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      Childhood adversity and psychosis: generalised or specific effects?

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          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.

          Method.

          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.

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          Most cited references57

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          Meta-analysis of the association of urbanicity with schizophrenia.

          The association between urbanicity and risk of schizophrenia is well established. The incidence of schizophrenia has been observed to increase in line with rising levels of urbanicity, as measured in terms of population size or density. This association is expressed as Incidence Rate Ratio (IRR), and the results are usually presented by comparing the most urban with the most rural environment. In this study, we undertook to express the effect of urbanicity on the risk of schizophrenia in a linear form and to perform a meta-analysis of all available evidence. We first employed a simple regression analysis of log (IRR) as given in each study on the urbanicity category, assuming a uniform distribution and a linear association. In order to obtain more accurate estimates, we developed a more sophisticated method that generates individual data points with simulation from the summary data presented in the original studies, and then fits a logistic regression model. The estimates from each study were combined with meta-analysis. Despite the challenges that arise from differences between studies as regards to the number and relative size of urbanicity levels, a linear association was observed between the logarithm of the odds of risk for schizophrenia and urbanicity. The risk for schizophrenia at the most urban environment was estimated to be 2.37 times higher than in the most rural environment. The same effect was found when studies measuring the risk for nonaffective psychosis were included.
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            Childhood poverty and health: cumulative risk exposure and stress dysregulation.

            A massive literature documents the inverse association between poverty or low socioeconomic status and health, but little is known about the mechanisms underlying this robust relation. We examined longitudinal relations between duration of poverty exposure since birth, cumulative risk exposure, and physiological stress in two hundred seven 13-year-olds. Chronic stress was assessed by basal blood pressure and overnight cortisol levels; stress regulation was assessed by cardiovascular reactivity to a standard acute stressor and recovery after exposure to this stressor. Cumulative risk exposure was measured by multiple physical (e.g., substandard housing) and social (e.g., family turmoil) risk factors. The greater the number of years spent living in poverty, the more elevated was overnight cortisol and the more dysregulated was the cardiovascular response (i.e., muted reactivity). Cardiovascular recovery was not affected by duration of poverty exposure. Unlike the duration of poverty exposure, concurrent poverty (i.e., during adolescence) did not affect these physiological stress outcomes. The effects of childhood poverty on stress dysregulation are largely explained by cumulative risk exposure accompanying childhood poverty.
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              Reliability and comparability of psychosis patients' retrospective reports of childhood abuse.

              An increasing number of studies are demonstrating an association between childhood abuse and psychosis. However, the majority of these rely on retrospective self-reports in adulthood that may be unduly influenced by current psychopathology. We therefore set out to explore the reliability and comparability of first-presentation psychosis patients' reports of childhood abuse. Psychosis case subjects were drawn from the Aetiology and Ethnicity of Schizophrenia and Other Psychoses (ÆSOP) epidemiological study and completed the Childhood Experience of Care and Abuse Questionnaire to elicit abusive experiences that occurred prior to 16 years of age. High levels of concurrent validity were demonstrated with the Parental Bonding Instrument (antipathy: r(s)=0.350-0.737, P<.001; neglect: r(s)=0.688-0.715, P<.001), and good convergent validity was shown with clinical case notes (sexual abuse: κ=0.526, P<.001; physical abuse: κ=0.394, P<.001). Psychosis patients' reports were also reasonably stable over a 7-year period (sexual abuse: κ=0.590, P<.01; physical abuse: κ=0.634, P<.001; antipathy: κ=0.492, P<.01; neglect: κ=0.432, P<.05). Additionally, their reports of childhood abuse were not associated with current severity of psychotic symptoms (sexual abuse: U=1768.5, P=.998; physical abuse: U=2167.5, P=.815; antipathy: U=2216.5, P=.988; neglect: U=1906.0, P=.835) or depressed mood (sexual abuse: χ(2)=0.634, P=.277; physical abuse: χ(2)=0.159, P=.419; antipathy: χ(2)=0.868, P=.229; neglect: χ(2)=0.639, P=.274). These findings provide justification for the use in future studies of retrospective reports of childhood abuse obtained from individuals with psychotic disorders. © The Author 2009. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
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                Author and article information

                Journal
                Epidemiol Psychiatr Sci
                Epidemiol Psychiatr Sci
                EPS
                Epidemiology and Psychiatric Sciences
                Cambridge University Press (Cambridge, UK )
                2045-7960
                2045-7979
                August 2016
                09 July 2015
                : 25
                : 4
                : 349-359
                Affiliations
                [1 ]Institute of Psychology, Health and Society, University of Liverpool , Liverpool, UK
                [2 ]Early Intervention Services, Auckland District Health Board , Auckland, New Zealand
                [3 ]Department of Psychological Sciences, Swinburne University of Technology , Melbourne, Australia
                Author notes
                [* ]Address for correspondence: Dr E. Longden, Institute of Psychology, Health and Society, Block B 2nd Floor, Waterhouse Building, University of Liverpool , Liverpool L69 3GL, UK. (Email: Eleanor.Longden@ 123456liverpool.ac.uk )
                Article
                S204579601500044X 00044
                10.1017/S204579601500044X
                7137611
                26156083
                ae1ddae5-ae8b-4475-89d0-b993c75991d1
                © Cambridge University Press 2015

                This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 17 February 2015
                : 24 April 2015
                : 27 April 2015
                Page count
                Tables: 3, References: 78, Pages: 11
                Categories
                Original Articles

                childhood abuse,maltreatment,schizophrenia,specificity
                childhood abuse, maltreatment, schizophrenia, specificity

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