Trauma and psychosis symptoms in a sample of help-seeking youth
Introduction
Childhood exposure to traumatic events is generally considered to be a risk factor for later development of psychosis (Read et al., 2005). A recent meta-analysis concluded that adverse events including sexual, physical, and emotional abuse, neglect, parental death, and bullying by peers strongly contribute to the risk of psychosis in adulthood, with a cumulative dose-response relationship between the number of trauma exposures and the likelihood of psychotic symptoms (Varese et al., 2012). These effects were found even when controlling for likely confounds such as genetic liability, comorbid psychopathology, substance use, and urban vs. rural environment (Varese et al., 2012). Further, repeated exposure to adversity and/or traumatic events during childhood appears to have profound, lifelong effects on mental and physical wellbeing within the general population (Anda et al., 2006) that may be additive for those with additional familial or neurodevelopmental vulnerability towards serious mental illness (Dvir et al., 2013).
Recent efforts have aimed to improve services for young people at risk for or in early stages of a psychotic illness (Fusar-Poli et al., 2013). Given the young age and still-emerging symptoms within at-risk and early psychosis samples, these individuals may constitute a uniquely informative group in which to study associations between trauma and symptom expression. Seventy to 100% of people at “clinical high risk” (CHR) across multiple samples report a history of traumatic experiences including physical abuse and neglect; sexual traumas; witnessing or being victimized by serious violence; and involvement in uncontrollable events such as accidents, war, and natural disasters (Bechdolf et al., 2010, Thompson et al., 2009, Tikka et al., 2013). Certain traumas (in particular, sexual abuse) have been found to exacerbate the likelihood of progression to psychosis over time (Bechdolf et al., 2010, Cutajar et al., 2010, Thompson et al., 2014). This observation is consistent with the notion that interpersonal traumas, that is traumas experienced as violations of relationships or social contracts, may be especially effective at provoking a physiological stress response, activating neural structures important for negative emotional processing (e.g., the amygdala), and disrupting overall mental health and social functioning (Amstadter and Vernon, 2008, Arseneault et al., 2011, Jones and Fernyhough, 2007, Meyer-Lindenberg and Tost, 2012, Resnick et al., 1997, Santiago et al., 2013). These processes may lead to a variety of psychiatric symptoms among otherwise typically developing youth; however, for those with preexisting vulnerability to psychosis, they may trigger or exacerbate the development of psychotic symptoms (Van Os et al., 2008).
Despite these established associations, the influence of trauma on the specific presentation of psychosis symptoms remains unclear. Trauma and stress reaction disorders share clinical features with the emerging psychosis construct, such as dysregulations in affect, cognition, and sleep. Further, posttraumatic thought intrusions relating to past experiences may be difficult to distinguish clinically from psychosis-related thought insertions and “loss of control” over internal experiences. Determining whether psychosis-like symptoms are better accounted for by traumatic experiences may be particularly difficult among adolescents, for whom illusions, hallucinations, and suspicions are common features of Post-Traumatic Stress Disorder (PTSD; Schlosser et al., 2012). Further complicating the issue, despite the high rates of traumatic events reported in CHR cohorts, the prevalence of diagnosable PTSD within this population (3–15%; Bechdolf et al., 2010, Lim et al., 2015, Meyer et al., 2005, Rosen et al., 2006, Woods et al., 2009) appears to be relatively typical for populations exposed to traumatic stress (Santiago et al., 2013). Understanding the relation between trauma and specific symptoms may help to inform best practices for differential diagnosis and trauma-informed treatment for this vulnerable population.
The current study aims to investigate the association of potentially traumatic events with early psychosis and psychosis-risk symptoms among youth receiving mental health services. Because the literature to date on this topic is scant, our investigations were exploratory rather than hypothesis-driven with the goals of exploring the prevalence of violent and non-violent traumas within a CHR/early psychosis group relative to a naturalistic clinical control group and investigating the relation between trauma exposure and specific symptom domains within the early psychosis construct.
Section snippets
Procedures
This study took place within the context of a longitudinal investigation conducted at the Strive for Wellness (SFW) clinic at the University of Maryland, Baltimore County (UMBC) and the University of Maryland Medical Center (UMMC). SFW is a specialty team of clinicians, researchers, and trainees focused on identification and treatment of individuals at CHR for psychosis. The clinic is embedded within the Maryland Early Intervention Program, a multi-institutional research/clinical/training
Results
Current analyses include data from 125 individuals. Participants' mean age was 15.88 years (SD = 2.93). The sample was 61% female and racially diverse (46.4% African American, 34.4% Caucasian, 1.6% Native American, 0.8% Asian, and 14.4% multiracial/other; 2.4% left this item blank). Median household income was $40,000 with 31% reporting annual household income of less than $20,000.
Using SIPS criteria, 60 individuals were categorized within the CHR/EP group (46 with a CHR syndrome and 14 with a
Discussion
The prevalence of traumatic events within this sample was high (75%), especially within the CHR/EP participant group (85%). These figures are similar to the rates of 70–100% found within other CHR/EP samples (Bechdolf et al., 2010, Thompson et al., 2009, Tikka et al., 2013, Russo et al., 2014) and in a recent meta-analysis examining child trauma prevalence in CHR literature (87%; Kraan et al., 2015). This prevalence is also similar to that seen in general help-seeking adolescents in inpatient
Role of funding source
The funders had no role in study design, data analyses, interpretation of results, or decision to publish this manuscript.
Contributors
Dr. Kline collected data, designed analyses, interpreted results, and wrote the manuscript. Mr. Millman was instrumental in assisting with data collection, analyses, interpretation, and manuscript preparation. Ms. Denenny, Ms. Wilson, Ms. Demro, and Ms. Thompson aided in data collection and manuscript preparation. Ms. Bussell supervised study implementation and contributed to study design and interpretation of results. Ms. Connors served as an expert consultant in the area of pediatric
Conflict of interest
The authors have no actual or potential conflict of interest to declare.
Acknowledgment
This work was supported in part by funding from the Maryland Department of Health and Mental Hygiene, Behavioral Health Administration through the Center for Excellence on Early Intervention for Serious Mental Illness (OPASS# 14-13717G/M00B4400241).
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