The association of child abuse and neglect with adult disability in schizophrenia and the prominent role of physical neglect.
OBJECTIVE
To assess long-lasting effects of childhood trauma on the functional outcome of adult patients diagnosed with schizophrenia.


METHODS
Ninety-nine stable patients with schizophrenia followed in an outpatient program at a public university hospital in Porto Alegre, southern Brazil, were investigated for childhood traumatic experiences by the Childhood Trauma Questionnaire (CTQ) and for functional impairment by the World Health Organization Disability Assessment Schedule (WHO/DAS). The schizophrenia diagnosis was assessed by ICD-10 and DSM-IV criteria according to the Operational Criteria Checklist for Psychotic Illness (OPCRIT).


RESULTS
Childhood trauma in general was associated with increased disability in adulthood, reflected by impaired Overall Behavior (p=.023) and Global Evaluation (p=.032). Analysis of specific traumatic domains revealed that increased childhood physical neglect was associated with functional impairment in Overall Behavior (p<.000), Social Role Performance (p=.037) and Global Evaluation (p=.014). Higher emotional abuse was associated with impaired Overall Behavior (p=.026), and higher emotional neglect with poor Global Evaluation (p=.047). Additionally, earlier onset of illness was associated with lower level of functioning evidenced by impairment in Overall Behavior (p=.042). Linear regression using WHO/DAS sections (Overall Behavior, Social Role Performance and Global Evaluation) as dependent variables and CTQ subscales indicated that only physical neglect had an effect on adult functionality.


CONCLUSIONS
Childhood trauma was associated with functional and social impairment in adult patients with schizophrenia. Specific types of abuse and neglect, such as physical neglect and emotional abuse and neglect, influenced disability, and the most robust association was physical neglect. Studies involving more patients, with normal controls and additional measurements of biological liability, should be conducted to confirm this association and to increase the understanding of gene-environment relationship in schizophrenia and pathways to disability.


CONCLUSIONS
Further investigation is warranted to clarify the association between childhood trauma and disability in schizophrenia, as well as to develop standardized instruments for the assessment of trauma and earlier detection of risk along with education of patients and families about adequate care, in an effort to reduce the incidence of disability in schizophrenia.
Gil
Alexei
A
Programa de Pós-Graduação em Medicina, Psiquiatria, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400 - 2 degrees andar, 90035-003 Porto Alegre, RS, Brazil.
Gama
Clarissa S
CS
de Jesus
Danilo Rocha
DR
Lobato
Maria Inês
MI
Zimmer
Marilene
M
Belmonte-de-Abreu
Paulo
P
D000328:Adult; D001938:Brazil; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000523:psychology / Q000706:statistics & numerical data*; D002650:Child Abuse, Sexual / Q000175:diagnosis* / Q000523:psychology / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D018570:Risk Assessment / Q000706:statistics & numerical data; D012307:Risk Factors; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D013223:Statistics as Topic; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology