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Childhood adversities in people at ultra-high risk (UHR) for psychosis: a systematic review and meta-analysis

Published online by Cambridge University Press:  08 January 2019

Oon Him Peh Open the ORCID record for Oon Him Peh [Opens in a new window] ,
Attilio Rapisarda  and
Jimmy Lee
Oon Him Peh*
Affiliation:
Research Division, Institute of Mental Health, Singapore
Attilio Rapisarda
Affiliation:
Research Division, Institute of Mental Health, Singapore Duke-NUS Medical School, Singapore
Jimmy Lee
Affiliation:
Research Division, Institute of Mental Health, Singapore Department of General Psychiatry, Institute of Mental Health, Singapore
*
Author for correspondence: Oon Him Peh, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747 E-mail: oonhim.peh@gmail.com
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Abstract

Childhood adversities have been reported to be more common among individuals at ultra-high risk (UHR) for psychosis. This paper systematically reviewed and meta-analysed (i) the severity and prevalence of childhood adversities (childhood trauma exposure, bullying victimisation and parental separation or loss) among the UHR, and (ii) the association between adversities and transition to psychosis (TTP). PsycINFO, PubMed and Embase databases were searched for studies reporting childhood adversities among UHR individuals. Only published articles were included. Risk of bias was assessed using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline (von Elm et al., 2007) and the tool developed by Hoy et al. (2012). Seventeen case–control, cross-sectional and longitudinal studies were included. UHR individuals experienced significantly more severe trauma than controls, regardless of trauma subtype. UHR were 5.5, 2.5 and 3.1 times as likely to report emotional abuse, physical abuse and bullying victimisation, respectively. There was no association with parental separation. However, childhood trauma was not significantly associated with TTP (follow-up periods: 6 months to 15 years), suggesting that trauma alone may not be a sufficient risk factor. Sexual abuse was associated with TTP but this may have been driven by a single large study. Potential confounders and low rates of TTP among UHR are limitations of this review. This is the first meta-analysis that quantitatively summarises the associations between childhood adversities and TTP among UHR, and between specific abuse subtypes and TTP. Specific recommendations have been made to increase the quality of future research. PROSPERO registration no. CRD42017054884.

Keywords

Childhood adversitieschild and adolescent psychiatryclinical high riskrisk factorsschizophreniatraumaultra-high risk
Type
Review Article
Information
Psychological Medicine , Volume 49 , Issue 7 , May 2019 , pp. 1089 - 1101
Copyright
Copyright © Cambridge University Press 2019 

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