Hostname: page-component-77c89778f8-5wvtr Total loading time: 0 Render date: 2024-07-18T10:49:10.241Z Has data issue: false hasContentIssue false
  • English
  • Français

The association of adverse childhood experiences with long-term outcomes of psychosis: a 21-year prospective cohort study after a first episode of psychosis

Published online by Cambridge University Press:  30 May 2024

Victor Peralta Open the ORCID record for Victor Peralta [Opens in a new window] ,
Elena García de Jalón ,
Lucía Moreno-Izco ,
David Peralta ,
Lucía Janda ,
Ana M. Sánchez-Torres ,
Manuel J. Cuesta  and
SEGPEPs group
Victor Peralta*
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
Elena García de Jalón
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
Lucía Moreno-Izco
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
David Peralta
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
Lucía Janda
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
Ana M. Sánchez-Torres
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Campus de Arrosadia, Pamplona, España
Manuel J. Cuesta
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
SEGPEPs group
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
*
Corresponding author: Victor Peralta; Email: victor.peralta.martin@cfnavarra.es
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Evidence suggests a possible relationship between exposure to childhood adversity (CA) and functional impairment in psychosis. However, the impact of CA on long-term outcomes of psychotic disorders remains poorly understood.

Methods

Two hundred and forty-three patients were assessed at their first episode of psychosis for CA and re-assessed after a mean of 21 years of follow-up for several outcome domains, including symptoms, functioning, quality of life, cognitive performance, neurological dysfunction, and comorbidity. The unique predictive ability of CA exposure for outcomes was examined using linear regression analysis controlling for relevant confounders, including socioeconomic status, family risk of schizophrenia, and obstetric complications.

Results

There were 54% of the patients with a documented history of CA at mild or higher levels. CA experiences were more prevalent and severe in schizophrenia than in other psychotic disorders (p < 0.001). Large to very large effect sizes were observed for CA predicting most role functioning variables and negative symptoms (ΔR2 between 0.105 and 0.181). Moderate effect sizes were observed for positive symptoms, personal functioning, impaired social cognition, impaired immediate verbal learning, poor global cognition, internalized stigma, poor personal recovery, and drug abuse severity (ΔR2 between 0.040 and 0.066). A dose–response relationship was observed between levels of CA and severity of outcome domains.

Conclusion

Our results suggest a strong and widespread link between early adversity exposure and outcomes of psychotic disorders. Awareness of the serious long-term consequences of CA should encourage better identification of those at risk and the development of effective interventions.

Keywords

childhood adversityfirst-episode psychosislong-term follow-upoutcome
Type
Original Article
Information
Psychological Medicine , First View , pp. 1 - 10
Check for updates
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

SEGPEPs group: A. Ballesterosa, L. Fañanásb,c, G. Gil-Berrozped,e, R. Hernándezf, R. Lorented, S. Papiolg,h, M. Ribeirod,e, A. Roseroi and M. Zandiod,e

aRed de Salud Mental de Álava, Vitoria-Gasteiz, Spain; bDepartment of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; cNetwork Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain; dInstituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; eDepartment of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; fCSMIJ Ciutat Vella. Consorci Parc de Salut Mar, Barcelona, Spain; gInstitute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; hDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany and iMental Health Department, Servicio Navarro de Salud, Pamplona, Spain

References

Ajnakina, O., Trotta, A., Forti, M. D., Stilo, S. A., Kolliakou, A., Gardner-Sood, P., … Fisher, H. L. (2018). Different types of childhood adversity and 5-year outcomes in a longitudinal cohort of first-episode psychosis patients. Psychiatry Research, 269, 199–206. https://doi.org/10.1016/j.psychres.2018.08.054CrossRefGoogle Scholar
Alameda, L., Christy, A., Rodriguez, V., Salazar de Pablo, G., Thrush, M., Shen, Y., … Murray, R. M. (2021). Association between specific childhood adversities and symptom dimensions in people with psychosis: Systematic review and meta-analysis. Schizophrenia Bulletin, 47(4), 975–985. https://doi.org/10.1093/schbul/sbaa199CrossRefGoogle ScholarPubMed
Alameda, L., Ferrari, C., Baumann, P. S., Gholam-Rezaee, M., Do, K. Q., & Conus, P. (2015). Childhood sexual and physical abuse: Age at exposure modulates impact on functional outcome in early psychosis patients. Psychological Medicine, 45(13), 2727–2736. https://doi.org/10.1017/S0033291715000690CrossRefGoogle ScholarPubMed
Allen, M. S., Iliescu, D., & Greiff, S. (2022). Single item measures in psychological science. European Journal of Psychological Assessment, 38(1), 1–5. https://doi.org/10.1027/1015-5759/a000699CrossRefGoogle Scholar
Andreasen, N. C. (1987). The comprehensive assessment of symptoms and history (CASH). Iowa: University of Iowa.Google Scholar
Andreasen, N. C. (1992). The Comprehensive Assessment of Symptoms and History (CASH): An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry, 49(8), 615. https://doi.org/10.1001/archpsyc.1992.01820080023004CrossRefGoogle ScholarPubMed
Andreasen, N. C., Endicott, J., Spitzer, R. L., & Winokur, G. (1977). The family history method using diagnostic criteria. Reliability and validity. Archives of General Psychiatry, 34(10), 1229–1235.10.1001/archpsyc.1977.01770220111013CrossRefGoogle ScholarPubMed
Arranz, S., Monferrer, N., Jose Algora, M., Cabezas, A., Sole, M., Vilella, E., … Sanchez-Gistau, V. (2018). The relationship between the level of exposure to stress factors and cannabis in recent onset psychosis. Schizophrenia Research, 201, 352–359. https://doi.org/10.1016/j.schres.2018.04.040CrossRefGoogle ScholarPubMed
Bailey, T., Alvarez-Jimenez, M., Garcia-Sanchez, A. M., Hulbert, C., Barlow, E., & Bendall, S. (2018). Childhood trauma is associated with severity of hallucinations and delusions in psychotic disorders: A systematic review and meta-analysis. Schizophrenia Bulletin, 44(5), 1111–1122. https://doi.org/10.1093/schbul/sbx161CrossRefGoogle ScholarPubMed
Balaji, S., & Sankaranarayanan, A. (2023). The association between adverse childhood experiences and metabolic syndrome in severe mental illness: A literature review. Australasian Psychiatry: Bulletin of Royal Australian and New Zealand College of Psychiatrists, 31(3), 381–388. https://doi.org/10.1177/10398562231167782CrossRefGoogle ScholarPubMed
Barrigón, M. L., Diaz, F. J., Gurpegui, M., Ferrin, M., Salcedo, M. D., Moreno-Granados, J., … Ruiz-Veguilla, M. (2015). Childhood trauma as a risk factor for psychosis: A sib-pair study. Journal of Psychiatric Research, 70, 130–136. https://doi.org/10.1016/j.jpsychires.2015.08.017CrossRefGoogle ScholarPubMed
Brooks, R. (1996). EuroQol: The current state of play. Health Policy (Amsterdam, Netherlands), 37(1), 53–72. https://doi.org/10.1016/0168-8510(96)00822-6CrossRefGoogle ScholarPubMed
Buchanan, R. W., & Heinrichs, D. W. (1989). The Neurological Evaluation Scale (NES): A structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Research, 27(3), 335–350.10.1016/0165-1781(89)90148-0CrossRefGoogle Scholar
Christy, A., Cavero, D., Navajeeva, S., Murray-O'Shea, R., Rodriguez, V., Aas, M., … Alameda, L. (2023). Association between childhood adversity and functional outcomes in people with psychosis: A meta-analysis. Schizophrenia Bulletin, 49(2), 285–296. https://doi.org/10.1093/schbul/sbac105CrossRefGoogle ScholarPubMed
Cotter, J., Kaess, M., & Yung, A. R. (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(1), 21–30. https://doi.org/10.1017/ipm.2014.74CrossRefGoogle ScholarPubMed
Dong, M., Anda, R. F., Felitti, V. J., Dube, S. R., Williamson, D. F., Thompson, T. J., … Giles, W. H. (2004). The interrelatedness of multiple forms of childhood abuse, neglect, and household dysfunction. Child Abuse & Neglect, 28(7), 771–784. https://doi.org/10.1016/j.chiabu.2004.01.008CrossRefGoogle ScholarPubMed
Dragioti, E., Radua, J., Solmi, M., Arango, C., Oliver, D., Cortese, S., … Fusar-Poli, P. (2022). Global population attributable fraction of potentially modifiable risk factors for mental disorders: A meta-umbrella systematic review. Molecular Psychiatry, 27(8), 3510–3519. https://doi.org/10.1038/s41380-022-01586-8CrossRefGoogle ScholarPubMed
Du Rocher Schudlich, T., Youngstrom, E. A., Martinez, M., KogosYoungstrom, J., Scovil, K., Ross, J., … Findling, R. L. (2015). Physical and sexual abuse and early-onset bipolar disorder in youths receiving outpatient services: Frequent, but not specific. Journal of Abnormal Child Psychology, 43(3), 453–463. https://doi.org/10.1007/s10802-014-9924-3CrossRefGoogle Scholar
Elixhauser, A., Steiner, C., Harris, D. R., & Coffey, R. M. (1998). Comorbidity measures for use with administrative data. Medical Care, 36(1), 8–27. https://doi.org/10.1097/00005650-199801000-00004CrossRefGoogle ScholarPubMed
Evans, G. W., Li, D., & Whipple, S. S. (2013). Cumulative risk and child development. Psychological Bulletin, 139(6), 1342–1396. https://doi.org/10.1037/a0031808CrossRefGoogle ScholarPubMed
Fares-Otero, N. E., Alameda, L., Pfaltz, M. C., Martinez-Aran, A., Schäfer, I., & Vieta, E. (2023). Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: A systematic review and meta-analysis. Psychological Medicine, 53(13), 5909–5932. https://doi.org/10.1017/S0033291723001678CrossRefGoogle ScholarPubMed
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (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 Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749-3797(98)00017-8CrossRefGoogle ScholarPubMed
Funder, D. C., & Ozer, D. J. (2019). Evaluating effect size in psychological research: Sense and nonsense. Advances in Methods and Practices in Psychological Science, 2(2), 156–168. https://doi.org/10.1177/2515245919847202CrossRefGoogle Scholar
Garner, A., Yogman, M., & Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics, Council on Early Childhood. (2021). Preventing childhood toxic stress: Partnering with families and communities to promote relational health. Pediatrics, 148(2), e2021052582. https://doi.org/10.1542/peds.2021-052582CrossRefGoogle ScholarPubMed
Gayer-Anderson, C., Reininghaus, U., Paetzold, I., Hubbard, K., Beards, S., Mondelli, V., … Morgan, C. (2020). A comparison between self-report and interviewer-rated retrospective reports of childhood abuse among individuals with first-episode psychosis and population-based controls. Journal of Psychiatric Research, 123, 145–150. https://doi.org/10.1016/j.jpsychires.2020.02.002CrossRefGoogle ScholarPubMed
Grundy, S. M., Cleeman, J. I., Daniels, S. R., Donato, K. A., Eckel, R. H., Franklin, B. A., … Costa, F. (2005). Diagnosis and management of the metabolic syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation, 112(17), 2735–2752. https://doi.org/10.1161/circulationaha.105.169404CrossRefGoogle ScholarPubMed
Hammer, J. H., & Toland, M. D. (2017). Internal structure and reliability of the Internalized Stigma of Mental Illness Scale (ISMI-29) and Brief Versions (ISMI-10, ISMI-9) among Americans with depression. Stigma and Health, 2(3), 159–174. https://doi.org/10.1037/sah0000049CrossRefGoogle Scholar
Hardt, J., & Rutter, M. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45(2), 260–273. https://doi.org/10.1111/j.1469-7610.2004.00218.xCrossRefGoogle ScholarPubMed
Hardy, A., Keen, N., van den Berg, D., Varese, F., Longden, E., Ward, T., … Brand, R. M. (2024). Trauma therapies for psychosis: A state-of-the-art review. Psychology and Psychotherapy, 97(1), 74-90. https://doi.org/10.1111/papt.12499CrossRefGoogle ScholarPubMed
Hawes, D. J., Lechowicz, M., Roach, A., Fisher, C., Doyle, F. L., Noble, S., & Dadds, M. R. (2021). Capturing the developmental timing of adverse childhood experiences: The adverse life experiences scale. American Psychologist, 76(2), 253–267. https://doi.org/10.1037/amp0000760CrossRefGoogle ScholarPubMed
Kessler, R. C., McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., … Williams, D. R. (2010). Childhood adversities and adult psychopathology in the WHO world mental health surveys. The British Journal of Psychiatry: The Journal of Mental Science, 197(5), 378–385. https://doi.org/10.1192/bjp.bp.110.080499CrossRefGoogle ScholarPubMed
Law, H., Neil, S. T., Dunn, G., & Morrison, A. P. (2014). Psychometric properties of the questionnaire about the process of recovery (QPR). Schizophrenia Research, 156(2–3), 184–189. https://doi.org/10.1016/j.schres.2014.04.011CrossRefGoogle ScholarPubMed
Leeb, R., Paulozzi, L., Melanson, C., Simon, T., & Arias, I. (2008). Child maltreatment surveillance: Uniform definitions for public health and recommended data elements. Atlanta: Centers for Disease Control and Prevention. Recuperado de Centers for Disease Control and Prevention website: https://www.ncbi.nlm.nih.gov/nlmcatalog?cmd=PureSearch&term=101521605%5Bnlmid%5D 10.1037/e587022010-001CrossRefGoogle Scholar
Lewis, S. W., Owen, R. M., & Murray, R. M. (1989). Obstetric complications and schizophrenia. In Schulz, S. C. & Tamminga, C. A. (Eds.), Schizophrenia: Scientific progress (pp. 56–68). New York: Oxford University Press.Google Scholar
Marques-Feixa, L., Palma-Gudiel, H., Romero, S., Moya-Higueras, J., Rapado-Castro, M., & Castro-Quintas, Á., … EPI-Young Stress GROUP. (2023). Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose-response relationship in children and adolescents. Psychological Medicine, 53(3), 1060–1073. https://doi.org/10.1017/S003329172100249XCrossRefGoogle Scholar
McKay, M. T., Kilmartin, L., Meagher, A., Cannon, M., Healy, C., & Clarke, M. C. (2022). A revised and extended systematic review and meta-analysis of the relationship between childhood adversity and adult psychiatric disorder. Journal of Psychiatric Research, 156, 268–283. https://doi.org/10.1016/j.jpsychires.2022.10.015CrossRefGoogle ScholarPubMed
McLellan, A. T., Luborsky, L., Cacciola, J., Griffith, J., Evans, F., Barr, H. L., & O'Brien, C. P. (1985). New data from the addiction severity index. Reliability and validity in three centers. Journal of Nervous and Mental Disease, 173(7), 412–423. https://doi.org/10.1097/00005053-198507000-00005CrossRefGoogle ScholarPubMed
Murray, R. M., Bhavsar, V., Tripoli, G., & Howes, O. (2017). 30 Years on: How the neurodevelopmental hypothesis of schizophrenia morphed into the developmental risk factor model of psychosis. Schizophrenia Bulletin, 43(6), 1190–1196. https://doi.org/10.1093/schbul/sbx121CrossRefGoogle ScholarPubMed
Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., & Vos, T. (2012). The long-term health consequences of child physical abuse, emotional abuse, and neglect: A systematic review and meta-analysis. PLoS Medicine, 9(11), e1001349. https://doi.org/10.1371/journal.pmed.1001349CrossRefGoogle ScholarPubMed
Nuechterlein, K. H., & Green, M. F. (2006). MCCB: Matrics consensus cognitive batery. Los Angeles: MATRICS Assessment.Google Scholar
Peralta, V., de Jalón, E. G., Moreno-Izco, L., Peralta, D., Janda, L., Sánchez-Torres, A. M., … SEGPEPs group. (2023). A clinical staging model of psychotic disorders based on a long-term follow-up of first-admission psychosis: A validation study. Psychiatry Research, 322, 115109. https://doi.org/10.1016/j.psychres.2023.115109CrossRefGoogle ScholarPubMed
Peralta, V., García de Jalón, E., Moreno-Izco, L., Peralta, D., Janda, L., Sánchez-Torres, A. M., & Cuesta, M. J. (2022). Long-Term outcomes of first-admission psychosis: A naturalistic 21-year follow-Up study of symptomatic, functional and personal recovery and their baseline predictors. Schizophrenia Bulletin, 48(3), 631–642. https://doi.org/10.1093/schbul/sbab145CrossRefGoogle ScholarPubMed
Peralta, V., Moreno-Izco, L., Garcia de Jalon, E., Sanchez-Torres, A. M., Janda, L., Peralta, D., … SEGPEPs Group. (2021). Prospective long-term cohort study of subjects with first-episode psychosis examining eight major outcome domains and their predictors: Study protocol. Frontiers in Psychiatry, 12, 643112. https://doi.org/10.3389/fpsyt.2021.643112CrossRefGoogle ScholarPubMed
Purdon, S. E. (2005). The screen for cognitive impairment in psychiatry (SCIP): Instructions and three alternate forms. Edmonton, AB: PNL.Google Scholar
Rey, J., Peng, R., Morales-Blanquez, C., Widyawati, I., Peralta, V., & Walter, G. (2000). Rating the quality of the family environment in different cultures. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1168–1174. https://doi.org/10.1097/00004583-200009000-00017CrossRefGoogle ScholarPubMed
Rey, J. M., Singh, M., Hung, S. F., Dossetor, D. R., Newman, L., Plapp, J. M., & Bird, K. D. (1997). A global scale to measure the quality of the family environment. Archives of General Psychiatry, 54(9), 817–822. https://doi.org/10.1001/archpsyc.1997.01830210061006CrossRefGoogle ScholarPubMed
Rodriguez, V., Aas, M., Vorontsova, N., Trotta, G., Gadelrab, R., Rooprai, N. K., & Alameda, L. (2021). Exploring the interplay between adversity, neurocognition, social cognition, and functional outcome in people with psychosis: A narrative review. Frontiers in Psychiatry, 12, 596949. https://doi.org/10.3389/fpsyt.2021.596949CrossRefGoogle ScholarPubMed
Rutter, M. (1997). Child psychiatric disorder. Measures, causal mechanisms, and interventions. Archives of General Psychiatry, 54(9), 785–789. https://doi.org/10.1001/archpsyc.1997.01830210021002CrossRefGoogle ScholarPubMed
Selten, J.-P., van der Ven, E., Rutten, B. P. F., & Cantor-Graae, E. (2013). The social defeat hypothesis of schizophrenia: An update. Schizophrenia Bulletin, 39(6), 1180–1186. https://doi.org/10.1093/schbul/sbt134CrossRefGoogle ScholarPubMed
Shonkoff, J. P. (2016). Capitalizing on advances in science to reduce the health consequences of early childhood adversity. JAMA Pediatrics, 170(10), 1003–1007. https://doi.org/10.1001/jamapediatrics.2016.1559CrossRefGoogle ScholarPubMed
Struck, N., Krug, A., Yuksel, D., Stein, F., Schmitt, S., Meller, T., … Brakemeier, E.-L. (2020). Childhood maltreatment and adult mental disorders – The prevalence of different types of maltreatment and associations with age of onset and severity of symptoms. Psychiatry Research, 293, 113398. https://doi.org/10.1016/j.psychres.2020.113398CrossRefGoogle ScholarPubMed
Teicher, M. H., Gordon, J. B., & Nemeroff, C. B. (2022). Recognizing the importance of childhood maltreatment as a critical factor in psychiatric diagnoses, treatment, research, prevention, and education. Molecular Psychiatry, 27(3), 1331–1338. https://doi.org/10.1038/s41380-021-01367-9CrossRefGoogle ScholarPubMed
Teicher, M. H., Samson, J. A., Anderson, C. M., & Ohashi, K. (2016). The effects of childhood maltreatment on brain structure, function and connectivity. Nature Reviews. Neuroscience, 17(10), 652–666. https://doi.org/10.1038/nrn.2016.111CrossRefGoogle ScholarPubMed
Trotta, A., Murray, R. M., David, A. S., Kolliakou, A., O'Connor, J., Di Forti, M., … Fisher, H. L. (2016). Impact of different childhood adversities on 1-year outcomes of psychotic disorder in the genetics and psychosis study. Schizophrenia Bulletin, 42(2), 464–475. https://doi.org/10.1093/schbul/sbv131CrossRefGoogle ScholarPubMed
Vargas, T., & Mittal, V. (2018). Issues affecting reliable and valid assessment of early life stressors in psychosis. Schizophrenia Research, 192, 465–466. https://doi.org/10.1016/j.schres.2017.04.021CrossRefGoogle ScholarPubMed
Verdoux, H., van Os, J., Sham, P., Jones, P., Gilvarry, K., & Murray, R. (1996). Does familiality predispose to both emergence and persistence of psychosis? A follow-up study. British Journal of Psychiatry, 168(5), 620–626.10.1192/bjp.168.5.620CrossRefGoogle ScholarPubMed
Vila-Badia, R., Del Cacho, N., Butjosa, A., Serra Arumí, C., Esteban Santjusto, M., Abella, M., … Usall, J. (2022). Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables. Journal of Psychiatric Research, 146, 102–108. https://doi.org/10.1016/j.jpsychires.2021.12.033CrossRefGoogle ScholarPubMed
Wilkinson, G., Hesdon, B., Wild, D., Cookson, R., Farina, C., Sharma, V., … Jenkinson, C. (2000). Self-report quality of life measure for people with schizophrenia: The SQLS. British Journal of Psychiatry, 177, 42–46. https://doi.org/10.1192/bjp.177.1.42CrossRefGoogle ScholarPubMed
Wolke, D., Waylen, A., Samara, M., Steer, C., Goodman, R., Ford, T., & Lamberts, K. (2009). Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. The British Journal of Psychiatry: The Journal of Mental Science, 195(3), 249–256. https://doi.org/10.1192/bjp.bp.108.053751CrossRefGoogle ScholarPubMed
World Health Organization (1988). WHO Psychiatric disability assessment schedule. Geneva: World Health Organization.Google Scholar
Supplementary material: File

Peralta et al. supplementary material

Peralta et al. supplementary material
Download Peralta et al. supplementary material(File)
File 28.6 KB