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Childhood Trauma and Psychosis in a Prospective Cohort Study: Cause, Effect, and Directionality
Ian Kelleher, M.D., Ph.D.; Helen Keeley, M.D.; Paul Corcoran, Ph.D.; Hugh Ramsay, M.D.; Camilla Wasserman, M.A.; Vladimir Carli, M.D., Ph.D.; Marco Sarchiapone, M.D.; Christina Hoven, Dr.P.H.; Danuta Wasserman, M.D., Ph.D.; Mary Cannon, M.D., Ph.D.
Am J Psychiatry 2013;170:734-741. doi:10.1176/appi.ajp.2012.12091169
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All authors report no financial relationships with commercial interests.

The Saving and Empowering Young Lives in Europe (SEYLE) project is supported through Coordination Theme 1 (Health) of the European Union Seventh Framework Programme, Grant agreement number HEALTH-F2-2009-223091. Dr. Kelleher was supported by an Interdisciplinary Capacity Enhancement Award from the Health Research Board (Ireland) (ICE/2012/11). Dr. Cannon was supported by an Essel NARSAD Independent Investigator Award and a Clinician Scientist Award (CSA/2004/1) from the Health Research Board (Ireland).

ClinicalTrials.gov Identifier: NCT00906620; German Clinical Trials Register: DRKS00000214.

The Project Leader and Coordinator of SEYLE is Professor in Psychiatry and Suicidology Danuta Wasserman, Head of NASP, Karolinska Institute, Stockholm. Other members of the Executive Committee are Dr. Marco Sarchiapone, Department of Health Sciences, University of Molise, Campobasso, Italy; Dr. Vladimir Carli, National Swedish Prevention of Mental Ill-Health and Suicide (NASP), Karolinska Institute, Stockholm; Dr. Christina Hoven and Dr. Camilla Wasserman, Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York. The SEYLE Consortium comprises centers in 12 European countries. Site leaders for each respective center and country are as follows: Danuta Wasserman (Karolinska Institute, Sweden), Christian Haring (University for Medical Information Technology, Austria), Airi Varnik (Estonian-Swedish Mental Health and Suicidology Institute, Estonia), Jean-Pierre Kahn (University of Nancy, France), Romuald Brunner (University of Heidelberg, Germany), Judit Balazs (Vadaskert Child and Adolescent Psychiatric Hospital, Hungary), Paul Corcoran (National Suicide Research Foundation, Ireland), Alan Apter (Schneider Children’s Medical Center of Israel, Tel Aviv University, Israel), Marco Sarchiapone (University of Molise, Italy), Doina Cosman (Iuliu Hatieganu University of Medicine and Pharmacy, Romania), Dragan Marusic (University of Primorska, Slovenia), and Julio Bobes (University of Oviedo, Spain).

From the Department of Psychiatry, Royal College of Surgeons in Ireland, Education and Research Centre, Beaumont Hospital, Dublin, Ireland; National Suicide Research Foundation, Cork, Ireland; Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York; National Swedish Prevention of Suicide and Mental Ill-Health (NASP), Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden; and Department of Health Sciences, University of Molise, Campobasso, Italy.

Address correspondence to Dr. Kelleher (iankelleher@rcsi.ie).

Copyright © 2013 by the American Psychiatric Association

Received September 05, 2012; Revised October 28, 2012; Revised December 13, 2012; Accepted December 17, 2012.

Abstract

Objective  Using longitudinal and prospective measures, the authors assessed the relationship between childhood trauma and psychotic experiences, addressing the following questions: 1) Does exposure to trauma predict incident psychotic experiences? 2) Does cessation of trauma predict cessation of psychotic experiences? 3) What is the direction of the relationship between childhood trauma and psychotic experiences?

Method  This was a nationally representative prospective cohort study of 1,112 school-based adolescents 13–16 years of age, assessed at baseline and at 3-month and 12-month follow-ups for childhood trauma (physical assault and bullying) and psychotic experiences.

Results  A bidirectional relationship was observed between childhood trauma and psychosis, with trauma predicting psychotic experiences over time and vice versa. However, even after accounting for this bidirectional relationship with a number of strict adjustments (only newly incident psychotic experiences occurring over the course of the study following exposure to traumatic experiences were examined), trauma was strongly predictive of psychotic experiences. A dose-response relationship was observed between severity of bullying and risk for psychotic experiences. Moreover, cessation of trauma predicted cessation of psychotic experiences, with the incidence of psychotic experiences decreasing significantly in individuals whose exposure to trauma ceased over the course of the study.

Conclusions  After a series of conservative adjustments, the authors found that exposure to childhood trauma predicted newly incident psychotic experiences. The study also provides the first direct evidence that cessation of traumatic experiences leads to a reduced incidence of psychotic experiences.

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FIGURE 1. Point Prevalence of Psychotic Experiences in Individuals for Whom Abuse Ceased or Persisted Across Two Time Points, Compared With Individuals Who Did Not Report Abuse at Either Time Pointa

a Panel A shows the point prevalence of psychotic experiences in individuals whose physical abuse ceased from baseline to 3-month follow-up compared with individuals whose physical abuse persisted. Panel B shows the point prevalence of psychotic experiences in individuals whose physical abuse ceased from 3-month to 12-month follow-up compared with individuals whose physical abuse persisted. Panel C shows the point prevalence of psychotic experiences in individuals whose bullying ceased from baseline to 3-month follow-up compared with individuals whose bullying persisted. Panel D shows the point prevalence of psychotic experiences in individuals whose bullying ceased from 3-month to 12-month follow-up compared with individuals whose bullying persisted.

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TABLE 1.Demographic Characteristics of Participants in a Study of Trauma and Psychosis (N=1,112)
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TABLE 2.Bullying or Physical Assault Reported at Baseline and Odds of Psychotic Experiences at 3-Month and 12-Month Follow-Ups
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TABLE 3.Number of Bullying Items (Out of Six) Endorsed and Odds of Psychotic Experiences at Baseline and at 3-Month and 12-Month Follow-Ups
Table Footer Note

a Test for linear trend, Z=5.30, p<0.001.

Table Footer Note

b Test for linear trend, Z=5.97, p<0.001.

Table Footer Note

c Test for linear trend, Z=5.80, p<0.001.

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