Silver Linings After Abuse and Neglect

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.