Gender differences in the association between childhood physical and sexual abuse, social support and psychosis

Charlotte Gayer-Anderson,Paul Fearon,Paola Dazzan,Craig Morgan,Thomas K Craig,Peter B Jones,Jane Boydell,Kevin Morgan,Gerard Hutchinson,Helen L Fisher,Gillian A Doody,Robin M Murray

doi:10.1007/s00127-015-1058-6

Abstract

PurposeChildhood adversity (variously defined) is a robust risk factor for psychosis, yet the mitigating effects of social support in adulthood have not yet been explored. This study aimed to investigate the relationships between childhood sexual and physical abuse and adult psychosis, and gender differences in levels of perceived social support.MethodsA sample of 202 individuals presenting for the first time to mental health services with psychosis and 266 population-based controls from south-east London and Nottingham, UK, was utilised. The Childhood Experience of Care and Abuse Questionnaire was used to elicit retrospective reports of exposure to childhood adversity, and the Significant Others Questionnaire was completed to collect information on the current size of social networks and perceptions of emotional and practical support.ResultsThere was evidence of an interaction between severe physical abuse and levels of support (namely, number of significant others; likelihood ratio test χ2 = 3.90, p = 0.048). When stratified by gender, there were no clear associations between childhood physical or sexual abuse, current social support and odds of psychosis in men. In contrast, for women, the highest odds of psychosis were generally found in those who reported severe abuse and low levels of social support in adulthood. However, tests for interaction by gender did not reach conventional levels of statistical significance.ConclusionsThese findings highlight the importance of investigating the potential benefits of social support as a buffer against the development of adult psychosis amongst those, particularly women, with a history of early life stress.Electronic supplementary materialThe online version of this article (doi:10.1007/s00127-015-1058-6) contains supplementary material, which is available to authorized users.

Highlights

There is strong evidence of increased risk of psychosis in those who have been exposed to severe adverse events in childhood, such as physical abuse, sexual abuse, psychological abuse, and bullying
There were no clear associations between childhood physical or sexual abuse, current social support and odds of psychosis in men
Tests for interaction by gender did not reach conventional levels of statistical significance. These findings highlight the importance of investigating the potential benefits of social support as a buffer against the development of adult psychosis amongst those, women, with a history of early life stress

Summary

Introduction

There is strong evidence of increased risk of psychosis in those who have been exposed to severe adverse events in childhood, such as physical abuse, sexual abuse, psychological abuse, and bullying (see [1] for a meta-analysis of existing studies). Preliminary evidence suggests that gender differences in the relationships between abuse and psychosis exist; that is, risk of psychosis following childhood sexual abuse appears to be higher in women compared with men [2,3,4]. In our analyses of data from the Aetiology and Ethnicity in Schizophrenia and Other Psychoses (AESOP) study, we found that severe physical and sexual childhood abuse were associated with psychosis onset only in women [5]. There are three broad dimensions of social support [8]: (a) social networks (e.g. number of contacts or frequency of contact); (b) perceived social support; and (c) enacted support, i.e. practical and emotional aid in the face of severe stress or daily hassles

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