The relationship between childhood trauma and schizophrenia in the Genomics of Schizophrenia in the Xhosa people (SAX) study in South Africa

Psychol Med. 2020 Jul;50(9):1570-1577. doi: 10.1017/S0033291719001703. Epub 2019 Aug 7.


Background: Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa.

Methods: Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia.

Results: Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77-3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28-1.97), neglect (OR 1.39, CI 1.16-1.68), and sexual abuse (OR 1.22, CI 1.03-1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose-response relationship.

Conclusion: Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia.

Keywords: Case–control; South Africa; childhood trauma; psychosis.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Child
  • Child Abuse / psychology
  • Child Abuse / statistics & numerical data*
  • Child Abuse, Sexual / psychology
  • Child Abuse, Sexual / statistics & numerical data*
  • Female
  • Genomics
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Models, Psychological
  • Prevalence
  • Schizophrenia / diagnosis
  • Schizophrenia / epidemiology*
  • Schizophrenic Psychology*
  • South Africa / epidemiology
  • Surveys and Questionnaires
  • Young Adult