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).