Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea
Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea
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DOI：
10.1016/s2215-0366(23)00228-6
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发表时间：
2023-09-20
影响因子：
64.3
通讯作者：
Bloomfield，Michael
中科院分区：
文献类型：
--
作者：
Mason，Ava J. C.;Jung，Paul;Bloomfield，Michael
研究背景儿童期虐待是创伤后应激障碍和精神病发生的危险因素。然而，创伤后应激障碍（PTSD），包括复杂的PTSD，和精神病症状之间的联系是未知的。我们调查了创伤后应激障碍和复杂创伤后应激障碍的存在是否与发育性创伤幸存者的精神病症状严重程度有关。方法作为儿童创伤相关精神病（IMPACT）研究的调查机制的一部分，从2020年8月20日到2021年1月24日，以及从2022年9月9日到2023年2月21日，利用在线平台上的研究广告，我们招募了在英国和韩国经历过发育性创伤但没有精神病诊断的成年（≥18岁）参与者。我们使用自我报告的国际创伤问卷来测量参与者是否符合PTSD和复杂PTSD的诊断阈值，并使用自我报告的精神体验社区评估来测量精神病症状。我们使用线性回归，调整社会人口学变量，如年龄，性别，种族，教育程度和社会经济地位，以检查PTSD和复杂PTSD和精神病症状之间是否存在关联。该研究在英国注册（伦敦大学学院研究伦理委员会[14317/001]和国家卫生服务研究伦理委员会[22/YH/0096]）和韩国（首尔国立大学盆唐医院机构审查委员会[B-2011-648-306]），并正在进行中。1273例患者经历了发育性创伤，并被纳入英国（n=475）和韩国（n=798）的研究，包括422例（33%）男性和851例（67%）女性，平均年龄为26.9岁（SD 6，范围18-40），大多数为英国白色人（n=328）或韩国人（n=798）。与不符合PTSD或复杂PTSD病例的受试者相比，我们发现PTSD和精神病性症状严重程度之间没有显著相关性（总严重程度β=-2统计40 [SE 3.28]，p= 0.47）。我们发现复杂的创伤后应激障碍和精神病症状严重程度之间有显著的关系（总严重度β=22·62 [SE 1·65]，p<0·0001），包括阳性（β=12·07 [SE 0·99]，p<0·0001）和阴性症状（β=10·5 [SE 0·95]，p<0·0001），与不符合PTSD或复杂PTSD病例的参与者相比。解释卫生系统必须评估先前有复杂PTSD发展性创伤的个体并治疗受影响的个体。这些人还应评估精神病症状，如有必要，应采取预防措施，以减少转换的风险。进一步的工作应该评估治疗复杂的PTSD是否会改变转化为精神病的风险。FundingUKRI未来领袖奖学金，英国医学会玛格丽特·坦普尔精神分裂症研究奖，以及韩国-韩国政府国家研究基金会。
BackgroundChildhood maltreatment is a risk factor for the development of post-traumatic stress disorders and psychosis. However, the association between post-traumatic stress disorder (PTSD), including complex PTSD, and psychotic symptoms is unknown. We investigated whether the presence of PTSD and complex PTSD was associated with psychotic symptom severity within survivors of developmental trauma.MethodsAs part of the Investigating Mechanisms underlying Psychosis Associated with Childhood Trauma (IMPACT) study, from Aug 20, 2020, to Jan 24, 2021, and from Sept 9, 2022, to Feb 21, 2023, using study advertisement on online platforms we recruited adult (≥18 years) participants who had experienced developmental trauma without a psychiatric diagnosis in the UK and South Korea. We measured whether participants met diagnostic thresholds for PTSD and complex PTSD using the self-reported International Trauma Questionnaire, and psychotic symptoms using the self-reported Community Assessment of Psychic Experiences. We used linear regression, adjusting for sociodemographic variables such as age, sex, ethnicity, educational attainment, and socioeconomic status, to examine whether there was an association between PTSD and complex PTSD and psychotic symptoms. The study is registered in the UK (University College London Research Ethics Committee [14317/001] and the National Health Service Research Ethics Committee [22/YH/0096]) and South Korea (Institutional Review Board of Seoul National University Bundang Hospital [B-2011-648-306]), and is ongoing.FindingsOf the 2675 participants who took part in the study, 1273 had experienced developmental trauma and were included in the study in the UK (n=475) and South Korea (n=798), comprising 422 (33%) men and 851 (67%) women with a mean age of 26·9 years (SD 6, range 18–40), mostly of White British (n=328) or South Korean (n=798) ethnicity. We found no significant association between PTSD and psychotic symptom severity (total severity β=–2·40 [SE 3·28], p=0·47), compared with participants who did not meet PTSD or complex PTSD caseness. We found a significant relationship between complex PTSD and psychotic symptom severity (total severity β=22·62 [SE 1·65], p<0·0001), including for positive (β=12·07 [SE 0·99], p<0·0001) and negative symptoms (β=10·5 [SE 0·95], p<0·0001), compared with participants who did not meet PTSD or complex PTSD caseness.InterpretationHealth systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis.FundingUKRI Future Leaders Fellowship, British Medical Association Margaret Temple Award for Schizophrenia Research, and the National Research Foundation of Korea—Korea Government.