title: The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries.
abstract: BACKGROUND
  Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.
  
  
  METHODS
  We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.
  
  
  RESULTS
  Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).
  
  
  CONCLUSIONS
  Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.
authors.affiliation: Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia.
authors.forename: J J
authors.initials: JJ
authors.lastname: McGrath
authors.affiliation: Department of Psychology,University of Washington,Seattle,Washington,USA.
authors.forename: K A
authors.initials: KA
authors.lastname: McLaughlin
authors.affiliation: Queensland Centre for Mental Health Research, andQueensland Brain Institute,University of Queensland,Australia.
authors.forename: S
authors.initials: S
authors.lastname: Saha
authors.affiliation: Center for Reducing Health Disparities,UC Davis Health System,Sacramento,California,USA.
authors.forename: S
authors.initials: S
authors.lastname: Aguilar-Gaxiola
authors.affiliation: College of Medicine, Al-Qadisiya University,Diwaniya governorate,Iraq.
authors.forename: A
authors.initials: A
authors.lastname: Al-Hamzawi
authors.affiliation: Health Services Research Unit,IMIM-Hospital del Mar Medical Research Institute,Barcelona,Spain.
authors.forename: J
authors.initials: J
authors.lastname: Alonso
authors.affiliation: Universitair Psychiatrisch Centrum - Katholieke Universiteit Leuven (UPC-KUL),Campus Gasthuisberg,Leuven,Belgium.
authors.forename: R
authors.initials: R
authors.lastname: Bruffaerts
authors.affiliation: IRCCS St John of God Clinical Research Centre,IRCCS Centro S. Giovanni di Dio Fatebenefratelli,Brescia,Italy.
authors.forename: G
authors.initials: G
authors.lastname: de Girolamo
authors.affiliation: Department of Developmental Psychology,Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen,Groningen,The Netherlands.
authors.forename: P
authors.initials: P
authors.lastname: de Jonge
authors.affiliation: Department of Psychiatry,University of Ibadan,Nigeria.
authors.forename: O
authors.initials: O
authors.lastname: Esan
authors.affiliation: National School of Public Health, Management and Professional Development,Bucharest,Romania.
authors.forename: S
authors.initials: S
authors.lastname: Florescu
authors.affiliation: Department of Psychiatry,University College Hospital,Ibadan,Nigeria.
authors.forename: O
authors.initials: O
authors.lastname: Gureje
authors.affiliation: Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona,Barcelona,Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Haro
authors.affiliation: Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital,Shenzhen,China.
authors.forename: C
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Psychiatry and Clinical Psychology, Faculty of Medicine,Balamand University,Beirut,Lebanon.
authors.forename: E G
authors.initials: EG
authors.lastname: Karam
authors.affiliation: Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University,Paris,France.
authors.forename: V
authors.initials: V
authors.lastname: Kovess-Masfety
authors.affiliation: Department of Psychiatry,Chinese University of Hong Kong,Tai Po,Hong Kong.
authors.forename: S
authors.initials: S
authors.lastname: Lee
authors.affiliation: Hôpital Lariboisière Fernand Widal,Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144,University Paris Diderot and Paris Descartes,Paris,France.
authors.forename: J P
authors.initials: JP
authors.lastname: Lepine
authors.affiliation: Queensland Brain Institute, The University of Queensland,St. Lucia, Queensland,Australia.
authors.forename: C C W
authors.initials: CC
authors.lastname: Lim
authors.affiliation: National Institute of Psychiatry Ramón de la Fuente,Mexico City,Mexico.
authors.forename: M E
authors.initials: ME
authors.lastname: Medina-Mora
authors.affiliation: Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA.
authors.forename: Z
authors.initials: Z
authors.lastname: Mneimneh
authors.affiliation: Survey Research Center,Institute for Social Research,University of Michigan,Ann Arbor,Michigan,USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Pennell
authors.affiliation: Universidad Cayetano Heredia,Lima,Peru.
authors.forename: M
authors.initials: M
authors.lastname: Piazza
authors.affiliation: Colegio Mayor de Cundinamarca University,Bogota,Colombia.
authors.forename: J
authors.initials: J
authors.lastname: Posada-Villa
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: N
authors.initials: N
authors.lastname: Sampson
authors.affiliation: Department of Social Medicine,Federal University of Espírito Santo,Vitoria,Brazil.
authors.forename: M C
authors.initials: MC
authors.lastname: Viana
authors.affiliation: Department of Mental Health,Faculdade de Ciências Médicas,Chronic Diseases Research Center (CEDOC) and Universidade Nova de Lisboa,Campo dos Mártires da Pátria,Lisbon,Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Xavier
authors.affiliation: Department of Psychiatry,Stony Brook University School of Medicine,Stony Brook,New York,USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Bromet
authors.affiliation: Department of Psychiatry,Virginia Commonwealth University,USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Kendler
authors.affiliation: Department of Health Care Policy,Harvard Medical School,Boston, Massachusetts,USA.
authors.forename: R C
authors.initials: RC
authors.lastname: Kessler
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Childhood adversity; World Mental Health survey; discrete-time survival analysis; maladaptive family functioning; population attributable risk proportion; psychotic experiences