Longitudinal effects of lifetime trauma exposure and childhood sexual trauma by gender in individuals with first episode psychosis.

OBJECTIVES: A history of trauma is common among people with psychotic disorders, and such a history is associated with more severe symptoms. Men and women with psychosis often experience differences in their course of illness and symptom profiles. Although past work has found gender differences in trauma among those with first episode psychosis, data in this domain are limited and primarily focused on childhood trauma with cross-sectional designs. The current analysis examined the relationship between lifetime trauma exposure at baseline and changes in functioning and symptom severity. DESIGN: Secondary data analysis from the Recovery After an Initial Episode of Schizophrenia-Early Treatment Program (RAISE-ETP) study. METHODS: Four hundred participants (27% female) completed assessments at 6-month intervals over 24 months that were analysed cross-sectionally and longitudinally by high/low trauma exposure and gender. RESULTS: Results suggested that gender differences exist in the relationship between trauma exposure and symptoms for individuals with first episode psychosis. Cross-sectionally at baseline, more reported trauma was related to greater symptom severity for both men and women and most significantly related to depression. However, over the first 2 years of treatment, women with a greater history of trauma demonstrated significantly less improvement in psychotic symptoms than those with less trauma, whereas trauma history in men was not related to clinical improvement. Similar gender differences in improved psychotic symptoms were found when history of childhood sexual trauma was examined. CONCLUSIONS: Overall, the findings indicate that clinical interventions should systematically assess and address lifetime trauma exposure in first episode psychosis care. CLINICAL TRIAL REGISTRATION: The overall RAISE-ETP study is registered on clinicaltrials.gov NCT#: NCT01321177.