Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies

Filippo Varese, Feikje Smeets, Marjan Drukker, Ritsaert Lieverse, Tineke Lataster, Wolfgang Viechtbauer, John Read, Jim van Os, Richard P Bentall, Filippo Varese, Feikje Smeets, Marjan Drukker, Ritsaert Lieverse, Tineke Lataster, Wolfgang Viechtbauer, John Read, Jim van Os, Richard P Bentall

Abstract

Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies (n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies (n = 41,803) and 8 population-based cross-sectional studies (n = 35,546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34-3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90-3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12-4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17-3.47]). The estimated population attributable risk was 33% (16%-47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

Figures

Fig. 1.
Fig. 1.
Flowchart of studies included in meta-analysis.
Fig. 2.
Fig. 2.
Forest plot (stratified by research design) for the meta-analysis examining the overall association between childhood adverse experiences and psychosis.

References

    1. Kessler RC, McLaughlin KA, Green JG, et al. Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. Br J Psychiatry. 2010;197:378–385.
    1. Sarchiapone M, Carli V, Cuomo C, Marchetti M, Roy A. Association between childhood trauma and aggression in male prisoners. Psychiatry Res. 2009;165:187–192.
    1. Scher CD, Forde DR, McQuaid JR, Stein MB. Prevalence and demographic correlates of childhood maltreatment in an adult community sample. Child Abuse Negl. 2004;28:167–180.
    1. Green JG, McLaughlin KA, Berglund PA, et al. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: associations with first onset of DSM-IV disorders. Arch Gen Psychiatry. 2010;67:113–123.
    1. Kessler RC, Davis CG, Kendler KS. Childhood adversity and adult psychiatric disorder in the US National Comorbidity Survey. Psychol Med. 1997;27:1101–1119.
    1. Cuijpers P, Smit F, Unger F, Stikkelbroek Y, Ten Have M, de Graaf R. The disease burden of childhood adversities in adults: a population-based study. Child Abuse Negl. 2011;35:937–945.
    1. Bendall S, Jackson HJ, Hulbert CA, McGorry PD. Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophr Bull. 2008;34:568–579.
    1. Morgan C, Fisher H. Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma—a critical review. Schizophr Bull. 2007;33:3–10.
    1. Read J, Fink PJ, Rudegeair T, Whitfield CL. Child maltreatment and psychosis: a return to a genuinely integrated bio-psycho-social model. Clin Schizophr Relat Psychoses. 2008;2:235–254.
    1. Stroup DF, Berlin JA, Morton SC, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283:2008–2012.
    1. Friedman S, Harrison G. Sexual histories, attitudes, and behavior of schizophrenic and “normal” women. Arch Sex Behav. 1984;13:555–567.
    1. Convoy H, Weiss P, Zverina J. Sexual abuse experiences of psychiatric patients. Med Law. 1995;14:283–292.
    1. Furukawa T, Mizukawa R, Hirai T, Fujihara S, Kitamura T, Takahashi K. Childhood parental loss and schizophrenia: evidence against pathogenic but for some pathoplastic effects. Psychiatry Res. 1998;81:353–362.
    1. Agid O, Shapira B, Zislin J, et al. Environment and vulnerability to major psychiatric illness: a case control study of early parental loss in major depression, bipolar disorder and schizophrenia. Mol Psychiatry. 1999;4:163–172.
    1. Dell'Erba G, Venturi P, Tallarico V. Childhood stressful experiences in familial and sporadic schizophrenic patients [Italian] Italian J Psychopathol. 2003;9:32–39.
    1. Giblin S, Clare L, Livingston G, Howard R. Psychosocial correlates of late-onset psychosis: life experiences, cognitive schemas, and attitudes to ageing. Int J Geriatr Psychiatry. 2004;19:611–623.
    1. Fennig S, Horesh N, Aloni D, Apter A, Weizman A. Life events and suicidality in adolescents with schizophrenia. Eur Child Adolesc Psychiatry. 2005;14:454–460.
    1. Morgan C, Fearon P. Social experience and psychosis insights from studies of migrant and ethnic minority groups. Epidemiol Psichiatr Soc. 2007;16:118–123.
    1. Weber K, Rockstroh B, Borgelt J, et al. Stress load during childhood affects psychopathology in psychiatric patients. BMC Psychiatry. 2008;8:63.
    1. Rubino IA, Nanni RC, Pozzi DM, Siracusano A. Early adverse experiences in schizophrenia and unipolar depression. J Nerv Ment Dis. 2009;197:65–68.
    1. Cohen CI, Abdallah CG, Diwan S. Suicide attempts and associated factors in older adults with schizophrenia. Schizophr Res. 2010;119:253–257.
    1. Fisher HL, Jones PB, Fearon P, et al. The varying impact of type, timing and frequency of exposure to childhood adversity on its association with adult psychotic disorder. Psychol Med. 2010;40:1967–1978.
    1. Husted JA, Ahmed R, Chow EW, Brzustowicz LM, Bassett AS. Childhood trauma and genetic factors in familial schizophrenia associated with the NOS1AP gene. Schizophr Res. 2010;121:187–192.
    1. Bartels-Velthuis AA, van de Willige G, Jenner JA, Wiersma D, van Os J. Auditory hallucinations in childhood: associations with adversity and delusional ideation. Psychol Med. 2011;42:1–11.
    1. Evans G. Trauma and psychosis: investigating dissociation and self-concept clarity [Unpublished doctoral dissertation] University of Liverpool, UK; 2011
    1. Heins M, Simons C, Lataster T, et al. Childhood trauma and psychosis: a case-control and case-sibling comparison across different levels of gnetic liability, psychopathology, and type of trauma. Am J Psychiatry. 2011;168:1286–1294.
    1. Varese F, Barkus E, Bentall RP. Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med. 2011:1–12.
    1. Daalman K, Diederen KMJ, Derks EM, van Lutterveld R, Kahn RS, Sommer IEC. Childhood trauma and auditory verbal hallucinations. Psychol Med. In press, 2012
    1. McCabe KL, Maloney EA, Stain HJ, Loughland CM, Carr VJ. Relationship between childhood adversity and clinical and cognitive features in schizophrenia. J Psychiatr Res. doi:10.1016/j.jpsychires.2012.01.023.
    1. Mäkikyrö T, Sauvola A, Moring J, et al. Hospital-treated psychiatric disorders in adults with a single-parent and two-parent family background: a 28-year follow-up of the 1966 Northern Finland Birth Cohort. Fam Process. 1998;37:335–344.
    1. Janssen I, Krabbendam L, Bak M, et al. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand. 2004;109:38–45.
    1. Spauwen J, Krabbendam L, Lieb R, Wittchen HU, van Os J. Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. Br J Psychiatry. 2006;188:527–533.
    1. De Loore E, Drukker M, Gunther N, et al. Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study. Early Intervention in Psychiatry. 2007;1:201–1107.
    1. Schreier A, Wolke D, Thomas K, et al. Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Arch Gen Psychiatry. 2009;66:527–536.
    1. Arseneault L, Cannon M, Fisher HL, Polanczyk G, Moffitt TE, Caspi A. Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. Am J Psychiatry. 2011;168:65–72.
    1. Cutajar MC, Mullen PE, Ogloff JR, Thomas SD, Wells DL, Spataro J. Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Arch Gen Psychiatry. 2010;67:1114–1119.
    1. Wigman JTW, Van Winkel R, Raaijmakers QAW, et al. Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychol Med. 2011;41:2317.
    1. Murphy SM, Kilpatrick DG, Amick-McMullan A, et al. Current psychological functioning of child sexual assault survivors: a community study. J Interperson Viol. 1988;3:55–79.
    1. Ross CA, Joshi S. Schneiderian symptoms and childhood trauma in the general population. Compr Psychiatry. 1992;33:269–273.
    1. Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse childhood experiences and hallucinations. Child Abuse Negl. 2005;29:797–810.
    1. Kim HS. Incestuous experience among Korean adolescents: prevalence, family problems, perceived family dynamics, and psychological characteristics. Public Health Nurs. 2005;22:472–482.
    1. Shevlin M, Dorahy MJ, Adamson G. Trauma and psychosis: an analysis of the National Comorbidity Survey. Am J Psychiatry. 2007;164:166–169.
    1. Shevlin M, Houston JE, Dorahy MJ, Adamson G. Cumulative traumas and psychosis: an analysis of the national comorbidity survey and the British Psychiatric Morbidity Survey. Schizophr Bull. 2008;34:193–199.
    1. Houston JE, Murphy J, Adamson G, Stringer M, Shevlin M. Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophr Bull. 2008;34:580–585.
    1. Kelleher I, Harley M, Lynch F, Arseneault L, Fitzpatrick C, Cannon M. Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. Br J Psychiatry. 2008;193:378–382.
    1. Nishida A, Tanii H, Nishimura Y, et al. Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens. Schizophr Res. 2008;99:125–133.
    1. Shevlin M, Murphy J, Read J, Mallett J, Adamson G, Houston JE. Childhood adversity and hallucinations: a community-based study using the National Comorbidity Survey Replication. Soc Psychiatry Psychiatr Epidemiol. 2010
    1. Harley M, Kelleher I, Clarke M, et al. Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence. Psychol Med. 2010;40:1627–1634.
    1. Bebbington P, Jonas S, Kuipers E, et al. Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. Br J Psychiatry. 2011;199:29–37.
    1. van Nierop M, van Os J, Gunther N, et al. Phenotypically continuous with clinical psychosis, discontinuous in need for care: evidence for an extended psychosis phenotype. Schizophr Bull. 2011;38:231–238.
    1. Golding J, Pembrey M, Jones R. ALSPAC—the Avon Longitudinal Study of parents and children. I. Study methodology. Paediatr Perinat Epidemiol. 2001;15:74–87.
    1. Bosch NM, Riese H, Ormel J, Verhulst FC, Oldehinkel AJ. Stressful life events and depressive symptoms in young adolescents: modulation by respiratory sinus arrhythmia? The TRAILS study. Biol Psychol. 2009;81:40–47.
    1. Bradburn MJ, Deeks JJ, Altman JJ. Metan—a command for meta-analysis in Stata. In: Sterne JAC, editor. Meta-analysis in Stata: An Updated Collection from the Stata Journal. College Station, TX: Stata Press Publications; 2009. pp. 22–47.
    1. Fliess JL, Berlin JA. Effect sizes for dichotomous data. In: Cooper H, Hedhes LV, Valentine JC, editors. The Handbook of Research Synthesis and Meta-analysis. 2nd ed. New York: Sage Russell Foundation; 2009. pp. 237–1153.
    1. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR. Introduction to Meta-analysis. Chichester, UK: John Wiley; 2009.
    1. Zhang J, Yu KF. What's the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280:1690–1691.
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560.
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–634.
    1. Duval S, Tweedie RA. A non-parametric 'trim and fill' method of accounting for publication bias in meta-analysis. J Am Stat Assoc. 2000;95:89–98.
    1. Schreier A, Wolke D, Thomas K, et al. Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Arch Gen Psychiatry. 2009;66:527–536.
    1. Hardt J, Rutter M. Validity of adult retrospective reports of adverse childhood experiences: review of the evidence. J Child Psychol Psychiatry. 2004;45:260–273.
    1. Fisher HL, Craig TK, Fearon P, et al. Reliability and comparability of psychosis patients' retrospective reports of childhood abuse. Schizophr Bull. 2011;37:546–553.
    1. Janssen I, Krabbendam L, Bak M, et al. Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatr Scand. 2004;109:38–45.
    1. Spauwen J, Krabbendam L, Lieb R, Wittchen H-U, van Os J. Impact of psychological trauma on the development of psychotic symptoms: relationship with psychosis proneness. Br J Psychiatry. 2006;188:527–533.
    1. Nishida A, Tanii H, Nishimura Y, et al. Associations between psychotic-like experiences and mental health status and other psychopathologies among Japanese early teens. Schizophr Res. 2008;99:125–133.
    1. Shevlin M, Houston JE, Dorahy MJ, Adamson G. Cumulative traumas and psychosis: an analysis of the National Comorbidity Survey and the British Psychiatric Morbidity Survey. Schizophr Bull. 2008;34:193–199.
    1. Arseneault L, Cannon M, Fisher HL, et al. Psychotic symptoms: a genetically sensitive longitudinal cohort study. Am J Psychiatry. 2010;168:65–72.
    1. Morgan C, Kirkbride J, Leff J, et al. Parental separation, loss and psychosis in different ethnic groups: a case-control study. Psychol Med. 2007;37:495–503.
    1. De Loore E, Drukker M, Gunther N, et al. Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study. Early Interv Psychiatry. 2007;1:201–207.
    1. Whitfield CL, Dube SR, Felitti VJ, Anda RF. Adverse childhood experiences and hallucinations. Child Abuse & Neglect. 2005;29:797–810.
    1. Shevlin M, Murphy J, Houston JE, Adamson G. Childhood sexual abuse, early cannabis use, and psychosis: testing the effects of different temporal orderings based on the National Comorbidity Survey. Psychosis: Psychol, Social Integr Approach. 2009;1:19–28.
    1. Houston JE, Murphy J, Adamson G, Stringer M, Shevlin M. Childhood sexual abuse, early cannabis use, and psychosis: testing an interaction model based on the National Comorbidity Survey. Schizophr Bull. 2008;34:580–585.
    1. Husted JA, Ahmed R, Chow EWC, Brzustowicz LM, Bassett AS. Childhood trauma and genetic factors in familial schizophrenia associated with the NOS1AP gene. Schizophr Res. 2010;121:187–192.
    1. Habets P, Marcelis M, Gronenschild E, Drukker M, van Os J. Reduced cortical thickness as an outcome of differential sensitivity to environmental risks in schizophrenia. Biol Psychiatry. 2011;69:487–494.
    1. Read J, Bentall RP. Negative childhood experiences and mental health: theoretical, clinical and primary prevention implications. Br J Psychiatry. 2012;200:89–91.
    1. Scott J, Varghese D, McGrath J. As the twig is bent, the tree inclines: adult mental health consequences of childhood adversity. Arch Gen Psychiatry. 2010;67:111–112.
    1. Read J, Bentall R, Dillon J, editors. Models of Madness: Psychological, Social and Biological Approaches to Psychosis. 2nd ed. London: Routledge; In press.
    1. Read J, Hammersley P, Rudegeair T. Why, when and how to ask about child abuse. Adv Psychiatr Treat. 2007;13:101–110.
    1. van Os J, Kenis G, Rutten BP. The environment and schizophrenia. Nature. 2010;468:203–212.
    1. Bentall RP, Fernyhough C. Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophr Bull. 2008;34:1012–1020.

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