Association between Adverse Childhood Experiences and long-term outcomes in people at Clinical High-Risk for Psychosis
Stefania Tognin,
Ana Catalan,
Claudia Aymerich,
Anja Richter,
Matthew J. Kempton,
Gemma Modinos,
Ryan Hammoud,
Iñigo Gorostiza,
Evangelos Vassos,
Mark van der Gaag,
Lieuwe de Haan,
Barnaby Nelson,
Anita Riecher-Rössler,
Rodrigo Bressan,
Neus Barrantes-Vidal,
Marie-Odile Krebs,
Merete Nordentoft,
Stephan Ruhrmann,
Gabriele Sachs,
Bart P. F. Rutten,
The EU-GEI High Risk Study,
Lucia Valmaggia,
Philip McGuire
Affiliations
Stefania Tognin
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Ana Catalan
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Claudia Aymerich
Basurto University Hospital, OSI Bilbao-Basurto. Biobizkaia Health Research Institute. University of the Basque Country UPV/EHU. Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III
Anja Richter
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Matthew J. Kempton
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Gemma Modinos
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Ryan Hammoud
Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Iñigo Gorostiza
Research Unit, Basurto University Hospital, REDISSEC
Evangelos Vassos
Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London
Mark van der Gaag
VU University, Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and Parnassia Psychiatric Institute, Department of Psychosis Research
Lieuwe de Haan
AMC, Academic Psychiatric Centre, Department Early Psychosis
Barnaby Nelson
Orygen
Anita Riecher-Rössler
Medical Faculty, University of Basel
Rodrigo Bressan
LiNC—Lab Interdisciplinar Neurociências Clínicas, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo — UNIFESP
Neus Barrantes-Vidal
Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Spanish Mental Health Research Network (CIBERSAM)
Marie-Odile Krebs
University of Paris, GHU-Paris, Sainte-Anne, C’JAAD, Hospitalo-Universitaire department SHU
Merete Nordentoft
Mental Health Centre Copenhagen and CINS, Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen
Stephan Ruhrmann
Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne
Gabriele Sachs
Department of Psychiatry and Psychotherapy, Medical University of Vienna
Bart P. F. Rutten
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Centre
Abstract Adverse childhood experiences (ACEs) are common in people at clinical high-risk for psychosis (CHR), however, the relationship between ACEs and long-term clinical outcomes is still unclear. This study examined associations between ACEs and clinical outcomes in CHR individuals. 344 CHR individuals and 67 healthy controls (HC) were assessed using the Childhood Trauma Questionnaire (CTQ), the Bullying Questionnaire and the Childhood Experience of Care and Abuse (CECA). CHR were followed up for up to 5 years. Remission from the CHR state, transition to psychosis (both defined with the Comprehensive Assessment of an At Risk Mental State), and level of functioning (assessed with the Global Assessment of Functioning) were assessed. Stepwise and multilevel logistic regression models were used to investigate the relationship between ACEs and outcomes. ACEs were significantly more prevalent in CHR individuals than in HC. Within the CHR cohort, physical abuse was associated with a reduced likelihood of remission (OR = 3.64, p = 0.025). Separation from a parent was linked to an increased likelihood of both remission (OR = 0.32, p = 0.011) and higher level of functioning (OR = 1.77, p = 0.040). Death of a parent (OR = 1.87, p = 0.037) was associated with an increased risk of transitioning to psychosis. Physical abuse and death of a parent are related to adverse long-term outcomes in CHR. The counter-intuitive association between separation from a parent and outcomes may reflect the removal of a child from an adverse environment. Future studies should investigate whether interventions targeting the effect of specific ACEs might help to improve outcomes in this population.
