title: The functional and clinical relevance of childhood trauma-related admixture of affective, anxious and psychosis symptoms.
abstract: OBJECTIVE
  Previous work has shown that across different patient samples, patients with childhood trauma are more likely to have co-occurrence of affective, anxious and psychosis symptoms than non-traumatized patients. However, the clinical relevance of trauma-related admixture remains to be established.
  
  
  METHODS
  We examined patients with mood disorder (NEMESIS-2; n = 1260), anxiety disorder (NEMESIS-2; n = 896) or psychotic disorder (GROUP; n = 532) in terms of symptom profiles, quality of life (QOL) and social functioning.
  
  
  RESULTS
  Results showed that mood disorder patients with both trauma and co-occurrence of affective, anxious and psychosis symptoms had a lower QOL (B-12.6, 95% CI -17.7 to -7.5, P < 0.001), more help-seeking behaviour [odds ratio (OR) 2.5, 95% CI 1.1-5.7, P = 0.031] and higher prevalence of substance use disorders (OR 7.8, 95% CI 1.1-58.0, P = 0.044), compared with patients without trauma history and symptom admixture (Trauma-/CL-). Similar results were found in patients with an anxiety disorder. Traumatized patients with a psychotic disorder and admixture showed lower QOL (B-0.6, 95% CI -0.9 to -0.4, P < 0.001), higher prevalence of drug disorders (OR 2.2, 95% CI 1.2-3.9, P = 0.008) and lower global assessment of functioning (B-12.8, 95% CI -17.1 to -8.5, P < 0.001) than Trauma-/CL- patients.
  
  
  CONCLUSIONS
  Stratification according to childhood trauma exposure thus identifies a phenotype characterized by admixture of affective, anxiety and psychotic symptoms that, when combined, has clinical relevance. Identification of functionally meaningful aetiological subgroups may aid clinical practice.
authors.affiliation: Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Nierop
authors.affiliation: Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Bak
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: de Graaf
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Ten Have
authors.affiliation: Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Dorsselaer
authors.affiliation: Department of Psychiatry & Psychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre, Maastricht, the Netherlands.|University Psychiatric Center KU Leuven, Department of Psychiatry, Leuven, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: van Winkel
keywords: admixture of symptoms; childhood trauma; functional outcome; stratified medicine