The effects of childhood adversity on treatment delays and its components in first-episode psychosis

Psychiatry Res. 2022 Feb;308:114341. doi: 10.1016/j.psychres.2021.114341. Epub 2021 Dec 16.


Apart from increasing risk for psychotic disorders, childhood adversity has been associated with worse outcomes. One way in which childhood adversity may worsen outcomes is by lengthening treatment delays, which are associated with negative impacts. We tested the influence of childhood trauma on treatment delays, measured as the duration of untreated psychosis (DUP), and its help-seeking and referral components, in a first-episode psychosis cohort (N = 203). We accounted for pertinent social (e.g., migrant status) and other determinants (i.e., age at onset, diagnosis, symptoms) of treatment delays. Multiple linear regression analyses revealed that for a one-unit increase in Childhood Trauma Questionnaire (CTQ) scores, average overall DUP increased by 25%. Higher CTQ scores also significantly predicted help-seeking and referral DUPs. Patients with schizophrenia-spectrum psychosis had longer help-seeking and total DUPs than those with affective psychosis. More severe positive symptoms predicted longer help-seeking DUPs, while more severe negative symptoms predicted longer referral DUPs. Indicators of social disadvantage did not affect DUP. Our results show that childhood trauma increases DUP by prolonging the help-seeking process and delaying access to mental healthcare even after help is sought. Early identification of psychosis among populations with trauma histories seems warranted and can likely positively impact outcomes.

Keywords: Childhood adversity; DUP; First-episode psychosis; Help-seeking; Treatment delays.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adverse Childhood Experiences*
  • Humans
  • Psychotic Disorders* / diagnosis
  • Psychotic Disorders* / epidemiology
  • Psychotic Disorders* / therapy
  • Referral and Consultation
  • Schizophrenia* / diagnosis
  • Time-to-Treatment

Grant support