Exploring the Intersections of Trauma, Structural Adversity, and Psychosis among a Primarily African-American Sample: A Mixed-Methods Analysis

Abstract

Traumatic life events (TLEs) have been associated with multiple psychiatric diagnoses, including anxiety disorders, major depression, PTSD, and psychosis. To advance our understanding of the complex interactions between forms of adversity as they manifest across the lifespan, psychosis, and symptom content, we undertook a mixed-methods investigation of TLEs and psychosis. Our research explored the association between cumulative exposures, type of TLE, and proximity to the traumatic event and psychosis; the association between TLEs and clinical symptomology including specific types of delusions and/or hallucinations; and how qualitative data further inform understanding of complex relationships and patterns of past trauma and symptoms as they unfold over time. There were a total of 97 participants in the quantitative study sample, 51 participants with present state psychosis and 46 non-clinical. There were a total of 34 qualitative study participants, all of whom were experiencing psychosis. The quantitative analysis showed that when comparing persons with psychosis to the non-clinical group, there were no group differences in the overall total score of TLEs. However, there was a significant difference in cumulative TLEs that “Happened,” demonstrating that as the number of TLEs increased, the likelihood of clinical psychosis also increased. We also found a correlation between lifetime cumulative TLEs that “Happened” and PANSS five-factor analysis: positive, excitement, depression, thought disorder, activation, and paranoia scores. The qualitative analysis further built on these finding by providing rich narratives regarding the timing of trauma-related onset, relationships between trauma and both trauma-related and religious–spiritual content, and trauma and hallucinatory modality. Analysis of participant narratives suggests the central role of localized cultural and sociopolitical influences on onset, phenomenology, and coping and contributes to a growing literature calling for strengths-based, client-driven approaches to working with distressing voices and beliefs that centers the exploration of the personal and social meaning of such experiences including links to life narratives. Findings also underscore the clinical importance of trauma assessment and trauma-informed care.

Hallucinations Beyond Voices: A Conceptual Review of the Phenomenology of Altered Perception in Psychosis

“…Traumatic events are the prototype of eminently interpersonal, environmental factors that could significantly destabilize and alter subjective experience at various levels. 106 A history of neglect significantly increases the likelihood of developing schizophrenia (and other forms of clinical symptomology) 107,108 ; traumatic and other adverse events are also associated with the development of hallucinations in both clinical and nonclinical samples, and across a range of diagnoses. 109 It has been proposed that several psychological processes may be involved in the development of psychotic symptoms among trauma survivors, including patterns of emotion regulation developed to cope with trauma, unique qualities associated with memories of traumatic events (including encoding, retrieval, and processing), and changes to personal semantic memory.…”

Negative voice-content as a full mediator of a relation between childhood adversity and distress ensuing from hearing voices

“…Corstens & Longden (2013) found that 94% of voice-hearers (the majority of whom had been diagnosed with schizophrenia) had voices whose content could be related to earlier emotionally overwhelming events. A number of other studies have also reported associations between the nature of stressors/traumas preceding AVH and the content of the ensuing AVH (Hardy et al, 2005; Thompson & Waltz, 2010; Raune et al, 2006; Rosen et al, 2017).…”

Research watch: people of Black African and African Caribbean heritage in the UK and USA – psychosis, racism and inclusion

“…These circumstances include poverty and disadvantage. However, Rosen et al (2017) highlight a lack of previous research on psychosis and traumatic experiences in African Americans.…”

“…In this article, I look at three recent articles about the experiences of people of Black African and African Caribbean heritage, in relation to psychosis services in the UK and the USA. Rosen et al (2017) have extended research on traumatic life events and psychosis to Black Americans. Wagstaff et al (2018) report on their in-depth interviews with seven Black men in the UK about their experience of mental health services, shedding important light on why professionals often see them as disengaging.…”

“…Traumatic and stressful lives are common for Black Americans diagnosed with psychosis Rosen et al (2017) begin by reminding us of the links that have been found between past traumatic life experiences and a range of mental health difficulties including psychosis.…”