The experience of childhood trauma is linked to more severe symptoms and poorer functioning in severe mental disorders; however, the mechanisms behind this are poorly understood. We investigate the relationship between childhood trauma and sleep disturbances in severe mental disorders including the role of sleep disturbances in mediating the relationship between childhood trauma and the severity of clinical symptoms and poorer functioning.

In total, 766 participants with schizophrenia-spectrum (n = 418) or bipolar disorders (n = 348) were assessed with the Childhood Trauma Questionnaire. Sleep disturbances were assessed through the sleep items in the self-reported Inventory of Depressive Symptoms. Clinical symptoms and functioning were assessed with The Positive and Negative Syndrome Scale and the Global Assessment of Functioning Scale. Mediation analyses using ordinary least squares regression were conducted to test if sleep disturbances mediated the relationship between childhood trauma and the severity of clinical symptoms and poorer functioning.

Symptoms of insomnia, but not hypersomnia or delayed sleep phase, were significantly more frequent in participants with childhood trauma experiences compared to those without. Physical abuse, emotional abuse, and emotional neglect were significantly associated with insomnia symptoms. Insomnia symptoms partly mediate the relationship between childhood trauma and the severity of positive and depressive/anxiety symptoms, in addition to poorer functioning.

We found frequent co-occurrence of childhood trauma history and current insomnia in severe mental disorders. Insomnia partly mediated the relationship between childhood trauma and the severity of clinical symptoms and functional impairment.

Recently there has been a renewed interest in defining the boundaries and subdomains of the negative syndrome in schizophrenia and new scales have been asked for. Apathy is one of the symptoms in focus. The Apathy Evaluation Scale (AES) with its clinical version (AES-C) is one of the most used scales in an interdisciplinary context, but it has never previously been used in a population with first episode psychosis. The main aims of this study were to examine the psychometric properties of the AES-C and its relationship to the Positive and Negative Syndrome Scale (PANSS).

A total of 104 patients with first episode psychosis from the ongoing Thematic Organized Psychosis Research (TOP) study were included.

A factor analysis of the AES-C identified three subscales: Apathy, Insight and Social Contacts. Only the Apathy subscale showed satisfactory psychometric properties and showed acceptable convergent and discriminate properties by correlating strongly with the apathy-related items of the PANSS.

This study shows that the AES-C measures more than one dimension. The main factor, the Apathy subscale, can however be used to assess apathy in first episode psychosis patients in the ongoing work of refining the subdomains of the negative syndrome.