Traumatic life events and psychosis: A case-control study at the Moi Teaching and Referral Hospital, Eldoret-Kenya

Abstract

Background: Globally close to 70% of the general population have experienced at the very least one traumatic life event (TLE). Similarly, psychotic disorders are among the leading causes of disability in the world. There is a positive association between TLEs and development of psychosis. However, despite the high level of violence and other potentially traumatic life events in the African continent, the vast majority of the research on the experience of trauma and psychosis was conducted in the developed world. Therefore, given the paucity of data touching on African populations, further research to holistically establish association between trauma and psychosis is warranted. Study objectives: To compare the proportion of TLE exposure, identify the types of TLEs, its frequencies and explore the association between TLEs and psychosis in patients with psychotic disorders and individuals without. Methods; The study adopted case-control design, where participants were matched by age and sex. Cases were patients with a diagnosis of psychosis (N=254) and controls were individuals who came to the hospital for indications other than mental illness (N=254). The study was conducted at the Moi Teaching and Referral Hospital, Chandaria Cancer and Chronic Disease Centre outpatient clinics, Eldoret. Ethical approval was sought from institutional Research and Ethics Committee. A structured questionnaire was used to collect data on the demographics and Life Events Checklist for DSM-5 (LEC-5) used to obtain data on TLEs. Ethical approval was obtained from institutional research and ethics committee and data analyzed using STATA V.14. Results: Compared to cases, controls had a significant higher proportion who were married (39.4% vs 53.5%, p=0.002,) and low proportion of those separated (6.3% vs 12.6%) and those never married (37.8% vs 46.8%). On the other hand, compared to controls cases were significantly (p<0.001) less likely to have achieved higher level of education.The proportion of those who had traumatic life experiences were almost equal among the cases and controls, [cases 204(80.3%) vs. controls 202(79.5%]. However, Cases had higher proportion of participants who reported that the traumatic life event happened to them (cases 60.3% vs. controls 46%, p=0.004). After multivariate logistic regression analysis was done to determine the association between TLEs and psychosis while adjusting for marital status and education level, the following specific traumatic events remained statistically significant.: Physical assault (aOR=3.66, 95% CI 2.28-5.48), assaults with a weapon (aOR= 5.26, 95% CI 2.15-10.48), sexual assault (aOR=4.55, 95% CI 1.08-10.48). Sudden death of a loved one (aOR=2.33, 95% CI 1.15-4.70), a serious injury/harm to others (aOR=10.53, 95% CI 1.47-89.37). However, Cases were less likely to report a life threatening illness/injury than the controls (aOR=0.37, 95% CI 0.24-0.55). Conclusion: The study found a high proportion of exposure to traumatic life events among cases and controls as well as an increased number of individuals with psychosis directly experience trauma. The TLE types that are more common among patients with psychosis include: - physical assault, assault with a weapon, sexual assault, experiencing sudden death of a loved one and causing serious injury/ harm to someone else. The main finding in the final analysis shows an association between specific traumatic life events and psychosis. Recommendations: There‟s need for healthcare workers to continuously assess for and the healthcare system to be trauma informed as well as put in place policies at various levels aimed at the prevention of such traumatic events like, physical assault, assault with a weapon and sexual assault. A further longitudinal research to be conducted in our setting that is able to delineate the timing of the first episode psychosis so as to deeply understand the causal link between trauma and psychosis.