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Prospective investigation of psychological and affective pathways from childhood trauma to psychosis-like experiences in a UK birth cohort
E6
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
with childhood maltreatment and sex on the risk for alcohol dependence. Using national data with extensive measures, we address these issues: (1) Do childhood sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect predict adult lifetime DSM-IV alcohol dependence, controlling for co-occurring maltreatments and other childhood traumas? (2) Are these relationships synergistically modified by parental alcoholism history? Method: Face-to-face interviews of 27 712 adult participants in the National Epidemiological Survey on Alcohol and Related Conditions were conducted. Results: Childhood physical, emotional, and sexual abuse, and physical neglect were associated with alcohol dependence (P b .001), controlling for demographics, co-occurring maltreatments, and other childhood trauma. A significant (P b .05) synergistic relationship between parental history and physical abuse was found in the entire sample (AP, 0.21), and between parental history and sexual abuse (AP, 0.31) and emotional neglect (AP, 0.26) in women. In other words, the risk of alcohol dependence given both parental history and the maltreatment was higher than what would be expected given the additive effect of each alone. Conclusions: Childhood maltreatments independently increased the risk of alcohol dependence, underscoring the importance of early identification and prevention and suggesting the need to develop and incorporate alcohol preventative components, such as cognitive restructuring, in maltreatment interventions. Importantly, the effect of physical abuse on alcohol dependence may depend on genetic vulnerability as suggested by the effect of parental history of alcoholism, whereas the effects of sexual abuse and emotional neglect may depend on this vulnerability among women. Thus, maltreatment may have a long-term negative impact, which may depend on genetic vulnerability and sex. Findings can be used to guide genetic studies and intervention development. doi:10.1016/j.comppsych.2011.04.021 Prospective investigation of psychological and affective pathways from childhood trauma to psychosis-like experiences in a UK birth cohort H. Fisher a, A. Schreier b, S. Zammit c, G. Lewis c, B. Maughan a, M. Munafo c, G. Harrison c, D. Wolke b a London, UK b Warwick, UK c Bristol, UK Introduction: Several large population-based studies have demonstrated associations between adverse experiences in childhood and later development of psychosis-like symptoms (PLIKS). However, little attention has been paid to investigating the mechanisms involved in this pathway; and the few existing studies have relied on cross-sectional assessments. Methods: Prospectively collected data on 6779 children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used to address this issue. Mothers provided reports of children's exposure to physical and emotional cruelty, sexual abuse, parental loss, and domestic violence between birth and 6 years of age along with the child's mental state at 7 and 10 years and their depressive symptoms at 9 and 11 years. The children completed assessments of self-esteem and locus of control at 8.5 years, self-reported exposure to bullying before age 8.5, and were interviewed regarding PLIKS at 12.9 years. Multiple mediation analysis was performed to examine direct and indirect effects of each childhood adversity on PLIKS using the weighted least squares mean and variance adjusted (WLSMV) method. Results: Early victimization exerted most of its effects directly on PLIKS, with smaller indirect pathways via depression, low self-esteem, and external locus of control. The strongest indirect effect of bullying on PLIKS was via locus of control, whereas depressive symptoms were the strongest mediator between domestic violence, maternal physical cruelty, emotional cruelty from a father figure, and PLIKS. Conclusion: These findings tentatively suggest that cognitive and affective difficulties in childhood could be targeted to prevent at least some adolescents exposed to early trauma from developing subclinical psychosis.
Such prevention efforts could subsequently reduce the incidence of psychotic disorders, which place a massive burden on the individual, their family, and society. Funding Source: This aspect of the ALSPAC study was funded by the Wellcome Trust (GR072043MA). Dr Fisher is supported by an interdisciplinary postdoctoral fellowship from the Medical Research Council and the Economic and Social Research Council in the UK and a travel award from the National Institute on Drug Abuse's Division of Epidemiology, Services, and Prevention Research. doi:10.1016/j.comppsych.2011.04.022 Childhood victimization and risk for smoking in middle adulthood M. Ghirmay , C.S. Widom New York, NY Introduction: The aim was to investigate whether childhood abuse and/or neglect increases a person's risk for smoking. Methods: Using data from a prospective cohort design study, participants were 808 individuals with documented cases of physical and sexual abuse and neglect (ages 0-11) from a Midwestern metropolitan county area during the years 1967 to 1971 and a control group of children without such histories matched on the basis of age, sex, race/ethnicity, and approximate family social class. The sample was about half male (51.3%) and half female (48.7%) and approximately 62% white, 33% black, and 4% Hispanic. The average age of the sample at the time of smoking assessment was 41.2 years old. The assessment of smoking was based on questions taken from the 1999-2000 NHANES Survey and administered during in-person interviews during 2003-2005. Results: Individuals with documented histories of child abuse and/or neglect were significantly more likely to have smoked at least 100 cigarettes compared with the control group (74.9% vs 61.9%, respectively; OR = 1.83; P b .001). When examining each specific type of maltreatment, only the neglected group was at significantly increased risk for having smoked at least 100 cigarettes in their lifetime compared with controls (77.33% vs 61.93%, respectively; OR = 2.11; P b.001). The increased risk for smoking was found for abused/neglected women (74.6% vs 59.9%, respectively; OR = 1.96; P = .002), men (75.4% vs 64.0%; OR = 1.70; P = .025), whites (76.5% vs 64.3%; OR = 1.76; P = .006), and blacks (72.3 vs 57.9%; OR = 1.91; P b .05). Interestingly, there were no significant differences between the groups in terms of age of first cigarette smoking, number of cigarettes currently smoked, or number of years smoked. Controlling for a history of major depressive disorder, dysthymia, generalized anxiety disorder, posttraumatic stress disorder, and alcohol and drug abuse/dependence diagnoses and current levels of anxiety, depression, illicit drug use, and heavy drinking, child abuse and neglect remained a significant predictor of smoking. Conclusion: Childhood abuse/and or neglect increases risk for smoking. Cigarette smoking has been found to act as a gateway drug for subsequent substance abuse and as a threat to a person's health. These findings suggest that preventative efforts should be developed for victims of child abuse/and or neglect to assist them in minimizing risk for adverse health consequences associated with smoking and to avoid subsequent risks for illicit drug use. Funding: This research was supported in part by grants from NICHD (HD40774), NIMH (H49467, MH58386), NIJ (86-IJ-CX-0033, 89-IJ-CX0007), NIDA (DA17842, DA10060); NIAAA (AA09238, AA11108), and the Doris Duke Charitable Foundation to CS Widom. Points of view are those of the authors and do not necessarily represent the position of the US Department of Justice. doi:10.1016/j.comppsych.2011.04.023 Religiosity and substance use disorders in an adult Israeli household sample E. Greenstein , D. Shmulewitz , D. Hasin New York, NY Introduction: Research shows a relationship between religiosity and many health behaviors and practices. Previous studies show an inverse
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
with childhood maltreatment and sex on the risk for alcohol dependence. Using national data with extensive measures, we address these issues: (1) Do childhood sexual abuse, physical abuse, emotional abuse, physical neglect, and emotional neglect predict adult lifetime DSM-IV alcohol dependence, controlling for co-occurring maltreatments and other childhood traumas? (2) Are these relationships synergistically modified by parental alcoholism history? Method: Face-to-face interviews of 27 712 adult participants in the National Epidemiological Survey on Alcohol and Related Conditions were conducted. Results: Childhood physical, emotional, and sexual abuse, and physical neglect were associated with alcohol dependence (P b .001), controlling for demographics, co-occurring maltreatments, and other childhood trauma. A significant (P b .05) synergistic relationship between parental history and physical abuse was found in the entire sample (AP, 0.21), and between parental history and sexual abuse (AP, 0.31) and emotional neglect (AP, 0.26) in women. In other words, the risk of alcohol dependence given both parental history and the maltreatment was higher than what would be expected given the additive effect of each alone. Conclusions: Childhood maltreatments independently increased the risk of alcohol dependence, underscoring the importance of early identification and prevention and suggesting the need to develop and incorporate alcohol preventative components, such as cognitive restructuring, in maltreatment interventions. Importantly, the effect of physical abuse on alcohol dependence may depend on genetic vulnerability as suggested by the effect of parental history of alcoholism, whereas the effects of sexual abuse and emotional neglect may depend on this vulnerability among women. Thus, maltreatment may have a long-term negative impact, which may depend on genetic vulnerability and sex. Findings can be used to guide genetic studies and intervention development. doi:10.1016/j.comppsych.2011.04.021 Prospective investigation of psychological and affective pathways from childhood trauma to psychosis-like experiences in a UK birth cohort H. Fisher a, A. Schreier b, S. Zammit c, G. Lewis c, B. Maughan a, M. Munafo c, G. Harrison c, D. Wolke b a London, UK b Warwick, UK c Bristol, UK Introduction: Several large population-based studies have demonstrated associations between adverse experiences in childhood and later development of psychosis-like symptoms (PLIKS). However, little attention has been paid to investigating the mechanisms involved in this pathway; and the few existing studies have relied on cross-sectional assessments. Methods: Prospectively collected data on 6779 children from the UK Avon Longitudinal Study of Parents and Children (ALSPAC) were used to address this issue. Mothers provided reports of children's exposure to physical and emotional cruelty, sexual abuse, parental loss, and domestic violence between birth and 6 years of age along with the child's mental state at 7 and 10 years and their depressive symptoms at 9 and 11 years. The children completed assessments of self-esteem and locus of control at 8.5 years, self-reported exposure to bullying before age 8.5, and were interviewed regarding PLIKS at 12.9 years. Multiple mediation analysis was performed to examine direct and indirect effects of each childhood adversity on PLIKS using the weighted least squares mean and variance adjusted (WLSMV) method. Results: Early victimization exerted most of its effects directly on PLIKS, with smaller indirect pathways via depression, low self-esteem, and external locus of control. The strongest indirect effect of bullying on PLIKS was via locus of control, whereas depressive symptoms were the strongest mediator between domestic violence, maternal physical cruelty, emotional cruelty from a father figure, and PLIKS. Conclusion: These findings tentatively suggest that cognitive and affective difficulties in childhood could be targeted to prevent at least some adolescents exposed to early trauma from developing subclinical psychosis.
Such prevention efforts could subsequently reduce the incidence of psychotic disorders, which place a massive burden on the individual, their family, and society. Funding Source: This aspect of the ALSPAC study was funded by the Wellcome Trust (GR072043MA). Dr Fisher is supported by an interdisciplinary postdoctoral fellowship from the Medical Research Council and the Economic and Social Research Council in the UK and a travel award from the National Institute on Drug Abuse's Division of Epidemiology, Services, and Prevention Research. doi:10.1016/j.comppsych.2011.04.022 Childhood victimization and risk for smoking in middle adulthood M. Ghirmay , C.S. Widom New York, NY Introduction: The aim was to investigate whether childhood abuse and/or neglect increases a person's risk for smoking. Methods: Using data from a prospective cohort design study, participants were 808 individuals with documented cases of physical and sexual abuse and neglect (ages 0-11) from a Midwestern metropolitan county area during the years 1967 to 1971 and a control group of children without such histories matched on the basis of age, sex, race/ethnicity, and approximate family social class. The sample was about half male (51.3%) and half female (48.7%) and approximately 62% white, 33% black, and 4% Hispanic. The average age of the sample at the time of smoking assessment was 41.2 years old. The assessment of smoking was based on questions taken from the 1999-2000 NHANES Survey and administered during in-person interviews during 2003-2005. Results: Individuals with documented histories of child abuse and/or neglect were significantly more likely to have smoked at least 100 cigarettes compared with the control group (74.9% vs 61.9%, respectively; OR = 1.83; P b .001). When examining each specific type of maltreatment, only the neglected group was at significantly increased risk for having smoked at least 100 cigarettes in their lifetime compared with controls (77.33% vs 61.93%, respectively; OR = 2.11; P b.001). The increased risk for smoking was found for abused/neglected women (74.6% vs 59.9%, respectively; OR = 1.96; P = .002), men (75.4% vs 64.0%; OR = 1.70; P = .025), whites (76.5% vs 64.3%; OR = 1.76; P = .006), and blacks (72.3 vs 57.9%; OR = 1.91; P b .05). Interestingly, there were no significant differences between the groups in terms of age of first cigarette smoking, number of cigarettes currently smoked, or number of years smoked. Controlling for a history of major depressive disorder, dysthymia, generalized anxiety disorder, posttraumatic stress disorder, and alcohol and drug abuse/dependence diagnoses and current levels of anxiety, depression, illicit drug use, and heavy drinking, child abuse and neglect remained a significant predictor of smoking. Conclusion: Childhood abuse/and or neglect increases risk for smoking. Cigarette smoking has been found to act as a gateway drug for subsequent substance abuse and as a threat to a person's health. These findings suggest that preventative efforts should be developed for victims of child abuse/and or neglect to assist them in minimizing risk for adverse health consequences associated with smoking and to avoid subsequent risks for illicit drug use. Funding: This research was supported in part by grants from NICHD (HD40774), NIMH (H49467, MH58386), NIJ (86-IJ-CX-0033, 89-IJ-CX0007), NIDA (DA17842, DA10060); NIAAA (AA09238, AA11108), and the Doris Duke Charitable Foundation to CS Widom. Points of view are those of the authors and do not necessarily represent the position of the US Department of Justice. doi:10.1016/j.comppsych.2011.04.023 Religiosity and substance use disorders in an adult Israeli household sample E. Greenstein , D. Shmulewitz , D. Hasin New York, NY Introduction: Research shows a relationship between religiosity and many health behaviors and practices. Previous studies show an inverse