A new study in social psychiatry has shown a link between childhood trauma and the later onset of psychosis.
Researchers in Canada and the United States interviewed hundreds of participants, many of whom were determined to be at “clinically high risk” (CHR) for developing psychosis, and followed up two years later with further interviews, concluding that trauma and perceived discrimination at an early age proved to be associative with the later development of psychosis.
Researchers found the connection between perceived discrimination and later development of psychosis to be the most significant. “CHR participants report experiencing more trauma, bullying and perceived discrimination compared to healthy controls. Additionally, the more lifetime perceived discrimination endorsed, the greater the chance of conversion to psychosis,” say the study’s authors.
The CHR designation is a relatively recent construction in psychiatry, indicating a patient’s prepsychotic phase during which a range of mental health concerns and symptoms may present, with or without transition to full psychosis. Specialists have found CHR to have therapeutic merit since it places emphasis on treatment and care during the early stages of psychotic development, potentially warding off further psychotic trajectories, and it helps to justify service provision for those who may need help but find it difficult to access psychiatric care due to a lack of established diagnosis. Roughly one third of people presenting as CHR move on to full blown psychoses such as schizophrenia and bipolar disorder while two thirds do not progress to full psychosis.
The study found that of the 654 CHR participants interviewed, 46.2 per cent reported experiencing at least one type of trauma earlier on in life and 72.4 per cent reported experiencing at least one type of discrimination, which compares with control groups reporting trauma and discrimination at 11.4 per cent and 57.5 per cent respectively.
Studies have shown that a society’s minority groups -such as ethnic or sexual minorities- are at a higher risk for schizophrenia and other psychotic disorders. This has been described is as a type of “social defeat,” where continual exposure to social experiences placing a person in a negative and subordinate position effectively produces feelings of social adversity and self perception as an outsider. Migrants from low- and middle-income countries, people with low IQ, hearing impairments or a history of abuse are all said to be at a disadvantage due to social defeat, which can lead to neurological changes such as dopamine hyperactivity and behavioural sensitization.
The study’s authors conclude that clinicians should be aware of these elevated risks of psychoses amongst minorities and tailor therapy options accordingly. “While it is difficult to determine the actual experience of discrimination, an attempt to at least identify perceived discrimination may help eliminate feelings of having an outsider status, and ultimately contribute to a reduction or prevention of psychosis,” say the authors.
The study was led by Dr. Jacqueline Stowkowy of the Department of Psychiatry, University of Calgary, and was published this month in the journal Social Psychiatry and Psychiatric Epidemiology.