Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Giulio Cesare Square, 11, Bari, Italy.
Saint John of God Clinical Research Centre, Brescia, Italy.
Eur Child Adolesc Psychiatry. 2022 Feb;31(2):215-228. doi: 10.1007/s00787-020-01574-9. Epub 2020 Jun 24.
Evidence of the association between traumatic experiences and psychosis are uncertain with respect to temporal order, clinical outcomes and the role of the age and genetic liability. The aim of the present meta-analysis was to explore the temporal relationship between the development of psychosis and traumatic exposure using prospective studies and to examine the role of moderation factors on overall effect sizes. Studies were identified by searching Embase-Ovid, PsycINFO (EBSCO), Pubmed, Scopus, Web of Science databases, and yielded an initial total of 9016 papers, leaving finally 23 after the screening process. Three sets of meta-analyses estimated the risk of developing psychotic experiences or full clinical psychosis by having experienced maltreatment by an adult or bullying by peers or parental death, using the random-effects model. Bullying by peers (OR = 2.28 [1.64, 4.34]), maltreatment by an adult (OR = 2.20 [1.72, 2.81]) and parental death (OR = 1.24 [1.06, 1.44]) all increased the risk of psychosis. Moderator analysis showed that negative effects of bullying were detected especially in those with genetic liability for psychosis and exposure to multiple trauma types; studies with higher prevalence of males showed a stronger risk for those exposed to parental death. No significant meta-regression was found between the risk of developing a full clinical psychosis or a psychotic experience. Lack of studies hampered the results about the age of trauma occurrence. The cumulative effect of being bullied from peers and experiencing other adversities during childhood and/or adolescence, together with genetic liability for psychosis, appears to confer the highest risk for developing psychotic symptoms later in life.
创伤经历与精神病之间的关联证据在时间顺序、临床结局以及年龄和遗传易感性的作用方面并不确定。本荟萃分析的目的是使用前瞻性研究探讨精神病发展与创伤暴露之间的时间关系，并研究调节因素对总体效应大小的作用。通过搜索 Embase-Ovid、PsycINFO（EBSCO）、Pubmed、Scopus、Web of Science 数据库，共得到 9016 篇初始论文，经过筛选后最终留下 23 篇。三组荟萃分析使用随机效应模型，估计了遭受成人虐待、同伴欺凌或父母死亡的创伤经历与出现精神病体验或全临床精神病的风险比。同伴欺凌（OR=2.28[1.64, 4.34]）、成人虐待（OR=2.20[1.72, 2.81]）和父母死亡（OR=1.24[1.06, 1.44]）均增加了精神病的发病风险。调节分析表明，在有精神病遗传易感性和暴露于多种创伤类型的人群中，同伴欺凌的负面影响更为明显；在男性比例较高的研究中，暴露于父母死亡的人群风险更大。未发现发展为全临床精神病或精神病体验的风险与任何因素之间存在显著的元回归关系。创伤发生年龄的相关研究缺乏，限制了结果的准确性。童年和/或青少年时期遭受同伴欺凌和其他逆境，以及精神病遗传易感性的累积效应，似乎会使个体在以后的生活中发展出精神病症状的风险最高。
