Study uncovers gender-specific links between childhood trauma and psychosis

A new study published in Psychological Medicine explores the distinct role childhood trauma plays in the development of mental health disorders, especially schizophrenia spectrum disorders (SSDs). This research suggests that past traumatic events experienced in childhood affect men and women differently when it comes to the onset and progression of these disorders.

The researchers found that in men with recent-onset psychosis, depressive symptoms were more associated with total trauma scores and emotional abuse ratings. In women, depressive symptoms were more associated with ratings of sexual abuse.

Principal investigator, Anne-Sophie D Enthoven, highlighted the significance of these findings, stating:

Severity of depressive symptoms was associated with different types of trauma in men and women with recent-onset SSD. Specifically, in women, the severity of depressive symptoms was associated with childhood sexual abuse, which was reported three times more often than in men.

The impetus of this study was twofold: first, to evaluate gender differences in the types of trauma experienced by people with early-onset psychosis, and second, to investigate the correlation between these various forms of trauma and depressive or negative symptoms.

In reaching their conclusions, the researchers drew on data from two previous studies: the Simvastatin Rising for Recent Onset Psychotic Disorders Study and the Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment (HAMLETT) Study.

The simvastatin study attracted participants from Dutch inpatient and outpatient treatment settings. These individuals, aged 18 to 50, were diagnosed with a spectrum range of schizophrenia and other psychotic disorders while participating in the study while in remission.

The HAMLETT study recruited participants aged 16 to 60 from Dutch outpatient clinics. These individuals had experienced their first attack of psychosis and were in remission for 3-6 months after being diagnosed with various psychotic disorders. In total, the current research used data from 302 participants, including 218 men and 84 women.

To assess depressive and negative symptoms, the researchers used the Positive and Negative Symptom Scale (PANSS). Childhood trauma was assessed using the Dutch version of the Childhood Trauma Questionnaire – Short Form (CTQ – SF).

The study found that sexual abuse was reported three times more frequently by women than men (23.5% vs 7.8%). Emotional abuse was reported twice as often by women (21.2% vs 11%). Women reported significantly more sexual abuse when rated on a rolling scale (degree of experience rather than a yes-or-no binary), but there was no notable gender difference in reports of emotional abuse. Rates for all other childhood trauma categories were comparable between genders.

Depressive symptoms in the whole sample, including men and women, showed a strong association with total trauma scores. The correlation between depressive symptoms and emotional abuse was particularly pronounced. However, the authors report a potentially insignificant link between depressive symptoms, emotional neglect, and sexual abuse.

The analysis involving exclusively male participants showed a strong link between depressive symptoms and both overall trauma scores and emotional abuse. Focusing only on women, depressive symptoms were found to be strongly linked to sexual abuse, while the correlation with overall trauma scores and emotional abuse severity appeared weaker and potentially insignificant.

Negative symptoms in the full sample were strongly related to overall trauma scores, emotional abuse, and emotional neglect. In men, negative symptoms were strongly related to overall trauma scores and emotional neglect, while in women, no significant association was found between trauma and negative symptoms, a phenomenon the authors potentially attribute to a lack of statistical power.

The authors point out several limitations of their study. The population sample may not represent those with first-episode psychosis because individuals who agree to participate in research often exhibit better health and function. The study also limited its focus to the sex of birth participants, not taking into account socially constructed gender roles. Furthermore, the relatively low number of women included and a lower-than-expected prevalence of childhood trauma may have led to insignificant associations. The authors conclude:

Our study found important sex differences in the prevalence of sexual and emotional abuse in a large sample of patients with first-episode psychosis and recent-onset SSD. Because sexual abuse was associated with depressive symptoms only in women, the high rates of depressive symptoms generally seen in women with SSD may be partly explained by their much higher rates of childhood sexual trauma. Total trauma scores, as well as emotional abuse and emotional neglect, correlated with both depressive and negative symptoms in the total patient sample and in men. Lack of power may be one reason why these associations were absent in women.

Previous research has linked traumatic experiences and psychosis. A 2018 meta-analysis specifically linked childhood trauma to symptoms of psychosis. Similar research has also found a link between trauma and the development of psychosis in children. A 2022 study found an association between sexual assault and psychosis.

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Enthoven, ASD, Gangadin, SS, de Haan, L., Veling, W., de Vries, EFJ, Doorduin, J., . . . Summer, IEC (2023). The association of childhood trauma with depressive and negative symptoms in recent-onset psychosis: A sex-specific analysis. Psychological Medicine. Advanced online publishing. (Connection)

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