Understanding risk and building mental health resilience after childhood psychological trauma: focus on the subjective experience.

Psychological Trauma: Understanding risk, building resilience PhD Scholarship 2021 - King's College London

Supervisors: Professor Andrea Danese and Dr Kelly Rose-Clarke

Lay Summary:

Childhood trauma is a key modifiable risk factor for mental health difficulties throughout the life-course. It is, therefore, essential to understand how childhood trauma brings about mental health difficulties and how to prevent or minimise this detrimental effect. Recent research has shown that, like for traumatic experiences later in life, risk of mental health difficulties is linked more closely to the subjective experience of traumatised children than their documented exposure: adult participants in long-term longitudinal studies who retrospectively recall childhood trauma are at elevated risk of mental health difficulties regardless of whether there was contemporary evidence of their traumatic experiences during assessments in childhood years; in contrast, children with documented traumatic experiences are at elevated risk of mental health difficulties only when they recall trauma in adulthood. The proposed research project aims to understand why mental health difficulties emerges as a function of subjective rather than objective experience of childhood trauma. We will capitalise on two rare cohort studies that have followed children from birth into adult life and have measured both documented experience of trauma in childhood years and adult recall of childhood experiences. From the rich datasets and notes, we will identify factors that differentiate participants who do or do not recall childhood trauma in the context of documented childhood experiences, for example investigating their personality, personal relationships, and attitudes about themselves and others. The factors identified will point to potential targets for the development of new psychological interventions to prevent or minimise mental health difficulties associated with childhood trauma.

Aims:

The Mental Health Research UK Studentship project will investigate the determinants of psychopathology uniquely associated with the subjective experience of childhood trauma. In particular, the student will test why some participants without prospective measures of childhood trauma retrospectively report it, and why some participants with prospective measures of childhood trauma do not retrospectively report it. The identified factors will help characterise the mechanisms of risk and resilience to psychopathology underlying the associations described in our previous epidemiological work (Reuben, 2016, J Child Psychol Psychiatry; Newbury, 2018, J Psychiatry Res; Danese & Widom, Nat Human Behav, in press). In turn, better understanding of these mechanisms will inform subsequent psychological intervention development.

Research Student: Oonagh Coleman

Hi, my name is Oonagh and I have just started my PhD at the Social, Genetic and Developmental Psychiatry Centre at King’s College London with Professor Andrea Danese and Dr Kelly Rose-Clarke. The project aims to understand the sources of disagreement between prospective and retrospective measures of childhood maltreatment, and why mental health difficulties are associated with subjective rather than objective experiences of childhood trauma.

As an undergraduate, I studied History of Art at the University of Cambridge, before beginning a Psychological Science MSc Conversion course at University College London. My master’s thesis focused on anxiety in autism and its relationship to sensory sensitivities, sparking my interest in mental health research. I am particularly excited to explore the relationship between trauma, memory and psychopathology, and the resilience mechanisms that protect individuals from developing psychopathology in the aftermath of traumatic experiences. I am looking forward to developing my research skills in both qualitative and quantitative methods and am incredibly excited to be part of a project that aims to inform the development of more effective psychological interventions.

Progress Report year 2, 2023

During my second year I have continued work on the projects I began in my first year and started work on a number of new projects. The narrative review I began work on last year has been expanded to incorporate a broader range of literature and recently published findings. I have discussed drafts with co-authors and the review is currently at the stage of being prepared for submission.

For the meta-analysis, I completed data extraction for the 24 studies we identified through the systematic search that have data on the association between prospective and retrospective measures of child maltreatment and psychopathology. We then conducted a multi-level random effects meta-analysis examining both the unadjusted and adjusted associations between each measure of maltreatment and psychopathology. We also conducted sensitivity and moderation analyses to explore heterogeneity within the results. I am currently drafting a paper to present our results.

I have completed the framework analysis of interviewer impression notes from the E-Risk study for the qualitative project I started last year. This has yielded a rich variety of results identifying possible reasons for discrepant reports in the measurement of maltreatment prospectively vs retrospectively. These results highlight the different limitations of prospective and retrospective measures of maltreatment, and also underscore the variety of interpretations individuals can have of the same experience. I am at the stage of editing a full draft of this paper alongside my supervisor.

This year I have also begun work on a project which quantitatively explores reasons for discrepancy between different maltreatment measures, testing for differences in psycho-social characteristics between groups of participants with consistent vs inconsistent reports of maltreatment. This project capitalises on a comprehensive range of variables available in the E-Risk study. Having obtained permission to access the E-Risk data, I am currently at the stage of running analyses in R to understand predictors of measurement discrepancy.

Work has also begun on another systematic review and meta-analysis on the test-retest reliability of self-reports of maltreatment. The aim of this project is to test the consistency of memory and the subjective experience of childhood maltreatment. So far, we have completed a full systematic search and identified 43 studies which we are in the process of extracting data from.

Finally, I have also published a book chapter in ‘Innovative Methods in Child Maltreatment Research and Practice: Advances in Detection, Causal Estimation, and Intervention’ which reviews evidence examining whether prospective and retrospective measures of maltreatment identify the same individuals and differentially predict mental and physical health outcomes.

I am extremely appreciative to Mental Health Research UK for this opportunity and really look forward to working with Professor Andrea and Dr Kelly Rose-Clarke."

Progress Report Year 1, 2022

The aim of my PhD is to understand why retrospective and prospective reports of maltreatment identify different individuals, and how that might inform understanding of pathways of risk and resilience to psychopathology after childhood trauma. The key focus of my first year has been a conceptual review, which has used published quantitative and qualitative literature to explore factors that might explain measure disagreement, mapping research directions (e.g., the contribution of memory to measures of maltreatment) that I will then explore empirically. Given the evidence of the differential association between different measurement types and psychopathology, a further aim of the conceptual review has been to bring together discussion of factors that might explain measurement disagreement, and those that have been previously identified as vulnerability or protective factors in the existing literature. I am currently finalizing the review with the goal of submitting the paper for publication.

I am also collaborating on a systematic review and meta-analysis, looking at studies that have both prospective and retrospective measures of childhood maltreatment and also associations between each measure and psychopathology. This meta-analysis aims to assess whether prospective and retrospective measures of maltreatment are independently associated with psychopathology, as well as looking at factors that might predict heterogeneity in effect sizes, such as type of maltreatment, type of measure, or type of psychopathology. We have pre-registered the study on Prospero, decided on key search terms, and completed an initial database search, which yielded 1468 results. I have independently completed an initial screening of the 1468 study titles and abstracts alongside another collaborator, followed by a full text screening of 52 studies to identify potential studies for inclusion, which narrowed the search down to 25 studies. We are now in the process of extracting data from those 25 studies to complete a meta-analysis.

I am also currently working on conducting a qualitative analysis using data from the E-Risk longitudinal study. Prospective measures of child maltreatment were reported by parents from ages 5-12, and in addition, participants were interviewed at age 18 and asked retrospectively about their experiences of childhood trauma. Following the interviews with the study participants at age 18, the interviewers were asked to make notes of their impression of the participant and their reactions to specific questions during assessment, as well as making note of the setting and context of the interview. This offers a rich source of data for qualitative analysis. Having identified participants with discrepant retrospective and prospective reports of maltreatment, I am now in the process of conducting a thematic analysis of the interviewer impression notes using the Framework Approach. The thematic analysis aims to explore individual variation in appraisal and coping styles, as well as accounts of the contextual conditions within which the interviews took place, that might account for discrepant reports.

Having completed a qualitative comparison, my next step is to conduct a quantitative analysis of E-Risk study data, which offers a way to empirically test the exploratory hypotheses that the qualitative analysis aims to generate. I plan to test for differences in psycho-social characteristics between the groups of participants with consistent and inconsistent reports of maltreatment, capitalising on the comprehensive range of variables available in the E-Risk study that might explain report disagreement (e.g., current psychopathology, temperament, cognitive capacity, personality, coping style, social relationships).