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Unraveling the link between childhood maltreatment and depression: Insights from the role of ventral striatum and middle cingulate cortex in hedonic experience and emotion regulation

Published online by Cambridge University Press:  05 January 2024

Han-yu Zhou
Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China Shanghai Changning Mental Health Centre, Shanghai, China
Lan Zhou
Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
Tong-xuan Zheng
Shanghai Changning Mental Health Centre, Shanghai, China
Li-ping Ma
Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
Ming-xia Fan
Department of Physics, Shanghai Key Laboratory of Magnetic Resonance, School of Physics and Materials Science, East China Normal University, Shanghai, China
Liang Liu
Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pu-dong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
Xu-dong Zhao
Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pu-dong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
Chao Yan*
Shanghai Changning Mental Health Centre, Shanghai, China Key Laboratory of Brain Functional Genomics (MOE&STCSM), Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
Corresponding author: C. Yan; Email:


Childhood maltreatment is an established risk factor for psychopathology. However, it remains unclear how childhood traumatic events relate to mental health problems and how the brain is involved. This study examined the serial mediation effect of brain morphological alterations and emotion-/reward-related functions on linking the relationship from maltreatment to depression. We recruited 156 healthy adolescents and young adults and an additional sample of 31 adolescents with major depressive disorder for assessment of childhood maltreatment, depressive symptoms, cognitive reappraisal and anticipatory/consummatory pleasure. Structural MRI data were acquired to identify maltreatment-related cortical and subcortical morphological differences. The mediation models suggested that emotional maltreatment of abuse and neglect, was respectively associated with increased gray matter volume in the ventral striatum and greater thickness in the middle cingulate cortex. These structural alterations were further related to reduced anticipatory pleasure and disrupted cognitive reappraisal, which contributed to more severe depressive symptoms among healthy individuals. The above mediating effects were not replicated in our clinical group partly due to the small sample size. Preventative interventions can target emotional and reward systems to foster resilience and reduce the likelihood of future psychiatric disorders among individuals with a history of maltreatment.

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© The Author(s), 2024. Published by Cambridge University Press

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Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217237. CrossRefGoogle ScholarPubMed
Baker, L. M., Williams, L. M., Korgaonkar, M. S., Cohen, R. A., Heaps, J. M., & Paul, R. H. (2013). Impact of early vs. late childhood early life stress on brain morphometrics. Brain Imaging and Behavior, 7(2), 196203. CrossRefGoogle ScholarPubMed
Beck, A., & Steer, R. (1993). Manual for the beck depression inventory (1993 edn). The Psychological Corporation.Google Scholar
Beck, A. T. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4(6), 5361.CrossRefGoogle ScholarPubMed
Bernstein, D., & Fink, L. (1998). Childhood trauma questionnaire: A retrospective self-report. The Psychological Corporation.Google Scholar
Bowlby, J. (1982). Attachment: Attachment and loss volume one (2nd edn). Basic Books.Google Scholar
Cassiers, L. L. M., Sabbe, B. G. C., Schmaal, L., Veltman, D. J., Penninx, B. W. J. H., & Van Den Eede, F. (2018). Structural and functional brain Abnormalities associated with exposure to different childhood trauma subtypes: A systematic review of neuroimaging findings. Frontiers in Psychiatry, 9, 329. CrossRefGoogle ScholarPubMed
Chan, R. C. K., Shi, Y.-F., Lai, M.-K., Wang, Y.-N., Wang, Y., Kring, A. M., Heaton, R. K. (2012). The temporal experience of pleasure scale (TEPS): Exploration and confirmation of factor structure in a healthy chinese sample. PLoS One, 7(4), e35352. CrossRefGoogle Scholar
Dahnke, R., Yotter, R. A., & Gaser, C. (2013). Cortical thickness and central surface estimation. Neuroimage, 65, 336348. CrossRefGoogle ScholarPubMed
Dannlowski, U., Kugel, H., Huber, F., Stuhrmann, A., Redlich, R., Grotegerd, D., Dohm, K., Sehlmeyer, C., Konrad, C., Baune, B. T., Arolt, V., Heindel, W., Zwitserlood, P., Suslow, T. (2013). Childhood maltreatment is associated with an automatic negative emotion processing bias in the amygdala. Human Brain Mapping, 34(11), 28992909. CrossRefGoogle ScholarPubMed
Destrieux, C., Fischl, B., Dale, A., & Halgren, E. (2010). Automatic parcellation of human cortical gyri and sulci using standard anatomical nomenclature. Neuroimage, 53(1), 115. CrossRefGoogle ScholarPubMed
Dillon, D. G., Holmes, A. J., Birk, J. L., Brooks, N., Lyons-Ruth, K., & Pizzagalli, D. A. (2009). Childhood adversity is associated with left basal ganglia dysfunction during reward anticipation in adulthood. Biological Psychiatry, 66(3), 206213. CrossRefGoogle ScholarPubMed
Duncan, N. W., Hayes, D. J., Wiebking, C., Tiret, B., Pietruska, K., Chen, D. Q., Rainville, P., Marjańska, Młgorzata, Ayad, O., Doyon, J., Hodaie, M., Northoff, G. (2015). Negative childhood experiences alter a prefrontal-insular-motor cortical network in healthy adults: A preliminary multimodal rsfMRI-fMRI-MRS-dMRI study. Human Brain Mapping, 36(11), 46224637. CrossRefGoogle Scholar
Fan, J., Liu, W., Xia, J., Li, S., Gao, F., Zhu, J., Han, Y., Zhou, H., Liao, H., Yi, J., Tan, C., Zhu, X. (2021). Childhood trauma is associated with elevated anhedonia and altered core reward circuitry in major depression patients and controls. Human Brain Mapping, 42(2), 286297. CrossRefGoogle ScholarPubMed
Favrod, J., Giuliani, F., Ernst, F., & Bonsack, C. (2010). Anticipatory pleasure skills training: A new intervention to reduce anhedonia in schizophrenia. Perspectives in Psychiatric Care, 46(3), 171181. CrossRefGoogle ScholarPubMed
Gard, D. E., Gard, M. G., Kring, A. M., & John, O. P. (2006). Anticipatory and consummatory components of the experience of pleasure: A scale development study. Journal of Research in Personality, 40, 10861102. CrossRefGoogle Scholar
Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire: Psychometric features and prospective relationships with depression and anxiety in adults. European Journal of Psychological Assessment, 23(3), 141149. CrossRefGoogle Scholar
Green, J. G., McLaughlin, K. A., Berglund, P. A., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2010). Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Archives of General Psychiatry, 67(2), 113123. CrossRefGoogle ScholarPubMed
Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281291. CrossRefGoogle ScholarPubMed
Gross, J. J., & John, O. P. (2003). Individual differences in two emotion regulation processes: Implications for affect, relationships, and well-being. Journal of Personality and Social Psychology, 85(2), 348362. CrossRefGoogle ScholarPubMed
Hamilton, M. (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology, 6(4), 278296. CrossRefGoogle ScholarPubMed
Hayes, A. F., & Rockwood, N. J. (2017). Regression-based statistical mediation and moderation analysis in clinical research: Observations, recommendations, and implementation. Behaviour Research and Therapy, 98, 3957. CrossRefGoogle ScholarPubMed
He, C., Fan, D., Liu, X., Wang, Q., Zhang, H., Zhang, H., Zhang, Z., Xie, C. (2022). Insula network connectivity mediates the association between childhood maltreatment and depressive symptoms in major depressive disorder patients. Translational Psychiatry, 12(1), 89. CrossRefGoogle ScholarPubMed
Hilbert, K., Pine, D. S., Muehlhan, M., Lueken, U., Steudte-Schmiedgen, S., & Beesdo-Baum, K. (2015). Gray and white matter volume abnormalities in generalized anxiety disorder by categorical and dimensional characterization. Psychiatry Research: Neuroimaging, 234(3), 314320. CrossRefGoogle ScholarPubMed
Hovens, J. G. F. M., Giltay, E. J., Wiersma, J. E., Spinhoven, P., Penninx, B. W. J. H., & Zitman, F. G. (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica, 126(3), 198207. CrossRefGoogle ScholarPubMed
Infurna, M. R., Reichl, C., Parzer, P., Schimmenti, A., Bifulco, A., & Kaess, M. (2016). Associations between depression and specific childhood experiences of abuse and neglect: A meta-analysis. Journal of Affective Disorders, 190, 4755. CrossRefGoogle ScholarPubMed
Jaffee, S. R. (2017). Child maltreatment and risk for psychopathology in childhood and adulthood. Annual Review of Clinical Psychology, 13(1), 525551. CrossRefGoogle ScholarPubMed
Karakurt, G., & Silver, K. E. (2013). Emotional abuse in intimate relationships: The role of gender and age. Violence and Victims, 28(5), 804821. CrossRefGoogle ScholarPubMed
Keren, H., O’Callaghan, G., Vidal-Ribas, P., Buzzell, G. A., Brotman, M. A., Leibenluft, E., Pan, P. M., Meffert, L., Kaiser, A., Wolke, S., Pine, D. S., Stringaris, A. (2018). Reward processing in depression: A conceptual and meta-analytic review across fMRI and EEG studies. American Journal of Psychiatry, 175(11), 11111120. CrossRefGoogle ScholarPubMed
Kim, J., & Cicchetti, D. (2010). Longitudinal pathways linking child maltreatment, emotion regulation, peer relations, and psychopathology. Journal of Child Psychology and Psychiatry, 51(6), 706716. CrossRefGoogle ScholarPubMed
Kim, M. J., Shin, J., Taylor, J. M., Mattek, A. M., Chavez, S. J., & Whalen, P. J. (2017). Intolerance of uncertainty predicts increased striatal volume. Emotion, 17(6), 895899. CrossRefGoogle ScholarPubMed
Kirschner, M., Hodzic-Santor, B., Antoniades, M., Nenadic, I., Kircher, T., Krug, A., Meller, T., Grotegerd, D., Fornito, A., Arnatkeviciute, A., Bellgrove, M. A., Tiego, J., Dannlowski, U., Koch, K., Hülsmann, C., Kugel, H., Enneking, V., Klug, M., Leehr, E. J., Böhnlein, J., … (2022). Cortical and subcortical neuroanatomical signatures of schizotypy in 3004 individuals assessed in a worldwide ENIGMA study. Molecular Psychiatry, 27(2), 11671176. CrossRefGoogle Scholar
Kuzminskaite, E., Penninx, B. W. J. H., van Harmelen, A. L., Elzinga, B. M., Hovens, J. G. F. M., & Vinkers, C. H. (2021). Childhood trauma in adult depressive and anxiety disorders: An integrated review on psychological and biological mechanisms in the NESDA cohort. Journal of Affective Disorders, 283, 179191. CrossRefGoogle ScholarPubMed
Langen, M., Bos, D., Noordermeer, S. D., Nederveen, H., van Engeland, H., & Durston, S. (2014). Changes in the development of striatum are involved in repetitive behavior in autism. Biological Psychiatry, 76(5), 405411. CrossRefGoogle ScholarPubMed
Lavi, I., Katz, L. F., Ozer, E. J., & Gross, J. J. (2019). Emotion reactivity and regulation in maltreated children: A meta-analysis. Child Development, 90(5), 15031524. CrossRefGoogle ScholarPubMed
Liu, J. J. W., Ein, N., Gervasio, J., & Vickers, K. (2019). The efficacy of stress reappraisal interventions on stress responsivity: A meta-analysis and systematic review of existing evidence. PLoS One, 14(2), e0212854. CrossRefGoogle ScholarPubMed
Lubianiker, N., Paret, C., Dayan, P., & Hendler, T. (2022). Neurofeedback through the lens of reinforcement learning. Trends in Neuroscience, 45(8), 579593. CrossRefGoogle ScholarPubMed
Luo, L., Yang, T., Zheng, X., Zhang, X., Gao, S., Li, Y., Kendrick, K. M., & et al. (2022). Altered centromedial amygdala functional connectivity in adults is associated with childhood emotional abuse and predicts levels of depression and anxiety. Journal of Affective Disorders, 303, 148154. CrossRefGoogle ScholarPubMed
Mandelli, L., Petrelli, C., & Serretti, A. (2015). The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, 30(6), 665680. CrossRefGoogle ScholarPubMed
McCrory, E. J., Gerin, M. I., & Viding, E. (2017). Annual research review: Childhood maltreatment, latent vulnerability and the shift to preventative psychiatry-the contribution of functional brain imaging. Journal of Child Psychology and Psychiatry, 58(4), 338357. CrossRefGoogle ScholarPubMed
McCrory, E. J., & Viding, E. (2015). The theory of latent vulnerability: Reconceptualizing the link between childhood maltreatment and psychiatric disorder. Development and Psychopathology, 27(2), 493505. CrossRefGoogle ScholarPubMed
Mehta, M. A., Gore-Langton, E., Golembo, N., Colvert, E., Williams, S. C., & Sonuga-Barke, E. (2010). Hyporesponsive reward anticipation in the basal ganglia following severe institutional deprivation early in life. Journal of Cognitive Neuroscience, 22(10), 23162325. CrossRefGoogle ScholarPubMed
Miu, A. C., Szentágotai-Tătar, A., Balázsi, R., Nechita, D., Bunea, I., & Pollak, S. D. (2022). Emotion regulation as mediator between childhood adversity and psychopathology: A meta-analysis. Clinical Psychology Review, 93, 102141. CrossRefGoogle ScholarPubMed
Morawetz, C., Riedel, M. C., Salo, T., Berboth, S., Eickhoff, S. B., Laird, A. R., & Kohn, N. (2020). Multiple large-scale neural networks underlying emotion regulation. Neuroscience and Biobehavioral Reviews, 116, 382395. CrossRefGoogle ScholarPubMed
Nanni, V., Uher, R., & Danese, A. (2012). Childhood maltreatment predicts unfavorable course of illness and treatment outcome in depression: A meta-analysis. American Journal of Psychiatry, 169(2), 141151. CrossRefGoogle ScholarPubMed
Nelson, J., Klumparendt, A., Doebler, P., & Ehring, T. (2017). Childhood maltreatment and characteristics of adult depression: Meta-analysis. British Journal of Psychiatry, 210(2), 96104. CrossRefGoogle ScholarPubMed
Novick, A. M., Levandowski, M. L., Laumann, L. E., Philip, N. S., Price, L. H., & Tyrka, A. R. (2018). The effects of early life stress on reward processing. Journal of Psychiatric Research, 101, 80103. CrossRefGoogle ScholarPubMed
Opel, N., Redlich, R., Dohm, K., Zaremba, D., Goltermann, J., Repple, J., Dannlowski, U., & et al. (2019). Mediation of the influence of childhood maltreatment on depression relapse by cortical structure: A 2-year longitudinal observational study. Lancet Psychiatry, 6(4), 318326. CrossRefGoogle ScholarPubMed
Popovic, D., Ruef, A., Dwyer, D. B., Antonucci, L. A., Eder, J., Sanfelici, R., Kambeitz-Ilankovic, L., Oztuerk, O. F., Dong, M. S., Paul, R., Paolini, M., Hedderich, D., Haidl, T., Kambeitz, J., Ruhrmann, S., Chisholm, K., Schultze-Lutter, F., Falkai, P., Pergola, G., Blasi, G., … (2020). Traces of trauma: A multivariate pattern analysis of childhood trauma, brain structure, and clinical phenotypes. Biological Psychiatry, 88(11), 829842. CrossRefGoogle ScholarPubMed
Radell, M. L., Abo Hamza, E. G., Daghustani, W. H., Perveen, A., Moustafa, A. A., Rybakowski, J. K. (2021). The impact of different types of abuse on depression. Depression Research and Treatment, 2021, 112. ScholarPubMed
Ringwald, K. G., Pfarr, J.-K., Schmitt, S., Stein, F., Brosch, K., Meller, T., Andrae, J., Zech, R., Steinsträter, O., Meinert, S., Waltemate, L., Lemke, H., Thiel, K., Winter, A., Opel, N., Goltermann, J., Jansen, A., Dannlowski, U., Krug, A., Nenadić, I., Kircher, T. (2022). Interaction of recent stressful life events and childhood abuse on orbitofrontal grey matter volume in adults with depression. Journal of Affective Disorders, 312, 122127. CrossRefGoogle ScholarPubMed
Romens, S. E., Casement, M. D., McAloon, R., Keenan, K., Hipwell, A. E., Guyer, A. E., & Forbes, E. E. (2015). Adolescent girls' neural response to reward mediates the relation between childhood financial disadvantage and depression. Journal of Child Psychology and Psychiatry, 56(11), 11771184. CrossRefGoogle ScholarPubMed
Salokangas, R. K. R., From, T., Luutonen, S., & Hietala, J. (2018). Adverse childhood experiences leads to perceived negative attitude of others and the effect of adverse childhood experiences on depression in adulthood is mediated via negative attitude of others. European Psychiatry, 54, 2734. CrossRefGoogle ScholarPubMed
Schmaal, L., Hibar, D. P., Sämann, P. G., Hall, G. B., Baune, B. T., Jahanshad, N., Cheung, J. W., van Erp, T. G. M., Bos, D., Ikram, M. A., Vernooij, M. W., Niessen, W. J., Tiemeier, H., Hofman, A., Wittfeld, K., Grabe, H. J., Janowitz, D., Bülow, R., Selonke, M., Völzke, H., … (2017). Cortical abnormalities in adults and adolescents with major depression based on brain scans from 20 cohorts worldwide in the ENIGMA major depressive disorder working group. Molecular Psychiatry, 22(6), 900909. CrossRefGoogle ScholarPubMed
Shapero, B. G., Black, S. K., Liu, R. T., Klugman, J., Bender, R. E., Abramson, L. Y., & Alloy, L. B. (2014). Stressful life events and depression symptoms: The effect of childhood emotional abuse on stress reactivity. Journal of Clinical Psychology, 70(3), 209223. CrossRefGoogle ScholarPubMed
Sheridan, M. A., & McLaughlin, K. A. (2014). Dimensions of early experience and neural development: Deprivation and threat. Trends in Cognitive Sciences, 18(11), 580585. CrossRefGoogle ScholarPubMed
Stringaris, A., Vidal-Ribas Belil, P., Artiges, E., Lemaitre, , Gollier-Briant, F., Wolke, S., Vulser, Hélène, Miranda, R., Penttilä, J., Struve, M., Fadai, T., Kappel, V., Grimmer, Y., Goodman, R., Poustka, L., Conrod, P., Cattrell, A., Banaschewski, T., Bokde, A. L. W., Bromberg, U., … (2015). The brain’s response to reward anticipation and depression in adolescence: Dimensionality, specificity, and longitudinal predictions in a community-based sample. American Journal of Psychiatry, 172(12), 12151223. CrossRefGoogle Scholar
Teicher, M. H., & Samson, J. A. (2016). Annual research review: Enduring neurobiological effects of childhood abuse and neglect. Journal of Child Psychology and Psychiatry, 57(3), 241266. CrossRefGoogle ScholarPubMed
Wan, Z., Rolls, E. T., Feng, J., & Cheng, W. (2022). Brain functional connectivities that mediate the association between childhood traumatic events, and adult mental health and cognition. EBioMedicine, 79, 104002. CrossRefGoogle ScholarPubMed
Weissman, D. G., Lambert, H. K., Rodman, A. M., Peverill, M., Sheridan, M. A., & McLaughlin, K. A. (2020). Reduced hippocampal and amygdala volume as a mechanism underlying stress sensitization to depression following childhood trauma. Depression and Anxiety, 37(9), 916925. CrossRefGoogle ScholarPubMed
Zald, D. H., & Treadway, M. T. (2017). Reward processing, neuroeconomics, and psychopathology. Annual Review of Clinical Psychology, 13(1), 471495. CrossRefGoogle ScholarPubMed
Zhao, X., Zhang, Y., Li, L., Zhou, Y., Li, H., & Yang, S. (2005). Reliability and validity of the chinese version of childhood trauma questionnaire. Chinese Journal of Clinical Rehabilitation, 9, 105107.Google Scholar
Zheng, Y., & Lin, K. M. (1991). Comparison of the chinese depression inventory and the chinese version of the beck depression inventory. Acta Psychiatrica Scandinavica, 84(6), 531536.CrossRefGoogle ScholarPubMed
Zhu, X., Auerbach, R. P., Yao, S., Abela, J. R. Z., Xiao, J., & Tong, X. (2008). Psychometric properties of the cognitive emotion regulation questionnaire: Chinese version. Cognition and Emotion, 22(2), 288307. CrossRefGoogle Scholar
Zilverstand, A., Parvaz, M. A., & Goldstein, R. Z. (2017). Neuroimaging cognitive reappraisal in clinical populations to define neural targets for enhancing emotion regulation. A systematic review. Neuroimage, 151, 105116. CrossRefGoogle ScholarPubMed
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