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The association of adverse childhood experiences with long-term outcomes of psychosis: a 21-year prospective cohort study after a first episode of psychosis

Published online by Cambridge University Press:  30 May 2024

Victor Peralta Open the ORCID record for Victor Peralta [Opens in a new window] ,
Elena García de Jalón ,
Lucía Moreno-Izco ,
David Peralta ,
Lucía Janda ,
Ana M. Sánchez-Torres ,
Manuel J. Cuesta  and
SEGPEPs group
Victor Peralta*
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
Elena García de Jalón
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
Lucía Moreno-Izco
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
David Peralta
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
Lucía Janda
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
Ana M. Sánchez-Torres
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Departamento de Ciencias de la Salud, Universidad Pública de Navarra (UPNA), Campus de Arrosadia, Pamplona, España
Manuel J. Cuesta
Affiliation:
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain Department of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain
SEGPEPs group
Affiliation:
Mental Health Department, Servicio Navarro de Salud, Pamplona, Spain
*
Corresponding author: Victor Peralta; Email: victor.peralta.martin@cfnavarra.es
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Abstract

Background

Evidence suggests a possible relationship between exposure to childhood adversity (CA) and functional impairment in psychosis. However, the impact of CA on long-term outcomes of psychotic disorders remains poorly understood.

Methods

Two hundred and forty-three patients were assessed at their first episode of psychosis for CA and re-assessed after a mean of 21 years of follow-up for several outcome domains, including symptoms, functioning, quality of life, cognitive performance, neurological dysfunction, and comorbidity. The unique predictive ability of CA exposure for outcomes was examined using linear regression analysis controlling for relevant confounders, including socioeconomic status, family risk of schizophrenia, and obstetric complications.

Results

There were 54% of the patients with a documented history of CA at mild or higher levels. CA experiences were more prevalent and severe in schizophrenia than in other psychotic disorders (p < 0.001). Large to very large effect sizes were observed for CA predicting most role functioning variables and negative symptoms (ΔR2 between 0.105 and 0.181). Moderate effect sizes were observed for positive symptoms, personal functioning, impaired social cognition, impaired immediate verbal learning, poor global cognition, internalized stigma, poor personal recovery, and drug abuse severity (ΔR2 between 0.040 and 0.066). A dose–response relationship was observed between levels of CA and severity of outcome domains.

Conclusion

Our results suggest a strong and widespread link between early adversity exposure and outcomes of psychotic disorders. Awareness of the serious long-term consequences of CA should encourage better identification of those at risk and the development of effective interventions.

Keywords

childhood adversityfirst-episode psychosislong-term follow-upoutcome
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 11 , August 2024 , pp. 3099 - 3108
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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Footnotes

*

SEGPEPs group: A. Ballesterosa, L. Fañanásb,c, G. Gil-Berrozped,e, R. Hernándezf, R. Lorented, S. Papiolg,h, M. Ribeirod,e, A. Roseroi and M. Zandiod,e

aRed de Salud Mental de Álava, Vitoria-Gasteiz, Spain; bDepartment of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Biomedicine Institute of the University of Barcelona (IBUB), Barcelona, Spain; cNetwork Centre for Biomedical Research in Mental Health (CIBER of Mental Health, CIBERSAM), Spain; dInstituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain; eDepartment of Psychiatry, Complejo Hospitalario de Navarra, Pamplona, Spain; fCSMIJ Ciutat Vella. Consorci Parc de Salut Mar, Barcelona, Spain; gInstitute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, 80336, Germany; hDepartment of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, 80336, Germany and iMental Health Department, Servicio Navarro de Salud, Pamplona, Spain

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