Elsevier

Schizophrenia Research

Volume 228, February 2021, Pages 159-179
Schizophrenia Research

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

https://doi.org/10.1016/j.schres.2020.11.047Get rights and content

Abstract

This paper reviews and discusses the literature on childhood trauma (CT) in people with first-episode psychosis (FEP). The aim is to update the knowledge on the prevalence and the types of CT suffered by FEP people, to compare them with other samples, to study the impact of gender, and to examine the relationship between CT and symptoms and functional outcomes. We conducted a literature search (1995–2019), to identify reported data on any topic related to CT in FEP samples. The following terms were used in the search: CT or sexual abuse or physical abuse or neglect, and first-episode psychosis. We found 493 studies, of which 68 were included in the review. FEP presented a higher prevalence of CT than controls. Women suffer more sexual abuse. The effect of CT on the severity, the prognosis and the evolution of FEP is unclear. FEP have a high prevalence of CT. Its relationship with symptoms and functional outcomes indicates its importance within treatment. This suggests the importance of creating and implementing specific interventions and personalized therapies addressed to work through their past traumatic experiences to improve their quality of live and their prognosis.

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)

  • M.T. Compton et al.

    Preliminary evidence of an association between childhood abuse and cannabis dependence among African American first-episode schizophrenia-spectrum disorder patients

    Drug Alcohol Depend.

    (2004)
  • V. Doré-Gauthier et al.

    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.

    (2019)
  • N. Dorji et al.

    Adverse childhood experiences: association with physical and mental health conditions among older adults in Bhutan

    Public Health

    (2020)
  • C. Galletti et al.

    Auditory and non-auditory hallucinations in first-episode psychosis: differential associations with diverse clinical features

    Psychiatry Res.

    (2017)
  • M. Garcia et al.

    Sex differences in the effect of childhood trauma on the clinical expression of early psychosis

    Compr. Psychiatry

    (2016)
  • P.H. Lysaker et al.

    The prevalence and correlates of trauma-related symptoms in schizophrenia spectrum disorder

    Compr. Psychiatry

    (2008)
  • M. Michail et al.

    Social anxiety in first-episode psychosis: the role of childhood trauma and adult attachment

    J. Affect. Disord.

    (2014)
  • B. Misiak et al.

    Childhood traumatic events and types of auditory verbal hallucinations in first-episode schizophrenia patients

    Compr. Psychiatry

    (2016)
  • V. Mondelli et al.

    Abnormal cortisol levels during the day and cortisol awakening response in first-episode psychosis: the role of stress and of antipsychotic treatment

    Schizophr. Res.

    (2010)
  • J. Palmier-Claus et al.

    Childhood adversity and social functioning in psychosis: exploring clinical and cognitive mediators

    Psychiatry Res.

    (2016)
  • E. Paolini et al.

    Delusions in first-episode psychosis: principal component analysis of twelve types of delusions and demographic and clinical correlates of resulting domains

    Psychiatry Res.

    (2016)
  • M. Pruessner et al.

    The neural diathesis-stress model of schizophrenia revisited: an update on recent findings considering illness stage and neurobiological and methodological complexities

    Neurosci. Biobehav. Rev.

    (2017)
  • M. Pruessner et al.

    Gender differences in childhood trauma in first episode psychosis: association with symptom severity over two years

    Schizophr. Res.

    (2019)
  • C.E. Ramsay et al.

    Clinical correlates of maltreatment and traumatic experiences in childhood and adolescence among predominantly African American, socially disadvantaged, hospitalized, first-episode psychosis patients

    Psychiatry Res.

    (2011)
  • L.S. Schenkel et al.

    Histories of childhood maltreatment in schizophrenia: relationships with premorbid functioning, symptomatology, and cognitive deficits

    Schizophr. Res.

    (2005)
  • R. Seitz et al.

    The Trier social stress test in first episode psychosis patients: impact of perceived stress, protective factors and childhood trauma

    Psychoneuroendocrinology

    (2019)
  • L. Sideli et al.

    Failure to find association between childhood abuse and cognition in first-episode psychosis patients

    Eur. Psychiatry

    (2014)
  • A. Spidel et al.

    Early psychosis and aggression: predictors and prevalence of violent behaviour amongst individuals with early onset psychosis

    Int. J. Law Psychiatry

    (2010)
  • P. Sun et al.

    Does dissociation mediate the relationship between childhood trauma and hallucinations, delusions in first episode psychosis?

    Compr. Psychiatry

    (2018)
  • C. Theleritis et al.

    Brain derived neurotropic factor (BDNF) is associated with childhood abuse but not cognitive domains in first episode psychosis

    Schizophrenia Res.

    (2014)
  • A.M. Trauelsen et al.

    Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis

    Schizophr. Res.

    (2015)
  • A.M. Trauelsen et al.

    Metacognition in first-episode psychosis and its association with positive and negative symptom profiles $

    Psychiatry Res.

    (2016)
  • A. Trotta et al.

    Interaction between childhood adversity and functional polymorphisms in the dopamine pathway on first-episode psychosis

    Schizophr. Res.

    (2019)
  • M. Aas et al.

    Abnormal cortisol awakening response predicts worse cognitive function in patients with first-episode psychosis

    Psychol. Med.

    (2010)
  • Aas, M, Andreassen, O. A., Aminoff, S. R., Faerden, A., Romm, K. L., Nesvåg, R., Berg, A. O., Simonsen, C., Agartz, I.,...
  • Ajnakina, O, Trotta, A., Oakley-Hannibal, E., Forti, M. di, Stilo, S. A., Kolliakou, A., Gardner-Sood, P., Gaughran,...
  • L. Alameda et al.

    Childhood sexual and physical abuse: age at exposure modulates impact on functional outcome in early psychosis patients

    Psychol. Med.

    (2015)
  • Luis Alameda et al.

    Mild depressive symptoms mediate the impact of childhood trauma on long-term functional outcome in early psychosis patients

    Schizophr. Bull.

    (2017)
  • M.-J. Alvárez et al.

    Prevalence and clinical impact of childhood trauma in patients with severe mental disorders

    J. Nerv. Ment. Dis.

    (2011)
  • H. Bae et al.

    Childhood abuse and verbal intelligence among adults diagnosed with first-episode schizophrenia

    Psychosis

    (2010)
  • S. Bendall et al.

    Childhood trauma increases the risk of post-traumatic stress disorder in response to first-episode psychosis

    Aust. N. Z. J. Psychiatry

    (2012)
  • S. Bendall et al.

    Testing a model of the relationship between childhood sexual abuse and psychosis in a first-episode psychosis group

    J. Nerv. Ment. Dis.

    (2013)
  • R.P. Bentall et al.

    From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms

    Soc. Psychiatry Psychiatr. Epidemiol.

    (2014)
  • A. Bifulco et al.

    Childhood experience of care and abuse (CECA): a retrospective interview measure

    J. Child Psychol. Psychiatry

    (1994)
  • C. Braehler et al.

    Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls

    Psychiatry Res.

    (2013)
  • J. Bremner et al.

    Psychometric properties of the early trauma inventory-self report

    J. Nerv. Ment. Dis.

    (2007)
  • C. Campbell et al.

    The relationship between childhood trauma and neuropsychological functioning in first episode psychosis

    Psychosis

    (2013)
  • A. Catalan et al.

    Can childhood trauma influence facial emotion recognition independently from a diagnosis of severe mental disorder?

    Revista de Psiquiatria Y Salud Mental.

    (2018)
  • P. Conus et al.

    The first-episode psychosis outcome study: premorbid and baseline characteristics of an epidemiological cohort of 661 first-episode psychosis patients

    Early Interv. Psychiatry

    (2007)
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