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McGill N, Curtin M, Hodgins G, Parnell T, Verdon S, Crockett J, Davison WR. Supporting children's recovery from bushfires: Stakeholders' views about the impact of a community-based intervention program on children. Aust J Rural Health 2024; 32:42-52. [PMID: 37964697 DOI: 10.1111/ajr.13060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 08/14/2023] [Accepted: 10/25/2023] [Indexed: 11/16/2023] Open
Abstract
INTRODUCTION A multidisciplinary Bushfire Recovery Program was developed by Royal Far West focused on reducing the short- and medium-term impacts of the 2019-2020 bushfires in Australia on children's wellbeing and resilience. OBJECTIVES To evaluate the impact of the Program's psychosocial groups on children's wellbeing and resilience. DESIGN A two-phase mixed method approach was used, involving post-intervention surveys and interviews of children impacted by the 2019-2020 bushfires in Australia who participated in the Bushfire Recovery Program, their parents/carers, teachers, and the facilitators of the workshops. Statistical analysis was undertaken with quantitative data and content and thematic analysis of qualitative data. FINDINGS Children learnt to talk to and trust adults, share thoughts and experiences with others, recognise they were not alone in their experiences, build connections with peers, understand and manage feelings, and implement strategies that enabled them to cope with change. DISCUSSION Psychosocial groups delivered in preschools and schools as part of the Bushfire Recovery Program reportedly led to significant learning and positive impacts for children in the areas of coping, wellbeing, and peer connections. Similar themes occurred across surveys and interviews and findings reflected the perceptions of the children who participated in the groups, and key adults around the children. CONCLUSIONS Community-based psychoeducational interventions can provide effective support in the short- and medium-term post-bushfire for children to develop strategies and skills to enable them to cope with changes and their emotional reactions.
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Affiliation(s)
- Nicole McGill
- Charles Sturt University, Bathurst, New South Wales, Australia
- Speech Pathology, Melbourne, Victoria, Australia
| | - Michael Curtin
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Gene Hodgins
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Tracey Parnell
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Sarah Verdon
- Charles Sturt University, Bathurst, New South Wales, Australia
| | - Judith Crockett
- Charles Sturt University, Bathurst, New South Wales, Australia
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Ng LC, Hook K, Hailemariam M, Selamu M, Fekadu A, Hanlon C. Experience of traumatic events in people with severe mental illness in a low-income country: a qualitative study. Int J Ment Health Syst 2023; 17:45. [PMID: 38053187 PMCID: PMC10699012 DOI: 10.1186/s13033-023-00616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/22/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND This study describes the trauma experiences of people with severe mental illness (SMI) in Ethiopia and presents a model of how SMI and trauma exposure interact to reduce functioning and quality of life in this setting. METHODS A total of 53 participants living and working in a rural district in southern Ethiopia were interviewed: 18 people living with SMI, 21 caregivers, and 14 primary health care providers. RESULTS Many participants reported that exposure to traumatic and stressful events led to SMI, exacerbated SMI symptoms, and increased caregiver stress and distress. In addition, SMI symptoms and caregiver desperation, stress or stigma were also reported to increase the possibility of trauma exposure. CONCLUSIONS Results suggest it is incumbent upon health professionals and the broader health community to view trauma exposure (broadly defined) as a public health problem that affects all, particularly individuals with SMI.
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Affiliation(s)
- Lauren C Ng
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA.
- Department of Psychiatry, Boston University, School of Medicine, Boston, MA, USA.
| | - Kimberly Hook
- Department of Psychiatry, Boston Medical Center, Boston, MA, USA
- Department of Psychiatry, Boston University, School of Medicine, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Maji Hailemariam
- Department of Obstetrics, Gynecology and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, USA
- Charles Stewart Mott Department of Public Health, College of Human Medicine, Michigan State University, Flint, MI, USA
| | - Medhin Selamu
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Center for Innovative Drug Development, Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, School of Medicine, College of Health Sciences, Addis Ababa, Ethiopia
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Health Service and Population Research Department, Centre for Global Mental Health, King's College London, WHO Collaborating Centre for Mental Health Research and Training, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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3
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Gao Y, Huang W, Yu P, Xu R, Yang Z, Gasevic D, Ye T, Guo Y, Li S. Long-term impacts of non-occupational wildfire exposure on human health: A systematic review. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2023; 320:121041. [PMID: 36639044 DOI: 10.1016/j.envpol.2023.121041] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/14/2022] [Accepted: 01/06/2023] [Indexed: 06/17/2023]
Abstract
The intensity and frequency of wildfires is increasing globally. The systematic review of the current evidence on long-term impacts of non-occupational wildfire exposure on human health has not been performed yet. To provide a systematic review and identify potential knowledge gaps in the current evidence of long-term impacts of non-occupational exposure to wildfire smoke and/or wildfire impacts on human health. We conducted a systematic search of the literature via MEDLINE, Embase and Scopus from the database inception to July 05, 2022. References from the included studies and relevant reviews were also considered. The Newcastle-Ottawa Scale (NOS) and a validated quality assessment framework were used to evaluate the quality of observational studies. Study results were synthesized descriptively. A total of 36 studies were included in our systematic review. Most studies were from developed countries (11 in Australia, 9 in Canada, 7 in the United States). Studies predominantly focused on mental health (21 studies, 58.33%), while evidence on long-term impacts of wildfire exposure on health outcomes other than mental health is limited. Current evidence indicated that long-term impacts of non-occupational wildfire exposure were associated with mortality (COVID-19 mortality, cardiovascular disease mortality and acute myocardial disease mortality), morbidity (mainly respiratory diseases), mental health disorders (mainly posttraumatic stress disorder), shorter height of children, reduced lung function and poorer general health status. However, no significant associations were observed for long-term impacts of wildfire exposure on child mortality and respiratory hospitalizations. The population-based high-quality evidence with quantitative analysis on this topic is still limited. Future well-designed studies considering extensive wildfire smoke air pollutants (e.g., particulate matter, ozone, nitrogen oxides) and estimating risk coefficient values for extensive health outcomes (e.g., mortality, morbidity) are warranted to fill current knowledge gaps.
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Affiliation(s)
- Yuan Gao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Wenzhong Huang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Pei Yu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Rongbin Xu
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Zhengyu Yang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia; Centre for Global Health, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Tingting Ye
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Yuming Guo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Shanshan Li
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
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4
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Rosenfield PJ, Jiang D, Pauselli L. Childhood adversity and psychotic disorders: Epidemiological evidence, theoretical models and clinical considerations. Schizophr Res 2022; 247:55-66. [PMID: 34210561 DOI: 10.1016/j.schres.2021.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/08/2023]
Abstract
While genetic factors play a critical role in the risk for schizophrenia and other psychotic disorders, increasing evidence points to the role of childhood adversity as one of several environmental factors that can significantly impact the development, manifestations and outcome of these disorders. This paper reviews the epidemiological evidence linking childhood adversity and psychotic disorders and explores various theoretical models that seek to explain the connection. We discuss neurobiological parallels between the impact of childhood trauma and psychosis on the brain and then explore the impact of childhood adversity on different domains of clinical presentation. Finally, implications for prevention and treatment are considered, both on individual and structural levels.
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Affiliation(s)
- Paul J Rosenfield
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - David Jiang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
| | - Luca Pauselli
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States of America.
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5
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Brandt JM, Hemager N, Gregersen M, Søndergaard A, Falkenberg Krantz M, Ohland J, Wilms M, Birkehøj Rohd S, Hjorthøj C, Veddum L, Bruun Knudsen C, Krogh Andreassen A, Greve A, Spang KS, Christiani CA, Ellersgaard D, Klee Burton B, Gantriis DL, Bliksted V, Mors O, Plessen KJ, Møllegaard Jepsen JR, Nordentoft M, Elgaard Thorup AA. Childhood trauma in children at familial high risk of schizophrenia or bipolar disorder: A longitudinal study. The Danish High Risk and Resilience Study - VIA 7 and VIA 11. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:875-894. [PMID: 35332530 DOI: 10.1111/bjc.12364] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/24/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Childhood trauma increases the risk of developing mental illness as does being born to parents with schizophrenia or bipolar disorder. We aimed to compare prevalence of lifetime childhood trauma among 11-year-old children at familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) compared with population-based controls (PBCs). DESIGN The study is a longitudinal, prospective cohort study of children at FHR-SZ, FHR-BP, and PBCs. METHODS A cohort of 512 children at FHR-SZ (N = 199), FHR-BP (N = 118), and PBCs (N = 195) were examined at baseline (mean age 7.8, SD 0.2) and 451 children at FHR-SZ (N = 172), FHR-BP (N = 104), and PBCs (N = 175) were examined at four-year follow-up (mean age 11.9, SD 0.2, retention rate 87.3%). Childhood trauma was measured with a semi-structured interview. RESULTS Children at FHR-BP had an elevated risk of exposure to any lifetime trauma (age 0-11 years) compared with PBCs (OR 2.082, 95%CI 1.223-3.545, p = .007) measured with binary logistic regression. One-way ANOVA revealed that both FHR-groups had a higher lifetime prevalence of exposure to a greater number of types of trauma compared with PBCs (FHR-SZ: observed mean: 1.53, 95%CI 1.29-1.77; FHR-BP: observed mean: 1.56, 95%CI 1.26-1.85; PBCs: observed mean: 0.99, 95%CI 0.82-1.17; p < .001). Binary logistic regression showed that the lifetime risk of exposure to interpersonal trauma (age 0-11 years) was elevated for both FHR-groups (FHR-SZ: OR 3.773, 95%CI 2.122-6.710, p < .001; FHR-BP: OR 3.602, 95%CI 1.913-6.783, p < .001). CONCLUSIONS Children at FHR-SZ and FHR-BP are at increased risk for being exposed to childhood trauma compared with PBCs. This study underscores the need for early detection, support, and prevention of childhood trauma in children at FHR-SZ and FHR-BP.
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Affiliation(s)
- Julie Marie Brandt
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Gregersen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mette Falkenberg Krantz
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Jessica Ohland
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Martin Wilms
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Sinnika Birkehøj Rohd
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Carsten Hjorthøj
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Katrine Søborg Spang
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Camilla Austa Christiani
- Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Ditte Ellersgaard
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark
| | - Birgitte Klee Burton
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
| | - Ditte Lou Gantriis
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Vibeke Bliksted
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark.,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Skejby, Aarhus, Denmark
| | - Kerstin Jessica Plessen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark.,Division of Child and Adolescent Psychiatry, Department of Psychiatry, University Hospital Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Jens Richardt Møllegaard Jepsen
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Hellerup, Denmark
| | - Merete Nordentoft
- CORE - Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Hellerup, Denmark.,The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research - iPSYCH, Aarhus, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Mental Health Services in the Capital Region of Denmark, Child and Adolescent Mental Health Center, Copenhagen, Denmark
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6
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Pastore A, de Girolamo G, Tafuri S, Tomasicchio A, Margari F. Traumatic experiences in childhood and adolescence: a meta-analysis of prospective studies assessing risk for psychosis. Eur Child Adolesc Psychiatry 2022; 31:215-228. [PMID: 32577908 DOI: 10.1007/s00787-020-01574-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Evidence of the association between traumatic experiences and psychosis are uncertain with respect to temporal order, clinical outcomes and the role of the age and genetic liability. The aim of the present meta-analysis was to explore the temporal relationship between the development of psychosis and traumatic exposure using prospective studies and to examine the role of moderation factors on overall effect sizes. Studies were identified by searching Embase-Ovid, PsycINFO (EBSCO), Pubmed, Scopus, Web of Science databases, and yielded an initial total of 9016 papers, leaving finally 23 after the screening process. Three sets of meta-analyses estimated the risk of developing psychotic experiences or full clinical psychosis by having experienced maltreatment by an adult or bullying by peers or parental death, using the random-effects model. Bullying by peers (OR = 2.28 [1.64, 4.34]), maltreatment by an adult (OR = 2.20 [1.72, 2.81]) and parental death (OR = 1.24 [1.06, 1.44]) all increased the risk of psychosis. Moderator analysis showed that negative effects of bullying were detected especially in those with genetic liability for psychosis and exposure to multiple trauma types; studies with higher prevalence of males showed a stronger risk for those exposed to parental death. No significant meta-regression was found between the risk of developing a full clinical psychosis or a psychotic experience. Lack of studies hampered the results about the age of trauma occurrence. The cumulative effect of being bullied from peers and experiencing other adversities during childhood and/or adolescence, together with genetic liability for psychosis, appears to confer the highest risk for developing psychotic symptoms later in life.
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Affiliation(s)
- Adriana Pastore
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy.
| | | | - Silvio Tafuri
- Department of Biomedical Sciences and Human Oncology, University of Bari, Bari, Italy
| | - Aldo Tomasicchio
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
| | - Francesco Margari
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy
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7
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Downey C, Crummy A. The impact of childhood trauma on children's wellbeing and adult behavior. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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8
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Kisely S, Strathearn L, Najman JM. A comparison of psychosis-like symptoms following self-reported and agency-notified child abuse in a population-based birth cohort at 30-year-follow-up. Schizophr Res 2022; 239:116-122. [PMID: 34875509 DOI: 10.1016/j.schres.2021.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/24/2021] [Accepted: 11/17/2021] [Indexed: 11/15/2022]
Abstract
There is a strong association between self-reported child abuse and subsequent psychosis in retrospective data. Prospective studies of reports to statutory agencies are less common with limited information on people in their 30s. There have also been no comparisons of the influence of self- and agency-reported abuse on psychosis in adulthood. We therefore compared the prevalence of delusions and hallucinations in 30-year-olds who had experienced either self- or agency-reported childhood maltreatment with that in the remainder of a birth cohort. There were 2427 participants with data on psychosis and child abuse at 30-year follow-up. Information on self-reported abuse came from the Child Trauma Questionnaire (CTQ) and was linked to notifications of child maltreatment reported to statutory agencies. We measured psychotic-like experiences using the Peter's Delusions Inventory (PDI) and screening questions from the Composite International Diagnostic Interview. The prevalence of self- and agency-reported maltreatment was 599 (24.7%) and 141 (5.8%) respectively. At 30-year follow-up, 556 participants had PDI scores in the top two deciles, while 232 had experienced visual hallucinations and 134 auditory phenomena. On adjusted analyses, self-reported maltreatment, apart from sexual abuse, showed a strong association with all three outcomes. Associations were less strong for agency-notified child maltreatment and largely restricted to physical and emotional abuse. These findings suggest that people presenting with psychosis should be screened for child maltreatment, particularly physical and emotional abuse, as well as the possibility of psychosis considered in survivors of child maltreatment.
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Affiliation(s)
- Steve Kisely
- School of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia; Metro South Addiction and Mental Health Service, Princess Alexandra Hospital Ipswich Road, Brisbane, Australia; Department of Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada.
| | - Lane Strathearn
- Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA, USA; Center for Disabilities and Development, University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA.
| | - Jake M Najman
- School of Public Health, The University of Queensland, Herston Road, Herston, Queensland, Australia.
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9
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Tong J, Zhang T, Chen F, Wang Q, Zhao X, Hu M. Prevalence and Contributing Factors of Childhood Trauma, Anxiety, and Depression Among Adolescents From Two-Child Families in China. Front Psychiatry 2022; 13:782087. [PMID: 35370843 PMCID: PMC8971896 DOI: 10.3389/fpsyt.2022.782087] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
The two-child policy has been implemented in China since 2016 and has attracted the attention of the world. Adolescents may face huge psychological challenges in the process of changing family structures and relationships. To date, no mental health survey of adolescents from two-child families has been conducted. We investigated the prevalence and risk factors for childhood trauma, anxiety, and depression in two-child families in a statistically representative sample of Chinese senior high school students from Shanghai. A total of 426 participants were randomly selected from 1,059 students of four senior high schools in different districts of Shanghai. The childhood trauma questionnaire-short form (CTQ-SF), self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used as the screening tools. We found that the overall prevalence of childhood trauma, anxiety, and depression among senior high school students in two-child families was 46.70% (95% CI, 39.93-53.47%), 22.17% (95% CI, 16.53-27.81%), and 35.85% (95% CI, 29.34-42.36%), respectively. The two-child families was an important factor associated childhood trauma, emotional neglect, and physical neglect (χ2 = 5.984, p = 0.014; χ2 = 4.071, p = 0.044; χ2 = 4.202, p = 0.040). Ranking in two-child families was a risk factor for childhood trauma (β = -0.135, p = 0.048). Parental preference was a significantly correlated with physical abuse, physical neglect, anxiety, and depression (β = -1.581 to 0.088, p < 0.05). Meanwhile, emotional abuse, physical abuse, emotional neglect, and physical neglect of participants in the two groups were positively correlated with anxiety and depression (r = 0.195-0.478, p < 0.05). There was a significant relationship between sexual abuse and anxiety symptoms in the one-child family group (r = 0.161, p < 0.05). The findings suggest that the overall prevalence of childhood trauma, anxiety and depression among adolescents from two-child families in China was high. The two-child families and family ranking are important factors associated childhood trauma, while parental preference is related to anxiety and depression. These results highlight an urgent need to be addressed by adolescents' mental health service providers and policy-makers.
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Affiliation(s)
- Jie Tong
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Tingting Zhang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Fazhan Chen
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Qiang Wang
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
| | - Xudong Zhao
- School of Medicine, Tongji University, Shanghai, China
| | - Manji Hu
- Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
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Zhang Y, Workman A, Russell MA, Williamson M, Pan H, Reifels L. The long-term impact of bushfires on the mental health of Australians: a systematic review and meta-analysis. Eur J Psychotraumatol 2022; 13:2087980. [PMID: 35957633 PMCID: PMC9359172 DOI: 10.1080/20008198.2022.2087980] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The long-term health effects of bushfires include the potential to trigger new and exacerbate existing mental health problems. OBJECTIVE This review aimed to determine the prevalence of long-term mental health issues in Australian populations exposed to bushfires. METHOD A systematic search was conducted in five databases (Embase, Medline, PsycINFO, Scopus, and Web of Science) to identify studies focusing on Australian populations impacted by bushfires with the prevalence of mental health issues reported at 2+ years after bushfire. The Joanna Briggs Institute prevalence critical appraisal tool was utilised. We conducted meta-analyses to determine the prevalence of general psychological distress in the general population, and a narrative synthesis. RESULTS We included 21 articles based on 5 studies and conducted on 3 bushfire events. Meta-analyses showed a pooled prevalence of 14% (95% CI 12%-16%) for psychological distress in the general population at 2-4 years post bushfire. The overall prevalence of long-term psychological problems in firefighters at 2-7 years ranged from 28% to 47.6%. The prevalence of some psychological issues decreased with time and was directly proportional to the level of bushfire impact. CONCLUSIONS As the magnitude of long-term bushfire-related mental health impacts in Australia is severe, it is important to monitor psychological problems and assist communities in future. Future research needs include: (a) more studies on the full range of long-term psychological impacts of bushfires, and (b) consensus on instruments and diagnostic criteria to define mental health issues. HIGHLIGHTS First systematic review of long-term bushfire mental health issues in Australia.Indicating substantial mental health problems among affected populations.Long-term issues were linked to bushfire impact and elevated among firefighters.Highlighting need for further rigorous research on long-term disaster sequalae.
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Affiliation(s)
- Yanqin Zhang
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Annabelle Workman
- Melbourne Climate Futures, Melbourne Law School, The University of Melbourne, Parkville, Australia
| | - Melissa A Russell
- Centre of Epidemiology and Biostatics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Michelle Williamson
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Haotai Pan
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
| | - Lennart Reifels
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
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Muñoz-Samons D, Tor J, Rodríguez-Pascual M, Álvarez-Subiela X, Sugranyes G, de la Serna E, Puig O, Dolz M, Baeza I. Recent stressful life events and stress sensitivity in children and adolescents at clinical risk for psychosis. Psychiatry Res 2021; 303:114017. [PMID: 34217983 DOI: 10.1016/j.psychres.2021.114017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/16/2021] [Indexed: 12/18/2022]
Abstract
Although psychosocial stress is consistently described as a casual factor for psychosis, the role of recent stressful life events (SLEs) is inconclusive. Studies with subjects with psychosis risk syndrome (PRS), fail to show a large number of SLEs but suggest greater stress sensitivity in these populations. We evaluate the presence of recent SLEs and stress sensitivity, and their relationship with symptoms and functionality in a sample consisting exclusively of help-seeking children and adolescents. Seventy-two 10- to 17-year-old help-seeking subjects who met PRS criteria and forty-two healthy control (HC) subjects participated in a naturalistic multi-site study. Measures of stress included the Stressful Life Events Schedule (SLES) and the G4 item of the Scale for Prodromal Syndromes (SOPS) scale. Child and adolescent PRS subjects presented greater number of SLEs during the previous year, greater total accumulated stress, greater sensitivity to stress, and more impaired tolerance to normal stress than did HC subjects. Stress measures showed a relationship with positive and negative attenuated symptoms, clinical variables and functionality. Our results support the role of stress in the PRS status. It reinforces the suggested differences for clinical presentation of PRS in terms of age, highlighting the importance of gathering data on the under-18 population.
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Affiliation(s)
- Daniel Muñoz-Samons
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain.
| | - Jordina Tor
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Marta Rodríguez-Pascual
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Xavier Álvarez-Subiela
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain
| | - Gisela Sugranyes
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain
| | - Elena de la Serna
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain
| | - Olga Puig
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain
| | - Montse Dolz
- Child and Adolescent Mental Health Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, 39-57, 08950 Esplugues de Llobregat, Barcelona, Spain; Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu of Barcelona, Passeig Sant Joan de Déu, 002, 08950 Esplugues de Llobregat, Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain
| | - Inmaculada Baeza
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Av. Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029 Madrid, Spain; Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic Universitari of Barcelona, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM (2017SGR881), Spain. Villarroel 170, 08036 Barcelona, Spain; Institut Clinic of Neurosciences, CERCA-IDIBAPS (Institut d'Investigacions Biomèdiques August Pi Sunyer), Villarroel 170, 08036 Barcelona, Spain; Department of Psychiatry and Psychobiology, Health Sciences Division, University of Barcelona, Casanova 143, 08036 Barcelona, Spain
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Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Med J Aust 2021; 213 Suppl 11:S3-S32.e1. [PMID: 33314144 DOI: 10.5694/mja2.50881] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022]
Abstract
CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia. STUDY DESIGN Rapid review of articles published between January 2000 and May 2020. DATA SOURCES We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries. DATA SYNTHESIS Twenty-one articles met the inclusion criteria, including five conducted in Australia. Four of the Australian studies were conducted in very remote populations and in grocery stores, and one was conducted in regional Australia. All of the overseas studies were conducted in rural North America. All of them revealed a positive influence on food environment or consumer behaviour, and all were conducted in disadvantaged, rural communities. Positive outcomes were consistently revealed by studies of initiatives that focused on promotion and awareness of healthy foods and included co-design to generate community ownership and branding. CONCLUSION Initiatives aimed at improving rural food retail environments were effective and, when implemented in different rural settings, may encourage improvements in population diets. The paucity of studies over the past 20 years in Australia shows a need for more research into effective food retail environment initiatives, modelled on examples from overseas, with studies needed across all levels of remoteness in Australia. Several retail initiatives that were undertaken in rural North America could be replicated in rural Australia and could underpin future research. CHAPTER 2: WHICH INTERVENTIONS BEST SUPPORT THE HEALTH AND WELLBEING NEEDS OF RURAL POPULATIONS EXPERIENCING NATURAL DISASTERS?: Objective: To explore and evaluate health and social care interventions delivered to rural and remote communities experiencing natural disasters in Australia and other high income countries. STUDY DESIGN We used systematic rapid review methods. First we identified a test set of citations and generated a frequency table of Medical Subject Headings (MeSH) to index articles. Then we used combinations of MeSH terms and keywords to search the MEDLINE (Ovid) database, and screened the titles and abstracts of the retrieved references. DATA SOURCES We identified 1438 articles via database searches, and a further 62 articles via hand searching of key journals and reference lists. We also found four relevant grey literature resources. After removing duplicates and undertaking two stages of screening, we included 28 studies in a synthesis of qualitative evidence. DATA SYNTHESIS Four of us read and assessed the full text articles. We then conducted a thematic analysis using the three phases of the natural disaster response cycle. CONCLUSION There is a lack of robust evaluation of programs and interventions supporting the health and wellbeing of people in rural communities affected by natural disasters. To address the cumulative and long term impacts, evidence suggests that continuous support of people's health and wellbeing is needed. By using a lens of rural adversity, the complexity of the lived experience of natural disasters by rural residents can be better understood and can inform development of new models of community-based and integrated care services. CHAPTER 3: THE IMPACT OF BUSHFIRE ON THE WELLBEING OF CHILDREN LIVING IN RURAL AND REMOTE AUSTRALIA: Objective: To investigate the impact of bushfire events on the wellbeing of children living in rural and remote Australia. STUDY DESIGN Literature review completed using rapid realist review methods, and taking into consideration the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for systematic reviews. DATA SOURCES We sourced data from six databases: EBSCOhost (Education), EBSCOhost (Health), EBSCOhost (Psychology), Informit, MEDLINE and PsycINFO. We developed search terms to identify articles that could address the research question based on the inclusion criteria of peer reviewed full text journal articles published in English between 1983 and 2020. We initially identified 60 studies and, following closer review, extracted data from eight studies that met the inclusion criteria. DATA SYNTHESIS Children exposed to bushfires may be at increased risk of poorer wellbeing outcomes. Findings suggest that the impact of bushfire exposure may not be apparent in the short term but may become more pronounced later in life. Children particularly at risk are those from more vulnerable backgrounds who may have compounding factors that limit their ability to overcome bushfire trauma. CONCLUSION We identified the short, medium and long term impacts of bushfire exposure on the wellbeing of children in Australia. We did not identify any evidence-based interventions for supporting outcomes for this population. Given the likely increase in bushfire events in Australia, research into effective interventions should be a priority. CHAPTER 4: THE ROLE OF NATIONAL POLICIES TO ADDRESS RURAL ALLIED HEALTH, NURSING AND DENTISTRY WORKFORCE MALDISTRIBUTION: Objective: Maldistribution of the health workforce between rural, remote and metropolitan communities contributes to longstanding health inequalities. Many developed countries have implemented policies to encourage health care professionals to work in rural and remote communities. This scoping review is an international synthesis of those policies, examining their effectiveness at recruiting and retaining nursing, dental and allied health professionals in rural communities. STUDY DESIGN Using scoping review methods, we included primary research - published between 1 September 2009 and 30 June 2020 - that reported an evaluation of existing policy initiatives to address workforce maldistribution in high income countries with a land mass greater than 100 000 km2 . DATA SOURCES We searched MEDLINE, Ovid Embase, Ovid Emcare, Informit, Scopus, and Web of Science. We screened 5169 articles for inclusion by title and abstract, of which we included 297 for full text screening. We then extracted data on 51 studies that had been conducted in Australia, the United States, Canada, United Kingdom and Norway. DATA SYNTHESIS We grouped the studies based on World Health Organization recommendations on recruitment and retention of health care workers: education strategies (n = 27), regulatory change (n = 11), financial incentives (n = 6), personal and professional support (n = 4), and approaches with multiple components (n = 3). CONCLUSION Considerable work has occurred to address workforce maldistribution at a local level, underpinned by good practice guidelines, but rarely at scale or with explicit links to coherent overarching policy. To achieve policy aspirations, multiple synergistic evidence-based initiatives are needed, and implementation must be accompanied by well designed longitudinal evaluations that assess the effectiveness of policy objectives. CHAPTER 5: AVAILABILITY AND CHARACTERISTICS OF PUBLICLY AVAILABLE HEALTH WORKFORCE DATA SOURCES IN AUSTRALIA: Objective: Many data sources are used in Australia to inform health workforce planning, but their characteristics in terms of relevance, accessibility and accuracy are uncertain. We aimed to identify and appraise publicly available data sources used to describe the Australian health workforce. STUDY DESIGN We conducted a scoping review in which we searched bibliographic databases, websites and grey literature. Two reviewers independently undertook title and abstract screening and full text screening using Covidence software. We then assessed the relevance, accessibility and accuracy of data sources using a customised appraisal tool. DATA SOURCES We searched for potential workforce data sources in nine databases (MEDLINE, Embase, Ovid Emcare, Scopus, Web of Science, Informit, the JBI Evidence-based Practice Database, PsycINFO and the Cochrane Library) and the grey literature, and examined several pre-defined websites. DATA SYNTHESIS During the screening process we identified 6955 abstracts and examined 48 websites, from which we identified 12 publicly available data sources - eight primary and four secondary data sources. The primary data sources were generally of modest quality, with low scores in terms of reference period, accessibility and missing data. No single primary data source scored well across all domains of the appraisal tool. CONCLUSION We identified several limitations of data sources used to describe the Australian health workforce. Establishment of a high quality, longitudinal, linked database that can inform all aspects of health workforce development is urgently needed, particularly for rural health workforce and services planning. CHAPTER 6: RAPID REALIST REVIEW OF OPIOID TAPERING IN THE CONTEXT OF LONG TERM OPIOID USE FOR NON-CANCER PAIN IN RURAL AREAS: Objective: To describe interventions, barriers and enablers associated with opioid tapering for patients with chronic non-cancer pain in rural primary care settings. STUDY DESIGN Rapid realist review registered on the international register of systematic reviews (PROSPERO) and conducted in accordance with RAMESES standards. DATA SOURCES English language, peer-reviewed articles reporting qualitative, quantitative and mixed method studies, published between January 2016 and July 2020, and accessed via MEDLINE, Embase, CINAHL Complete, PsycINFO, Informit or the Cochrane Library during June and July 2020. Grey literature relating to prescribing, deprescribing or tapering of opioids in chronic non-cancer pain, published between January 2016 and July 2020, was identified by searching national and international government, health service and peek organisation websites using Google Scholar. DATA SYNTHESIS Our analysis of reported approaches to tapering conducted across rural and non-rural contexts showed that tapering opioids is complex and challenging, and identified several barriers and enablers. Successful outcomes in rural areas appear likely through therapeutic relationships, coordination and support, by using modalities and models of care that are appropriate in rural settings and by paying attention to harm minimisation. CONCLUSION Rural primary care providers do not have access to resources available in metropolitan centres for dealing with patients who have chronic non-cancer pain and are taking opioid medications. They often operate alone or in small group practices, without peer support and access to multidisciplinary and specialist teams. Opioid tapering approaches described in the literature include regulation, multimodal and multidisciplinary approaches, primary care provider support, guidelines, and patient-centred strategies. There is little research to inform tapering in rural contexts. Our review provides a synthesis of the current evidence in the form of a conceptual model. This preliminary model could inform the development of a model of care for use in implementation research, which could test a variety of mechanisms for supporting decision making, reducing primary care providers' concerns about potential harms arising from opioid tapering, and improving patient outcomes.
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Rossi R, Socci V, Gregori E, Talevi D, Collazzoni A, Pacitti F, Stratta P, Rossi A, Di Lorenzo G. ResilienCity: Resilience and Psychotic-Like Experiences 10 Years After L'Aquila Earthquake. Front Psychiatry 2020; 11:77. [PMID: 32180736 PMCID: PMC7059251 DOI: 10.3389/fpsyt.2020.00077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/31/2020] [Indexed: 12/15/2022] Open
Abstract
An earthquake hit the city of L'Aquila in central Italy in 2009, leaving the city completely destroyed and 309 casualties. Unexpectedly, lower rates of psychotic experiences in persons affected by the earthquake compared to non-affected persons were found 10 months after the earthquake. The very long-term impact of a natural disaster on the prevalence of psychotic experiences deserves more in-depth detailing. The Authors examined resilience and psychotic experiences in a university student sample of 494. No effect of direct exposure to the earthquake (odds ratio = 0.64, 95%CI [0.37, 1.11]), material damages (odds ratio = 0.86, 95%CI [0.60, 1.23]), psychological suffering (odds ratio = 1.06, 95% CI [0.83, 1.36]), or global impact severity (odds ratio = 0.92, 95%CI [0.76, 1.12]) on psychotic experiences was detected. Resilience levels did not differ between affected and non-affected persons. Resilience showed a strong protective effect on psychotic experiences (odds ratio=0.38, 95% CI [0.28, 0.51]. The protective effect of the RSA factor "Perception of Self" was significantly stronger in individuals affected by the earthquake compared to non-affected subjects. Being affected by an earthquake is not a risk factor for psychotic experiences in a university student sample, as no direct effect of the earthquake was detected after 10 years after the event. Resilience is confirmed as a strong protective factor for psychotic experiences irrespectively of large collective traumatic events. Extension of these results to a general population sample could provide interesting insights into recovery from natural disasters.
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Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Socci
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Eleonora Gregori
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Dalila Talevi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Alberto Collazzoni
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Paolo Stratta
- Department of Mental Health, ASL1 Abruzzo, L'Aquila, Italy
| | - Alessandro Rossi
- Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
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Honda Y, Fujiwara T, Yagi J, Homma H, Mashiko H, Nagao K, Okuyama M, Ono-Kihara M, Kihara M. Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake. Front Psychiatry 2019; 10:496. [PMID: 31404309 PMCID: PMC6675868 DOI: 10.3389/fpsyt.2019.00496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
Longitudinal studies of the long-term psychological impact of the Great East Japan Earthquake (GEJE) on parents and their children have been limited. The current study aimed to monitor parents' post-traumatic stress disorder (PTSD) symptoms and behavioral problems among their children over time and to analyze their long-term associations among the survivors of the GEJE. We used data from the GEJE Follow-up for Children study, which recruited 4- to 6-year-old children and those children's parents immediately after the GEJE in March 2011, with ongoing follow-up. Children's total, internalizing, and externalizing behavioral problems were assessed using the Child Behavior Checklist (CBCL), and parental probable PTSD was assessed using the Impact of Event Scale-R (IES-R), in 2012 (baseline) and 2014 (follow-up). Parental PTSD symptoms and children's behavioral problems declined slightly over time, and both showed a significant correlation between the surveys (r = 0.55-0.77, P < 0.001). The association between parental PTSD symptoms and children's behavioral problems was investigated using multivariate logistic regression analysis adjusting for baseline children's behavioral problems and other potential confounders. Cross-sectionally, while no significant association was detected in 2012, all types of children's behavioral problems exhibited significant positive associations with parental PTSD symptoms in multiple logistic regression analysis adjusted odds ratio (AOR) = 3.03, 3.30, and 5.34 for total, internalizing, and externalizing behavior problems, respectively. Maternal educational attainment level (higher than high school education) showed a significant negative association with children's total and externalizing behavioral problems (AOR = 0.30 and 0.13, respectively) in 2014. Longitudinally, parental PTSD symptoms in 2012 showed a significant association with children's internalizing behavioral problems in 2014 after adjusting for children's behavioral problems in 2012 and parental PTSD symptoms in 2014 (AOR = 4.62). These results suggest that the effect of the GEJE on parental PTSD symptoms and children's behavioral problems was long-term, lasting for at least 3 years. These possibilities should be carefully considered in mental health support for parents and their offspring in areas affected by the GEJE.
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Affiliation(s)
- Yukiko Honda
- Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junko Yagi
- Department of Psychiatry, Iwate Medical University, Iwate, Japan
| | | | | | | | - Makiko Okuyama
- Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Mansueto G, Palmieri S, Faravelli C. Parental style and Cloninger's model in psychosis. Psychiatry Res 2018; 269:221-228. [PMID: 30153600 DOI: 10.1016/j.psychres.2018.08.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 12/25/2022]
Abstract
Parental style and Cloninger's dimensions are associated with psychosis, but it is still unclear whether temperament, character and parenting variables are linked to specific psychotic symptoms. This study extends previous research exploring these issues. 78 patients with psychosis and 156 control subjects were recruited. Parental style was evaluated using the Measure of Parental Style. Temperament and character were evaluated using the Temperament and Character Inventory-Revised. Psychotic symptoms were assessed using the Positive and Negative Syndrome Scale. T-tests, correlations and moderation and mediation analyses were performed. Patients reported dysfunctional parenting and had higher scores for harm avoidance (HA) and self transcendence (ST), and lower scores for self directedness (SD) and cooperativeness (CO) than controls. Maternal indifference, abuse and overcontrol were correlated with positive symptoms (PS). Novelty seeking (NS), reward dependence, SD, CO were correlated with PS; HA and ST were correlated with negative symptoms. After adjusting for age, gender and family history of psychopathology lower CO partially mediated the relationship between maternal abuse and PS; the positive NS-maternal abuse interaction was associated with PS. Different parenting and personality variables may be associated with different psychotic symptoms. NS and CO may be part of a pathway between maternal abuse and PS.
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Affiliation(s)
- Giovanni Mansueto
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Italy; Maastricht University Medical Center, Department of Psychiatry & Psychology, School for Mental Health & Neuroscience, Maastricht, The Netherlands.
| | - Sara Palmieri
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Italy
| | - Carlo Faravelli
- Department of Health Sciences, Psychology and Psychiatry Unit, University of Florence, Italy
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Boyda D, McFeeters D, Dhingra K, Rhoden L. Childhood maltreatment and psychotic experiences: Exploring the specificity of early maladaptive schemas. J Clin Psychol 2018; 74:2287-2301. [DOI: 10.1002/jclp.22690] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/26/2018] [Accepted: 07/13/2018] [Indexed: 12/11/2022]
Affiliation(s)
- David Boyda
- Institute of Sport and Human Science, University of Wolverhampton; Wolverhampton UK
| | - Danielle McFeeters
- Institute of Sport and Human Science, University of Wolverhampton; Wolverhampton UK
| | - Katie Dhingra
- School of Social Sciences, Leeds Beckett University; Leeds UK
| | - Laura Rhoden
- Institute of Sport and Human Science, University of Wolverhampton; Wolverhampton UK
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Kocsis-Bogár K, Mészáros V, Perczel-Forintos D. Gender differences in the relationship of childhood trauma and the course of illness in schizophrenia. Compr Psychiatry 2018; 82:84-88. [PMID: 29452966 DOI: 10.1016/j.comppsych.2018.01.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Different types of childhood trauma have been repeatedly shown to contribute to psychotic symptoms. Gender differences in schizophrenia are well known. Some studies argue that trauma history means a significantly higher risk of psychosis for women than men. However, there is evidence of early adverse life events to be associated with higher stress-sensitivity in men. Little is known about the connection of specific type of trauma and specific psychotic symptoms as well as the course of illness with explicit regard to gender differences. METHODS 102 men and women with schizophrenia spectrum disorder were tested using Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Scale for Assessing Positive Symptoms, Early Trauma Inventory-SR. RESULTS Although, women had a later age at onset without regarding trauma history (d = 0.74), this difference became non-significant when introducing trauma variables. Patients reporting physical abuse had a significantly earlier age at onset, regardless of their sex (V = 0.13, F = 3.11, p = 0.03. Physical abuse predicted an earlier age at onset only in women (R2 = 0.23). History of general trauma predicted more frequent hospitalizations only in men (R2 = 0.55). CONCLUSIONS Although women generally tend to have a more favorable course of illness including a later age at onset men, women with CPA seem to lose this "advantage". It is necessary to investigate the contribution of gender interacting with adverse life events in contribution to the phenomenology and etiology of schizophrenia.
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Affiliation(s)
- Krisztina Kocsis-Bogár
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary; Department of Applied Psychology: Health, Development, Enhancement and Intervention, University of Vienna, Austria.
| | - Veronika Mészáros
- Department of Clinical Psychology, Semmelweis University, Budapest, Hungary
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Adebäck P, Schulman A, Nilsson D. Children exposed to a natural disaster: psychological consequences eight years after 2004 tsunami. Nord J Psychiatry 2018; 72:75-81. [PMID: 28990835 DOI: 10.1080/08039488.2017.1382569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a need for studies that follow up children and adolescents for many years post disaster since earlier studies have shown that exposure during natural disasters constitutes a risk factor for poor psychological health. AIMS The main aim was to examine whether there was an association between severity of exposures during a natural disaster experienced in childhood or adolescence and posttraumatic stress symptoms, psychological distress, self-rated health, diagnosis of depression, anxiety or worry, thoughts about or attempted suicide, physical symptoms or daily functioning eight years later in young adulthood. A second aim was to compare psychological distress and self-rated health of exposed young adults with a matched population-based sample. METHOD Young adults, who experienced the 2004 tsunami as children between 10 and 15 years of age, responded to a questionnaire eight years post disaster. The results were compared to a matched population sample. RESULTS The results showed that the likelihood for negative psychological outcomes was higher for those who had been exposed to several types of exposures during this natural disaster. CONCLUSIONS The negative psychological impact on children and adolescents can still be present eight years post-disaster and seems to have association with the type of exposure; loss, physical presence and subjective experience. It is important for clinicians, who meet young adults seeking help, to be conscious about the impact as long as eight years post disaster and to be aware of possible clinical implications associated with severity of exposures.
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Affiliation(s)
- Petra Adebäck
- a Department of Neurobiology Care Sciences and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden
| | - Abbe Schulman
- a Department of Neurobiology Care Sciences and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden
| | - Doris Nilsson
- a Department of Neurobiology Care Sciences and Society, Division of Family Medicine and Primary Care , Karolinska Institutet , Huddinge , Sweden.,b Department for Behavioral Sciences and Learning, Section for Clinical Psychology , Linköping University , Linköping , Sweden
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Abajobir AA, Kisely S, Scott JG, Williams G, Clavarino A, Strathearn L, Najman JM. Childhood Maltreatment and Young Adulthood Hallucinations, Delusional Experiences, and Psychosis: A Longitudinal Study. Schizophr Bull 2017; 43:1045-1055. [PMID: 28338760 PMCID: PMC5581886 DOI: 10.1093/schbul/sbw175] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Child maltreatment is a widespread public health problem associated with a range of mental health disorders later in life. In order to effectively address these disorders, there is a need to understand more about the mental health consequences of different types of child maltreatment. This study examines the associations between prospectively substantiated child maltreatment (ages 0-14 y) and reports of hallucinations and delusional experiences at 21 years after birth. As well, we examined 12-month and lifetime psychotic disorders using data from a longitudinal birth cohort. The study comprised 3752 participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian prebirth cohort study. Psychotic experiences and 12-month and lifetime psychosis were measured using the Achenbach Young Adults Self-Report, the Peter's Delusions Inventory, and Composite International Diagnostic Interview at the 21-year follow-up. In adjusted analyses, those children who had experienced any maltreatment and who were emotionally abused and neglected were more likely to report (1) hallucinations and lifetime delusional experiences and (2) more likely to experience lifetime psychosis than their nonabused counterparts. In expanded models, those exposed to multiple forms of maltreatment, in particular with emotional abuse and neglect, had an increased likelihood of hallucinations and delusional experiences. There is an association between child maltreatment, especially emotional abuse and neglect, and later hallucinations, delusional experiences, and psychosis. It is, however, relevant to note that the vast majority of children experiencing childhood maltreatment do not appear to develop psychotic experiences or psychotic disorder. Further research to determine the reasons for highly variable outcomes of child maltreatment is warranted.
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Affiliation(s)
- Amanuel Alemu Abajobir
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia;,To whom correspondence should be addressed; School of Public Health, The University of Queensland, Herston, 887 Public Health Building, Level 2 Herston 4006, Brisbane, Queensland 4029, Australia; tel: +61-4-940-4314, fax: +61-7-336-53344, e-mail:
| | - Steve Kisely
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia;,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James G Scott
- The University of Queensland Centre for Clinical Research, Brisbane, Queensland, Australia;,Metro North Mental Health, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Gail Williams
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Alexandra Clavarino
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, Australia
| | - Lane Strathearn
- Department of Paediatrics, Developmental and Behavioral Pediatrics, University of Iowa, Iowa City, IA
| | - Jake Moses Najman
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia;,School of Social Sciences, The University of Queensland, Brisbane, Queensland, Australia;,Queensland Alcohol and Drug Research and Education Centre, The University of Queensland, Brisbane, Queensland, Australia
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Catalan A, Angosto V, Díaz A, Valverde C, de Artaza MG, Sesma E, Maruottolo C, Galletero I, Bustamante S, Bilbao A, van Os J, Gonzalez-Torres MA. Relation between psychotic symptoms, parental care and childhood trauma in severe mental disorders. Psychiatry Res 2017; 251:78-84. [PMID: 28189941 DOI: 10.1016/j.psychres.2017.02.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 12/15/2016] [Accepted: 02/05/2017] [Indexed: 10/20/2022]
Abstract
A relation between different types of parental care, trauma in childhood and psychotic symptoms in adulthood has been proposed. The nature of this association is not clear and if it is more related to psychotic disorders per se or to a cluster of symptoms such as positive psychotic symptoms remains undefined. We have analysed the presence of childhood trauma using the CTQ scale and types of parental care using the PBI scale in three groups of subjects: borderline personality disorder patients (n=36), first psychotic episode patients (n=61) and healthy controls (n=173). Positive psychotic symptomatology was assessed with the CAPE scale. General linear models were used to study the relation between positive psychotic symptomatology and variables of interest. BPD patients had the highest rate of any kind of trauma, followed by FEP patients. We found a positive relationship between psychotic symptomatology and the existence of trauma in childhood in all groups. Moreover, an affectionless control rearing style was directly associated with the existence of trauma. Furthermore, subjects with trauma presented less probability of having an optimal parenting style in childhood. The relation between psychotic symptoms and trauma remained statistically significant after adjusting for other variables including parental rearing style. There seems to be a link between trauma in childhood and psychotic symptomatology across different populations independently of psychiatric diagnosis. Taking into account that there is an association between trauma and psychosis and that trauma is a modifiable factor, clinicians should pay special attention to these facts.
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Affiliation(s)
- Ana Catalan
- Department of Neuroscience, University of the Basque Country, Basque Country, Spain; Department of Psychiatry, Basurto University Hospital, Bilbao, Spain.
| | - Virxina Angosto
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Aida Díaz
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Cristina Valverde
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | | | - Eva Sesma
- Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | | | | | - Sonia Bustamante
- Department of Neuroscience, University of the Basque Country, Basque Country, Spain; Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Vizcaya, Spain
| | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Centre, Maastricht, The Netherlands; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom
| | - Miguel Angel Gonzalez-Torres
- Department of Neuroscience, University of the Basque Country, Basque Country, Spain; Department of Psychiatry, Basurto University Hospital, Bilbao, Spain
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21
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Honings S, Drukker M, ten Have M, de Graaf R, van Dorsselaer S, van Os J. The interplay of psychosis and victimisation across the life course: a prospective study in the general population. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1363-1374. [PMID: 28861657 PMCID: PMC5663809 DOI: 10.1007/s00127-017-1430-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/07/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE Psychosis has been associated with adult victimisation. However, it remains unclear whether psychosis predicts incident adult victimisation, or whether adult victimisation predicts incident psychosis. Furthermore, a moderating effect of childhood victimisation on the association between psychosis and adult victimisation has not been investigated. METHODS The longitudinal association between baseline psychotic experiences and six-year incidence of adult victimisation was assessed in a prospective general population cohort of 6646 adults using logistic regression analysis. The association between baseline adult victimisation and six-year incidence of psychotic experiences was examined as well. Furthermore, the moderating effect of childhood victimisation on these bidirectional associations was analysed. RESULTS Psychotic experiences and childhood victimisation were both associated with an increased risk of incident adult victimisation. However, this was through competing pathways, as suggested by a negative interaction between psychotic experiences and childhood victimisation. Baseline adult victimisation and childhood victimisation both independently increased the risk of incident psychotic experiences, but there was no interaction between adult victimisation and childhood victimisation. CONCLUSIONS Psychosis and victimisation are interconnected throughout the life course. Childhood victimisation is connected to psychosis through two pathways: one direct and one indirect through adult victimisation. In individuals without childhood victimisation, psychosis and adult victimisation bidirectionally impact on each other.
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Affiliation(s)
- Steven Honings
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Margreet ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | | | - Jim van Os
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, Maastricht, The Netherlands. .,King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK. .,Department of Psychiatry, Brain Center Rudolf Magnus Institute, University Medical Center Utrecht, PO BOX 85500, 3508 GA, Utrecht, The Netherlands.
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22
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Kim JS, Lee SH. Influence of interactions between genes and childhood trauma on refractoriness in psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2016; 70:162-9. [PMID: 26827636 DOI: 10.1016/j.pnpbp.2016.01.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/08/2016] [Accepted: 01/28/2016] [Indexed: 01/18/2023]
Abstract
Psychiatric disorders are excellent disease models in which gene-environmental interaction play a significant role in the pathogenesis. Childhood trauma has been known as a significant environmental factor in the progress of, and prognosis for psychiatric illness. Patients with refractory illness usually have more severe symptoms, greater disability, lower quality of life and are at greater risk of suicide than other psychiatric patients. Our literature review uncovered some important clinical factors which modulate response to treatment in psychiatric patients who have experienced childhood trauma. Childhood trauma seems to be a critical determinant of treatment refractoriness in psychotic disorder, bipolar disorder, major depressive disorder, and post-traumatic stress disorder. In patients with psychotic disorders, the relationship between childhood trauma and treatment-refractoriness appears to be mediated by cognitive impairment. In the case of bipolar disorder, the relationship appears to be mediated by greater affective disturbance and earlier onset, while in major depressive disorder the mediating factors are persistent, severe symptoms and frequent recurrence. In suicidal individuals, childhood maltreatment was associated with violent suicidal attempts. In the case of PTSD patients, it appears that childhood trauma makes the brain more vulnerable to subsequent trauma, thus resulting in more severe, refractory symptoms. Given that several studies have suggested that there are distinct subtypes of genetic vulnerability to childhood trauma, it is important to understand how gene-environment interactions influence the course of psychiatric illnesses in order to improve therapeutic strategies.
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Affiliation(s)
- Ji Sun Kim
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea; Department of Psychiatry, Inje University College of Medicine, Goyang, Republic of Korea
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Goyang, Republic of Korea; Department of Psychiatry, Inje University College of Medicine, Goyang, Republic of Korea.
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Gibson LE, Alloy LB, Ellman LM. Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms. Clin Psychol Rev 2016; 49:92-105. [PMID: 27632064 DOI: 10.1016/j.cpr.2016.08.003] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 06/17/2016] [Accepted: 08/30/2016] [Indexed: 01/14/2023]
Abstract
Traumatic life events have been robustly associated with various psychosis outcomes, including increased risk of psychotic disorders, the prodrome of psychosis, and dimensional measures of psychotic symptoms, such as attenuated positive psychotic symptoms. However, trauma exposure has been linked to various mental disorders; therefore, the specificity of trauma exposure to psychosis remains unclear. This review focuses on two understudied areas of the trauma and psychosis literature: 1) the specificity between trauma and psychosis in relation to other disorders that often result post-trauma, and 2) proposed mechanisms that uniquely link trauma to psychosis. We begin by discussing the underlying connection between trauma exposure and the entire psychosis spectrum with a focus on the influence of trauma type and specific psychotic symptoms. We then consider how the principles of multifinality and equifinality can be useful in elucidating the trauma-psychosis relationship versus the trauma-other disorder relationship. Next, we discuss several cognitive and neurobiological mechanisms that might uniquely account for the association between trauma and psychosis, as well as the role of gender. Lastly, we review important methodological issues that complicate the research on trauma and psychosis, ending with clinical implications for the field.
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Affiliation(s)
- Lauren E Gibson
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lauren M Ellman
- Department of Psychology, Temple University, Philadelphia, PA, USA.
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24
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Cristóbal-Narváez P, Sheinbaum T, Ballespí S, Mitjavila M, Myin-Germeys I, Kwapil TR, Barrantes-Vidal N. Impact of Adverse Childhood Experiences on Psychotic-Like Symptoms and Stress Reactivity in Daily Life in Nonclinical Young Adults. PLoS One 2016; 11:e0153557. [PMID: 27082442 PMCID: PMC4833319 DOI: 10.1371/journal.pone.0153557] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/31/2016] [Indexed: 11/19/2022] Open
Abstract
Background There is increasing interest in elucidating the association of different childhood adversities with psychosis-spectrum symptoms as well as the mechanistic processes involved. This study used experience sampling methodology to examine (i) associations of a range of childhood adversities with psychosis symptom domains in daily life; (ii) whether associations of abuse and neglect with symptoms are consistent across self-report and interview methods of trauma assessment; and (iii) the role of different adversities in moderating affective, psychotic-like, and paranoid reactivity to situational and social stressors. Method A total of 206 nonclinical young adults were administered self-report and interview measures to assess childhood abuse, neglect, bullying, losses, and general traumatic events. Participants received personal digital assistants that signaled them randomly eight times daily for one week to complete questionnaires about current experiences, including symptoms, affect, and stress. Results Self-reported and interview-based abuse and neglect were associated with psychotic-like and paranoid symptoms, whereas only self-reported neglect was associated with negative-like symptoms. Bullying was associated with psychotic-like symptoms. Losses and general traumatic events were not directly associated with any of the symptom domains. All the childhood adversities were associated with stress reactivity in daily life. Interpersonal adversities (abuse, neglect, bullying, and losses) moderated psychotic-like and/or paranoid reactivity to situational and social stressors, whereas general traumatic events moderated psychotic-like reactivity to situational stress. Also, different interpersonal adversities exacerbated psychotic-like and/or paranoid symptoms in response to distinct social stressors. Discussion The present study provides a unique examination of how childhood adversities impact the expression of spectrum symptoms in the real world and lends support to the notion that stress reactivity is a mechanism implicated in the experience of reality distortion in individuals exposed to childhood trauma. Investigating the interplay between childhood experience and current context is relevant for uncovering potential pathways to the extended psychosis phenotype.
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Affiliation(s)
- Paula Cristóbal-Narváez
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tamara Sheinbaum
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sergi Ballespí
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mercè Mitjavila
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Thomas R. Kwapil
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychology, University of North Carolina at Greensboro, Greensboro, North Carolina, United States of America
- Sant Pere Claver – Fundació Sanitària, Barcelona, Spain
- Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- * E-mail:
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Woodberry KA, Shapiro DI, Bryant C, Seidman LJ. Progress and Future Directions in Research on the Psychosis Prodrome: A Review for Clinicians. Harv Rev Psychiatry 2016; 24:87-103. [PMID: 26954594 PMCID: PMC4870599 DOI: 10.1097/hrp.0000000000000109] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
LEARNING OBJECTIVES After participating in this activity, learners should be better able to: ABSTRACT The psychosis prodrome, or period of clinical and functional decline leading up to acute psychosis, offers a unique opportunity for identifying mechanisms of psychosis onset and for testing early-intervention strategies. We summarize major findings and emerging directions in prodromal research and provide recommendations for clinicians working with individuals suspected to be at high risk for psychosis. The past two decades of research have led to three major advances. First, tools and criteria have been developed that can reliably identify imminent risk for a psychotic disorder. Second, longitudinal clinical and psychobiological data from large multisite studies are strengthening individual risk assessment and offering insights into potential mechanisms of illness onset. Third, psychosocial and pharmacological interventions are demonstrating promise for delaying or preventing the onset of psychosis in help-seeking, high-risk individuals. The dynamic psychobiological processes implicated in both risk and onset of psychosis, including altered gene expression, cognitive dysfunction, inflammation, gray and white matter brain changes, and vulnerability-stress interactions suggest a wide range of potential treatment targets and strategies. The expansion of resources devoted to early intervention and prodromal research worldwide raises hope for investigating them. Future directions include identifying psychosis-specific risk and resilience factors in children, adolescents, and non-help-seeking community samples, improving study designs to test hypothesized mechanisms of change, and intervening with strategies that, in order to improve functional outcomes, better engage youth, address their environmental contexts, and focus on evidence-based neurodevelopmental targets. Prospective research on putatively prodromal samples has the potential to substantially reshape our understanding of mental illness and our efforts to combat it.
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Affiliation(s)
- Kristen A Woodberry
- From Harvard Medical School (Drs. Woodberry, Shapiro, and Seidman) and Beth Israel Deaconess Medical Center (Drs. Woodberry, Shapiro, and Seidman, and Ms. Bryant)
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DeVylder JE, Jahn DR, Doherty T, Wilson CS, Wilcox HC, Schiffman J, Hilimire MR. Social and psychological contributions to the co-occurrence of sub-threshold psychotic experiences and suicidal behavior. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1819-30. [PMID: 26493307 DOI: 10.1007/s00127-015-1139-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 12/21/2022]
Abstract
PURPOSE Psychotic experiences and suicidal behavior commonly co-occur in the general population, which can have implications for suicide prevention approaches. However, little is known about the nature of this relation in non-clinical samples. This cross-sectional study aimed to address a research gap by testing whether the relation between psychotic experiences and suicide-related outcomes (ideation, intent, and attempts) is explained by common social and psychological factors. METHODS Young adult college students (N = 590) were assessed for psychotic experiences, suicidal behavior, and a comprehensive set of 24 potential shared risk factors selected through review of past epidemiological studies and meta-analyses. Nonparametric bootstrapped regression models were used to examine whether these factors attenuated or eliminated the associations between psychotic experiences and suicide-related outcomes. RESULTS Psychotic experiences were associated with greater risk for suicidal ideation and behaviors. Adjustment for psychosocial factors, particularly those contributing to cumulative stress, accounted for the associations between psychotic experiences and suicide-related outcomes, except broadly defined suicidal ideation. CONCLUSIONS These results suggest that the robust associations between psychotic experiences and suicidal behavior demonstrated in past studies may be primarily explained by shared risk factors, rather than by causal relations. In our sample, suicidal behavior and sub-threshold psychosis appear to be trans diagnostic clinical outcomes that share common causes, notably cumulative stress, but do not cause one another.
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Affiliation(s)
- Jordan E DeVylder
- School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA.
| | - Danielle R Jahn
- VA Capitol Health Care Network (VISN 5) Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA.,Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tracie Doherty
- School of Social Work, University of Maryland, 525 W Redwood Street, Baltimore, MD, 21201, USA
| | - Camille S Wilson
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jason Schiffman
- Department of Psychology, University of Maryland Baltimore County, Baltimore, MD, USA
| | - Matthew R Hilimire
- Department of Psychology, The College of William and Mary, Williamsburg, VA, USA
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27
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Psychotic experiences in the population: Association with functioning and mental distress. Schizophr Res 2015; 165:9-14. [PMID: 25868930 DOI: 10.1016/j.schres.2015.03.020] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 03/03/2015] [Accepted: 03/22/2015] [Indexed: 11/23/2022]
Abstract
Psychotic experiences are far more common in the population than psychotic disorder. They are associated with a number of adverse outcomes but there has been little research on associations with functioning and distress. We wished to investigate functioning and distress in a community sample of adolescents with psychotic experiences. Two hundred and twelve school-going adolescents were assessed for psychotic experiences, mental distress associated with these experiences, global (social/occupational) functioning on the Children's Global Assessment Scale, and a number of candidate mediator variables, including psychopathology, suicidality, trauma (physical and sexual abuse and exposure to domestic violence) and neurocognitive functioning. Seventy five percent of participants who reported psychotic experiences reported that they found these experiences distressing (mean score for severity of distress was 6.9 out of maximum 10). Participants who reported psychotic experiences had poorer functioning than participants who did not report psychotic experiences (respective means: 68.6, 81.9; OR=0.25, 95% CI=0.14-0.44). Similarly, participants with an Axis-1 psychiatric disorder who reported psychotic experiences had poorer functioning than participants with a disorder who did not report psychotic experiences (respective means: 61.8, 74.5; OR=0.28, 95% CI=0.12-0.63). Candidate mediator variables explained some but not all of the relationship between psychotic experiences and functioning (OR=0.48, 95% CI=0.22-1.05, P<0.07). Young people with psychotic experiences have poorer global functioning than those who do not, even when compared with other young people with psychopathology (but who do not report psychotic experiences). A disclosure of psychotic experiences should alert treating clinicians that the individual may have significantly more functional disability than suggested by the psychopathological diagnosis alone.
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28
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de Bont PAJM, van den Berg DPG, van der Vleugel BM, de Roos C, de Jongh A, van der Gaag M, van Minnen A. Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. Br J Psychiatry 2015; 206:408-16. [PMID: 25792693 DOI: 10.1192/bjp.bp.114.148486] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 01/15/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is highly prevalent in patients with a psychotic disorder. Because a PTSD diagnosis is often missed in patients with psychosis in routine care, a valid screening instrument could be helpful. AIMS To determine the validity of the Trauma Screening Questionnaire (TSQ) as a screening tool for PTSD among individuals with psychotic disorders. METHOD Among 2608 patients with a psychotic disorder, the rate of trauma exposure was determined and the TSQ was administered to screen for PTSD. PTSD status was verified in 455 patients using the Clinician-Administered PTSD Scale (trial registration: ISRCTN 79584912). RESULTS Trauma exposure was reported by 78.2% of the 2608 patients. PTSD prevalence was estimated at 16% (95% CI 14.6-17.4%) compared with 0.5% reported in the patients' clinical charts. A TSQ cut-off score of six predicted PTSD with 78.8% sensitivity, 75.6% specificity, 44.5% correct positives and 93.6% correct negatives. CONCLUSIONS The TSQ seems to be a valid screening tool for PTSD in patients with a psychotic disorder.
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Affiliation(s)
- Paul A J M de Bont
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - David P G van den Berg
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Berber M van der Vleugel
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Carlijn de Roos
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Ad de Jongh
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Mark van der Gaag
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
| | - Agnes van Minnen
- Paul A. J. M. de Bont, MSc, Community Mental Health Service GGZ Oost Brabant Land van Cuijk en Noord Limburg, Boxmeer and Radboud University Nijmegen, Behavioural Science Institute, NijCare, The Netherlands; David P. G. van den Berg, MSc, Parnassia Psychiatric Institute, Den Haag, The Netherlands; Berber M. van der Vleugel, MSc, Community Mental Health Service GGZ Noord-Holland Noord, Alkmaar, The Netherlands; Carlijn de Roos, MSc, MHO Rivierduinen, Leiden, The Netherlands; Ad de Jongh, PhD, Department of Behavioral Sciences, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands and School of Health Sciences, Salford University, Manchester, UK; Mark van der Gaag, PhD, VU University Amsterdam and EMGO Institute for Health and Care Research, Department of Clinical Psychology, Amsterdam and Parnassia Psychiatric Institute, Den Haag, The Netherlands; Agnes van Minnen, PhD, Radboud University Nijmegen, Behavioural Science Institute, NijCare and MHO 'Pro Persona', Centre for Anxiety Disorders Netherlands, Nijmegen, The Netherlands
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Upthegrove R, Chard C, Jones L, Gordon-Smith K, Forty L, Jones I, Craddock N. Adverse childhood events and psychosis in bipolar affective disorder. Br J Psychiatry 2015; 206:191-7. [PMID: 25614532 DOI: 10.1192/bjp.bp.114.152611] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There has been increasing interest in the association between childhood trauma and psychosis. Proposals for potential mechanisms involved include affective dysregulation and cognitive appraisals of threat. AIMS To establish if, within bipolar disorder, childhood events show a significant association with psychosis, and in particular with symptoms driven by dysregulation of mood or with a persecutory content. METHOD Data on lifetime-ever presence of psychotic symptoms were determined by detailed structured interview with case-note review (n = 2019). Childhood events were recorded using a self-report questionnaire and case-note information. RESULTS There was no relationship between childhood events, or childhood abuse, and psychosis per se. Childhood events were not associated with an increased risk of persecutory or other delusions. Significant associations were found between childhood abuse and auditory hallucinations, strongest between sexual abuse and mood congruent or abusive voices. These relationships remain significant even after controlling for lifetime-ever cannabis misuse. CONCLUSIONS Within affective disorder, the relationship between childhood events and psychosis appears to be relatively symptom-specific. It is possible that the pathways leading to psychotic symptoms differ, with delusions and non-hallucinatory symptoms being influenced less by childhood or early environmental experience.
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Affiliation(s)
- Rachel Upthegrove
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Christine Chard
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Lisa Jones
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Katherine Gordon-Smith
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Liz Forty
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Ian Jones
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
| | - Nick Craddock
- Rachel Upthegrove, MRCPsych, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, Bipolar Disorder Research Network and Early Intervention Service, Birmingham and Solihull Mental Health Foundation Trust, Birmingham; Christine Chard, BMedSc, Lisa Jones, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham and Bipolar Disorder Research Network; Katherine Gordon-Smith, PhD, Department of Psychiatry, School of Clinical & Experimental Medicine, University of Birmingham, Birmingham, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK; Liz Forty, PhD, Ian Jones, MRCPsych, PhD, Nick Craddock, FRCPsych, PhD, FMedSci, National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff and Bipolar Disorder Research Network, UK
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Patterson ML, Moniruzzaman A, Somers JM. History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk. BMC Psychiatry 2015; 15:32. [PMID: 25884810 PMCID: PMC4349718 DOI: 10.1186/s12888-015-0411-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 02/13/2015] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND It is well documented that a disproportionate number of homeless adults have childhood histories of foster care placement(s). This study examines the relationship between foster care placement as a predictor of adult substance use disorders (including frequency, severity and type), mental illness, vocational functioning, service use and duration of homelessness among a sample of homeless adults with mental illness. We hypothesize that a history of foster care predicts earlier, more severe and more frequent substance use, multiple mental disorder diagnoses, discontinuous work history, and longer durations of homelessness. METHODS This study was conducted using baseline data from two randomized controlled trials in Vancouver, British Columbia for participants who responded to a series of questions pertaining to out-of-home care at 12 months follow-up (n = 442). Primary outcomes included current mental disorders; substance use including type, frequency and severity; physical health; duration of homelessness; vocational functioning; and service use. RESULTS In multivariable regression models, a history of foster care placement independently predicted incomplete high school, duration of homelessness, discontinuous work history, less severe types of mental illness, multiple mental disorders, early initiation of drug and/or alcohol use, and daily drug use. CONCLUSIONS This is the first Canadian study to investigate the relationship between a history of foster care and current substance use among homeless adults with mental illness, controlling for several other potential confounding factors. It is important to screen homeless youth who exit foster care for substance use, and to provide integrated treatment for concurrent disorders to homeless youth and adults who have both psychiatric and substance use problems. TRIALS REGISTRATION NUMBERS Both trials are registered with the International Standard Randomized Control Trial Number Register and were assigned ISRCTN57595077 (Vancouver At Home Study: Housing First plus assertive community treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home Study: Housing First plus intensive case management versus treatment as usual) on September 9, 2012.
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Affiliation(s)
- Michelle L Patterson
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British, Columbia, Canada.
| | - Akm Moniruzzaman
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British, Columbia, Canada.
| | - Julian M Somers
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British, Columbia, Canada.
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Stress exposure and sensitivity in the clinical high-risk syndrome: initial findings from the North American Prodrome Longitudinal Study (NAPLS). Schizophr Res 2014; 160:104-9. [PMID: 25443665 PMCID: PMC4593703 DOI: 10.1016/j.schres.2014.09.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 08/28/2014] [Accepted: 09/04/2014] [Indexed: 01/02/2023]
Abstract
There is inconsistent evidence for increased stress exposure among individuals at clinical high risk (CHR) for psychosis. Yet similar to patients with a diagnosed psychotic illness, the preponderance of evidence suggests that CHR individuals tend to experience stressful life events (LE) and daily hassles (DH) as more subjectively stressful than healthy individuals. The present study utilizes data from the North American Prodrome Longitudinal Study Phase 2 (NAPLS-2) to test the hypotheses that (1) CHR individuals manifest higher self-reported stress in response to both LE and DH when compared to healthy controls (HC), (2) group differences in self-reported stress increase with age, (3) baseline self-reported stress is associated with follow-up clinical status, and (4) there is a sensitization effect of LE on the response to DH. In contrast to some previous research, the present findings indicate that the CHR group (N=314) reported exposure to more LE when compared to the HC group (N=162). As predicted, CHR participants rated events as more stressful, and those who progressed to psychosis reported a greater frequency of LE and greater stress from events compared to those whose prodromal symptoms remitted. There was also some evidence of stress-sensitization; those who experienced more stress from LE rated current DH as more stressful. The results indicate that the "prodromal" phase is a period of heightened stress and stress sensitivity, and elevated cumulative lifetime exposure to stressful events may increase reactions to current stressors.
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DeVylder JE, Burnette D, Yang LH. Co-occurrence of psychotic experiences and common mental health conditions across four racially and ethnically diverse population samples. Psychol Med 2014; 44:3503-3513. [PMID: 25065632 DOI: 10.1017/s0033291714000944] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prior research with racially/ethnically homogeneous samples has demonstrated widespread co-occurrence of psychotic experiences (PEs) and common mental health conditions, particularly multi-morbidity, suggesting that psychosis may be related to the overall severity of psychiatric disorder rather than any specific subtype. In this study we aimed to examine whether PEs are associated with the presence of specific disorders or multi-morbidity of co-occurring disorders across four large racially/ethnically diverse samples of adults in the USA. METHOD Data were drawn from the National Comorbidity Survey Replication (NCS-R), the National Survey of American Life (NSAL) and separately from the Asian and Latino subsamples of the National Latino and Asian American Study (NLAAS). Logistic regression models were used to examine the relationship between PEs and individual subtypes of DSM-IV disorder, and to test for a linear dose-response relationship between the number of subtypes and PEs. RESULTS Prevalence of PEs was moderately greater among individuals with each subtype of disorder in each data set [odds ratios (ORs) 1.8-3.8], although associations were only variably significant when controlling for clinical and demographic variables. However, the sum of disorder subtypes was related to odds for PEs in a linear dose-response fashion across all four samples. CONCLUSIONS PEs are related primarily to the extent or severity of psychiatric illness, as indicated by the presence of multiple psychiatric disorders, rather than to any particular subtype of disorder in these data. This relationship applies to the general population and across diverse racial/ethnic groups.
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Affiliation(s)
- J E DeVylder
- Columbia University School of Social Work,New York, NY,USA
| | - D Burnette
- Columbia University School of Social Work,New York, NY,USA
| | - L H Yang
- Mailman School of Public Health,Columbia University,New York, NY,USA
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Brain derived Neurotropic Factor (BDNF) is associated with childhood abuse but not cognitive domains in first episode psychosis. Schizophr Res 2014; 159:56-61. [PMID: 25171858 DOI: 10.1016/j.schres.2014.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/13/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Brain-derived Neurotrophic Factor (BDNF) modulates cognitive processes and is associated with increased risk of schizophrenia. Childhood trauma (CT) is frequent in patients with psychosis and severely affects course and outcome. AIMS We investigated the hypothesis that BDNF is associated with both CT and cognitive deficits in a sample of first-episode psychosis (FEP) cases and unaffected controls. METHOD Participants with FEP and healthy controls were recruited between August 2008 and July 2011 from South London, UK. Childhood traumatic events were detected using the Childhood Experience of Care and Abuse Questionnaire (CECA-Q). Neuropsychological data were also collected. BDNF plasma levels were measured from fasting blood samples. RESULTS Data were available on 87 FEP patients and 152 controls. Our results showed a significant effect of separation (F=5.5; df=1,115; p=.02), physical (F=4.7; df=1, 118; p=.03) and sexual abuse (F=5.4; df=1,117; p=.02) on BDNF levels with lower levels among those who experienced the traumatic event compared to those who did not. Physical abuse predicted lower plasma levels of BDNF (β=-.30; p=.03) whereas sexual and/or physical abuse showed a trend (β=-.26; p=.06) in FEP patients but not in unaffected controls. No association between BDNF plasma levels and cognitive functions was found among patients with FEP and controls. CONCLUSION Our findings suggest the possible involvement of BDNF in the onset of first-episode psychosis in individuals exposed to early trauma and propose BDNF as a potential clinical biomarker to detect the detrimental effects of CT on human brain plasticity.
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Refining and integrating schizophrenia pathophysiology – Relevance of the allostatic load concept. Neurosci Biobehav Rev 2014; 45:183-201. [DOI: 10.1016/j.neubiorev.2014.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 04/02/2014] [Accepted: 06/09/2014] [Indexed: 12/20/2022]
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Abstract
Psychotic disorders continue to be among the most disabling and scientifically challenging of all mental illnesses. Accumulating research findings suggest that the etiologic processes underlying the development of these disorders are more complex than had previously been assumed. At the same time, this complexity has revealed a wider range of potential options for preventive intervention, both psychosocial and biological. In part, these opportunities result from our increased understanding of the dynamic and multifaceted nature of the neurodevelopmental mechanisms involved in the disease process, as well as the evidence that many of these entail processes that are malleable. In this article, we review the burgeoning research literature on the prodrome to psychosis, based on studies of individuals who meet clinical high risk criteria. This literature has examined a range of factors, including cognitive, genetic, psychosocial, and neurobiological. We then turn to a discussion of some contemporary models of the etiology of psychosis that emphasize the prodromal period. These models encompass the origins of vulnerability in fetal development, as well as postnatal stress, the immune response, and neuromaturational processes in adolescent brain development that appear to go awry during the prodrome to psychosis. Then, informed by these neurodevelopmental models of etiology, we turn to the application of new research paradigms that will address critical issues in future investigations. It is expected that these studies will play a major role in setting the stage for clinical trials aimed at preventive intervention.
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van Vugt RWM, Meyer F, van Hulten JA, Vernooij J, Cools AR, Verheij MMM, Martens GJM. Maternal care affects the phenotype of a rat model for schizophrenia. Front Behav Neurosci 2014; 8:268. [PMID: 25157221 PMCID: PMC4128220 DOI: 10.3389/fnbeh.2014.00268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/20/2014] [Indexed: 12/14/2022] Open
Abstract
Schizophrenia is a complex mental disorder caused by an interplay between genetic and environmental factors, including early postnatal stressors. To explore this issue, we use two rat lines, apomorphine-susceptible (APO-SUS) rats that display schizophrenia-relevant features and their phenotypic counterpart, apomorphine-unsusceptible (APO-UNSUS) rats. These rat lines differ not only in their gnawing response to apomorphine, but also in their behavioral response to novelty (APO-SUS: high, APO-UNSUS: low). In this study, we examined the effects of early postnatal cross-fostering on maternal care and on the phenotypes of the cross-fostered APO-SUS and APO-UNSUS animals later in life. Cross-fostered APO-UNSUS animals showed decreased body weights as pups and decreased novelty-induced locomotor activity as adults (i.e., more extreme behavior), in accordance with the less appropriate maternal care provided by APO-SUS vs. their own APO-UNSUS mothers (i.e., the APO-SUS mother displayed less non-arched-back nursing and more self-grooming, and was more away from its nest). In contrast, cross-fostered APO-SUS animals showed increased body weights as pups and reduced apomorphine-induced gnawing later in life (i.e., normalization of their extreme behavior), in line with the more appropriate maternal care provided by APO-UNSUS relative to their own APO-SUS mothers (i.e., the APO-UNSUS mother displayed more non-arched-back nursing and similar self-grooming, and was not more away). Furthermore, we found that, in addition to arched-back nursing, non-arched-back nursing was an important feature of maternal care, and that cross-fostering APO-SUS mothers, but not cross-fostering APO-UNSUS mothers, displayed increased apomorphine-induced gnawing. Thus, cross-fostering not only causes early postnatal stress shaping the phenotypes of the cross-fostered animals later in life, but also affects the phenotypes of the cross-fostering mothers.
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Affiliation(s)
- Ruben W M van Vugt
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen, Netherlands
| | - Francisca Meyer
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen, Netherlands
| | - Josephus A van Hulten
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen, Netherlands
| | - Jeroen Vernooij
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen, Netherlands
| | - Alexander R Cools
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands
| | - Michel M M Verheij
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre Nijmegen, Netherlands ; Committee on the Neurobiology of Addictive Disorders, The Scripps Research Institute La Jolla, CA, USA
| | - Gerard J M Martens
- Department of Molecular Animal Physiology, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Radboud University Nijmegen, Netherlands
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Holtzman CW, Trotman HD, Goulding SM, Ryan AT, Macdonald AN, Shapiro DI, Brasfield JL, Walker EF. Stress and neurodevelopmental processes in the emergence of psychosis. Neuroscience 2013; 249:172-91. [PMID: 23298853 PMCID: PMC4140178 DOI: 10.1016/j.neuroscience.2012.12.017] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 11/24/2012] [Accepted: 12/02/2012] [Indexed: 11/28/2022]
Abstract
The notion that stress plays a role in the etiology of psychotic disorders, especially schizophrenia, is longstanding. However, it is only in recent years that the potential neural mechanisms mediating this effect have come into sharper focus. The introduction of more sophisticated models of the interplay between psychosocial factors and brain function has expanded our opportunities for conceptualizing more detailed psychobiological models of stress in psychosis. Further, scientific advances in our understanding of adolescent brain development have shed light on a pivotal question that has challenged researchers; namely, why the first episode of psychosis typically occurs in late adolescence/young adulthood. In this paper, we begin by reviewing the evidence supporting associations between psychosocial stress and psychosis in diagnosed patients as well as individuals at clinical high risk for psychosis. We then discuss biological stress systems and examine changes that precede and follow psychosis onset. Next, research findings on structural and functional brain characteristics associated with psychosis are presented; these findings suggest that normal adolescent neuromaturational processes may go awry, thereby setting the stage for the emergence of psychotic syndromes. Finally, a model of neural mechanisms underlying the pathogenesis of psychosis is presented and directions for future research strategies are explored.
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Affiliation(s)
- C. W. Holtzman
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - H. D. Trotman
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - S. M. Goulding
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - A. T. Ryan
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - A. N. Macdonald
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - D. I. Shapiro
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - J. L. Brasfield
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
| | - E. F. Walker
- Department of Psychology, Emory University, 36 Eagle Row, Atlanta, GA 30322, United States
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Brietzke E, Kauer Sant'anna M, Jackowski A, Grassi-Oliveira R, Bucker J, Zugman A, Mansur RB, Bressan RA. Impact of childhood stress on psychopathology. BRAZILIAN JOURNAL OF PSYCHIATRY 2013; 34:480-8. [PMID: 23429820 DOI: 10.1016/j.rbp.2012.04.009] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Accepted: 04/16/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Advances in our knowledge of mental disorder (MD) genetics have contributed to a better understanding of their pathophysiology. Nonetheless, several questions and doubts persist. Recent studies have focused on environmental influences in the development of MDs, and the advent of neuroscientific methodologies has provided new perspectives. Early life events, such as childhood stress, may affect neurodevelopment through mechanisms such as gene-environment interactions and epigenetic regulation, thus leading to diseases in adulthood. The aim of this paper is to review the evidence regarding the role of the environment, particularly childhood stress, in the pathophysiology of MD. METHODOLOGY We reviewed articles that evaluated environmental influences, with a particular focus on childhood trauma, brain morphology, cognitive functions, and the development of psychopathology and MD. RESULTS AND CONCLUSION MRI studies have shown that exposure to trauma at an early age can result in several neurostructural changes, such as the reduction of the hippocampus and corpus callosum. Cognitive performance and functioning are also altered in this population. Finally, childhood stress is related to an increased risk of developing MD such as depression, bipolar disorder, schizophrenia and substance abuse. We conclude that there is robust evidence of the role of the environment, specifically adverse childhood experiences, in various aspects of MD.
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Affiliation(s)
- Elisa Brietzke
- Recognition and Intervention in Individuals in at-Risk Mental States, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil.
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Linscott RJ, van Os J. An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol Med 2013; 43:1133-1149. [PMID: 22850401 DOI: 10.1017/s0033291712001626] [Citation(s) in RCA: 759] [Impact Index Per Article: 69.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The psychosis-proneness-persistence-impairment model of psychotic disorder incorporates notions of both phenomenological and temporal continuity (persistence) of psychotic experiences (PE), but not structural continuity. Specific testable propositions of phenomenological continuity and persistence are identified. Method Propositions are tested by systematic reviews of the epidemiology of PE, persistence of PE and disorder outcomes, and meta-analyses (including Monte Carlo permutation sampling, MCPS) of reported rates and odds ratios (ORs). RESULTS Estimates of the incidence and prevalence of PE obtained from 61 cohorts revealed a median annual incidence of 2.5% and a prevalence of 7.2%. Meta-analysis of risk factors identified age, minority or migrant status, income, education, employment, marital status, alcohol use, cannabis use, stress, urbanicity and family history of mental illness as important predictors of PE. The mode of assessment accounted for significant variance in the observed rates. Across cohorts, the probability of persistence was very strongly related to the rate of PE at baseline. Of those who report PE, ∼20% go on to experience persistent PE whereas for ∼80%, PE remit over time. Of those with baseline PE, 7.4% develop a psychotic disorder outcome. CONCLUSIONS Compelling support is found for the phenomenological and temporal continuity between PE and psychotic disorder and for the fundamental proposition that this relationship is probabilistic. However, imprecision in epidemiological research design, measurement limitations and the epiphenomenological nature of PE invite further robust scrutiny of the continuity theory.
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Affiliation(s)
- R J Linscott
- Department of Psychology, University of Otago, New Zealand
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Abstract
We examined the prevalence of childhood (≤ 18 years) physical and sexual abuse reported among patients admitted to the psychiatric inpatient service and the differential rates of this abuse associated with psychiatric diagnoses. This study consisted of a retrospective chart review of 603 patients admitted to a psychiatric ward during a period of 1 year at Atlanta Veterans Affairs Medical Center who had data on childhood physical and sexual abuse. The prevalence of reported childhood physical or sexual abuse in this inpatient clinical population was 19.4% (117/603). The prevalence of reported physical abuse was 22.6% (19/84) in the women and 12.0% (62/519) in the men (p = 0.008); the prevalence of sexual abuse was 33.3% (28/84) in the women and 7.7% (40/519) in the men (p < 0.0001). More patients with depressive disorders reported sexual abuse than did those without these disorders. More patients with posttraumatic stress disorder (PTSD) reported physical and sexual abuse than did those without these disorders. Stratifying by race, sex, and diagnoses, multivariate analyses showed that the women with PTSD had a greater likelihood to report physical abuse (p = 0.03) and sexual abuse histories (p = 0.008) than did the women without PTSD. The men with substance-induced mood disorder (p = 0.01) were more likely to report physical abuse compared with the men without substance-induced mood disorder. Screening for abuse in patients with depressive disorders and PTSD is warranted to tailor individualized treatments for these patients. More research is needed to better understand the potential implications of childhood abuse on psychiatric diagnoses.
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Trauma profile in Egyptian adolescents with first-episode schizophrenia: relation to psychopathology and plasma brain-derived neurotrophic factor. J Nerv Ment Dis 2013; 201:23-9. [PMID: 23274291 DOI: 10.1097/nmd.0b013e31827ab268] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
We aimed to investigate the relation of trauma profile to schizophrenia psychopathology in a sample of Egyptian drug-naïve adolescent patients with first-episode schizophrenia. In addition, a hypothesized mediating effect of brain-derived neurotrophic factor (BDNF) in this relation was formally tested. We assessed 74 eligible outpatients using the Positive and Negative Syndrome Scale (PANSS) for measuring psychopathology. Trauma histories were recorded with the help of the Cumulative Trauma Measure. Serum BDNF levels were estimated by enzyme-linked immunosorbent assay. Total cumulative trauma, personal identity trauma, and survival trauma were found to be the significant predictors for schizophrenia psychopathology. BDNF fully mediated the associations between total cumulative trauma and overall schizophrenia psychopathology. BDNF also mediated the associations between some types of trauma and both PANSS-positive and PANSS-negative symptom factors. We concluded that total cumulative trauma and certain trauma types are linked with schizophrenia psychopathology. BDNF appears to mediate these links.
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van Winkel R, van Nierop M, Myin-Germeys I, van Os J. Childhood trauma as a cause of psychosis: linking genes, psychology, and biology. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:44-51. [PMID: 23327756 DOI: 10.1177/070674371305800109] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent studies have provided robust evidence for an association between childhood trauma (CT) and psychosis. Meta-analyses have quantified the association, pointing to odds ratios in the order of around 3, and prospective studies have shown that reverse causation is unlikely to explain the association. However, more work is needed to address the possibility of a gene-environment correlation, that is, whether genetic risk for psychosis predicts exposure to CT. Nevertheless, multiple studies have convincingly shown that the association between CT and psychosis remains strong and significant when controlling for genetic risk, in agreement with a possible causal association. In addition, several studies have shown plausible psychological and neurobiological mechanisms linking adverse experiences to psychosis, including induction of social defeat and reduced self-value, sensitization of the mesolimbic dopamine system, changes in the stress and immune system, and concomitant changes in stress-related brain structures, such as the hippocampus and the amygdala, findings that should be integrated, however, in more complex models of vulnerability. It is currently unclear whether genetic vulnerability plays a role in conferring the mental consequences of adversity, and which genes are likely to be involved. The current, limited evidence points to genes that are not specifically involved in psychosis but more generally in regulating mood (serotonin transporter gene), neuroplasticity (brain-derived neurotrophic factor), and the stress-response system (FKBP5), in line with a general effect of CT on a range of mental disorders, rather than suggesting specificity for psychosis.
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Affiliation(s)
- Ruud van Winkel
- Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, European Graduate School of Neuroscience, EURON, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Kapfhammer HP. [Trauma and psychosis--part 2. On the association of early childhood maltreatment and risk of psychosis in general population]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2012; 27:21-37. [PMID: 23055282 DOI: 10.1007/s40211-012-0031-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
Abstract
Any association of early childhood maltreatment and later risk of psychosis may be favourably investigated by epidemiological studies in the general population. Primary outcome variable in these studies is the prevalence of subclinical psychotic symptoms (hallucinations, delusions) in early trauma-exposed groups compared to control groups without any significant trauma in childhood. A systematic literature search underlines a significant association of early childhood trauma and later non-clinical psychotic symptoms in representative samples of the general population both during childhood, adolescence and adulthood. Important questions deal with the issues, which psychological, psychosocial and neurobiological mechanisms may mediate the risk of early trauma in respect of later psychotic symptoms on the one side, and which factors may determine the transition from non-clinical psychotic symptoms to major psychotic disorders cared for within mental health services. Both theoretical models and first data derived from empirical studies will be presented.
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Affiliation(s)
- Hans-Peter Kapfhammer
- Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich.
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Dennison U, McKernan D, Cryan J, Dinan T. Schizophrenia patients with a history of childhood trauma have a pro-inflammatory phenotype. Psychol Med 2012; 42:1865-1871. [PMID: 22357348 DOI: 10.1017/s0033291712000074] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing evidence indicates that childhood trauma is a risk factor for schizophrenia and patients with this syndrome have a pro-inflammatory phenotype. We tested the hypothesis that the pro-inflammatory phenotype in schizophrenia is associated with childhood trauma and that patients without a history of such trauma have a similar immune profile to healthy controls. METHOD We recruited 40 schizophrenia patients and 40 controls, all of whom completed the Childhood Trauma Questionnaire (CTQ). Using enzyme-linked immunosorbent assay (ELISA) techniques, we measured peripheral levels of interleukin (IL)-1β, IL-6, IL-8 and tumour necrosis factor (TNF)-α. These immune parameters were compared in schizophrenia with childhood trauma, schizophrenia without childhood trauma and healthy controls. RESULTS Patients with childhood trauma had higher levels of IL-6 and TNF-α than patients without trauma and healthy controls, and TNF-α levels correlated with the extent of the trauma. Patients with no trauma had similar immune profiles to controls. CONCLUSIONS Childhood trauma drives changes, possibly epigenetic, that generate a pro-inflammatory phenotype.
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Affiliation(s)
- U Dennison
- Department of Psychiatry, University College Cork, Cork, Ireland.
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Sideli L, Mule A, La Barbera D, Murray RM. Do child abuse and maltreatment increase risk of schizophrenia? Psychiatry Investig 2012; 9:87-99. [PMID: 22707958 PMCID: PMC3372572 DOI: 10.4306/pi.2012.9.2.87] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 01/18/2012] [Accepted: 01/18/2012] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Although childhood abuse is a recognised risk factor for depression, post-traumatic stress disorder, and substance misuse, its role in the aetiology of psychotic disorder remained controversial. This is in part because the putative effect of childhood trauma on psychosis has been mostly evaluated by small, cross sectional, uncontrolled studies that raised methodological issues. METHODS Papers concerning the association between childhood trauma and psychotic disorders (to November, 2011) were identified using a comprehensive search of PubMed, Psychinfo, and Scopus and analysing reference list of relevant papers. A narrative synthesis was used to summarise results. RESULTS An association between childhood abuse and psychotic symptoms was consistently reported by large cross sectional surveys with an effect ranging from 1.7 to 15. However, we cannot conclude that the relationship is causal as lack of longitudinal studies prevent us from fully excluding alternative explanations such as reverse causality. Gender, cannabis use, and depressive and post-traumatic stress disorder symptoms appear to moderate the effect of childhood trauma on psychotic disorders. However, specificity of childhood abuse in psychotic disorders and, particularly, in schizophrenia has not been demonstrated. CONCLUSION Although the association between childhood abuse and psychosis has been replicated, the etiological role of such early adversity has yet to be fully clarified. So far none of the studies reported support the hypothesis that childhood abuse is either sufficient or necessary to develop a psychotic disorder. It seems likely that any effect of childhood abuse on schizophrenia needs to be understood in terms of genetic susceptibility and interaction with other environmental risk factors.
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Affiliation(s)
- Lucia Sideli
- Institute of Psychiatry, King's College London, London, UK
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Alice Mule
- Institute of Psychiatry, King's College London, London, UK
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Daniele La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
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Husted JA, Ahmed R, Chow EW, Brzustowicz LM, Bassett AS. Early environmental exposures influence schizophrenia expression even in the presence of strong genetic predisposition. Schizophr Res 2012; 137:166-8. [PMID: 22381191 PMCID: PMC3436901 DOI: 10.1016/j.schres.2012.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/27/2022]
Abstract
There are few studies of environmental factors in familial forms of schizophrenia. We investigated whether childhood adversity or environmental factors were associated with schizophrenia in a familial sample where schizophrenia is associated with the NOSA1P gene. We found that a cumulative adversity index including childhood illness, family instability and cannabis use was significantly associated with narrow schizophrenia, independent of NOSA1P risk genotype, previously measured childhood trauma, covariates and familial clustering (adjusted odds ratio (95% confidence interval)=1.55 (1.01, 2.38)). The results provide further support that early environmental exposures influence schizophrenia expression even in the presence of strong genetic predisposition.
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Affiliation(s)
- Janice A. Husted
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada,Corresponding author at: University of Waterloo, School of Public Health and Health Systems, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1. Tel.: +1 519 888 4567; fax: +1 519 746 2510. (J.A. Husted)
| | - Rashid Ahmed
- Department of Statistics, University of Waterloo, Waterloo, Ontario, Canada
| | - Eva W.C. Chow
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Anne S. Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Lataster J, Myin-Germeys I, Lieb R, Wittchen HU, van Os J. Adversity and psychosis: a 10-year prospective study investigating synergism between early and recent adversity in psychosis. Acta Psychiatr Scand 2012; 125:388-99. [PMID: 22128839 DOI: 10.1111/j.1600-0447.2011.01805.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Recent studies have suggested that early adverse events, such as childhood trauma, may promote enduring liability for psychosis whereas more recent adverse events may act as precipitants. Examination of these environmental dynamics, however, requires prospective studies in large samples. This study examines whether the association between recent adverse events and psychosis is moderated by exposure to early adversity. METHOD A random regional representative population sample of 3021 adolescents and young adults in Munich, Germany, was assessed three times over a period of up to 10 years, collecting information on sociodemographic factors, environmental exposures, and measures of psychopathology and associated clinical relevance. Evidence of statistical non-additivity between early adversity (two levels) and more recent adversity (four levels) was assessed in models of psychotic symptoms. Analyses were a priori corrected for age, gender, cannabis use, and urbanicity. RESULTS Early and recent adversity were associated with each other (RR = 1.32, 95% CI 1.06-1.66; P = 0.014) and displayed statistical non-additivity at the highest level of exposure to recent adversity (χ(2) = 4.59; P = 0.032). CONCLUSION The findings suggest that early adversity may impact on later expression of psychosis either by increasing exposure to later adversity and/or by rendering individuals more sensitive to later adversity if it is severe.
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Affiliation(s)
- J Lataster
- Department of Psychiatry and Psychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University Medical Center, The Netherlands
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van den Berg DPG, van der Gaag M. Treating trauma in psychosis with EMDR: a pilot study. J Behav Ther Exp Psychiatry 2012; 43:664-71. [PMID: 21963888 DOI: 10.1016/j.jbtep.2011.09.011] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 09/10/2011] [Accepted: 09/12/2011] [Indexed: 11/16/2022]
Abstract
BACKGROUND Initial studies have shown that posttraumatic stress disorder (PTSD) can be effectivelytreated in patients with a psychotic disorder. These studies however used adapted treatment protocols, avoided direct exposure to trauma related stimuli or preceded treatment with stabilizing techniques making treatment considerably longer in duration. METHOD An open trial in which adult subjects with a psychotic disorder and a comorbid PTSD (n = 27) received a maximum of six Eye Movement Desensitization and Reprocessing (EMDR) therapy sessions. PTSD symptoms, psychotic symptoms and additional symptoms were assessed at baseline and end-of-treatment. RESULTS The dropout rate was 18.5 percent (five subjects). Only five of the twenty-two completers (22.7%) still met criteria for PTSD after treatment. PTSD symptoms, auditory verbal hallucinations, delusions, anxiety, depression, and self-esteem all improved significantly. Paranoid ideation and feelings of hopelessness did not improve significantly. Treatment did not lead to symptom exacerbation in subjects. There were no adverse events, such as suicide attempts, self-mutilation, aggressive behavior or admission to a general or psychiatric hospital. CONCLUSIONS This pilot study shows that a short EMDR therapy is effective and safe in the treatment of PTSD in subjects with a psychotic disorder. Treatment of PTSD has a positive effect on auditory verbal hallucinations, delusions, anxiety symptoms, depression symptoms, and self-esteem. EMDR can be applied to this group of patients without adapting the treatment protocol or delaying treatment by preceding it with stabilizing interventions.
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