Examining associations, moderators and mediators between childhood maltreatment, social functioning, and social cognition in psychotic disorders: a systematic review and meta-analysis

Abstract

Childhood maltreatment (CM) has been related to social functioning and social cognition impairment in people with psychotic disorders (PD); however, evidence across different CM subtypes and social domains remains less clear. We conducted a systematic review and meta-analysis to quantify associations between CM, overall and its different subtypes (physical/emotional/sexual abuse, physical/emotional neglect), and domains of social functioning and social cognition in adults with PD. We also examined moderators and mediators of these associations. A PRISMA-compliant systematic search was performed on 24 November 2022 (PROSPERO CRD42020175244). Fifty-three studies (N = 13 635 individuals with PD) were included in qualitative synthesis, of which 51 studies (N = 13 260) with 125 effects sizes were pooled in meta-analyses. We found that CM was negatively associated with global social functioning and interpersonal relations, and positively associated with aggressive behaviour, but unrelated to independent living or occupational functioning. There was no meta-analytic evidence of associations between CM and social cognition. Meta-regression analyses did not identify any consistent moderation pattern. Narrative synthesis identified sex and timing of CM as potential moderators, and depressive symptoms and maladaptive personality traits as possible mediators between CM and social outcomes. Associations were of small magnitude and limited number of studies assessing CM subtypes and social cognition are available. Nevertheless, adults with PD are at risk of social functioning problems after CM exposure, an effect observed across multiple CM subtypes, social domains, diagnoses and illness stages. Maltreated adults with PD may thus benefit from trauma-related and psychosocial interventions targeting social relationships and functioning.

Cognitive reserve moderates the relationship between childhood maltreatment, objective and subjective cognition, and psychosocial functioning in individuals with first-episode psychosis.

“…Independent of CR, CM exposure was associated with higher subjective cognitive complaints and poorer neurocognitive function and psychosocial functioning in individuals with FEP, which is in line with previous research (Aas et al, 2011, 2012, 2014; Dauvermann & Donohoe, 2019; Hjelseng et al, 2022; Lantrip et al, 2023; Stain et al, 2014; Vargas et al, 2019). Also in line with previous work (only in females, though; Letkiewicz, Funkhouser, & Shankman, 2021), we found that in particular physical abuse was associated with poorer executive functioning, and that emotional neglect was associated with poorer interpersonal relationships (Fares-Otero, Alameda, et al, 2023; Haslam & Taylor, 2022) in FEP. However, our results linking emotional abuse with higher subjective cognitive complaints differ from prior study to date on the association between early traumatic events and subjective cognition, yet in people with current posttraumatic stress disorder symptoms (Lantrip et al, 2023).…”

“…Notably, the association between emotional neglect and interpersonal relationships and leisure time was better at higher levels of CR. Although there is no definitive evidence on the association between CM and leisure time at this point (Fares-Otero, Alameda, et al, 2023), this pattern is in line with previous research (Buonocore et al, 2022) and may indicate that CR exerts control over social behavior and leisure time, and has the potential to improve autonomy and social life in those with FEP and a history of neglect. This lack of efficacy over social relations and behaviors is consistent with previous research on survivors (Conaway & Hansen, 1989; Haslam & Taylor, 2022).…”

“…Altogether, the analyses of CM subtypes showed moderation effects of CR between specific CM subtypes and cognitive/psychosocial domains, but no clear pattern emerged. The variations across CR within and between samples in the literature may be one explanation for the inconsistent findings regarding whether CM and its subtypes impact the accuracy of cognitive (Dauvermann & Donohoe, 2019) and psychosocial outcomes (Alameda et al, 2014; Christy et al, 2023; Fares-Otero, Alameda, et al, 2023) in FEP. Also, these inconsistencies could be due to individual stress responses, different coping strategies, factors of resilience (Fares-Otero, Jiaqing, et al, 2023; Nugent et al, 2014), anxiety and depressive symptoms (García-Moreno et al, 2021; Goltermann et al, 2021), and variability of cognitive and psychosocial functioning in psychotic disorders that is partially explained by genetic risk (Popovic et al, 2019; Richards et al, 2019).…”

“…Furthermore, there is sound evidence of a relationship between CM and psychosocial impairment in people with psychotic disorders, such as difficulties in global functioning and establishing or maintaining social roles and relationships (Alameda et al, 2014; Christy et al, 2023; Fares-Otero, Alameda, et al, 2023). Although recent meta-analytic evidence is not in support of an association between CM and independent living or occupational functioning in psychotic disorders (Christy et al, 2023; Fares-Otero, Alameda, et al, 2023), some of the research narratively summarized suggests that for specific subpopulations there might in fact exist such a relationship. The fact that only overall CM was examined across studies, and independent living was mainly based on living status while occupational functioning on employment status measures may explain mixed results.…”

“…In addition, meta-analytic research indicates that all CM subtypes except sexual abuse (Christy et al, 2023) are associated with global functioning, with emotional and physical neglect emerging as primary predictors of functional outcomes. Moreover, most CM types are negatively associated with global social functioning and interpersonal relations, but unrelated to independent living or occupational functioning (Fares-Otero, Alameda, et al, 2023) in psychotic disorders. As such, there is empirical support for differential relationships between CM subtypes and specific cognitive and psychosocial dimensions.…”