Table 2.

Summary of Recent Population-Based Studies of Childhood Trauma and Psychosis

	Study Design	Sample	Measure of Childhood Trauma	Measure of Outcome	Number Exposed	Number With Outcome	Measure of Effect
Spataro et al5(Australia)	Prospective cohort	1612 children (1327 female, 285 male) who had been sexually abused; 3 139 745 population controls.	Records from Victorian Institute of Forensic Medicine of medical examinations confirming sexual abuse.	Cases registered on Victorian Psychiatric Case Register.	1612 subjects identified as having been sexually abused.	113 907 had contacts with psychiatric services (113 707 controls; 200 cases); 20 805 with a schizophrenic disorder diagnosis (20 792 [0.7%] controls; 13 [0.8%] cases).	Relative risk of schizophrenic disorder in controls vs schizophrenic disorder in cases who had been abused: RR 1.2 (0.7–2.1)
Bebbington et al18(United Kingdom)	Cross-sectional survey	8580 adults aged 16–74 recruited to the second British National Survey of Psychiatric Morbidity.	Respondents shown cards with a list of stressful life events, including sexual abuse, and asked if they had experienced any in their lifetime. Presence or absence only rated.	A 2-stage approach was adopted to assess presence of psychotic disorder: (1) Psychosis Screening Questionnaire64 was administered to all participants; (2) those who screened positive, and a proportion who screened negative were interviewed with the SCAN.65	2982 (3.5%) with no disorder responded positively to the question on sexual abuse; 21 (34.5%) with a probable psychotic disorder responded positively.	60 with a probable or definite psychotic disorder.	Sexual abuse vs none:Adj. ORa 2.9 (1.3–6.4)
Janssen et al19(Netherlands)	Prospective cohort	4045 adults aged 18–64 recruited to the Netherlands Mental Health and Incidence Study.	At baseline, subjects were asked about experiences of any kind of emotional, physical, psychological or sexual abuse before age 16, using a 4-item semistructured interview designed for the study. Presence or absence, and frequency of events rated.	CIDI66 for screening followed by 2 items of the BPRS67 and need for care assessed using CAN.683 outcome groups:1. BPRS any psychosis2. BPRS pathology level psychosis3. Need-based disorder	423 (10.5%) reported childhood abuse; 260 (61.5%) were women	Psychosis outcome at follow-up:BPRS any psychosis: n = 38 (0.94%) BPRS pathology level: n = 10 (0.25%) Need-based disorder: n = 7 (0.17%)	Abuse vs no abuse:BPRS any psychosisAdj. ORb 2.5 (1.1–5.7)BPRS pathology level Adj. ORb 9.3 (2.0–43.6)Need-based disorderAdj. ORb 7.3 (1.1–49.0)
Whitfield et al20(United States)	Cross-sectional	17 337 subjects (mean age 57) recruited to the Adverse Childhood Experiences study	Self-report postal questionnaire comprising questions from other scales and studies. Presence or absence and frequency before the age of 19 were noted	A single question used to determine lifetime history of hallucinations (“Have you ever had, or do you have, hallucinations (seen, smelled, or heard things that were not really there?”)).	Emotional abuse: 13% Physical abuse: 27% Sexual abuse: 25%	Lifetime history of hallucinations: 2%	Risk of ever having had a hallucination: Emotional abuse:Adj. ORc 2.3 (1.8–3.0) Physical abuse:Adj. ORc 1.7 (1.4–2.1) Sexual abuse:Adj. ORc 1.7 (1.4–2.1)
Spauwen et al21(Germany)	Prospective cohort	2524 subjects aged 14–24 recruited to the Early Developmental Stages of Psychopathology study	Lifetime exposure to 9 traumatic events were measured at baseline using a module from the CIDI	Ratings from the 15 M-CIDI core psychosis items were used to assess presence of psychotic symptoms. Psychosis outcome was defined as “broad” (one or more psychotic symptom), “medium” (2 or more psychotic symptoms), or “narrow” (3 or more psychotic symptoms).	Any trauma n = 491 (19.5%) Sexual abuse n = 39 (1.5%)	Psychotic symptoms broad n = 441 (17.5%); medium n = 183 (7.3%); narrow n = 85 (3.4%)	Narrow psychosis Any trauma:Adj. OR 1.89d (1.16–3.08) Sexual abuse: Adj. ORd 1.55 (0.47–5.08) Physical threat:Adj. ORd 2.14 (1.18–3.89) Rape: Adj. ORd 2.26 (0.55–9.21)

Note: CIDI, Composite International Diagnostic Interview; BPRS, Brief Psychiatric Rating Scale; CAN, Camberwell Assessment of Need; SCAN, Schedules for Clinical Assessment in Neuropsychiatry.

^aAdjusted for interrelationship between other adverse events and depression.

^bAdjusted for a range of variables, including an other psychiatric diagnosis and psychosis in first-degree relatives.

^cAdjusted for age, sex, race, and educational attainment.

^dAdjusted for gender, socioeconomic status, urbanicity, cannabis use, time 0 DSM-IV mental disorders and time 0 psychosis proneness.