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Childhood adversity

What is childhood adversity in schizophrenia?

Childhood adversities encompass a range of childhood experiences, including loss of a close relative, parental separation, bullying, physical abuse, sexual abuse, emotional abuse, and neglect. The nature, timing, severity, and duration of exposure are likely to influence mental health, however any evidence that childhood adversity directly causes psychosis or schizophrenia is controversial. Firstly, psychotic disorders may be secondary to comorbid affective, substance use, personality, or post-traumatic stress disorders, all of which have been linked to early adversities, and all are common in those with a psychotic mental illness. Another difficulty is accurately measuring childhood adversity, as it is dependent on assessment of the experiences via information collected retrospectively. This is particularly problematic if having a psychotic disorder impacts on memory recall.

What is the evidence for childhood adversity?

Moderate to high quality evidence found a small to medium-sized increased risk of schizophrenia and other psychotic disorders following exposure to childhood adversities (abuse, neglect, bullying, or parental loss) compared to people without exposure to childhood adversities. Rates of childhood sexual abuse in people with psychosis was approximately 26.3%, childhood physical abuse was approximately 38.8%, and childhood emotional abuse was approximately 34%. Rates were highest in older studies, in studies with more females, in studies with older patients, and in studies of patients with comorbid substance abuse.

In people with a psychotic disorder, exposure to any childhood adversity was associated with more severe symptom severity and poor cognition. For increased positive symptoms, there were small associations with sexual abuse, physical abuse, emotional abuse, and emotional neglect, and no association with physical neglect. For increased negative symptoms, there were small associations with sexual abuse, physical abuse, physical neglect, and emotional neglect, and no association with emotional abuse. For increased depression, there were small to medium-sized associations with sexual abuse, physical abuse, emotional abuse, emotional neglect, and physical neglect.

Compared to people with anxiety disorders, there was a medium-sized increased risk of childhood adversity in people with schizophrenia. Compared to people with dissociative disorders or post-traumatic stress disorder, there was a large decreased risk of childhood adversity in people with schizophrenia. There were no differences in rates of childhood adversity between people with schizophrenia and people with depressive disorders or affective psychosis.

Moderate to low quality evidence finds mediation and moderating effects of other life events and stressors, social defeat, loneliness, and social support on the relationship between childhood adversity and psychosis. Mediation, but not moderating effects were found for negative cognitive schemas about the self, the world and others, attachment style and parental bonding, mood symptoms, emotional dysregulation, post-traumatic stress disorder, and dissociation. Mediators are mechanisms through which the relationship may be at least partly explained, while moderators were factors that changed the relationship.

April 2022

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Last updated at: 4:27 pm, 7th April 2022
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