title: Childhood adversity and psychosis: generalised or specific effects?
abstract: BACKGROUND
  This study examines relationships between childhood adversity and the presence of characteristic symptoms of schizophrenia. It was hypothesised that total adversity exposures would be significantly higher in individuals exhibiting these symptoms relative to patients without. Recent proposals that differential associations exist between specific psychotic symptoms and specific adversities was also tested, namely: sexual abuse and hallucinations, physical abuse and delusions, and fostering/adoption and delusions.
  
  
  METHODS
  Data were collected through auditing 251 randomly selected medical records, drawn from adult patients in New Zealand community mental health centres. Information was extracted on presence and subtype of psychotic symptoms and exposure to ten types of childhood adversity, including five types of abuse and neglect.
  
  
  RESULTS
  Adversity exposure was significantly higher in patients experiencing hallucinations in general, voice hearing, command hallucinations, visions, delusions in general, paranoid delusions and negative symptoms than in patients without these symptoms. There was no difference in adversity exposure in patients with and without tactile/olfactory hallucinations, grandiose delusions or thought disorder. Indication of a dose-response relationship was detected, in that total number of adversities significantly predicted total number of psychotic symptoms. Although fostering/adoption was associated with paranoid delusions, the hypothesised specificity between sexual abuse and hallucinations, and physical abuse and delusions, was not found. The two adversities showing the largest number of associations with psychotic symptoms were poverty and being fostered/adopted.
  
  
  CONCLUSIONS
  The current data are consistent with a model of global and cumulative adversity, in which multiple exposures may intensify psychosis risk beyond the impact of single events. Implications for clinical intervention are discussed.
authors.affiliation: Institute of Psychology,Health and Society,University of Liverpool,Liverpool,UK.
authors.forename: E
authors.initials: E
authors.lastname: Longden
authors.affiliation: Early Intervention Services,Auckland District Health Board,Auckland,New Zealand.
authors.forename: M
authors.initials: M
authors.lastname: Sampson
authors.affiliation: Department of Psychological Sciences,Swinburne University of Technology,Melbourne,Australia.
authors.forename: J
authors.initials: J
authors.lastname: Read
mesh_terms: D002648:Child; D002649:Child Abuse; D003702:Delusions; D006212:Hallucinations; D006801:Humans; D008485:Medical Audit; D009520:New Zealand; D011618:Psychotic Disorders; D012559:Schizophrenia
keywords: Childhood abuse; maltreatment; schizophrenia; specificity