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ORIGINAL RESEARCH
published: 04 October 2021
doi: 10.3389/fpsyt.2021.754174
Frontiers in Psychiatry | www.frontiersin.org 1October 2021 | Volume 12 | Article 754174
Edited by:
Tianhong Zhang,
Shanghai Jiao Tong University, China
Reviewed by:
Yangyang Xu,
Xiamen Xianyue Hospital, China
Junjie Wang,
Suzhou Guangji Hospital, China
Ling Zhang,
Suzhou Guangji Hospital, China
*Correspondence:
Qiang Wang
13524114828@163.com
†These authors have contributed
equally to this work
Specialty section:
This article was submitted to
Schizophrenia,
a section of the journal
Frontiers in Psychiatry
Received: 06 August 2021
Accepted: 06 September 2021
Published: 04 October 2021
Citation:
Zhao N, Shi D, Huang J, Chen Q and
Wang Q (2021) Comparing the
Self-Reported Personality Disorder
Traits and Childhood Traumatic
Experiences Between Patients With
Schizophrenia Vs. Major Depressive
Disorder.
Front. Psychiatry 12:754174.
doi: 10.3389/fpsyt.2021.754174
Comparing the Self-Reported
Personality Disorder Traits and
Childhood Traumatic Experiences
Between Patients With Schizophrenia
Vs. Major Depressive Disorder
Nan Zhao †, Dianhong Shi †, Juan Huang, Qiuying Chen and Qiang Wang*
Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
Introduction: Personality disorder (PD) and childhood traumatic experience (CTE) are
well- recognized risk factors for the development of schizophrenia (SZ) and major
depressive disorder (MDD). The relationship between CTE and PD is extremely close,
and both conditions can affect subsequent psychiatric disorders. Little is known about
the differences of these factors in patients with SZ and those with MDD.
Materials and Methods: A total of 1,026 outpatients participated in the study, including
533 (51.9%) with SZ and 493 (48.1%) with MDD who were sequentially sampled. The PD
traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus
(PDQ-4+). The Child Trauma Questionnaire Short Form (CTQ-SF) was used to assess
childhood adversities. The scores and associations of PDQ-4+and CTQ-SF between
patients with SZ and those with MDD were compared.
Results: The MDD group exhibited more PD traits and more childhood emotional
neglect than the SZ group. In patients with MDD, the correlation between PD traits and
CTE was significantly higher than that in patients with SZ. Patients with SZ vs. those with
MDD showed different PD traits and CTE. The schizotypal and antisocial PD traits, as well
as sexual abuse and physical neglect CTE, were significantly related to SZ. In contrast,
the borderline, narcissistic and avoidant PD traits, and emotional abuse/neglect CTE
were significantly associated with MDD.
Discussion: These findings indicated a robust relationship between CTE and PD traits.
Moreover, patients with SZ or MDD, have different interactive patterns. Both CTE and
PD traits have the potential to be premorbid risk factors that could be targeted for
preventative interventions.
Keywords: affective disorder, psychosis, childhood maltreatment, personality disorder, clinical population
Zhao et al. Comparation Between Schizophrenia and Depression
INTRODUCTION
Increasing evidence shows that serious psychiatric disorders,
such as schizophrenia (SZ) and major depressive disorder
(MDD), are characterized by multiple personality pathology
(MPP) (1–3), to a large extent. MPP is an end outcome of
childhood traumatic experience (CTE) (4,5), such as emotional
or sexual abuse (6,7). Personality disorders (PD) often co-
occur. The presence of both CTE and PD may result in a longer
duration and greater severity of major psychiatric symptoms,
such as psychotic or depressive symptoms (8,9). CTE is a shared
risk factor of psychiatric disorders and PD (10). CTE has also
been related to the severity and duration of psychiatric disorders
in numerous studies (11). These complex relationships are not
yet well-elucidated. The current clinical understanding of these
correlations is very superficial. Often, only the similarities are
seen, which, to a large extent, cover up the differences among
psychiatric disorders.
Although SZ is conceptualized as a neurodevelopmental
disorder, initial evidence suggests that the presence of PD
traits predicts the development of SZ (12,13). Several lines of
evidence have raised the possibility that PD traits may be also
associated with the onset of MDD (14,15). Whether PD traits
are associated with the heterogeneity seen in clinical symptoms
and categories, and therefore, identify a specific transdiagnostic
subgroup, remains unknown (16). Importantly, the relationship
between PD traits and CTE is extremely close, and they can
both affect subsequent psychiatric disorders. However, it remains
unclear whether there is a similar pattern of PD traits and CTE
contributing to the development of specific psychiatric disorders.
In this study, we aimed to replicate and build on previous
findings on the differences in PD traits and CTE between patients
with SZ and those with MDD in a larger sample, and to determine
the differences in PD traits and CTE between the two groups.
We predict that patients with SZ will have more psychosis-related
PD traits, such as paranoid, schizoid, schizotypal PD traits, than
patients with MDD. We also hypothesize that patients with
MDD will show more affective and anxiety-related PD traits,
such as histrionic, narcissistic, borderline, avoidant, dependent,
obsessive PD traits, than patients with SZ. We hypothesize that
the relationship between PD traits and CTE will vary and may be
increased in patients with MDD compared with those with SZ.
METHODS
Sample and Procedure
The study participants were drawn from a consecutive clinical
sample of adult patients, aged 18–60 years, who presented at
the Shanghai Pudong New Area Mental Health Center, Tongji
University School of Medicine. The hospital’s Ethical Committee
approved the study, and it was performed according to the
Declaration of Helsinki. Informed written consent was provided
by patients prior to inclusion in the study. Only patients with
SZ or MDD according to the Diagnostic and Statistical Manual
of Mental Disorders, 4th edition (DSM-IV), who completed the
screening questionnaires, were included in the current analyses.
The inclusion criteria were as follows. (1) Age 18–60 years. (2)
Completed at least 6 years of education and able to understand
the study. (3) Met the DSM-IV criteria for SZ or MDD based
on the Structured Clinical Interview for DSM Disorders/Patient
edition (SCID-I/P). (4) In a stable treatment condition, that
defined as the dose or type of the medication with which the
patient has reached psychopathological stability must be constant
for at least 2 months prior to inclusion in the study. None of the
patients had a history of stroke, brain trauma, central nervous
system infection, or seizure. The final sample comprised 1,026
participants (n=533 with SZ and n=493 with MDD). The age
and sex distribution between the two groups differed significantly
(see Results for further details).
Self-Reported PD Traits and CTE
The Personality Diagnostic Questionnaire (PDQ-4+) (17), a
self-reporting questionnaire, was used to evaluate pathological
personality traits, based on DSM-IV criteria. The Chinese version
of the PDQ-4+has been validated as having a high sensitivity
(0.89) and moderate specificity (0.65) for screening PD patients
(18). The PDQ-4+screens 12 types of PDs (i.e., paranoid (PAR),
schizoid (SCH), schizotypal (SCHT), histrionic (HIS), narcissistic
(NAR), borderline (BOR), antisocial (ANT), avoidant (AVO),
dependent (DEP), obsessive (OBS), depressive, and negativistic
PDs). The depressive and negativistic PDs proposed in the
appendix of DSM-IV were not included in the current study.
The PDQ-4+consists of 107 true-false items, including four
“too good” questions to prevent participants from undermining
the problems and two “suspect questions” to determine whether
participants are lying or responding without sincerity. Except
for the four “too good” and the two “suspect questions,”
“yes” responses to the remaining 93 questions are regarded as
pathological responses and counted as 1 point each. Higher
subscale scores indicate a greater likelihood of having a certain
type of personality disorder.
A quantitative index of childhood maltreatment severity
was assessed using the Chinese version of the Child Trauma
Questionnaire Short Form (CTQ-SF) (19–21). The CTQ-SF
comprises 28 self-report items assessed on five childhood
maltreatment subscales: Emotional abuse (EA), physical abuse
(PA), sexual abuse (SA), emotional neglect (EN), and physical
neglect (PN). The frequency with which each event occurred is
rated on a 5-point scale from 1 (never) to 5 (always), with higher
scores indicating a higher rate of occurrence. The Chinese version
of the CTQ-SF has been confirmed to be a reliable and valid
measurement in assessing CTE among Chinese clinical samples
(20,22).
Statistical Analyses
Statistical analyses were performed on IBM SPSS version 21.0
(IBM Corp., Armonk, NY, USA). One sample Kolmogorov-
Smirnov Test was used to examine the data’s normal distribution.
Demographic characteristics, PD traits, and CTE data for SZ
and MD groups were analyzed using frequency and descriptive
analyses. Group differences were analyzed using the independent
t-test or kappa test. Effect sizes were calculated using Cohen’s
d for mean comparisons. Because some variables do not satisfy
the normal distribution, Spearman’s correlation analysis was
Frontiers in Psychiatry | www.frontiersin.org 2October 2021 | Volume 12 | Article 754174
Zhao et al. Comparation Between Schizophrenia and Depression
TABLE 1 | Demographic characteristics, personality disorder traits, and childhood traumatic experiences in patients with schizophrenia and major depressive disorder.
Variables SZ MDD Comparison t/χ2ap-value effect-size
Cases [n (%)] 533 (51.9) 493 (48.1) – – –
Age (years) [Mean (SD)] 29.7 (9.1) 31.3 (9.9) 2.730 0.006 –
Male [n(%)] 228 (42.8) 181 (36.7) 3.927 0.048 –
Family history [n(%)] 59 (11.1) 49 (9.9) 0.347 0.556 –
Personality disorder traits by PDQ-4+[Mean (SD)]
Paranoid personality disorder 3.3 (1.7) 3.4 (1.7) 1.139 0.255 −0.059
Schizoid personality disorder 2.7 (1.6) 2.9 (1.6) 2.215 0.027 −0.125
Schizotypal personality disorder 4.5 (1.9) 4.3 (1.0) 1.504 0.133 0.138
Histrionic personality disorder 3.8 (1.9) 4.1 (1.7) 2.700 0.007 −0.167
Narcissistic personality disorder 3.7 (2.0) 4.1 (2.0) 3.938 <0.001 −0.2
Borderline personality disorder 4.8 (2.3) 5.5 (2.2) 5.195 <0.001 −0.311
Antisocial personality disorder 2.2 (1.7) 2.0 (1.8) 1.638 0.102 0.114
Avoidant personality disorder 4.2 (1.7) 4.7 (1.7) 4.657 <0.001 −0.294
Dependent personality disorder 3.9 (1.9) 4.1 (2.0) 2.168 0.030 −0.103
Obsessive-compulsive personality disorder 4.2 (1.8) 4.5 (1.7) 2.946 0.003 −0.171
Childhood traumatic experiences by CTQ-SF [Mean (SD)]
Emotional abuse 7.7 (3.1) 7.9 (3.4) 0.843 0.400 −0.062
Physical abuse 6.3 (2.3) 6.2 (2.3) 1.012 0.312 0.043
Sexual abuse 6.1 (2.1) 5.8 (1.8) 2.725 0.007 0.154
Emotional neglect 12.3 (4.7) 12.9 (5.1) 1.970 0.049 −0.122
Physical neglect 9.3 (3.0) 8.9 (3.2) 1.836 0.067 0.129
Total scores of abuse and neglect 41.6 (10.1) 41.5 (10.2) 0.089 0.929 0.010
at/χ2: t for the independent t-test; χ2for kappa test. SZ, schizophrenia; MDD, major depressive disorder; PDQ-4+, Personality Diagnostic Questionnaire Fourth Edition Plus; CTQ-SF,
Child Trauma Questionnaire Short Form. Bold in significant.
used for PD traits and CTE in the two groups. Lastly, stepwise
regression was performed using SZ/MDD as dependent variables,
and age, sex, family history, and subscales of PDQ-4+and CTQ-
SF as independent variables. Statistical significance was indicated
by p<0.05.
RESULTS
A total of 1,026 outpatients participated in the study, including
533 (51.9%) with SZ and 493 (48.1%) with MDD. Detailed
sociodemographic and clinical characteristics between the SZ and
MDD groups are reported in Table 1. The two groups did not
differ regarding their family history (χ2=0.347, p=0.556),
but significantly differed in age (t=2.730, p=0.006) and sex
distribution (χ2=3.927, p=0.048). The MDD group endorsed
more SCH, HIS, NAR, BOR, AVO, DEP, and OBS traits and more
childhood emotional neglect than the SZ group (p<0.05).
Associations between all variables of interest (PDQ-4+and
CTQ-SF) were tested. Non-parametric Spearman correlation
analysis yielded significant correlations between different types
of PD traits (Table 2) and different types of CTE (Table 3).
In patients with SZ, the PAR and SCHT PD traits were
significantly associated with the EA type of CTE. In patients with
MDD, the correlation between PD and CTE was more significant
than that in patients with SZ (Table 4).
As shown in Table 5, forward stepwise logistic regression was
used to identify which of the PDQ-4+and CTQ-SF variables
were most strongly related to the SZ and MDD diagnosis. The
SZ/MDD was listed as the dependent variable, while age, sex,
family history, and the PDQ-4+and CTQ-SF variables were
listed as independent variables. The PD variables of SCHT (p
<0.001) and ANT (p<0.001) were significantly related to SZ.
In contrast, the BOR (p<0.001), NAR (p=0.006), AVO (p=
0.009) PD traits were significantly associated with MDD in this
model. The CTE variables of SA (p=0.004) and PN (p=0.005)
were significantly related to SZ, while EA (p=0.017) and EN (p=
0.028) were significantly related MDD.
DISCUSSION
Major Findings
The primary aim of the present study was to examine the
difference and relationship between PD traits and CTE within
two major psychiatric diagnostic groups, namely, SZ and MDD.
We noted three key findings. First, patients with MDD reported
more PD traits (7 in 10 PD domains) than those with SZ. Second,
the correlation between PD traits and CTE was more obvious
in the MDD group than in the SZ group. Third, SZ and MDD
are associated with different PD traits and CTE. These findings
indicated that a robust relationship exists between CTE and PD
traits in patients with SZ and those with MDD, with different
interactive patterns. To the best of our knowledge, this is the first
study conducted in a large Chinese clinical sample to establish
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Zhao et al. Comparation Between Schizophrenia and Depression
TABLE 2 | Correlations of different types of personality disorder traits in patients with schizophrenia and those with major depressive disorder.
SZ (r) PAR SCH SCHT HIS NAR BOR ANT AVO DEP OBS
PAR 1.000 0.112** 0.531** 0.302** 0.625** 0.514** 0.331** 0.321** 0.297** 0.430**
SCH – 1.000 0.188** 0.065 0.104* 0.109* 0.069 0.120** 0.128** 0.112**
SCHT – – 1.000 0.402** 0.499** 0.575** 0.392** 0.321** 0.338** 0.445**
HIS – – – 1.000 0.529** 0.602** 0.543** 0.182** 0.398** 0.354**
NAR – – – – 1.000 0.565** 0.382** 0.413** 0.398** 0.579**
BOR – – – – – 1.000 0.594** 0.388** 0.480** 0.409**
ANT – – – – – – 1.000 0.223** 0.340** 0.272**
AVO – – – – – – – 1.000 0.466** 0.406**
DEP – – – – – – – – 1.000 0.387**
OBS – – – – – – – – – 1.000
MDD (r) PAR SCH SCHT HIS NAR BOR ANT AVO DEP OBS
PAR 1.000 0.217** 0.514** 0.209** 0.487** 0.493** 0.325** 0.364** 0.252** 0.329**
SCH – 1.000 0.328** −0.047 0.072 0.263** 0.103* 0.376** 0.171** 0.163**
SCHT – – 1.000 0.200** 0.396** 0.498** 0.383** 0.392** 0.333** 0.364**
HIS – – – 1.000 0.419** 0.415** 0.404** 0.043 0.268** 0.202**
NAR – – – – 1.000 0.435** 0.366** 0.253** 0.199** 0.379**
BOR – – – – – 1.000 0.534** 0.400** 0.426** 0.293**
ANT – – – – – – 1.000 0.114* 0.191** 0.097*
AVO – – – – – – – 1.000 0.510** 0.303**
DEP – – – – – – – – 1.000 0.245**
OBS – – – – – – – – – 1.000
SZ, schizophrenia; MDD, major depressive disorder; PAR, Paranoid; SCH, Schizoid; SCHT, Schizotypal; HIS, Histrionic; NAR, Narcissistic; BOR, Borderline; ANT, Antisocial; AVO,
Avoidant; DEP, Dependent; OBS, Obsessive-compulsive. *Correlation is significant at the 0.05 level (2-tailed). **Correlation is significant at the 0.01 level (2-tailed). Bold in significant.
TABLE 3 | Correlations of different types of childhood traumatic experiences in patients with schizophrenia and those with major depressive disorder.
SZ (r) EA PA SA EN PN
EA 1.000 0.392** 0.400** 0.245** 0.194**
PA – 1.000 0.321** 0.185** 0.176**
SA – – 1.000 0.130** 0.138**
EN – – – 1.000 0.383**
PN – – – – 1.000
MDD (r) EA PA SA EN PN
EA 1.000 0.543** 0.338** 0.396** 0.336**
PA – 1.000 0.272** 0.237** 0.201**
SA – – 1.000 0.119** 0.115*
EN – – – 1.000 0.454**
PN – – – – 1.000
SZ, schizophrenia; MDD, major depressive disorder; EA, Emotional abuse; PA, Physical abuse; SA, Sexual abuse; EN, Emotional neglect; PN, Physical neglect. *Correlation is significant
at the 0.05 level (2-tailed). **Correlation is significant at the 0.01 level (2-tailed). Bold in significant.
and compare the associations between CTE and PDs between SZ
and MDD.
PD Traits
In this study, patients with MDD reported increased PD traits
compared to patients with SZ, even in Cluster A PD traits (i.e.,
schizoid PD) that are marked by odd and eccentric behaviors.
These results are in line with those of Zhang et al. (18), who
found that nearly 42.18% of the cases with mood disorders were
associated with at least one DSM-IV PD and that the comorbidity
rate was higher than that found in patients with SZ (24.00%).
The high comorbidity rate of 42.36% was also reported by Zheng
et al. for 258 of 609 patients with MDD who met at least one
criterion of diagnosis for the DSM-IV PD (2). Ryo et al. (23)
Frontiers in Psychiatry | www.frontiersin.org 4October 2021 | Volume 12 | Article 754174
Zhao et al. Comparation Between Schizophrenia and Depression
TABLE 4 | Correlations of different types of personality disorder traits in patients with schizophrenia and those with major depressive disorder.
SZ r(p) PAR SCH SCHT HIS NAR BOR ANT AVO DEP OBS
EA 0.112** 0.011 0.132** 0.024 0.101* 0.062 0.108* 0.000 0.057 0.042
PA 0.018 −0.037 0.022 0.036 0.044 0.034 0.117** −0.057 −0.011 −0.036
SA 0.070 0.002 0.104* 0.056 0.083 0.081 0.117** 0.011 0.081 0.026
EN 0.085 0.036 0.071 0.043 0.062 0.049 0.028 −0.015 −0.067 0.005
PN 0.036 0.026 −0.003 −0.002 0.057 0.016 0.001 −0.025 0.020 0.004
MDD r(p) PAR SCH SCHT HIS NAR BOR ANT AVO DEP OBS
EA 0.198** 0.074 0.144** 0.124** 0.195** 0.206** 0.266** 0.043 0.078 0.023
PA 0.159** 0.062 0.124** 0.048 0.127** 0.137** 0.193** −0.015 0.020 0.024
SA 0.110* −0.025 0.059 0.161** 0.103* 0.194** 0.198** −0.041 0.053 0.010
EN 0.090* 0.080 0.098* 0.052 0.038 0.083 0.083 0.064 0.023 −0.009
PN 0.054 0.106* 0.118** 0.038 −0.030 0.062 0.074 0.025 0.054 0.014
SZ, schizophrenia; MDD, major depressive disorder; PAR, Paranoid; SCH, Schizoid; SCHT, Schizotypal; HIS, Histrionic; NAR, Narcissistic; BOR, Borderline; ANT, Antisocial; AVO,
Avoidant; DEP, Dependent; OBS, Obsessive-compulsive; EA, Emotional abuse; PA, Physical abuse; SA, Sexual abuse; EN, Emotional neglect; PN, Physical neglect. *Correlation is
significant at the 0.05 level (2-tailed). **Correlation is significant at the 0.01 level (2-tailed). Bold in significant.
TABLE 5 | Forward stepwise regression for distinguishing between patients with schizophrenia and major depressive disorder.
Variables in Model Beta S.E. Odds ratio 95% CI Wald statistic p-value
Age 0.020 0.007 1.020 1.006–1.035 7.436 0.006
SCHT −0.239 0.044 0.788 0.723–0.858 29.665 0.000
ANT −0.231 0.049 0.793 0.720–0.874 21.968 0.000
BOR 0.277 0.043 1.320 1.212–1.437 40.772 0.000
NAR 0.113 0.041 1.119 1.033–1.213 7.629 0.006
AVO 0.116 0.044 1.123 1.029–1.225 6.772 0.009
EA 0.061 0.025 1.062 1.011–1.117 5.730 0.017
SA −0.112 0.039 0.894 0.828–0.966 8.091 0.004
EN 0.035 0.016 1.036 1.004–1.068 4.799 0.028
PN −0.070 0.025 0.932 0.887–0.979 7.854 0.005
SCHT, Schizotypal; ANT, Antisocial; BOR, Borderline; NAR, Narcissistic; AVO, Avoidant; EA, Emotional abuse; SA, Sexual abuse; EN, Emotional neglect; PN, Physical neglect.
explored the role of personality traits, childhood abuse, and
depressive symptoms in patients with SZ. They found that
personality traits mediate the relationship between childhood
abuse and depressive symptoms, and that such mediator effect
could occur independently of the type of psychiatric disorders.
In other words, PD traits may play a more important role in the
relationship between CTE and MDD (24), than between CTE
and SZ. From the perspective of clinical intervention, it may
be of more significance to systematically understand CTE and
PD traits for psychological intervention of patients with MDD
than SZ.
CTE
EN reported by the participants were more frequent in
the patients with MDD than those with SZ, as confirmed
through a recent meta-analysis (11). Surprisingly, patients with
SZ endorsed SA more than patients with MDD. Consistent
with an umbrella review by Helen et al. (25), they found
that there is high-quality evidence supporting the association
between childhood SA and two psychiatric disorders: SZ and
post-traumatic stress disorder. Other studies have found that
the association of SA with schizophrenia is not consistent
(26–28). The current retrospective study cannot conclude that
SA is a causal factor of SZ, but it does not rule out the
possibility. At the very least, the evidence suggests that victims
of childhood adversities are more vulnerable to particular kinds
of stress in many ways and that the adverse effects can be
long-lasting (29). We also note that emotional abuse and
neglect elevate susceptibility to MDD. Emotional abuse and
neglect, defined as recurrent parental critical attacks, rejection,
devaluation, contempt, and ignoring the child. An implication
of this perspective is that emotional maltreatment should have
significant consequences for depression development, impacting
not only on the personality organization but also on the
individual’s mood states.
Associations Between PD Traits and CTE
Interestingly, significant associations were mainly between
childhood abuse and cluster A PD traits in the SZ group.
Moreover, all types of CTE and Cluster B (including BOR, HIS,
NAR, ANT, are characterized by dramatic and unpredictable
behaviors) and Cluster A PD traits were significantly related
Frontiers in Psychiatry | www.frontiersin.org 5October 2021 | Volume 12 | Article 754174
Zhao et al. Comparation Between Schizophrenia and Depression
in the MDD group. Previous evidence (30,31) has suggested
possible mediating effects of PD traits between childhood
adversities and psychiatric disorders. Our results further
determined that this intermediate effect may be more focused in
related PD traits corresponding to specific psychiatric disorders
(i.e., Cluster A PDs to SZ, Cluster B PDs to MDD). Such
correlation patterns were confirmed by our regression analysis.
This suggests that the effects of CTE and PD traits are different in
different psychiatric disorders. For example, MDD and SZ may
result from two pathways with different types of CTE and PD
traits contributing: (1) SZ: childhood SA and PN to Cluster A
PD traits to SZ, and (2) MDD: childhood EA and EN to Cluster
B PD traits to MDD. However, it is very difficult to be certain if
CTE acts as a general stressor for PD and psychiatric disorders,
or if CTE is a causative factor with a more genetic influence in
its development?
Limitations
Several limitations should be considered when interpreting our
findings. The patients with SZ were significantly younger than
those with MDD (by an average of ∼1–2 years). Thus, there
may be potential selection bias and memory information bias,
as younger patients would be more likely to recall and report
CTE than the elderly. Second, PD traits and CTE were assessed
using a self-report, retrospective measure. Self-report measures
assume reliable reporting, which may be a concern in our patient
populations, especially in patients with SZ, who are more likely
to have cognitive impairment (32–34). Furthermore, the data are
cross-sectional, cohort studies are more valuable for establishing
a temporal link between CTE, PD traits, and later psychiatric
disorders. Finally, this is a single-center study, and our sample
may not represent the entire Chinese population. Consequently,
the generalizability of our findings may be limited. However, the
single-site design may have increased sample homogeneity and
diagnostic consistency.
CONCLUSIONS
Our results show that most PD traits and childhood emotional
adversities were more prominent in patients with MDD.
In contrast, childhood sexual and physical adversities are more
prominent in patients with SZ. The history of CTE is significantly
related to specific PD traits of the disease spectrum, such as SCH
and SCHT PD traits in the psychotic spectrum, and BOR and
NAR PD traits in the affective spectrum. Therefore, both CTE
and PD traits have the potential to be premorbid risk factors
that could be targeted for preventative interventions, including
cognitive behavioral therapy (35).
DATA AVAILABILITY STATEMENT
The original contributions presented in the study are included
in the article/supplementary material, further inquiries can be
directed to the corresponding author/s.
ETHICS STATEMENT
The studies involving human participants were reviewed and
approved by Ethical Committee of Shanghai Pudong New Area
Mental Health Center. The patients/participants provided their
written informed consent to participate in this study. Written
informed consent was obtained from the individual(s) for the
publication of any potentially identifiable images or data included
in this article.
AUTHOR CONTRIBUTIONS
NZ collected the data and performed the statistical analyses. DS
wrote the original manuscript. JH and QC designed and wrote
the study protocol. QW offered many important suggestions on
this study. All authors contributed to the article and approved the
submitted version.
FUNDING
This study was supported from Excellent Young Medical
Talents Training of Health Commission of Pudong New Area
(PWRq2020-49); Pudong New Area of Science and Technology
Development Fund (PKJ2019-Y25); Shanghai Municipal Health
Industry Clinical Research Project (2020Y194).
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