Skip to main content Accessibility help

Childhood abuse and psychotic experiences – evidence for mediation by adulthood adverse life events

  • V. Bhavsar (a1), J. Boydell (a2), P. McGuire (a1), V. Harris (a3), M. Hotopf (a4), S. L. Hatch (a4), J. H. MacCabe (a1) and C. Morgan (a5)...



We have previously reported an association between childhood abuse and psychotic experiences (PEs) in survey data from South East London. Childhood abuse is related to subsequent adulthood adversity, which could form one pathway to PEs. We aimed to investigate evidence of mediation of the association between childhood abuse and PEs by adverse life events.


Data were analysed from the South East London Community Health Study (SELCoH, n = 1698). Estimates of the total effects on PEs of any physical or sexual abuse while growing up were partitioned into direct (i.e. unmediated) and indirect (total and specific) effects, mediated via violent and non-violent life events.


There was strong statistical evidence for direct (OR 1.58, 95% CI: 1.19–2.1) and indirect (OR 1.51, 95% CI: 1.32–1.72) effects of childhood abuse on PEs after adjustment for potential confounders, indicating partial mediation of this effect via violent and non-violent life events. An estimated 47% of the total effect of abuse on PEs was mediated via adulthood adverse life events, of which violent life events made up 33% and non-violent life events the remaining 14%.


The association between childhood abuse and PEs is partly mediated through the experience of adverse life events in adulthood. There is some evidence that a larger proportion of this effect was mediated through violent life events than non-violent life events.


Corresponding author

*Address for correspondence: V. Bhavsar, Department of Psychosis Studies, King's College London, IOPPN, London, UK. (Email:


Hide All
Alemany, S, Arias, B, Aguilera, M, Villa, H, Moya, J, Ibáñez, MI, Vossen, H, Gastó, C, Ortet, G, Fañanás, L (2011). Childhood abuse, the BDNF-Val66Met polymorphism and adult psychotic-like experiences. The British Journal of Psychiatry 199, 3842.
Alemany, S, Goldberg, X, Van Winkel, R, Gastó, C, Peralta, V, Fañanás, L (2013). Childhood adversity and psychosis: examining whether the association is due to genetic confounding using a monozygotic twin differences approach. European Psychiatry 28, 207212.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011 a). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011 b). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Baron, RM, Kenny, DA (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173.
Bebbington, P, Nayani, T (1995). The psychosis screening questionnaire. International Journal of Methods in Psychiatric Research 5, 1119.
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004 a). Psychosis, victimisation and childhood disadvantage evidence from the second British national survey of psychiatric morbidity. The British Journal of Psychiatry 185, 220226.
Bebbington, PE, Bhugra, D, Brugha, T, Singleton, N, Farrell, M, Jenkins, R, Lewis, G, Meltzer, H (2004 b). Psychosis, victimisation and childhood disadvantage: evidence from the second British national survey of psychiatric morbidity. The British Journal of Psychiatry 185, 220226.
Bhavsar, V, Maccabe, J, Hatch, SL, Hotopf, M, Boydell, J, Mcguire, P (2017). Subclinical psychotic experiences and subsequent contact with mental health services. British Journal of Psychiatry Open 3, 6470.
Bonoldi, I, Simeone, E, Rocchetti, M, Codjoe, L, Rossi, G, Gambi, F, Balottin, U, Caverzasi, E, Politi, P, Fusar-Poli, P (2013). Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies. Psychiatry Research 210, 815.
Borges, S, Gayer-Anderson, C, Mondelli, V (2013). A systematic review of the activity of the hypothalamic–pituitary–adrenal axis in first episode psychosis. Psychoneuroendocrinology 38, 603611.
Briere, J, Runtz, M (1987). Post sexual abuse trauma data and implications for clinical practice. Journal of Interpersonal Violence 2, 367379.
Carr, CP, Martins, CMS, Stingel, AM, Lemgruber, VB, Juruena, MF (2013). The role of early life stress in adult psychiatric disorders: a systematic review according to childhood trauma subtypes. The Journal of Nervous and Mental Disease 201, 10071020.
Chu, JA, Dill, DL (1990). Dissociative symptoms in relation to childhood physical and sexual abuse. The American Journal of Psychiatry 147, 887.
Collip, D, Nicolson, N, Lardinois, M, Lataster, T, Van Os, J, Myin-Germeys, I (2011). Daily cortisol, stress reactivity and psychotic experiences in individuals at above average genetic risk for psychosis. Psychological Medicine 41, 23052315.
Das-Munshi, J, Becares, L, Boydell, JE, Dewey, ME, Morgan, C, Stansfeld, SA, Prince, MJ (2012). Ethnic density as a buffer for psychotic experiences: findings from a national survey (EMPIRIC). British Journal of Psychiatry 201, 282290.
Devylder, JE, Oh, HY, Corcoran, CM, Lukens, EP (2014). Treatment seeking and unmet need for care among persons reporting psychosis-like experiences. Psychiatric Services 65, 774780.
Finkelhor, D (1979). Sexually Victimized Children. Free Press: New York.
Fisher, H, Schreier, A, Zammit, S, Lewis, G, Maughan, B, Munafo, M, Harrison, G, Wolke, D (2011). Prospective investigation of psychological and affective pathways from childhood trauma to psychosis-like experiences in a UK birth cohort. Comprehensive Psychiatry 52, E6.
Fisher, HL, Caspi, A, Poulton, R, Meier, MH, Houts, R, Harrington, H, Arseneault, L, Moffitt, TE (2013 a). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: a birth cohort study. Psychological Medicine 43, 20772086.
Fisher, HL, Schreier, A, Zammit, S, Maughan, B, Munafo, MR, Lewis, G, Wolke, D (2013 b). Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophrenia Bulletin 39, 10451055.
Garety, PA, Kuipers, E, Fowler, D, Freeman, D, Bebbington, P (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189195.
Garety, PA, Bebbington, P, Fowler, D, Freeman, D, Kuipers, E (2007). Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.
Hatch, SL, Frissa, S, Verdecchia, M, Stewart, R, Fear, NT, Reichenberg, A, Morgan, C, Kankulu, B, Clark, J, Gazard, B (2011). Identifying socio-demographic and socioeconomic determinants of health inequalities in a diverse London community: the South East London Community health (SELCoH) study. BMC Public Health 11, 861.
Hatch, SL, Woodhead, C, Frissa, S, Fear, NT, Verdecchia, M, Stewart, R, Reichenberg, A, Morgan, C, Bebbington, P, Mcmanus, S, Brugha, T, Kankulu, B, Clark, JL, Gazard, B, Medcalf, R, Hotopf, M, TEAM, S. E. S. (2012). Importance of thinking locally for mental health: data from cross-sectional surveys representing South East London and England. PLoS ONE 7, e48012.
Howes, OD, Kapur, S (2009). The dopamine hypothesis of schizophrenia: version III – the final common pathway. Schizophrenia Bulletin 35, 549562.
Iverson, KM, Litwack, SD, Pineles, SL, Suvak, MK, Vaughn, RA, Resick, PA (2013). Predictors of intimate partner violence revictimization: the relative impact of distinct PTSD symptoms, dissociation, and coping strategies. Journal of Traumatic Stress 26, 102110.
Johns, LC, Nazroo, JY, Bebbington, P, Kuipers, E (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. The British Journal of Psychiatry 180, 174178.
Johns, LC, Cannon, M, Singleton, N, Murray, RM, Farrell, M, Brugha, T, Bebbington, P, Jenkins, R, Meltzer, H (2004). Prevalence and correlates of self-reported psychotic symptoms in the British population. The British Journal of Psychiatry 185, 298305.
Kaymaz, N, Drukker, M, Lieb, R, Wittchen, HU, Werbeloff, N, Weiser, M, Lataster, T, Van Os, J (2012). Do subthreshold psychotic experiences predict clinical outcomes in unselected non-help-seeking population-based samples? A systematic review and meta-analysis, enriched with new results. Psychological Medicine 42, 22392253.
Kelleher, I, Lynch, F, Harley, M, Molloy, C, Roddy, S, Fitzpatrick, C, Cannon, M (2012). Psychotic symptoms in adolescence index risk for suicidal behavior: findings from 2 population-based case-control clinical interview studies. Archives of General Psychiatry 69, 12771283.
Kelleher, I, Corcoran, P, Keeley, H, Wigman, JT, Devlin, N, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C (2013 a). Psychotic symptoms and population risk for suicide attempt: a prospective cohort study. JAMA Psychiatry 70, 940948.
Kelleher, I, Keeley, H, Corcoran, P, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2013 b). Childhood trauma and psychosis in a prospective cohort study: cause, effect, and directionality. American Journal of Psychiatry 170, 734741.
Krieger, N (1994). Epidemiology and the web of causation: has anyone seen the spider? Social Science and Medicine 39, 887903.
Kuijpers, KF, Van Der Knaap, LM, Winkel, FW (2012). PTSD symptoms as risk factors for intimate partner violence revictimization and the mediating role of victims’ violent behavior. Journal of Traumatic Stress 25, 179186.
Linscott, RJ, Van Os, J (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine 43, 11331149.
Mäkikyrö, T, Sauvola, A, Moring, J, Veijola, J, Nieminen, P, Järvelin, MR, Isohanni, M (1998). Hospital-treated psychiatric disorders in adults with a single-parent and two-parent family background: a 28-year follow-up of the 1966 Northern Finland birth cohort. Family Process 37, 335344.
Mayall, A, Gold, SR (1995). Definitional issues and mediating variables in the sexual revictimization of women sexually abused as children. Journal of Interpersonal Violence 10, 2642.
Mcmanus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult psychiatric morbidity in England, 2007: results of a household survey. London: The NHS Information Centre for Health and Social Care.
Morgan, C, Kirkbride, J, Hutchinson, G, Craig, T, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2008). Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study. Psychological Medicine 38, 17011715.
Morgan, C, Charalambides, M, Hutchinson, G, Murray, RM (2010). Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.
Morgan, C, Frissa, S, Verdecchia, M, Stewart, R, Fear, NT, Reichenberg, A, Hotopf, M, Hatch, SL (2013). Trauma, life events and psychosis: evidence of synergistic effects from the selcoh study. Schizophrenia Bulletin 39, S71S72.
Morgan, C, Reininghaus, U, Fearon, P, Hutchinson, G, Morgan, K, Dazzan, P, Boydell, J, Kirkbride, J, Doody, GA, Jones, PB (2014 a). Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study. Psychological Medicine 44, 407419.
Morgan, C, Reininghaus, U, Reichenberg, A, Frissa, S, Hotopf, M, Hatch, SL, SELCoH study team (2014 b). Adversity, cannabis use and psychotic experiences: evidence of cumulative and synergistic effects. The British Journal of Psychiatry 204, 346.
Morrison, AP, Frame, L, Larkin, W (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology 42, 331353.
Mueser, KT, Rosenberg, SD, Goodman, LA, Trumbetta, SL (2002). Trauma, PTSD, and the course of severe mental illness: an interactive model. Schizophrenia Research 53, 123143.
Muthén, L, Muthén, B (1998). Mplus Version 7 [Statistical Software]. Muthén & Muthén: Los Angeles, CA.
Myin-Germeys, I, Van Os, J (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.
Pantazis, C, Gordon, D, Levitas, R (2006). Poverty and Social Exclusion in Britain: The Millennium Survey. Policy Press: Bristol.
Reininghaus, U, Priebe, S, Bentall, RP (2013). Testing the psychopathology of psychosis: evidence for a general psychosis dimension. Schizophrenia Bulletin 39, 884895.
Reuben, A, Moffitt, TE, Caspi, A, Belsky, DW, Harrington, H, Schroeder, F, Hogan, S, Ramrakha, S, Poulton, R, Danese, A (2016). Lest we forget: comparing retrospective and prospective assessments of adverse childhood experiences in the prediction of adult health. Journal of Child Psychology and Psychiatry 57, 11031112.
Rottenberg, J, Yaroslavsky, I, Carney, RM, Freedland, KE, George, CJ, Baji, I, Dochnal, R, Gádoros, J, Halas, K, Kapornai, K (2014). The association between major depressive disorder in childhood and risk factors for cardiovascular disease in adolescence. Psychosomatic Medicine 76, 122.
Russell, DE (1983). The incidence and prevalence of intrafamilial and extrafamilial sexual abuse of female children. Child Abuse and Neglect 7, 133146.
Schofield, P, Das-Munshi, J, Bécares, L, Morgan, C, Bhavsar, V, Hotopf, M, Hatch, S (2016). Minority status and mental distress: a comparison of group density effects. Psychological Medicine 46, 3051.
Schreier, A, Wolke, D, Thomas, K, Horwood, J, Hollis, C, Gunnell, D, Lewis, G, Thompson, A, Zammit, S, Duffy, L (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Sheinbaum, T, Ros, A, Kwapil, TR, Ballespi, S, Mitjavila, M, Barrantes-Vidal, N (2012). Insecure attachment style mediates the association between childhood adversity and subclinical psychotic symptoms in a non-clinical sample. Early Intervention in Psychiatry 6, 124.
Siegel, JM, Sorenson, SB, Golding, JM, Burnam, MA, Stein, JA (1987). The prevalence of childhood sexual assault The Los Angeles epidemiologic catchment area project. American Journal of Epidemiology 126, 11411153.
Van Nierop, M, Lataster, T, Smeets, F, Gunther, N, Van Zelst, C, De Graaf, R, Ten Have, M, Van Dorsselaer, S, Bak, M, Myin-Germeys, I, Viechtbauer, W, Van Os, J, Van Winkel, R (2014). Psychopathological mechanisms linking childhood traumatic experiences to risk of psychotic symptoms: analysis of a large, representative population-based sample. Schizophrenia Bulletin 40, S123S130.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, Van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Werbeloff, N, Drukker, M, Dohrenwend, BP, Levav, I, Yoffe, R, Van Os, J, Davidson, M, Weiser, M (2012). Self-reported attenuated psychotic symptoms as forerunners of severe mental disorders later in life. Archives of General Psychiatry 69, 467475.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed