What the study found
The study found that adverse childhood experiences, or ACEs, were associated with a higher risk of treatment-resistant depression, or depression that does not improve after multiple adequate antidepressant trials. This association remained even in analyses designed to account for shared genetic and family factors.
Why the authors say this matters
The authors conclude that preventing ACEs and asking about ACE history in clinical assessment may help identify people with major depressive disorder who are at elevated risk for treatment resistance.
What the researchers tested
The researchers used a cohort study with a co-twin control design in two Swedish Twin Registry cohorts, linking survey data with national patient and prescription registers. They studied twins born from 1959 to 1992 and followed them until the end of 2016.
What worked and what didn't
In the main analysis, each additional ACE was associated with higher odds of treatment-resistant depression. The association also appeared in monozygotic and dizygotic twin analyses, and physical neglect and sexual abuse showed the largest associations with treatment-resistant depression.
What to keep in mind
ACEs were measured with seven self-reported yes-or-no items, and treatment-resistant depression was defined using clinical diagnosis or self-reported major depressive disorder plus antidepressant switching criteria. The abstract does not describe other limitations beyond the study's focus on the available twin cohorts and registers.
Key points
- The study linked adverse childhood experiences with increased odds of treatment-resistant depression.
- The association remained in co-twin analyses, including monozygotic twins.
- Physical neglect and sexual abuse had the strongest reported associations with treatment-resistant depression.
- The sample included 17,814 twins in the main analysis, with 1.3% meeting the study definition of treatment-resistant depression.
- The authors suggest ACE history may be useful in clinical assessment for depression.
Disclosure
- Research title:
- Adverse childhood experiences were linked to treatment-resistant depression
- Authors:
- Ying Xiong, Philip Lindersten, Tong Gong, P. O. Magnusson, S. Liu, Yi Lu
- Institutions:
- Karolinska Institutet, Karolinska Institutet, Karolinska Institutet, Karolinska Institutet, Karolinska Institutet, Karolinska Institutet, University of Edinburgh
- Publication date:
- 2026-03-12
- OpenAlex record:
- View
- Image credit:
- Perumalnadar, Wikimedia Commons, CC0
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