title: Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders.
abstract: BACKGROUND
  Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.
  
  
  METHODS
  Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.
  
  
  RESULTS
  Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R 2 = 0.21-0.29).
  
  
  CONCLUSIONS
  Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.
authors.affiliation: NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway.
authors.forename: T
authors.initials: T
authors.lastname: Østefjells
authors.affiliation: NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway.
authors.forename: J U
authors.initials: JU
authors.lastname: Lystad
authors.affiliation: NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway.
authors.forename: A O
authors.initials: AO
authors.lastname: Berg
authors.affiliation: Department of Psychology,Norwegian University of Science and Technology,Trondheim,Norway.
authors.forename: R
authors.initials: R
authors.lastname: Hagen
authors.affiliation: Department of Psychiatry,University of California San Francisco,San Francisco,CA,USA.
authors.forename: R
authors.initials: R
authors.lastname: Loewy
authors.affiliation: Oslo Centre for Biostatistics and Epidemiology,Research Support Services,Oslo University Hospital,Oslo,Norway.
authors.forename: L
authors.initials: L
authors.lastname: Sandvik
authors.affiliation: NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway.
authors.forename: I
authors.initials: I
authors.lastname: Melle
authors.affiliation: NORMENT,KG Jebsen Centre for Psychosis Research,Oslo University Hospital and Institute of Clinical Medicine,University of Oslo,Oslo,Norway.
authors.forename: J I
authors.initials: JI
authors.lastname: Røssberg
mesh_terms: D000328:Adult; D054523:Adult Survivors of Child Abuse; D001007:Anxiety / Q000209:etiology / Q000503:physiopathology*; D001714:Bipolar Disorder / Q000209:etiology / Q000503:physiopathology*; D003863:Depression / Q000209:etiology / Q000503:physiopathology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D000067489:Metacognition / Q000502:physiology*; D011618:Psychotic Disorders / Q000209:etiology / Q000503:physiopathology*; D055815:Young Adult
keywords: Bipolar disorder; mediation; metacognition; psychosis