Forms of Childhood Adversity Related to First-Episode Psychosis Outcomes

Researchers found a degree of specificity in the associations between different forms of childhood adversity and adverse psychosis outcomes, including service utilization and substance dependence, following first contact with mental health services for psychosis, according to a study published in Psychiatry Research.

Previous studies have linked childhood adversity to the presence of psychotic disorders and risk for psychosis onset. The investigators of this study explored the relationships between 6 different types of childhood adversity and long-term clinical and social outcomes of first-episode psychosis patients during a 5-year follow-up period.

The study sample included 237 first-episode psychosis patients aged 18 to 65 years recruited from the National Institute for Health Research Biomedical Research Center Genetics and Psychosis Study in South London. Researchers assessed childhood adversity before age 17 using the Childhood Experience of Care and Abuse Questionnaire and focused on 6 forms of childhood adversity previously associated with psychosis: physical abuse, sexual abuse, parental separation, parental death, taken into care by authorities, or changes in family arrangements. Participants were followed for an average of 5 years after first contact with mental health services for psychosis; follow-up data were extracted retrospectively, including clinical and social outcomes, service utilization, and self-injurious behaviors.

The most common type of childhood adversity was parental separation (57.8%), followed by physical abuse (24.5%) and disrupted family arrangements (21.9%). Results showed that reporting at least 1 type of childhood adversity was associated with a significantly lower likelihood of achieving remission, longer inpatient stays, and compulsory admission over the 5-year follow-up period. Parental separation during childhood was significantly associated with greater likelihood of nonadherence to antipsychotic medications, substance dependence, and compulsory admission. Parental death was associated with compulsory admission, whereas institutional care was significantly associated with longer inpatient stays during follow-up. Self-injurious behaviors were not associated with childhood adversity, nor were associations with physical abuse significant.

Limitations of the study included potential systematic bias due to nonrandom attrition during the follow-up period and variation in quality and completeness of reported information. Furthermore, inaccuracies in classification may have occurred during periods when patients were not in contact with mental health services. Retrospective accounts of childhood adversity could be vulnerable to bias; other forms of childhood adversity that may have been associated with psychotic outcomes were left out of the study.

The present study demonstrated associations between specific adverse childhood events (parental separation, parental death, and institutional care) and adverse clinical outcomes (inpatient stays, compulsory admission, medication nonadherence) and substance dependence. Clinicians should screen patients with first-episode psychosis for childhood adversity to better inform treatment strategies and improve outcomes.

This study was supported by the Maudsley Charitable Fund, the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, and the UK National Institute of Health Research. See source for full list of authors’ disclosures.

Reference                                                                                                                       

Ajnakina O, Trotta A, Di Forti M, et al. Different types of childhood adversity and 5-year outcomes in a longitudinal cohort of first-episode psychosis patients. Psychiatry Res. 2018; 269: 199–206.