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Childhood adversity in schizophrenia: a systematic meta-analysis

Published online by Cambridge University Press:  30 April 2012

S. L. Matheson*
Affiliation:
Schizophrenia Research Institute, Darlinghurst, Sydney, Australia Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia
A. M. Shepherd
Affiliation:
Schizophrenia Research Institute, Darlinghurst, Sydney, Australia Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia
R. M. Pinchbeck
Affiliation:
Schizophrenia Research Institute, Darlinghurst, Sydney, Australia
K. R. Laurens
Affiliation:
Schizophrenia Research Institute, Darlinghurst, Sydney, Australia Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, King's College London, UK
V. J. Carr
Affiliation:
Schizophrenia Research Institute, Darlinghurst, Sydney, Australia Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia
*
*Address for correspondence: Ms. S. L. Matheson, UNSW Research Unit for Schizophrenia Epidemiology, O'Brien Centre, Level 4, St Vincent's Hospital, 394–404 Victoria Street, Darlinghurst, NSW 2010, Australia. (Email: s.matheson@schizophreniaresearch.org.au)

Abstract

Background

Childhood adversity is a putative risk factor for schizophrenia, although evidence supporting this suggestion is inconsistent and controversial. The aim of this review was to pool and quality assess the current evidence pertaining to childhood adversity in people with schizophrenia compared to other psychiatric disorders and to non-psychiatric controls.

Method

Included were case-control, cohort and cross-sectional studies. Medline, EMBASE and PsycINFO databases were searched. Study reporting was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist and pooled evidence quality was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

Twenty-five studies met inclusion criteria. Moderate to high quality evidence suggests increased rates of childhood adversity in schizophrenia compared to controls [odds ratio (OR) 3.60, p < 0.00001]. Increased childhood adversity was also reported in schizophrenia compared to anxiety disorders (OR 2.54, p = 0.007), although the effect was not significant in the subgroup analysis of five studies assessing only sexual abuse. No differences in rates of childhood adversity were found between schizophrenia and affective psychosis, depression and personality disorders whereas decreased rates of childhood adversity were found in schizophrenia relative to dissociative disorders and post-traumatic stress disorder (OR 0.03, p < 0.0001).

Conclusions

This is the first meta-analysis to report a medium to large effect of childhood adversity in people with schizophrenia and to assess specificity for schizophrenia. Further research is required that incorporates longitudinal design and other potentially causal variables to assess additive and/or interactive effects.

Type
Review Article
Copyright
Copyright © Cambridge University Press 2012

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