The functional and clinical relevance of childhood trauma-related admixture of affective, anxious and psychosis symptoms

Objective: Previous work has shown that across different patient samples, patients with childhood trauma are more likely to have co-occurrence of affective, anxious and psychosis symptoms than non-traumatized patients. However, the clinical relevance of trauma-related admixture remains to be established. Method: We examined patients with mood disorder (NEMESIS-2; n=1260), anxiety disorder (NEMESIS-2; n=896) or psychotic disorder (GROUP; n=532) in terms of symptom profiles, quality of life (QOL) and social functioning. Results: Results showed that mood disorder patients with both trauma and co-occurrence of affective, anxious and psychosis symptoms had a lower QOL (B-12.6, 95% CI -17.7 to -7.5, P<0.001), more help-seeking behaviour [odds ratio (OR) 2.5, 95% CI 1.1-5.7, P=0.031] and higher prevalence of substance use disorders (OR 7.8, 95% CI 1.1-58.0, P=0.044), compared with patients without trauma history and symptom admixture (Trauma-/CL-). Similar results were found in patients with an anxiety disorder. Traumatized patients with a psychotic disorder and admixture showed lower QOL (B-0.6, 95% CI -0.9 to -0.4, P<0.001), higher prevalence of drug disorders (OR 2.2, 95% CI 1.2-3.9, P=0.008) and lower global assessment of functioning (B-12.8, 95% CI -17.1 to -8.5, P<0.001) than Trauma-/CL- patients. Conclusion: Stratification according to childhood trauma exposure thus identifies a phenotype characterized by admixture of affective, anxiety and psychotic symptoms that, when combined, has clinical relevance. Identification of functionally meaningful aetiological subgroups may aid clinical practice.