AbstractsPsychology

OBJECTIVES This thesis examined three types of childhood adversity, low parental care, overprotection and abuse, as predictors of response to two types of depression treatment: antidepressant medication and psychotherapy. These three types of childhood adversity were also examined in association with adults who made a lifetime suicide attempt or engaged in non-suicidal self-injury (NSSI). Post-hoc analyses were conducted to explore for associations between patients who selected the most extreme responses, lowest or highest, on a pre-treatment measure of depression cognitions and their response to psychotherapy. These analyses were termed the “extreme responder hypothesis.” METHOD Two outpatient groups, recruited for separate but sequential clinical trials, comprised a sample of 372 adults with a primary diagnosis of major depressive episode. The first trial compared the antidepressant medications fluoxetine to nortriptyline (n = 195), and the second compared interpersonal psychotherapy (IPT) to cognitive behavioural therapy (CBT) (n = 177). At baseline, all patients underwent a detailed clinical interview. The structured assessment was conducted by a trained clinician who asked a range of diagnostic questions including incidence of suicide attempts or self-harm; the research nurse asked about childhood abuse. Outcome data were gathered from these interviews, the clinician-rated Montgomery Åsberg Depression Rating Scale (MADRS), and the Clinical Global Impression Scale (CGI), as well as the self-report Parental Bonding Instrument (PBI). OUTCOMES In the medication trial, three outcomes were examined: whether or not the patient had an adequate trial of medication; the percentage improvement at six weeks as measured against MADRS baseline; and whether or not the patient achieved two months of sustained recovery, measured by the CGI at six months. In the psychotherapy trial, two outcomes were examined: whether or not the patient achieved a ≥60% improvement on the MADRS and percentage improvement at end-of-treatment as measured against MADRS baseline. Responses to suicide and NSSI questions were dichotomized outcomes. KEY RESULTS Medication trial: • Low paternal care predicted an inadequate trial of medication. • Maternal overprotection predicted poor patient response to treatment at six weeks and a lower rate of achieving two months of sustained recovery, measured at six months. Psychotherapy trial: • Maternal care showed a non-linear relationship with response across both therapies. Patients reporting intermediate levels of maternal care (versus low or high levels of care) responded best to psychotherapy. • Across therapies, the interaction effect of maternal care by therapy and paternal protection by therapy were statistically significant. • Maternal care and paternal protection levels were associated with a differential response to IPT but not CBT. • The extreme responder hypothesis did not explain the downward response trend in patients who reported high maternal care. Suicide attempts and NSSI:…