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Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology

  • D. S. van Dam (a1), M. van Nierop (a2), W. Viechtbauer (a2), E. Velthorst (a1) (a3), R. van Winkel (a2) (a4), Genetic Risk and Outcome of Psychosis (GROUP) investigators, R. Bruggeman (a5), W. Cahn (a6), L. de Haan (a1), R. S. Kahn (a6), C. J. Meijer (a1), I. Myin-Germeys (a2), J. van Os (a2) (a7) and D. Wiersma (a5)...

The association between childhood trauma and psychotic and depressive symptomatology is well established. However, less is known about the specificity and course of these symptoms in relation to childhood trauma.


In a large sample (n = 2765) of patients with psychosis (n = 1119), their siblings (n = 1057) and controls (n = 589), multivariate (mixed-effects) regression analyses with multiple outcomes were performed to examine the association between childhood trauma and psychotic and depressive symptomatology over a 3-year period.


A dose–response relationship was found between childhood trauma and psychosis. Abuse was more strongly associated with positive symptoms than with negative symptoms whereas the strength of the associations between neglect and positive and negative symptoms was comparable. In patients, similar associations between childhood trauma and psychotic or depressive symptoms were found, and in siblings and controls, stronger associations were found between trauma and depressive symptomatology. Childhood trauma was not related to a differential course of symptoms over a 3-year time period.


In congruence with earlier work, our findings suggest that childhood trauma, and abuse in particular, is associated with (subthreshold) psychosis. However, childhood trauma does not seem to be associated with a differential course of symptoms, nor does it uniquely heighten the chance of developing (subthreshold) psychotic symptomatology. Our results indicate that trauma may instead contribute to a shared vulnerability for psychotic and depressive symptoms.

Corresponding author
* Address for correspondence: C. J. Meijer, M.Sc., Ph.D., Department of Psychiatry, Early Psychosis Section, Academic Medical Center, Meibergdreef 5, Room PA1-136, 1105 AZ Amsterdam, The Netherlands. (Email:
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Addington, D, Addington, J, Schissel, B (1990). A depression rating scale for schizophrenics. Schizophrenia Research 3, 247251.
Addington, J, van Mastrigt, S, Addington, D (2003). Patterns of premorbid functioning in first-episode psychosis: initial presentation. Schizophrenia Research 62, 2330.
Andreasen, NC (1982). Negative symptoms in schizophrenia. Definition and reliability. Archives of General Psychiatry 39, 784788.
Andreasen, NC (1984). Scale for the Assessment of Positive Symptoms. University of Iowa: Iowa City, IA.
Andreasen, NC, Flaum, M, Arndt, S (1992). The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry 49, 615623.
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. DSM-IV-TR. American Psychiatric Association: Washington, DC.
Arseneault, L, Cannon, M, Fisher, HL, Polanczyk, G, Moffitt, TE, Caspi, A (2011). Childhood trauma and children's emerging psychotic symptoms: a genetically sensitive longitudinal cohort study. American Journal of Psychiatry 168, 6572.
Bentall, RP, Fernyhough, C (2008). Social predictors of psychotic experiences: specificity and psychological mechanisms. Schizophrenia Bulletin 34, 10121020.
Bentall, RP, Wickham, S, Shevlin, M, Varese, F (2012). Do specific early-life adversities lead to specific symptoms of psychosis? A study from the 2007 the Adult Psychiatric Morbidity Survey. Schizophrenia Bulletin 38, 734740.
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse and Neglect 27, 169190.
Binder, EB, Bradley, RG, Liu, W, Epstein, MP, Deveau, TC, Mercer, KB, Tang, Y, Gillespie, CF, Heim, CM, Nemeroff, CB (2008). Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. Journal of the American Medical Association 299, 12911305.
Collip, D, Myin-Germeys, I, Wichers, M, Jacobs, N, Derom, C, Thiery, E, Lataster, T, Simons, C, Delespaul, P, Marcelis, M, van Os, J, van Winkel, R (2013). FKBP5 as a possible moderator of the psychosis-inducing effects of childhood trauma. British Journal of Psychiatry 202, 261268.
Colvert, E, Rutter, M, Kreppner, J, Beckett, C, Castle, J, Groothues, C, Hawkins, A, Stevens, S, Sonuga-Barke, EJ (2008). Do theory of mind and executive function deficits underlie the adverse outcomes associated with profound early deprivation? Findings from the English and Romanian adoptees study. Journal of Abnormal Child Psychology 36, 10571068.
Conus, P, Cotton, S, Schimmelmann, BG, McGorry, PD, Lambert, M (2010). Pretreatment and outcome correlates of sexual and physical trauma in an epidemiological cohort of first-episode psychosis patients. Schizophrenia Bulletin 36, 11051114.
Cougnard, A, Marcelis, M, Myin-Germeys, I, de Graaf, R, Vollebergh, W, Krabbendam, L, Lieb, R, Wittchen, HU, Henquet, CEC, Spauwen, J (2007). Does normal developmental expression of psychosis combine with environmental risk to cause persistence of psychosis? A psychosis proneness-persistence model. Psychological Medicine 37, 513528.
De Loore, E, Drukker, M, Gunther, N, Feron, F, Deboutte, D, Sabbe, B, Mengelers, R, van Os, J, Myin-Germeys, I (2007). Childhood negative experiences and subclinical psychosis in adolescence: a longitudinal general population study. Early Intervention in Psychiatry 1, 201207.
Fisher, HL, Craig, TK, Fearon, P, Morgan, K, Dazzan, P, Lappin, J, Hutchinson, G, Doody, GA, Jones, PB, McGuffin, P (2011). Reliability and comparability of psychosis patients’ retrospective reports of childhood abuse. Schizophrenia Bulletin 37, 546553.
Garety, P, Kuipers, E, Fowler, D, Freeman, D, Bebbington, P (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine 31, 189195.
Glaser, D (2000). Child abuse and neglect and the brain – a review. Journal of Child Psychology and Psychiatry 41, 97116.
Greenfield, SF, Strakowski, SM, Tohen, M, Batson, SC, Kolbrener, ML (1994). Childhood abuse in first-episode psychosis. British Journal of Psychiatry 164, 831834.
Hanssen, M, Krabbendam, L, Vollema, M, Delespaul, P, van Os, J (2006). Evidence for instrument and family-specific variation of subclinical psychosis dimensions in the general population. Journal of Abnormal Psychology 115, 514.
Heim, C, Nemeroff, CB (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies. Biological Psychiatry 49, 10231039.
Heim, C, Newport, DJ, Mletzko, T, Miller, AH, Nemeroff, CB (2008). The link between childhood trauma and depression: insights from HPA axis studies in humans. Psychoneuroendocrinology 33, 693710.
Heins, M, Simons, C, Lataster, T, Pfeifer, S, Versmissen, D, Lardinois, M, Marcelis, M, Delespaul, P, Krabbendam, L, van Os, J, Myin-Germeys, I (2011). Childhood trauma and psychosis: a case-control and case-sibling comparison across different levels of genetic liability, psychopathology, and type of trauma. American Journal of Psychiatry 168, 12861294.
Hovens, JGFM, Giltay, EJ, Wiersma, JE, Spinhoven, P, Penninx, BWJH, Zitman, FG (2012). Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatrica Scandinavica 126, 198207.
Hox, JJ (2010). Multilevel Analysis: Techniques and Applications, 2nd edn. Routledge: New York, NY.
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, de Graaf, R, van Os, J (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.
Kapur, S (2003). Psychosis as a state of aberrant salience: a framework linking biology, phenomenology, and pharmacology in schizophrenia. American Journal of Psychiatry 160, 1323.
Kay, SR, Fiszbein, A, Opfer, LA (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261276.
Kelleher, I, Keeley, H, Corcoran, P, Ramsay, H, Wasserman, C, Carli, V, Sarchiapone, M, Hoven, C, Wasserman, D, Cannon, M (2013). Childhood trauma and psychosis in a prospective cohort study: cause, effect, and directionality. American Journal of Psychiatry 170, 734741.
Kendler, KS, Lieberman, JA, Walsh, D (1989). The Structured Interview for Schizotypy (SIS): a preliminary report. Schizophrenia Bulletin 15, 559571.
Korver, N, Quee, PJ, Boos, H, Simons, CJ, Haan, L (2012). Genetic Risk and Outcome of Psychosis (GROUP), a multi-site longitudinal cohort study focused on gene–environment interaction: objectives, sample characteristics, recruitment and assessment methods. International Journal of Methods in Psychiatric Research 21, 205221.
Leverich, GS, McElroy, SL, Suppes, T, Keck, PE Jr., Denicoff, KD, Nolen, WA, Altshuler, LL, Rush, AJ, Kupka, R, Frye, MA (2002). Early physical and sexual abuse associated with an adverse course of bipolar disorder. Biological Psychiatry 51, 288297.
Lysaker, P, Beattie, NL, Strasburger, AM, Davis, LW (2005). Reported history of child sexual in schizophrenia: associations with heightened symptoms levels and poorer participation over four months in vocational rehabilitation. Journal of Nervous and Mental Disease 193, 790795.
Mackie, CJ, Castellanos-Ryan, N, Conrod, PJ (2011). Developmental trajectories of psychotic-like experiences across adolescence: impact of victimization and substance use. Psychological Medicine 41, 4758.
Matheson, SL, Shepherd, AM, Laurens, KR, Carr, VJ (2011). A systematic meta-review grading the evidence for non-genetic risk factors and putative antecedents of schizophrenia. Schizophrenia Research 133, 133142.
Matheson, SL, Shepherd, AM, Pinchbeck, RM, Laurens, KR, Carr, VJ (2013). Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225238.
Maxwell, ME (1992). Manual for the FIGS (Family Interview for Genetic Studies). Clinical Neurogenetics Branch, Intramural Research Program, National Institute of Mental Health: Bethesda, MD.
Morgan, C, Charalambides, M, Hutchinson, and Murray, R (2010). Migration, ethnicity and psychosis: toward a sociodevelopmental model. Schizophrenia Bulletin 36, 655664.
Morgan, C, Fisher, H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.
Morrison, AP, Frame, L, Larkin, W (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology 42, 331353.
Neria, Y, Bromet, EJ, Carlson, GA, Naz, B (2005). Assaultive trauma and illness course in psychotic bipolar disorder: findings from the Suffolk county mental health project. Acta Psychiatrica Scandinavica 111, 380383.
Perry, BD, Beauchaine, T, Hinshaw, S (2008). Child maltreatment: a neurodevelopmental perspective on the role of trauma and neglect in psychopathology. In Child and Adolescent Psychopathology (ed. Beauchaine, T. P. and Hinshaw, S. P.), pp. 93128. Wiley & Sons: Hoboken, NJ.
Pocock, SJ, Assmann, SE, Enos, LE, Kasten, LE (2002). Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Statistics in Medicine 21, 29172930.
Rabinowitz, J, De Smedt, G, Harvey, PD, Davidson, M (2002). Relationship between premorbid functioning and symptom severity as assessed at first episode of psychosis. American Journal of Psychiatry 159, 20212026.
Read, J, Gumley, A (2008). Can attachment theory help explain the relationship between childhood adversity and psychosis? Attachment: New Directions in Psychotherapy and Relational Psychoanalysis 2, 135.
Ross, CA, Anderson, G, Clark, P (1994). Childhood abuse and the positive symptoms of schizophrenia. Hospital and Community Psychiatry 45, 489491.
Schreier, A, Wolke, D, Thomas, K, Horwood, J, Hollis, C, Gunnell, D, Lewis, G, Thompson, A, Zammit, S, Duffy, L (2009). Prospective study of peer victimization in childhood and psychotic symptoms in a nonclinical population at age 12 years. Archives of General Psychiatry 66, 527536.
Thombs, BD, Bernstein, DP, Lobbestael, J, Arntz, A (2009). A validation study of the Dutch Childhood Trauma Questionnaire-Short Form: factor structure, reliability, and known-groups validity. Child Abuse and Neglect 33, 518523.
van Nierop, M, van Os, J, Gunther, N, Myin-Germeys, I, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, van Winkel, R (2012). Phenotypically continuous with clinical psychosis, discontinuous in need for care: evidence for an extended psychosis phenotype. Schizophrenia Bulletin 38, 231238.
van Winkel, R, Kahn, RS, Linszen, DH, van Os, J, Wiersma, D, Bruggeman, R, Cahn, W, de Haan, L, Krabbendam, L, Myin-Germeys, I (2010). Family-based analysis of genetic variation underlying psychosis-inducing effects of cannabis: sibling analysis and proband follow-up. Archives of General Psychiatry 68, 148157.
van Winkel, R, van Nierop, M, Myin-Germeys, I, van Os, J (2013). Childhood trauma as a cause of psychosis: linking genes, psychology and biology. Canadian Journal of Psychiatry 58, 4451.
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.
Vollema, MG, Ormel, J (2000). The reliability of the Structured Interview for Schizotypy–Revised. Schizophrenia Bulletin 26, 619629.
Vollema, MG, Postma, B (2002). Neurocognitive correlates of schizotypy in first degree relatives of schizophrenia patients. Schizophrenia Bulletin 28, 367378.
Walker, EF, Diforio, D (1997). Schizophrenia: a neural diathesis-stress model. Psychological Review 104, 667685.
Wechsler, D (1997). Wechsler Adult Intelligence Scale-III (WAIS-III). Psychological Corporation: San Antonio, TX.
WHO (1990). Composite International Diagnostic Interview (CIDI), Version 1.0. World Health Organization: Geneva.
Wigman, JTW, van Winkel, R, Raaijmakers, QAW, Ormel, J, Verhulst, FC, Reijneveld, SA, van Os, J, Vollebergh, WAM (2011). Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychological Medicine 41, 23172329.
Wing, JK, Babor, T, Brugha, T, Burke, J, Cooper, J, Giel, R, Jablenski, A, Regier, D, Sartorius, N (1990). SCAN. Schedules for Clinical Assessment in Neuropsychiatry. Archives of General Psychiatry 47, 589593.
Zlotnick, C, Ryan, CE, Miller, IW, Keitner, GI (1995). Childhood abuse and recovery from major depression. Child Abuse and Neglect 19, 15131516.
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