Accepted for/Published in: JMIR Mental Health
Date Submitted: Oct 8, 2021
Date Accepted: Dec 9, 2022
Momentary self-esteem as a process underlying the association between childhood trauma and psychosis: an experience sampling study
ABSTRACT
Background:
Exposure to childhood trauma is associated with an increased risk of developing and maintaining psychotic symptoms later in life. Self-esteem is a psychological mechanism that has been suggested to be involved in the pathway from childhood trauma tot psychosis, but there is only limited evidence to support this claim, especially in daily life.
Objective:
In the current study, we aimed to investigate whether exposure to childhood trauma (physical, emotional, and sexual abuse, and physical and emotional neglect) modifies the cross-sectional and temporal associations between self-esteem and psychotic experiences in patients with psychotic disorder, first-degree relatives and controls.
Methods:
We assessed momentary self-esteem and psychotic experiences in daily life using the Experience Sampling Method in 139 patients with psychotic disorder, 118 first-degree relatives of patients with psychotic disorder and 111 controls. Childhood trauma was measured with the Childhood Trauma Questionnaire.
Results:
The association between momentary self-esteem and psychotic experiences in daily life was modified by prior exposure to high vs. low levels of several types of childhood trauma, i.e. physical (χ2=24.90, pfwe<.001) and sexual abuse (χ2=15.86, pfwe<.001) and physical neglect (χ2=116.67, pfwe<.001). Specifically, momentary self-esteem was associated with more intense psychotic experiences in patients exposed to high vs. low levels of physical neglect, in relatives exposed to high vs. low levels of physical abuse, and in relatives and controls exposed to high vs. low levels of sexual abuse. When investigating temporal order, results showed no evidence that childhood trauma modified the temporal associations of self-esteem at tn-1 and psychotic experiences at tn on the one hand, and psychotic experiences at tn-1 and self-esteem at tn, on the other.
Conclusions:
Self-esteem may be an important underlying psychological mechanism through which childhood trauma (i.e., physical abuse, sexual abuse, and physical neglect) may impact on the intensity of psychotic experiences in daily life.
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