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Trauma and psychosis: The mediating role of premorbid adjustment and recent stressful events in a 3-year longitudinal study

Abstract

Background

Some
of the most-studied environmental factors that can contribute to the
development of psychosis are the adversities experienced at an early
age. Among these, childhood interpersonal trauma (CIT) has been
considered especially influential in the onset of the disease. The aim
of the study was to explore the relationship between CIT and the first
episode of psychosis (FEP), as well as the relationship between CIT and
clinical and functional outcomes 3 years after illness onset.

Methods

A total of 278 patients with a FEP and 52 healthy controls were studied. Logistic regression analysis
was carried out to examine the explained variation by CIT at the
beginning of psychosis. Recent stressful events and premorbid adjustment
related to CIT, were introduced in path analyses to determine their
mediating effects between CIT and the disease and its clinical and
functional results.

Results

Mediation
analyses showed that CIT was indirectly associated with belonging to
the FEP group through recent stressful events (Effect = 0.981;
SE = 0.323; CI = 0.485 to 1.761). Premorbid academic adjustment in late
adolescence mediated the relationship between CIT and clinical and
functional outcomes, specifically in the measurements of the Scales for
Assessment of Positive and Negative Symptoms, in the Brief Psychiatric Rating Scale, and in the Disability Assessment Scale.

Conclusions

These
findings suggest that early traumatic experiences play an important
role in the FEP. Early intervention that promotes good academic
adjustment during adolescence and/or avoids retraumatisation could
positively impact both the onset and the course of psychotic illness.

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