Clinical and Demographic Associations of Interpersonal Trauma Experiences in a Real-World Early Psychosis Sample

Background and Purpose: People with early psychosis (EP) often report previous trauma exposure, including interpersonal trauma experiences (ITE), which refers specifically to trauma directly caused by another person. In this project, we examined the association between ITE, symptom severity, and demographic characteristics in a real-world sample of people with early psychosis (EP) engaged in coordinated specialty care (CSC) programs in Massachusetts.

Methods: The Life Events Checklist (LEC-5) was completed by 232 people enrolled in CSC for EP. The median age for study participants was 23 years (IQR = 20-25) with most participants identifying as white (64%), non-Hispanic (77%), heterosexual (79%) men (65%). About 80% of participants reported having never received Supplemental Security Income (SSI) and that at least one parent received a bachelor’s degree or higher. Suicidal ideation (SI) was endorsed by approximately 41% of participants, with 44% reporting a mental health hospitalization within the past six-months. The median time in treatment at the time the LEC-5 was completed was two months (IQR = 1-15). Five LEC-5 items were used to create a weighted total ITE burden score (physical assault, assault with a weapon, sexual assault, other unwanted sexual experiences, captivity). Wilcoxon rank sum tests and chi-square tests were used to assess group differences. A linear model (LM) examined whether ITE burden was associated with higher Colorado Symptom Index (CSI) scores.

Results: Overall, 95 people reported experiencing at least one ITE. The ITE group had significantly higher CSI total scores (W = 4567, p = < .001), including on items of depression (X²(4) = 17.941, p = < .001) and hallucinations (X²(4) = 12.198, p = 0.01), than those reporting no ITE. The ITE group also reported significantly more SI (X²(1) = 7.0484, p = 0.007) than those reporting no ITE. The groups differed significantly in gender (X²(2) = 10.545, p = 0.005) and sexual orientation (X²(1) = 25.938, p = < .001). No significant group differences were found for age, race, ethnicity, parental education, SSI, mental health hospitalizations, time in CSC, and social or occupational functioning. Our LM examining whether ITE burden was a significant predictor of CSI total scores was significant (F (6, 136) = 15.63, p = < .001, adj. R² = 0.38); model covariates included our significant between group findings, as well as variables shown to be correlated with CSI scores (time in treatment, occupational functioning scores).

Conclusions: Our findings suggest that ITE is associated with greater clinical severity in people with EP. Those reporting ITE in our sample were more likely to identify as women, non-binary, or non-heterosexual. Total ITE burden scores remained a significant predictor of symptom severity after controlling for SI, time in treatment, occupational functioning, gender, and sexual orientation. More research is needed to examine whether specific types of ITE are associated with specific clinical outcomes, and whether clinically significant ITEs have an impact on specific CSC outcomes or treatment trajectories for people with EP.