The Relationship Between Trauma and Clinical Outcome Variables Among Older Adults With Schizophrenia Spectrum Disorders

Objective: Stressful and traumatic life events have been implicated in the etiology and persistence of symptoms in schizophrenia, but little is known about their impact in later life. This article contrasts lifetime trauma among older persons with schizophrenia with their age peers in the general population, and examines whether greater trauma is associated with higher rates of nonremission of positive and negative symptoms, depression, or anxiety symptoms in the schizophrenia group. Methods: The schizophrenia group consisted of 198 community-dwelling persons age 55 and older who developed a schizophrenia spectrum disorder before age 45. A community comparison group (N = 113) was recruited using randomly selected block-groups. Using the Trauma and Victimization Scale, the frequency x severity of lifetime traumatic events scores were calculated. In the schizophrenia group, subjects were dichotomized into low and high trauma groups. Results: As compared to the community group, the schizophrenia group scored significantly higher on the total score and on 6 of 11 items of the Trauma and Victimization Scale. The schizophrenia group had significantly more traumatic events before age 17. In logistic regression analysis, a high level of trauma accumulated across the lifespan in the schizophrenia group was associated only with non-remission of positive symptoms; however, the persistence of positive symptoms was not associated with a traumatic event prior to age 17. Conclusion: Early trauma may play some role in the development of schizophrenia, but it does not seem to have any special role in the persistence of positive symptoms in later life. Rather, accumulated stressors may be more relevant clinically. The findings suggest that it may be profitable to consider therapies that reduce the psychological impact of traumatic events. (Am J Geriatr Psychiatry 2012; 20:408-415)