The association between childhood adversities and subsequent first onset of psychotic experiences: A cross-national analysis of 23 998 respondents from 17 countries

J. J. McGrath, K. A. McLaughlin, S. Saha, S. Aguilar-Gaxiola, A. Al-Hamzawi, J. Alonso, R. Bruffaerts, G. De Girolamo, P. De Jonge, O. Esan, S. Florescu, O. Gureje, J. M. Haro, C. Hu, E. G. Karam, V. Kovess-Masfety, S. Lee, J. P. Lepine, C. C.W. Lim, M. E. Medina-MoraZ. Mneimneh, B. E. Pennell, M. Piazza, J. Posada-Villa, N. Sampson, M. C. Viana, M. Xavier, E. J. Bromet, K. S. Kendler, R. C. Kessler

Research output: Contribution to journalArticle


Background Although there is robust evidence linking childhood adversities (CAs) and an increased risk for psychotic experiences (PEs), little is known about whether these associations vary across the life-course and whether mental disorders that emerge prior to PEs explain these associations. Method We assessed CAs, PEs and DSM-IV mental disorders in 23 998 adults in the WHO World Mental Health Surveys. Discrete-time survival analysis was used to investigate the associations between CAs and PEs, and the influence of mental disorders on these associations using multivariate logistic models. Results Exposure to CAs was common, and those who experienced any CAs had increased odds of later PEs [odds ratio (OR) 2.3, 95% confidence interval (CI) 1.9-2.6]. CAs reflecting maladaptive family functioning (MFF), including abuse, neglect, and parent maladjustment, exhibited the strongest associations with PE onset in all life-course stages. Sexual abuse exhibited a strong association with PE onset during childhood (OR 8.5, 95% CI 3.6-20.2), whereas Other CA types were associated with PE onset in adolescence. Associations of other CAs with PEs disappeared in adolescence after adjustment for prior-onset mental disorders. The population attributable risk proportion (PARP) for PEs associated with all CAs was 31% (24% for MFF). Conclusions Exposure to CAs is associated with PE onset throughout the life-course, although sexual abuse is most strongly associated with childhood-onset PEs. The presence of mental disorders prior to the onset of PEs does not fully explain these associations. The large PARPs suggest that preventing CAs could lead to a meaningful reduction in PEs in the population.

Original languageEnglish
Pages (from-to)1230-1245
Number of pages16
JournalPsychological Medicine
Issue number7
Publication statusPublished - May 1 2017



  • Childhood adversity
  • discrete-time survival analysis
  • maladaptive family functioning
  • population attributable risk proportion
  • psychotic experiences
  • World Mental Health survey

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health

Cite this

McGrath, J. J., McLaughlin, K. A., Saha, S., Aguilar-Gaxiola, S., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., De Girolamo, G., De Jonge, P., Esan, O., Florescu, S., Gureje, O., Haro, J. M., Hu, C., Karam, E. G., Kovess-Masfety, V., Lee, S., Lepine, J. P., Lim, C. C. W., ... Kessler, R. C. (2017). The association between childhood adversities and subsequent first onset of psychotic experiences: A cross-national analysis of 23 998 respondents from 17 countries. Psychological Medicine, 47(7), 1230-1245.