The Role of Trauma and Stressful Life Events among Individuals at Clinical High Risk for Psychosis: A Review

Abstract

The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic–pituitary–adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.

Psychotic‐spectrum symptoms, cumulative adversity exposure and substance use among high‐risk girls

“…Consistent with research linking trauma with psychosis vulnerability (Mayo et al, ), 90% of delinquent girls in the present study reported exposure to ≥10 adversity types, including sexual assault (>60%) which is the most common childhood trauma associated with transition to psychosis (Bechdolf et al, ; Thompson et al, ). Nearly 82% of girls met moderate to extreme levels of PTSD in their lifetime, and trauma exposure types were specifically associated with “relational” psychotic‐spectrum symptoms (hypersensitivity, paranoid, schizoid) likely to disrupt social outcomes.…”

“…The SCI‐PSY (Sbrana et al, ) is a 164‐item structured interview that includes total, domain and subdomain scores derived from dichotomous (0 = no, 1 = yes) lifetime classic positive and negative symptoms, prodromal/soft signs and personal characteristics (Appendix S1). The spectrum‐model has established reliability and validity with controls and patient groups as well as our delinquent girls (Appendix S1), and is consistent with a psychosis‐continuum supported by a wide literature (Cuesta & Peralta, ; Linscott & Van Os, ; Mayo et al, ; Rossi & Daneluzzo, ; Van Os et al, ). While not intended to be diagnostic, the SCI‐PSY captures treatment‐relevant symptoms, with items reflecting sensitivity, specificity, and predictive values for psychotic‐like experiences (hallucinations, paranoid thoughts) when comparing screens to clinical interviews (Kelleher, Harley, Murtagh, & Cannon, ).…”

“…Taken together, these data suggest a significant portion of justice‐involved youth mirror populations designated clinical (or ultra) high‐risk for psychosis conversion (Mayo et al, ). Further, high‐density, correctional environments and solitary confinement may exacerbate psychotic‐spectrum symptoms (Haney, ; Metzner & Fellner, ), resulting in cascading disparities and impairment (e.g., interference with ability to aid in their legal defence, heightened perceptions of non‐compliance, disciplinary sanction escalation; Skeem, Manchak, & Peterson, ).…”

“…Further, high‐density, correctional environments and solitary confinement may exacerbate psychotic‐spectrum symptoms (Haney, ; Metzner & Fellner, ), resulting in cascading disparities and impairment (e.g., interference with ability to aid in their legal defence, heightened perceptions of non‐compliance, disciplinary sanction escalation; Skeem, Manchak, & Peterson, ). Girls also endorsed multiple risk factors predictive of transition to psychosis: unusual/odd thoughts and suspiciousness (Cannon et al, ; Fusar‐Poli et al, ; Schultze‐Lutter et al, ), early traumatic experiences (Mayo et al, ; Stowkowy et al, ), and substance use (Cannon et al, ). Psychotic‐spectrum symptoms appear highly relevant to justice‐involved girls, whether representing a prodromal phase, trauma‐response or cross‐diagnostic psychiatric symptomatology.…”

“…Specifically, psychosis predisposes individuals to adversity; adversity induces psychosis and/or the cognitive liability for psychosis (paranoid delusions, increased stress sensitivity); and post‐traumatic stress disorder (PTSD) and psychosis may both arise from adversity (Garety, Kuipers, Fowler, Freeman, & Bebbington, ; Mayo et al, ; Morrison, Frame, & Larkin, ; Read, Perry, Moskowitz, & Connolly, ). Child maltreatment is particularly implicated in hallucinations and delusions (Schenkel, Spaulding, Dilillo, & Silverstein, ; Shevlin, Dorahy, & Adamson, ).…”