Traumatic Events, Social Adversity and Discrimination as Risk Factors for Psychosis - An Umbrella Review

Abstract

Exposure to childhood trauma is a well-known risk factor for severe mental disorders including schizophrenia and other non-affective psychoses. Beyond childhood trauma, there is increasing evidence that bullying, social exclusion, and discrimination during adolescence and adulthood may increase the risk of developing a psychotic disorder, and that such forms of traumatization may also underlie the elevated psychosis risk among migrants or persons with a visible minority status. In this umbrella review, we systematically assess meta-analyses regarding trauma and social adversity. A systematic literature review yielded 11 meta-analyses that met inclusion criteria and could be summarized quantitatively with a random effect model. Furthermore, six meta-analyses were evaluated qualitatively. Heterogeneity and publication bias were apparent in several meta-analyses. We observed that most significant social risk factors for psychosis were vulnerability for racist discrimination [OR = 3.90 (3.25–4.70)], migration [OR = 2.22 (1.75–2.80)], and childhood adversities [OR = 2.81 (2.03–3.83)]. Furthermore, social factors increasing the risk for psychosis were variation/impairment of parental communication, aversive adult life events, bullying, and factors associated with social isolation and discrimination. In spite of these environmental risk factors, there is a lack of evidence regarding treatment of trauma and psychosis, although some psychotherapeutic and art therapy approaches appear to be promising. Beyond individual interventions, stigmatization, racism, and other forms of discrimination need to be targeted to increase solidarity and communal support.

Estimating the Association Between Exposome and Psychosis as Well as General Psychopathology: Results From the ABCD Study

“…It is difficult to evaluate which correlates might have had an impact on the individual level and subsequently on the manifestation of psychopathology. State-level environment might have entailed proxies of several factors such as cannabis use, social adversity, exclusion, and discrimination that are consistently associated with psychopathology as well as psychosis ( 20 , 65 , 66 , 67 ). However, our results suggest that the exposures in state-level environment may not be specifically associated with psychosis but generally with psychopathology.…”

The effects of social isolation stress and discrimination on mental health

“…The adverse mental health effects have an early onset in children and adolescents, as there have been consistent reports of positive associations between racist discrimination and anxiety as well as depression, and of negative associations between racist discrimination and self-esteem as well as selfworth [109]. The impact of discrimination and other potentially traumatic experiences associated with migration [76,[110][111][112] and childhood adversities [113] on the development of serious mental illness including psychotic disorders has repeatedly been addressed, and a recent umbrella review [114] demonstrated a strong effect of racist discrimination (odds ratio 3.90; 95% CI 3.25, 4.70), childhood adversities (odds ratio 2.81; 95% CI 2.03, 3.83) and migration (odds ratio 2.22; 95% CI 1.75, 2.80) on the risk of developing a non-affective psychotic disorder. Discrimination and a lack social support can also contribute to the increased risk of psychosis for individuals with a visible minority status (e.g., African and Caribbean communities in England) [113][114][115].…”

“…The impact of discrimination and other potentially traumatic experiences associated with migration [76,[110][111][112] and childhood adversities [113] on the development of serious mental illness including psychotic disorders has repeatedly been addressed, and a recent umbrella review [114] demonstrated a strong effect of racist discrimination (odds ratio 3.90; 95% CI 3.25, 4.70), childhood adversities (odds ratio 2.81; 95% CI 2.03, 3.83) and migration (odds ratio 2.22; 95% CI 1.75, 2.80) on the risk of developing a non-affective psychotic disorder. Discrimination and a lack social support can also contribute to the increased risk of psychosis for individuals with a visible minority status (e.g., African and Caribbean communities in England) [113][114][115]. This effect may be particularly strong when there is perceived social isolation due to low community support from equally afflicted persons, e.g., due to so-called low "ethnic density" [116].…”

“…Exposure to discrimination and racism can be associated with personal insecurity in social interactions [76], and ambivalent and ambiguous social interactions can in turn be accompanied by increased anxiety, vigilance, and feelings of threat, resulting in an increased focus on the current situation [108,114]. On a neurobiological level, imprecise prior knowledge of the expected outcome and a stronger reliance on current sensory input increases prediction errors, which can trigger dopamine release and increase the risk of developing a psychotic disorder [76,[120][121][122].…”

Expert Opinion on Psychedelic-Assisted Psychotherapy for People with Psychotic Symptoms

“…Cases of trauma being the primary precipitant for the development of hallucinations, dissociation, delusional thinking, and similarly debilitating symptoms generally lead to a diagnosis of PTSD, raising questions about the meaningfulness and utility of drawing clear distinctions between psychotic disorders and PTSD. Furthermore, the highly ltered recognition of traumatic events that, as an example, excludes experiences of racism and discrimination, undermines the far-reaching complexity and variety of trauma [51,52,53].…”