Researchers at University of California San Diego School of Medicine have determined that psychological resilience has a positive effect on health outcomes for people living with schizophrenia. This is the first study to quantitatively assess the effects of both childhood trauma and psychological resilience on health and metabolic function in people living with schizophrenia.
Globally 1 percent of people suffer from schizophrenia, a chronic and severe mental disorder that can affect all types of people and greatly impacts how a person thinks, feels and behaves. The psychiatric symptoms are typically treated with antipsychotic drugs; however, persons with schizophrenia are also more vulnerable to physical disorders, such as diabetes and cardiovascular disease and premature death. Although the cause of schizophrenia is not entirely known, the disorder is linked to genetic and environmental risk factors, including childhood adversity.
The findings are published in the April 17 online issue of the Journal of Clinical Psychiatry.
"In this study we found that people living with schizophrenia who had a history of severe childhood adversity and high levels of psychological resilience had health and biomarkers of insulin resistance similar to those in non-psychiatric comparison participants (NCs) with severe adversity and low levels of resilience," said senior author Dilip V. Jeste, MD, Distinguished Professor of Psychiatry and Neurosciences and director of the UC San Diego Center for Healthy Aging.
"What is further striking is the observation that in both groups (those with schizophrenia and NCs), persons with high levels of resilience had overall better physical and mental health and metabolic biomarkers."
Ellen Lee, MD, first author and a research fellow at UC San Diego described resilience as "a psychological trait that helps people cope with and recover from adversities or hardships of different kinds. It is essentially a personality trait that is partially genetic, but is also determined by a variety of life and social experiences."
As such, Jeste said it should be possible to ameliorate some of the negative effects of adversities associated with schizophrenia. "There are a variety of resilience-enhancing interventions that exist in a variety of settings. The military has been using resilience training for years to enhance this trait in soldiers before they head to war. Other resilience-enhancing interventions include mindfulness, meditation and positive psychology," he said.
The research team evaluated data from 114 participants with schizophrenia and 101 non-psychiatric comparison subjects between the ages of 26 and 65 years. The participants were recruited from the larger San Diego area.
Childhood abuse was assessed with the Childhood Trauma Questionnaire, a 25-item scale that evaluates emotional, physical and sexual abuse or neglect that occurred in childhood. Jeste and colleagues used the 10-item Connor-Davidson Resilience scale to measure resilience, using factors such as hardiness ("the ability to cope with change and adversity") and persistence ("putting forth ones best effort despite adverse circumstance.")
Metabolic biomarkers of the most interest to the research team were Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and hemoglobin A1C. These were selected for their ability to indicate health problems, such as diabetes, obesity and cardiovascular diseases that are common in persons suffering from schizophrenia.
Additionally, the measures of childhood abuse and resilience were based on self-reporting by participants; however, these have been previously validated in other studies and are commonly used. Jeste also cautioned that the results of this cross-sectional study will need to be replicated in a longitudinal investigation.
"The finding that resilience can play a protective or coping role in persons with schizophrenia provides clinicians an opportunity to use non-drug interventions in treatment," said Jeste. "High resilience could potentially play a large role in improving health outcomes for people living with schizophrenia. Interventions, like resilience training, could be combined with other therapies, allowing for more comprehensive treatment plans."
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Ellen E. Lee et al, Childhood Adversity and Schizophrenia, The Journal of Clinical Psychiatry (2018). DOI: 10.4088/JCP.17m11776