Trauma and recent life events in individuals at ultra high risk for psychosis: Review and meta-analysis

doi:10.1016/j.schres.2014.11.026

Schizophrenia Research

Volume 161, Issues 2–3, February 2015, Pages 143-149

https://doi.org/10.1016/j.schres.2014.11.026 Get rights and content

Abstract

Background

Childhood trauma and recent life-events have been related to psychotic disorders. The aim of the present study was to examine whether childhood trauma and recent life-events are significantly more prevalent in patients at Ultra High Risk (UHR) of developing a psychotic disorder compared to healthy controls.

Method

A search of PsychInfo and Embase was conducted, relevant papers were reviewed, and three random-effects meta-analyses were performed. One meta-analysis assessed the prevalence rate of childhood trauma in UHR subjects and two meta-analyses were conducted to compare UHR subjects and healthy control subjects on the experience of childhood trauma and recent life-events.

Results

We found 12 studies on the prevalence of (childhood) trauma in UHR populations and 4 studies on recent life-events in UHR populations. We performed a meta-analysis on 6 studies (of which trauma prevalence rates were available) on childhood trauma in UHR populations, yielding a mean prevalence rate of 86.8% (95% CI 77%–93%). Childhood trauma was significantly more prevalent in UHR subjects compared to healthy control groups (Random effects Hedges' g = 1.09; Z = 4.60, p < .001). In contrast to our hypothesis, life-event rates were significantly lower in UHR subjects compared to healthy controls (Random effects Hedges' g = − 0.53; Z = − 2.36, p < .02).

Conclusions

Our meta-analytic results illustrate that childhood trauma is highly prevalent among UHR subjects and that childhood trauma is related to UHR status. These results are in line with studies on childhood trauma in psychotic populations. In contrast to studies on recent life-events in psychotic populations, our results show that recent life-events are not associated with UHR status.

Introduction

A growing body of literature has addressed the role of childhood trauma as one of the risk factors for the development of psychosis (Morgan and Fisher, 2007, Bendall et al., 2008, Krabbendam, 2008, Varese et al., 2012). Childhood trauma is defined as psychological, physical, emotional or sexual abuse, and emotional neglect, before age 17 years (Bernstein et al., 2003). Higher rates of traumatic events have been found in individuals with psychotic disorders compared to the general population (Janssen et al., 2004, Bebbington et al., 2011). In a recent meta-analysis examining both retrospective and prospective studies, early childhood trauma was found to increase the odds of psychotic disorder by almost a factor 3 (Varese et al., 2012).

Although most studies investigating the relationship between trauma and psychosis have focused on childhood adversity before age 17 years, there is growing evidence for a role for recent stressful life events in the pathway to psychosis. Recent stressful life events are defined as events in the last months prior to onset of psychosis that usually involve danger and that cause a substantial change in one's positive or negative personal circumstances (Brown and Birley, 1968). A recent meta-analysis of 16 studies on the association between recent life events and onset of psychosis reported that individuals with psychotic disorders were three times more likely to have experienced recent life events prior to the onset of psychosis compared to healthy controls (Beards et al., 2013).

Criteria have been established to identify ultra-high risk (UHR) patients, mainly based on the presence of subthreshold psychotic symptoms in help-seeking individuals with a recent decline in social functioning (Yung et al., 2003, Yung et al., 2005, Yung et al., 2006). The focus of studies on childhood trauma or recent life events has recently broadened to UHR patients (Bechdolf et al., 2010, Thompson et al., 2010, Phillips et al., 2012, Addington et al., 2013).

The present study aimed to present all available results on both early childhood trauma and recent stressful life events in UHR populations. The prevalence rate of traumatic events in UHR patients was estimated based on a meta-analysis. Following evidence from studies in clinical samples (Bendall et al., 2008, Beards et al., 2013), we hypothesized that childhood trauma and recent life events would be significantly more prevalent in UHR patients than in healthy controls.

Section snippets

Data collection

Following the PRISMA database search guidelines (www.prisma-statement.org), systematic database searches of publications from 1993 (year of first UHR paper) to April 2014 were conducted in Embase and PsychINFO, including all UHR studies that involved data on trauma or recent life events. We combined the following sets of keywords:

1)
‘ultra high risk’ OR ‘uhr’ OR ‘prodrome’ OR ‘prodromal’ OR ‘at high risk’ OR ‘clinical* at risk’ OR ‘at clinical* risk’ OR ‘clinical high risk’ OR ‘at risk mental

Prevalence of childhood trauma in UHR patients

We conducted a meta-analysis including six studies (Fig. 2). The mean prevalence rate of trauma was 86.8% (95% CI 77%–93%). Although there was no publication bias, heterogeneity was high Q(5) = 29.386, p < 0.001 and I² = 83.0.

Trauma in UHR patients versus healthy controls

Three studies compared the prevalence of childhood trauma between UHR patients and healthy controls. Trauma scores were significantly higher in UHR patients than in healthy controls, in which trauma ranged from 42.7 to 60% (Addington et al., 2013, Tikka et al., 2013) (Random

Discussion

Our meta-analysis clearly indicates that prevalence rates of childhood trauma in UHR populations are high. The mean prevalence rate of 86.8% is consistent with the reported prevalence rate of 85% in patients diagnosed with schizophrenia (Larsson et al., 2013). UHR patients reported higher trauma scores, but seemed to experience less recent life events than healthy controls. In addition, recent life events were not related to transition to psychosis.

Role of the funding source

There was no direct funding source for this study.

Contributors

None.

Conflict of interest

None.

Acknowledgments

We are supported by the European Union [European Community's Seventh Framework Program (grant agreement no. HEALTH-F2-2009-241909) (Project EU-GEI)].

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ReviewTrauma and recent life events in individuals at ultra high risk for psychosis: Review and meta-analysis

Abstract

Background

Method

Results

Conclusions

Introduction

Section snippets

Data collection

Prevalence of childhood trauma in UHR patients

Trauma in UHR patients versus healthy controls

Discussion

Role of the funding source

Contributors

Conflict of interest

Acknowledgments

Psychoneuroendocrinology

Child Abuse Negl.

Physiol. Behav.

Compr. Psychiatry

Lancet

Compr. Psychiatry

Schizophr. Res.

Schizophr. Res.

Schizophr. Res.

J. Psychiatr. Res.

Schizophr. Res.

Psychiatry Res.

Psychiatry Res.

Schizophr. Res.

Psychiatry Res.

Schizophr. Res.

Schizophr. Res.

Early traumatic experiences in those at clinical high risk for psychosis

Early Interv. Psychiatry

Preliminary evidence for sensitive periods in the effect of childhood sexual abuse on regional brain development

J. Neuropsychiatry Clin. Neurosci.

Life events and psychosis: a review and meta-analysis

Schizophr. Bull.

Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England

Br. J. Psychiatry

Experience of trauma and conversion to psychosis in an ultra‐high‐risk (prodromal) group

Acta Psychiatr. Scand.

Childhood trauma and psychotic disorders: a systematic, critical review of the evidence

Schizophr. Bull.

Crises and life changes and the onset of schizophrenia

J. Health Soc. Behav.

The impact of child maltreatment and psychopathology on neuroendocrine functioning

Dev. Psychopathol.

Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being

Psychol. Med.

Temporal association of stress sensitivity and symptoms in individuals at clinical high risk for psychosis

Psychol. Med.

A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis

J. Am. Stat. Assoc.

Trim and fill: a simple funnel‐plot-based method of testing and adjusting for publication bias in meta‐analysis

Biometrics

Review
Trauma and recent life events in individuals at ultra high risk for psychosis: Review and meta-analysis