Stress exposure and sensitivity in the clinical high-risk syndrome: Initial findings from the North American Prodrome Longitudinal Study (NAPLS)

• Type of Material: Article
• Authors: Hanan Trotman, Emory University; Carrie W. Holtzman, Emory University; Elaine Walker, Emory University; Jean M. Addington, University of Calgary; Carrie E. Bearden, University of California, Los Angeles; Kristin S. Cadenhead, University of California, San Diego; Tyrone D. Cannon, Yale University; Barbara A. Cornblatt, Zucker Hillside Hospital; Robert K. Heinssen, National Institute of Mental Health; Daniel H. Mathalon, University of California, San Francisco; Ming T. Tsuang, University of California, Irvine; Diana O. Perkins, University of North Carolina; Larry J. Seidman, Harvard University; Scott W. Woods, Yale University; Thomas H. McGlashan, Yale University
• Language: English
• Date: 2014-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 Elsevier B.V.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.schres.2014.09.017
• Title of Journal or Parent Work: Schizophrenia Research
• ISSN: 0920-9964
• Volume: 160
• Issue: 1-3
• Start Page: 104
• End Page: 109
• Grant/Funding Information: This study was supported by the National Institute of Mental Health (grant U01MH081988 to Dr. Walker; grant U01MH081984 to Dr. Addington; grants U01 MH081928; P50 MH080272; Commonwealth of Massachusetts SCDMH82101008006 to Dr. Seidman; grants R01 MH60720, U01 MH082022 and K24 MH76191 to Dr. Cadenhead; grant MH081902 to Dr. Cannon; grant U01MH082004-01A1 to Dr. Perkins; grant U01MH082022 to Dr. Woods; and grant UO1 MH081857-05 to Dr. Cornblatt).
• Keywords: PERI Life Events Scale; Daily Stress Inventory; Stress; Prodrome; Clinical high risk; Daily hassles
• Research Categories: Psychology, Clinical; Health Sciences, Mental Health

Abstract

There is inconsistent evidence for increased stress exposure among individuals at clinical high risk (CHR) for psychosis. Yet similar to patients with a diagnosed psychotic illness, the preponderance of evidence suggests that CHR individuals tend to experience stressful life events (LE) and daily hassles (DH) as more subjectively stressful than healthy individuals. The present study utilizes data from the North American Prodrome Longitudinal Study Phase 2 (NAPLS-2) to test the hypotheses that (1) CHR individuals manifest higher self-reported stress in response to both LE and DH when compared to healthy controls (HC), (2) group differences in self-reported stress increase with age, (3) baseline self-reported stress is associated with follow-up clinical status, and (4) there is a sensitization effect of LE on the response to DH. In contrast to some previous research, the present findings indicate that the CHR group (N=314) reported exposure to more LE when compared to the HC group (N=162). As predicted, CHR participants rated events as more stressful, and those who progressed to psychosis reported a greater frequency of LE and greater stress from events compared to those whose prodromal symptoms remitted. There was also some evidence of stress-sensitization; those who experienced more stress from LE rated current DH as more stressful. The results indicate that the "prodromal" phase is a period of heightened stress and stress sensitivity, and elevated cumulative lifetime exposure to stressful events may increase reactions to current stressors.