Davies Kimberley, Lappin Julia M, Briggs Nancy, Isobel Sophie, Steel Zachary
Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia.
Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, NSW 2052, Australia; The Tertiary Referral Service for Psychosis, Prince of Wales Hospital, Randwick 2031, NSW, Australia.
Schizophr Res. 2025 Jan;275:87-97. doi: 10.1016/j.schres.2024.12.008. Epub 2024 Dec 17.
Meta-analytic evidence has linked shame separately to both potentially traumatic events (PTEs) and psychosis, but the influence of shame on the relationship between PTEs and psychosis has not yet been examined. This study used meta-analytic structural equation modelling (MASEM) to examine whether shame plays a mediatory role between PTEs and experiences of psychosis.
A nested search was conducted within a previous systematic review on psychosis and shame to identify articles that contained a measure of PTEs. Included studies reported a quantitative association between psychosis and shame, and additionally a quantitative relationship between either i) PTEs and psychosis; or ii) PTEs and shame.
Of the 40 articles initially included, 14 met criteria and 13 were included in the analyses. Overall, shame partially mediated the relationship between PTE's and psychosis, observed through a significant indirect effect (β = 0.15, 95 % CI: 0.11-0.19) and a reduction in the direct path that remained significant (β = 0.13, 95 % CI: 0.06-0.20). Indirect paths through shame between childhood PTEs and psychosis (β = 0.07, 95 % CI: 0.03-0.11), and between lifespan PTEs and psychosis (β = 0.09, 95 % CI: 0.03-0.11), were both small but significant. Both direct paths remained significant, suggesting that shame acts a partial mediator for both types of PTE.
Shame is one path through which potentially traumatic events may influence the experience of psychosis and should be considered alongside other affective types in future modelling of psychosis. Qualitative research may aid further understanding of the mechanisms by which shame operates in this relationship.
荟萃分析证据表明，羞耻感分别与潜在创伤性事件（PTEs）和精神病相关，但羞耻感对PTEs与精神病之间关系的影响尚未得到研究。本研究采用荟萃分析结构方程模型（MASEM）来检验羞耻感在PTEs与精神病体验之间是否起中介作用。
在之前一项关于精神病与羞耻感的系统评价中进行嵌套搜索，以识别包含PTEs测量指标的文章。纳入的研究报告了精神病与羞耻感之间的定量关联，以及以下两者之一的定量关系：i）PTEs与精神病；或ii）PTEs与羞耻感。
最初纳入的40篇文章中，14篇符合标准，13篇纳入分析。总体而言，羞耻感部分介导了PTEs与精神病之间的关系，通过显著的间接效应（β = 0.15，95%CI：0.11 - 0.19）以及直接路径的减少（β = 0.13，95%CI：0.06 - 0.20）得以观察到。童年PTEs与精神病之间通过羞耻感的间接路径（β = 0.07，95%CI：0.03 - 0.11）以及终生PTEs与精神病之间通过羞耻感的间接路径（β = 0.09，95%CI：0.03 - 0.11）均较小但显著。两条直接路径均保持显著，表明羞耻感对两种类型的PTE均起部分中介作用。
羞耻感是潜在创伤性事件可能影响精神病体验的一条途径，在未来精神病模型构建中应与其他情感类型一并考虑。定性研究可能有助于进一步理解羞耻感在这种关系中发挥作用的机制。
