. Due to the study design, we cannot say for sure to what extent the current symptoms of depression impacted pre-existing cognitive difficulties in the patient group.
Q: From a stigma perspective, it might be interesting for readers to see that depression causes cognitive impairments above and beyond those that may result from earlier childhood experiences. Providing a bit more info about average pre-/post-intervention scores in the results or conclusion sections could be validating for readers.
A: It is important to be aware that depression and a history of childhood maltreatment can each contribute to cognitive difficulties. Our results suggest that having both may put one at risk for having more severe cognitive deficits.
Q: Does severity and/or chronicity of depression impact cognitive functioning?
A: Though there are some inconsistencies in the literature. Generally, studies suggest that more severe symptoms and having more frequent episodes of depression are associated with higher degree of cognitive deficits.
Q: Did the research look at differences between the sexes?
A: We didn’t look at sex differences specifically in this study. Previous studies have found that childhood maltreatment impacts brain structure differently in males and females.
Q: The study finds that patients who have experienced childhood maltreatment are at risk for more severe and persisting cognitive difficulties, even after other symptoms of depression improve. Is it possible that these enduring cognitive difficulties are not the result of depression, but rather a return to a baseline level of cognitive functioning?
A: Based on the evidence that childhood maltreatment can cause persistent cognitive difficulties, we would hypothesize that the enduring cognitive deficits seen in remitted patients with a history of childhood maltreatment does represent a return to baseline cognitive functioning. Another possibility is that patients with childhood maltreatment may be delayed in their recovery of certain cognitive functions. However, since we don’t have cognitive data from prior to the current depressive episode or past the end of the 16 week study, we can’t say which possibility is more likely.