Article

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: 8.45). 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
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    • "There is now solid evidence for a relation between adverse life events (ALE) and psychotic symptoms, both from studies including patients with psychosis (Bentall, Wickham, Shevlin, & Varese, 2012; Hacioglu Yildirim et al., 2014) and general population studies (Freeman & Fowler, 2009; Spauwen, Krabbendam, Lieb, Wittchen, & van Os, 2006). Most of these studies have investigated the effects of ALE experienced in childhood (Varese et al., 2012), although the effects of more recent events have also been studied (Hacioglu Yildirim et al., 2014). Moreover, several studies have suggested relationships between specific ALE and specific positive psychotic symptoms (Bentall et al., 2012; Bentall et al., 2014), for example, between hallucinations and childhood sexual abuse, and between delusions and being brought up in institutional care – thus indicating the importance of investigating symptoms individually. "
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    ABSTRACT: Introduction: There is now solid evidence for a relation between adverse life events (ALE) and psychotic symptoms in patients with psychosis and in the general population. A recent study has shown that this relation may be partially mediated by stress sensitivity, suggesting the influence of other factors. The aim of this study was to assess the mediation effect of emotion regulation strategies and stress sensitivity in the relation between ALE and attenuated positive psychotic symptoms (APPS) in the general population. Methods: Hundred and twelve healthy volunteers were evaluated with measures of APPS, emotion regulation strategies, ALE and stress sensitivity. Results: Results demonstrated that the relation between ALE, hallucination and delusion proneness was completely mediated by maladaptive emotion regulation strategies, but not by stress sensitivity. However, in addition to maladaptive emotion regulation strategies, stress sensitivity demonstrated a mediation effect between ALE and attenuated positive psychotic positive symptoms when positive psychotic symptoms were grouped together. Conclusions: There are probably several possible trajectories leading to the formation of positive psychotic symptoms and the results of the present study reveal that one such trajectory may involve the maladaptive regulation of negative emotions alongside a certain general vulnerability after experiencing ALE.
    Full-text · Article · Feb 2016 · Cognitive Neuropsychiatry
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    • "With respect to their response to psychosocial stressors (e.g., major life events, childhood trauma, and milder daily hassles), which have been shown to contribute to the development and maintenance of psychosis in retrospective and prospective studies303132, FHx and ASz children aged 11-14 years reported greater exposure to negative life events and daily hassles, respectively, compared to TD children, and were more distressed by these experiences [33]. Thus, while both groups were more responsive to psychosocial stressors, ASz and FHx children may be susceptible to different stressors. "

    Full-text · Article · Jan 2016 · Social Psychiatry and Psychiatric Epidemiology
    • "T here is compelling evidence that persons with schizophrenia spectrum disorders often experience high levels of childhood trauma compared with persons without these disorders (Varese et al., 2012), and it seems that untreated trauma constitutes an important risk factor in terms of worse long-term outcome (McGorry et al., 2008). A recent study found that 89% of persons with first-episode psychosis had experienced trauma compared with 37% in a healthy control group and that there was a dose-response effect, in which the risk of psychosis increased 2.5 times for each additional adversity (Trauelsen et al., 2015). "
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    ABSTRACT: Persons with schizophrenia spectrum disorders often report high levels of childhood trauma, which often exacerbates symptoms and impede the process of recovery. However, little is known about how these traumas are experienced by service users and how they are integrated in their life stories. To examine this, we conducted in-depth interviews with 15 service users with a diagnosis of a first-episode nonaffective psychosis who had reported 1 or more childhood traumas in self-report measures. There was an unexpected discrepancy between the number of traumas reported in self-report measures and in semistructured interviews, and many of the traumas did not seem integrated in their personal narratives. The analyses further revealed that although participants often described complicated and traumatic childhood environments, they still felt supported by their families; they reported a range of ways in which they tried to cope with and gain control of their psychotic disorder, and they described a general optimistic view of the future.
    No preview · Article · Dec 2015 · The Journal of nervous and mental disease
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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

    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).

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  • 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
    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.
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      [Show abstract] [Hide abstract]
      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.
      Full-text · Article · Mar 2012 · Schizophrenia Bulletin