Skip to main content Accessibility help
×
Home

Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder

  • A. O. Berg (a1), M. Aas (a1), S. Larsson (a2), M. Nerhus (a1), E. Hauff (a2) (a3), O. A. Andreassen (a1) (a2) and I. Melle (a1) (a2)...

Abstract

Background

Ethnic minority status and childhood trauma are established risk factors for psychotic disorders. Both are found to be associated with increased level of positive symptoms, in particular auditory hallucinations. Our main aim was to investigate the experience and effect of childhood trauma in patients with psychosis from ethnic minorities, hypothesizing that they would report more childhood trauma than the majority and that this would be associated with more current and lifetime hallucinations.

Method

In this cross-sectional study we included 454 patients with a SCID-I DSM-IV diagnosis of non-affective or affective psychotic disorder. Current hallucinations were measured with the Positive and Negative Syndrome Scale (P3; Hallucinatory Behaviour). Lifetime hallucinations were assessed with the SCID-I items: auditory hallucinations, voices commenting and two or more voices conversing. Childhood trauma was assessed with the Childhood Trauma Questionnaire, self-report version.

Results

Patients from ethnic minority groups (n = 69) reported significantly more childhood trauma, specifically physical abuse/neglect, and sexual abuse. They had significantly more current hallucinatory behaviour and lifetime symptoms of hearing two or more voices conversing. Regression analyses revealed that the presence of childhood trauma mediated the association between ethnic minorities and hallucinations.

Conclusions

More childhood trauma in ethnic minorities with psychosis may partially explain findings of more positive symptoms, especially hallucinations, in this group. The association between childhood trauma and these first-rank symptoms may in part explain this group's higher risk of being diagnosed with a schizophrenia-spectrum diagnosis. The findings show the importance of childhood trauma in symptom development in psychosis.

Copyright

Corresponding author

* Author for correspondence: A. O. Berg, PhD, NORMENT, K. G. Jebsen Center for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital HF, Ullevål Hospital, Building 49, PO Box 4956 Nydalen, N-0424 Oslo, Norway.(Email: a.o.berg@medisin.uio.no)

References

Hide All
Aas, M, Djurovic, S, Athanasiu, L, Steen, NE, Agartz, I, Lorentzen, S, Sundet, K, Andreassen, OA, Melle, I (2012 a). Serotonin transporter gene polymorphism, childhood trauma, and cognition in patients with psychotic disorders. Schizophrenia Bulletin 38, 1522.
Aas, M, Steen, NE, Agartz, I, Aminoff, SR, Lorentzen, S, Sundet, K, Andreassen, OA, Melle, I (2012 b). Is cognitive impairment following early life stress in severe mental disorders based on specific or general cognitive functioning? Psychiatry Research 198, 495500.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. American Psychiatric Association: Washington, D.C.
Arnold, LM, Keck, PE, Collins, J, Wilson, R, Fleck, DE, Corey, KB, Amicone, J, Adebimpe, VR, Strakowski, SM (2004). Ethnicity and first-rank symptoms in patients with psychosis. Schizophrenia Research 67, 207212.
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, 11731182.
Barrio, C, Yamada, AM, Atuel, H, Hough, RL, Yee, S, Berthot, B, Russo, PA (2003). A tri-ethnic examination of symptom expression on the positive and negative syndrome scale in schizophrenia spectrum disorders. Schizophrenia Research 60, 259269.
Bentall, RP, Wickham, S, Shevlin, M, Varese, F (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 the Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734740.
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect 27, 169190.
Bourque, F, van der Ven, E, Malla, A (2011). A meta-analysis of the risk for psychotic disorders among first- and second-generation immigrants. Psychological Medicine 41, 897910.
Bresnahan, M, Begg, MD, Brown, A, Schaefer, C, Sohler, N, Insel, B, Vella, L, Susser, E (2007). Race and risk of schizophrenia in a US birth cohort: another example of health disparity? International Journal of Epidemiology 36, 751758.
Cantor-Graae, E, Selten, J (2005). Schizophrenia and migration: a meta-analysis and review. American Journal of Psychiatry 162, 1224.
Daalman, K, Diederen, KM, Derks, EM, van Lutterveld, R, Kahn, RS, Sommer, IE (2012). Childhood trauma and auditory verbal hallucinations. Psychological Medicine 42, 24752484.
Dealberto, MJ (2007). Why are immigrants at increased risk for psychosis? Vitamin D insufficiency, epigenetic mechanisms, or both? Medical Hypotheses 68, 259267.
Dzamarija, MT, Kalve, T (2004). Children and youth with immigrant background. Statistics Norway: Oslo.
Elmsley, RA, Roberts, MC, Rataemane, S, Pretorius, J, Oosthuizen, PP, Turner, J, Niehaus, DJ, Keyter, N, Stein, DJ (2002). Ethnicity and treatment response in schizophrenia: a comparison of 3 ethnic groups. Journal of Clinical Psychiatry 63, 914.
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J, Hutchinson, G, Doody, GA, Jones, PB, McGuffin, P, Murray, RM, Leff, J, Morgan, C (2011). Reliability and comparability of psychosis patients' retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546553.
Gara, MA, Vega, WA, Arndt, S, Escamilla, M, Fleck, DE, Lawson, WB, Lesser, I, Neighbors, HW, Wilson, DR, Arnold, LM, Strakowski, SM (2012). Influence of patient race and ethnicity on clinical assessment in patients with affective disorders. Archives of General Psychiatry 69, 593600.
Goldstone, E, Farhall, J, Ong, B (2012). Modelling the emergence of hallucinations: early acquired vulnerabilities, proximal life stressors and maladaptive psychological processes. Social Psychiatry and Psychiatric Epidemiology 47, 13671380.
Hammersley, P, Dias, A, Todd, G, Bowen-Jones, K, Reilly, B, Bentall, RP (2003). Childhood trauma and hallucinations in bipolar affective disorder: preliminary investigation. British Journal of Psychiatry 182, 543547.
Harvey, I, Williams, M, McGuffin, P, Toone, BK (1990). The functional psychoses in Afro-Caribbeans. British Journal of Psychiatry 157, 515522.
Henriksen, K, Østby, L, Ellingsen, DE (2010). Migration and immigration. Statistics Norway: Oslo.
Hien, D, Bukszpan, C (1999). Interpersonal violence in a ‘normal’ low-income control group. Women & Health 29, 116.
Hill, R (2007). An analysis of racial/ethnic disproportionality and disparity at the national, state, and country level. Casey-CSSP Alliance for Racial Equity in Child Welfare: Seattle, WA.
IBM Corp (2012). IBM SPSS Statistics for Windows. IBM Corp.: Armonk, NY.
Iversen, T, Ma, C-tA, Meyer, HE (2013). Immigrants’ acculturation and changes in body mass index. Economics & Human Biology 11, 17.
Johns, LC, Nazroo, JY, Bebbington, P, Kuipers, E (2002). Occurrence of hallucinatory experiences in a community sample and ethnic variations. British Journal of Psychiatry 180, 174178.
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 1323.
Karlsen, S, Nazroo, JY, McKenzie, K, Bhui, K, Weich, S (2005). Racism, psychosis and common mental disorder among ethnic minority groups in England. Psychological Medicine 35, 17951803.
Kay, SR, Fiszbein, A, Opler, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kennedy, N, Boydell, J, van Os, J, Murray, R (2004). Ethnic differences in first clinical presentation of bipolar disorder: results from an epidemiological study. Journal of Affective Disorders 83, 161168.
Larsson, S, Andreassen, OA, Aas, M, Rossberg, JI, Mork, E, Steen, NE, Barrett, EA, Lagerberg, TV, Peleikis, D, Agartz, I, Melle, I, Lorentzen, S (2013). High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder. Comprehensive Psychiatry 54, 123127.
Lataster, T, van Os, J, Drukker, M, Henquet, C, Feron, F, Gunther, N, Myin-Germeys, I (2006). Childhood victimisation and developmental expression of non-clinical delusional ideation and hallucinatory experiences: victimisation and non-clinical psychotic experiences. Social Psychiatry and Psychiatric Epidemiology 41, 423428.
Lindenmayer, JP, Bossie, CA, Kujawa, M, Zhu, Y, Canuso, CM (2008). Dimensions of psychosis in patients with bipolar mania as measured by the positive and negative syndrome scale. Psychopathology 41, 264270.
Lysaker, PH, Buck, KD, LaRocco, VA (2007). Clinical and psychosocial significance of trauma history in the treatment of schizophrenia. Journal of Psychosocial Nursing and Mental Health Services 45, 4451.
McGrath, JJ, Saha, S, Chant, D, Welham, J (2008). Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiologic Reviews 30, 6776.
Morgan, C, Fearon, P (2007). Social experience and psychosis insights from studies of migrant and ethnic minority groups. Epidemiologia e psichiatria sociale 16, 118123.
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma-a critical review. Schizophrenia Bulletin 33, 310.
Morgan, C, Fisher, H, Hutchinson, G, Kirkbride, J, Craig, TK, Morgan, K, Dazzan, P, Boydell, J, Doody, GA, Jones, PB, Murray, RM, Leff, J, Fearon, P (2009). Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatrica Scandinavica 119, 226235.
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, Kirkbride, J, Leff, J, Craig, T, Hutchinson, G, McKenzie, K, Morgan, K, Dazzan, P, Doody, GA, Jones, P, Murray, R, Fearon, P (2007). Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychological Medicine 37, 495503.
Pedersen, G, Hagtvet, KA, Karterud, S (2007). Generalizability studies of the Global Assessment of Functioning – Split version. Comprehensive Psychiatry 48, 8894.
Perona-Garcelan, S, Carrascoso-Lopez, F, Garcia-Montes, JM, Ductor-Recuerda, MJ, Lopez Jimenez, AM, Vallina-Fernandez, O, Perez-Alvarez, M, Gomez-Gomez, MT (2012). Dissociative experiences as mediators between childhood trauma and auditory hallucinations. Journal of Traumatic Stress 25, 323329.
Ramsay, CE, Flanagan, P, Gantt, S, Broussard, B, Compton, MT (2011). Clinical correlates of maltreatment and traumatic experiences in childhood and adolescence among predominantly African American, socially disadvantaged, hospitalized, first-episode psychosis patients. Psychiatry Research 188, 343349.
Read, J, Agar, K, Argyle, N, Aderhold, V (2003). Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder. Psychology and Psychotherapy 76, 122.
Read, J, van Os, J, Morrison, AP, Ross, CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Roy, CA, Perry, JC (2004). Instruments for the assessment of childhood trauma in adults. Journal of Nervous and Mental Disease 192, 343351.
Schaffer, A, Cairney, J, Cheung, A, Veldhuizen, S, Kurdyak, P, Levitt, A (2009). Differences in prevalence and treatment of bipolar disorder among immigrants: results from an epidemiologic survey. Canadian Journal of Psychiatry 54, 734742.
Scher, CD, Stein, MB, Asmundson, GJ, McCreary, DR, Forde, DR (2001). The childhood trauma questionnaire in a community sample: psychometric properties and normative data. Journal of Traumatic Stress 14, 843857.
Selten, JP, Blom, JD, van der Tweel, I, Veling, W, Leliefeld, B, Hoek, HW (2008). Psychosis risk for parents and siblings of Dutch and Moroccan-Dutch patients with non-affective psychotic disorder. Schizophrenia Research 104, 274278.
Selten, JP, Hoek, HW (2008). Does misdiagnosis explain the schizophrenia epidemic among immigrants from developing countries to Western Europe? Social Psychiatry and Psychiatric Epidemiology 43, 937939.
Sobel, ME (1982). Asymptotic confidence intervals for indirect effects in structural equation models. Sociological Methodology 13, 290312.
Sohler, NL, Bromet, EJ (2003). Does racial bias influence psychiatric diagnoses assigned at first hospitalization? Social Psychiatry and Psychiatric Epidemiology 38, 463472.
Strakowski, SM, McElroy, SL, Keck, PE, West, SA (1996). Racial influence on diagnosis in psychotic mania. Journal of Affective Disorders 39, 157162.
Thombs, BD, Bennett, W, Ziegelstein, RC, Bernstein, DP, Scher, CD, Forde, DR (2007). Cultural sensitivity in screening adults for a history of childhood abuse: evidence from a community sample. Journal of General Internal Medicine 22, 368373.
Thompson, JL, Kelly, M, Kimhy, D, Harkavy-Friedman, JM, Khan, S, Messinger, JW, Schobel, S, Goetz, R, Malaspina, D, Corcoran, C (2009). Childhood trauma and prodromal symptoms among individuals at clinical high risk for psychosis. Schizophrenia Research 108, 176181.
Vanheusden, K, Mulder, CL, van der Ende, J, Selten, JP, van Lenthe, FJ, Verhulst, FC, Mackenbach, JP (2008). Associations between ethnicity and self-reported hallucinations in a population sample of young adults in The Netherlands. Psychological Medicine 38, 10951102.
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.
Veling, W, Selten, JP, Susser, E, Laan, W, Mackenbach, JP, Hoek, HW (2007). Discrimination and the incidence of psychotic disorders among ethnic minorities in The Netherlands. The International Journal of Epidemiology 36, 761768.
Ventura, J, Liberman, RP, Green, MF, Shaner, A, Mintz, J (1998). Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research 79, 163173.
Wang, Z, Xue, Z, Pu, W, Yang, B, Li, L, Yi, W, Wang, P, Liu, C, Wu, G, Liu, Z, Rosenheck, RA (2013). Comparison of first-episode and chronic patients diagnosed with schizophrenia: symptoms and childhood trauma. Early Intervention in Psychiatry 7, 2330.
Whitfield, CL, Dube, SR, Felitti, VJ, Anda, RF (2005). Adverse childhood experiences and hallucinations. Child Abuse & Neglect 29, 797810.
Wigman, JT, van Nierop, M, Vollebergh, WA, Lieb, R, Beesdo-Baum, K, Wittchen, HU, van Os, J (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity – implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin 38, 247257.
Wigman, JT, van Winkel, R, Raaijmakers, QA, Ormel, J, Verhulst, FC, Reijneveld, SA, van Os, J, Vollebergh, WA (2011). Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychological Medicine 41, 23172329.
WMA (2008). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects, p. 5. World Medical Association: Seoul.

Keywords

Related content

Powered by UNSILO

Childhood trauma mediates the association between ethnic minority status and more severe hallucinations in psychotic disorder

  • A. O. Berg (a1), M. Aas (a1), S. Larsson (a2), M. Nerhus (a1), E. Hauff (a2) (a3), O. A. Andreassen (a1) (a2) and I. Melle (a1) (a2)...

Metrics

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.