The relationship between lifetime trauma exposure and psychosis in a multi-country case-control study in Africa

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Background: Exposure to traumatic events is a known risk factor for psychosis. Additionally, psychosis may be a risk factor for exposure to traumatic events. There are little data on the relationship between traumatic events and psychosis in sub-Saharan Africa, particularly in large, cross-country samples using the same instrument. Methods: In a case-control study, 21,606 adults were recruited with psychosis (cases) and 21,329 adults without any history of psychosis (controls) in Ethiopia, Kenya, South Africa, and Uganda from 2018 to 2023 (n = 42,935). Lifetime trauma exposure was assessed using the Life Events Checklist-5. Regression models included the: i) prevalence of any trauma exposure; ii) cumulative burden of trauma exposure; and iii) the odds of exposure to specific trauma types. Analyses were run by case-control status for the full sample and within each country; trauma types endorsed by cases and controls were further stratified by sex. Results: There was a modest increased odds of trauma among cases compared with controls. Cases had higher odds of reporting exposure to ≥1 trauma and ≥3 trauma types (adjusted odds ratio (AOR) = 1.23, 95 % CI: 1.18-1.28 and AOR = 1.19, 95 % CI: 1.15-1.23, respectively). The trauma types with the highest odds were sexual violence (AOR = 1.99, 95 % CI: 1.86-2.14), physical violence (AOR = 1.69, 95 % CI: 1.62-1.76), and network trauma (causing injury, harm, or death to someone else) (AOR = 1.52, 95 % CI: 1.38-1.67). Similar trends were seen within each country. Sexual violence and physical violence were most endorsed by female cases and male cases, respectively. Network trauma was most endorsed by male cases and particularly from South Africa. Conclusion: People in eastern and southern Africa report significant exposure to trauma with a slightly higher prevalence among individuals with psychosis. Special attention should be paid to potential trauma exposure including interpersonal violence when providing treatment for this population.

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