Original Research ARTICLE
Childhood adversity impairs theory of mind abilities in adult patients with major depressive disorder
- 1János Szentágothai Research Centre, University of Pécs, Hungary
- 2Clinical Center, Pécs University, Hungary
Background: Patients with major depressive disorder (MDD) have various theory of mind (ToM) impairments which often predict a poor outcome. However, findings on ToM deficits in MDD are inconsistent and suggest the role of moderating factors. Child abuse and neglect are strong predictors of adult MDD and are often associated with a poorer clinical course trajectory.
Objective: Because early-life adversities result in various forms of ToM deficits in clinical and nonclinical samples, our aim was to investigate if they are significant confounding factors of ToM impairments in MDD.
Methods: We investigated 60 mildly or moderately depressed, nonpsychotic adult patients with MDD during an acute episode, and 32 matched healthy controls. The mental state decoding subdomain of ToM was examined with the Reading the Mind in the Eyes Test (RMET). Childhood adversities were assessed with the Childhood Trauma Questionnaire and the Early Trauma Inventory.
Results: There was no difference between the control and MDD groups in RMET performance. However, when we divided the MDD group into two subgroups, one (N=30) with high and the other (N=30) with low levels of childhood adversities, a significant difference emerged between the controls and the highly maltreated MDD subgroup in RMET performance. A series of 3 (group) 3 (valence) mixed-model ANCOVAs revealed that childhood emotional and physical neglect had a significant negative impact on the response accuracy in RMET in general, whereas emotional abuse specifically interfered with the accuracy in the positive and negative valences if it co-occurred with early-life neglect. To test the dose–response relationship between the number of childhood adversities and RMET capacities, we subjected RMET data of the MDD group to multiple hierarchical regressions: the number of childhood adversities was a significant predictor of RMET total scores and RMET scores in the negative valence after controlling for age, sex, years of education, and the severity of current depression.
Conclusion: Childhood adversities impair ToM capacities in MDD. Exposure to early-life emotional abuse and neglect have a negative impact on the performance in the emotional valences of RMET. Multiple early-life adversities have a dose-dependent association with mental state decoding deficits.
Keywords: Adverse childhood experiences, early life stress, Childhood Trauma Questionnaire, Depression, Theory of Mind, Mental state decoding, Reading the Mind in the Eyes Test, Major Depressive Disorder
Received: 09 May 2019;
Accepted: 04 Nov 2019.
Copyright: © 2019 Simon, Németh, Gálber, Lakner, Csernela, Tényi and Czeh. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Dr. Maria Simon, János Szentágothai Research Centre, University of Pécs, Pécs, 7624, Hungary, firstname.lastname@example.org