Associations between Diagnosis and Childhood Trauma across Psychiatric Outpatient Services in Ireland- an Analysis of Diagnosis and Associated Biopsychosocial Variables

Abstract

It is known that a variety of bio-psycho-social factors are important in determining disease prevalence. In this paper we look at psychiatric diagnoses and how these are influenced by gender differences, geographical differences, urbanity and exposure to trauma, namely childhood physical and sexual abuse. Data was collected prospectively over a fifty two week period across 6 research sites in Ireland. Multiple diagnostic and psycho-social interview schedules were utilized for eligible patients. Statistical tests of association between diagnoses and biopsychosocial variables were conducted. A total of five hundred and forty participants were included in this study. Depression was the most common diagnosis in both sexes. Depression was significantly more common in females and alcohol dependence significantly more common in males. Depression, anxiety and schizophrenia were all more common in the North of Ireland with rates of bipolar affective disorder and alcohol dependence similar between the North and South. Depression and anxiety affected largely equal numbers in urban and rural areas but schizophrenia, bipolar affective disorder and alcohol dependence were more common in rural areas. 28% of the study population experienced child sexual abuse and 20% child physical abuse. Both forms of abuse were more common in females and in the North of Ireland. Urban areas revealed higher levels of childhood sexual abuse. Depression was the most common diagnosis in those with a history of sexual abuse and schizophrenia most common in those with a history of physical abuse. The differing rates of diagnoses between the North and South may reflect historical background differences. Our analysis reveals a high level of both childhood sexual and physical abuse in the study population. Both forms of abuse were more common in the North and this is associated with higher rates of schizophrenia. Our study supports trauma as a risk factor for depression and schizophrenia.