Adverse childhood experiences and functional stability in the affective-to-psychotic spectrum: a longitudinal multistate analysis of employment and relationship outcomes.

BACKGROUND

Adverse childhood experiences (ACEs) exert transdiagnostic influences on disorders of the affective-to-psychotic spectrum which share genetic similarities. While ACEs are established risk factors for developing disorders across this spectrum, the impact of ACEs on functional outcomes in adulthood remains insufficiently understood. This study aims to investigate the impact of ACEs on functional outcomes such as relationship and employment stability.

METHODS

We used multistate Markov models to analyze data from the longitudinal PsyCourse Study (N = 810) to investigate whether ACEs and ACE subtypes influence relationship and employment stability in individuals with affective-to-psychotic spectrum disorders and neurotypical controls. We analyzed whether protective factors (e.g., experience of feeling loved in childhood and polygenic resilience score for schizophrenia) modify these associations.

RESULTS

ACEs significantly increased the hazard of job loss (hazard ratio [HR] = 2.02, p = 0.0005), even after controlling for disease status and illness severity. Feeling loved in childhood emerged as a protective factor against job loss (HR = 0.52, p = 0.0096). For personal relationships, illness severity overshadowed ACE effects, with higher clinical severity rating predicting a higher hazard ratio for partnership separation. Among ACE subtypes, emotional abuse significantly predicted a higher hazard for partnership separation and lower for re-employment. Polygenic resilience score of schizophrenia did not contribute significantly.

DISCUSSION: In participants of the PsyCourse Study, ACEs substantially impact employment stability, personal relationship stability appears to be predominantly influenced by illness severity. These findings suggest the need for ACE-guided approaches in vocational rehabilitation and tailored interventions for partnership support in this population.