Association Between Specific Childhood Adversities and Symptom Dimensions in People With Psychosis: Systematic Review and Meta-Analysis

Abstract

Despite the accepted link between childhood abuse and positive psychotic symptoms, findings between other adversities, such as neglect, and the remaining dimensions in people with psychosis have been inconsistent, with evidence not yet reviewed quantitatively. The aim of this study was to systematically examine quantitatively the association between broadly defined childhood adversity (CA), abuse (sexual/physical/emotional), and neglect (physical/emotional) subtypes, with positive, negative, depressive, manic, and disorganized dimensions in those with psychosis. A search was conducted across EMBASE, MEDLINE, PsychINFO, and Cochrane Libraries using search terms related to psychosis population, CA, and psychopathological dimensions. After reviewing for relevance, data were extracted, synthesized, and meta-analyzed. Forty-seven papers were identified, including 7379 cases across 40 studies examining positive, 37 negative, 20 depressive, 9 disorganized, and 13 manic dimensions. After adjustment for publication bias, general adversity was positively associated with all dimensions (ranging from r = 0.08 to r = 0.24). Most forms of abuse were associated with depressive (ranging from r = 0.16 to r = 0.32), positive (ranging from r = 0.14 to r = 0.16), manic (r = 0.13), and negative dimensions (ranging from r = 0.05 to r = 0.09), while neglect was only associated with negative (r = 0.13) and depressive dimensions (ranging from r = 0.16 to r = 0.20). When heterogeneity was found, it tended to be explained by one specific study. The depressive dimension was influenced by percentage of women (ranging from r = 0.83 to r = 1.36) and poor-quality scores (ranging from r = −0.21 and r = −0.059). Quality was judged as fair overall. Broadly defined adversity and forms of abuse increase transdimensional severity. Being exposed to neglect during childhood seems to be exclusively related to negative and depressive dimensions suggesting specific effects.

Time of exposure to social defeat stress during childhood and adolescence and redox dysregulation on long-lasting behavioral changes, a translational study

“…Although it is unclear why no group difference was observed during the first months following psychosis onset, these data suggest that male EPP reporting a first PSA before 12 years old are prone to anxiety. We found however no effect of PSA on any of the other psychopathological dimensions, despite a weak association between positive symptoms and physical or sexual abuse revealed by a meta-analysis in people with psychosis [ 8 ]. Explanation for this apparent discrepancy may include the relatively small size of our cohort, but also the fact that the meta-analysis considered both sexes and PSA until age of 18 years regardless of the time of exposure.…”

“…Some forms of severe abuses with first exposure before 12 years old have the most robust association with poor functional outcome [ 5 ]. Thus, increasing evidence suggests that the time at first exposure to trauma, but also the type of traumatic/adverse experiences determine their impact on later outcome [ 8 – 11 ]. Moreover, studies report either additive or synergistic interactions between CT and polygenetic risk score for schizophrenia [ 12 – 14 ].…”

Can epigenetics shine a light on the biological pathways underlying major mental disorders?

“…Moreover, the outcomes are often considered as SCZ, or MDD or even major psychoses (combining SCZ & BD), which are extremely heterogeneous entities, involving microphenotypes (Maj et al, 2021), and which accordingly may have very different biological underpinnings. Evidence is showing that there are some levels of specificity between adversity subtypes and symptoms domains, for example, abuse is more related to positive symptoms while neglect is not (Alameda et al, 2021) and that CU is associated with paranoia (Freeman et al, 2005). Thus, using a composite measure of CA and broadly defined conditions when trying to understand specific mediating epigenetic pathways may consider such specific links between environment and psychopathology first.…”

Associations between PTSD symptoms and other psychiatric symptoms among college students exposed to childhood sexual abuse: a network analysis

“…Findings from previous research reported that those with a history of sexual abuse are at risk of developing disturbances involving emotion regulation, interpersonal relationships, and self-concept, which are considered essential pieces of criteria for ‘complex PTSD’ (World Health Organization, 2019 ). In support of the affective pathway to psychosis, most research demonstrated that CSA was connected to the positive and negative symptoms of psychosis through symptoms of general psychopathology (Alameda, 2021 ; Bloomfield, 2021 ). These findings underline the potential utility of examining the interactions between psychosis and PTSD (Hardy et al, 2021 ; Isvoranu, 2017 ; Liotti & Gumley, 2008 ).…”

“…Moreover, increasing evidence from large population-based and prospective studies supports the notion of a causal relationship between the experience of CSA and psychosis risk (Fisher, 2013 ; Misiak, 2017 ). Growing meta-analytical research also accentuated the associations between developmental trauma and psychosis via PTSD, dissociation, and emotional dysregulation (Alameda, 2021 ; Bloomfield, 2021 ; Matheson et al, 2013 ; Varese, 2012 ). Childhood trauma, such as sexual abuse, has been shown to be associated with more severe clinical psychotic symptoms and consistently higher severity of both psychotic experiences and symptoms over time (Garcia, 2016 ; Trotta et al, 2015 ).…”