title: Psychological Mechanisms Mediating Effects Between Trauma and Psychotic Symptoms: The Role of Affect Regulation, Intrusive Trauma Memory, Beliefs, and Depression.
abstract: Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, intrusive trauma memory, beliefs, and depression. The majority of participants (74.1%) reported victimization trauma, and a fifth (21.5%) met symptomatic criteria for Posttraumatic Stress Disorder. We found a specific link between childhood sexual abuse and auditory hallucinations (adjusted OR = 2.21, SE = 0.74, P = .018). This relationship was mediated by posttraumatic avoidance and numbing (OR = 1.48, SE = 0.19, P = .038) and hyperarousal (OR = 1.44, SE = 0.18, P = .045), but not intrusive trauma memory, negative beliefs or depression. In contrast, childhood emotional abuse was specifically associated with delusions, both persecutory (adjusted OR = 2.21, SE = 0.68, P = .009) and referential (adjusted OR = 2.43, SE = 0.74, P = .004). The link with persecutory delusions was mediated by negative-other beliefs (OR = 1.36, SE = 0.14, P = .024), but not posttraumatic stress symptoms, negative-self beliefs, or depression. There was no evidence of mediation for referential delusions. No relationships were identified between childhood physical abuse and psychosis. The findings underline the role of cognitive-affective processes in the relationship between trauma and symptoms, and the importance of assessing and treating victimization and its psychological consequences in people with psychosis.
authors.affiliation: Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; amy.hardy@kcl.ac.uk.
authors.forename: Amy
authors.initials: A
authors.lastname: Hardy
authors.affiliation: Centre for Biostatistics, University of Manchester, Manchester, UK;
authors.forename: Richard
authors.initials: R
authors.lastname: Emsley
authors.affiliation: Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK;
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.affiliation: UCL Mental Health Sciences Unit, University College London, London, UK;
authors.forename: Paul
authors.initials: P
authors.lastname: Bebbington
authors.affiliation: Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK;
authors.forename: Philippa A
authors.initials: PA
authors.lastname: Garety
authors.affiliation: Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK;
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Kuipers
authors.affiliation: Centre for Biostatistics, University of Manchester, Manchester, UK;
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: School of Psychology, University of Sussex, Brighton, UK.
authors.forename: David
authors.initials: D
authors.lastname: Fowler
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D000339:Affect / Q000502:physiology; D015897:Comorbidity; D003702:Delusions / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D005260:Female; D006212:Hallucinations / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D008297:Male; D061212:Memory, Episodic; D008875:Middle Aged; D000067073:Psychological Trauma / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D012008:Recurrence; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D006113:United Kingdom / Q000453:epidemiology
keywords: avoidance; hyperarousal; psychosis; reexperiencing; schema; victimization