Impact of Childhood Trauma and Adult Separation Anxiety Disorder on Quality of Life in Individuals with Schizophrenia

Figures & data

Table 1 Sociodemographic Features of the Participants

	Schizophrenia (n=111)	Controls (n=85)	p
Age^#	34.2 ± 10.0	33.1 ± 8.5	0.527*
Age^§	32.0 [18.0–63.0]	32.0 [18.0–58.0]
Gender^‡
Female	33 (29.7)	28 (32.9)	0.745**
Male	78 (70.3)	57 (67.1)
Education^‡
Primary School	24 (21.6)	22 (25.9)	0.783**
Secondary School	46 (41.4)	33 (38.8)
University	41 (36.9)	30 (35.3)
Marital Status^‡
Single	80 (72.1)	27 (31.8)	<0.001**
Married	31 (27.9)	58 (68.2)
Employment Status^‡
Employed	27 (24.3)	58 (68.2)	<0.001**
Unemployed	84 (75.7)	27 (31.8)
Residence^‡
Urban	71 (64.0)	61 (71.8)	0.317**
Rural	40 (36.0)	24 (28.2)

Notes: ^‡n (%), ^#Mean ± standard deviation, ^§Median [min-max]. *Independent Samples t test. **Pearson Chi-Square test. The p values in bold are statistically significant (p<0.05).

Table 2 Clinical Characteristics of the Individuals with Schizophrenia

	ASAD(+) (n=64)	ASAD(-) (n=47)	p
Age of onset (year)^#	25.09 ± 9.2	24.2 ± 11.2	0.658*
Number of hospitalizations^§	3.3 ± 6.1	3 ± 5.3	0.793*
Family history of psychiatric disorder^‡
Presence	31 (48.4)	16 (34.04)	0.129**
Absence	33 (51.6)	31 (65.96)
Adminstration of ECT^‡
Presence	18 (28.1)	19 (40.4)	0.174**
Absence	46 (35.9)	28 (59.6)
History of suicide attempt^‡
Presence	22 (34.3)	6 (12.8)	0.018**
Absence	42 (29.7)	41 (34.2)
Education^‡
Primary School	16 (25.0)	8 (17.0)	0.314**
Secondary School	28 (43.8)	18 (38.3)
University	20 (31.2)	21 (44.7)
Marital Status^‡
Single	47 (73.4)	33 (70.2)	0.873**
Married	17 (26.6)	14 (29.8)
Employment Status^‡
Employed	14 (21.9)	13 (27.7)	0.633**
Unemployed	50 (78.1)	34 (72.3)
Alcohol use, presence^‡	5 (7.8)	4 (8.5)	0.999**
Substance use, presence^‡	7 (10.9)	1 (2.1)	0.135**
Positive and Negative Syndrome Scale (PANSS), Total^§	77.5 [30.0–157.0]	48.0 [30.0–106.0]	0.002***
Positive	15.0 [7.0–47.0]	10.0 [7.0–30.0]	0.003***
Negative	20.0 [2.0–42.0]	13.0 [7.0–34.0]	0.010***
General Psychopathology	41.0 [16.0–83.0]	27.0 [16.0–67.0]	0.001***
Childhood Trauma Questionnaire (CTQ)^§	44.0 [32.0–80.0]	44.0 [34.0–90.0]	0.793***
Emotional Abuse	7.0 [5.0–25.0]	5.0 [5.0–20.0]	0.113***
Physical Abuse	5.0 [5.0–25.0]	5.0 [5.0–25.0]	0.228***
Sexual Abuse	5.0 [5.0–18.0]	5.0 [5.0–20.0]	0.235***
Physical Neglect	15.0 [11.0–20.0]	16.0 [11.0–22.0]	0.124***
Emotional Neglect	11.0 [5.0–25.0]	11.0 [5.0–22.0]	0.814***

Notes: ^‡n (%), ^#Mean ± standard deviation, ^§Median [min-max]. *Independent Samples t test. **Pearson Chi-Square test. ***Mann–Whitney U-test. The p values in bold are statistically significant (p<0.05).

Abbreviations: ECT, Electroconvulsive therapy; ASAD, Adult Separation Anxiety Disorder.

Table 3 The Scale Scores of the Participants

	Schizophrenia (n=111)	Controls (n=85)	p
Separation Anxiety Symptom Inventory (SASI)^§	12.0 [0.0–44.0]	8.0 [0.0–28.0]	0.039*
SCI- Childhood Separation Anxiety Symptoms, positive^‡	63 (56.8)	17 (20.0)	<0.001**
Adult Separation Anxiety Questionnaire (ASAQ)^§	27.0 [0.0–81.0]	9.0 [0.0–45.0]	<0.001*
SCI- Adult Separation Anxiety Symptoms, positive^‡	64 (57.7)	21 (24.7)	<0.001**
Positive and Negative Symptom Scale (PANSS) Total^§	64.0 [30.0–157.0]	-	-
Positive	12.0 [7.0–47.0]	-	-
Negative	17.0 [2.0–42.0]	-	-
General Psychopathology	34.0 [16.0–83.0]	-	-
Childhood Trauma Questionnaire (Total)^§	44.0 [32.0–90.0]	29.0 [25.0–41.0]	<0.001*
Emotional abuse	7.0 [5.0–25.0]	5.0 [5.0–10.0]	<0.001*
Physical abuse	5.0 [5.0–25.0]	6.0 [5.0–9.0]	0.014*
Sexual abuse	5.0 [5.0–20.0]	5.0 [5.0–9.0]	0.104*
Physical neglect	15.0 [11.0–22.0]	5.0 [5.0–9.0]	<0.001*
Emotional neglect	11.0 [5.0–25.0]	5.0 [5.0–9.0]	<0.001*
WHOQoL-BREF-TR^§
Psychological health	19.0 [6.0–30.0]	30.0 [24.0–30.0]	<0.001*

Notes: ^‡n (%), ^§Median [min-max]. *Mann–Whitney U-test, p < 0.05 statistically significant, Bonferroni-Holm correction was used for pairwise comparisons (Significance level p=0.025). **Pearson Chi-Square test. The p values in bold are statistically significant (p<0.05).

Abbreviations: WHOQoL-BREF-TR, World Health Organization Quality of Health Scale-Short Form; SCI, Structured Clinical Interview.

Table 4 Correlations Among PANSS, CTQ, WHOQoL-BREF-TR, SASI, and ASAQ

	Separation Anxiety Symptom Inventory (SASI)		Adult Separation Anxiety Questionnaire (ASAQ)		WHOQoL-BREF-TR Psychological Health
	r	p	r	p	r	p
Positive and Negative Syndrome Scale (PANSS), Total	0.247	0.009	0.289	0.002	-	-
Positive	0.234	0.014	0.253	0.007	-	-
Negative	0.184	0.054	0.254	0.007	-	-
General Psychopathology	0.241	0.011	0.291	0.002	-	-
Childhood Trauma Questionnaire (CTQ)	0.184	0.053	0.331	<0.001	−0.410	<0.001
Emotional Abuse	0.336	<0.001	0.449	<0.001	−0.479	<0.001
Physical Abuse	0.363	<0.001	0.393	<0.001	−0.443	<0.001
Sexual Abuse	0.195	0.040	0.186	0.051	−0.178	0.062
Physical Neglect	−0.211	0.026	−0.174	0.068	0.285	0.002
Emotional Neglect	0.055	0.569	0.163	0.088	−0.299	0.001
WHOQoL-BREF-TR
Psychological health	−0.460	<0.001	−0.561	<0.001	-	-
Adult Separation Anxiety Questionnaire (ASAQ)	0.707	<0.001	-	-	-	-

Notes: Spearman’s rho correlation coefficient. The p values in bold are statistically significant (p<0.05).

Abbreviation: WHOQoL-BREF-TR, World Health Organization Quality of Health Scale-Short Form.

Figure 1 Correlations among CTQ, SASI and ASAQ scores.

Figure 2 Correlations among SASI, ASAQ and WHOQoL-BREF-TR Psychological health scores.

Figure 3 Correlations between CTQ and WHOQoL-BREF-TR Psychological health scores.

Table 5 The Univariate and Multiple Linear Regression Models for Variables Related to WHOQoL-BREF-TR Psychological Health Subscale

	Beta [95% CI]	p-value	Adj. Beta [95% CI]	p-value
Emotional Abuse	−0.55 [−0.78--0.32]	< 0.001	−0.29 [−0.65–0.07]	0.118
Physical Abuse	−0.37 [−0.6--0.14]	0.002	0.07 [−0.25–0.40]	0.654
Sexual Abuse	−0.31 [−0.62--0.01]	0.046	−0.17 [−0.45–0.11]	0.228
Physical Neglect	0.77 [0.27–1.27]	0.003	0.61 [0.19–1.03]	0.006
Emotional Neglect	−0.33 [−0.54--0.13]	0.002	−0.10 [−0.31–0.1]	0.318
PANSS Positive	−0.22 [−0.33--0.11]	< 0.001	−0.07 [−0.19–0.06]	0.300
PANSS Negative	−0.21 [−0.32--0.11]	< 0.001	−0.11 [−0.24–0.01]	0.068
SASI	−0.23 [−0.32--0.14]	< 0.001	−0.06 [−0.19–0.06]	0.318
ASAQ	−0.14 [−0.19--0.10]	< 0.001	−0.05 [−0.13–0.02]	0.144

Notes: Dependent Variable: WhoQol-Bref-TR psychological health. The p values in bold are statistically significant (p<0.05).

Abbreviations: PANSS, Positive and Negative Syndrome Scale; SASI, Separation Anxiety Symptom Inventory; ASAQ, Adult Separation Anxiety Questionnaire; WHOQoL-BREF, World Health Organization Quality of Health Scale-Short Form; CI, Confidence Interval; Adj, Adjusted.

Table 6 The Mediation Analysis of SASI on the Effect of CTQ on WHOQoL-BREF-TR

Model	Pathway	Std. Path Coefficient (β)	Std Error (Sβ)	p-value
Model I. Basic model (without SASI)	CTQ Total → WHOQoL-BREF-TR psychological health	−0.341	0.083	<0.001
Model II. Mediation Analysis	CTQ Total → SASI	0.178	0.095	0.060
Model II. Mediation Analysis	SASI→ WHOQoL-BREF-TR psychological health	−0.401	0.076	<0.001
Model II. Mediation Analysis (Direct effect)	CTQ total → WHOQoL-BREF-TR psychological health	−0.269	0.075	<0.001
Model II. Mediation Analysis (Indirect Effect)	CTQ total → SASI → WHOQoL-BREF-TR psychological health	−0.071	0.042	0.089

Note: The p values in bold are statistically significant (p<0.05).

Abbreviations: CTQ, Childhood Trauma Questionnaire; SASI, Separation Anxiety Symptom Inventory; WHOQoL-BREF, World Health Organization Quality of Health Scale-Short Form.

Table 7 The Mediation Analysis of ASAQ on the Effect of CTQ on WHOQoL-BREF-TR

Model	Pathway	Std. Path Coefficient (β)	Std Error (Sβ)	p-value
Model I. Basic model (Without ASAQ)	CTQ total → WHOQoL-BREF-TR-psychological health	−0.341	0.083	<0.001
Model II. Mediation Analysis	CTQ total → ASAQ	0.263	0.094	0.005
Model II. Mediation Analysis	ASAQ→ WHOQoL-BREF-TR-psychological health	−0.436	0.087	<0.001
Model II. Mediation Analysis (Direct Effect)	CTQ total → WHOQoL-BREF-TR-psychological health	−0.226	0.081	0.006
Model II. Mediation Analysis (Indirect Effect)	CTQ total → ASAQ → WHOQoL-BREF-TR-psychological health	−0.115	0.051	0.024

Note: The p values in bold are statistically significant (p<0.05).

Abbreviations: CTQ, Childhood Trauma Questionnaire; ASAQ, Adult Separation Anxiety Questionnaire; WHOQoL-BREF, World Health Organization Quality of Health Scale-Short Form.

Figure 4 The role of SASI scores on the effect of CTQ scores on the WHOQoL-BREF-TR Psychological health scores.

Figure 5 The role of ASAQ scores on the effect of CTQ scores on the WHOQoL-BREF-TR Psychological health scores.