4.2 Recorded Rates of Trauma
Contrary to the hypothesis of this study, the results found a high rate
of trauma recorded in the assessments. The results indicated that the
majority of participants had some exposure to traumatic events, which
was recorded by clinicians. This result contrasted with the findings by
Neill and Read (2022), which found a very low rate of documented trauma
exposure. This finding indicated that clinicians working within this
service acted in line with the NICE (2014) recommendations for assessing
FEP patients for trauma-exposure. This finding also aligns with other
studies indicating a high rate of trauma-exposure in psychosis
populations (Conus et al., 2010 (83%); DeTore et al., 2021 (80%);
Neria et al., 2002 (68.5%). It was noticeable that this data was
included as part of detailed clinical assessment, but was not
systematically recorded or summarised, nor did it lead to further
diagnostic assessment of PTSD or C-PTSD. Detailed clinical assessments,
particularly within specialist services where there is a prominent focus
on developmental and early life risk factors, may glean information
about trauma exposure both deliberately and incidentally. The context of
an initial assessment with an individual with a FEP means that by
definition the trauma exposure will not represent the primary reason for
help-seeking. The absence of a systematic, trauma-informed assessment
protocol increases the risk that an event may be recorded but its
relevance and sequalae missed. Longitudinally, the benefits of the
trauma-informed history taking may be lost as the patient progresses
through their treatment, if the trauma component of their presentation
is not systematically incorporated into the treatment plan. This may be
an intermediate link to appropriately deploying standardised assessments
for PTSD or C-PTSD.
Forty-seven percent of the participants reported childhood
trauma-exposure, indicating the potential importance of adverse early
experiences in the development of psychosis. Although the variables of
interest are not identical, this finding is in line with DeTore et al.’s
(2021) prospective study and Conus et al. (2010) retrospective study of
PTSD in FEP populations which indicated that a significant amount of the
trauma exposure in FEP cohorts occurs before the age of 18. For
instance, in DeTore et al., the average age for all trauma exposures was
18 or under. The current literature suggests that individuals
experiencing psychosis may benefit from trauma therapies, such as TF-CBT
or EMDR (van den Berg et al., 2015), where difficulties of PTSD or
C-PTSD are identified.
In the current study, and similarly to DeTore et al. (2021) and Conus et
al. (2010), attachment-oriented items were prominent (i.e., Item 2:
Loss/ permanent separation from someone close to the patient; Item 3: a
period of separation from someone close to the patient). The importance
of attachment-oriented items aligns with a range of recent findings on
the role of attachment difficulties as a mediator in the development of
psychosis (e.g., Degnan et al., 2022; Grady et al., 2024), as well as
the development of novel psychological interventions targeting
attachment difficulties in psychosis (Airey et al., 2023).
Notably, later life experiences such as interpersonal stressors and
work-related stress were related to psychotic symptoms and were commonly
reported in participant assessments. The significant relationship
between work-related stress and SANS scores supported research
implicating stressful life events and work-related stress specifically
in the development of psychosis (Amin, 2023; Collip et al., 2010).
The significant relationship between interpersonal stressors and SAPS
scores is consistent with research by Bentall and colleagues (2014). It
also supports the previously identified link between adulthood bullying
and positive symptoms (O’Moore et al., 1998).