Abstract
Background
Consistent evidence suggests that there is an association between childhood trauma and psychotic disorders. Exposure to childhood trauma among people with severe mental illness (SMI) is associated with a range of negative outcomes, including exacerbation of symptoms, higher rates of readmission and relapse, poorer levels of social and vocational functioning, substance use and self-harm (Grubaugh et al., 2011). We aimed to identify people with SMI and a history of CSA as recorded in electronic health records in a large mental healthcare provider in the UK, describe the clinical and functional characteristics these patients and compare their clinical outcomes (admissions, medication) to those of patients with no recorded history of CSA.
Methods
Data for this study were obtained from Camden & Islington NHS Foundation Trust using the Clinical Record Interactive Search (CRIS) tool. CRIS is an application developed to enable routinely collected electronic health records to be used in research. C&I NHS FT is a large mental health provider serving a geographic catchment area of two inner-city London boroughs, and approximately 470,000 residents. For purposes of this study we identified patients with an ICD-10 diagnosis of F20-F29 or F30-31 with at least one year of follow-up. We searched text records (clinical notes and documents) for keywords associated with CSA, using an iterative process of inclusion and exclusion rules. We then tested the positive predictive value of this search. We compared the demographic, clinical and functional characteristics of patients with and without a history of CSA using chi square tests. Next, we used logistic regression models to examine the outcomes of inpatient admission and receipt of antipsychotic medication among the study population.
Results
We identified 7,000 patients with SMI, of which 619 (8.8%) hade a recorded history of CSA. Patients with a recorded history of CSA were more likely to be female (63.8% vs. 43.3%), single (76.9% vs. 66.5%), of white ethnic origin (66.4% vs. 54.3%) than their counterparts without CSA. There was no difference in the distribution of social deprivation between the groups. Major depressive disorder, posttraumatic stress disorder and personality disorders were all more prevalent in patients with CSA (13.4% vs. 7.6%, 4.7% vs. 1.4%, and 22.0% vs. 5.8%, respectively). Higher rates of moderate-severe psychotic symptoms, depressed mood, self-harm, substance use and aggression were also evident in this group, as were problems with relationships and accommodation. There was a 2-fold increase in the odds of inpatient admissions in patients with a history of CSA than in those without (adjusted OR=1.95, 95% CI: 1.64–2.33), and they were more likely to have spent at least 10 days a year as inpatients (adjusted OR=1.32, 95% CI: 1.07–1.62). Similarly, patients with a history of CSA were more likely to be prescribed antipsychotic medication (adjusted OR=2.48, 95% CI: 1.69–3.66), and more likely to be given over 75% of the maximum recommended dose (adjusted OR=1.72, 95% CI: 1.44–2.04).
Discussion
The current study used routinely recorded data from electronic health records to identify a history of childhood sexual abuse in patients with SMI. Consistent with previous findings, the study demonstrated that exposure to childhood trauma is associated with negative clinical and functional outcomes in these patients. Clinicians working with patients with SMI should be trained and skilled at assessing childhood adversity, and addressing such adversity in the clinical setting.
A qualitative study of the views of patients with human immunodeficiency virus and childhood trauma on the consent process for a neurocognitive and neuroimaging study
