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All types of childhood trauma linked to later psychotic experiences

Exposure to any type of trauma at any time from early childhood through adolescence was linked to subsequent psychotic experiences, according to study findings published in JAMA Psychiatry.

“Few studies have examined whether different types of trauma affect the risk of psychotic experiences in different ways,” Jazz Croft, MSc, from the Centre for Academic Mental Health at Bristol Medical School, England, and colleagues wrote. “However, whether a specific type of interpersonal trauma is more strongly associated with psychosis risk than other types is unclear.”

Using longitudinal data from a large population-based birth cohort in the U.K., researchers assessed whether exposure to trauma, examined at multiple age periods throughout childhood and adolescence, was connected to an increased risk for psychotic experiences by age 18 years. They also examined whether this relationship differed according to trauma type, age and/or frequency of exposure. Psychotic experiences were evaluated via the psychosis-like symptoms semi-structured interview at ages 12 and 18 years.

Croft and colleagues examined data on psychotic experiences and trauma variables obtained from self-reported or patient-reported assessments. The variables represented:

• exposure to any trauma type (ie, physical abuse, sexual abuse, emotional abuse, emotional neglect, domestic violence or bullying) between ages 0 and 17 years;
• any trauma type within a distinct age period: early childhood (younger than 4.9 years), middle childhood (5 to 10.9 years) or adolescence (11 to 17 years);
• specific trauma types between ages 0 and 17 years; and
• specific trauma types within early childhood, middle childhood or adolescence.

Of 4,433 participants included in this sample, 410 had suspected or definite psychotic experiences by age 18 years. Overall, 83.8% of participants with psychotic experiences reported exposure to trauma while 62.6% of those without psychotic experiences reported trauma.

Exposure to any trauma by age 17 years was linked to increased risk for psychotic experiences at age 18 years (adjusted OR = 2.91; 95% CI, 2.15-3.93), and the population-attributable fraction was 45% (95% CI, 25-60).

The results also revealed an increase in effect size with exposure to a greater number of trauma types throughout childhood and adolescence (adjusted OR = 1.7; 95% CI, 1.54-1.87). In addition, participants who reported three or more types of trauma were at 4.7- fold increased risk for psychotic experiences (95% CI, 3.4-6.59).

The researchers reported that the CIs for associations between specific trauma types and psychotic experiences all showed substantial overlap. Results from the multivariable model adjusted for all trauma types revealed strong evidence of association with psychotic experiences remained for physical abuse, sexual abuse, bullying and emotional neglect, but was attenuated from exposure to domestic violence and emotional abuse.

Furthermore, exposure to trauma during any age period was linked with higher risk for increased psychotic experiences. After conducting analysis to minimize reverse causality, Croft and colleagues found that adolescent trauma was also tied to past-year incident psychotic experiences at age 18 years.

“This study indicates that, assuming the association is accurate and causal, a substantial proportion of participants would not have developed psychotic experiences if they had not been exposed to traumatic experiences during childhood,” the investigators wrote. “Novel interventions that aim to address how trauma affects the mechanisms underlying the development of psychotic experiences could improve mental health outcomes in population-based and clinical contexts.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.