Silver Linings After Abuse and Neglect
The neuroprotective role of resilience in patients with schizophrenia who experienced early childhood trauma is evaluated in this brief update.
The neuroprotective role of resilience in patients with schizophrenia who experienced early childhood trauma is evaluated in this brief update. Scroll through the slides and captions for descriptions and links to a recent study on this important topic.
• Childhood maltreatment is associated with multiple adverse mental and physical health outcomes, and has an increased prevalence in schizophrenia [1]
• Schizophrenia is associated with increased cardiometabolic morbidity and mortality
• Childhood trauma may be associated with metabolic dysfunction in schizophrenia [2]
Resilience
• Psychological resilience-mental health despite experiencing adversity-may positively impact mental and physical health and mortality [3]
• No previous studies have investigated whether resilience has a moderating effects on the negative impact of childhood trauma on health in patients with schizophrenia
Study aim
• Lee and colleagues [4] investigated the association of childhood adversity on mental and physical health outcomes in patients with schizophrenia and healthy controls, including moderating effects of resilience
• No previous studies have investigated whether resilience has a moderating effects on the negative impact of childhood trauma on health in patients with schizophrenia
Methods
• The authors included 114 patients with schizophrenia and 101 controls
• The diagnosis of schizophrenia or schizoaffective disorder was confirmed with SCID interviews; controls were screened with the MINI
• Subjects with non-tobacco substance use disorders in the past 3 months, dementia, intellectual disability, or major neurologic disorders were excluded
• Patients with schizophrenia were assessed with standard rating scales for psychotic disorders
• Resilience was assessed using the 10-item Connor-Davidson Resilience Scale
• Mental and physical well-being were assessed using the Short Form Health Survey, and measurement of height and weight
• Participants also completed the Childhood Trauma Questionnaire
• Blood samples were collected for fasting glucose and insulin, and hemoglobin A1c
• General linear models were used to analyze the effects of subject group, trauma, and resilience on mental and physical health measured and metabolic biomarkers
Results
• Patients with schizophrenia had worse self-reported mental and physical well-being, higher levels of trauma, higher BMI, and worse cognition and metabolic biomarkers than controls
• In both patients and controls, childhood trauma was significantly associated with physical well-being, fasting insulin, and insulin resistance
• In patients with schizophrenia, childhood trauma was not associated with worse mental health
Key findings
• In both patients and controls, higher resilience was associated with better mental well-being, regardless of trauma severity
• High resilience was also associated with better physical well-being and metabolic biomarkers
• Patients with schizophrenia, high resilience, and high trauma had physical and mental well-being scores comparable to controls with low resilience and high trauma
Discussion
• The authors concluded that patients with schizophrenia have higher levels of childhood trauma than controls, which is associated with worse physical, but not mental, health
• Resilience was associated with better mental and physical health outcomes and metabolic biomarkers, independent of trauma severity
• The authors note that the cross-sectional design limits the ability to make causal inferences
Take home point: Resilience plays an important role in mental and metabolic health in patients with schizophrenia and controls.
REFERENCES:
1. Bendall S, Jackson HJ, Hulbert CA, et al. Childhood trauma and psychotic disorders: a systematic, critical review of the evidence. Schizophr Bull. 2008;34:568-579.
2. Misiak B, Kiejna A, Frydecka D. The history of childhood trauma is associated with lipid disturbances and blood pressure in adult first-episode schizophrenia patients. Gen Hosp Psychiatry. 2015;37:365-367.
3. Yi JP, Vitaliano PP, Smith RE, et al. Measurement and predictors of resilience among community-dwelling older women. J Psychiatr Res. 2008;43:148-154.
4. Lee EE, Martin AS, Tu X, et al. Childhood adversity and schizophrenia: the protecting role of resilience in mental and physical health and metabolic markers. J Clin Psychiatry. 2018;79:e1-e9.
This slideshow article was originally posted on 5/4/2018 and has since been updated in our July 2018 issue.
Dr. Miller is Associate Professor in the Department of Psychiatry and Health Behavior at Augusta University in Augusta, GA, and Schizophrenia Section Editor for Psychiatric Times. He reports no conflicts of interest concerning the subject matter of this slide show.
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