The Long-Term Effect of Trauma History on Adolescent Depression Treatment

Background: Childhood trauma is associated with the development of depression during adolescence. Prior research suggests that traumatic experiences may result in differential acute treatment outcomes for depressed adolescents. However, the long-term effects of trauma on treatment response remain unclear. Method: Participants (N = 318) with a primary diagnosis of major depressive disorder were randomly assigned to 1 of 3 treatment groups: cognitive– behavioral therapy (CBT), fluoxetine (FLX), or their combination (COMB). All participants received 36 weeks of active treatment followed by 1 year of open follow-up. We hypothesized that (a) adolescents without a trauma history would have greater symptom reduction over the course of treatment compared to those with a trauma history and (b) there would be an interaction between trauma history, treatment arm, and time such that adolescents without trauma histories in combination treatment would improve the most rapidly. Linear mixed effects modeling, factorial ANOVAs, and log-linear analyses were used to test these hypotheses. Results: The linear mixed effect model revealed a significant 3-way interaction of time, trauma, and treatment type. In the CBT and COMB groups, adolescents without trauma histories improved more rapidly than traumatized adolescents. In the single-time-point analyses, there were no significant differences between adolescents with trauma histories and those without trauma histories. Conclusions: Whereas all treatment groups experienced significant reductions in depression regardless of trauma history, adolescents without trauma histories receiving psychotherapy demonstrated more rapid improvements in depression symptom severity. Treatment response did not differ between traumatized and nontraumatized youth at long-term follow-up.