Pathways linking adverse childhood experiences to psychosis risk in Lagos, Nigeria: A structural equation modeling approach.

BACKGROUND

Adverse childhood experiences (ACEs) are established risk factors for psychosis, yet evidence from low- and middle-income countries (LMICs) remains limited. This study investigated associations between ACEs, psychotic-like experiences (PLEs), and psychosis diagnosis in Nigeria, examining psychological and cognitive mediating pathways.

METHODS

Data from the Lagos State Mental Health Survey included 1953 adults: 945 cases with persistent PLEs (including 95 with psychosis) and 1008 matched controls. Generalized structural equation modeling with probit links examined: (1) direct ACE-psychosis associations; (2) mediation via common mental disorders (CMDs), resilience, self-esteem, and cognitive functioning; (3) moderation by family history and obstetric complications; and (4) contributions of cannabis use, parental bonding, and adult trauma. Population validation utilized the full representative sample (N = 11,246) with inverse probability weights.

RESULTS

The model demonstrated acceptable fit (CFI = 0.94, RMSEA = 0.057). ACEs showed significant associations with PLEs (β = 0.225, p = 0.038) and psychosis (β = 0.105, p = 0.002). CMDs and resilience significantly mediated these relationships, accounting for 21 % and 23 % of total effects respectively. Cognitive functioning mediated 18 % of associations, while self-esteem showed non-significant mediation. Family history and obstetric complications significantly moderated ACE-psychosis pathways. Cannabis use and adult trauma were non-significant; parental bonding showed weak associations.

CONCLUSION

ACEs are significantly linked to psychosis in Nigeria through psychological and cognitive pathways, with effects amplified by familial and perinatal vulnerabilities. Prevention strategies in LMICs should integrate trauma-informed interventions, resilience enhancement, and community-based support systems targeting identified mediating mechanisms.