Adverse childhood experiences and clinical severity in bipolar disorder and schizophrenia: A transdiagnostic two-step cluster analysis

• Published in: Journal of affective disorders Vol. 259; pp. 104 - 111
• Main Authors: Carbone, Elvira Anna, Pugliese, Valentina, Bruni, Antonella, Aloi, Matteo, Calabrò, Giuseppina, Jaén-Moreno, Maria José, Segura-Garcia, Cristina, De Fazio, Pasquale
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.12.2019
• Subjects: Abuse; Bipolar disorder; Childhood trauma; Neglect; Psychotic symptoms; Schizophrenia; Schizophrenia; Bipolar disorder; Abuse; Childhood trauma; Psychotic symptoms; Neglect
• DOI: 10.1016/j.jad.2019.08.049
• ISSN: 0165-0327; 1573-2517

•Adverse childhood events (ACEs) are risk factors for psychiatric disorders.•ACEs were clustered and clusters of ACEs were compared regarding clinical severity.•Clinical severity seems associated with specific clusters of ACEs.•ACEs linked to abuse/neglect are associated to highest clinical severity.•ACEs linked to lack of support/isolation are related to moderate clinical severity. Adverse childhood experiences (ACEs) are risk factors for psychiatric disorders, but evidence about their relationship with clinical severity is limited. We aimed to classify patients according to ACEs and to compare these clusters with regards to the clinical severity. Seventy-four patients with Bipolar Disorder (BD) and 91 patients with a diagnosis within the Schizophrenia Spectrum Disorders (SSDs) were interviewed. The Childhood Experience of Care and Abuse scale (CECA) and the Positive and Negative Symptoms Scale (PANSS) were administered. A two-step cluster analysis was run to identify clusters according to ACEs. PANSS average scores were compared between clusters. Three clusters emerged; significant differences in ACEs distribution were evident. Cluster 1 was characterized by very low frequency of ACEs. ACEs related to lack of support/isolation were more frequent within Cluster 2, instead ACEs related to abuse/neglect were over represented in Cluster 3. The comparison of PANSS through ANOVA demonstrated that Cluster 3 not only had significantly higher scores in all dimensions than Cluster 1 and 2 but also a higher average number of ACEs. CECA is a self-report scale and is subject to recall bias. Specific ACEs are related to clinical severity among BD and SSD patients. Early life adversities related to abuse and neglect are associated to greater symptomatic severity than those related to lack of support/isolation. Our findings suggest that a history of ACEs could be used to identify patients at higher risk of unfavorable clinical features.