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Daily stressors and negative life events in children at elevated risk of developing schizophrenia

  • Alexis E. Cullen (a1), Helen L. Fisher (a2), Ruth E. Roberts (a1), Carmine M. Pariante (a3) and Kristin R. Laurens (a4)...

Psychological stress is implicated in the development of schizophrenia, but little is known about experiences of stress among children at elevated risk for the disorder.


To examine stressor exposure and reactivity in children with different vulnerability profiles for schizophrenia: (a) children presenting multiple antecedents of schizophrenia (ASz group), (b) children with a family history of schizophrenia (FHx group) and (c) typically developing low-risk (TD) children.


Ninety-five children (ASz = 29; FHx = 19; ASz+FHx = 5; TD = 42), identified aged 9–12 years using a community-based screening procedure or as relatives of individuals with schizophrenia, completed questionnaires assessing environmental stressors and psychopathology at age 11–14 years.


Relative to their typically developing peers, children in the FHx and ASz groups were exposed to a greater number of negative life events and a higher frequency of daily stressors, respectively; and were more distressed by these experiences.


Stress exposure and reactivity may constitute useful targets of early intervention for psychosis.

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Corresponding author
Alexis E. Cullen, Department of Forensic and Neurodevelopmental Sciences (Box P023), Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email:
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Senior author.

This work was supported by funding to K.R.L. from a National Institute for Health Research (NIHR) Career Development Fellowship (CDF/08/01/015); a Bial Foundation Research Grant (35/06); a NARSAD Young Investigator Award (2005); and the British Medical Association Margaret Temple Award for schizophrenia research (2006). H.L.F. was supported by a Medical Research Council (MRC) Population Health Scientist award (G1002366).

Declaration of interest


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Daily stressors and negative life events in children at elevated risk of developing schizophrenia

  • Alexis E. Cullen (a1), Helen L. Fisher (a2), Ruth E. Roberts (a1), Carmine M. Pariante (a3) and Kristin R. Laurens (a4)...
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Re: Invisible children: attempting to engage the most vulnerable families

Kristin R Laurens
13 June 2014

We commend Minnis and colleagues on their diligent efforts to access information regarding mental health outcomes for children born to vulnerable mothers who received care 7 years previously via the Women's Reproductive Health Service in Glasgow. Notwithstanding the logistical and ethical issues that make this sensitive research difficult to accomplish, we agree that prospective investigations of children followed from early childhood offer the best prospect for identifying mechanisms underpinning the relationship between childhood adversity and later outcomes such as mental health, social functioning, and educational/occupational attainment. In response to the authors' query regarding how this important research might be achieved given the challenges they identified, we suggest that longitudinal, population record-linkage studies offer excellent capacity to examine these relationships in an unbiased, inclusive, and ethical manner.

One such investigation is the New South Wales Child Development Study ( based at the University of New South Wales. This is a longitudinal investigation following the development of a cohort of 87,026 children who entered full-time schooling in 2009 (representing 99.9% of the population). Via local record-linkage infrastructure provided by the Centre for Health and Record Linkage ( and operated under strict privacy provisions, anonymised individual multi-agency records on the children (including health, education, welfare, birth, and developmental records) have been combined by researchers with records on their parents (including health and criminal records). As part of this study, diverse measures of childhood adversity are available from early childhood, including particularly from population-based government child protection records from the New South Wales Department of Family and Community Services (records were available for 3,926 children [4.5%] in the cohort by the age of five years). These records, in combination with linked information on mental health and well-being outcomes in childhood (and in due course, in adolescence and adulthood), offer excellent capacity to determine the childhood, adolescent, and adult sequelae of early exposure to adversity. Publications on this topic, and others, from the initial phase of the investigation (spanning birth to five years in the population cohort) are currently in preparation.
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Conflict of interest: None declared

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Invisible children: attempting to engage the most vulnerable families

Helen Minnis, Senior Lecturer in Child and Adolescent Psychiatry
20 May 2014

Dear Editor,

Cullen et al1describe childhood antecedents of schizophrenia: such prospective studies are rare. Retrospective research suggests that as thenumber of adverse childhood experiences increases, so does the risk for health problems including alcohol abuse, ischemic heart disease, suicide attempts and externalising behaviours2,3. However, retrospective studies are prone to the biases associated with recalling early childhood. The best way to fully understand the mechanisms underpinning the relationship between ACEs and later development would be to follow children prospectively from early childhood.

We had a unique opportunity to achieve this in Glasgow because of theexistence of the Women's Reproductive Health Service (WRHS) which providesantenatal care for some of the most vulnerable women in Glasgow: those affected by problem drug or alcohol use or significant mental health or personality problems. This cohort is well characterised in terms of family adversity.

We conducted a feasibility study to see if it was possible to assess the mental health of children of very vulnerable mothers. We selected a random sample of 10 women who had had their antenatal care with the WRHS 7years earlier. Of the 10 children targeted, 1 child was deceased, 2 hadbeen adopted and 1 was uncontactable because the mother was in a woman's refuge in a secret location. Of the remaining 6, 3 opted out, 1 was uncontactable despite repeat attempts and of the 2 who provided consent, 1then became uncontactable and the last later opted out. Each woman received a minimum of 10 phone calls and 5 attempted visits with a letter left each time (unless they had opted out in writing or by phone). Despite two members of staff working full time for 8 weeks, it was not possible to conduct any mental health assessments on these children of very vulnerable mothers. Only two out of our target sample of 10 women were ever met with by our research team and we did not succeed in assessing any of the children. In other words, despite persistent phone calls and home visits, eight of these vulnerable women and all of their children remain invisible.

The considerable resources available to our research team - includingthe potential to make multiple phonecalls and visits - are not usually open to health or social care professionals. The question we then have toask is: how do we reach these most vulnerable of families and safeguard the health of their children?

Sincerely, Fiona Sim (psychology), Rachel Pritchett (psychology), Mary Hepburn (obstetrics) and Helen Minnis (psychiatry)

[1] Cullen AE, Fisher HL, Roberts RE, et al. Daily stressors and negative life events in children at elevated risk of developing schizophrenia. BJP May 2014 204:354-360; [2] Felitti VJ, Anda RF, Nordenberg D, et al. The relationship of adult health status to childhood abuse and household dysfunction. Am J Prev Med.1998;14:245-258[3] Hillis SD, Anda RF, Felitti VJ, et al. Adverse childhood experiences and sexual risk behaviours in women: a retrospective cohort study. Family Planning Perspectives. 2001; 33: 206-211

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