Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort

Abstract

Background: Several large population-based studies have demonstrated associations between adverse childhood experiences and later development of psychotic symptoms. However, little attention has been paid to the mechanisms involved in this pathway and the few existing studies have relied on cross-sectional assessments.

Methods: Prospective data on 6692 children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used to address this issue. Mothers reported on children's exposure to harsh parenting and domestic violence in early childhood, and children self-reported on bullying victimization prior to 8.5 years. Presence of children's anxiety at 10 years and their depressive symptoms at 9 and 11 years were ascertained from mothers, and children completed assessments of self-esteem and locus of control at 8.5 years. Children were interviewed regarding psychotic symptoms at a mean age of 12.9 years. Multiple mediation analysis was performed to examine direct and indirect effects of each childhood adversity on psychotic symptoms.

Results: The association between harsh parenting and psychotic symptoms was fully mediated by anxiety, depressive symptoms, external locus of control, and low self-esteem. Bullying victimization and exposure to domestic violence had their associations with psychotic symptoms partially mediated by anxiety, depression, locus of control, and self-esteem. Similar results were obtained following adjustment for a range of confounders and when analyses were conducted for boys and girls separately.

Conclusions: These findings tentatively suggest that specific cognitive and affective difficulties in childhood could be targeted to minimize the likelihood of adolescents exposed to early trauma from developing psychotic symptoms.

Keywords: bullying; etiology; longitudinal; psychosis; trauma.

Fig. 1.

Conceptual path diagram of associations between victimization and psychotic symptoms. Hypothesized direct paths are indicated by solid arrows and indirect paths by dashed arrows.

Fig. 2.

Proportion of the total effect of harsh parenting (Panel A), exposure to domestic violence (Panel B), and bullying victimization (Panel C) in childhood on broadly defined psychotic symptoms at 12.9 years of age mediated via affective and cognitive factors. The red portion of each bar indicates the percentage of the effect mediated (indirect effect), initially by all of the factors together and then separately for anxiety disorder, depressive symptoms, external locus of control, and low self-esteem.

Fig. 3.

Proportion of the total effect of harsh parenting (Panel A), exposure to domestic violence (Panel B), and bullying victimization (Panel C) in childhood on narrowly defined psychotic symptoms at 12.9 years of age mediated via affective and cognitive factors. The red portion of each bar indicates the percentage of the effect mediated (indirect effect), initially by all of the factors together and then separately for anxiety disorder, depressive symptoms, external locus of control, and low self-esteem.