University of Basel, Basel, Switzerland.
University College London, London, UK.
Psychol Med. 2023 Dec;53(16):7817-7826. doi: 10.1017/S003329172300185X. Epub 2023 Jul 24.
Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect.
We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 ( = 5954) and 2014 ( = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality.
In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms.
Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis.
性虐待和欺凌与成年后患精神健康问题有关。我们之前已经证实了欺凌与精神病症状之间存在明确的关系。同样，我们预计性虐待也会通过对负面情绪的影响与精神病症状的出现有关。
我们分析了 2007 年（n=5954）和 2014 年（n=5946）进行的英国成人精神疾病发病率调查的英文数据，这些数据基于居住在私人家庭中的代表性全国样本。我们使用有向无环图（DAG）表示的概率图形模型。我们从精神病筛查问卷中获得迫害观念和听觉幻觉的测量值，并使用临床访谈时间表识别情感症状。我们纳入了大麻消费和性别，因为它们可能会影响症状之间的关系。我们将传入边约束到性虐待和欺凌，以尊重时间性。
在 DAG 分析中，与我们的预期相反，偏执出现在关系链的早期，接近虐待变量，通常位于情感症状的上游。偏执与幻觉直接相关，但也通过非精神病症状间接相关。幻觉也是涉及非精神病症状的途径的终点。
通过担忧，性虐待和欺凌似乎会引发一系列情感症状，而在某些人中，这些症状可能会促使幻觉的出现。不良经历与偏执之间的联系更加直接。这些发现对管理困扰的结果具有重要意义。特别是，担忧可能是精神病干预的一个重要目标。
