T3. AFTER 20 YEARS OF RESEARCH ON CHILDHOOD TRAUMA IN SCHIZOPHRENIA RESEARCH, WHERE ARE WE?

Childhood maltreatment affects one third of children and adolescents and constitutes one of the costliest public health burdens of our societies. In the last two decades, we observed an explosion of research on childhood trauma in the field of schizophrenia and early exposure to trauma has been associated with endophenotypes of schizophrenia and other psychotic disorders, with the risk of conversion to a major psychiatric disorder and with a worse pre- and post-morbid functioning. This study aimed to appraise the current state of the research on childhood trauma and schizophrenia by classifying the main objective of all articles published on this matter during the three last years. We conducted a systematic review of all articles on childhood trauma and schizophrenia published between 2016 and 2018. References for this review were identified through searches of PubMed and Medline for articles published from the beginning of January 2016 to the beginning of November 2018 by use of the terms “child abuse and neglect OR child abuse OR child neglect OR child maltreatment OR childhood adversity OR childhood victimization OR adverse childhood experiences” AND “schizo* OR psychosis OR psychoti* OR “ultra-high risk” OR hallucinat* OR delusion* OR paranoi*”. Of the 285 articles retrieved, 156 were retained. The main objective of the studies were classified as belonging to one of the following categories: Consequences (including studies on the association between childhood trauma and a characteristic of schizophrenia or another psychotic disorder), Mechanisms (including studies principally evaluating interaction effects or mediators of the association between childhood trauma and psychotic disorders), Intervention (including studies evaluating the effect of an intervention with a sample exposed to childhood abuse or neglect), and Others. A subset of 50 articles were reviewed independently by two coders. Intraclass correlations revealed excellent interrater reliability, with an average ICC of .958 [95% CI from .926 to .976, F(49,49)= 23.80, p<.001]. We observed that, between 2016 and 2018, only 7 articles addressed intervention (5%) while the majority (55%; n = 86) were treating of the now well-known fact that childhood trauma is associated with the clinical features of schizophrenia. These researches more often than not conclude with generalities about intervention. Interestingly, 30% (n = 47) principally aimed to identify potential mechanisms through which trauma may lead to psychotic symptoms or psychosis, and then be helpful in the design of future clinical research on interventions by addressing these mechanisms. The present review documented a surprising paradox: despite the increasing number of publications on the theme of child abuse and neglect in the field of schizophrenia, one can observe a paucity of reports on intervention. Clinical innovations and related intervention research should address the issues raised by the numerous and convincing correlational research.

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