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The association between depressive symptoms and specific forms of childhood trauma in patients with recent-onset schizophrenia spectrum disorders is a gender-specific

Different types of childhood trauma, such as sexual, physical, and emotional abuse, as well as physical and emotional neglect, are known risk factors for the development of schizophrenia spectrum disorders (SSD). The type, frequency, and impact of trauma may differ between genders. In this study, the authors from the Netherlands investigated the association between depressive symptoms and specific forms of childhood trauma in patients with recent-onset schizophrenia spectrum disorders (SSD) and possible differences related to gender. 

About the study

The researchers used two studies, the Simvastatin Augmentation for recent-onset Psychotic Disorder study ( Simvastatin study) and the ongoing Handling antipsychotic medication: Long-term Evaluation of Targeted Treatment (HAMLETT) study.

Patients 18–50 years old, with a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder, or unspecified schizophrenia spectrum and other psychotic disorders were taken from the Simvastatin study. All the patients were in remission at the time of the inclusion. Patients 16–60 years old, who were in remission for 3–6 months after their first episode of schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, delusional disorder, substance/medication-induced psychotic disorder, or unspecified schizophrenia spectrum and other psychotic disorders were taken from the ongoing HAMLETT study. The Comprehensive assessment of symptoms and history (CASH) was used to confirm the diagnoses in both studies. The dosage of the antipsychotic therapy was recorded and converted to an equivalent dose of chlorpromazine.

The positive and negative symptom scale (PANSS) was used to assess depressive and negative symptoms. The Dutch version of the Childhood trauma questionnaire – short form (CTQ-SF) was used to assess childhood trauma. This questionnaire examines five specific forms of trauma: emotional, physical, and sexual abuse, as well as emotional and physical neglect.

Results

This cross-sectional study included a total of 302 patients, 187 patients in the first episode of psychosis in remission (HAMLETT study) and 115 recent-onset SSD patients (Simvastatin study). 218 patients were men, and 84 patients were women.

The rates of sexual abuse were three times higher in women than in men, whereas the rates of emotional abuse were two times higher in women than in men, showing that the prevalence of specific forms of trauma was gender-specific.

In the total sample, a higher total trauma score was significantly associated with more severe depressive symptoms and more severe negative symptoms. Emotional abuse showed a stronger association with depressive symptoms, while emotional neglect and sexual abuse only reached trend-level significance after adjusting for multiple comparisons. Emotional abuse and emotional neglect were significantly associated with negative symptoms.

The results in men were very similar to those found in the total sample. Depressive symptoms were significantly associated with total trauma score and emotional abuse ratings, while the association with emotional neglect did not survive multiple comparison corrections. Negative symptoms were significantly associated with a total trauma score and emotional neglect.

In women, sexual abuse was significantly associated with an increase in the severity of depressive symptoms. This is consistent with previous data that showed that sexual abuse in women was associated with high levels of anxiety, guilt, and a pervasive sense of defeat, resulting in a depressed mood. However, there were no significant correlations between negative symptoms and a total trauma score.

Conclusion

According to the authors, the findings revealed a gender-specific association between depressive symptoms and specific forms of childhood trauma in patients with recent-onset schizophrenia spectrum disorders (SSD). In women, the severity of depressive symptoms was associated with childhood sexual abuse, which was three times as often as in men. These results emphasize that it is important to evaluate trauma history in patients because it may be connected to a specific profile or presentation of symptoms. In conclusion, this research highlighted the significance of a gender-specific analysis in SSD research.

This article was published in Psychological Medicine.

Journal Reference

Enthoven AD et al. The association of childhood trauma with depressive and negative symptoms in recent onset psychosis: a sex-specific analysis. Psychological Medicine 110, 2023. (Open Access)   https://doi.org/10.1017/S0033291723001824

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