TIPS Centre for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
NORMENT Centre, Division of Mental Health and Addiction Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Schizophr Res. 2021 Jun;232:87-94. doi: 10.1016/j.schres.2021.05.015. Epub 2021 May 21.
Childhood interpersonal trauma (CIT) and premorbid adjustment are both associated with poor outcome in psychosis. In this study we investigate the relative impact of CIT and premorbid adjustment on symptom remission in first episode psychosis (FEP) over two years.
A total of 232 participants with FEP were recruited through the early detection program of the The early detection and Intervention in Psychosis (TIPS)-2 study and followed up after two years. Symptom remission was according to consensus criteria. CIT was assessed with the semi-structured interview Freyd Goldberg Brief Betrayal Trauma Survey, and premorbid adjustment with the Premorbid Adjustment Scale. Generalized estimating equations and multivariate models were used to analyze the associations between remission, symptom levels over time, CIT and premorbid adjustment; and a path analysis of mediation effects of CIT through premorbid adjustment on remission.
In this sample with 57% males and a mean age of 26.6 years (SD 10.2), a third of participants had experienced CIT. The participants with CIT had poorer premorbid adjustment compared to those without. Statistical analyses found independent effects of CIT and an interaction effect of CIT with premorbid adjustment on remission after two years, suggesting that CIT moderates the effect of premorbid adjustment. However contrary to expectations, premorbid adjustment did not mediate the effect of CIT.
Our findings indicate a complex interplay between effects of interpersonal trauma and premorbid social adjustment on remission in psychosis. CIT appeared to moderate the effect of premorbid adjustment such that individuals with CIT and who had poor social functioning in childhood are at greater risk of non-remission. Findings indicate that better premorbid social relations could provide a buffer for the effects of trauma on symptom course.
儿童期人际创伤（CIT）和发病前适应均与精神病预后不良有关。在这项研究中，我们调查了 CIT 和发病前适应对首发精神病（FEP）两年后症状缓解的相对影响。
共有 232 名 FEP 患者通过早期检测计划的早期检测和干预精神病（TIPS）-2 研究招募，并在两年后进行随访。根据共识标准判断症状缓解。CIT 使用半结构化访谈弗雷德·戈德堡简要背叛创伤调查进行评估，发病前适应使用发病前适应量表进行评估。使用广义估计方程和多变量模型分析缓解与症状水平随时间的关系、CIT 和发病前适应之间的关系；以及 CIT 通过发病前适应对缓解的中介效应的路径分析。
在这个样本中，男性占 57%，平均年龄为 26.6 岁（SD=10.2），三分之一的参与者经历过 CIT。与没有 CIT 的参与者相比，有 CIT 的参与者发病前适应较差。统计分析发现，CIT 有独立的影响，以及 CIT 与发病前适应的交互作用对两年后的缓解有影响，这表明 CIT 调节了发病前适应的作用。然而，与预期相反，发病前适应并不能中介 CIT 的作用。
我们的研究结果表明，人际创伤和发病前社会适应对精神病缓解的影响之间存在复杂的相互作用。CIT 似乎调节了发病前适应的作用，因此，有 CIT 和儿童期社会功能较差的个体更有可能无法缓解。研究结果表明，更好的发病前社会关系可能为创伤对症状过程的影响提供缓冲。
