Kindliche Traumatisierung, elterliche Erziehungsstile, familiäre Vorbelastung und Geburtsrisikofaktoren bei Patienten mit Schizophrenie

Abstract

Background: Until recently the frequency of child trauma in patients with schizophrenia has not been examined in studies using a sufficiently large sample and including a control group. The aim of this study was therefore to investigate whether patients with schizophrenia differ from healthy control subjects as far as their reports of traumatic childhood experiences are concerned. In addition other possible causal factors were investigated (parental parenting styles, psychiatric disorder history in the family and birth risk factors).Method: A hundred consecutive patients with schizophrenia (ICD-10;) WHO 1991 or DSM-IV; (APA 2000) from psychiatric and psychotherapeutic clinics (University of Göttingen, Bremen-OST, Dortmund-Aplerbeck) were compared with a healthy control group (n = 110) using a questionnaire in the form of a retrospective interview. This questionnaire included 203 questions regarding parenting styles, family history of psychiatric disorders, traumatic childhood experiences and birth risk factors.Results: Numerous traumatic childhood experiences and unfavourable influencing factors were reported significantly more often by patients than by members of the control group. The responses of both groups were also evaluated using a 0-10 point comprehensive "severe trauma scale" (heavy trauma scale) to determine whether not only individual trauma, but possibly also the sum of negative childhood events are associated with the emergence of schizophrenia. Here 86 (71.7%) schizophrenic patients, yet only 72 (46.2%) control subjects reported on at least one severely traumatic event (p = 0.0001). On average 2.18 cases of severe trauma were specified by patients compared to 0.78 in the control group (p = 0.0001). In almost all aspects the schizophrenic patients reported significantly less favourable parenting styles than the healthy subjects. Significantly higher rates of psychiatric disorders in the family were found in the patient group compared than in the control group. With regard to the birth risk factors interrogated no significant differences were found between patients and controls. The relative contributions of the individual risk factors to the overall model were examined using a logistic regression. The analysis revealed that a family history of schizophrenia was the most significant risk factor, followed by sexual abuse and parental separation. Birth trauma did not contribute. According to logistic regression unfavourable parenting styles did not increase the risk of schizophrenia.Conclusion: The study confirmed a vulnerability-stress model for the emergence of schizophrenia, where family factors - here particularly family history as well as severe traumatic events - seem to play a clearer role than environmental factors.