Childhood Trauma Exposure and Severity of Psychotic Symptoms in a First-Episode Psychosis Group in Singapore

Aim: This paper examines the prevalence of childhood trauma as well as its association with severity of psychotic symptoms in patients with first episode psychosis. Method: Eighty one patients on follow-up with the Singapore Early Psychosis Intervention Programme were recruited for the study. They were administered the Childhood Trauma Questionnaire Short Form (CTQ-SF) to assess history of childhood trauma exposure. Clinical diagnosis was assessed using the Structured Clinical Interview for DSM-IV (SCID-clinician version). Severity of symptoms was assessed by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS) and Global Assessment of Functioning (GAF) scale at baseline, 6 months and 1 year. Sociodemographic and clinical data were compared between the two groups using independent t-test and chi square test followed by multiple linear regressions to adjust for confounder effects. Results: The mean age of patients was 25.9 (6) years. There were slightly more females (50.6%) than males (49.4%). Prevalence of trauma was 54.3% in the cohort. PANSS negative and total scores were positively and significantly associated with female gender, unemployment and lower education and negatively associated with positive history of childhood trauma. There was a significant improvement in GAF total scores over 1 year of follow-up across the entire cohort (39.7 vs. 67.8, Mean Diff. = -28.1; p <0.001), however, those with a history of childhood trauma had lower mean scores on GAF symptoms scale than those who did not have a history of childhood trauma F(df) = 2.7(3,108), p value = 0.047). Conclusion: We found a high prevalence of trauma history in the first episode group, consistent with previous findings. Contrary to our hypotheses, we found that a history of trauma was associated with lower symptom severity at first presentation, especially the negative symptoms. However, we did find that at one year those with a positive history of childhood trauma had lesser improvement in symptom severity compared to those without a history of trauma. Functioning outcome was also worse for those who had experienced trauma in their childhood, making exposure to childhood trauma a poor prognostic factor.