Types, prevalence and gender differences of childhood trauma in first-episode psychosis. What is the evidence that childhood trauma is related to symptoms and functional outcomes in first episode psychosis? A systematic review
Introduction
Traumatic experiences have an important impact on physical and emotional health for people of any age and at any stage of development (Dorji et al., 2020; Kalmakis and Chandler, 2015; Sonu et al., 2019).
The impact of traumatic experiences in childhood and adolescence can be particularly significant because the human brain is still under development. Traumatic experiences can sometimes produce irreversible harm in the physical, emotional and cognitive spheres (López-Soler, 2008; Mesa-Gresa and Moya-Albiol, 2011). Recent research has focused on studying the role that traumatic experiences during childhood and adolescence may play in the onset and the prognosis of different mental illnesses, including psychotic disorders and, more specifically, in first episode psychosis (FEP).
Childhood Trauma (CT) appears to be a risk factor for developing psychosis (Bentall et al., 2014; Varese et al., 2012). In addition, the presence of CT has been linked to more clinical severity and to worse functional outcomes in FEP, leading to earlier diagnosis and a higher number of suicide attempts (Alvárez et al., 2011; Conus et al., 2010a, Conus et al., 2010b; Garno et al., 2005; Lysaker and LaRocco, 2008; Morrison et al., 2003; Schenkel et al., 2005).
CT is a very broad concept which is usually difficult to conceptualize and summarize. This has caused heterogeneity in previous results. The most common traumatic experiences described in childhood are emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect (Bernstein et al., 2003). However, most of the instruments created to assess CT have also considered stressful live events as traumatic experiences. These include loss or abandonment of one parent, parental divorce and being under institutional care (Bifulco et al., 1994; Bremner et al., 2007; Goldberg and Freyd, 2006; Smith et al., 2002; Wolfe et al., 1996). Existing literature has differences in methods, diverse conceptualizations of CT and heterogeneity in its assessment. This heterogeneity hinders comparability and obtaining solid conclusions.
We consider that proper assessment of CT provides with crucial information and possible implications for therapeutic interventions in first-episode psychosis. Understanding what specific psychotic symptoms and functional outcomes are related to CT could, in turn, improve the patient's clinical evolution and prognosis.
Given the former rationale, we believe a review and discussion of CT in patients with FEP deems appropriate.
The purpose of the present study is to review the literature exploring CT in people with FEP. Specifically, we decided to address: the instruments used in assessing CT, the description of the characteristics of CT in patients with FEP, differences in CT suffered by people with FEP in comparison to other clinical and healthy samples, gender differences in CT and explore CT in relation with symptoms and functional outcome.
Section snippets
Search strategy
The article selection was carried out by 4 psychologists and 2 psychiatrists. The systematic search was conducted in MEDLINE, PsycINFO and Scopus. We included articles dating from 1995 to September 2019. The search terms were: “Childhood Trauma” OR “sexual abuse” OR “physical abuse” OR “neglect” AND “first-episode psychosis”.
Eligibility criteria
Original articles were included if they explored and described CT in samples with FEP or if they explored the relation of CT with symptoms and functional outcomes. Trauma
Results
A total of 68 articles met inclusion criteria. The results were divided in 5 sections: 1) Instruments to assess CT. 2) Description of the characteristics of CT in patients with FEP, 3) CT in FEP patients in comparison with other samples, 4) Gender differences in CT, 5) CT in relation to symptoms and functional outcomes.
Discussion
This work provides a systematic review about patients with FEP and CT. Specifically, we have reviewed the instruments used in the assessment of CT, the description of the characteristics of CT in FEP patients, comparisons between FEP patients with CT and different samples (including healthy controls and other clinical samples), gender differences in FEP and CT and finally, FEP and CT in relation to symptoms and functional outcome.
The instruments used in the assessment of CT can be
Clinical perspectives
This review reveals the high prevalence of childhood trauma in patients with FEP. Childhood trauma should be addressed from primary prevention with the objective of reducing or eliminating these experiences. Campaigns addressed to the general population, but most importantly to infants, teachers and family doctors, could be beneficial in building awareness and giving detection strategies. Similarly, secondary prevention programs could help children that have experienced a traumatic event reduce
Limitations of the included studies
The main limitation was that most studies did not account for variables that might affect on the outcomes presented. For instance, most studies did not control for symptoms, neurocognition or cannabis use when assessing the relationship between CT and functional outcome. Most studies used cross-sectional designs, making it difficult to disentangle cause and effect. Although we included a few longitudinal studies, there was not enough data to study the impact of childhood trauma throughout the
Limitation and strengths
The variety of instruments used to assess CT and the different methodologies used in the literature hampered the comparability of the studies. Consequently, we could not find homogeneous results. The heterogeneity did not only include instruments, but also a poor conceptualization of CT which was sometimes merged with stressful life events. For this reason, we decided to include only those articles that reported the following experiences: physical, emotional or sexual abuse and physical and
Contributors
Regina Vila-Badia, Núria Del Cacho, Anna Butjosa, Susana Ochoa and Judith Usall conducted the literature review and contributed to the writing and structure of the manuscript. Clara Serra-Arumí and Marina Esteban Santjusto contributed to the writing and the structure of the review.
Funding sources
This work was supported by the Spanish Ministry of Health Carlos III, research grant number PI17/00111 and a research personal grant number FI18/00028.
Declaration of competing interest
None.
Acknowledgments
The authors wish to thank Ms. Marta Ferrer for her support in editing of the manuscript.
References (98)
- et al.
Childhood trauma and cognitive function in first-episode affective and non-affective psychosis
Schizophr. Res.
(2011) - et al.
Is there a link between childhood trauma, cognition, and amygdala and hippocampus volume in fi rst-episode psychosis?
Schizophr. Res.
(2012) - et al.
Different types of childhood adversity and 5-year outcomes in a longitudinal cohort of first-episode psychosis patients
Psychiatry Res.
(2018) - et al.
Childhood abuse in the etiological continuum underlying psychosis from first-episode psychosis to psychotic experiences
Eur. Psychiatry
(2015) - et al.
Childhood trauma and psychosis: beyond the association
Child Abuse Negl.
(2017) - et al.
What self-generated speech is externally misattributed in psychosis? Testing three cognitive models in a first-episode sample
Schizophr. Res.
(2011) - et al.
Development and validation of a brief screening version of the childhood trauma questionnaire
Child Abuse Negl.
(2003) - et al.
Relation between psychotic symptoms, parental care and childhood trauma in severe mental disorders
Psychiatry Res.
(2017) - et al.
Cortisol awakening response is decreased in patients with first-episode psychosis and increased in healthy controls with a history of severe childhood abuse
Schizophr. Res.
(2019) - et al.
The impact of gender and childhood abuse on age of psychosis onset, psychopathology and needs for care in psychosis patients
Schizophr. Res.
(2019)
Preliminary evidence of an association between childhood abuse and cannabis dependence among African American first-episode schizophrenia-spectrum disorder patients
Drug Alcohol Depend.
How to help homeless youth suffering from first episode psychosis and substance use disorders? The creation of a new intensive outreach intervention team
Psychiatry Res.
Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan
Public Health
Auditory and non-auditory hallucinations in first-episode psychosis: differential associations with diverse clinical features
Psychiatry Res.
Sex differences in the effect of childhood trauma on the clinical expression of early psychosis
Compr. Psychiatry
The prevalence and correlates of trauma-related symptoms in schizophrenia spectrum disorder
Compr. Psychiatry
Social anxiety in first-episode psychosis: the role of childhood trauma and adult attachment
J. Affect. Disord.
Childhood traumatic events and types of auditory verbal hallucinations in first-episode schizophrenia patients
Compr. Psychiatry
Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment
Schizophr. Res.
Childhood adversity and social functioning in psychosis: exploring clinical and cognitive mediators
Psychiatry Res.
Delusions in first-episode psychosis: principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains
Psychiatry Res.
The neural diathesis-stress model of schizophrenia revisited: an update on recent findings considering illness stage and neurobiological and methodological complexities
Neurosci. Biobehav. Rev.
Gender differences in childhood trauma in first episode psychosis: association with symptom severity over two years
Schizophr. Res.
Clinical correlates of maltreatment and traumatic experiences in childhood and adolescence among predominantly African American, socially disadvantaged, hospitalized, first-episode psychosis patients
Psychiatry Res.
Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits
Schizophr. Res.
The Trier social stress test in first episode psychosis patients: impact of perceived stress, protective factors and childhood trauma
Psychoneuroendocrinology
Failure to find association between childhood abuse and cognition in first-episode psychosis patients
Eur. Psychiatry
Early psychosis and aggression: predictors and prevalence of violent behaviour amongst individuals with early onset psychosis
Int. J. Law Psychiatry
Does dissociation mediate the relationship between childhood trauma and hallucinations, delusions in first episode psychosis?
Compr. Psychiatry
Brain derived neurotropic factor (BDNF) is associated with childhood abuse but not cognitive domains in first episode psychosis
Schizophrenia Res.
Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis
Schizophr. Res.
Metacognition in first-episode psychosis and its association with positive and negative symptom profiles $
Psychiatry Res.
Interaction between childhood adversity and functional polymorphisms in the dopamine pathway on first-episode psychosis
Schizophr. Res.
Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis
Psychol. Med.
Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients
Psychol. Med.
Mild depressive symptoms mediate the impact of childhood trauma on long-term functional outcome in early psychosis patients
Schizophr. Bull.
Prevalence and clinical impact of childhood trauma in patients with severe mental disorders
J. Nerv. Ment. Dis.
Childhood abuse and verbal intelligence among adults diagnosed with first-episode schizophrenia
Psychosis
Childhood trauma increases the risk of post-traumatic stress disorder in response to first-episode psychosis
Aust. N. Z. J. Psychiatry
Testing a model of the relationship between childhood sexual abuse and psychosis in a first-episode psychosis group
J. Nerv. Ment. Dis.
From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms
Soc. Psychiatry Psychiatr. Epidemiol.
Childhood experience of care and abuse (CECA): a retrospective interview measure
J. Child Psychol. Psychiatry
Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls
Psychiatry Res.
Psychometric properties of the early trauma inventory-self report
J. Nerv. Ment. Dis.
The relationship between childhood trauma and neuropsychological functioning in first episode psychosis
Psychosis
Can childhood trauma influence facial emotion recognition independently from a diagnosis of severe mental disorder?
Revista de Psiquiatria Y Salud Mental.
The first-episode psychosis outcome study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients
Early Interv. Psychiatry
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