Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies

University of Liverpool, UK.
Schizophrenia Bulletin (Impact Factor: 8.61). 03/2012; 38(4):661-71. DOI: 10.1093/schbul/sbs050
Source: PubMed

ABSTRACT Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

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Available from: Filippo Varese, Aug 30, 2015
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    • "A dose–response model is suggested to interpret these relationships, with an increased dose of childhood abuse predicting the increased response of mental health issues or substance misuse in adulthood (Kendler, Kuhn, & Prescott, 2004; Kennedy et al., 2013; Read, van Os, Morrison, & Ross, 2005; Sciolla et al., 2011; Varese et al., 2012). In this model, the dose–response relationship of CPA, CSA, and CPSA with the development of mental health and substance misuse issues can be explained by the severity, duration, and frequency of these adverse experiences (Read et al., 2005; Varese et al., 2012). Frequency of abuse and CPSA moderate the relationship between the presence or absence of abuse and subsequent difficulties. "
    Women & Criminal Justice 07/2015; DOI:10.1080/08974454.2015.1023486
    • "The data confirm existing evidence that increased childhood adversity exposure is related to more severe psychiatric outcomes in adulthood, including psychosis (e.g., Varese et al. 2012), and that this association follows a dose-dependent pattern (e.g., Shevlin et al. 2008). However, although fostering/adoption was significantly associated with paranoid delusions, no relationship was found between CSA and any type of hallucination, or CPA and paranoid delusions. "
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    ABSTRACT: This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions. Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect. Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose-response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted. The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.
    Epidemiology and Psychiatric Sciences 07/2015; DOI:10.1017/S204579601500044X · 3.36 Impact Factor
    • "Systematic reviews of studies of adults with psychosis have found that between a third and a half have experienced physical or sexual abuse (Matheson, Shepherd, Pinchbeck, Laurens, & Carr, 2013; Morgan & Fisher, 2007; Read, Van Os, Morrison, & Ross, 2005; Varese et al., 2012). High rates of CM have been found in studies of personality disorders. "
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    ABSTRACT: One-hundred-ninety-nine adult mental health service users were interviewed with a protocol that included the Childhood Trauma Questionnaire, the Structured Clinical Interviews for Axis I and II DSM-IV disorders, the Global Assessment of Functioning scale, the SCORE family assessment measure, the Camberwell Assessment of Need Short Appraisal Schedule, and the Readiness for Psychotherapy Index. Compared to a U.S. normative sample, Irish clinical cases had higher levels of maltreatment. Cases with comorbid axis I and II disorders reported more child maltreatment than those with axis I disorders only. There was no association between types of CM and types of psychopathology. Current family adjustment and service needs (but not global functioning and motivation for psychotherapy) were correlated with a CM history. It was concluded that child maltreatment may contribute to the development of adult psychopathology, and higher levels of trauma are associated with co-morbid personality disorder, greater service needs and poorer family adjustment. A history of child maltreatment should routinely be determined when assessing adult mental health service users, especially those with personality disorders and where appropriate evidence-based psychotherapy which addresses childhood trauma should be offered. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Child abuse & neglect 05/2015; 45. DOI:10.1016/j.chiabu.2015.04.021 · 2.34 Impact Factor
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Questions & Answers about this publication

  • Graeme Reid added an answer in Schizophrenia:
    I'm searching after some information about the risk of self-injury with schizophrenia?

    What can you do to prevent it? What are the risk factors? What is the prevalation?

    Graeme Reid · Lancashire Care NHS Foundation Trust

    Many good references and suggestions given above.  I'd also suggest asking about imagery that people experience in relation to a) their psychotic experiences, and b) their self-injurious behaviour (links to full text given).  However the key issue here is that self injurious behaviour can have multiple functions for people, regardless of diagnosis. I'd therefore suggest spending time with your clients developing individualised formulations of the difficulties they wish to work with.  The problems that clients wish to work on may or may not include self injurious behaviour - often SIB can be viewed as a coping strategy rather than a problem to be targeted in therapy, though it may have secondary consequences such as shame that need some attention (and sometimes SIB can be directly related to psychotic experiences, such as attempts to placate a commanding voice/auditory hallucination).

    I would also strongly suggest routinely assessing for trauma histories in people who have distressing psychotic experiences (whether or not they have been labelled with what I consider to be unscientific and possibly harmful labels such as schizophrenia).  The causal relationship between early trauma and the development of psychosis has been (I believe) convincingly demonstrated in numerous studies (link given).  In my experience, self harm can often be a coping response to past traumas, and it can be important to include trauma and its' consequences in any formulation and treatment plan.  Trauma-focused therapeutic interventions for people experiencing psychosis are still being developed - in the Netherlands there's a research group doing some great work looking in to the application of EMDR for trauma & psychosis (although I've had good results with cognitive therapy based interventions too).

  • Guilherme Canta added an answer in Schizophrenia:
    Is a person born with Schizophrenia or can it develop because of extreme abuse as a child?
    Would like to know.
    Guilherme Canta · Centro Hospitalar Psiquiátrico de Lisboa
    There seems to be some evidence regarding the role of childhood abuse in the later development of psychotic conditions. The work of John Read and Richard Bentall provides some insight in that direction.