Developmental Trauma as a Prognostic Factor for Later Psychotic Disorder in an Adolescent Clinical Cohort: A 20-Year Follow Up Study

Abstract

Background and Hypothesis

Recent studies demonstrate that individuals who attend psychiatric services in adolescence, especially inpatient care, have an increased risk of psychotic disorders in adulthood. Given the extensive literature demonstrating a relationship between developmental trauma and psychosis, we investigated whether trauma history would help to identify elevated psychosis risk within a clinical cohort.

Study Design

The sample consisted of patients admitted to a regional adolescent inpatient psychiatric unit (Oulu, Finland) between April 2001 and March 2006. The Kiddie Schedule for Affective Disorders and Schizophrenia was used to assess history of developmental trauma. Primary analyses investigated childhood sexual and/or physical abuse and secondary analyses investigated other types of traumatic events (car accident, other accident, fire, witness of a disaster, witness of a violent crime, victim of a violent crime, confronted with traumatic news, witness to domestic violence, other). Diagnoses from specialist healthcare were followed up in the national healthcare register until June 2023. Logistic regression was used to assess the relationship between childhood trauma and subsequent schizophrenia-spectrum disorders (SSDs).

Study Results

Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 14% reported a history of childhood sexual abuse and 27% reported a history of childhood physical abuse. Exposure to childhood sexual or physical abuse was not associated with a subsequently increased risk of SSDs (adjusted OR = 1.05, 95% CI = 0.59–1.83). Similarly, none of the other developmental adversities were associated with a subsequently increased risk of SSDs.

Conclusions

In a clinical cohort made up of non-psychotic adolescent psychiatry inpatients, a group known to be at elevated risk of psychosis, none of the assessed developmental adversities were prognostic factors for subsequent psychotic disorders.