Childhood trauma, specifically emotional abuse, is associated with psychiatric symptom severity in drug‑naïve first‑episode patients with schizophrenia.

Schizophrenia (SCZ) is a highly heterogeneous disorder. Childhood trauma (CT) is a well‑established risk factor, although the contribution of specific CT dimensions remains incompletely understood. This study systematically investigated which CT dimensions were most strongly associated with symptom severity in drug‑naïve first‑episode SCZ patients. In a cross‑sectional design, 284 patients were classified into a SCZ‑ct group (n = 234) and a SCZ‑nct group (n = 50) based on Childhood Trauma Questionnaire. Symptom severity was assessed using the Positive and Negative Syndrome Scale. Hierarchical regression analyses adjusted for demographic and clinical covariates were performed, with rater effects examined via a linear mixed‑effects model. The SCZ‑ct group exhibited significantly higher total and positive symptom scores, whereas negative symptom scores did not differ. Higher total CTQ scores were associated with greater overall symptom severity. Emotional abuse was independently associated with total PANSS scores after adjustment for other CT dimensions and covariates, and this association remained robust after additionally accounting for rater effects. These findings support the potential value of addressing childhood trauma, particularly emotional abuse, in both clinical practice and public health strategies.