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Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis

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Abstract

This umbrella review is the first to systematically examine psychological trauma as a transdiagnostic risk factor across psychiatric conditions. We searched Pubmed, Scopus, and PsycNET databases from inception until 01/05/2021 for systematic reviews/meta-analyses evaluating the association between psychological trauma and at least one diagnosed mental disorder. We re-calculated the odds ratio (OR), then classified the association as convincing, highly suggestive, suggestive, or weak, based on the number of cases and controls with and without psychological trauma, random-effects p value, the 95% confidence interval of the largest study, heterogeneity between studies, 95% prediction interval, small-study effect, and excess significance bias. Additional outcomes were the association between specific trauma types and specific mental disorders, and a sensitivity analysis for childhood trauma. Transdiagnosticity was assessed using TRANSD criteria. The review was pre-registered in Prospero CRD42020157308 and followed PRISMA/MOOSE guidelines. Fourteen reviews met inclusion criteria, comprising 16,277 cases and 77,586 controls. Psychological trauma met TRANSD criteria as a transdiagnostic factor across different diagnostic criteria and spectra. There was highly suggestive evidence of an association between psychological trauma at any time-point and any mental disorder (OR = 2.92) and between childhood trauma and any mental disorder (OR = 2.90). Regarding specific trauma types, convincing evidence linked physical abuse (OR = 2.36) and highly suggestive evidence linked sexual abuse (OR = 3.47) with a range of mental disorders, and convincing evidence linked emotional abuse to anxiety disorders (OR = 3.05); there were no data for emotional abuse with other disorders. These findings highlight the importance of preventing early traumatic events and providing trauma-informed care in early intervention and psychiatric services.

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Data availability

The data that support the findings of this study are openly available in Figshare at https://doi.org/10.6084/m9.figshare.18677786

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Acknowledgements

The authors would like to thank Prof. Paolo Fusar-Poli for guidance on applying the TRANSD criteria, and also to Prof. Jordi Alsono for guidance. B.L. Amann received two project grants (PI/15/02242, PI18/00009) and a mobility grant (BA21/00002) from the Instituto de Salud Carlos III-Subdirección General de Evaluación y Fomento de la Investigación, Plan Nacional 2008-2011 and 2013-2016, a NARSARD Independent Investigator Grant from the Brain & Behavior Research Foundation (24397) and a grant within the “Pla estratègic de recerca i innovació en salut” (PERIS; G60072253) by the Catalan Government. A. Moreno-Alcázar wants to thank also to the “Secretaria d’Universitats i Recerca del Departament d’Economia i Coneixement (2017 SGR 46 to “Unitat de Recerca del Centre Fòrum”), Generalitat de Catalunya (Government of Catalonia)” for the recognition as an emerging research group. B. Hogg thanks the support and funding of the Instituto de Salud Carlos III with a PFIS grant (FI10/00017). We acknowledge also the continuous support by the CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental). Alicia Valiente-Gómez thanks the support and funding of by the Instituto de Salud Carlos III with a Juan Rodés grant (JR19/00001).

Funding

The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Centre Fòrum Research Unit, Institute of Neuropsychiatry and Addiction (INAD), Parc de Salut Mar, C/Llull 410, 08019, Barcelona, Spain

    Bridget Hogg, Itxaso Gardoki-Souto, Alicia Valiente-Gómez, Benedikt L. Amann & Ana Moreno-Alcázar

  2. Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain

    Bridget Hogg, Itxaso Gardoki-Souto, Alicia Valiente-Gómez, Benedikt L. Amann & Ana Moreno-Alcázar

  3. PhD Programme, Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain

    Bridget Hogg & Itxaso Gardoki-Souto

  4. Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain

    Bridget Hogg, Alicia Valiente-Gómez, Lydia Fortea, Joaquim Radua, Benedikt L. Amann & Ana Moreno-Alcázar

  5. Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil

    Adriane Ribeiro Rosa

  6. Department of Pharmacology, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil

    Adriane Ribeiro Rosa

  7. Postgraduate Program in Psychiatry and Behavioral Sciences, Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, RS, Brazil

    Adriane Ribeiro Rosa

  8. Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Lydia Fortea & Joaquim Radua

  9. Institute of Neurosciences, University of Barcelona, Barcelona, Spain

    Lydia Fortea

  10. Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, King’s College London, Psychology & Neuroscience, London, UK

    Joaquim Radua

  11. Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden

    Joaquim Radua

  12. Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain

    Benedikt L. Amann

  13. Department of Psychiatry and Psychotherapy, Klinikum Der Universität München, Munich, Germany

    Benedikt L. Amann

Authors
  1. Bridget Hogg
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  2. Itxaso Gardoki-Souto
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  3. Alicia Valiente-Gómez
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  4. Adriane Ribeiro Rosa
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  5. Lydia Fortea
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  6. Joaquim Radua
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  7. Benedikt L. Amann
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  8. Ana Moreno-Alcázar
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Contributions

BLA conceived the original idea for the paper. AM-A, AV-G, BH, BLA, IG-S and JR were involved in the design of the work. AM-A, ARR, AV-G, BH and IG-S carried out the article search and data extraction. LF and JR were involved in the analysis of the data. All authors were involved in the interpretation of the data and in writing and revising the draft of the manuscript. All authors have given final approval of the version to be published and are accountable for all aspects of the work.

Corresponding author

Correspondence to Benedikt L. Amann.

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The authors have no relevant financial or non-financial interests to disclose.

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Hogg, B., Gardoki-Souto, I., Valiente-Gómez, A. et al. Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis. Eur Arch Psychiatry Clin Neurosci 273, 397–410 (2023). https://doi.org/10.1007/s00406-022-01495-5

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