Abstract
While the role of childhood adversity in increasing the risk of psychosis has been extensively investigated, it is not clear what the impact of early adverse experiences is on the outcomes of psychotic disorders. Therefore, we investigated associations between childhood adversity and 1-year outcomes in 285 first-presentation psychosis patients. Exposure to childhood adversity prior to 17 years of age was assessed using the Childhood Experience of Care and Abuse Questionnaire. Data on illness course, symptom remission, length of psychiatric hospitalization, compliance with medication, employment, and relationship status were extracted from clinical records for the year following first contact with mental health services for psychosis. Seventy-one percent of patients reported exposure to at least 1 type of childhood adversity (physical abuse, sexual abuse, parental separation, parental death, disrupted family arrangements, or being taken into care). No robust associations were found between childhood adversity and illness course or remission. However, childhood physical abuse was associated with almost 3-fold increased odds of not being in a relationship at 1-year follow-up compared to patients who did not report such adverse experiences. There was also evidence of a significant association between parental separation in childhood and longer admissions to psychiatric wards during 1-year follow-up and 2-fold increased odds of noncompliance with medication compared to those not separated from their parents. Therefore, our findings suggest that there may be some specificity in the impact of childhood adversity on service use and social functioning among psychosis patients over the first year following presentation to mental health services.
Highlights
There is a wealth of evidence suggestive of an association between childhood adversity and psychosis,[1,2,3] reported from both general population[4,5,6,7,8,9,10] and clinical studies.[11,12,13,14] little is known about the effect of experiences of adversity during childhood on the course or outcomes of psychosis
The sample was drawn from patients who participated in the Genetics and Psychosis Biomedical Research Centre (GAP-BRC) study from the Lambeth, Southwark, Lewisham, and Croydon adult in-patient and out-patients units of the South London and Maudsley Mental Health NHS Foundation Trust (SLAM)
Information on childhood adversity was available for 285 first-presentation psychosis patients
Summary
There is a wealth of evidence suggestive of an association between childhood adversity (eg, physical and sexual abuse, neglect, death of or separation from a parent) and psychosis,[1,2,3] reported from both general population[4,5,6,7,8,9,10] and clinical studies.[11,12,13,14] little is known about the effect of experiences of adversity during childhood on the course or outcomes of psychosis. Other studies have not confirmed the effect of childhood adversity on clinical and social course of psychosis.[22,23] The heterogeneity of the samples employed, the variety of outcome measures utilized, the reliance on self-rated assessments of adversity, and the tendency to focus on only 1 or 2 types of childhood adversity make it difficult to draw firm conclusions
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