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Childhood adversity and clinical and psychosocial outcomes in psychosis

  • S. Turner (a1), C. Harvey (a2) (a3), L. Hayes (a4), D. Castle (a2) (a5), C. Galletly (a6) (a7) (a8), S. Sweeney (a6) (a7), S. Shah (a9), L. Keogh (a10) and M. J. Spittal (a10)...

Abstract

Aims

Associations between childhood abuse and various psychotic illnesses in adulthood are commonly reported. We aim to examine associations between several reported childhood adverse events (sexual abuse, physical abuse, emotional abuse, neglect and interpersonal loss) among adults with diagnosed psychotic disorders and clinical and psychosocial outcomes.

Methods

Within a large epidemiological study, the 2010 Australian National Survey of Psychosis (Survey of High Impact Psychosis, SHIP), we used logistic regression to model childhood adverse events (any and specific types) on 18 clinical and psychosocial outcomes.

Results

Eighty percent of SHIP participants (1466/1825) reported experiencing adverse events in childhood (sexual abuse, other types of abuse and interpersonal loss). Participants reporting any form of childhood adversity had higher odds for 12/18 outcomes we examined. Significant associations were observed with all psychosocial outcomes (social dysfunction, victimisation, offending and homelessness within the previous 12 months, and definite psychosocial stressor within 12 months of illness onset), with the strongest association for homelessness (odds ratio (OR) = 2.82). Common across all adverse event types was an association with lifetime depression, anxiety and a definite psychosocial stressor within 12 months of illness onset. When adverse event types were non-hierarchically coded, sexual abuse was associated with 11/18 outcomes, other types of abuse 13/18 and, interpersonal loss occurring in the absence of other forms of abuse was associated with fewer of the clinical and psychosocial outcomes, 4/18. When adverse events types were coded hierarchically (to isolate the effect of interpersonal loss in the absence of abuse), interpersonal loss was associated with lower odds of self-reproach (OR = 0.70), negative syndrome (OR = 0.75) and victimisation (OR = 0.82).

Conclusions

Adverse childhood experiences among people with psychosis are common, as are subsequent psychosocial stressors. Mental health professionals should routinely enquire about all types of adversities in this group and provide effective service responses. Childhood abuse, including sexual abuse, may contribute to subsequent adversity, poor psychosocial functioning and complex needs among people with psychosis. Longitudinal research to better understand these relationships is needed, as are studies which evaluate the effectiveness of preventative interventions in high-risk groups.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Matthew J. Spittal, E-mail: m.spittal@unimelb.edu.au

References

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Alameda, L, Ferrari, C, Baumann, P, Gholam-Rezaee, M, Do, K and Conus, P (2015) Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients. Psychological Medicine 45, 27272736.
American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders: DSM-IV, 4th Edn rev.Washington, DC: American Psychiatric Association.
Australian Bureau of Statistics (2005) 4509.0 – Crime and Safety, Australia. Available at http://www.abs.gov.au/ausstats/abs@.nsf/mf/4509.0 (Accessed 6 May 2018).
Australian Bureau of Statistics (2011) Socio-Economic Indexes for Areas (SEIFA). Available at http://www.abs.gov.au/websitedbs/censushome.nsf/home/seifa (Accessed 6 July 2018).
Australian Institute of Health and Welfare (2012) Child Protection Australia 2010–11. Child Welfare Series no. 53. Cat. no. CWS 41. Canberra: AIHW.
Bebbington, P, Jonas, S, Kuipers, E, King, M, Cooper, C, Brugha, T, Meltzer, H, McManus, S and Jenkins, R (2011) Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. British Journal of Psychiatry 199, 2937.
Bendall, S, Jackson, H, Hulbert, C and McGorry, P (2008) Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Bentall, R, Wickham, S, Shevlin, M and Varese, F (2012) Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734740.
Berthelot, N, Paccalet, T, Gilbert, E, Moreau, I, Merette, C, Gingras, N, Rouleau, N and Maziade, M (2015) Childhood abuse and neglect may induce deficits in cognitive precursors of psychosis in high-risk children. Journal of Psychiatry and Neuroscience 40, 336343.
Bolton, D (2010) Social, biological and person constructions of mental illness. In Morgan, C and Bhugra, D (eds), Principles of Social Psychiatry. Chichester, West Sussex: John Wiley & Sons, Ltd, pp. 3950.
Briere, J and Elliott, D (2003) Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women. Child Abuse and Neglect 27, 12051222.
Cantor-Graae, E (2007) The contribution of social factors to the development of schizophrenia: a review of recent findings. Canadian Journal of Psychiatry 52, 277286.
Casey, E and Nurius, P (2005) Trauma exposure and sexual re-victimisation risk: comparisons across single, multiple incident and multiple perpetrator victimisations. Violence Against Women 11, 505530.
Castle, D, Jablensky, A, McGrath, J, Carr, V, Morgan, V, Waterreus, A, Valuri, G, Stain, H, McGuffin, P and Farmer, A (2006) The diagnostic interview for psychoses (DIP): development, reliability and applications. Psychological Medicine 36, 6980.
Conus, P, Cotton, S, Schimmelmann, B, McGorry, P and Lambert, M (2009) Pretreatment and outcome correlates of sexual and physical trauma in an epidemiological cohort of first-episode psychosis patients. Schizophrenia Bulletin 36, 11051114.
Cotter, J, Kaess, M and Yung, A (2015) Childhood trauma and functional disability in psychosis, bipolar disorder and borderline personality disorder: a review of the literature. Irish Journal of Psychological Medicine 32, 2130.
Craig, T (2010) Depression. In Morgan, C and Bhugra, D (eds), Principles of Social Psychiatry. Chichester, West Sussex: John Wiley and Sons, Ltd, pp. 215226.
Cristobal-Narvaez, P, Sheinbaum, T, Ballespi, S, Mitjavila, M, Myin-Germeys, I, Kwapil, T and Barrantes-Vidal, N (2016) Impact of adverse childhood experiences on psychotic-like symptoms and stress reactivity in daily life in nonclinical young adults. PLoS One 11, e0153557.
Cutajar, M, Mullen, P, Ogloff, J, Thomas, S, Wells, D and Spataro, J (2010) Psychopathology in a large cohort of sexually abused children followed up to 43 years. Child Abuse and Neglect 34, 813822.
Darke, S, Ward, J, Hall, W, Heather, N and Wodak, A (1991) The Opiate Treatment Index (OTI) Manual. New South Wales: National Drug and Alcohol Research Centre.
Felitti, V, Anda, R, Nordenberg, D, Williamson, D, Spitz, A, Edwards, V, Koss, M and Marks, J (1998) Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. American Journal of Preventative Medicine 14, 245258.
Fossey, E and Harvey, C (2001) A conceptual review of functioning: implications for the development of consumer outcome measures. Australian and New Zealand Journal of Psychiatry 35, 9198.
Gallagher, B and Jones, B (2016) Neglect and hereditary risk: their relative contribution to schizophrenia with negative symptomatology. International Journal of Social Psychiatry 62, 235242.
Garety, P, Bebbington, P, Fowler, D, Freeman, D and Kuipers, E (2007) Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychological Medicine 37, 13771391.
Gil, A, Gama, C, de Jesus, D, Lobato, M, Zimmer, M and Belmonte-de-Abreu, P (2009) The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect. Child Abuse and Neglect 33, 618624.
Gilbert, R, Widom, C, Browne, K, Fergusson, D, Webb, E and Janson, S (2009) Burden and consequences of child maltreatment in high-income countries. Lancet 373, 6881.
Gonzalez, A, Boyle, M, Kyu, H, Georgiades, K, Duncan, L and MacMillan, H (2012) Childhood and family influences on depression, chronic physical conditions, and their comorbidity: findings from the Ontario Child Health Study. Journal of Psychiatric Research 46, 14751482.
Gracie, A, Freeman, D, Green, S, Garety, P, Kuipers, E, Hardy, A, Ray, K, Dunn, G, Bebbington, P and Fowler, D (2007) The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatrica Scandinavica 116, 280289.
Gustafson, T and Sarwer, D (2004) Childhood sexual abuse and obesity. Obesity Reviews 5, 129135.
Harvey, C, Brophy, L, Parsons, S, Moeller-Saxone, K, Grigg, M and Siskind, D (2016) People living with psychosocial disability: rehabilitation and recovery-informed service provision within the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 50, 534547.
Holshausen, K, Bowie, C and Harkness, K (2016) The relation of childhood maltreatment to psychotic symptoms in adolescents and young adults with depression. Journal of Clinical Child and Adolescent Psychology 45, 241247.
Hooven, C, Nurius, P, Logan-Greene, P and Thompson, E (2012) Childhood violence exposure: cumulative and specific effects on adult mental health. Journal of Family Violence 27, 511522.
Jablensky, A, McGrath, J, Herrman, H, Castle, D, Gureje, O, Evans, M, Carr, V, Morgan, V, Korten, A and Harvey, C (2000) Psychotic disorders in urban areas: an overview of the study on low prevalence disorders. Australian and New Zealand Journal of Psychiatry 34, 221236.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R and van Os, J (2004) Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.
Killackey, E, Harvey, C, Amering, M and Herrman, H (2015) Partnerships for meaningful community living: rehabilitation and recovery-informed practices. In Tasman, A, Kay, J, Lieverman, J, First, M and Riba, M (eds) Psychiatry. Chichester, West Sussex: John Wiley and Sons, Ltd, pp. 19591982.
Kirkpatrick, B, Buchanan, R, McKenney, P, Alphs, L and Carpenter, W (1989) The schedule for the Deficit Syndrome: an instrument for research in schizophrenia. Psychiatry Research 30, 119123.
Lataster, J, Myin-Germeys, I, Lieb, R, Wittchen, H and van Os, J (2012) Adversity and psychosis: a 10-year prospective study investigating synergism between early and recent adversity in psychosis. Acta Psychiatrica Scandinavica 125, 388399.
Matheson, S, Shepherd, A, Pinchbeck, R, Laurens, K and Carr, V (2013) Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225238.
Mauritz, M, Goossens, P, Draijer, N and van Achterberg, T (2013) Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European Journal of Psychotraumatology 4. doi: 10.3402/ejpt.v4i0.19985.
McCabe, K, Maloney, E, Stain, H, Loughland, C and Carr, V (2012) Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research 46, 600607.
McGuffin, P, Farmer, A and Harvey, I (1991) A polydiagnostic application of operational criteria in studies of psychotic illness. Development and reliability of the OPCRIT system. Archives of General Psychiatry 48, 764770.
Messman-Moore, T, Walsh, K and DiLillo, D (2010) Emotion dysregulation and risky sexual behavior in revictimization. Child Abuse and Neglect 34, 967976.
Misiak, B, Krefft, M, Bielawski, T, Moustafa, A, Sasiadek, M and Frydecka, D (2017) Toward a unified theory of childhood trauma and psychosis: a comprehensive review of epidemiological, clinical, neuropsychological and biological findings. Neuroscience and Biobehavioral Reviews 75, 393406.
Moore, E, Romaniuk, H, Olsson, C, Jayasinghe, Y, Carlin, J and Patton, G (2010) The prevalence of childhood sexual abuse and adolescent unwanted sexual contact among boys and girls living in Victoria, Australia. Child Abuse and Neglect 34, 379385.
Morgan, C and Fisher, H (2007) Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma –a critical review. Schizophrenia Bulletin 33, 310.
Morgan, V, Waterreus, A, Jablensky, A, Mackinnon, A, McGrath, J, Carr, V, Bush, R, Castle, D, Cohen, M, Harvey, C, Galletly, C, Stain, H, Neil, A, McGorry, P, Hocking, B, Shah, S and Saw, S (2012) People living with psychotic illness in 2010. An overview of findings from the second Australian national survey of psychosis. Australian and New Zealand Journal of Psychiatry 46, 735752.
Morgan, V, McGrath, J, Jablensky, A, Badcock, J, Wattereus, A, Bush, R, Carr, V, Castle, D, Cohen, M, Galletly, C, Harvey, C, Hocking, B, McGorry, P, Neil, A, Saw, S, Shah, S, Stain, H and Mackinnon, A (2014) Psychosis prevalence and physical, metabolic and cognitive co-morbidity: data from the second Australian National Survey of Psychosis. Psychological Medicine 44, 21632176.
Morosini, P, Magliano, L, Brambilla, L, Ugolini, S and Pioli, R (2000) Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica 101, 323329.
Mueser, K, Rosenberg, S, Xie, H, Jankowski, M, Bolton, E and Lu, W (2008) A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology 76, 259271.
National Mental Health Commission (2014) The National Review of Mental Health Programmes and Services. Sydney: National Mental Health Commission.
Palmier-Claus, J, Berry, K, Bucci, S, Mansell, W and Varese, F (2016) Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis. British Journal of Psychiatry 209, 454459.
Pereda, N, Guilera, G, Forns, M and Gomez-Benito, J (2009) The prevalence of child sexual abuse in community and student samples: a meta-analysis. Clinical Psychology Review 29, 328338.
Perry, B, Pollard, R, Blakey, T, Baker, W and Vigilante, D (1995) Childhood trauma, the neurobiology of adaptation, and ‘use-dependent’ development of the brain: how ‘states’ become ‘traits’. Infant Mental Health Journal 16, 271291.
Pluck, G, Lee, K, David, R, Macleod, D, Spence, S and Parks, R (2011) Neurobehavioural and cognitive function is linked to childhood trauma in homeless adults. British Journal of Clinical Psychology 50, 3345.
Poon, AWC, Harvey, C, Mackinnon, A and Joubert, L (2017) A longitudinal population-based study of carers of people with psychosis. Epidemiology and Psychiatric Sciences 26, 265275.
Read, J, Agar, K, Argyle, N and Aderhold, V (2003) Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy: Theory, Research and Practice 76, 122.
Read, J, Fink, P, Tudegeir, T, Felitti, V and Whitfield, C (2008) Child maltreatment and psychosis: a return to a genuinely integrated bio-psycho-social model. Clinical Schizophrenia and Related Psychoses 2, 235254.
Robinson, C (2003) Understanding Iterative Homelessness: The Case of People with Mental Disorders (Final Report No. 45). Sydney: Australian Housing and Urban Research Institute, pp. 155.
Rosenberg, SD, Lu, W, Mueser, KT, Jankowski, MK and Cournos, F (2007) Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services 58, 245253.
Rosenman, S and Rodgers, B (2004) Childhood adversity in an Australian population. Social Psychiatry and Psychiatric Epidemiology 39, 695702.
Schenkel, L, Spaulding, W, DiLillo, D and Silverstein, S (2005) Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits. Schizophrenia Research 76, 273286.
Scott, J, Chant, D, Andrews, G, Martin, G and McGrath, J (2007) Association between trauma exposure and delusional experiences in a large community-based sample. British Journal of Psychiatry 190, 339343.
Shah, S, Mackinnon, A, Galletly, C, Carr, V, McGrath, J, Stain, H, Castle, D, Harvey, C, Sweeney, S and Morgan, V (2014) Prevalence and impact of childhood abuse in people with a psychotic illness. Data from the second Australian National Survey of Psychosis. Schizophrenia Research 159, 2026.
Shevlin, M, Dorahy, M and Adamson, G (2007) Childhood traumas and hallucinations: an analysis of the National Comorbidity Survey. Journal of Psychiatric Research 41, 222228.
Stolerman, I and Price, L (2015) Functional outcome. In Stolerman, I and Price, L (eds), Encyclopedia of Psychopharmacology. Berlin, Heidelberg: Springer, 546547.
Trauelsen, A, Bendall, S, Jansen, J, Nielsen, H, Pedersen, M, Trier, C, Haahr, U and Simonsen, E (2015) Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research 165, 5259.
Van der Kolk, B, Roth, S, Pelcovitz, D, Sunday, S and Spinazzola, J (2005) Disorders of extreme stress: the empirical foundation of a complex adaptation to trauma. Journal of Traumatic Stress 18, 389399.
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 and Viechtbauer, W (2014) Psychopathological mechanisms linking childhood traumatic experiences to risk of psychotic symptoms: analysis of a large, representative population-based sample. Schizophrenia Bulletin 40, S123S130.
van Nierop, M, Viechtbauer, W, Gunther, N, van Zelst, C, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M and van Winkel, R (2015) Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries. Psychological Medicine 6, 12771288.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J and Bentall, R (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Wing, J, Babor, T, Brugha, T, Burke, J, Cooper, J, Giel, R, Jablenski, A, Regier, D and Sartorius, N (1990) SCAN. Schedules for clinical assessment in neuropsychiatry. Archives of General Psychiatry 47, 589593.
Wing, J, Curtins, R and Beevor, A (1999) Health of the Nation Outcome Scales (HoNOS): glossary for HoNOS score sheet. British Journal of Psychiatry 174, 432434.
World Health Organisation (1992) The ICD-10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organisation.
World Health Organisation (2015) International Classification of Diseases (ICD-10). Available at http://apps.who.int/classifications/icd10/browse/2015/en (Accessed 20 May 2018).

Keywords

Childhood adversity and clinical and psychosocial outcomes in psychosis

  • S. Turner (a1), C. Harvey (a2) (a3), L. Hayes (a4), D. Castle (a2) (a5), C. Galletly (a6) (a7) (a8), S. Sweeney (a6) (a7), S. Shah (a9), L. Keogh (a10) and M. J. Spittal (a10)...

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