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The contribution of early adverse stress to complex and severe depression in depressed outpatients
Fecha
2021-02
Autores
Gloger, Sergio
Vöhringer, Paul A.
Martínez, Pablo
Chacón, M. Victoria
Cáceres, Cristian
Diez de Medina, Dante
Cottin, Marianne
Behn, Alex
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Editor
Wiley
ISBN
ISSN
1091-4269
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DOI
Resumen
Background: To assess whether linear effects or threshold effects best describe the
association between early adverse stress (EAS) and complex and severe depression (i.e.,
depression with treatment resistance, psychotic symptoms, and/or suicidal ideation), and
to examine the attributable risk of complex and severe depression associated with EAS.
Methods: A cross‐sectional study was conducted using deidentified clinical data (on
demographics, presence of complex and severe depression, and exposure to seven
types of EAS) from 1,013 adults who were seen in an outpatient mental health clinic
in Santiago, Chile, for a major depressive episode. Multivariate logistic regressions
were fitted to estimate odds ratios (ORs), using a bootstrap approach to compute
95% bias‐corrected confidence intervals (95% BC CIs). A detailed examination of
the cumulative risk score and calculations of the attributable risk was conducted.
Results: Exposure to at least five EASs was reported by 3.6% of the sample. In the
multivariate logistic regression models, there was a marked increase in the odds of
having complex and severe depression associated with exposure to at least five
EASs (OR = 4.24; 95% BC CI: 1.25 to 9.09), according to a threshold effect. The
attributable risk of complex and severe depression associated with exposure to at
least one EAS was 36.8% (95% BC CI: 17.7 to 55.9).
Conclusions: High levels of EAS distinctively contribute to complex clinical presentations of depression in adulthood. Patients with complex clinical presentations
of depression and history of EAS should need a differentiated treatment approach,
particularly those having high levels of EAS.
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Gloger, S., Vöhringer, P. A., Martínez, P., Chacón, M. V., Cáceres, C., Diez de Medina, D., Cottin, M., & Behn, A.. The contribution of early adverse stress to complex and severe depression in depressed outpatients. Depress Anxiety. 2021;38:431–438. https://doi.org/10.1002/da.23144
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Atribución-NoComercial-CompartirIgual 3.0 Chile (CC BY-NC-SA 3.0 CL)