Differential association between childhood trauma subtypes and neurocognitive performance in adults with major depression

Abstract

Background

Neurocognitive impairment is one of the prominent manifestations of major depressive disorder (MDD). Childhood trauma enhances vulnerability to developing MDD and contributes to neurocognitive dysfunctions. However, the distinct impacts of different types of childhood trauma on neurocognitive processes in MDD remain unclear.

Methods

This study comprised 186 individuals diagnosed with MDD and 268 healthy controls. Childhood trauma was evaluated using the 28-item Childhood Trauma Questionnaire-Short Form. Neurocognitive abilities, encompassing sustained attention, vigilance, visual memory, and executive functioning, were measured by the Cambridge Neuropsychological Testing Automated Battery.

Results

Multivariable linear regressions revealed that childhood trauma and MDD diagnosis were independently associated with neurocognitive impairment. Physical neglect was associated with impaired visual memory and working memory. MDD diagnosis is associated with working memory and planning. Interactive analysis revealed that physical/sexual abuse was associated with a high level of vigilance and that emotional neglect was linked with better performance on cognitive flexibility in MDD patients. Furthermore, childhood emotional abuse, physical abuse, and emotional neglect were revealed to be risk factors for developing early-onset, chronic depressive episodes.

Conclusion

Thus, specific associations between various childhood traumas and cognitive development in depression are complex phenomena that need further study.

Introduction

Neurocognitive impairments are a common feature in individuals with major depressive disorder (MDD) [1, 2]. It has been observed that approximately two-thirds of MDD patients exhibit disturbances in neurocognitive functioning [3]. Some reviews have consistently identified impairments across various domains of neurocognition in MDD, encompassing attention, vigilance, visual memory, working memory, and executive functions such as cognitive flexibility/shifting, planning, and decision-making [4, 5]. Furthermore, these neurocognitive impairments often endure even during periods of remission, indicating that they may not solely be a consequence of acute depressive symptoms (state-like) but rather possess a more enduring nature (trait-like) [6]. Nevertheless, the underlying mechanisms contributing to neurocognitive impairment in individuals diagnosed with MDD remain elusive.

Childhood trauma has been widely studied as a significant contributing factor in the development of MDD [7]. Research has shown that approximately 54% of MDD patients have experienced traumatic events during their early life [8]. Meta-analyses consistently show a strong link between emotional, physical, or sexual trauma in childhood and an increased incidence of depressive episodes in adulthood [9, 10]. Such adversities not only increase susceptibility to suicidal ideation, reduce quality of life, and elevate the prevalence of comorbid psychiatric conditions [11], but they also contribute to earlier onset of depressive symptoms [12], poorer treatment response [13], higher relapse rates, and a prolonged course of depression [14]. However, further investigation is warranted to elucidate how specific types of childhood trauma affect the age of onset and duration of depression.

Evidence suggests that childhood trauma is linked to neurocognitive impairments, particularly declines in executive function like inhibitory control, neurocognitive flexibility, decision-making, organization and planning, and working memory [15–17]. Individuals with a history of childhood trauma are also at a higher risk for severe executive dysfunction, which affects problem-solving, decision-making, attention regulation, and multitasking [18, 19]. Studies show that adults with childhood trauma often have poorer performance in cognitive domains like visuospatial skills, episodic memory, language fluency, verbal learning and recognition, and cognitive processing speed [20–22]. Additionally, different types of trauma, such as childhood neglect or abuse, are linked to distinct impacts on neurocognitive impairment: neglect often leads to severe long-term deficits, while abuse is associated with slower cognitive responses [23–26] .

Incorporating childhood trauma into studies of neurocognitive function in individuals with MDD is critical for a comprehensive understanding of the complex interplay between trauma, psychopathology, and cognition. Many previous studies, however, did not account for childhood trauma as a potential confounding factor when investigating neurocognitive outcomes in patients with MDD [1, 27]. Recent research has increasingly focused on the interaction between childhood trauma, MDD diagnosis, and neurocognitive function, though findings remain inconsistent. For instance, adults with MDD with a history of childhood trauma showed poorer performance in delayed visuospatial recall and verbal memory recognition compared to healthy controls [28]. Contrarily, another study has reported a positive correlation between the severity of childhood trauma and the decreased processing speed in MDD patients [29]. Moreover, specific types of childhood trauma such as physical abuse and neglect, have been associated with enhanced cognitive abilities in visual and verbal memory, respectively, among MDD patients [30, 31]. However, some studies have not observed significant interactions between MDD diagnosis and childhood trauma experiences on neurocognitive functions, highlighting the need for further research to clarify these complex relationships [32].

In this study, we hypothesize that specific subtypes of childhood trauma experienced by patients with MDD may lead to distinct patterns of neurocognitive impairment. Accordingly, the primary aim of the current study is to explore the interactions between different subtypes of childhood trauma and MDD diagnosis on neurocognitive functions. In addition, we examined the potential associations between various forms of childhood trauma and clinical characteristics observed in patients with MDD.

Materials and methods

Participants

The current study comprised 454 individuals, with ages ranging from 16 to 55 years. This study included 186 participants diagnosed with MDD (125 women, mean age: 27.7 years) and 268 healthy controls (HCs) (169 women, mean age: 26.4 years). The recruitment of MDD participants took place at the Department of Psychiatry in West China Hospital, Sichuan University, while HCs were enrolled through community-based postings and media advertising. The diagnosis of MDD was established by experienced psychiatrists utilizing the Structured Clinical Interview for DSM-IV. The clinical status of MDD patients was assessed using the 17-item Hamilton Rating Scale for Depression (HAMD), with a score greater than 7. Notably, all MDD patients were either drug-naïve or had discontinued psychotropic medication for at least three months prior to enrollment to in order to minimize the potential impact of medication on neurocognitive function [33].

Exclusion criteria for all participants included (1) other major psychiatric disorders, such as bipolar disorder or schizophrenia; (2) uncontrolled or severe physical disease; (3) substance or alcohol abuse/dependence history; (4) neurological disease, head trauma, or loss of consciousness for more than five minutes of consequent neurocognitive impairment; and (5) less than 6 years of education or inability to complete neurocognitive assessment. In addition to these criteria, the HCs group was further excluded if they had a current or previous psychiatric disorder, were on psychotropic medication, or had a family history of mental disorders within three generations on either side of their family.

Written informed consent was obtained from all participants or their legally authorized representatives. The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University, and conducted in accordance with the principles outlined in the Declaration of Helsinki.

Childhood trauma assessments

To evaluate childhood trauma experiences, the 28-item Childhood Trauma Questionnaire-Short Form (CTQ-SF) was administered. This questionnaire assessed five types of self-reported childhood trauma occurring prior to the age of 16 years, namely, emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). Each subscale consisted of five items, with response options ranging from “never” (1 point) to “always” (5 points). The total score of the CTQ-SF ranged from 25 to 125, with higher scores indicating more severe experiences of abuse and neglect. Exposure to childhood trauma was defined as the presence of moderate to severe levels of trauma if at least one CTQ-SF subscale score exceeded its respective cut-off value (EA score ≥ 13, PA score ≥ 10, SA score ≥ 8, EN score ≥ 15, and PN score ≥ 10). The “number of traumas” variable was then calculated based on the number of subscales that exceeded their cut-off values [34]. The Chinese version of the CTQ-SF has demonstrated high reliability and validity in patients with depression [35].

Neurocognition assessments

The Cambridge Neuropsychological Testing Automated Battery (CANTAB) (https://www.cambridgecognition.com/cantab/neurocognitive-tests/) was used to assess neurocognitive abilities. Specifically, six subtests were administered: Rapid Visual Information Processing (RVP) for sustained attention and vigilance, Delayed Matching to Sample (DMS) and Pattern Recognition Memory (PRM) for visual memory, Intra/Extradimensional Shift (IED) for shifting/cognitive flexibility, Spatial Working Memory (SWM) for working memory, and Stockings of Cambridge (SOC) for spatial planning and decision-making. Shifting/cognitive flexibility, working memory, planning and decision-making are crucial aspects of executive function. The neurocognitive tests were conducted in a fixed order, namely, RVP, PRM, DMS, SWM, IED, and SOC, and took approximately 50 min to complete. Detailed information regarding the neurocognitive performance testing procedure distribution of neurocognitive variable residuals (Figure S1) were presented in the Supplementary material. The neurocognitive variables were Z-transformed for presentation in Fig. 1, using the formula: Z = (X - mean) / standard deviation. The main outcome variables are provided in sTable 1, with higher scores indicating better neurocognitive performance, except for SWM_Str.

Fig. 1.

Differences in childhood trauma between MDD and HCs groups^###, q < 0.001; ^##, q < 0.01

Statistical analyses

Statistical analyses were conducted using R version 4.0. Categorical variables (such as sex) were analysed using χ² tests, while continuous variables (such as age and years of education) were analysed using two-tailed t tests to detect differences between diagnostic groups.

Linear models were employed to compare the differences in childhood trauma and cognition functions between diagnostic groups, with age, sex, and years of education serving as covariates. The Benjamini–Hochberg (BH) procedure [36] was used to control false discovery rates (FDR) of multiple tests in comparisons of childhood trauma and neurocognition functions between diagnostic groups. A p < 0.05 after FDR correction (q) was considered statistically significant.

Multiple linear regression analyses were conducted to explore potential interactions between childhood trauma subtypes and MDD diagnosis on neurocognitive dimensions, with age, education, and sex as covariates. Partial Spearman correlations were performed to investigate the association between clinical characteristics (such as onset age, disease duration, and HAMD scores) and childhood trauma in MDD, controlling for age, sex, and years of education. Given the exploratory nature of these analyses, adjustments for multiple comparisons were also applied [37].

Results

Demographics and clinical characteristics

As depicted in Table 1, there was no significant difference in age or sex between the MDD and HC groups (all p > 0.05). However, the MDD patients exhibited fewer years of education than the HCs (t = 5.66, p < 0.001). The onset age of depression was 25.18 ± 8.70 years, the total disease duration was 34.45 ± 50.01 months, and the HAMD total score was 20.44 ± 5.75.

Table 1.

Demographics and clinical characteristics of the participants

Variables	HCs (n = 268)	MDD (n = 186)	t/ χ2	p
Sex (Male/Female)	99/169	61/125	0.655	0.418
Age	26.38 ± 8.29	27.74 ± 8.97	1.660	0.097
Education year (years)	15.45 ± 2.67	13.96 ± 2.89	-5.660	< 0.001
Onset age		25.18 ± 8.70
Total disease duration (months)		34.45 ± 50.01
First episode (Y/N)		117/69
HAMD total scores		20.44 ± 5.75

HCs, healthy controls; MDD, major depressive disorder; Data presented as mean ± standard deviation

Differences in childhood trauma between MDD patients and HCs

As illustrated in Table 2; Fig. 2, the total and subscale scores of the CTQ-SF were significantly higher in the MDD groups compared to and HC groups (CTQ-SF total score: t = 10.4, q < 0.001, Cohen’s d = 1.04; EA: t = 8.04, q < 0.001, Cohen’s d = 0.799; PA: t = 3.7, q < 0.001, Cohen’s d = 0.368; SA: t = 2.71, q = 0.007, Cohen’s d = 0.27; EN: t = 10.4, q < 0.001, Cohen’s d = 1.03; PN: t = 8.58, q < 0.001, Cohen’s d = 0.853). In the MDD group, 56.5% reported experiencing at least one type of childhood trauma, and 37.1% reported experiencing multiple types of childhood trauma. In contrast, these figures were only 18.3% and 4.9%, respectively, in the HCs. Moreover, MDD patients reported a significantly higher number of childhood traumas than HCs (t = 9.62, q < 0.001, Cohen’s d = 0.956).

Table 2.

Differences in childhood trauma between MDD and HCs groups

Variables	HCs (n = 268)	MDD (n = 186)	t	Cohen’s d	p	q
CTQ-SF total scores	32.2 ± 6.79	42.6 ± 13	10.40	1.040	< 0.001	< 0.001
Emotional abuse	6.43 ± 1.91	8.85 ± 4.33	8.04	0.799	< 0.001	< 0.001
Physical abuse	5.80 ± 1.64	6.65 ± 2.85	3.70	0.368	< 0.001	< 0.001
Sexual abuse	5.29 ± 0.86	5.63 ± 1.50	2.71	0.270	< 0.001	0.007
Emotional neglect	8.24 ± 3.30	12.53 ± 5.08	10.40	1.030	< 0.001	< 0.001
Physical neglect	6.44 ± 2.08	8.98 ± 3.52	8.58	0.853	< 0.001	< 0.001
Reporting any trauma N (%)	18.3	56.5	-		-	-
Reporting multiple traumas N (%)	4.9	37.1	-		-	-
Number of traumas	0.25 ± 0.59	1.20 ± 1.32	9.62	0.956	< 0.001	< 0.001

HCs, healthy controls; MDD, major depressive disorder; CTQ-SF, Childhood Trauma Questionnaire-Short Form; Data presented as mean ± standard deviation; q, p corrected by false discovery rates

Fig. 2.

Differences in cognitive functions between MDD and HCs groups ^##, q < 0.01

Association of childhood trauma and MDD diagnosis with neurocognitive functions

The neurocognitive differences between MDD patients and HCs, adjusted for sex, age, and years of education, without controlling for trauma, are presented in sTable 2 and Fig. 2. The results of multiple linear regression analyses are displayed in Table 3.

Table 3.

The effects of childhood maltreatment and MDD diagnosis on cognitive performance

	Sustained attention						Visual memory						Executive function
	RVP A’ a			RVP_PH a			DMS_PC a			PRM_PCd a			IED_SC a			SWM_Str b			SOC_PS a
	R2 = 0.107			R2 = 0.170			R2 = 0.218			R2 = 0.104			R2 = 0.127			R2 = 0.160			R2 = 0.153
	β	p		β	p		β	p		β	p		β	p		β	p		β	p
MDD diagnosis	-0.136	0.008 ##		-0.181	0.072		-5.970	0.167		-4.130	0.626		-0.245	0.674		7.320	0.011#		-1.130	0.277
EA	0.005	0.143		0.005	0.458		-0.227	0.461		-0.393	0.517		-0.009	0.825		0.145	0.476		-0.040	0.589
PA	-0.006	0.146		-0.007	0.412		-0.109	0.739		0.989	0.125		-0.001	0.974		0.268	0.216		-0.074	0.348
SA	-0.025	< 0.001 ##		-0.021	0.118		0.306	0.592		1.820	0.107		0.029	0.709		0.392	0.300		0.119	0.391
EN	0.002	0.458		0.002	0.561		0.130	0.486		0.086	0.813		0.012	0.638		-0.085	0.491		0.072	0.112
PN	-0.006	0.095		-0.009	0.169		-0.173	0.535		-1.260	0.023#		-0.044	0.246		0.433	0.019#		-0.156	0.021#
EA × MDD	-0.009	0.031#		-0.013	0.128		0.405	0.277		-0.528	0.470		-0.061	0.225		-0.024	0.922		-0.011	0.904
PA × MDD	0.011	0.037#		0.017	0.087		0.183	0.667		0.119	0.886		0.069	0.229		-0.148	0.598		-0.030	0.771
SA × MDD	0.026	0.002 ##		0.021	0.208		0.430	0.541		-0.912	0.510		-0.120	0.200		-0.794	0.088		-0.027	0.875
EN × MDD	< 0.001	0.909		0.002	0.786		-0.229	0.373		0.364	0.471		0.097	0.006##		0.042	0.806		0.014	0.818
PN × MDD	< 0.001	0.933		< -0.001	0.990		-0.071	0.843		0.653	0.353		-0.031	0.520		-0.333	0.159		0.113	0.192

RVP, Rapid Visual Information Processing; RVP A’, Sensitivity to correct target; RVP_PH, RVP probability of hit; DSM, DMS_PC; EA, Emotional abuse; PA, Physical abuse; SA, Sexual abuse; EN, Emotional neglect; PN, Physical neglect

a, the higher value presents the better cognitive function; b, the higher value presents the worse cognitive function

^##, p < 0.01; ^#, p < 0.05; The bold font indicates that the value is still less than 0.05 after FDR correction

Sustained attention and vigilance

In the RVP task, MDD patients showed a lower probability of hits (RVP_PH: t = -3.25, q = 0.004, Cohens d = 0.324). MDD diagnosis showed a negative effect on the sensitivity to error score (RVP A’, β = -0.136, p = 0.008, FDR corrected). Moreover, sexual abuse was negatively associated with RVP A’ scores (β = -0.025, p = 0.001, FDR corrected). These results indicate that both sexual abuse and MDD diagnosis were associated with lower levels of vigilance.

The interaction between MDD diagnosis and emotional abuse (β = -0.009, p = 0.031) indicated that a higher score of emotional abuse was associated with a lower RVP A’ score in MDD patients. Nevertheless, the interaction between MDD diagnosis and physical abuse (β = 0.011, p = 0.037), and MDD diagnosis and sexual abuse (β = 0.026, p = 0.002, FDR corrected), suggest that physical abuse and sexual abuse were associated with a higher level of vigilance in MDD patients.

Visual memory

Without controlling for trauma, MDD patients displayed lower percentages of total correct scores in DMS task and lower percentages of correct response in the delayed pattern recognition in PRM task compared to HCs (DMS_PC: t = -3.42, q = 0.004, Cohen’s d = 0.34; PRM_PCd: t = -3.19, q = 0.004, Cohen’s d = 0.32). After controlling for trauma, no significant difference between the MDD patients and HCs. The physical neglect score exhibited a negative correlation with PRM_PCd (PRM_PCd: β = -1.26, p = 0.023, uncorrected).

No interactions between childhood trauma and MDD diagnosis were found in relation to visual memory.

Executive function

In MDD patients, lower scores were observed in the number of problems solved in minimum moves of the SOC task when trauma was not accounted for (SOC_PS: t = -3.07, q = 0.004, Cohen’s d = 0.307). After controlling for trauma, MDD diagnosis was positively associated with the scores on the searching strategy in the SWM task (SWM_Stra: β = 7.32, p = 0.011). Physical neglect was positively corrected with SWM strategy scores (SWM_Stra: β = 0.433, p = 0.019) and negatively corrected with scores on SOC_PS (SOC_PS: β = -0.156, p = 0.021).

A significant interaction between MDD diagnosis and emotional neglect was found for the number of switches completed in the IED task (IED_SC: β = 0.097, p = 0.006), indicating that MDD patients with higher scores of emotional neglect tend to performe better on cognitive flexibility tasks. However, these results were not corrected for FDR.

Association between childhood trauma and clinical variables in depression

As illustrated in Table 4, the onset age of depression exhibited a significantly negative correlation with childhood trauma (EA: r = -0.180, p = 0.018, PA: r = -0.200, p = 0.009, EN: r =-0.258, p = 0.001, PN: r = -0.160, p = 0.037). Furthermore, the total disease duration was significantly positively correlated with childhood trauma (EA: r = 0.167, p = 0.029, PA: r = 0.188, p = 0.014, EN: r = 0.23, p = 0.003, PN: r = 0.183, p = 0.017). However, no significant correlation was observed between childhood trauma and HAMD scores.

Table 4.

Correlations of childhood trauma with clinical characteristics in MDD group

Variables	EA	PA	SA	EN	PN
	p (r)	p (r)	p (r)	p (r)	p (r)
Onset age	0.018 (-0.181) #	0.009 (-0.200) ##	0.496 (-0.052)	0.001 (-0.258) ##	0.037 (-0.160)
Total disease duration (months)	0.029 (0.167) #	0.014 (0.188) #	0.37 (0.069)	0.003 (0.230) ##	0.017 (0.183)
HAMD total scores	0.415 (-0.063)	0.088 (-0.130)	0.083 (-0.132)	0.904 (-0.009)	0.352 (-0.071)

EA, Emotional abuse; PA, Physical abuse; SA, Sexual abuse; EN, Emotional neglect; PN, Physical neglect; ^##, p < 0.01; ^#, p < 0.05

Discussion

The current study revealed that childhood trauma, particularly physical neglect, and sexual abuse, but not emotional neglect/abuse, independently predicted neurocognitive impairment in adults. These deficits were manifested in diminished strategic planning, visual memory, and vigilance abilities. MDD diagnosis also showed negative effects on vigilance and working memory, irrespective of trauma. However, individuals with MDD who experienced certain types of childhood trauma, namely, emotional neglect/abuse and sexual abuse, displayed heightened levels of vigilance and cognitive flexibility.

Our findings indicate that childhood trauma, particularly physical neglect, is linked to cognitive impairments, independent of a diagnosis of MDD. Physical neglect was associated with impaired visual memory and working memory, highlighting memory deficits in individuals with a history of such trauma [16, 38]. These results are consistent with prior research showing that childhood physical neglect can impair memory function and increase the risk of developing dementia in later life [39]. Furthermore, physical neglect is also associated with impaired executive function, which can have a profound impact on an individual’s social functioning. As noted by Moreno-Manso et al. (2022), individuals who experienced childhood physical neglect tend to exhibit difficulties in planning and impulsivity, which impaired their decision-making and problem-solving abilities in their daily life [40]. This suggests that physical neglect not only disrupts cognitive processes but also has long-lasting consequences on an individual’s ability to navigate social and psychological challenges. Although we did not measure brain activity in this study, prior research suggests that the memory deficits observed in individuals who experienced physical neglect may be related to structural and functional changes in specific brain regions, particularly the prefrontal cortex and hippocampus, which are crucial for memory and executive function [41, 42]. While these results did not survive FDR correction, they provide important clues that warrant attention to the role of physical neglect in cognitive development.

Our results revealed that patients with MDD presented impairments in sustained attention, visual memory, and planning and decision-making, consistent with previous studies [1, 4]. Nevertheless, these neurocognitive dysfunctions are influenced, at least in part, by childhood trauma. The differences in sustained attention and visual memory between the MDD and HCs groups disappeared after controlling for five types of childhood trauma. Parlar et al. (2016) highlighted the prevalence of dissociative symptoms among MDD individuals, particularly those with a history of childhood trauma. It is possible that dissociative symptoms, instead of depression symptom severity, are linked with poor visuospatial memory, verbal memory, and processing speed in MDD patients with trauma history [28]. However, the effect of depressive symptoms on memory may be confounded by the mild to moderate severity of depressive symptoms and the small sample size in our study. These findings suggest that future research on cognitive function in patients with MDD should incorporate an assessment of childhood trauma history, as it may be a key factor contributing to the cognitive difficulties observed in this population.

The interaction between childhood trauma and MDD diagnosis is evident in our findings, which suggest that physical and sexual abuse are associated with heightened vigilance in adults with MDD. These results are consistent with some previous studies. For instance, a previous study found that individuals affected by childhood sexual abuse may experience a state of hypervigilance, excessive self-reliance, and feelings of guilt [43]. Children who have suffered physical abuse attend to selectively focus on anger-related stimuli and more likely to misinterpreting facial expressions, particularly those associated with anger or fear [44]. Jaffee (2017) further revealed that the victim of childhood abuse may develop a heightened state of vigilance towards potential threats, characterized by an exaggerated negative bias even in response to mild threat cues [45]. MDD patients often have a subjective perception of negative experiences [46], and negative bias is indeed one of the most prominent symptoms exhibited by individuals with MDD [47]. A potential mechanism underlying this heightened vigilance could involve the overactivation of the amygdala, a brain region critically involved in threat detection and emotional processing [48]. Researches have shown that the amygdala tends to be hyperactive in individuals with a history of trauma leading to an exaggerated response to perceived threats and contributing to the persistent state of hypervigilance [49, 50]. The findings of this study also offer valuable insights for providing rational psychological interventions for MDD patients who have experienced childhood physical and sexual abuse.

Childhood emotional neglect is revealed correlated with better performance in cognitive flexibility in MDD patients. While emotional neglect has traditionally been linked to deficits in cognitive flexibility [16], and depression has also been associated with impaired cognitive flexibility [51], this finding suggests a more complex relationship between early emotional experiences and cognitive outcomes in MDD. The underlying cause of this apparent discrepancy remains unclear. Some evidence indicates that individuals raised in unpredictable environments may display diminished inhibitory control but heightened cognitive flexibility [52]. The “hidden talent hypothesis” proposes that individuals have the potential to develop latent abilities, particularly cognitive skills, that are strengthened by challenging circumstances [53]. Furthermore, it has been shown that MDD patients who experience neglect might possess better metacognitive abilities and greater resilience [54]. Therefore, it is crucial to employ more sophisticated methodology to better understand the impact of childhood emotional neglect on MDD patients, as emotional neglect may function as an unpredictable, mild stressor rather than a severe threat [53].

Childhood trauma can lead to an earlier age of onset of depression and a longer disease duration. Similarly, previous research has indicated that childhood trauma predicted a younger age of onset, with emotional abuse and physical neglect being the strongest predictors [55]. Individuals who have experienced childhood trauma tend to experience depression episodes approximately four years earlier than those without trauma [56]. Childhood trauma can trigger a cascade of neurophysiological responses that lead to persistent changes in the brain’s microscopic organization and function, contributing to the early onset of MDD and prolonged duration of MDD [34, 57].

Several limitations should be taken into account in the present study. First, while the CTQ-SF is a reliable method for evaluating childhood trauma, its retrospective nature makes it susceptible to recall bias. Second, the effects of childhood trauma on neurocognitive functions are complex and may vary depending on factors such as developmental stage, timing of trauma exposure, and trauma severity [58]. Third, excluding MDD patients on psychotropic medication may limit the generalizability of our findings, as such medications can influence cognitive function. Future studies should include patients on psychotropic medication to better account for how these treatments interact with childhood trauma in shaping neurocognitive outcomes in MDD patients. Finally, the cross-sectional design of this study does not allow for establishing causal relationship between childhood trauma and cognitive dysfunction, which future longitudinal research should aim to address.

Conclusions

In summary, this study suggests that physical neglect and sexual abuse in early life have adverse neurocognitive effects. Physical and sexual abuse are associated with a higher level of vigilance, and emotional neglect is associated with better cognitive flexibility in MDD patients. Future neurocognitive research in MDD needs to evaluate and control for childhood trauma to better understand the effects of MDD and specific childhood trauma on neurocognitive functions.

Abbreviations

MDD

Major Depressive Disorder

HCs

Healthy Controls

HAMD

Hamilton Rating Scale for Depression

EA

Emotional Abuse

PA

Physical Abuse

SA

Sexual Abuse

EN

Emotional Neglect

PN

Physical Neglect

CTQ-SF

Childhood Trauma Questionnaire-Short Form

RVP

Rapid Visual Information Processing

DMS

Delayed Matching to Sample

PRM

Pattern Recognition Memory

IED

Intra/Extradimensional Shift

SWM

Spatial Working Memory

SOC

Stockings of Cambridge

FDR

False Discovery Rates

Author contributions

MW, JW and XM co-designed this study. MW drafted the manuscript. MW, JW, XM and XY designed and modified the manuscript. MW, XY, YD, YY, YW, HF, YD, LZ and QW collected data. MW and JW designed the statistical analysis. MW and JW contributed equally to this study. All authors read and approved the final version of the manuscript.

Funding

This work was supported by the Ministry of Science and Technology of the People’s Republic of China (No. 2022ZD0211700), the National Natural Science Foundation of China (No. 82001432), the Sichuan Science and Technology Program (Nos. 2022YFS0346, 2022YFS0348), the 135 Project from West China Hospital of Sichuan University (Nos. 2023HXFH006, 2023HXFH040), and Sichuan University (No. 2022SCUH0023).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The study protocol was approved by the Ethics Committee of West China Hospital, Sichuan University, and conducted in accordance with the principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants or their legally authorized representatives.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.