Stress reactivity as a putative mechanism linking childhood trauma with clinical outcomes in individuals at ultra-high-risk for psychosis: Findings from the EU-GEI High Risk Study.

I Paetzold,I Myin-Germeys,M Van Der Gaag,J Hartmann,L Valmaggia,F Schirmbeck,E Velthorst,A Schick,B Nelson,P Mcguire,J Van Os,C Morgan,L De Haan,M Kempton,U Reininghaus

doi:10.1017/s2045796021000251

Abstract

Childhood trauma is associated with an elevated risk for psychosis, but the psychological mechanisms involved remain largely unclear. This study aimed to investigate emotional and psychotic stress reactivity in daily life as a putative mechanism linking childhood trauma and clinical outcomes in individuals at ultra-high-risk (UHR) for psychosis. Experience sampling methodology was used to measure momentary stress, affect and psychotic experiences in the daily life of N = 79 UHR individuals in the EU-GEI High Risk Study. The Childhood Trauma Questionnaire was used to assess self-reported childhood trauma. Clinical outcomes were assessed at baseline, 1- and 2-year follow-up. The association of stress with positive (β = -0.14, p = 0.010) and negative affect (β = 0.11, p = 0.020) was modified by transition status such that stress reactivity was greater in individuals who transitioned to psychosis. Moreover, the association of stress with negative affect (β = 0.06, p = 0.019) and psychotic experiences (β = 0.05, p = 0.037) was greater in individuals exposed to high v. low levels of childhood trauma. We also found evidence that decreased positive affect in response to stress was associated with reduced functioning at 1-year follow-up (B = 6.29, p = 0.034). In addition, there was evidence that the association of childhood trauma with poor functional outcomes was mediated by stress reactivity (e.g. indirect effect: B = -2.13, p = 0.026), but no evidence that stress reactivity mediated the association between childhood trauma and transition (e.g. indirect effect: B = 0.14, p = 0.506). Emotional and psychotic stress reactivity may be potential mechanisms linking childhood trauma with clinical outcomes in UHR individuals.

Highlights

IntroductionMeta-analytic evidence suggests that childhood trauma (i.e. potentially harmful experiences as sexual, physical and emotional abuse as well as physical and emotional neglect; Morgan and Fisher, 2007) increases transition risk in individuals at ultra-high-risk state for psychosis (UHR; Varese et al, 2012)
Meta-analytic evidence suggests that childhood trauma increases transition risk in individuals at ultra-high-risk state for psychosis (UHR; Varese et al, 2012)
We further aimed to investigate whether (i) the magnitude of associations between momentary stress and negative affect, positive affect and psychotic experiences is modified by transition status, and (ii) the effect of childhood trauma on transition status will be mediated via pathways through stress reactivity

Summary

Introduction

Meta-analytic evidence suggests that childhood trauma (i.e. potentially harmful experiences as sexual, physical and emotional abuse as well as physical and emotional neglect; Morgan and Fisher, 2007) increases transition risk in individuals at ultra-high-risk state for psychosis (UHR; Varese et al, 2012). A UHR state is commonly based on three criteria Within 2 years, 20% of UHR individuals have been reported to transition to psychosis (Fusar-Poli et al, 2016) and a considerable proportion experience comorbid anxiety or depression (Fusar-Poli et al, 2014). Meta-analyses show that the majority of UHR individuals who do not transition to psychosis do not remit from UHR status within 2 years either, and show marked impairments in functioning (Simon et al, 2013; Fusar-Poli et al, 2015b). UHR individuals’ functional level is comparable to that reported in patients with social phobia or major depressive disorder, and closer to that observed in psychosis patients than in healthy controls (Fusar-Poli et al, 2015b). The persistence of symptoms and functioning are important outcomes

Methods

Results

Conclusion