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Journal of Trauma & Dissociation

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A Longitudinal Study of the Effects of

Childhood Trauma on Symptoms and
Functioning of People with Severe
Mental Health Problems
a b
Gavin Davidson PhD , Ciaran Shannon DClinPsych , Ciaran
c d
Mulholland MD & Jim Campbell PhD
a
Department of Social Work , Northern Health and Social Care
Trust , Antrim, Northern Ireland
b
Department of Clinical Psychology , Northern Health and Social
Care Trust, Holywell Hospital , Antrim, Northern Ireland
c
Division of Psychiatry and Neuroscience , Queen's University
Belfast , Belfast, Northern Ireland
d
School of Sociology, Social Policy, and Social Work , Queen's
University Belfast , Belfast, Northern Ireland
Published online: 22 Jan 2009.

To cite this article: Gavin Davidson PhD , Ciaran Shannon DClinPsych , Ciaran Mulholland MD & Jim
Campbell PhD (2009) A Longitudinal Study of the Effects of Childhood Trauma on Symptoms and
Functioning of People with Severe Mental Health Problems, Journal of Trauma & Dissociation, 10:1,
57-68, DOI: 10.1080/15299730802485169

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 Journal of Trauma & Dissociation, 10:57–68, 2009
Copyright © Taylor & Francis Group, LLC
ISSN: 1529-9732 print/1529-9740 online
DOI: 10.1080/15299730802485169

A Longitudinal Study of the Effects

1529-9740
1529-9732
WJTD
Journal of Trauma & Dissociation,
Dissociation Vol. 10, No. 1, Nov 2008: pp. 0–0

of Childhood Trauma on Symptoms

and Functioning of People with
Severe Mental Health Problems

GAVIN DAVIDSON, PhD

Effects
G. Davidson
of Childhood
et al. Trauma

Department of Social Work, Northern Health and Social Care Trust, Antrim, Northern Ireland
Downloaded by [Tulane University] at 15:01 07 January 2015

CIARAN SHANNON, DClinPsych

Department of Clinical Psychology, Northern Health and Social Care Trust,
Holywell Hospital, Antrim, Northern Ireland

CIARAN MULHOLLAND, MD
Division of Psychiatry and Neuroscience, Queen’s University Belfast, Belfast, Northern Ireland

JIM CAMPBELL, PhD

School of Sociology, Social Policy, and Social Work, Queen’s University
Belfast, Belfast, Northern Ireland

This study examines the relationship between childhood trauma

and the psychiatric symptoms and psychosocial functioning of
adults with severe mental health problems. Participants (n = 31)
were recruited from the caseloads of community mental health
services in Northern Ireland and assessed at baseline, 9 months,
and 18 months. More than half had a history of childhood trauma
(n = 17). There were no differences between the no childhood
trauma (n = 14) and childhood trauma groups on psychiatric
symptoms, but a significant relationship was found between
trauma history and all aspects of social functioning. Those with no
history of trauma showed improved psychosocial functioning over

Received 6 September 2007; accepted 19 November 2007.

This study was funded by the Research and Development Office for Health and Social
Services in Northern Ireland.
Address correspondence to Ciaran Shannon, DClinPsych, Department of Clinical
Psychology, Northern Health and Social Care Trust, Holywell Hospital, 60 Steeple Road,
Antrim, Northern Ireland, BT41 2RJ. E-mail: ciaran.shannon@qub.ac.uk

57
 58 G. Davidson et al.

time, whereas those with a history of trauma deteriorated. These

findings have implications for current service provision.

KEYWORDS trauma, psychosis, psychosocial functioning,

psychiatric symptoms

In recent years there has been a growing literature on the importance of

adverse childhood experience in shaping the course of people’s lives and its
impact on their physical and mental health. Childhood abuse (sexual, physical,
and emotional) has been causally linked to a wide range of adult disorders
including depression, anxiety disorders, posttraumatic stress disorder, and
eating disorders (e.g., Chapman, Dube, & Anda, 2007; Dube, Felitti, Dong,
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Giles, & Anda, 2003; Kendler et al., 2000).

A high proportion of people with severe mental health problems have
been exposed to traumatic experiences, including sexual abuse and physical
abuse (Larkin & Morrison, 2006; Morrison, Frame, & Larkin, 2003; Read,
1998; Read, van Os, Morrison, & Ross, 2005). Rates of childhood abuse have
been found to be much higher among this group compared to the wider
population. Read, Goodman, Morrison, Ross, and Aderhold (2004) reviewed
more than 40 studies on the prevalence of childhood abuse among female
psychiatric inpatients and outpatients and reported rates of childhood sexual
abuse ranging from 22% to 85% (weighted M = 50%) and rates of childhood
physical abuse ranging from 17% to 87% (weighted M = 48%). Based on 25
published studies, the prevalence of childhood abuse among male psychiat-
ric inpatients and outpatients is slightly less dramatic. Rates of childhood
sexual abuse ranged from 0% to 47% (weighted M = 28%), and rates of childhood
physical abuse ranged from 21% to 68% (weighted M = 51%; Read et al., 2004).
Despite this, little is known about the impact of trauma on the clinical
course of illness in such patients. A number of cross-sectional studies have
been published comparing individuals who have a trauma history and a
diagnosis of severe mental illness to those with a similar history but no
diagnosis. Lysaker, Myers, Evans, Clements, and Marks (2001) reported that
those with a diagnosis of schizophrenia and who reported a history of
childhood sexual abuse had poorer psychosocial functioning in adulthood,
had poorer role functioning and fewer of the psychological resources
necessary for sustaining intimacy, and had high levels of emotional instability
and turmoil. Mulholland et al. (2008) reported that people diagnosed with
schizophrenia and who had a history of exposure to trauma had signifi-
cantly higher levels of anxiety, depression, hopelessness, and dissociative
symptoms and had a greater number of hospital admissions compared to
those patients with no such exposure. Maguire, McCusker, Meenagh,
Mulholland, and Shannon (2008) reported that, in a bipolar disorder sample,
 Effects of Childhood Trauma 59

trauma predicted the frequency of hospital admission, quality of life, and

inter-episode depressive symptoms. Interpersonal difficulties, but not alco-
hol dependence, appeared to play an important role in mediating these
adverse effects. Similar findings were reported by Schenkel, Spaulding, DiLillo,
and Silverstein (2005). Within their sample of adults with a diagnosis of
schizophrenia, child abuse or neglect was associated with lower educational
achievement, problems with peers at school, earlier age at first admission,
number of admissions, anxiety, depression, suicidality, hallucinations, and delu-
sions. Kim, Kaspar, Hoh, and Nam (2006) also reported that a history of sexual
or physical abuse was associated with higher levels of anxiety and depression.
Other studies using similar cross-sectional designs have found childhood
exposure to trauma to be associated with higher symptom levels, deficits in
working memory (Lysaker, Myers, Evans, & Marks, 2001), and greater service
utilization (Newmann, Greenley, & Sweeney, 1998). Lysaker, Nees, Lancaster,
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and Davis (2004) found poorer work performance over a 4-week work reha-
bilitation program. Another study (Spence et al., 2006) reported that child-
hood exposure to trauma negatively correlated with communication skills,
suggesting that childhood exposure to trauma has a depleting effect on inter-
communication functioning. Childhood exposure to trauma also significantly
correlated with withdrawal and less recreational activity.
To our knowledge, there has been no published research investigating
the effects of childhood trauma on symptoms and psychosocial functioning
on a longitudinal basis. This study aimed to examine the effect of such
trauma on the psychiatric symptoms and social functioning of a group of
people with severe mental health problems over an 18-month period.
We hypothesized that people with severe mental health problems and
a history of childhood trauma exposure would have more severe symptoms
and more problems with psychosocial functioning at outset and at each
follow-up assessment over an 18-month period compared to people with
severe mental health problems and no such history.

METHOD
Participants
The present study was part of a larger Northern Irish study comparing two
models of mental health team, Assertive Outreach (AO; referred to as Assertive
Community Treatment in North America) and standard Community Mental
Health Team (CMHT), both designed to support people with severe mental
health problems who are difficult to engage and have complex needs. The
AO model is distinguished from the CMHT model by lower caseloads, an
integrated team approach, more in vivo working, longer hours, and a
greater emphasis on strengths rather than deficits (Stein & Santos, 1998;
Stein & Test, 1978). The preliminary results of the larger study are presented
 60 G. Davidson et al.

elsewhere (Davidson & Campbell, 2007). The study design was quasi-
experimental, as allocation was based on geographical catchment area; and
longitudinal, as participants were interviewed at baseline, 9 months, and
18 months. The inclusion criteria for the study were the same as the generally
accepted criteria for AO programs in the United Kingdom: a severe mental
health problem; a history of high use of inpatient services; difficulties with
engagement; and multiple, complex needs (Department of Health, 2001).
For these reasons, it was anticipated that the level of participation would be
relatively low. A total of 102 people were referred to the study, and 76/102
(74.5%) met the inclusion criteria, 38 (50%) in the AO group and 38 (50%) in
the CMHT group. At baseline, 41/76 (53.9%) consented to be interviewed.
During the study period, 3/41 (7.3%) died (one suicide and two substance
abuse related) before data on their trauma history were collected, and 7/41
(17.1%) declined some aspect of follow-up interviews, so there are com-
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plete data for 31/41 (75.6%). Of the 31 participants, 28 (90.3%) were men
and 3 (9.7%) were women. Ages ranged from 20 to 69 years, and the mean
age was 34.3 (SD = 11.74). In all, 21 (67.7%) were single and 10 (32.2%)
were in a relationship. Also, 24 (77.4%) had a diagnosis of schizophrenia,
4 (12.9%) schizoaffective disorder, and 3 (9.7%) bipolar affective disorder.
Finally, 20 (64.5%) were in the AO group and 11 (35.5%) were in the CMHT
group.
Ethical approval was granted by a regional ethics committee. As this
was a study about people who were difficult to engage, approval included
the use of routinely collected data for those who declined to be involved.
This approach was important in order to provide some indication of how
representative the results from the 31 people reported here are of the wider
group of 76 who met the inclusion criteria. The three people who died
during the study were excluded from this analysis. Participants (n = 31)
were therefore compared with nonparticipants (n = 42) on a number of key
variables. There were no statistically significant differences between the two
groups in terms of gender, χ2(1,73) = 5.587, p > .05; age, t(71) = 0.987, p >
.05; number of hospital admissions, t(71) = 0.065, p > .05; or number of
involuntary admissions, t(71) = 1.105, p > .05, over the previous 18 months.

Instruments
Childhood trauma. The Childhood Trauma Questionnaire (CTQ;
Bernstein & Fink, 1998) is a 28-item questionnaire scored on a Likert scale
from never true to very often true, with some items reverse scored. It con-
tains five subscales covering emotional abuse, physical abuse, sexual abuse,
emotional neglect, and physical neglect. It also includes a minimization or
denial scale for detecting the possible underreporting of childhood trauma.
This measure was also used to distinguish between those who had a history
of childhood trauma on any of the subscales (the Trauma group) and those
 Effects of Childhood Trauma 61

who had no, or minimal, levels of trauma (the No Trauma group). The cutoff
point was determined by the guidelines for classifying the subscale scores
into none or minimal, low, moderate, and severe. If a person scored above
none or minimal on any of the subscales, he or she was included in the
Trauma group. For the Sexual Abuse subscale, this meant that people who
had any, even rare, instances of abuse were included in the Trauma group.
For example, the first question on the Sexual Abuse subscale is “When I was
growing up someone tried to touch me in a sexual way, or tried to make me
touch them,” and so any instance was regarded as traumatic. For the other
subscales, several rare instances of abuse could result in a minimal classifica-
tion and inclusion in the No Trauma group. For example, on the Emotional
Abuse subscale the first question is “When I was growing up people in my
family called me things like ‘stupid,’ ‘lazy’ or ‘ugly,’” and this could be rarely
true and the person still classified in the No Trauma group. Internal consis-
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tency reliability coefficients and test–retest reliability coefficients for CTQ

subscales range from .63 to .96 and .79 to .86, respectively (Bernstein, Fink,
Handlesman, & Foote, 1997). The CTQ was completed at the 9-month
follow-up. This was administered to participants by one of the authors (GD).
Psychiatric symptoms. The revised Manchester Scale, KGVM (Krawiecka
Goldberg Vaughan–Modified) Symptom Scale (Krawiecka, Goldberg, &
Vaughan, 1977) Version 6.2 (Lancashire, 1998) is a standardized psychiatric
assessment scale specifically designed for rating chronic psychotic patients.
Fourteen areas are assessed using a 5-point scale, with a higher score represent-
ing a higher level of symptoms. It produces a total score (0–52) but also
subscale scores for positive, negative, and affective symptoms (all three range
from 0–12). The KGVM has high retest reliability (Jackson, Knott, Skeate, &
Birchwood, 2004). This was completed at baseline and at the 9- and 18-month
follow-ups. This was administered by one of the authors (GD).
Social functioning. The Life Skills Profile (LSP; Rosen, Hadzi-Pavlovic, &
Parker, 1989) assesses community living skills, and its psychometric proper-
ties have been well tested (Parker, Rosen, Emdur, & Hadzi-Pavlovic, 1991).
It provides a total score and has five subscales that cover self-care, non-
turbulence, social contact, communication, and responsibility. A higher
score represents a lower level of functioning, and the total score ranges from
0 to 117. This was also completed at baseline and at the 9- and 18-month
follow-ups. Key workers administered this measure.

Data Analyses
Repeated measures analyses of variance were used to compare the mean
scores of the No Trauma and Trauma groups over time. SPSS Version 15
was used. The aim of the larger study was to compare AO and CMHT
approaches, so type of intervention was added to the analysis of variance as
another between-subjects factor. Parametric assumptions were met.
 62 G. Davidson et al.

RESULTS
Childhood Trauma
A total of 17 (55%) participants reported some level of childhood trauma
and 14 (45%) reported no trauma or minimal levels of childhood trauma.
The results of the subscales of the CTQ are presented in Table 1.

Psychiatric Symptoms
Means and standard deviations of total KGVM scores over the three time
points are presented in Table 2. No significant between-group differences
were found between the Trauma and No Trauma groups on total KGVM
score, F(1, 27) = 2.31, p > .05. Nor were there any between-group differ-
ences found between the CMHT group and the AO group, F(1, 27) = 0.07,
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p > .05. No significance between-group differences were found either

between the Trauma and No Trauma groups or the CMHT and AO groups
on any of the subscales of the KGVM (positive, negative, or affective
symptoms).

Social Functioning
Means and standard deviations of the total LSP scores over the three time
points are presented in Table 3. A higher score on the LSP represents
poorer functioning. No significant between-group differences were found

TABLE 1 Breakdown of Childhood Abuse and Neglect on the Childhood

Trauma Questionnaire (n = 31)

Subscale Level of Trauma n %

Emotional Abuse None/minimal 18 58.1

Low/moderate/severe 13 41.9
Physical Abuse None/minimal 23 74.2
Low/moderate/severe 8 25.8
Sexual Abuse None/minimal 24 77.4
Low/moderate/severe 7 22.6
Emotional Neglect None/minimal 25 80.6
Low/moderate/severe 6 19.4

TABLE 2 KGVM Mean (SD) Total Score by Trauma

Group Over Time

Time No Trauma Trauma

Baseline 12.6 (7.12) 13.4 (7.72)

9 months 9.7 (5.43) 12.8 (6.82)
18 months 7.3 (5.33) 12.7 (7.63)
 Effects of Childhood Trauma 63

TABLE 3 Life Skills Profile Mean (SD) Total Score by

Trauma Group Over Time

Time No Trauma Trauma

Baseline 43.1 (11.77) 28.7 (10.69)

9 months 36.3 (13.79) 32.1 (16.75)
18 months 29.5 (13.46) 36.8 (15.56)

50 Trauma Group
No Trauma
Trauma
Life Skills Profile Mean Total Score

45
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40

35

30

25

20

Baseline Nine Months Eighteen Months

Data Collection Point

FIGURE 1 Graph of life skills profile total scores by trauma group.

between the Trauma and No Trauma groups, F(1, 27) = 0.33, p > .05; or
between the CMHT or AO groups, F(1, 27) = 0.12, p > .05, on LSP total
scores.
A significant relationship was found between childhood trauma and
LSP total score over time, F(2, 54) = 13.93, p < .001, η2 = .34 (see Figure 1).
No significant relationship was found between membership in the CMHT/
AO group and LSP total score, F(2, 54) = 0.70, p > .05.
No between-group differences were found between childhood trauma
and any of the subscales of the LSP or between CMHT/AO group member-
ship and LSP subscales. Significant relationships were found with all
subscales of the LSP and childhood trauma over time. These included Self-
Care, F(2, 54) = 5.55, p < .01, η2 = .17; Non-Turbulence, F(2, 54) = 8.5, p < .01,
η2 = .24; Social Contact, F(2, 54) = 4.78, p < .05, η2 = .15; Communication,
F(2, 54) = 3.7, p < .05, η2 = .12; and Responsibility, F(2, 54) = 7.7, p < .01,
η2 = .22. No significant relationships were found between any of the LSP
subscales and CMHT/AO group membership.
 64 G. Davidson et al.

DISCUSSION

More than half (54%) of participants in this study reported some level of
childhood trauma. This finding reinforces the previous research in this area
that has reported very high levels of trauma among people with severe
mental health problems (Read et al., 2004). There was an overrepresentation
of men among the participants, which may have had some impact on level
of trauma, especially of sexual abuse, which tends to be higher in women
(Read et al., 2004). This study uniquely examined the implications of child-
hood trauma on the symptoms and psychosocial functioning of adults with
severe mental health problems over time. There were no statistically significant
differences on psychiatric symptoms between the Trauma and No Trauma
groups over the study period. The relationship between trauma history and
social functioning over time, as measured by the LSP, was significant on the
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total score and all of the subscales. The Trauma group’s social functioning
scores deteriorated over the 18 months, whereas the No Trauma group’s
scores improved. The longitudinal design allowed for this examination of the
course or development of both symptoms and social functioning. A further
strength of the design was the separation of measures based on researcher
interview with participant, KGVM and CTQ, and the administration of the
LSP by key workers.
The findings of this study raise questions about the appropriateness
and effectiveness of mental health interventions offered to those with a his-
tory of childhood trauma. At present, it is not routine practice in the CMHTs,
AO teams, or inpatient services involved in this study to take a detailed
trauma history and plan appropriate interventions to respond to any identi-
fied needs. Although some talking therapies are available, the main form of
intervention is medication, and all of those included in this study were pre-
scribed medication. This may have important implications. For example,
Nemeroff et al. (2003) reported that psychological approaches are more
effective than medication for depressed people who have suffered child-
hood trauma. From the results of this study, it would appear that traditional
approaches to mental health service delivery are ineffective in improving
the psychosocial functioning of those with severe mental health problems
and a history of childhood trauma. It may be that those clients with a his-
tory of childhood trauma, even when workers are not aware of that history,
are responded to and assessed differently from those with no history of
trauma. This could be due to the impact of trauma on people’s ability to
form constructive and trusting relationships. It may also be that if trauma is
not appropriately addressed, it can lead to ongoing and sometimes increas-
ing difficulties.
The findings also raise the fundamental issue of why trauma is not
being routinely addressed by mental health services, and there has been
some discussion of this issue in the research literature. Cavanagh, Read, and
 Effects of Childhood Trauma 65

New (2004) discussed barriers to workers asking about childhood trauma

and responding to it, including concerns about offending or distressing
clients, fear of vicarious traumatization, fear of inducing false memories, and
biogenetic causal beliefs about psychosis. Warne and McAndrew (2005)
reported that workers might not be appropriately trained to offer care to
those with a history of childhood abuse. They also mentioned the need to
consider the issue of workers who themselves have a history of abuse.
This study has a number of limitations. The participants all met the
criteria for AO and therefore had difficulties engaging with services, had
been high users of hospital services, and had high levels of complex needs.
It is therefore unknown if these results can be generalized to the wider pop-
ulation of people with severe mental health problems. A further limitation is
that the relatively small number of participants (n = 31) reduces the power
of the study and makes the detection of between-group differences more
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unlikely. In order to overcome these limitations, the study could be replicated

with a large sample of people experiencing their first episode of mental
health problems.
The issue of the accuracy of the reporting of trauma is a controversial
one. There may be underreporting due to the nature of the information.
One of the main difficulties in eliciting trauma histories is that those who
have experienced trauma, especially in childhood, may be more likely to
be mistrusting of others. Establishing a relationship that facilitates disclo-
sure is of utmost importance. A research interview may not be the ideal
setting for this to occur. There may also be overreporting of trauma due to
a participant’s mental state. For example, a participant might report a
“traumatic event” that is based on a delusional memory. In an outpatient
study that found some form of supporting evidence in 82% of child sexual
abuse cases, there was no difference in the frequency of such evidence
between those with and without psychotic symptoms or between those
with and without a diagnosis of schizophrenia (Read, Agar, Argyle, &
Aderhold, 2003). Another study found that “the problem of incorrect alle-
gations of sexual assaults was no different for schizophrenics than the
general population” (Darves-Bornoz, Lemperiere, Degiovanni, & Gaillard,
1995, p. 82).
Herman and Schatzow (1987) reported that 74% of their outpatient
psychiatric sample receiving treatment in a group setting for incest survivors
were able to validate their memories by obtaining corroborating evidence.
Goodman et al. (1999) reported fair to moderate test–retest reliability of
trauma reports in a population with severe mental illness, as did Mueser et al.
(2001). Meyer, Muenzenmaier, Cancienne, and Struening (1996) reported
reliability and validity of an instrument tapping sexual and physical abuse
among women with a serious mental illness. Test–retest reliability yielded a
kappa of .63 for the measure of physical abuse and .82 for the measure of
sexual abuse. Validity, assessed as consistency with an independent clinical
 66 G. Davidson et al.

assessment, showed 75% agreement for reports of physical abuse and 93%
agreement for reports of sexual abuse.
Given the findings of this study, it is recommended that people with
severe mental health problems be routinely asked if they have a history
of childhood trauma, and that professionals involved in this process be
adequately trained to respond. There may also be benefits to developing
intervention strategies (informed by treatments developed for posttraumatic
stress disorder) for patients with severe mental health problems who have
been traumatized (Morrison et al., 2003). It should also be considered
whether different approaches might be more appropriate for this group, as
current intervention strategies do not appear to be having a positive effect
on social functioning.
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REFERENCES

Bernstein, D. P., & Fink, L. (1998). The Childhood Trauma Questionnaire: A

retrospective self-report manual. San Antonio, TX: Psychological Corporation.
Bernstein, D. P., Fink, L., Handlesman, L., & Foote, J. (1997). Initial reliability and
validity of a new retrospective measure of child abuse and neglect. American
Journal of Psychiatry, 151, 1132–1136.
Cavanagh, M., Read, J., & New, B. (2004). Childhood abuse inquiry and response: A
New Zealand training programme. New Zealand Journal of Psychology, 33,
137–144.
Chapman, D. P., Dube, S. R., & Anda, R. F. (2007). Adverse childhood events as risk
factors for negative mental health outcomes. Psychiatric Annals, 37(5), 359–364.
Darves-Bornoz, J. M., Lemperiere, T., Degiovanni, A., & Gaillard, P. (1995). Sexual
victimization in women with schizophrenia and bipolar disorder. Social Psychiatry
and Psychiatric Epidemiology, 30, 78–84.
Davidson, G., & Campbell, J. (2007). An examination of the use of coercion by
assertive outreach and community mental health teams in Northern Ireland.
British Journal of Social Work, 37, 537–555.
Department of Health. (2001). Mental health policy implementation guide. London:
Author.
Dube, S. R., Felitti, V. J., Dong, M., Giles, W. H., & Anda, R. F. (2003). The impact of
childhood adversity on health problems: Evidence from four birth cohorts
dating back to 1900. Preventive Medicine, 37, 268–277.
Goodman, L. A., Thompson, K. M., Weinfurt, K., Corl, S., Acker, P., Mueser, K. T.,
et al. (1999). Reliability of reports of violent victimisation and PTSD among
men and women with severe mental illness. Journal of Traumatic Stress, 12,
587–599.
Herman, J. L., & Schatzow, E. (1987). Recovery and verification of memories of
childhood sexual trauma. Psychoanalytic Psychology, 4(1), 1–14.
Jackson, C., Knott, C., Skeate, A., & Birchwood, M. (2004). The trauma of first epi-
sode psychosis: The role of cognitive mediation. Australian and New Zealand
Journal of Psychiatry, 38, 327–333.
 Effects of Childhood Trauma 67

Kendler, K. S., Bulik, C. M., Silberg, J., Hettma, J. M., Myers, J., & Prescott, C. A.
(2000). Childhood sexual abuse and adult psychiatric and substance use disor-
ders in women. Archives of General Psychiatry, 57, 953–959.
Kim, D., Kaspar, V., Hoh, S., & Nam, J. H. (2006). Sexual and physical abuse among
Korean female inpatients with schizophrenia. Journal of Traumatic Stress, 19,
279–289.
Krawiecka, M., Goldberg, D., & Vaughan, M. (1977). A standardized psychiatric
assessment scale for rating chronic psychotic patients. Acta Psychiatrica
Scandinavica, 55, 299–308.
Lancashire, S. (1998). KGV (M) Symptom Scale: Version 6. London: Institute of Psychiatry.
Larkin, W., & Morrison, A. (Eds.). (2006). Trauma and psychosis. London: Brunner &
Routledge.
Lysaker, P. H., Myers, P. S., Evans, J. D., Clements, C. A., & Marks, K. A. (2001).
Childhood sexual trauma and psychosocial functioning in adults with
schizophrenia. Psychiatric Services, 52, 1485–1489.
Downloaded by [Tulane University] at 15:01 07 January 2015

Lysaker, P. H., Myers, P. S., Evans, J. D., & Marks, K. A. (2001). Neurocognitive and
symptom correlates of self-reported childhood sexual abuse in schizophrenia
spectrum disorders. Annals of Clinical Psychiatry, 13(2), 89–92.
Lysaker, P. H., Nees, M. A., Lancaster, R. S., & Davis, L. W. (2004). Vocational func-
tion among persons with schizophrenia with and without history of childhood
sexual trauma. Journal of Traumatic Stress, 17, 435–438.
Maguire, C., McCusker, C., Meenagh, C., Mulholland, C., & Shannon, C. (2008).
Effects of trauma on bipolar disorder: The mediational role of interpersonal dif-
ficulties and alcohol dependence. Bipolar Disorders, 10, 293–302.
Meyer, I. H., Muenzenmaier, K., Cancienne, J., & Struening, E. (1996). Reliability
and validity of a measure of sexual and physical abuse histories among women
with serious mental illness. Child Abuse & Neglect, 20, 213–219.
Morrison, A. P., Frame, L., & Larkin, W. (2003). Relationships between trauma and
psychosis: A review. British Journal of Clinical Psychology, 42, 331–353.
Mueser, K. T., Rosenberg, S. D., Fox, L., Salyes, M. P., Ford, J. D., & Carty, P. (2001).
Psychometric evaluation of trauma and PTSD assessments in persons with
severe mental illness. Psychological Assessment, 13(1), 110–117.
Mulholland, C., Boyle, C., Shannon, C., Huda, U., Clarke, L., Meenagh, C., &
Dempster, M. (2008). Exposure to “The Troubles” in Northern Ireland influ-
ences the clinical presentation of schizophrenia. Schizophrenia Research, 102,
278–282.
Nemeroff, C. B., Heim, C. M., Thase, M. E., Klein, D. N., Rush, A. J., Schatzberg, A. F.,
et al. (2003). Differential response to psychotherapy versus pharmacotherapy
in patients with chronic forms of major depression and childhood trauma.
Proceedings of the National Academy of Sciences, USA, 100, 14293–14296.
Newmann, J. P., Greenley, D., & Sweeney, J. K. (1998). Abuse histories, severe mental
illness and the cost of care. In B. K. Leven, A. K. Blanch, & A. Jennings (Eds.),
Women’s mental health services: A public health perspective (pp. 279–308).
London: Sage.
Parker, G., Rosen, A., Emdur, N., & Hadzi-Pavlovic, D. (1991). The Life Skills
Profile: Psychometric properties of a measure assessing function and disability
in schizophrenia. Acta Psychiatrica Scandinavica, 83, 145–152.
 68 G. Davidson et al.

Read, J. (1998). Child abuse and severity of disturbance among adult psychiatric
inpatients. Child Abuse & Neglect, 22, 359–368.
Read, J., Agar, K., Argyle, N., & Aderhold, V. (2003). Sexual and physical abuse during
childhood and adulthood as predictors of hallucinations, delusions and thought
disorder. Psychology and Psychotherapy: Theory, Research and Practice, 76, 1–22.
Read, J., Goodman, L., Morrison, A. P., Ross, C. A., & Aderhold, V. (2004). Child-
hood trauma, loss and stress. In J. Read, L. Mosher, & R. Bentall (Eds.), Model
of madness (pp. 223–252). Hove, England: Brunner-Routledge.
Read, J., van Os, J., Morrison, A. P., & Ross, C. A. (2005). Childhood trauma,
psychosis and schizophrenia: A literature review with theoretical and clinical
implications. Acta Psychiatrica Scandinavica, 112, 330–350.
Rosen, A., Hadzi-Pavlovic, D., & Parker, G. (1989). The Life Skills Profile: A mea-
sure assessing function and disability in schizophrenia. Schizophrenia Bulletin,
15, 325–337.
Schenkel, L. S., Spaulding, W. D., DiLillo, D., & Silverstein, S. M. (2005). Histories of
Downloaded by [Tulane University] at 15:01 07 January 2015

childhood maltreatment in schizophrenia: Relationships with premorbid func-

tioning, symptomatology, and cognitive deficits. Schizophrenia Research, 76,
273–286.
Spence, W., Mulholland, C., Lynch, G., McHugh, S., Dempster, M., & Shannon, C.
(2006). Rates of childhood trauma in a sample of patients with schizophrenia
as compared with a sample of patients with non-psychotic psychiatric diag-
noses. Journal of Trauma & Dissociation, 7(3), 7–22.
Stein, L. I., & Santos, A. B. (1998). Assertive community treatment of persons with
severe mental illness. New York: Norton.
Stein, L. I., & Test, M. A. (Eds.). (1978). Alternatives to mental hospital treatment.
New York: Plenum Press.
Warne, T., & McAndrew, S. (2005). The shackles of abuse: Unprepared to work at
the edges of reason. Journal of Psychiatric and Mental Health Nursing, 12,
679–686.