Lincoln T M, Marin N, Jaya E S
Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany.
Clinical Psychology and Psychotherapy, Institute of Psychology, University of Hamburg, Hamburg, Germany.
Eur Psychiatry. 2017 May;42:111-119. doi: 10.1016/j.eurpsy.2016.12.010. Epub 2017 Jan 2.
The causal role of childhood trauma for psychosis is well established, but the mechanisms that link trauma to psychosis are largely unknown. Since childhood trauma is known to cause difficulties in emotion regulation (ER) and patients with psychosis show impaired ER, we hypothesize that impaired ER explains why people with a background of trauma are prone to psychotic experiences.
The study used a longitudinal cohort design based on a community sample (N=562) from Germany, Indonesia, and the United States. Childhood trauma was assessed at baseline. ER and psychotic experiences (defined as positive symptom frequency and related distress) were measured repeatedly at a 4-, 8-, and 12-month follow-up. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the predictive value of ER on psychotic experiences and its mediating role in the association of childhood trauma and psychotic experiences.
The cross-lagged paths from impaired ER to symptom distress (but not frequency) were significant. However, there was also evidence for the reverse causation from symptom frequency and distress to impaired ER. ER partially mediated the significant prospective paths from childhood trauma to symptom distress.
The findings demonstrate that ER plays a role in translating childhood trauma into distressing psychotic experiences in later life. Moreover, the findings point to a maintenance mechanism in which difficulties in ER and symptom distress exacerbate each other. Thus, ER could be a promising target for interventions aimed at prevention of psychosis.
童年创伤对精神病的因果作用已得到充分证实，但将创伤与精神病联系起来的机制在很大程度上尚不清楚。由于已知童年创伤会导致情绪调节（ER）困难，且精神病患者表现出ER受损，我们假设ER受损解释了有创伤背景的人为何容易出现精神病体验。
该研究采用基于德国、印度尼西亚和美国社区样本（N = 562）的纵向队列设计。在基线时评估童年创伤。在4个月、8个月和12个月的随访中反复测量ER和精神病体验（定义为阳性症状频率和相关痛苦）。使用带有结构方程模型的交叉滞后面板和纵向中介分析来检验ER对精神病体验的预测价值及其在童年创伤与精神病体验关联中的中介作用。
从ER受损到症状痛苦（而非频率）的交叉滞后路径是显著的。然而，也有证据表明从症状频率和痛苦到ER受损存在反向因果关系。ER部分介导了从童年创伤到症状痛苦的显著前瞻性路径。
研究结果表明，ER在将童年创伤转化为晚年令人痛苦的精神病体验中起作用。此外，研究结果指出了一种维持机制，即ER困难和症状痛苦相互加剧。因此，ER可能是旨在预防精神病的干预措施的一个有前景的目标。
