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The association between childhood adversities and subsequent first onset of psychotic experiences: a cross-national analysis of 23 998 respondents from 17 countries

Published online by Cambridge University Press:  09 January 2017

J. J. McGrath ,
K. A. McLaughlin ,
S. Saha ,
S. Aguilar-Gaxiola ,
A. Al-Hamzawi ,
J. Alonso ,
R. Bruffaerts ,
G. de Girolamo ,
P. de Jonge  and
O. Esan
...Show all authors
J. J. McGrath*
Affiliation:
Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, Australia
K. A. McLaughlin
Affiliation:
Department of Psychology, University of Washington, Seattle, Washington, USA
S. Saha
Affiliation:
Queensland Centre for Mental Health Research, and Queensland Brain Institute, University of Queensland, Australia
S. Aguilar-Gaxiola
Affiliation:
Center for Reducing Health Disparities, UC Davis Health System, Sacramento, California, USA
A. Al-Hamzawi
Affiliation:
College of Medicine, Al-Qadisiya University, Diwaniya governorate, Iraq
J. Alonso
Affiliation:
Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain Pompeu Fabra University (UPF), Barcelona, Spain CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
R. Bruffaerts
Affiliation:
Universitair Psychiatrisch Centrum – Katholieke Universiteit Leuven (UPC-KUL), Campus Gasthuisberg, Leuven, Belgium
G. de Girolamo
Affiliation:
IRCCS St John of God Clinical Research Centre, IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
P. de Jonge
Affiliation:
Department of Developmental Psychology, Research Program Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
O. Esan
Affiliation:
Department of Psychiatry, University of Ibadan, Nigeria
S. Florescu
Affiliation:
National School of Public Health, Management and Professional Development, Bucharest, Romania
O. Gureje
Affiliation:
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
J. M. Haro
Affiliation:
Parc Sanitari Sant Joan de Déu, CIBERSAM, Universitat de Barcelona, Barcelona, Spain
C. Hu
Affiliation:
Shenzhen Institute of Mental Health & Shenzhen Kangning Hospital, Shenzhen, China
E. G. Karam
Affiliation:
Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
V. Kovess-Masfety
Affiliation:
Ecole des Hautes Etudes en Santé Publique (EHESP), EA 4057 Paris Descartes University, Paris, France
S. Lee
Affiliation:
Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
J. P. Lepine
Affiliation:
Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris INSERM UMR-S 1144, University Paris Diderot and Paris Descartes, Paris, France
C. C. W. Lim
Affiliation:
Queensland Brain Institute, The University of Queensland, St. Lucia, Queensland, Australia Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, New Zealand
M. E. Medina-Mora
Affiliation:
National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico
Z. Mneimneh
Affiliation:
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA IDRAAC, Beirut, Lebanon
B. E. Pennell
Affiliation:
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
M. Piazza
Affiliation:
Universidad Cayetano Heredia, Lima, Peru National Institute of Health, Lima, Peru
J. Posada-Villa
Affiliation:
Colegio Mayor de Cundinamarca University, Bogota, Colombia
N. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
M. C. Viana
Affiliation:
Department of Social Medicine, Federal University of Espírito Santo, Vitoria, Brazil
M. Xavier
Affiliation:
Department of Mental Health, Faculdade de Ciências Médicas, Chronic Diseases Research Center (CEDOC) and Universidade Nova de Lisboa, Campo dos Mártires da Pátria, Lisbon, Portugal
E. J. Bromet
Affiliation:
Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
K. S. Kendler
Affiliation:
Department of Psychiatry, Virginia Commonwealth University, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
*
*Address for correspondence: Professor J. McGrath, Queensland Brain Institute, The University of Queensland, St Lucia, Queensland, Australia. (Email: [email protected])
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Abstract

Background

Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations.

Method

We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models.

Results

Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9–2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6–20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF).

Conclusions

Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.

Keywords

Childhood adversitydiscrete-time survival analysismaladaptive family functioningpopulation attributable risk proportionpsychotic experiencesWorld Mental Health survey
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 7 , May 2017 , pp. 1230 - 1245
Copyright
Copyright © Cambridge University Press 2017 

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Footnotes

† The World Mental Health Survey Collaborators are listed in the Appendix.

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