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Objective: A substantial number of patients with major depressive disorder (MDD) do not respond to treatment, and recurrence rates remain high. The purpose of this study was to examine a history of severe childhood abuse as a moderator of response following a 16-week acute treatment trial, and of recurrence over a 12-month follow-up. Method: Participants included 203 adult outpatients with MDD (129 women; age 18-60). The design was a 16-week single-center randomized, open label trial of interpersonal psychotherapy, cognitive-behavioral therapy, or antidepressant medication, with a 12-month naturalistic follow-up, conducted at a university psychiatry center in Canada. The main outcome measure was Hamilton Depression Rating Scale scores at treatment end point. Childhood maltreatment was assessed at the completion of treatment using an interview-based contextual measure of childhood physical, sexual, and emotional abuse. Multiple imputation was adopted to estimate missing values. Results: Patients with severe maltreatment were significantly less likely to respond to interpersonal psychotherapy than to cognitive-behavioral therapy or medication (OR = 3.61), whereas no differences among treatments were found in those with no history of maltreatment (ORs less than 1.50). Furthermore, maltreatment significantly predicted a shorter time to recurrence over follow-up across treatment conditions (OR = 3.04). These findings were replicated in the sample with complete case data. Conclusions: Patients with a history of childhood abuse may benefit more from antidepressant medication or cognitive-behavioral therapy than from interpersonal psychotherapy. However, these patients remain vulnerable to recurrence regardless of treatment modality. (Contains 3 footnotes, 2 figures and 2 tables.)

The current study examined whether the personality traits of self-criticism or dependency moderated the effect of stressful life events on treatment response. Depressed outpatients (N = 113) were randomized to 16 weeks of cognitive-behavioral therapy, interpersonal psychotherapy, or antidepressant medication (ADM). Stressful life events were assessed with the Bedford College Life Events and Difficulties Schedule. Severe events reported during or immediately prior to treatment predicted poor response in the ADM condition but not in the psychotherapy conditions. In contrast, nonsevere life events experienced prior to onset predicted superior response to treatment. Further, self-criticism moderated the relation of severe life events to outcome across conditions, such that in the presence of severe stress those high in self-criticism were less likely to respond to treatment than were those low in self-criticism. (Contains 3 tables, 2 figures and 10 footnotes.)

The present study compared the role of life events in predicting time to index episode onset under conditions of no or variable treatment versus the role of life events in predicting time to recurrence during maintenance interpersonal psychotherapy (IPT). Eighty-three women with recurrent major depression participated in acute IPT treatment followed by 2 years of maintenance IPT. Life events were assessed using contextual interview and rating methods. Cox regression survival analyses indicated that, although severe life events were significantly associated with time to index episode onset, there was little evidence of an association between events experienced during maintenance treatment and time to recurrence. These results provide evidence that IPT may decrease the potency of life events in provoking recurrence.