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      Childhood Adversities Increase the Risk of Psychosis: A Meta-analysis of Patient-Control, Prospective- and Cross-sectional Cohort Studies

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          Evidence suggests that adverse experiences in childhood are associated with psychosis. To examine the association between childhood adversity and trauma (sexual abuse, physical abuse, emotional/psychological abuse, neglect, parental death, and bullying) and psychosis outcome, MEDLINE, EMBASE, PsychINFO, and Web of Science were searched from January 1980 through November 2011. We included prospective cohort studies, large-scale cross-sectional studies investigating the association between childhood adversity and psychotic symptoms or illness, case-control studies comparing the prevalence of adverse events between psychotic patients and controls using dichotomous or continuous measures, and case-control studies comparing the prevalence of psychotic symptoms between exposed and nonexposed subjects using dichotomous or continuous measures of adversity and psychosis. The analysis included 18 case-control studies ( n = 2048 psychotic patients and 1856 nonpsychiatric controls), 10 prospective and quasi-prospective studies ( n = 41 803) and 8 population-based cross-sectional studies ( n = 35 546). There were significant associations between adversity and psychosis across all research designs, with an overall effect of OR = 2.78 (95% CI = 2.34–3.31). The integration of the case-control studies indicated that patients with psychosis were 2.72 times more likely to have been exposed to childhood adversity than controls (95% CI = 1.90–3.88). The association between childhood adversity and psychosis was also significant in population-based cross-sectional studies (OR = 2.99 [95% CI = 2.12–4.20]) as well as in prospective and quasi-prospective studies (OR = 2.75 [95% CI = 2.17–3.47]). The estimated population attributable risk was 33% (16%–47%). These findings indicate that childhood adversity is strongly associated with increased risk for psychosis.

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          Most cited references 71

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          The environment and schizophrenia.

          Psychotic syndromes can be understood as disorders of adaptation to social context. Although heritability is often emphasized, onset is associated with environmental factors such as early life adversity, growing up in an urban environment, minority group position and cannabis use, suggesting that exposure may have an impact on the developing 'social' brain during sensitive periods. Therefore heritability, as an index of genetic influence, may be of limited explanatory power unless viewed in the context of interaction with social effects. Longitudinal research is needed to uncover gene-environment interplay that determines how expression of vulnerability in the general population may give rise to more severe psychopathology.
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            ALSPAC--the Avon Longitudinal Study of Parents and Children. I. Study methodology.

             J. Golding,  T. J. Jones,   (2000)
            ALSPAC (The Avon Longitudinal Study of Parents and Children, formerly the Avon Longitudinal Study of Pregnancy and Childhood) was specifically designed to determine ways in which the individual's genotype combines with environmental pressures to influence health and development. To date, there are comprehensive data on approximately 10,000 children and their parents, from early pregnancy until the children are aged between 8 and 9. The study aims to continue to collect detailed data on the children as they go through puberty noting, in particular, changes in anthropometry, attitudes and behaviour, fitness and other cardiovascular risk factors, bone mineralisation, allergic symptoms and mental health. The study started early during pregnancy and collected very detailed data from the mother and her partner before the child was born. This not only provided accurate data on concurrent features, especially medication, symptoms, diet and lifestyle, attitudes and behaviour, social and environmental features, but was unbiased by parental knowledge of any problems that the child might develop. From the time of the child's birth many different aspects of the child's environment have been monitored and a wide range of phenotypic data collected. By virtue of being based in one geographic area, linkage to medical and educational records is relatively simple, and hands-on assessments of children and parents using local facilities has the advantage of high quality control. The comprehensiveness of the ALSPAC approach with a total population sample unselected by disease status, and the availability of parental genotypes, provides an adequate sample for statistical analysis and for avoiding spurious results. The study has an open policy in regard to collaboration within strict confidentiality rules.
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              Validity of adult retrospective reports of adverse childhood experiences: review of the evidence.

              Influential studies have cast doubt on the validity of retrospective reports by adults of their own adverse experiences in childhood. Accordingly, many researchers view retrospective reports with scepticism. A computer-based search, supplemented by hand searches, was used to identify studies reported between 1980 and 2001 in which there was a quantified assessment of the validity of retrospective recall of sexual abuse, physical abuse, physical/emotional neglect or family discord, using samples of at least 40. Validity was assessed by means of comparisons with contemporaneous, prospectively obtained, court or clinic or research records; by agreement between retrospective reports of two siblings; and by the examination of possible bias with respect to differences between retrospective and prospective reports in their correlates and consequences. Medium- to long-term reliability of retrospective recall was determined from studies in which the test-retest period extended over at least 6 months. Retrospective reports in adulthood of major adverse experiences in childhood, even when these are of a kind that allow reasonable operationalisation, involve a substantial rate of false negatives, and substantial measurement error. On the other hand, although less easily quantified, false positive reports are probably rare. Several studies have shown some bias in retrospective reports. However, such bias is not sufficiently great to invalidate retrospective case-control studies of major adversities of an easily defined kind. Nevertheless, the findings suggest that little weight can be placed on the retrospective reports of details of early experiences or on reports of experiences that rely heavily onjudgement or interpretation. Retrospective studies have a worthwhile place in research, but further research is needed to examine possible biases in reporting.

                Author and article information

                Schizophr Bull
                Schizophr Bull
                Schizophrenia Bulletin
                Oxford University Press
                July 2012
                29 March 2012
                29 March 2012
                : 38
                : 4
                : 661-671
                [1 ]Institute of Psychology, Health and Society; University of Liverpool, UK
                [2 ]School of Psychological Sciences, University of Manchester, UK
                [3 ]Department of Psychiatry and Psychology, Maastricht University, The Netherlands
                [4 ]King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
                [5 ]Department of Psychology, University of Auckland, New Zealand
                Author notes
                [* ]To whom correspondence should be addressed; PO Box 616 (DRT10), 6200 MD Maastricht, The Netherlands; tel: +31-43-3688683, fax: +31-43-3688689, e-mail: j.vanos@

                Shared first authorship.

                © The Authors 2012. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Pages: 11
                Research Article


                adversity, psychosis, trauma, meta-analysis, neglect, abuse


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