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.