Relationship between childhood adversity and clinical and cognitive features in schizophrenia Kathryn L. McCabe a, b, * , Elizabeth A. Maloney a, c , Helen J. Stain a, b, d , Carmel M. Loughland a, b , Vaughan J. Carr a, c a Schizophrenia Research Institute, Darlinghurst, New South Wales, Australia b Centre for Brain and Mental Health Research, University of Newcastle, Newcastle, New South Wales, Australia c School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia d Centre for Rural and Remote Mental Health, University of Newcastle, Orange, New South Wales, Australia article info Article history: Received 2 August 2011 Received in revised form 18 January 2012 Accepted 19 January 2012 Keywords: Childhood adversity Schizophrenia Neurocognition Personality abstract Childhood adversity is associated with elevated risk for a wide range of adult psychiatric disorders, and has significant and sustained negative effects on adult behavioural and social functioning. Elevated rates of childhood adversity have been reported for people with a diagnosis of schizophrenia. The aim of the present study was to assess rates of retrospectively reported childhood adversity among adults with schizophrenia and to examine the relationship between childhood adversity and clinical and cognitive features. Data were available for 408 schizophrenia participants and 267 healthy control participants recruited through the Australian Schizophrenia Research Bank (ASRB). History of childhood adversity was obtained using the Childhood Adversity Questionnaire (CAQ). A five-factor solution was identified from the CAQ. Schizophrenia participants reported experiencing more childhood adversities than controls. In both groups, those reporting childhood adversity were more likely to be female and older. Among participants with schizophrenia, positive symptom severity and fewer years of education were associated with childhood adversity. Lower IQ scores and personality traits were associated with reporting a greater number of childhood adversities and with adversity sub-types of abusive, neglectful and dysfunctional parenting. The rate of childhood adversity reported in this sample was high which suggests greater exposure to adverse childhood events among participants with schizophrenia in comparison with healthy controls. We identified unique groups amongst CAQ items that provided a salient framework from which to investigate the connection between childhood adversity and clinical and cognitive features. Ó 2012 Elsevier Ltd. All rights reserved. 1. Introduction Childhood adversity refers to physical or emotional acts that are potentially harmful, or insensitive to a child’s development (Akmatov, 2011). It is associated with elevated risk for a wide range of adult psychiatric disorders (Wittchen et al., 1998) and has significant and sustained negative effects on adult behavioural and social functioning (Gilbert et al., 2009). In schizophrenia, childhood adversity has been associated with earlier first admissions, longer and more frequent hospitalizations, more medication, increased likelihood of self harm and higher global symptom severity (Schenkel et al., 2005). It is not known whether childhood adversity is more common in schizophrenia than other psychiatric disorders (Morgan and Fisher, 2007), but rates are higher compared to healthy controls and non-affected relatives (Read et al., 2005; Bentall and Fernyhough, 2008). Severity of psychotic symptoms is increased in schizophrenia patients who report abuse in childhood (Read et al., 2005), and childhood adversity, particularly sexual abuse, is associated with impaired cognition (eg, working memory, processing speed) (Lysaker et al., 2001b) and lowered IQ of up to 8 points (Koenen et al., 2003). Childhood adversity has been intensively studied in relation to personality disorders, especially borderline personality (Ball and Links, 2009), and population studies of childhood adversity show relationships to Cluster A (schizotypal, paranoid) and B (antisocial, histrionic, borderline) personalities in adults (Johnson et al., 2006). Thus, childhood adversity in schizophrenia may be related to comorbid personality disorders (Crawford et al., 2008). People with * Corresponding author. Schizophrenia Research Institute, 405 Liverpool Street, Darlinghurst, NSW 2010, Australia. Tel.: þ61 9295 8680; fax: þ61 9295 8415. E-mail address: kathryn.mccabe@newcastle.edu.au (K.L. McCabe). Contents lists available at SciVerse ScienceDirect Journal of Psychiatric Research journal homepage: www.elsevier.com/locate/psychires 0022-3956/$ e see front matter Ó 2012 Elsevier Ltd. All rights reserved. doi:10.1016/j.jpsychires.2012.01.023 Journal of Psychiatric Research 46 (2012) 600e607