Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Department of Public Health, San Francisco State University, San Francisco, CA, USA.
Compr Psychiatry. 2024 Aug;133:152504. doi: 10.1016/j.comppsych.2024.152504. Epub 2024 May 31.
The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms.
We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms.
The trauma type "exposure to a war zone" had the highest bridge strength, betweenness, and closeness. The psychotic symptom "odd or unusual beliefs" had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death.
Specific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.
创伤暴露与精神病障碍之间存在明确关联。此外，特定类型的创伤可能与特定的精神病症状相关。网络分析是一种能够深入了解不同创伤类型与精神病症状之间关联的方法。
我们对来自东非的 16628 名成年精神病患者（平均年龄[标准差]为 36.3 岁[11.5]；55.8%为男性）进行了网络分析，这些患者于 2018 年至 2023 年期间被招募。我们使用生活事件清单和迷你国际神经精神病访谈来确定一生中经历的特定创伤类型和特定精神病症状是否存在关联。我们使用伊辛模型来估计网络连接，并计算桥接中心度统计量，以识别可能影响创伤类型和精神病症状的节点。
创伤类型“暴露于战区”的桥接强度、介数和接近度最高。精神病症状“奇怪或不寻常的信念”的桥接强度次之。暴露于战区与幻觉、奇怪或不寻常的信念、被动现象和言语紊乱直接相关。奇怪或不寻常的信念与交通事故、身体攻击、战争和目睹突然意外死亡直接相关。
特定的创伤类型和精神病症状可能会相互作用。在有战争相关创伤的患者中筛查精神病症状，并在有奇怪或不寻常信念的患者中评估终生创伤，这在临床护理中可能被视为干预点，以限制刺激额外的精神病症状和创伤暴露。这项工作再次强调了对精神病患者进行创伤知情护理的重要性。
