Resilience and childhood trauma in mood disorders: Psychopathological implications and treatment response

Background and aim: Childhood trauma is a key risk factor for mood disorders and is associated with greater clinical severity, while resilience may act as a protective factor. This study investigates how childhood trauma and resilience interact to shape psychopathology and treatment response in patients with major depressive disorder (MDD) and bipolar disorder (BD). Methods: The study included 669 participants: 569 patients (380 MDD, 189 BD) and 100 healthy controls (HC). Symptom severity was assessed using standardized scales, with follow-up evaluations of depressive symptoms at six months. All participants completed the Childhood Trauma Questionnaire (CTQ) and Connor-Davidson Resilience Scale (CD-RISC). Results: Patients showed lower resilience and higher childhood trauma scores than HC (both p < 0.001), with more marked differences in those with depressive or anxiety symptoms (p < 0.05). In MDD, low resilience was linked to anhedonia, psychomotor retardation, general psychopathology, suicidality, and non-remission (all p ≤ 0.001), while in BD, it was associated with depressive and anxiety severity and anhedonia (all p ≤ 0.01). Childhood trauma was unrelated to most outcomes, except for higher scores in suicidal MDD patients (p = 0.010), and showed an inverse correlation with resilience in MDD and HC. Linear regression showed that gender (p = 0.013) and anhedonia (p = 0.005) significantly predicted resilience. Logistic regression revealed that higher resilience predicted remission (p = 0.012). Conclusions: Resilience and childhood trauma influence clinical severity in mood disorders. Resilience emerged as a protective factor and predictor of remission, supporting its role as a therapeutic target.