Abstract
The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic–pituitary–adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.
Highlights
While a wealth of data has demonstrated indirect associations between childhood trauma (CT) and psychosis in adulthood, the role of CT in the etiology of psychosis and its potential underlying mechanisms are not yet well-understood [1,2,3,4]
By targeting individuals presenting with attenuated psychotic symptoms or other markers indicative of increased psychosis risk, clinical high risk (CHR) programs seek to identify factors that could be addressed in order to mitigate a variety of negative outcomes and support resilience
Clinical high risk individuals may be at risk for experiencing various forms of traumatic experiences that are common within the general population
Summary
While a wealth of data has demonstrated indirect associations between childhood trauma (CT) and psychosis in adulthood, the role of CT in the etiology of psychosis and its potential underlying mechanisms are not yet well-understood [1,2,3,4]. Prospective studies of individuals who later develop psychosis provide a unique opportunity to examine potential risk factors, resilience factors, and mechanisms that may link CT and psychosis. CHR research makes an important contribution to understanding the potential etiologic role of CT in the development of psychosis. We review the emerging literature on trauma and stressful life events (SLEs) in CHR individuals, with a focus on both behavioral and neurobiological studies. This paper provides a risk model that explains the trauma and psychosis relationship. Current and important future directions for assessment, research, and clinical care are highlighted
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