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Publication - Professor Stan Zammit

    Association of Trauma Type, Age of Exposure, and Frequency in Childhood and Adolescence with Psychotic Experiences in Early Adulthood


    Croft, J, Heron, JE, Teufel, C, Cannon, M, Wolke, D, Thompson, A, Houtepen, LC & Zammit, S, 2019, ‘Association of Trauma Type, Age of Exposure, and Frequency in Childhood and Adolescence with Psychotic Experiences in Early Adulthood’. JAMA Psychiatry, vol 76., pp. 79-86


    Importance Cross-sectional and longitudinal studies have consistently reported associations between childhood trauma and psychotic experiences and disorders. However, few studies have been able to examine whether timing of exposure or specific trauma-types have differential effects on risk.

    Objectives To examine whether exposure to trauma, assessed at multiple time-points between 0 and 17 years of age, is associated with increased risk of psychotic experiences by age 18 years, and whether this association varies according to type, timing and frequency of exposure

    Design Birth cohort study using The Avon Longitudinal Study of Parents and Children, with participants recruited between April 1, 1991, and December 31, 1992. Analyses were carried out from January to November 2017.

    Setting Population-based

    Participants Participants who completed an assessment of psychotic experiences at age 18 years old.

    Exposure Exposure to 6 different types of trauma (covering inter-personal violence and neglect), measured contemporaneously during three age-periods (early childhood, mid-childhood, adolescence)

    Main Outcome Suspected or definite psychotic experiences (9.3%) assessed using the semi-structured PLIKSi interview at age 18 years.

    Results We analysed data from 4,433 participants (56.5% female). All trauma-types across ages 0-17 years were associated with an increased odds of psychotic experiences, with little attenuation when adjusting for confounding (OR¬crude for exposure to any trauma 3.13; 95%CI 2.32, 4.22; ORadj 2.91, 95% CI 2.15, 3.93). Assuming this estimate is accurate and causal, the population attributable fraction for childhood and adolescent trauma on psychotic experiences was 45% (95%CI 25%, 60%). Effect sizes for most trauma-types were greater for exposure that was more proximal to the outcome, though confidence intervals overlapped with those for more distal trauma. There was strong evidence to support dose-response associations for exposure to multiple trauma-types and for exposure at multiple timepoints. In an analysis aimed at minimising reverse causality, adolescent trauma was also associated with past-year incident psychotic experiences at age 18 years.

    Conclusions and Relevance Our findings are consistent with the thesis that trauma has a causal effect on psychotic experiences, and highlight the need to identify modifiable mediators of this relationship to inform prevention strategies for psychotic experiences and related adverse mental health outcomes.

    Full details in the University publications repository