Do Child Abuse and Maltreatment Increase Risk of Schizophrenia?

Abstract

IntroductionIntroductionaaAlthough childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues.MethodsPapers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results.ResultsAn association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated.ConclusionAlthough the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.

Sex and schizophrenia: a review of gender differences

“…Both retrospective (Fisher et al, 2011) and prospective (Sideli et al, 2012) studies have demonstrated that individuals with psychotic illnesses had higher rates of traumatic early life events such as sexual abuse, but later life trauma has also been found to be correlated with the subsequent development of psychotic illnesses (Grubaugh, Zinzow, Paul, Egede, & Frueh, 2011). Some research has attributed gender differences in schizophrenia to a different psychological vulnerPsychosis 3 ability of men and women (Ammari, Heinrichs, & Miles, 2010_ENREF_75).…”

“…The biological, through epigenetic, neurodevelopmental, and endocrine action, affects the psychological and sociological; whilst psychosocial distress can have adverse effects on biological function (Read, Bentall, & Fosse, 2009), the development of mental illness generally and psychosis specifically (Bentall, Wickham, Shevlin, & Varese, 2012) through all life stages, from pre-and peri-natally, through childhood and early life adversity, to adulthood . Such stressors affect endocrine function, genetic expression of various neuronal proteins, and more macro cortical functioning: the principles of a complex relationship of genetic factors, neurodevelopment and psychosocial distress and trauma has garnered a significant and growing evidence base, with the precise interplay remains an area of active research (Sideli, Mule, La Barbera, & Murray, 2012).…”

Childhood adversities in relation to psychiatric disorders

“…Chapman et al, 2004;Dube et al, 2003;McEwen, 2003;Rutter and Maughan, 1997;Teicher et al, 2002). Associations have been described for different diagnoses, including major depressive disorder (MDD; e.g., Kessler, 1997;Heim et al, 1997Heim et al, , 2004Teicher et al, 2006Teicher et al, , 2009Widom et al, 2007), borderline personality disorder (BPD; e.g., Crawford et al, 2009;Allen, 2008;Liotti et al, 2000;van der Kolk et al, 1994), anxiety disorders (e.g., Kessler et al, 1997) or schizophrenia spectrum disorders (overview Varese et al, 2012; see also Read and Bentall, 2010;Read et al, 2005;Rosenberg et al, 2007;Bebbington et al, 2004Bebbington et al, , 2011Betensky et al, 2009;Matheson et al, 2012;Sideli et al, 2012). Efforts to understand the impact of adverse experience on disorder have targeted developmental periods and type of experience.…”

“…This may vary with the 'dose' or intensity of experience, with different amounts of adversity cumulatively increasing the risk or predicting the onset of severe disorders (Rubino et al, 2009;Sugaya et al, 2012;Mueser et al, 2002). It may also vary with the definition of severe disorder: while increasing amounts of various adversities increase the risk in different disorders Read and Bentall, 2010), no dose effect was found for first-presentation psychosis patients (Fisher et al, 2010;Sideli et al, 2012).…”

A level playing field?: Are bio-genetic and psychosocial studies evaluated by the same standards?

“…For example, in a narrative review of the evidence on child maltreatment and psychosis, published at about the same time as our meta-analysis, Sideli, Mule, La Barbera, and Murray (2012) caution that, "specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated" and go on to argue that, "So far none of the studies reported indicate that childhood abuse is either sufficient or necessary to develop a psychotic disorder. "…”