Barnes Georgina L, Garety Philippa A, Emsley Richard, Jameel Leila, Hardy Amy
Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.
South London & Maudsley NHS Trust, Maudsley Hospital, London, UK.
Psychol Psychother. 2021 Sep;94(3):798-821. doi: 10.1111/papt.12328. Epub 2021 Feb 17.
Existing reviews of trauma and psychosis have identified associations between childhood emotional abuse (CEA) and psychosis. However, conceptual issues relating to assessment of CEA limit the conclusions that can be drawn from the literature. The aim of this review was to identify and evaluate studies reporting an association between childhood experiences of caregiver antipathy (i.e. criticism, hostility, coldness, or rejection from a parental figure experienced prior to age 17 years) and psychosis symptoms/diagnosis.
Five databases were systematically searched for articles published until May 2020. Studies were evaluated against inclusion/exclusion criteria, and a narrative synthesis of findings was completed. Study quality was assessed by two independent raters.
Fourteen studies comprised of 1,848 participants met inclusion criteria. Twelve of these studies found significant associations between caregiver antipathy and psychosis, and two did not. There was evidence that adults with schizophrenia-spectrum diagnoses report more severe caregiver antipathy in childhood than non-clinical controls and that caregiver antipathy severity is positively correlated with psychosis symptom severity. Most studies received weak or moderate quality ratings and all used cross-sectional or case-control designs which showed associations, rather than causal relationships, between childhood caregiver antipathy and later psychosis.
Future research would benefit from more rigorous and valid assessment of CEA, use of multivariate methods to account for possible patterns of co-occurrence, and longitudinal study designs to make more robust causal claims. The findings may have important implications for the delivery of psychological care for people with psychosis who report adverse caregiving experiences.
People with schizophrenia-spectrum diagnoses may report more severe caregiver antipathy in childhood than non-clinical controls. Caregiver antipathy severity appears to be positively correlated with psychosis symptom severity in clinical and non-clinical populations. Clinicians should consider the possible impact of caregiver antipathy on psychosis symptoms, their content and distress maintenance. Clinicians should also recognise the potential impact of adverse caregiving experiences on therapeutic relationships, patterns of help-seeking and service engagement. Best practice in clinical services would be to adopt individual, formulation-based approaches within trauma-informed models of care.
现有的关于创伤与精神病的综述已确定童年期情感虐待（CEA）与精神病之间存在关联。然而，与CEA评估相关的概念问题限制了从文献中得出的结论。本综述的目的是识别和评估报告17岁之前经历的照顾者反感（即来自父母一方的批评、敌意、冷漠或拒绝）与精神病症状/诊断之间关联的研究。
系统检索了五个数据库中截至2020年5月发表的文章。根据纳入/排除标准对研究进行评估，并完成研究结果的叙述性综合分析。研究质量由两名独立评估者进行评估。
14项研究共1848名参与者符合纳入标准。其中12项研究发现照顾者反感与精神病之间存在显著关联，2项研究未发现。有证据表明，患有精神分裂症谱系诊断的成年人报告童年期照顾者反感比非临床对照组更严重，且照顾者反感的严重程度与精神病症状严重程度呈正相关。大多数研究的质量评级为低或中等，所有研究均采用横断面或病例对照设计，显示出童年期照顾者反感与后期精神病之间的关联，而非因果关系。
未来的研究将受益于对CEA进行更严格有效的评估，采用多变量方法来解释可能的共现模式，以及采用纵向研究设计以做出更有力的因果推断。这些发现可能对为报告不良照顾经历的精神病患者提供心理护理具有重要意义。
患有精神分裂症谱系诊断的人可能比非临床对照组报告童年期更严重的照顾者反感。在临床和非临床人群中，照顾者反感的严重程度似乎与精神病症状严重程度呈正相关。临床医生应考虑照顾者反感对精神病症状、其内容和痛苦维持的可能影响。临床医生还应认识到不良照顾经历对治疗关系、求助模式和服务参与的潜在影响。临床服务的最佳实践是在创伤知情护理模式内采用基于个体、基于构想的方法。
