Article

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

The authors from the Netherlands examined the gender-specific association between depressive symptoms and specific forms of childhood trauma in patients with recent-onset schizophrenia spectrum disorders (SSD). 

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 SSD, particularly in relation to the increased severity of depressive or negative symptoms. The type and impact of trauma may differ between genders. Female SSD patients report a higher exposure to childhood trauma than male SSD patients. 

About the study

The data were obtained from the baseline measurements of two studies, the Simvastatin augmentation for recent-onset psychotic disorder (Simvastatin) study and the ongoing Handling antipsychotic medication: long-term evaluation of targeted treatment (HAMLETT) study.

From the Simvastatin study, patients 18–50 years old, with a diagnosis of schizophrenia, schizoaffective disorder, schizophreniform disorder or unspecified schizophrenia spectrum and other psychotic disorders were included. All the patients were in remission at the time of the inclusion. From the ongoing HAMLETT study, 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 included. 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, of whom 187 were first-episode psychosis patients in remission (HAMLETT study) and 115 were recent-onset SSD patients (Simvastatin study). Out of a total of 302 patients, 218 patients were men, and 84 patients were women.

The prevalence of specific forms of trauma was gender-specific, with three times higher rates of sexual abuse in women than in men, and two times higher rates of emotional abuse in women than in men, respectively.

In the total sample, 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 correction. Negative symptoms were significantly associated with a total trauma score and emotional neglect.

In women, sexual abuse was significantly associated with an increase in severity of depressive symptoms. This is consistent with previous studies 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.

The authors concluded that their findings revealed 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 gender-specific analyses 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