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European Journal of Psychotraumatology
ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zept20
Empirically-derived dimensions of childhood
adversity and cumulative risk: associations with
measures of depression, anxiety, and psychosis-
spectrum psychopathology
Alena Gizdic, Tamara Sheinbaum, Thomas R. Kwapil & Neus Barrantes-Vidal
To cite this article: Alena Gizdic, Tamara Sheinbaum, Thomas R. Kwapil & Neus Barrantes-Vidal
(2023) Empirically-derived dimensions of childhood adversity and cumulative risk: associations
with measures of depression, anxiety, and psychosis-spectrum psychopathology, European
Journal of Psychotraumatology, 14:2, 2222614, DOI: 10.1080/20008066.2023.2222614
To link to this article: https://doi.org/10.1080/20008066.2023.2222614
© 2023 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group
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BASIC RESEARCH ARTICLE
Empirically-derived dimensions of childhood adversity and cumulative risk:
associations with measures of depression, anxiety, and psychosis-spectrum
psychopathology
Alena Gizdic
a
#, Tamara Sheinbaum
b
#, Thomas R. Kwapil
c
and Neus Barrantes-Vidal
a,d
a
Departament de Psicología Cli
nica i de la Salut, Universitat Autonoma de Barcelona, Barcelona, Spain;
b
Dirección de Investigaciones
Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico;
c
Department of
Psychology, University of Illinois at Urbana-Champaign, Champaign, IL, USA;
d
Centro de Investigación Biomédica en Red de Salud Mental,
Instituto de Salud Carlos III, Barcelona, Spain
ABSTRACT
Background: Investigating different approaches to operationalizing childhood adversity and
how they relate to transdiagnostic psychopathology is relevant to advance research on
mechanistic processes and to inform intervention efforts. To our knowledge, previous
studies have not used questionnaire and interview measures of childhood adversity to
examine factor-analytic and cumulative-risk approaches in a complementary manner.
Objective: The first aim of this study was to identify the dimensions underlying multiple
subscales from three well-established childhood adversity measures (the Childhood Trauma
Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for
Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting
dimensions. The second aim of the study was to examine the childhood adversity
dimensions and the cumulative risk index as predictors of measures of depression, anxiety,
and psychosis-spectrum psychopathology.
Method: Participants were 214 nonclinically ascertained young adults who were administered
questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena,
and childhood adversity.
Results: Four childhood adversity dimensions were identified that captured experiences in the
domains of Intrafamilial Adversity,Deprivation,Threat, and Sexual Abuse. As hypothesized, the
adversity dimensions demonstrated some specificity in their associations with
psychopathology symptoms. Deprivation was uniquely associated with the negative
symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial
Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-
spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally,
the cumulative risk index was associated with all the outcome measures.
Conclusions: The findings support the use of both the empirically-derived adversity
dimensions and the cumulative risk index and suggest that these approaches may facilitate
different research objectives. This study contributes to our understanding of the complexity
of childhood adversity and its links to different expressions of psychopathology.
Dimensiones derivadas empíricamente de la adversidad infantil y el
riesgo acumulativo: Asociación con medidas de psicopatología de
depresión, ansiedad y del espectro psicótico.
Antecedentes: La investigación de los distintos abordajes para operacionalizar la adversidad
infantil y cómo se relacionan con la psicopatología transdiagnóstica es relevante para avanzar
en la investigación sobre los procesos mecanicistas y para informar los esfuerzos de
intervención. Hasta donde sabemos, los estudios previos no han utilizado cuestionarios ni
medidas de entrevistas de la adversidad infantil para examinar los enfoques analítico
factorial y de riesgo acumulativo de manera complementaria.
Objetivo: El primer objetivo de este estudio fue identificar las dimensiones subyacentes a
múltiples subescalas de tres medidas de adversidad infantil bien establecidas (el
Cuestionario de Trauma Infantil, la Entrevista de Experiencias de Cuidado y Abuso en la
infancia y la Entrevista de Eventos Traumáticos en la Infancia) y crear un índice de riesgo
acumulativo basado en las dimensiones resultantes. El segundo objetivo de este estudio
fue examinar las dimensiones de adversidad infantil y el índice de riesgo acumulativo
ARTICLE HISTORY
Received 10 November 2022
Revised 30 April 2023
Accepted 25 May 2023
KEYWORDS
Childhood adversity;
childhood trauma;
psychopathology;
dimensional models;
cumulative risk; schizotypy;
psychosis; depression;
anxiety
PALABRAS CLAVE
Adversidad infantil; trauma
infantil; psicopatología;
modelos dimensionales;
riesgo acumulativo;
esquizotipia; psicosis;
depresión; ansiedad
关键词
童年不良经历;童年创伤;
心理病理学;维度模型;累
积风险;分裂型;精神病;抑
郁;焦虑
HIGHLIGHTS
•We investigated how
different approaches to
operationalizing childhood
adversity relate to
transdiagnostic
psychopathology.
•Four childhood adversity
dimensions were found to
underlie multiple subscales
from three well-
established childhood
adversity measures.
•The childhood adversity
dimensions demonstrated
some specificity in their
associations with the
psychopathology
symptom domains and the
cumulative risk index was
associated with all the
outcomes.
© 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which
permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been
published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
CONTACT Neus Barrantes-Vidal neus.barrantes@uab.cat Departament de Psicología Cli
nica i de la Salut, Universitat Autonoma de Barcelona,
08193 Cerdanyola del Vallés, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Salud Mental, Instituto de Salud Carlos III.
#
These authors contributed equally and are joint first authors.
Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2023.2222614.
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY
2023, VOL. 14, NO. 2, 2222614
https://doi.org/10.1080/20008066.2023.2222614
como predictores de medidas de psicopatología de depresión, ansiedad y del espectro
psicótico.
Método: Los participantes fueron 214 adultos jóvenes evaluados no clínicamente a quienes
se les administraron cuestionarios y medidas de entrevista de depresión, ansiedad,
fenómenos del espectro psicótico y adversidad infantil.
Resultados: Se identificaron cuatro dimensiones de adversidad infantil que capturaron
experiencias en los dominios Adversidad Intrafamiliar, Deprivación, Amenaza, y Abuso
Sexual. Como hipotetizamos, las dimensiones de adversidad demostraron alguna
especificidad en sus asociaciones con síntomas psicopatológicos. La deprivación se asoció
únicamente con la dimensión de síntomas negativos de psicosis (síntomas esquizotípicos
negativos y esquizoides), la Adversidad Intrafamiliar con síntomas esquizotípicos y la
Amenaza con síntomas de depresión, ansiedad y del espectro psicótico. No se encontraron
asociaciones con la dimensión Abuso Sexual. Finalmente, el índice de riesgo acumulativo se
asoció con todas las medidas de resultado.
Conclusiones: Los hallazgos apoyan tanto el uso de las dimensiones de adversidad derivadas
empíricamente como del índice de riesgo acumulativo y sugieren que estos abordajes
pueden facilitar objetivos de investigación diferentes. Este estudio contribuye a nuestra
comprensión de la complejidad de la adversidad infantil y su nexo con diferentes
expresiones de psicopatología.
童年不良经历和累积风险的经验衍生维度：与抑郁、焦虑和精神病谱心理
病理学测量的关联
背景：考查处理童年不良经历的不同方法以及它们与跨诊断心理病理学的关系与推进机制
过程研究和启发干预工作相关。据我们所知，以前的研究没有使用童年不良经历的问卷调
查和访谈测量这样互补的方式来考查因素分析和累积风险方法。
目的：本研究第一个目的是从三个成熟的童年不良经历测量（童年创伤问卷、童年照顾和
虐待经历访谈以及童年创伤事件访谈）确定多个分量表的维度，并确定根据结果维度创建
一个累积风险指数。本研究第二个目的是考查童年不良经历维度和累积风险指数作为抑
郁、焦虑症和精神病谱心理病理学测量的预测因素。
方法：参与者是214 名非临床确定的年轻人，他们接受了抑郁、焦虑、精神病谱系现象和
童年不良经历的问卷调查和访谈测量。
结果：确定了捕捉了家庭内不良经历、剥夺、威胁和性虐待等领域经历的四个童年不良经
历维度。正如假设一样，不良经历维度在与心理病理学症状的关联中表现出一些特异性。
剥夺与精神病阴性症状维度（阴性分裂型和分裂样症状）、家庭内不良经历与分裂型症
状、威胁与抑郁、焦虑和精神病谱系症状具有独特关联。未发现与性虐待维度的关联。最
后，累积风险指数与所有结果指标相关联。
结论：研究结果支持使用实证得到的不良经历维度和累积风险指数，并表明这些方法可能
有助于实现不同的研究目标。本研究有助于我们理解童年不良经历的复杂性及其与心理病
理学不同表现形式的联系。
1. Introduction
The term childhood adversity refers to a range of nega-
tive early-life experiences that constitute deviations
from the expectable environment and are likely to
require considerable adaptation by a child (McLaugh-
lin, 2016). These experiences include childhood abuse
and neglect, bullying, witnessing domestic violence,
losses, and non-interpersonal experiences, such as acci-
dents and natural disasters (Bifulco & Thomas, 2012;
Butchart et al., 2006). Childhood adversity has been
increasingly recognized as a leading risk factor for the
development of multiple psychopathological conditions
and subclinical manifestations, including depression,
anxiety, and psychosis spectrum phenotypes (Copeland
et al., 2018; Humphreys et al., 2020; Varese et al., 2012).
Despitethenotableprogressinthefield of childhood
adversity over the last decades, researchers continue to
grapple with challenging conceptual and measurement
issues (Lacey & Minnis, 2020). One such issue concerns
how best to study the effects of childhood adversity on
the risk for psychopathology (McLaughlin et al., 2021;
Smith & Pollak, 2021), which has implications for advan-
cing research on mechanistic processes and the design of
intervention efforts (Danese & Lewis, 2022;Lacey&Min-
nis, 2020). For example, specificity models (i.e. focusing
on the effects of individual adversity subtypes, such as sex-
ual abuse) have received considerable theoretical atten-
tion and have been widely investigated. However, the
evidence of the substantial co-occurrence of different
adversity subtypes (and the resulting potential overesti-
mation of the effects of individual subtypes in such
models) has highlighted the need for complementary
approaches (Cecil et al., 2017;McLaughlinetal.,2021).
Currently, the most common approach to measur-
ing the effects of childhood adversity is the cumulative
risk approach (Lacey & Minnis, 2020), which involves
calculating a cumulative score by summing the num-
ber of adversities an individual experienced. Thus,
cumulative risk is an additive model that focuses on
the amount (not the kind) of adversities (Evans
et al., 2013; Sheridan & McLaughlin, 2020). This
approach offers several advantages, such as ease of
2A. GIZDIC ET AL.
interpretation and benefits in terms of statistical
power (Ettekal et al., 2019; Evans et al., 2013). Further-
more, a robust body of research demonstrates that
experiencing an increased number of childhood
adversities is associated with an increased risk for a
range of psychopathological outcomes (Chapman
et al., 2004; Evans et al., 2013; Stein et al., 2022).
Nevertheless, the cumulative risk approach has been
considered insufficient to fully characterize the
effects of childhood adverse experiences because,
among other things, it does not consider the pattern-
ing of adversities and assumes that all adversities
impact development via similar mechanisms (Lacey
& Minnis, 2020; McLaughlin & Sheridan, 2016).
Other approaches to operationalizing childhood
adversity have focused on deriving dimensions of
adversity. Theory-driven dimensional models suggest
that different adversity subtypes share common fea-
tures that are likely to influence developmental pro-
cesses in similar ways (McLaughlin et al., 2021). In
this regard, the Dimensional Model of Adversity and
Psychopathology (McLaughlin & Sheridan, 2016)is
an influential framework that proposes that childhood
adversities can be conceptualized along two dimen-
sions that have distinct pathways to psychopathology.
These dimensions are threat (involving harm or threat
of harm, e.g. abuse) and deprivation (involving lack of
expected environmental inputs, e.g. neglect).
Although empirical support for this approach has
begun to accumulate (e.g. Miller et al., 2018; Schäfer
et al., 2023), one limitation is that some adversity sub-
types do not clearly map onto these dimensions or
may include aspects of both (Smith & Pollak, 2021).
On the other hand, researchers have also obtained
dimensions using empirically-driven methods, such as
factor-analytic approaches, which group childhood
adversities based on the extent to which they are corre-
lated with each other. Factor scores have gained attention
in the assessment of several constructs, such as externaliz-
ing and internalizing disorders (Caspi et al., 2014)and,to
a lesser extent, childhood adversity (Brumley et al., 2019).
Factor-analytic approaches allow for examining the
impact of the specific patterning of childhood adversity
subtypes (Lacey & Minnis, 2020)andhavebenefits for
improving measurement parsimony (Mersky et al.,
2017). Overall, the empirical literature in this domain is
somewhat inconsistent, likely related to differences in
the childhood adversity subtypes included across studies
(Lian et al., 2022;Merskyetal.,2017). Other empiri-
cally-driven methods include person-centered
approaches, such as latent class analysis, which identifies
subgroups of individuals with similar patterns of adversi-
ties. Although studies vary in the number and compo-
sition of classes, several have identified low adversity
and poly-victimization classes (Debowska et al., 2017;
McLafferty et al., 2021)anddifferential associations
between some adversity classes and mental health
outcomes (Hagan et al., 2016;O’Donnell et al., 2017).
Of note, studies using empirically-driven methods to
operationalize adversity have tended to focus on experi-
ences of abuse and neglect (Lacey & Minnis, 2020). There-
fore, more work is needed that incorporates additional
relevant experiences within the family (e.g. role reversal)
and other relational environments (e.g. peer bullying).
Research has robustly linked childhood adversity
with dimensional and categorical measures of
depression, anxiety, and psychosis-spectrum phenom-
ena using various approaches, including cumulative
risk (Copeland et al., 2018; Kim et al., 2021;Longden
et al., 2016; Morgan et al., 2020). Although variability
in the operationalization of adversity complicates com-
paring results using other approaches, some notable
findings have emerged. For example, depression has
been prominently linked with experiences in the
domain of emotional maltreatment (Humphreys
et al., 2020; Mandelli et al., 2015). Meanwhile, in the
field of psychosis, the adversity-psychosis link is
especially robust for the positive symptom dimension
(Gibson et al., 2016; Velikonja et al., 2015), and experi-
ences characterized by an ‘intention to harm’appear to
be of particular relevance (Arseneault et al., 2011; Mor-
gan et al., 2020; van Nierop et al., 2014). Even though
the negative dimension of psychosis has received less
attention (Gibson et al., 2016), evidence indicates stron-
ger or more consistent associations with neglect than
with other adverse experiences (Alameda et al., 2021;
Bailey et al., 2018; Cristóbal-Narváez et al., 2016).
Several previous studies in the field have been lim-
ited by covering a narrow range of experiences and
using checklist measures of adversity. Hence, using
comprehensive questionnaire and interview measures
should allow for greater precision of models linking
childhood adversity and psychopathology (Bifulco &
Schimmenti, 2019). Furthermore, research using differ-
ent approaches in a complementary manner may offer
useful insights regarding the operationalization of
childhood adversity. For example, in a recent study,
McGinnis et al. (2022)foundthatdifferent theory-dri-
ven dimensions of adversity and a cumulative measure
(constructed from these dimensions plus an additional
adversity scale) were associated with long-term psychia-
tric and functional outcomes. They concluded that their
results supported using the cumulative measure for
estimating relative risk for these outcomes and the
adversity dimensions for obtaining mechanistic
insights. Thus, using theoretically –or empirically-
derived dimensions of adversity to build a cumulative
risk index may provide a valuable integration and con-
tribute to the refinement of cumulative models.
1.1. The present study
Leveraging interview and self-report assessments of a
range of childhood adversities, the present study used
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 3
factor-analytic and cumulative risk approaches in a
complementary manner to investigate associations of
childhood adversity with transdiagnostic psychopathol-
ogy assessed in a non-clinically ascertained sample of
young adults. Specifically, the first aim of the study was
to use principal components analysis (PCA) to identify
the dimensions underlying multiple subscales from
three well-established childhood adversity measures
and to create a cumulative risk index based on the result-
ing dimensions. As part of this aim, we sought to exam-
ine whether the PCA-derived childhood adversity
dimensions were consistent with those proposed by the
Dimensional Model of Adversity and Psychopathology,
in which experiences of threat and deprivation are distin-
guished. The second aim of the study was to examine the
PCA-derived childhood adversity dimensions and the
cumulative risk index as predictors of depression,
anxiety, and psychosis-spectrum symptom dimensions,
assessed via questionnaire and interview measures.
PCA is an exploratory approach, and we did not
make specific hypotheses regarding the number and
nature of the PCA-derived dimensions. However, we
expected that the resulting dimensions would show
at least some degree of specificity in their associations
with psychopathology symptoms. To provide a robust
test of this hypothesis and consistent with current rec-
ommendations (Cecil et al., 2017; Sheridan &
McLaughlin, 2020), the childhood adversity dimen-
sions were examined simultaneously to determine
their unique effects. Finally, we expected that higher
cumulative adversity would be associated with higher
levels of symptoms.
2. Methods
2.1. Participants and procedure
The present study is part of the Barcelona Longitudi-
nal Investigation of Schizotypy Study (BLISS; Bar-
rantes-Vidal et al., 2013a,2013b). Participants were
students from the Universitat Autonòma de Barcelona
who completed a battery of self-report and interview
measures. Specifically, at time 1 (T1), 589 undergradu-
ates completed self-report questionnaires as part of
mass-screening sessions. Usable screening data was
obtained from 547 participants (42 were excluded
due to the invalid protocols). The mean age was 20.6
years (SD = 4.1) and 83% were women. A subset of
339 participants was invited to take part in an inter-
view study with the goal of assessing 200 individuals.
Those invited included all 189 who had standard
scores based upon sample norms of at least 1.0 on
one or more measures of schizotypy and psychotic
like experiences, and 150 randomly selected partici-
pants who had standard scores < 1.0 on these
measures. This enrichment procedure was done to
increase the variance associated with mental health
outcomes in the sample. At time 2 (T2), 214 partici-
pants (mean age = 21.4; SD = 2.4; 78% female) com-
pleted the interview study. Of the participants, 123
had elevated scores in one or more of the measures
of schizotypy and psychotic-like experiences, and 91
had standard scores < 1.0. The mean time interval
between T1 and T2 was 1.7 years (SD = 0.2; range =
1.4–2.2 years). The university ethics committee
approved the study and participants provided
informed consent at both assessments.
2.2. Measures
Clinical psychologists and trained advanced graduate
students in clinical psychology administered the
measures described below, along with other measures
not used in the present study.
2.2.1. Childhood adversity measures
At T1, participants completed the Childhood Trauma
Questionnaire-Short Form (CTQ-SF; Bernstein &
Fink, 1998), a self-report measure that assesses sexual
abuse, physical abuse, emotional abuse, emotional
neglect, and physical neglect. CTQ items are answered
on a 5-point Likert-type scale ranging from ‘never
true’to ‘very often true’and are summed to obtain a
score for each subtype of maltreatment.
At T2, participants were administered two inter-
view measures, the Childhood Experience of Care
and Abuse (CECA; Bifulco et al., 1994) and the Inter-
view for Traumatic Events in Childhood (ITEC; Lob-
bestael et al., 2009; Lobbestael & Arntz, 2010). The
CECA is a semi-structured, investigator-based inter-
view that focuses on objective aspects of childhood
experiences. The following CECA scales were used:
Parental antipathy, role reversal, parental discord, vio-
lence between parents, and bullying. The scales are
rated on a 4-point scale ranging from ‘marked’to ‘lit-
tle/none,’based on specific rating rules and bench-
mark thresholds. When applicable, overall scale
ratings were obtained (i.e. peak rating taking into
account behaviour from both mother and father
figure; see Sheinbaum et al., 2015). CECA scores
were reversed such that higher scores indicate greater
severity. The ITEC is a semi-structured interview that
assesses sexual abuse, physical abuse, emotional abuse,
emotional neglect, and physical neglect. Every
endorsed ITEC item is followed by questions covering
different parameters of the experience, including the
age of onset, perpetrator(s), duration, and frequency.
These parameters are rated according to predefined
answer categories and are used to calculate composite
severity scores for each maltreatment subtype.
2.2.2 Psychopathology measures
At T1, participants completed the depression and
anxiety subscales of the Symptom Checklist- 90-
4A. GIZDIC ET AL.
Revised (SCL-90-R; Derogatis, 1977), the suspicious-
ness subscale of the Schizotypal Personality Question-
naire (SPQ; Raine, 1991), and the Wisconsin
Schizotypy Scales (WSS). The WSS are composed of
the Perceptual Aberration Scale (Chapman et al.,
1978), the Magical Ideation Scale (Eckblad & Chapman,
1983), the Revised Social Anhedonia Scale (Eckblad
et al., 1982), and the Physical Anhedonia Scale (Chap-
man et al., 1976). The WSS reliably yield two factors,
positive and negative schizotypy, that account for
80% of their variance. Participants were assigned posi-
tive and negative schizotypy dimensional scores based
upon norms from 6,137 American young adults (Kwa-
pil et al., 2007). Note that the factor structure under-
lying the WSS was found to be invariant across
Spanish and American samples (Kwapil et al., 2012).
At T2, we used the Structured Clinical Interview for
DSM–IV Axis II Disorders (SCID–II; First et al., 1997)
to assess schizophrenia-spectrum personality disorders.
Dimensional scores were computed by summing indi-
vidual item ratings for each personality disorder.
Depression was assessed via interview with the Calgary
Depression Scale for Schizophrenia (CDSS; Addington
et al., 1992) and via questionnaire with the Beck
Depression Inventory-II (BDI; Beck et al., 1996). All
of the measures are widely used and demonstrate
good psychometric properties in young adult samples.
3. Statistical analysis
We first calculated descriptive statistics for the study
variables and Pearson correlations among the child-
hood adversity subscales. To obtain the childhood
adversity dimensions, we performed a PCA with an
oblique (Promax) rotation, given that dimensions of
childhood adversity are not expected to be indepen-
dent. A parallel analysis was conducted to determine
the optimal number of factors to retain in the PCA
(Lim & Jahng, 2019). Factors were retained if their
associated eigenvalue was larger than the 95th percen-
tile of the corresponding eigenvalues derived from the
random dataset (Ledesma & Valero-Mora, 2007). In
addition, following guidelines by Hair et al. (2014),
the cut-offused for interpreting factor loadings from
the PCA was .40. When the childhood adversity sub-
scales loaded above .40 on more than one factor,
they were interpreted as belonging to the factor on
which they had the highest loading.
Linear regression analyses were computed to compare
the PCA-derived childhood adversity factor scores and
the cumulative risk index as predictors of ten question-
naire and interview measures of depression, anxiety,
and psychosis-spectrum psychopathology. Note that
the factor scores and cumulative index were examined
in separate regression models. In the regression analyses
examining the dimensions as predictors, the childhood
adversity factor scores were entered simultaneously to
examine their unique contribution. In the regression
analyses examining the cumulative risk approach, the
cumulative risk index was entered as the sole predictor.
The cumulative index was calculated by summing the
dichotomized factor scores (dichotomized as ‘present =
1’or ‘absent = 0’at the 75th percentile; see Evans et al.,
2013). Bootstrap procedures with 2,000 samples were
used for the regression models.
4. Results
Descriptive statistics for all study variables are displayed
in Table 1. The intercorrelations of the childhood adver-
sity subscales are reported in the Supplemental Material.
4.1. PCA of childhood adversity subscales
The parallel analysis indicated that a four-factor sol-
ution best accounted for the data. The Kaiser-
Meyer-Olkin measure verified the sampling adequacy
for the PCA (KMO = .77) and Bartlett´s test of spheri-
city was significant (χ2 (105) = 1270.22, p< .001). The
PCA yielded five components with Eigen values
greater than 1. However, following the parallel analy-
sis, we retained the first four factors.
Table 1. Descriptive statistics for the childhood adversity
subscales and the psychopathology measures.
Measure Mean SD
Observed
Range
Possible
Range
Adversity subscales
CTQ Emotional abuse 7.07 3.19 5–22 5–25
CTQ Physical abuse 5.42 1.35 5–17 5–25
CTQ Sexual abuse 5.39 1.87 5–25 5–25
CTQ Emotional neglect 9.27 3.43 5–21 5–25
CTQ Physical neglect 5.91 1.52 5–14 5–25
ITEC Emotional abuse* 3.96 4.50 0–22.58 NA
ITEC Physical abuse* 0.93 2.59 0–25.46 NA
ITEC Sexual abuse* 0.17 0.94 0–9.52 NA
ITEC Emotional neglect* 1.51 2.97 0–15.20 NA
ITEC Physical neglect* 1.59 3.22 0–21.40 NA
CECA Bullying 1.61 0.92 1–41–4
CECA Parental discord 1.70 1.00 1–41–4
CECA Violence between
parents
1.13 0.48 1–41–4
CECA Antipathy 1.57 0.91 1–41–4
CECA Role reversal 1.59 0.87 1–41–4
Psychopathology
measures
Positive schizotypy* 0.31 1.18 –1.28–5.13 NA
Negative schizotypy* 0.21 1.22 –1.63–5.18 NA
Suspiciousness 2.97 2.05 0–80–8
Paranoid symptoms 1.53 2.08 0–12 0–14
Schizoid symptoms 0.90 1.54 0–80–14
Schizotypal symptoms 1.00 1.93 0–13 0–18
SCL-90-R Anxiety 6.99 5.64 0–29 0–40
SCL-90-R Depression 12.33 8.23 0–43 0–52
CDSS Depression 1.21 2.07 0–13 0–27
BDI Depression 5.33 5.33 0–29 0–63
Note1: CTQ= Childhood Trauma Questionnaire; ITEC= Interview for Trau-
matic Events in Childhood; CECA= Childhood Experience of Care and
Abuse; SCL-90-R=Symptom Checklist-90-Revised; CDSS= Calgary
Depression Scale for Schizophrenia; BDI=Beck Depression Inventory-II.
SD=Standard Deviation; NA: Not applicable.
Note2: *Total range of ITEC severity scores are calculated for each individ-
ual based on a formula that includes parameters such as the age of
onset, proximity to the perpetrator, and duration; The WSS dimensional
scores are standardized scores with a mean of zero and SD of 1.
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 5
Table 2 presents the factor loadings of the rotated
four-factor solution. The four factors explained 63%
of the total variance and their intercorrelations ranged
from -.04 to .49. Factor 1 accounted for 32.3% of the
variance and was related to subscales indexing Intrafa-
milial Adversity, including CECA parental discord,
CECA role reversal, CECA violence between parents,
CECA antipathy, and ITEC emotional neglect. Factor
2 explained 12.4% of the variance and was mostly
related to subscales indexing Deprivation, including
ITEC physical neglect and CTQ physical and
emotional neglect. Factor 3 accounted for 10.1% of
the variance and was related to adversities indexing
Threat, including CECA bullying by peers, ITEC
emotional and physical abuse, and CTQ emotional
and physical abuse. Finally, Factor 4 accounted for
8.1% of the variance and was mostly related to experi-
ences of Sexual Abuse, including ITEC and CTQ sex-
ual abuse. Although the highest factor loading per
subscale was used to interpret the factors, the follow-
ing subscales had secondary loadings on an additional
factor: ITEC emotional abuse on Factor 1, CECA vio-
lence between parents on Factor 4, and CTQ
emotional abuse, CTQ physical abuse, and ITEC
emotional neglect on Factor 2.
4.2. Associations of the childhood adversity
dimensions and the cumulative risk index with
psychopathology
Table 3 shows the results of the linear regression ana-
lyses examining the PCA-derived childhood adver-
sity dimensions and the cumulative risk index as
predictors of the questionnaire and interview
measures of depression, anxiety, and psychosis-spec-
trum psychopathology (the bivariate correlations
between the adversity dimensions and outcomes are
presented in Supplemental Table 2). The results of
the regression analyses using the childhood adversity
factor scores as predictors showed that Intrafamilial
Adversity was significantly associated with schizoty-
pal symptoms, Deprivation with negative schizotypy
and schizoid symptoms, and Threat with all the out-
come measures except for schizoid symptoms and
CDSS depression. Sexual Abuse was not associated
with these outcomes. The results of the regression
analyses using the cumulative risk index as a predic-
tor showed that cumulative risk was significantly
associated with all the outcome measures. The
models using the adversity dimensions explained
between 8.5% and 25.3% of the variance in the psy-
chopathology symptoms, whereas those using the
cumulative risk index explained between 5% and
17.3% of the variance.
As seen in Table 3, the total effects tended to be lar-
ger for the adversity dimensions model (average effect
size across the ten analyses of .18 [medium effect])
compared to the cumulative approach (average effect
size of .12 [small effect]). All of the individual betas
for the Intrafamilial Adversity,Deprivation, and Sex-
ual Abuse dimensions were small effects. However,
the effects sizes tended to be larger for the Threat
dimension, especially for outcomes such as schizotypal
and paranoid personality disorder symptoms. The
beta values in the regression analyses represent the
results for the residualized predictors after partialling
out variance from the other three adversity dimen-
sions. Examination of the correlations in Supplemen-
tal Table 2 indicates that bivariate associations of the
individual adversity dimensions tended to be on the
order of small-medium effects for Intrafamilial Adver-
sity and Deprivation, and medium effects for the
Threat dimension. There were no significant corre-
lations with the Sexual Abuse dimension (all the values
were below .1).
5. Discussion
This study aimed to (1) identify the dimensions
underlying multiple subscales from three well-estab-
lished childhood adversity measures and (2) use
these dimensions and a cumulative risk index
based on them as predictors of depression, anxiety,
Table 2. Results of the principal components analysis with
promax rotation.
Adversity
subscales Factor scores
1 Intrafamilial
Adversity
2
Deprivation
3
Threat
4 Sexual
Abuse
CECA Parental
discord
.875 −.119 −.011 .073
CECA Role
reversal
.771 .082 −.048 −.029
CECA Violence
between
parents
a
.524 −.087 −.218 .458
ITEC Emotional
neglect
a
.513 .455 −.070 −.044
CECA Antipathy .506 .047 .345 −.179
CTQ Physical
neglect
−.077 .860 −.218 −.016
ITEC Physical
neglect
.221 .727 −.131 .045
CTQ Emotional
neglect
−.051 .709 .158 .004
CECA Bullying −.194 −.202 .859 .114
ITEC Emotional
abuse
a
.461 −.125 .706 .002
ITEC Physical
abuse
.190 −.020 .578 −.086
CTQ Emotional
abuse
a
−.048 .479 .517 .071
CTQ Physical
abuse
a
−.142 .421 .482 .064
ITEC Sexual
abuse
.015 −.012 .051 .904
CTQ Sexual
abuse
−.066 .081 .119 .875
Percentage of
Variance
32.25% 12.40% 10.05% 8.07%
Eigenvalue 4.84 1.86 1.51 1.21
Note1: Highest factor loadings for a given factor are bolded.
Note2:
a
This subscale has a loading of .40 or above on more than one
factor.
6A. GIZDIC ET AL.
and psychosis-spectrum psychopathology. To our
knowledge, this is the first investigation to use ques-
tionnaire and interview measures of adversity to
examine factor-analytic and cumulative-risk
approaches in a complementary manner. Our results
identified four meaningful childhood adversity
dimensions and showed that both approaches to
operationalizing adversity (i.e. empirically-derived
dimensions and cumulative risk) yielded significant
associations with the measures of psychopathology.
As hypothesized, the adversity dimensions demon-
strated some specificity in their associations with
the psychopathology symptom domains. Further-
more, the cumulative risk index was associated
with all the outcomes. Overall, the study contributes
to current efforts to elucidate how different
operationalization approaches can inform our
understanding of the complexity of childhood
adversity and its links to different expressions of
psychopathology.
5.1. Childhood adversity dimensions
Regarding the first aim of the study, the results ident-
ified four childhood adversity dimensions that cap-
tured experiences in the domains of Intrafamilial
Adversity,Deprivation,Threat, and Sexual Abuse.
The finding that the dimensions distinguished
between experiences of threat and deprivation pro-
vides empirical support to the conceptual distinction
proposed by the Dimensional Model of Adversity
and Psychopathology. At the same time, however,
the results did not fully align with the model, as not
all of the proposed threat-related adversities clustered
together in our data. Most notably, the CTQ and ITEC
sexual abuse subscales formed a coherent separate
dimension. This resonates with the results of large fac-
tor-analytic studies of adversity items in which sexual
abuse loaded separately from other forms of abuse
(Brown et al., 2013; Ford et al., 2014). Together, this
evidence appears to bolster the view that sexual
abuse may be considered a distinct form of adversity
(Cohen-Cline et al., 2019)–even distinct from those
that also share an element of threat. Alternatively,
the findings could be related to issues previously
reported to attenuate the association between sexual
and non-sexual maltreatment (i.e. the overall low
base rate of sexual abuse and that most cases are
accompanied by other maltreatment subtypes; see
Vachon et al., 2015). Additional research across
diverse sample types may help clarify the nature of
this finding.
Another consideration concerning the threat-
deprivation distinction is that CTQ physical and
emotional abuse cross-loaded onto the Deprivation
dimension. This finding seems to be consistent
with the common co-occurrence of experiences of
abuse and neglect, which has been proposed to com-
plicate distinguishing among these experiences in
research using data-driven approaches (Sheridan
et al., 2020). In this regard, the fact that CTQ, but
not ITEC, subscales cross-loaded onto Deprivation
may suggest that interview measures that assess
multiple features of maltreatment are better able
than self-reports to differentiate between the
domains of abuse and neglect. This possibility is in
line with several researchers’contention that in-
depth interview measures that allow for probing
and clarification offer greater precision in their
assessment of environmental experience (Bifulco &
Schimmenti, 2019;Fisheretal.,2015;Lobbestael
et al., 2009).
We also found that Intrafamilial Adversity
explained the most variance in our data, indicating
that the threat-deprivation model is insufficient to
account for the variability in childhood adversity.
Table 3. Linear regressions examining prediction of psychopathology measures by the childhood adversity dimensions and the
cumulative risk index.
Criteria
Regression models
Adversity dimensions Cumulative risk
Intrafamilial
Adversity Deprivation Threat Sexual abuse Total effect Risk index Total effect
βf
2
βf
2
βf
2
βf
2
R
2
f
2
βR
2
f
2
Questionnaire
Positive Schizotypy .094 .01 .150 .02 .169* .02 .095 .01 .116*** .13 .356*** .092*** .10
Negative Schizotypy −.113 .01 .215** .04 .216** .04 −.008 .00 .114*** .13 .316*** .067*** .07
Suspiciousness −.009 .00 .138 .02 .317*** .09 .031 .00 .160*** .19 .415*** .173*** .21
SCL-90 Anxiety .091 .01 .133 .01 .256*** .06 .045 .00 .153*** .18 .336*** .113*** .13
SCL-90 Depression .132 .02 .040 .00 .358*** .12 .093 .01 .205*** .26 .391*** .153*** .13
BDI Depression .130 .02 .009 .00 .263** .06 .018 .00 .115*** .13 .288*** .083*** .10
Interview
Paranoid Symptoms .080 .01 .012 .00 .434*** .18 .010 .00 .226*** .29 .401*** .161*** .19
Schizoid Symptoms .028 .00 .152* .02 .180 .03 −.005 .00 .091*** .10 .225** .050*** .05
Schizotypal Symptoms .168* .03 .085 .01 .362** .13 .037 .00 .253*** .34 .373*** .139*** .16
CDSS Depression .151 .02 .028 .00 .181 .03 .006 .00 .085*** .09 .249** .062*** .07
p< .05, ** p< .01, *** p< .001.
Note 1: Bootstrap procedures (with 2,000 samples) were employed.
Note 2: SCL-90 = Symptom Checklist-90-Revised; CDSS = Calgary Depression Scale for Schizophrenia; BDI = Beck Depression Inventory-II
Note 3: According to Cohen (1992), f
2
values above .15 are medium effect sizes (in bold).
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 7
Four CECA subscales and one ITEC subscale loaded
primarily onto this dimension. While shared method
variance may have contributed to the clustering of
CECA subscales, the finding that CECA bullying
loaded exclusively onto Threat appears to strengthen
the interpretation that these negative environmental
experiences within the family environment represent
a distinct construct. That ITEC emotional neglect
loaded primarily onto this dimension may reflect
that this subscale’s assessment of the failure to meet
a child’s emotional needs also taps into elements
associated with other poor parenting behaviors (e.g.
those related to role reversal). Although previous
research has not assessed the same adversity subtypes
included in our study, the emergence of this dimen-
sion is broadly consistent with earlier findings that
adversities related to household dysfunction tend to
form a separate factor (Ford et al., 2014; Mersky
et al., 2017).
5.2. Associations of childhood adversity with
the psychopathology measures
Regarding the second aim of the study, we found that
when the adversity dimensions were modelled
together, they tended to explain more variance in the
outcomes than the cumulative risk index. This dove-
tails with epidemiological research comparing latent
maltreatment factors with a cumulative maltreatment
score (Brumley et al., 2019) and supports the utility of
this empirical approach. Additionally, the analyses
with the adversity dimensions showed that Threat
was a significant predictor of depression, anxiety,
and psychosis-spectrum psychopathology. Notably,
within the psychosis symptom domains, Threat was
more consistently associated with phenotypes invol-
ving positive psychotic features, which is in keeping
with research pointing to the relevance of adversities
characterized by an ‘intention to harm’in conferring
risk for reality distortion (Arseneault et al., 2011; van
Nierop et al., 2014). Our results pertaining to Threat
are also in agreement with a recent study that found
that a dimension of threat-related adversities was
associated with anxiety and depressive disorders
(McGinnis et al., 2022). It is of note that we found
Threat to be associated with self-reported depressive
symptoms across two time points using different
instruments, but not with interview-rated symptoms.
Although the reason for this discrepancy is unclear,
it may be partly due to a relatively low representation
of CDSS ratings in our sample, which had lower mean
scores than those reported in a study that established
reference values in a healthy sample (Müller et al.,
2005). On the whole, the results with the Threat
dimension are consistent with theoretical and empiri-
cal accounts of the patterns of multifinality associated
with threat-related adversities (McLaughlin, 2016;
McLaughlin et al., 2020).
In line with our expectations, the results with the
adversity dimensions demonstrated the presence of
specificeffects. In particular, Deprivation showed a
unique association with the negative dimension of
psychosis across self-report and interview-based
assessments. This parallels meta-analytic findings
demonstrating associations between neglect and nega-
tive symptoms (Alameda et al., 2021; Bailey et al.,
2018) and extends such findings by showing an associ-
ation over-and-above the variance accounted for by
other adversity dimensions. Moreover, these results
support prior theorizing that the absence of expected
environmental inputs may shape the risk for deficit-
like features, such as diminished emotional experience
and social disinterest (Gallagher & Jones, 2013).
In addition, Intrafamilial Adversity was uniquely
associated with schizotypal PD symptoms. This is
important considering that identifying environmental
precursors to schizotypal PD can contribute to our
etiological understanding of the schizophrenia spec-
trum (Kwapil & Barrantes-Vidal, 2015). However,
the symptom heterogeneity that characterizes schizo-
typal PD complicates the interpretation of this
finding –particularly because positive, negative, and
disorganized symptoms are thought to involve differ-
ent developmental pathways (Barrantes-Vidal et al.,
2015). Thus, future work considering the multidimen-
sional nature of this construct may better elucidate its
associations with childhood adversity. Finally, it is
worth noting that the Sexual Abuse dimension was
not associated with our other adversity dimensions
or our outcome measures both in the regression and
bivariate analyses. While there is ample research
demonstrating links between sexual trauma and psy-
chopathology (Noll, 2021), the evidence in nonclinical
populations is less consistent (Vachon et al., 2015).
However, some caution should be taken in interpret-
ing the results for the Sexual Abuse dimension. This
is likely driven by the fact that a very small proportion
of participants reported any sexually abusive experi-
ences (only about 10% did so on the CTQ, with the
majority reporting the lowest rating for such experi-
ences). This may in part reflect less willingness of par-
ticipants to report sexual abuse relative to other forms
of abuse. Therefore, additional work is needed to
examine these associations in vulnerable populations
with greater sexual abuse prevalence and severity.
The current study also found that the cumulative
risk index was associated with all the symptoms –indi-
cating that an undifferentiated measure of adversity
provides broad (and undifferentiated) associations
with psychopathology outcomes. This converges
with the literature showing that the accumulation of
adverse experiences is pivotal in conferring risk for
various psychopathological outcomes, including
8A. GIZDIC ET AL.
depression, anxiety, and psychosis-spectrum phenom-
ena (Copeland et al., 2018; Evans et al., 2013;Kim
et al., 2021; Morgan et al., 2020). Furthermore, the
findings support the predictive value of focusing on
the cumulative effect of empirically-derived adversity
dimensions, which to our knowledge had not been
previously examined. Thus, we believe that a risk
score constructed from individual adversity dimen-
sions offers a refinement of cumulative indices that
merits further investigation.
The results of this study suggest that both operatio-
nalization approaches may offer complementary
information to the field. From a theoretical perspec-
tive, drawing on previous literature (e.g. Bentall
et al., 2014; Evans et al., 2013), it seems plausible
that the experiences comprising the childhood adver-
sity dimensions could shape certain developmental
processes in partially specific ways while also contri-
buting to a general vulnerability that cumulatively
impacts the expression of psychopathology. From a
research standpoint, we believe the results highlight
a point that other scholars have made (Henry et al.,
2021; McGinnis et al., 2022)–namely, that the optimal
operationalization approach may be goal-dependent.
For instance, while the empirically-derived dimen-
sions may facilitate identifying potential specificity
and underlying mechanisms, the cumulative approach
may help maximize adversity-outcome associations
and facilitate investigating complex interactions with
other levels of explanation (e.g. genetic factors).
5.3. Strengths and limitations
A strength of the current study is the comprehensive
assessment of childhood adversity and psychopathol-
ogy conducted with both questionnaire and interview
measures. In particular, employing in-depth interview
measures of childhood adversity serves to minimize
biases associated with subjective responding (Bifulco
& Schimmenti, 2019; Lobbestael et al., 2009). In
addition, the focus on subclinical phenotypes is con-
sidered to facilitate etiological research as participants
do not present with the critical confounding factors
associated with clinical status, such as high comorbid-
ity, biographical disruption, stigma, medication side
effects, etc. (e.g. Barrantes-Vidal et al., 2015).
The limitations of the study include its cross-sec-
tional nature, which limits inferences about the causal
effects of childhood adversities. In addition, our use of
a predominantly female university student sample
may restrict the generalizability of the findings. In
this regard, we note that a recent review found that
college student samples tend to produce similar
findings than non-student samples in the field of
trauma research (Boals et al., 2020). Nevertheless,
research in community samples with a more represen-
tative distribution of sociodemographic characteristics
would enhance generalizability. Finally, additional
studies are necessary to examine the extent to which
the findings apply to the clinical expression of these
phenotypes.
5.4. Conclusions and Future Directions
In sum, this study investigated different approaches to
operationalizing childhood adversity and their links to
transdiagnostic psychopathology. The use of compre-
hensive adversity measures allowed us to obtain a fine-
grained characterization of the environment that is
not typically afforded by epidemiological research
and thus complements existing literature in the field.
Using longitudinal designs and investigating the mod-
erators of the links identified in the present study rep-
resents an important avenue for future research. For
example, some research has found sex differences in
the exposure and effects of childhood adversities
(e.g. Haahr-Pedersen et al., 2020). Therefore, future
work with sex-balanced samples may consider investi-
gating sex as a moderating variable. Furthermore,
dimensional models have suggested some specificity
in the mechanisms linking different childhood adver-
sity dimensions with psychopathology (McLaughlin
et al., 2021). In this regard, elucidating mediating
mechanisms and their specificity is a relevant next
step that may help identify potential targets for inter-
vention. Continued work in this area is crucial to
advance our understanding of risk and resilience in
the service of informing preventive intervention and
clinical practice for individuals who have experienced
childhood adversity.
Acknowledgements
Authors contribution. Alena Gizdic: formal analyses, writ-
ing-original draft, review and editing, visualization;Tamara
Sheinbaum: conceptualization and methodology, writing-
original draft, review and editing, visualization, data cura-
tion;Thomas R. Kwapil: conceptualization and method-
ology, statistical consultation, review and editing; Neus
Barrantes-Vidal: conceptualization and methodology,
supervision, funding acquisition, resources, data curation,
investigation, project administration, writing original
draft, review and editing.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
This work was supported by Ministerio de Ciencia e Inno-
vación (PSI2017-87512-C2-1-R; PID2020-119211RB-I00)
and Generalitat de Catalunya (Suport als Grups de Recerca
2021SGR01010). Neus Barrantes-Vidal is supported by the
ICREA Acadèmia Research Award (Institució Catalana de
Recerca i Estudis Avançats) of the Catalan government;
EUROPEAN JOURNAL OF PSYCHOTRAUMATOLOGY 9
Alena Gizdic was supported by the Spanish Ministry of
Science and Innovation (grant number FPU18/04901
associated to project PSI2017-87512-C2-1-R and PID2020-
119211RB-I00).
Data availability statement
The data that support the findings of this study are available
on request from the corresponding author N.B.V. The data
are not publicly available due to privacy or ethical
restrictions.
ORCID
Alena Gizdic http://orcid.org/0000-0002-0901-7226
Tamara Sheinbaum http://orcid.org/0000-0002-2268-
7697
Thomas R. Kwapil http://orcid.org/0000-0003-1116-5954
Neus Barrantes-Vidal http://orcid.org/0000-0002-8671-
1238
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