A new study published in Psychological Medicine explores the distinct role childhood trauma plays in the development of mental health disorders, particularly schizophrenia spectrum disorders (SSD). This research suggests that past traumatic events experienced during childhood affect men and women differently when it comes to the onset and progression of these disorders.
The researchers found that in men with recent-onset psychosis, depressive symptoms were most associated with total trauma scores and emotional abuse ratings. In women, depressive symptoms were most associated with sexual abuse ratings.
The principal researcher, Anne-Sophie D Enthoven, highlighted the significance of these findings, stating:
“Depressive symptom severity was associated with different types of trauma in men and women with recent-onset SSD. Specifically, in women, depressive symptom severity was associated with childhood sexual abuse, which was reported three times as often as in men.”
The impetus of this study was twofold: firstly, to assess gender differences in the types of trauma experienced by people with early onset psychosis, and secondly, to investigate the correlation between these various forms of trauma and depressive or negative symptoms.
To reach their conclusions, the researchers relied on data from two previous studies: the Simvastatin augmentation for recent-onset psychotic disorder study and the Handling Antipsychotic Medication: Long-term Evaluation of Targeted Treatment (HAMLETT) study.
The Simvastatin study drew participants from Dutch inpatient and outpatient treatment settings. These individuals, aged between 18 and 50 years old, were diagnosed with a range of schizophrenia spectrum and other psychotic disorders, participating in the study while in remission.
The HAMLETT study recruited participants aged 16-60 years from Dutch outpatient clinics. These individuals had experienced their first bout of psychosis and were in remission for 3-6 months after being diagnosed with various psychotic disorders. In total, the current research utilized data from 302 participants, comprising 218 men and 84 women.
To gauge depressive and negative symptoms, the researchers employed the Positive and Negative Symptom Scale (PANSS). Childhood trauma was assessed using the Dutch version of the Childhood Trauma Questionnaire – Short Form (CTQ – SF).
The study discovered that sexual abuse was reported three times more frequently by women than men (23.5% vs 7.8%). Emotional abuse was reported twice as often by women (21.2% vs 11%). Women reported significantly more sexual abuse when assessed on a continuous scale (degree of experience rather than a binary “yes” or “no”), but there was no notable gender difference in reports of emotional abuse. Rates for all other categories of childhood trauma were comparable between genders.
Depressive symptoms across the entire sample, inclusive of both men and women, showed a strong association with total trauma scores. The correlation between depressive symptoms and emotional abuse was particularly pronounced. However, the authors report a potentially insignificant link between depressive symptoms, emotional neglect, and sexual abuse.
Analysis solely involving male participants showcased a strong link between depressive symptoms and both overall trauma scores and emotional abuse. Focusing on women alone, depressive symptoms were found to be strongly connected to sexual abuse, while the correlation with overall trauma scores and emotional abuse severity appeared weaker, and potentially insignificant.
Negative symptoms across the entire sample were tied strongly with overall trauma scores, emotional abuse, and emotional neglect. In men, negative symptoms were strongly linked to overall trauma scores and emotional neglect, while in women, no significant association was found between trauma and negative symptoms—a phenomenon the authors attribute potentially to a lack of statistical power.
The authors underscore several limitations of their study. The population sample may not represent those experiencing first-episode psychosis since individuals who agree to participate in research often exhibit better health and functionality. The study also confined its focus to participants’ sex at birth, not taking into account socially constructed gender roles. Furthermore, the relatively low number of women included and a lower-than-expected prevalence of childhood trauma might have led to insignificant associations. The authors conclude:
“Our study found prominent sex differences in the prevalence of sexual and emotional abuse in a large sample of first-episode psychosis and recent-onset SSD patients. As sexual abuse was associated with depressive symptoms only in women, the high rates of depressive symptoms generally observed in women with SSD may partly be explained by their much higher rates of childhood sexual trauma. Total trauma scores, as well as emotional abuse and emotional neglect, were related to both depressive and negative symptoms in the total patient sample and in men. Lack of power may be a reason why these associations were absent in women.”
Previous research has linked traumatic experiences and psychosis. A 2018 meta-analysis specifically linked childhood trauma to symptoms of psychosis. Similar research has also found a link between trauma and the development of psychosis in children. A 2022 study found an association between sexual assault and psychosis.
Enthoven, A. S. D., Gangadin, S. S., de Haan, L., Veling, W., de Vries, E. F. J., Doorduin, J., . . . Sommer, I. E. C. (2023). The association of childhood trauma with depressive and negative symptoms in recent-onset psychosis: a sex-specific analysis. Psychological Medicine. Advanced online publication. (Link)