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Themenschwerpunkt

Verlauf depressiver Erkrankungen in Abhängigkeit von belastenden Kindheitserfahrungen und Zurückweisungsempfindlichkeit

Published Online:March 10, 2016https://doi.org/10.1024/1661-4747/a000266

Abstract

Zusammenfassung. Belastende Kindheitserfahrungen erhöhen die Wahrscheinlichkeit für psychopathologische Entwicklungen. Misshandelte Kinder weisen ein mehrfaches Risiko auf an Depressionen zu erkranken. Der Krankheitsverlauf beginnt früher, ist schwerer und die Behandlungserfolge sind verringert. Personen, die besonders zurückweisungsempfindlich sind, berichten außerdem mehr belastende Kindheitserfahrungen. In der vorliegenden Studie wird in einer allgemeinpsychiatrischen Klinik mit stationärer und tagesklinischer Behandlung der Zusammenhang zwischen belastender Kindheit und Verlauf der Depression sowie Zurückweisungsempfindlichkeit quantifiziert. Bei 48 Patienten mit einer Diagnose der Depression (F31, F32, F33) wurde zu Behandlungsbeginn und -ende mit einem Selbsteinschätzungs- (BDI) und einem Fremdeinschätzungsmaß (HAM-D) die Schwere depressiver Symptomatik beurteilt. Während des Aufenthalts wurden die Patienten mit der «Skala belastende Kindheitserfahrungen» (KERF-I, Kurzversion) zu belastenden Kindheitserlebnissen interviewt und füllten einen Fragebogen zu Zurückweisungsempfindlichkeit (RSQ) aus. Die Hypothesen wurden mit Korrelationsanalysen getestet. Belastende Kindheitserfahrungen waren mit der BDI-basierten Selbsteinschätzung der Depressivität positiv assoziiert, aber nicht mit dem HAM-D Rating. Patienten mit rezidivierender Depression berichteten doppelt so viele belastende Erfahrungen in ihrer Kindheit als Patienten mit einer einzelnen depressiven Episode. Dreifach höhere Belastungswerte zeigten sich bei Patienten in stationärer Behandlung gegenüber solchen in tagesklinischer Behandlung. Belastende Kindheitserfahrungen waren mit einer erhöhten Zurückweisungsempfindlichkeit assoziiert und diese mit einem geringeren Therapieerfolg. Die Zusammenhänge von belastenden Kindheitserfahrungen mit depressiver Symptomatik und Zurückweisungsempfindlichkeit geben Hinweise auf die Bildung negativer kognitiver Schemata. Die negative Korrelation von Therapieerfolg und Zurückweisungsempfindlichkeit bietet eine Erklärung für den ungünstigeren Verlauf einer depressiven Erkrankung bei Patienten mit vielen belastenden Kindheitserfahrungen.


Examining the course of depression in relation to adverse childhood experiences and rejection sensitivity

Abstract. Adverse childhood experiences increase the risk for a psychopathological development. Maltreated children have double, in some instances multiple odds of developing depression. They have an earlier onset, a more severe course, more comorbidities and frequently respond more poorly to first-line treatments. Persons who are sensitive to social rejection also report more adverse childhood events. The current study quantifies the relationship between childhood adversities and course of depression as well as rejection sensitivity in a psychiatric clinic that includes an inpatient as well as a day care setting. The severity of depressive symptoms was evaluated for 48 patients with depression (including ICD diagnoses F31, F32, F33) at the beginning and the end of the treatment by self-assessment (BDI) and expert rating (HAM-D). Patients were interviewed during the treatment with the German version (KERF-I, short version) of the MACE (Maltreatment and Abuse Chronology of Exposure) scale and completed a questionnaire for rejection sensitivity (RSQ). Correlational analyses were used to test the hypotheses. Adverse childhood experiences were associated with depression severity measured by self-assessment (BDI) but not by expert rating (HAM-D). Patients with recurrent depression reported childhood adversities twice as much as patients with a single depressive episode. Inpatients reported triples of childhood adversities than patients in the day care treatment. Childhood adversities were also positively associated with higher rejection sensitivity and rejection sensitivity went along with a reduced treatment success. The association of adverse childhood experiences with depressive symptoms and rejection sensitivity suggests the development of negative cognitive schemata. The negative correlation of treatment success und rejection sensitivity allows a possible explanation for the less favorable course of depression in patients with many childhood adversities.

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