Childhood Interpersonal Trauma Indirectly Affects First Episode of Psychosis

Childhood interpersonal trauma (CIT) may be related to psychosis, according to study results published in the Journal of Psychiatric Research.

Patients with a first episode of psychosis (FEP) (n=278; 54.3% men) between 2001 and 2017 and healthy controls (n=52; 55.8% men) were evaluated for the incidence of CIT and its effect on psychosis outcomes at the Marqués de Valdecilla Universtiy Hospital in Spain.

The FEP and control cohorts comprised individuals with mean ages 30.6 (SD, 9.7) and 28.2 (SD, 7.8) years, 52.5% and 40.4% had a low socioeconomic status, and 25.9% and 0% had a family history of psychosis (P <.001), respectively.

During childhood, the FEP group and controls experienced sexual trauma (6.8% vs 3.8%; P =.418), physical trauma (10.1% vs 1.9%; P =.057), other interpersonal trauma (9% vs 5.8%; P =.444), and any CIT (20.5% vs 9.6%; P =.065), respectively. The FEP group had experienced more recent stressful events (63% vs 21%; P <.001) and had higher Recent Traumatic Events Scale (RTES) scores (mean, 4.1 vs 1.7; P <.001) compared with controls, respectively.

In the regression analysis, belonging to the FEP group was assoicated with RTES scores (β, -0.253; P <.001).

In the mediation analysis, CIT was an indirect predictor for belonging to the FEP group that was mediated by RTES scores (effect, 0.981).

Among only the FEP group, individuals with CIT (n=57) were significantly younger at illness onset (mean, 26.27 vs 30.32 years; P =.015), had higher RTES scores (mean, 4.94 vs 3.94; P =.044), and had poorer academic premorbid adjustment in early adolescence (mean, 0.46 vs 0.38; P =.010) and late adolescence (mean, 0.55 vs 0.42; P =.002) than those without CIT, respectively.

For longer-term outcomes, Brief Psychiatric Rating Scale, Scale for Assessment of Negative Symptoms, Scale for Assessment of Positive Symptoms, and Calgary Depression Scale for Schizophrenia scores at 3 years were all indirectly associated with CIT, mediated by academic premorbid adjustment, which in turn was predicted by instrument scores at baseline.

The study was limited in that CIT and recent stressful event evaluations are retrospective, and therefore may include recall bias.

Study authors conclude, “Childhood interpersonal trauma was found to be related with belonging to the FEP group and with the outcomes and symptoms as the disease evolved. These findings are of great importance since, once the existence of the trauma is known, a preventive intervention could be carried out in 2 ways: by addressing the psychological mechanisms involved in the transition towards a new traumatization through psychological interventions and/or by promoting good academic adjustment during adolescence.”