Childhood adversity and psychosis: a systematic review of bio-psycho-social mediators and moderators

Abstract

<jats:title>Abstract</jats:title> <jats:p>The association between childhood adversity (CA) and psychosis has been extensively investigated in recent years. An increasing body of research has also focused on the mediating or moderating role of biological and psychological mechanisms, as well as other risk factors that might account for the link between CA and psychosis. We conducted a systematic search of the PsychINFO, Embase, Ovid, and Web of Science databases for original articles investigating the role of genetic vulnerabilities, environmental factors, psychological and psychopathological mechanisms in the association between CA and psychosis up to August 2019. We included studies with individuals at different stages of the psychosis continuum, from subclinical psychotic experiences to diagnosed disorders. From the 28 944 records identified, a total of 121 studies were included in this review. Only 26% of the studies identified met the criteria for methodological robustness. Overall, the current evidence suggests that CA may be associated with psychosis largely independently of genetic vulnerabilities. More consistent and robust evidence supports interaction between early and recent adversities, as well as the mediating role of attachment and mood symptoms, which is suggestive of an affective pathway between CA and psychosis across the continuum from subclinical experiences to diagnosable disorder. This review highlighted numerous methodological issues with the existing literature, including selection bias, heterogeneity of measurement instruments utilised, and lack of control for potential confounders. Future research should address these limitations to more accurately estimate mediation and moderation effects on the CA-psychosis association to inform the development of preventive interventions.</jats:p>

General psychopathology links burden of recent life events and psychotic symptoms in a network approach

“…In sum, we adopted a network perspective to investigate the relationship between burden of recent life events and a comprehensive set of symptoms in a sample of patients at risk for psychosis and with recent-onset psychosis. Our findings provide further evidence for an affective pathway to psychosis 12,14,21,22 and show that unspecific, general psychopathology mediates the association between life event burden and expression of psychotic symptomatology, suggesting promising avenues for targeted interventions. These results highlight the added value of network analysis in deriving insights into psychological pathways implicated in the complex etiology of psychotic symptoms.…”

“…Overall, our results suggest that life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of mental disorders, corroborating previous considerations 11,14,15,19,31 . Early transdiagnostic pathways from life events to general psychopathology also align with the idea of multifinality in the emergence of psychopathology following recent stressful life events, similar to early trauma 12,22,39,40 . Accordingly, life events have been associated not only with increased risk for psychosis, but also with onset and course of other disorders, such as depressive 41,42 , anxiety 43 , bipolar 44,45 or obsessive-compulsive disorder 46 .…”

“…Our results can be interpreted in light of an affective pathway to psychosis. According to this hypothesis, adverse life events lead to expression of psychotic symptomatology through heightened emotional distress 13,20,22 . Major burdensome life events result in negative affect-e.g.…”

“…The percentages in brackets indicate how often each edge was included across 1000 bootstrap models. risk factors to advance the understanding of the etiology of psychotic symptomatology 18,22 . More research is necessary to work out differences in the specific mechanisms of actions of recent stressful life events and childhood trauma on general psychopathology and psychotic symptoms.…”

“…Overall, it seems reasonable to hypothesize that recent stressful life events may predispose expression of psychotic symptomatology by a pathway similar to childhood trauma, i.e. via heightened emotional distress 13,20,22 . Childhood trauma may interact with adult life events by sensitizing individuals to future stressful events and by increasing the risk of experiencing later burdensome life events 23,24 .…”