Childhood Trauma, Recent Stressors, and Risk of Depression Relapse in Late-Life Depression

BACKGROUND: Recent stressors have been linked to poor outcomes of late-life depression (LLD), including relapse. Emerging evidence has linked adverse childhood experiences (ACEs) to the occurrence of LLD. We sought to examine the relationships between recent exposure to stressful life events and ACEs with relapse following remission among older adult. METHODS: In this cohort study, depressed older adults (age ≥65) were provided standard antidepressant medications by a study psychiatrist. Each participant provided responses to the ACEs Questionnaire and to a list of questions regarding stressors in the past 12 months. We defined remission as Montgomery-Asberg Depression Rating Scale (MADRS) score <8 and relapse worsening with a MADRS score ≥15. We conducted both logistic regression analyses of relapse over 3 years and a time-to-relapse survival analysis. To assess moderation by ACE items on the association of stress and relapse, we included them in Cox proportional hazard (PH) models. RESULTS: Of 143 depressed elders, 98 achieved remission within 2 years, and 55 of them experienced a relapse. Exposure to emotional neglect in childhood and stressors later in life were each associated with relapse of LLD, and a history of childhood neglect moderated the relationship between recent stressor exposure and relapse. In bivariate analyses, ACE item 4 (emotional neglect), ACE item 9 (family mental illness), and the combination of both (ACE4 + ACE9) were significantly related to relapse. In subsequent logistic regression models controlling for age, sex, race, education, and baseline MADRS score, the dichotomous and continuous variables combining ACE items 4 and 9 were significantly associated with relapse. In analyses using time-to-relapse as the outcome, emotional neglect was associated with a shorter time to relapse. The number of recent negative stressors was also associated with relapse, and emotional maltreatment moderated that relationship in an unexpected way. CONCLUSION: We found that exposure to emotional neglect in childhood and stressors later in life both were associated with relapse of LLD, and a history of childhood neglect moderated the relationship between recent stressor exposure and relapse. These findings are consistent with, and extend, the robust research evidence base linking psychological neglect with depression in adolescence and adulthood.