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Objective To compare the intervention effects of antidepressants combined with Yi Shu psychodrama or with general health education on depression, anxiety, self-esteem and mental resilience in depression patients with childhood trauma so as to explore a better clinical program. Methods A total of 68 patients who met the diagnostic criteria of ICD-10 unipolar depressive episode and also were positive for Childhood Trauma Questionnaire 28 item Short Form (CTQ-SF) were recruited from the psychiatric outpatients of our hospital, and then they were randomly divided into antidepressants plus Yi Shu psychodrama group and antidepressants plus general health education group. The patients were subsequently intervened for 6 months and then followed up for another 6 months. Hamilton Depression Rating Scale-17 item (HAMD-17), Beck Anxiety Inventory-21 item (BAI-21), Self-Esteem Scale (SES) and Connor-Davidson Resilience Scale (CD-RISC) were used for assessment. Repeated-measures ANOVA was adopted to compare the effects on depression and anxiety improvement, as well as the results of self-esteem and resilience development between the 2 groups at the end of intervention and during follow-up. Results ① There were 35 cases enrolled in the psychodrama group and 33 in the joint health education group. By the end of follow-up, 4 cases were lost in the former and 13 in the latter group, with statistical difference in shedding rate between the 2 groups (11.4% vs 39.4%, P < 0.01). ② At the end of intervention, the total efficacy rate of the psychodrama group was higher than that of the health education group (63.63% vs 37.04%, Chi-square=4.207, P < 0.05). ③ The results of repeated-measures ANOVA and simple effect analysis revealed that at the end of intervention, the scores of depression and anxiety were decreased in both groups, while those of self-esteem, mental resilience and its dimensions were increased, with significant differences in scores of HAMD, SES, CD-RISC and its dimensions (P < 0.05), except for BAI score. During the follow-up, the scores of self-esteem and strength dimension were higher in the psychodrama group than the health education group (P < 0.05). Conclusion In the treatment of major depressive disorder with childhood trauma, antidepressants combined with Yi Shu psychodrama has better overall efficacy and maintenance effect in improving depression, anxiety, self-esteem and mental resilience than the joint general health education program, with better treatment compliance as well.

Objective To compare the effects of the combination of (Yishu) psychodrama versus general mental health education with antidepressants on clinical symptoms, coping style and neuroimaging features in patients with major depressive disorder (MDD) who experienced childhood trauma. Methods This prospective case-control study was conducted in MDD patients with childhood trauma recruited from our department of psychiatry. The patients were randomly assigned into observation group (n=16) for treatment with antidepressants combined with (Yishu) psychodrama and control group (n=16) treated with antidepressants and general mental health education, and selective serotonin reuptake inhibitors (SSRIs) was used as the main antidepressants for 6 months in both groups. After the interventions, the patients were assessed using Beck Depression Inventory-13 item (BDI-13), Beck Anxiety Inventory (BAI), and Trait Coping Style Questionnaire (TCSQ), and the amplitude of low frequency fluctuations (ALFF) in resting functional magnetic resonance imaging (fMRI) was determined and compared between the two groups. Results After 6 months of intervention, no significant differences were found in the changes of BDI score (P>0.05) or BAI score (P>0.05) between the two groups, but the changes in TCSQ positive score (P < 0.05) and TCSQ negative score (P < 0.01) differed significantly between them. Resting fMRI results showed 19 interactive brain regions (corrected by FDR, P < 0.05) in these patients. Post hoc analysis revealed that after the intervention, the patients in the observation group, as compared with the control patients, tended to have enhanced activation of the left medial superior frontal gyrus (P>0.05) and showed significant enhancement of activation in the right parahippocampal gyrus (P < 0.01) with attenuated activation in the left precuneus lobe (P < 0.05). Conclusion Antidepressants combined with psychodrama can more effectively modify the coping style of depressed patients with childhood trauma than the combination of medications and general mental health education, possibly due to the effect of psychodrama to enhance the activation of the right parahippocampal gyrus and attenuate the activation of the left anterior cuneiform lobe, which leads to reduction of the adverse effects of negative experiences on emotion and cognition-coping. Psychodrama combined with medications can be used in the treatment of depressed patients with childhood trauma.