Childhood adverseties and mental ill health: Studies on associations between reported childhood adverse and trauma experiences and adult perceived attitudes of others, mental disorders and suicidality

Several studies have indicated that childhood adversities and trauma (CAT) are not uncommon and that they are often associated with physical illnesses, mental problems and disturbed behaviour in adulthood. We have no standardised Finnish instrument for assessment of CAT, and our knowledge of the association between CAT and mental wellbeing is still sporadic. In particular, knowledge of specific associations of CAT with mental problems and gender differences is sparse. The aims of this study programme were to evaluate the feasibility of a new Finnish CAT instrument and the associations of CAT experiences with adult individuals’ perceived attitudes of other people, and the associations of CAT with suicidality and psychiatric disorders. The study samples comprise 692 adult individuals from the general population, 250 patients attending primary care, 160 patients attending psychiatric outpatient care, and 245 patients with clinical high risk (CHR) of psychosis. The three first samples were recruited from South-West Finland. The CHR sample was available from the European Prediction of Psychosis Study (EPOS). In each sample, CAT was assessed with the Trauma and Distress Scale (TADS) which was translated into Finnish. TADS and its five sub-scale domains indicated good psychometric properties in terms of internal consistency, content, inter-method reliability and concurrent validity for adults from a Finnish community sample. TADS appeared to be a useful instrument for the assessment of retrospectively reported childhood adversity and trauma in the general population and clinical samples. In the general population, nearly three fourths (72.3%) of individuals reported at least one and nearly a half (48.1%) two or more CAT experiences. In primary care, the corresponding figures were 76.9% and 57.7%, and in psychiatric outpatient care, 94.4% and 80.6%. Childhood adverse and trauma experiences in general and emotional neglect specifically associated with negative perceived attitude of others in adulthood. The effects of CAT experiences on adult perceived negative attitude of others seem to be stronger in males than in females. All CAT domains associated significantly with reported alcohol problems. In females, sexual abuse and physical abuse had a direct effect on alcohol problems, while in males the corresponding effects were mainly mediated via depressive mood. Emotional abuse and neglect and physical abuse associated most strongly with current mood and anxiety disorders. However, there were considerable inter¬correlations within the CAT domains, as well as comorbidity between clinical diagnoses. When these inter-correlations were taken into account, physical abuse and emotional neglect had the strongest specific association with adult psychiatric disorders and might transmit main effects of other CAT domains onto mental disorders. In a random clinical sample, most psychiatric disorders and CAT domains associated with suicide risk. However, when the effect of co-morbidity and overlap of CAT domains was controlled, major depression, social phobia, alcohol, drug dependency and emotional abuse seemed to increase the risk of suicide. This risk profile varied between the genders. In clinical high risk to psychosis patients, all CAT domains except physical neglect predicted suicidal ideations. The effect of CAT on suicidal ideation was mediated via clinical depression and concurrent depression symptoms. Gender proved to be a central moderating factor in effects of CAT experiences on mental wellbeing. Therefore, in addition to controlling for the effect of gender in the analyses, it is also important to carry out analyses for females and males separately. Emotional neglect and physical abuse proved to be associated specifically with adult psychiatric disorders and, emotional neglect also with perceived negative attitude of other people. These both CAT domains touche on child’s and adolescent’s basic needs of safety and love, and may consequently damage their psychic integrity and self¬esteem, predisposing him/her to a distrusting attitude towards other people and making him/her vulnerable to adult mental problems and disorders. The majority of childhood adverse and trauma experiences are family-centred. Parents’ mental health and their mutual interaction, i.e. family function, form a central basis for the children’s undisturbed development. Therefore, early family¬centred therapeutic and educational interventions directed to improving parents’ and children’s mental health, and to supporting parents in their parenthood can protect children from adverse and traumatic experiences. Societal measures to help families facing economic and other difficulties can contribute to the same goal. At the level of the whole society, it is a question of valuation of family life. Societal actions should be taken to support a stable and harmonious family life, and to really value children and their wellbeing. Moreover, the public media have an important role to play in these actions.Lukuisat tutkimukset ovat osoittaneet, että lapsuuden kaltoinkohtelu ja traumat (KT) eivät ole harvinaisia ja että ne usein yhdistyvät aikuisiän fyysisiin sairauksiin, mielenterveyden ongelmiin ja häiriintyneeseen käyttäytymiseen. Meillä ei ole vielä standardoitua suomenkielistä mittaria lapsuuden KT:n arviointiin ja tietomme KT:n ja psyykkisen hyvinvoinnin välisistä yhteyksistä on edelleen satunnaista. Varsinkin tietomme KT:n ja psyykkisten ongelmien välisistä spesifisistä yhteyksistä ja sukupuolieroista ovat niukkoja. Tässä tutkimuskokonaisuudessa pyrittiin arvioimaan uuden suomenkielisen lapsuuden KT-instrumentin käyttökelpoisuutta, KT:n yhteyksiä koettuun, muiden taholta tulevaan asennoitumiseen sekä KT:n yhteyksiä itsetuhoisuuteen ja psykiatrisiin häiriöihin. Tutkimusaineistot käsittävät 692 yleisväestön aikuista, 250 terveyskeskukseen ja 160 psykiatriseen avohoitoon tullutta sekä 245 psykoosiriskissä olevaa potilasta. Kolme ensiksi mainittua otosta kerättiin Lounais-Suomesta. Psykoosiriskiaineisto tuli European Prediction of Psychosis study’stä (EPOS). Kaikissa aineistoissa lapsuuden kaltoinkohtelu ja traumat arvioitiin Trauma and Distress Scale:lla (TADS), joka oli käännetty englannista suomeksi. TADS:n ja sen viiden komponentin psykometriset ominaisuudet: sisäinen konsistenssi, sisältö, menetelmällinen reliabiliteetti, samanaikaisvaliditeetti, osoit¬tautuivat hyviksi suomalaisessa väestöotoksessa. TADS osoittautui käyttökelpoi¬seksi instrumentiksi, kun takautuvasti raportoituja lapsuuden kaltoinkohtelua ja traumoja arvioidaan yleisväestössä ja kliinisissä aineistoissa. Yleisväestöstä lähes kolme neljäsosaa (72.3%) raportoi vähintään yhden ja lähes puolet (48.1) kaksi tai useamman lapsuuden KT-kokemuksen. Terveyskeskuksen potilailla vastaava osuudet olivat 76.7% ja 57.7% ja psykiatrisilla avohoitopotilailla 94.4% ja 80.6%. Lapsuuden kaltoinkohtelu ja traumakokemukset yleisesti ja emotionaalinen laiminlyönti spesifisesti yhdistyivät aikuisiässä koettuun, toisten ihmisten nega¬tiiviseen asenteeseen. KT-kokemusten vaikutukset aikuisiässä koettuun, toisten ihmisten negatiiviseen asenteeseen näyttivät olevan miehillä voimakkaampia kuin naisilla. Kaikki KT:n komponentit yhdistyivät merkitsevästi raportoituihin alkoholiongelmiin. Naisilla seksuaalinen hyväksikäyttö ja fyysinen kaltoinkohtelu yhdistyivät suoraan alkoholiongelmien esiintymiseen; miehillä vastaavat yhteydet välittyivät pääasiassa masentuneen mielialan kautta. Emotionaalinen kaltoinkohtelu ja laiminlyönti sekä fyysinen kaltoinkohtelu yhdistyivät vahvimmin ajankohtaisiin mieliala-ja ahdistuneisuushäiriöihin. KT:n komponentit kuitenkin korreloivat huomattavasti keskenään, samoin kliinisten diagnoosien kesken ilmeni samanaikaisesiintymistä. Kun nämä samanaikais¬korrelaatiot otettiin huomioon, fyysinen kaltoinkohtelu ja emotionaalinen laiminlyönti yhdistyivät spesifisesti aikuisiän psykiatrisiin häiriöihin ja saattoivat siten välittää KT:n muiden komponenttien pääasialliset vaikutukset mielenterveyden häiriöihin. Satunnaisessa kliinisessä aineistossa useimmat psykiatriset häiriöt ja lapsuuden KT:n komponentit yhdistyivät itsemurhariskiin. Kuitenkin kun oheissairaudet ja KT:n komponenttien päällekkäisyys oli kontrolloitu, masennustila, sosiaalinen fobia, alkoholi-ja huumeriippuvuus sekä emotionaalinen kaltoinkohtelu näyttivät lisänneen itsemurhariskiä. Tämä riskiprofiili vaihteli sukupuolten välillä. Psykoosi¬riskipotilailla kaikki KT:n komponentit paitsi fysikaalinen laiminlyönti ennustivat seuranta-aikaisia itsetuhoisia ajatuksia. KT:n vaikutus itsetuhoisiin ajatuksiin välittyi perusvaiheen kliinisen masennushäiriön ja samanaikaisen masentuneisuuden kautta. Sukupuoli osoittautui keskeiseksi muovaavaksi tekijäksi, kun tarkasteltiin lapsuuden KT:n vaikutusta psyykkiseen hyvinvointiin. Niinpä sen lisäksi, että sukupuolen vaikutus analyyseissä kontrolloidaan, on tärkeää myöskin suorittaa analyysit naisilla ja miehille erikseen. Emotionaalinen laiminlyönti ja fyysinen kaltoinkohtelu osoittautuivat yhdis¬tyvän spesifisti psykiatrisiin häiriöihin ja emotionaalinen laiminlyönti myös negatiiviseksi koettuun toisten ihmisten asenteeseen. Nämä molemmat KT:n muodot koskettavat lapsen ja nuoren perustavaa laatua olevia turvallisuuden ja rakastettuna olemisen tarpeita ja voivat siten vahingoittaa hänen psyykkistä eheyttään ja itsetuntoaan altistaen hänet aikuisiässä epäluottamuksen sävyttämälle asenteelle toisia ihmisiä kohtaan sekä mielenterveyden ongelmille ja häiriöille. Enemmistö lapsuuden kaltoinkohtelusta ja traumakokemuksista liittyy perheisiin. Vanhempien mielenterveys ja heidän keskinäinen vuorovaikutuksensa, ts. perhefunktio, muodostaa keskeisen pohjan lasten häiriöttömälle kehitykselle. Tämän vuoksi varhaiset vanhempien ja lasten mielenterveyttä tukevat perhekes¬keiset terapeuttiset ja neuvontatoimenpiteet sekä vanhempien tukeminen heidän vanhemmuuden tehtävässään voivat suojata lapsia ja nuoria kaltoinkohtelulta ja traumakokemuksilta. Sosiaalipoliittiset toimenpiteet, jotka suunnataan perheisin niiden kohdatessa taloudellisia ja muita vaikeuksia, voivat vaikuttaa samaan tavoitteeseen. Koko yhteiskunnan taholla kyse on perhe-elämän arvostamisesta. Yhteiskunnan tuleekin ryhtyä toimenpiteisiin stabiilin ja tasapainoisen perhe-elämän tukemiseksi sekä suhtautua todella arvostavasti lapsiin ja heidän hyvinvointiinsa. Myös julkisella medialla on tärkeä rooli näissä toimenpiteissä

General psychopathology links burden of recent life events and psychotic symptoms in a network approach

Recent life events have been implicated in the onset and progression of psychosis. However, psychological processes that account for the association are yet to be fully understood. Using a network approach, we aimed to identify pathways linking recent life events and symptoms observed in psychosis. Based on previous literature, we hypothesized that general symptoms would mediate between recent life events and psychotic symptoms. We analyzed baseline data of patients at clinical high risk for psychosis and with recent-onset psychosis (n = 547) from the Personalised Prognostic Tools for Early Psychosis Management (PRONIA) study. In a network analysis, we modeled links between the burden of recent life events and all individual symptoms of the Positive and Negative Syndrome Scale before and after controlling for childhood trauma. To investigate the longitudinal associations between burden of recent life events and symptoms, we analyzed multiwave panel data from seven timepoints up to month 18. Corroborating our hypothesis, burden of recent life events was connected to positive and negative symptoms through general psychopathology, specifically depression, guilt feelings, anxiety and tension, even after controlling for childhood trauma. Longitudinal modeling indicated that on average, burden of recent life events preceded general psychopathology in the individual. In line with the theory of an affective pathway to psychosis, recent life events may lead to psychotic symptoms via heightened emotional distress. Life events may be one driving force of unspecific, general psychopathology described as characteristic of early phases of the psychosis spectrum, offering promising avenues for interventions

The Psychopathology and Neuroanatomical Markers of Depression in Early Psychosis

Depression frequently occurs in first-episode psychosis (FEP) and predicts longer-term negative outcomes. It is possible that this depression is seen primarily in a distinct subgroup, which if identified could allow targeted treatments. We hypothesize that patients with recent-onset psychosis (ROP) and comorbid depression would be identifiable by symptoms and neuroanatomical features similar to those seen in recent-onset depression (ROD). Data were extracted from the multisite PRONIA study: 154 ROP patients (FEP within 3 months of treatment onset), of whom 83 were depressed (ROP+D) and 71 who were not depressed (ROP-D), 146 ROD patients, and 265 healthy controls (HC). Analyses included a (1) principal component analysis that established the similar symptom structure of depression in ROD and ROP+D, (2) supervised machine learning (ML) classification with repeated nested cross-validation based on depressive symptoms separating ROD vs ROP+D, which achieved a balanced accuracy (BAC) of 51%, and (3) neuroanatomical ML-based classification, using regions of interest generated from ROD subjects, which identified BAC of 50% (no better than chance) for separation of ROP+D vs ROP-D. We conclude that depression at a symptom level is broadly similar with or without psychosis status in recent-onset disorders; however, this is not driven by a separable depressed subgroup in FEP. Depression may be intrinsic to early stages of psychotic disorder, and thus treating depression could produce widespread benefit

Amygdala subnucleus volumes in psychosis high-risk state and first-episode psychosis

Structural and functional abnormalities of the amygdala in schizophrenia have been well documented. Post-mortem studies suggest that the lateral nucleus is particularly affected in schizophrenia. It is not known whether the amygdala subnuclei are differently affected at the time of the first-episode psychosis or already at high-risk state.75 first-episode psychosis patients (FEP), 45 clinical high-risk patients (CHR) and 76 population controls participated in this cross-sectional case-control study. Participants underwent T1-weighted 3T MRI scans, from which the amygdala was segmented using a newly developed automated algorithm. Because early adverse events increase risk for psychosis and affect the amygdala, we also tested whether experiences of childhood maltreatment associate with the putative amygdala subnuclei abnormalities.Compared to the population controls, FEP had smaller volumes of the lateral, and basal nuclei. In CHR, only the lateral nucleus was significantly smaller compared to the control subjects. Experience of childhood maltreatment was inversely associated with lateral nucleus volumes in FEP but not in CHR.These results show that the lateral and basal nuclei of the amygdala are already affected in FEP. These volumetric changes may reflect specific cellular abnormalities that have been observed in post-mortem studies in schizophrenia in the same subnuclei. Decreased volume of the lateral nucleus in CHR suggest that a smaller lateral nucleus could serve as a potential biomarker for psychosis risk. Finally, we found that the lateral nucleus volumes in FEP may be sensitive to the effects of childhood maltreatment.</p

Effects of childhood and adolescence physical activity patterns on psychosis risk—a general population cohort study

Schizophrenia spectrum disorders are associated with high morbidity and mortality in somatic diseases. The risk factors of this excess mortality include, e.g., obesity, dietary factors, and physical inactivity, especially after the onset of psychosis, but there are limited early developmental data on these factors in individuals who later develop psychosis. A population-based cohort study “Cardiovascular Risk of Young Finns” started in 1980 with 3596 children and adolescents from six different age groups (3, 6, 9, 12, 15, and 18 years). Cardiovascular health parameters, including questionnaire of physical activity before first hospitalization (≤18 years), were studied in 1980, 1983, and 1986. All psychiatric diagnoses of the participants were derived from the Finnish Hospital Discharge Register up to the year 2012. We identified diagnostic groups of non-affective psychosis (n = 68, including a schizophrenia subgroup, n = 41), personality disorders (n = 43), affective disorders (n = 111), and substance-related disorders (n = 49), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Groups were compared with controls with no psychiatric diagnoses (n = 3325). Sex, age, body mass index, birth weight, non-preterm birth, and mother’s mental disorders were included in the statistical model. Low physical activity in childhood and adolescence (9–18 years) independently predicted later development of non-affective psychosis. Lower physical activity index (relative risk 1.26 [1.1–1.5]), lower level of common activity during leisure time (relative risk 1.71 [1.2–2.5]), and non-participation in sports competitions (relative risk 2.58 [1.3–5.3]) were associated with a higher risk for later non-affective psychosis (expressed as increase in relative risk per physical activity unit). The findings were even stronger for schizophrenia, but no such link was observed for other diagnoses. The cause of low physical activity in premorbid/prodromal phase is likely to be multifactorial, including deviant motor and cognitive development. The results provide a rationale for including exercise and physical activity interventions as a part of psychosis prevention programs.</p

Extrapyramidal symptoms predict cognitive performance after first-episode psychosis

Extrapyramidal (EP) symptoms such as tremor, rigidity, and bradykinesia are common side effects of most antipsychotics, and may associate with impaired performance in neurocognitive testing. We studied EP symptoms in first-episode psychosis (FEP; n = 113). Cognitive testing and EP symptoms (three items of the Simpson-Angus Scale) were assessed at baseline and follow-up (mean follow-up time 12 months). Mild EP symptoms were present at treatment onset in 40% of the participants. EP symptoms were related with lower performance in neurocognitive testing at baseline and at follow-up, especially among those with nonaffective psychotic disorder, and especially in tasks requiring speed of processing. No associations between EP symptoms and social cognition were detected. In linear regression models, when positive and negative symptom levels and chlorpromazine equivalents were accounted for, baseline EP symptoms were associated with worse baseline global neurocognition and visuomotor performance. Baseline EP symptoms also longitudinally predicted global, verbal, and visuomotor cognition. However, there were no cross-sectional associations between EP symptoms and cognitive performance at follow-up. In sum, we found both cross-sectional and longitudinal associations between EP symptoms and neurocognitive task performance in the early course of psychosis. Those without EP symptoms at the start of treatment had higher baseline and follow-up neurocognitive performance. Even mild EP symptoms may represent early markers of long-term neurocognitive impairment.</p