ReviewTrauma and recent life events in individuals at ultra high risk for psychosis: Review and meta-analysis
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)].
References (59)
- et al.
Stress abnormalities in individuals at risk for psychosis: a review of studies in subjects with familial risk or with “at risk” mental state
Psychoneuroendocrinology
(2012) - et al.
Development and validation of a brief screening version of the Childhood Trauma Questionnaire
Child Abuse Negl.
(2003) - et al.
Adverse childhood experiences, allostasis, allostatic load, and age-related disease
Physiol. Behav.
(2012) - et al.
History of childhood sexual abuse and general psychopathology
Compr. Psychiatry
(1997) - et al.
Child developmental risk factors for adult schizophrenia in the British 1946 birth cohort
Lancet
(1994) - et al.
High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder
Compr. Psychiatry
(2013) - et al.
Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’
Schizophr. Res.
(2004) - et al.
Ultra high-risk state for psychosis and non-transition: a systematic review
Schizophr. Res.
(2011) - et al.
Predictors of a clinical high risk status among individuals with a family history of psychosis
Schizophr. Res.
(2013) - et al.
Stress and HPA-axis functioning in young people at ultra high risk for psychosis
J. Psychiatr. Res.
(2007)
Childhood trauma and prodromal symptoms among individuals at clinical high risk for psychosis
Schizophr. Res.
Psychotic symptoms with sexual content in the “ultra high risk” for psychosis population: frequency and association with sexual trauma
Psychiatry Res.
Externalized attributional bias in the Ultra High Risk (UHR) for psychosis population
Psychiatry Res.
Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis
Schizophr. Res.
History of trauma and the association with baseline symptoms in an Ultra-High Risk for psychosis cohort
Psychiatry Res.
Psychosis prediction: 12-month follow up of a high-risk (“prodromal”) group
Schizophr. Res.
Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people
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
Cited by (143)
Bullying in individuals at ultra-high risk for psychosis
2023, Annales Medico-PsychologiquesPsychotic Disorders and Risk-States in Adolescence: Etiology, Developmental Considerations, and Treatment
2022, Comprehensive Clinical Psychology, Second Edition