Association between Adverse Childhood Experiences and long-term outcomes in people at Clinical High-Risk for Psychosis
Authors: Tognin Stefania , Catalan Ana , Aymerich Claudia , Richter Anja , Kempton Matthew J. , Modinos Gemma , Hammoud Ryan , Gorostiza Iñigo , Vassos Evangelos , van der Gaag Mark , de Haan Lieuwe , Nelson Barnaby , Riecher-Rössler Anita , Bressan Rodrigo , Barrantes-Vidal Neus , Krebs Marie-Odile , Nordentoft Merete , Ruhrmann Stephan , Sachs Gabriele , Rutten Bart P. F. ,   The EU-GEI High Risk Study, McGuire Philip , Valmaggia Lucia R. , Kempton Matthew J. , Calem Maria , Modinos Gemma , de Haan Lieuwe , van der Gaag Mark , Velthorst Eva , Kraan Tamar C. , van Dam Daniella S. , Burger Nadine , Nelson Barnaby , McGorry Patrick , Amminger G. Paul , Pantelis Christos , Politis Athena , Goodall Joanne , Riecher-Rössler Anita , Borgwardt Stefan , Studerus Erich , Bressan Rodrigo , Gadelha Ary , Brietzke Elisa , Asevedo Graccielle , Asevedo Elson , Zugman Andre , Barrantes-Vidal Neus , Domínguez-Martínez Tecelli , Racciopi Anna , Kwapil Thomas R. , Monsonet Manel , Hinojosa Lídia , Kazes Mathilde , Daban Claire , Bourgin Julie , Gay Olivier , Mam-Lam-Fook Célia , Krebs Marie-Odile , Nordholm Dorte , Randers Lasse , Krakauer Kristine , Glenthøj Louise , Glenthøj Birte , Nordentoft Merete , Ruhrmann Stephan , Gebhard Dominika , Arnhold Julia , Klosterkötter Joachim , Sachs Gabriele , Lasser Iris , Winklbaur Bernadette , Delespaul Philippe A. , Rutten Bart P. , van Os Jim , Valmaggia Lucia , McGuire Philip 
Published: February 2025

Abstract
Adverse childhood experiences (ACEs) are common in people at clinical high-risk for psychosis (CHR), however, the relationship between ACEs and long-term clinical outcomes is still unclear. This study examined associations between ACEs and clinical outcomes in CHR individuals. 344 CHR individuals and 67 healthy controls (HC) were assessed using the Childhood Trauma Questionnaire (CTQ), the Bullying Questionnaire and the Childhood Experience of Care and Abuse (CECA). CHR were followed up for up to 5 years. Remission from the CHR state, transition to psychosis (both defined with the Comprehensive Assessment of an At Risk Mental State), and level of functioning (assessed with the Global Assessment of Functioning) were assessed. Stepwise and multilevel logistic regression models were used to investigate the relationship between ACEs and outcomes. ACEs were significantly more prevalent in CHR individuals than in HC. Within the CHR cohort, physical abuse was associated with a reduced likelihood of remission (OR = 3.64, p = 0.025). Separation from a parent was linked to an increased likelihood of both remission (OR = 0.32, p = 0.011) and higher level of functioning (OR = 1.77, p = 0.040). Death of a parent (OR = 1.87, p = 0.037) was associated with an increased risk of transitioning to psychosis. Physical abuse and death of a parent are related to adverse long-term outcomes in CHR. The counter-intuitive association between separation from a parent and outcomes may reflect the removal of a child from an adverse environment. Future studies should investigate whether interventions targeting the effect of specific ACEs might help to improve outcomes in this population.