Depressive symptom severity and treatment outcome in posttraumatic stress disorder following childhood trauma: A secondary analysis of a randomized clinical trial

Depressive symptoms are frequently comorbid with posttraumatic stress disorder (PTSD), yet it remains unclear whether depressive symptom severity before the start of treatment affects the results of trauma-focused psychotherapy. We hypothesized that baseline depressive symptom severity might reduce overall PTSD symptom improvement and could differentially affect treatment response to imagery rescripting (ImRs) versus eye movement desensitization and reprocessing (EMDR). This secondary analysis of a randomized controlled trial included 150 adults with childhood trauma-related PTSD. Participants received 12 sessions of EMDR or ImRs. Baseline depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II), and PTSD severity was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Mixed-effects models were used to examine (a) the effect of baseline depressive symptom severity on PTSD outcomes and (b) its interaction with treatment condition over time. Baseline depressive symptom severity did not significantly predict PTSD outcomes, RR = 1.005, p = .460, and did not moderate the relative effectiveness of EMDR and ImRs, RRs = 0.986-0.999, ps > .202. Both interventions were effective regardless of baseline depression, contrary to our hypotheses, though the findings may be limited by the use of a self-report depressive symptom measure, which may not capture broader clinical features of depression, and a sample limited to adults with childhood trauma-related PTSD. Overall, these findings support trauma-focused treatments irrespective of comorbid depressive symptom severity.