The association between trauma and delusional-like experiences
Introduction
A recent systematic review of population-based studies found that the median prevalence of hallucinations and/ or delusional-like experiences (DLE) was 5% (van Os et al., 2009). There has been a growing interest in hallucinations and DLE because studies suggest that there is psychopathological continuity between the subclinical phenotype and clinical psychosis (Van Os et al., 1998, van Os et al., 1999). Subclinical DLE share many demographic factors which are associated with the clinical diagnosis of schizophrenia (e.g. male gender, younger age, unemployment, and migrant status) (Van Os et al., 1998, Scott et al., 2006, Morgan et al., 2009). In addition to the association with clinical psychosis, hallucinations and DLE also occur with a range of other psychiatric disorders including substance use and/or dependence (Degenhardt and Hall, 2001), depression, panic attacks and anxiety disorders (Goodwin et al., 2004, Yung et al., 2007, Varghese et al., 2011). Of particular interest, increased prevalence of DLE is also associated with exposure to trauma (Seedat et al., 2003, Bebbington et al., 2004, Janssen et al., 2004, Spauwen et al., 2006, Scott et al., 2007, Shevlin et al., 2008). For example, based on the 1997 Australian Survey of Mental Health and Wellbeing, it was found that exposure to any traumatic event was associated with a two- to three-fold increased odds of endorsing DLE. A dose–response relationship has also been observed based on the total number of different types of trauma exposures and DLE (Scott et al., 2007).
Although there are now a number of well designed studies robustly showing the association between trauma exposure and DLE, studies have largely focused on trauma exposure during childhood, particularly child abuse. In much the same way that the adolescent brain is particularly sensitive to the effects of cannabis exposure during adolescence resulting in increased risk of DLE (McGrath et al., 2010), we hypothesized that exposure to trauma during childhood and adolescence would be associated with greater odds of DLE endorsement compared to trauma exposure during adulthood. We had the opportunity to explore this in a recent Australian national mental health survey.
Section snippets
Sampling and measures
The 2007 National Survey of Mental Health and Wellbeing was conducted by the Australian Bureau of Statistics from August to December 2007 based on a representative sample (random stratified multistage area sampling) of persons living in private dwellings in all States and Territories of Australia. Details of the survey methodology have been published elsewhere (Slade et al., 2009). In brief, 14,805 private dwellings were initially selected with one person aged 16 years or over from each dwelling
Results
Of the 8773 subjects included in the study, 776 (8.4%) positively endorsed one or more DLE. The details of the count of DLE are shown in the Appendix B. There was no significant sex difference in endorsing DLE (Females 50.4%; OR: 1.21; 95% CI 0.97–1.50). Three-quarters of the population (6,624; 74.8%) reported exposure to at least one traumatic event (Table 1). Endorsement counts for each of the 29 trauma items are shown in the Table 2. There was a wide variation in the frequency of exposure to
Main findings
Individuals exposed to traumatic events were twice as likely to endorse DLE compared with those who did not have any trauma exposure. There was a significant dose–response relationship between the number of types of trauma experienced and likelihood of endorsing DLE. These findings are broadly consistent with several studies based on different populations (Read et al., 2005, Sareen et al., 2005, Spauwen et al., 2006, Shevlin et al., 2007). We also confirm key findings from an earlier Australian
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