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Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators

Published online by Cambridge University Press:  06 July 2020

Lucia Sideli
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
Robin M. Murray
Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
Adriano Schimmenti
Faculty of Human and Social Sciences, Kore University of Enna, Italy
Mariangela Corso
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
Daniele La Barbera
Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, Italy
Antonella Trotta
King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK Tony Hillis Unit, South London and Maudsley NHS Foundation Trust, London, UK
Helen L. Fisher*
King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
Author for correspondence: Helen L. Fisher, E-mail:


The association between childhood adversity (CA) and psychosis has been extensively investigated in recent years. An increasing body of research has also focused on the mediating or moderating role of biological and psychological mechanisms, as well as other risk factors that might account for the link between CA and psychosis. We conducted a systematic search of the PsychINFO, Embase, Ovid, and Web of Science databases for original articles investigating the role of genetic vulnerabilities, environmental factors, psychological and psychopathological mechanisms in the association between CA and psychosis up to August 2019. We included studies with individuals at different stages of the psychosis continuum, from subclinical psychotic experiences to diagnosed disorders. From the 28 944 records identified, a total of 121 studies were included in this review. Only 26% of the studies identified met the criteria for methodological robustness. Overall, the current evidence suggests that CA may be associated with psychosis largely independently of genetic vulnerabilities. More consistent and robust evidence supports interaction between early and recent adversities, as well as the mediating role of attachment and mood symptoms, which is suggestive of an affective pathway between CA and psychosis across the continuum from subclinical experiences to diagnosable disorder. This review highlighted numerous methodological issues with the existing literature, including selection bias, heterogeneity of measurement instruments utilised, and lack of control for potential confounders. Future research should address these limitations to more accurately estimate mediation and moderation effects on the CA-psychosis association to inform the development of preventive interventions.

Review Article
Copyright © The Author(s), 2020. Published by Cambridge University Press

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