Rosh Psychiatry Board Practice Exam

Which of the following factors is associated with an increased risk of recurrence of major depressive disorder after treatment?

1. Childhood maltreatment

2. No prior exposure to adversity

3. Older age at time of initial symptoms

4. Substance misuse

The correct answer is: Childhood maltreatment

Childhood maltreatment is recognized as a significant factor that can increase the risk of recurrence of major depressive disorder after treatment. Individuals who have experienced maltreatment during childhood often have a complex interplay of biological, psychological, and social factors that contribute to the chronicity and recurrent nature of their depressive episodes. Experiences of maltreatment can lead to alterations in neurobiological processes, including dysregulation of the stress response system. This dysregulation may make individuals more susceptible to stressors in adulthood, heightening the chance of depressive episodes re-emerging. Furthermore, childhood trauma can negatively impact one's coping mechanisms, self-esteem, and overall resilience, predisposing them to future episodes of depression. In contrast, the other factors provided are less associated with recurrence in a direct manner. For example, having no prior exposure to adversity generally correlates with a lower risk of developing recurrent depression due to better resilience. Older age at the initial onset of symptoms might suggest a different trajectory or type of depressive disorder that could have different recurrence patterns, and while substance misuse is a significant risk factor for various mental health disorders, it is more directly linked to either the onset or exacerbation of depressive symptoms rather than specifically to the recurrence after treatment in all cases.