Psychotic experiences in the context of depression: The cumulative role of victimization
Introduction
Sub-threshold psychotic experiences, which consist of symptoms resembling delusions and hallucination that are not of sufficient severity to meet diagnostic criteria for a psychotic disorder, are reported by approximately 7.2% of the general population (Linscott and Van Os, 2013). Although the vast majority of these individuals will not develop a psychotic disorder (Werbeloff et al., 2012), these psychotic experiences nonetheless can be clinically significant (Oh et al., 2015), particularly as indicators of co-morbidity with common mental health conditions (DeVylder et al., 2014, Kelleher et al., 2012) including depression (Armando et al., 2010). Further, psychotic experiences appear to be markers of greater clinical and functional impairment among individuals with underlying depressive or anxiety disorders. Specifically, a study by Wigman et al. (2012) showed that 27% of adolescents and young adults in a community sample with a depressive or anxiety disorder also reported psychotic experiences (compared to 14% without these disorders), and that psychotic experiences were associated with poorer illness course, greater persistence of schizotypal and negative symptoms, greater service utilization, and more observable illness behavior (Wigman et al., 2012).
Despite the notable relevance of psychotic experiences among people with depression or anxiety, little is known about why some people with these common mental health symptoms also develop psychotic experiences. One possibility is that exposure to trauma and victimization, which have been linked to psychosis etiology, may also partly explain why some individuals with depression report psychotic experiences while others do not. A meta-analysis by Varese et al. (2012) demonstrated a significant relation between childhood adversity (i.e., sexual, physical, emotional abuse, neglect, and bullying) and psychosis. Bullying and sexual trauma in particular were found to increase risk for developing psychotic experiences among adolescents (Campbell and Morrison, 2007, Lataster et al., 2006, Schreier et al., 2009). In addition, exposure to multiple types of trauma has been associated with increased likelihood of delusion-like experiences (Saha et al., 2011).
In this study, we use data from a sample of young adult students to further examine the etiology of psychotic experiences among people with depressive symptoms. Specifically, we tested whether: (1) psychotic experiences were associated with severity of depressive symptoms; (2) whether this association may be more pronounced among individuals who reported childhood sexual trauma or bullying exposure; and (3) whether the combined effect of sexual trauma and bullying on the psychosis/depression association was greater than that of either exposure alone. We hypothesized that depressive symptoms would be associated with psychotic experiences in this sample, as in prior studies. Further, we predicted that exposure to victimization or traumatic events, operationalized as childhood sexual abuse and exposure to bullying, would moderate this association, such that the association between depression and psychosis would emerge specifically among individuals who had faced these exposures.
Section snippets
Sample and procedure
Primary data was collected through the administration of surveys to undergraduate college students during the Fall 2014 semester. Students who chose to participate in the survey for their course credit completed the computerized testing battery. Participants (N = 799) provided written informed consent before completing the survey. This study was approved by the Institutional Review Board at The College of William and Mary.
Psychotic experiences
The Prodromal Questionnaire-Brief (PQ-B; Loewy et al., 2011) was used to
Descriptive characteristics
The study sample mainly consisted of female and white young adult respondents, with a substantial minority reporting history of bullying and sexual trauma (Table 1). Many of the respondents who reported sexual trauma also reported being bullied, n (%) = 28(3.1).
Bivariate relationships among variables
Depression severity was positively correlated with distressing psychotic experiences, r = 0.398, p < 0.001. There were no significant associations between bullying, sexual trauma, depression, or psychotic experiences with any demographic
Main findings
Recent research has demonstrated a meaningful link between psychosis and depression in the general population, with psychotic experiences indicating greater clinical severity among people with depression (Wigman et al., 2012). However, the factors that might drive the occurrence of psychotic experiences in the context of depression remain unknown. Consistent with prior research, we found that distressing psychotic experiences were positively correlated with depressive symptoms (Eaton et al.,
Conflict of interest
The authors have no conflicts of interest to declare.
Contributors
Boyoung Nam contributed to the development of study hypotheses, conducted data analyses, and wrote and edited the primary and subsequent drafts of the manuscript. Matthew Hilimire collected the survey data, contributed to the analytic plan, and edited and revised drafts of the manuscript. Jason Schiffman provided expertise on sub-threshold psychosis in relation to social risk factors, and contributed to revisions of the manuscript. Jordan DeVylder designed the survey items and study hypotheses,
Role of funding source
The funding source for this study (University of Maryland, Baltimore) had no role in the design or conduct of the study, or the reporting of study findings.
Acknowledgments
This study was funded by an intramural research grant from the University of Maryland, Baltimore.
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