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Childhood adversity in schizophrenia: a systematic meta-analysis

  • S. L. Matheson (a1) (a2), A. M. Shepherd (a1) (a2), R. M. Pinchbeck (a1), K. R. Laurens (a1) (a2) (a3) and V. J. Carr (a1) (a2)...

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.


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.


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).


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.

Corresponding author
*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:
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Aas M, Dazzan P, Fisher HL, Morgan C, Morgan K, Reichenberg A, Zanelli J, Fearon P, Jones PB, Murray RM, Pariante CM (2011). Childhood trauma and cognitive function in first-episode affective and non-affective psychosis. Schizophrenia Research 129, 1219.
Alvarez M, Roura P, Osés A, Foguet Q, Solà J, Arrufat F (2011). Prevalence and clinical impact of childhood trauma in patients with severe mental disorders. Journal of Nervous and Mental Disease 199, 156161.
Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O'Connell D, Oxman AD, Phillips B, Schünemann HJ, Edejer TT, Varonen H, Vist GE, Williams JW Jr., Zaza S; GRADE Working Group (2004). Grading quality of evidence and strength of recommendations. British Medical Journal 328, 1490.
Bebbington P, Jonas S, Kuipers E, King M, Cooper C, Brugha T, Meltzer H, McManus S, Jenkins R (2011). Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. British Journal of Psychiatry 199, 2937.
Bendall S, Jackson HJ, Hulbert CA, McGorry PD (2008). Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophrenia Bulletin 34, 568579.
Borenstein M, Hedges L, Higgins J, Rothstein H (2005). Comprehensive Meta-Analysis, Version 2. Biostat: Englewood, NJ.
Byrne CP, Velamoor VR, Cernovsky ZZ, Cortese L (1990). A comparison of borderline and schizophrenic patients for childhood life events and parent-child relationships. Canadian Journal of Psychiatry 35, 590595.
Chen LP, Murad MH, Paras ML, Colbenson KM, Sattler AL, Goranson EN, Elamin MB, Seime RJ, Shinozaki G, Prokop LJ, Zirakzadeh A (2010). Sexual abuse and lifetime diagnosis of psychiatric disorders: systematic review and meta-analysis. Mayo Clinic Proceedings 85, 618629.
Choi KH, Reddy LF, Liu NH, Spaulding WD (2009). Memory as a moderator in the relationship between child sexual abuse and maladaptive functioning in people with severe mental illness. Journal of Nervous and Mental Disease 197, 282286.
Conus P, Cotton S, Schimmelmann B, McGorry P, 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.
Craine L, Henson C, Colliver J, MacLean D (1988). Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system. Hospital and Community Psychiatry 39, 300304.
Cutajar MC, Mullen PE, Ogloff JRP, Thomas SD, Wells DL, Spataro J (2010). Schizophrenia and other psychotic disorders in a cohort of sexually abused children. Archives of General Psychiatry 67, 11141119.
Darves-Bornoz JM, Lemperiere T, Degiovanni A, Gaillard P (1995). Sexual victimization in women with schizophrenia and bipolar disorder. Social Psychiatry and Psychiatric Epidemiology 30, 7884.
Edwards VJ, Holden GW, Felitti VJ, Anda RF (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the Adverse Childhood Experiences Study. American Journal of Psychiatry 160, 14531460.
Egger M, Davey Smith G, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. British Medical Journal 315, 629634.
Fink DL, Golinkoff M (1990). MPD, borderline personality disorder and schizophrenia: a comparative study of clinical features. Dissociation: Progress in the Dissociative Disorders 3, 127134.
Fossati A, Madeddu F, Maffei C (1999). Borderline personality disorder and childhood sexual abuse: a meta-analytic study. Journal of Personality Disorders 13, 268280.
Friedman S, Harrison G (1984). Sexual histories, attitudes, and behavior of schizophrenic and ‘normal’ women. Archives of Sexual Behavior 13, 555567.
Friedman S, Smith L, Fogel D, Paradis C, Viswanathan R, Ackerman R, Trappler B (2002). The incidence and influence of early traumatic life events in patients with panic disorder: a comparison with other psychiatric outpatients. Journal of Anxiety Disorders 16, 259272.
Gilbert R, Widom CS, Browne K, Fergusson D, Webb E, Janson S (2009). Burden and consequences of child maltreatment in high-income countries. Lancet 373, 6881.
Goff DC, Brotman AW, Kindlon D, Waites M, Amico E (1991). Self-reports of childhood abuse in chronically psychotic patients. Psychiatry Research 37, 7380.
Goodman L, Thompson K, Weinfurt K (1999). Reliability of violent victimization and PTSD among men and women with serious mental illness Journal of Trauma Stress 12, 587599.
GRADEpro (2008). [Computer program]. Version 3.2 for Windows. Jan Brozek, Andrew Oxman, Holger Schünemann.
Green JG, McLaughlin KA, Berglund PA, Gruber MJ, Sampson NA, Zaslavsky AM, Kessler RC (2010). Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication I. Associations with first onset of DSM-IV disorders. Archives of General Psychiatry 67, 113123.
Heim C, Newport DJ, Heit S, Graham YP, Wilcox M, Bonsall R, Miller AH, Nemeroff CB (2000). Pituitary-adrenal and autonomic responses to stress in women after sexual and physical abuse in childhood. Journal of the American Medical Association 284, 592597.
Higgins JPT, Green S (eds) (2008). Cochrane Handbook for Systematic Reviews of Interventions. Wiley: Chichester.
Hlastala SA, McClellan J (2005). Phenomenology and diagnostic stability of youths with atypical psychotic symptoms. Journal of Child and Adolescent Psychopharmacology 15, 497509.
Honig A, Romme MA, Ensink BJ, Escher SD, Pennings MH, deVries MW (1998). Auditory hallucinations: a comparison between patients and nonpatients. Journal of Nervous and Mental Disease 186, 646651.
Husted JA, Ahmed R, Chow EWC, Brzustowicz LM, Bassett AS (2010). Childhood trauma and genetic factors in familial schizophrenia associated with the NOS1AP gene. Schizophrenia Research 121, 187192.
Jumper SA (1995). A meta-analysis of the relationship of child sexual abuse to adult psychological adjustment. Child Abuse and Neglect 19, 715728.
Kessler RC, McLaughlin KA, Green JG, Gruber MJ, Sampson NA, Zaslavsky AM, Aguilar-Gaxiola S, Alhamzawi AO, Alonso J, Angermeyer M, Benjet C, Bromet E, Chatterji S, de Girolamo G, Demyttenaere K, Fayyad J, Florescu S, Gal G, Gureje O, Haro JM, Hu C-Y, Karam EG, Kawakami N, Lee S, Lepine J-P, Ormel J, Posada-Villa J, Sagar R, Tsang A, Ustun TB, Vassilev S, Viana MC, Williams DR (2010). Childhood adversities and adult psychopathology in the WHO World Mental Health Surveys. British Journal of Psychiatry 197, 378385.
Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ, Stein DJ, Zaslavsky AM, Aguilar-Gaxiola S, Alonso J, Andrade L, Benjet C, de Girolamo G, de Graaf R, Demyttenaere K, Fayyad J, Haro JM, Hu C, Karam A, Lee S, Lepine J-P, Matchsinger H, Mihaescu-Pintia C, Posada-Villa J, Sagar R, Ustun TB (2011). Development of lifetime comorbidity in the World Health Organization World Mental Health Surveys. Archives of General Psychiatry 68, 90100.
Kingdon DG, Ashcroft K, Bhandari B, Gleeson S, Warikoo N, Symons M, Taylor L, Lucas E, Mahendra R, Ghosh S, Mason A, Badrakalimuthu R, Hepworth C, Read J, Mehta R (2010). Schizophrenia and borderline personality disorder: similarities and differences in the experience of auditory hallucinations, paranoia, and childhood trauma. Journal of Nervous and Mental Disease 198, 399403.
Larkin W, Read J (2008). Childhood trauma and psychosis: evidence, pathways and implications. Journal of Postgraduate Medicine 54, 287293.
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.
McCabe KL, Maloney EA, Stein HJ, Laughland CM, Carr VJ (2012). Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research. Published online: 11 February 2012. doi:10.1016/j.jpsychires.2012.01.023.
Meyer I, Muenzenmaier K, Cancienne J, Struening E (1996). Reliability and validity of a measure of sexual and physical abuse histories among women with serious mental illness. Child Abuse and Neglect 2, 213219.
Molnar BE, Buka SL, Kessler RC (2001). Childhood sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. American Journal of Public Health 91, 753760.
Mondelli V, Pariante CM, Navari S, Aas M, D'Albenzio A, Di Forti M, Handley R, Hepgul N, Marques TR, Taylor H, Papadopoulos AS, Aitchison KJ, Murray RM, Dazzan P (2010). Higher cortisol levels are associated with smaller left hippocampal volume in first-episode psychosis. Schizophrenia Research 119, 7578.
Morgan C, Fisher H (2007). Environment and schizophrenia: environmental factors in schizophrenia: childhood trauma – a critical review. Schizophrenia Bulletin 33, 310.
Nettelbladt P, Svensson C, Serin U (1996). Background factors in patients with schizoaffective disorder as compared with patients with diabetes and healthy individuals. European Archives of Psychiatry and Clinical Neuroscience 246, 213218.
Neumann DA (1994). Long-term correlates of childhood sexual abuse in adult survivors. New Directions for Mental Health Services 64, 2938.
Nurcombe B, Mitchell W, Begtrup R, Ramontana M, Lababera J, Pruitt J (1996). Dissociative hallucinosis and allied conditions. In Psychoses and Pervasive Developmental Disorders in Childhood and Adolescence (ed. Volkmar F.), pp. 107128. American Psychiatric Press: Washington, DC.
Paolucci EO, Genuis ML, Violato C (2001). A meta-analysis of the published research on the effects of child sexual abuse. Journal of Psychology 135, 1736.
Pettigrew J, Burcham J (1997). Effects of childhood sexual abuse in adult female psychiatric patients. Australian and New Zealand Journal of Psychiatry 31, 208213.
Read J, van Os J, Morrison AP, Ross CA (2005). Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implications. Acta Psychiatrica Scandinavica 112, 330350.
Review Manager (2011). RevMan [Computer program]. Version 5.1. The Nordic Cochrane Centre, The Cochrane Collaboration: Copenhagen.
Rind B, Tromovitch P, Bauserman R (1998). A meta-analytic examination of assumed properties of child sexual abuse using college samples. Psychological Bulletin 124, 2253.
Ross CA, Heber S, Norton GR, Anderson G (1989). Differences between multiple personality disorder and other diagnostic groups on structured interview. Journal of Nervous and Mental Disease 177, 487491.
Rubino IA, Nanni RC, Pozzi DM, Siracusano A (2009). Early adverse experiences in schizophrenia and unipolar depression. Journal of Nervous and Mental Disease 197, 6568.
Spataro J, Mullen PE, Burgess PM, Wells DL, Moss SA (2004). Impact of child sexual abuse on mental health: prospective study in males and females. British Journal of Psychiatry 184, 416421.
Spence W, Mulholland C, Lynch G, McHugh S, Dempster M, Shannon C (2006). Rates of childhood trauma in a sample of patients with schizophrenia as compared with a sample of patients with non-psychotic psychiatric diagnoses. Journal of Trauma and Dissociation 7, 722.
Stefanopoulou E, Manoharan A, Landau S, Geddes JR, Goodwin G, Frangou S (2009). Cognitive functioning in patients with affective disorders and schizophrenia: a meta-analysis. International Review of Psychiatry 21, 336356.
Stein JA, Goldring JM, Siegal JM, Burnam MA, Sorrenson SB (1988). Long-term psychological sequelae of child sexual abuse. The Los Angeles Epidemiologic Catchment Area study. In Lasting Effects of Child Sexual Abuse (ed. Wyatt G. E. and Powell G. J.), pp. 135154. Sage Publications: Newbury Park, CA.
Tarbox SI, Pogue-Geile MF (2008). Development of social functioning in preschizophrenia children and adolescents: a systematic review. Psychological Bulletin 134, 561583.
Vogel M, Meier J, Gronke S, Waage M, Schneider W, Freyberger HJ, Klauer T (2011). Differential effects of childhood abuse and neglect: mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia? Psychiatry Research 189, 121127.
Wexler BE, Lyons L, Lyons H, Mazure CM (1997). Physical and sexual abuse during childhood and development of psychiatric illnesses during adulthood. Journal of Nervous and Mental Disease 185, 522524.
Wurr CJ, Partridge IM (1996). The prevalence of a history of childhood sexual abuse in an acute adult inpatient population. Child Abuse and Neglect 20, 867872.
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