The role of trauma and stressful life events among individuals at clinical high risk for psychosis: A review

Danessa Mayo, Sarah Corey, Leah H. Kelly, Seghel Yohannes, Alyssa L. Youngquist, Barbara K. Stuart, Tara A Niendam, Rachel L. Loewy

Research output: Contribution to journalReview articlepeer-review

87 Scopus citations


The experience of childhood trauma (CT) and stressful life events (SLEs) is associated with subsequent development of a variety of mental health conditions, including psychotic illness. Recent research identifying adolescents and young adults at clinical high risk (CHR) for psychosis allows for prospective evaluation of the impact of trauma and adverse life events on psychosis onset and other outcomes, addressing etiological questions that cannot be answered in studies of fully psychotic or non-clinical populations. This article provides a comprehensive review of the current emerging literature on trauma and adverse life events in the CHR population. Up to 80% of CHR youth endorse a lifetime history of childhood traumatic events and victimization (e.g., bullying). Several studies have shown that the experience of CT predicts psychosis onset among CHR individuals, while the literature on the influence of recent SLEs (e.g., death of a loved one) remains inconclusive. Multiple models have been proposed to explain the link between trauma and psychosis, including the stress-vulnerability and stress-sensitivity hypotheses, with emphases on both cognitive processes and neurobiological mechanisms (e.g., the hypothalamic-pituitary-adrenal axis). Despite the preponderance of CHR individuals who endorse either CT or SLEs, no clinical trials have been conducted evaluating interventions for trauma in CHR youth to date. Furthermore, the current process of formal identification and assessment of trauma, SLEs, and their impact on CHR youth is inconsistent in research and clinical practice. Recommendations for improving trauma assessment, treatment, and future research directions in the CHR field are provided.

Original languageEnglish (US)
Article number55
JournalFrontiers in Psychiatry
Issue numberAPR
StatePublished - Apr 20 2017


  • Clinical high risk
  • Early psychosis
  • Schizophrenia
  • Stressful life events
  • Trauma
  • Ultra-high risk

ASJC Scopus subject areas

  • Psychiatry and Mental health


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