BACKGROUND Child maltreatment is a broadly confirmed risk factor for mental and physical illness. Some psychological treatments specifically target mental health conditions associated with child maltreatment. For example, the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) focuses on maladaptive interpersonal behaviours in chronic depression. However, how the assessment of child maltreatment could inform personalised treatment is unclear. We used data from a previously published clinical trial to investigate whether a pre-established child maltreatment clustering approach predicts differential outcomes after CBASP versus non-specific supportive psychotherapy in patients with early-onset chronic depression. METHODS We did a cluster analysis of data from a previous randomised controlled trial of unmedicated adult outpatients with early-onset chronic depression who were treated at eight university clinics and psychological institutes in Germany with 32 sessions of CBASP or non-specific supportive psychotherapy. Participants were eligible for the original trial if they were aged 18-65 years; had major depressive disorder (MDD) with an early onset and duration of at least 2 years, current MDD superimposed on a pre-existing dysthymic disorder, or recurrent MDD with incomplete remission between episodes as defined by DSM-IV; and had a score of at least 20 points on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Participants were included in the current study if they had completed the short form of the Childhood Trauma Questionnaire (CTQ) at trial baseline. We used an agglomerative hierarchical clustering approach to derive child maltreatment clusters from individual patterns across the five domains of the CTQ. We used linear mixed models to investigate whether clustering could predict differential clinical outcomes (change in symptom severity on the HRSD-24) up to 2 years after treatment onset. People with lived experience were involved in the current study. FINDINGS 253 patients (129 [51%] treated with CBASP and 124 [49%] with supportive psychotherapy) had complete CTQ records and were included in the analysis. 169 (67%) participants were women, 84 (33%) were men, and the mean age was 45·9 years (SD 11·7). We identified seven child maltreatment clusters and found significant differences in treatment effects of CBASP and supportive psychotherapy between the clusters (F(6,948·76)=2·47; p=0·023); differences were maintained over the 2-year follow-up. CBASP was superior in distinct clusters of co-occurring child maltreatment: predominant emotional neglect (change in β -6·02 [95% CI -11·9 to -0·13]; Cohen's d=-0·98 [95% CI -1·94 to -0·02]; p=0·045), predominant emotional neglect and abuse (-6·39 [-10·22 to -2·56]; -1·04 [-1·67 to -0·42]; p=0·0011), and emotional neglect and emotional and physical abuse (-9·41 [-15·91 to -2·91]; -1·54 [-2·6 to -0·47]; p=0·0046). INTERPRETATION CTQ-based cluster analysis can facilitate identification of patients with early-onset chronic depression who would specifically benefit from CBASP. Child maltreatment clusters could be implemented in clinical assessments and serve to develop and personalise trauma-informed care in mental health. FUNDING The German Research Foundation and the German Federal Ministry of Education and Research.

中文翻译：

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基于儿童创伤问卷的儿童虐待概况，用于预测心理治疗认知行为分析系统与非特异性心理治疗对早发性慢性抑郁症成人的疗效：来自随机对照试验的数据的聚类分析。


背景技术虐待儿童是一个被广泛证实的导致精神和身体疾病的危险因素。一些心理治疗专门针对与虐待儿童相关的心理健康状况。例如，心理治疗认知行为分析系统（CBASP）专注于慢性抑郁症中的适应不良的人际行为。然而，虐待儿童的评估如何为个性化治疗提供信息尚不清楚。我们使用之前发表的一项临床试验的数据来调查，预先建立的儿童虐待聚类方法是否可以预测早发性慢性抑郁症患者接受 CBASP 与非特异性支持性心理治疗后的不同结果。方法 我们对之前一项随机对照试验的数据进行了聚类分析，试验对象是未接受药物治疗的早发性慢性抑郁症成年门诊患者，这些患者在德国八所大学诊所和心理研究所接受了 32 次 CBASP 或非特异性支持性心理治疗。如果参与者年龄在 18-65 岁，则有资格参加原始试验；患有早发且持续时间至少 2 年的重度抑郁症 (MDD)，当前的 MDD 叠加在先前存在的心境恶劣障碍上，或根据 DSM-IV 的定义，复发性 MDD 且两次发作之间未完全缓解；在 24 项汉密尔顿抑郁量表 (HRSD-24) 中得分至少为 20 分。如果参与者在试验基线时完成了简短的儿童创伤问卷（CTQ），则他们将被纳入当前的研究。我们使用凝聚层次聚类方法从 CTQ 五个领域的个体模式中得出儿童虐待聚类。 我们使用线性混合模型来研究聚类是否可以预测治疗开始后 2 年内的不同临床结果（HRSD-24 症状严重程度的变化）。有生活经验的人参与了当前的研究。结果 253 名患者（129 名 [51%] 接受 CBASP 治疗，124 名 [49%] 接受支持性心理治疗）拥有完整的 CTQ 记录，并纳入分析。 169 名 (67%) 参与者为女性，84 名 (33%) 为男性，平均年龄为 45·9 岁 (SD 11·7)。我们确定了七个儿童虐待集群，发现各集群之间 CBASP 和支持性心理治疗的治疗效果存在显着差异 (F(6,948·76)=2·47；p=0·023）；在两年的随访中，差异仍然存在。 CBASP 在同时发生的儿童虐待的不同集群中表现更佳：主要是情感忽视（β -6·02 的变化 [95% CI -11·9 至 -0·13]；Cohen's d=-0·98 [95% CI -1·94 至 -0·02]；p=0·045），主要是情感忽视和虐待（-6·39 [-10·22 至 -2·56]；-1·04 [-1·67 至-0·42]；p=0·0011），以及情感忽视和情感和身体虐​​待（-9·41 [-15·91 至 -2·91]；-1·54 [-2·6 至 -0 ·47]；p=0·0046)。解释 基于 CTQ 的聚类分析可以帮助识别可从 CBASP 中特别受益的早发慢性抑郁症患者。儿童虐待集群可以在临床评估中实施，并有助于开发和个性化心理健康领域的创伤知情护理。资助 德国研究基金会和德国联邦教育与研究部。