Relationships between trauma types and psychotic symptoms: A network analysis of patients with psychotic disorders in a large, multi-country study in East Africa.

Ethiopia Kenya Network analysis Psychosis Trauma Uganda

Journal

Comprehensive psychiatry
ISSN: 1532-8384
Titre abrégé: Compr Psychiatry
Pays: United States
ID NLM: 0372612

Informations de publication

Date de publication:
31 May 2024
Historique:
received: 11 12 2023
revised: 30 04 2024
accepted: 30 05 2024
medline: 15 6 2024
pubmed: 15 6 2024
entrez: 14 6 2024
Statut: aheadofprint

Résumé

The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms. We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms. The trauma type "exposure to a war zone" had the highest bridge strength, betweenness, and closeness. The psychotic symptom "odd or unusual beliefs" had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death. Specific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.

Sections du résumé

BACKGROUND BACKGROUND
The link between trauma exposure and psychotic disorders is well-established. Further, specific types of trauma may be associated with specific psychotic symptoms. Network analysis is an approach that can advance our understanding of the associations across trauma types and psychotic symptoms.
METHODS METHODS
We conducted a network analysis with data from 16,628 adult participants (mean age [standard deviation] = 36.3 years [11.5]; 55.8% males) with psychotic disorders in East Africa recruited between 2018 and 2023. We used the Life Events Checklist and the Mini International Neuropsychiatric Interview to determine whether specific trauma types experienced over the life course and specific psychotic symptoms were connected. We used an Ising model to estimate the network connections and bridge centrality statistics to identify nodes that may influence trauma types and psychotic symptoms.
RESULTS RESULTS
The trauma type "exposure to a war zone" had the highest bridge strength, betweenness, and closeness. The psychotic symptom "odd or unusual beliefs" had the second highest bridge strength. Exposure to a war zone was directly connected to visual hallucinations, odd or unusual beliefs, passivity phenomena, and disorganized speech. Odd or unusual beliefs were directly connected to transportation accidents, physical assault, war, and witnessing sudden accidental death.
CONCLUSION CONCLUSIONS
Specific trauma types and psychotic symptoms may interact bidirectionally. Screening for psychotic symptoms in patients with war-related trauma and evaluating lifetime trauma in patients with odd or unusual beliefs in clinical care may be considered points of intervention to limit stimulating additional psychotic symptoms and trauma exposure. This work reaffirms the importance of trauma-informed care for patients with psychotic disorders.

Identifiants

DOI: 10.1016/j.comppsych.2024.152504 PMID: 38876004
pubmed: 38876004
pii: S0010-440X(24)00055-5
doi: 10.1016/j.comppsych.2024.152504
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

152504

Informations de copyright

Copyright © 2024 The Author. Published by Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest None.

Auteurs

Anne Stevenson (A)

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. Electronic address: astevens@broadinstitute.org.

Supriya Misra (S)

Department of Public Health, San Francisco State University, San Francisco, CA, USA.

Engida Girma (E)

Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Adela-Maria Isvoranu (AM)

Department of Psychology, National University of Singapore, Singapore.

Dickens Akena (D)

Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

Melkam Alemayehu (M)

Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Lukoye Atwoli (L)

Department of Mental Health and Behavioural Sciences, School of Medicine, Moi University College of Health Sciences, Eldoret, Kenya; Brain and Mind Institute, The Aga Khan University, Nairobi, Kenya; Department of Medicine, Medical College East Africa, The Aga Khan University, Nairobi, Kenya.

Bizu Gelaye (B)

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Department of Psychiatry, Harvard Medical School and the Chester M. Pierce MD, Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA.

Stella Gichuru (S)

Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.

Symon M Kariuki (SM)

Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK.

Edith Kamaru Kwobah (EK)

Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.

Joseph Kyebuzibwa (J)

Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.

Rehema M Mwema (RM)

Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya.

Carter P Newman (CP)

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.

Charles R J C Newton (CRJC)

Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Research Programme-Coast, Kilifi, Kenya; Department of Psychiatry, University of Oxford, Oxford, UK.

Linnet Ongeri (L)

Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.

Rocky E Stroud (RE)

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA.

Solomon Teferra (S)

Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.

Karestan C Koenen (KC)

Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, Cambridge, MA, USA; Psychiatric & Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Soraya Seedat (S)

South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.

Classifications MeSH