Introduction
Psychotic-like experiences (PLEs) are conceptualized as the resemblance of positive symptoms of psychosis in the absence of a full-blown psychotic disorder and mostly transient in nature [
1]. PLEs are commonly observed in both adolescents and young adults, while the prevalence rate reported is highly variable because of different measures and ways of constructing definitions. For example, Mamah et al. using the Washington Early Recognition Center Affectivity and Psychosis (pWERCAP) Screen reported that 72% of the adolescents and young adults in Kenya experienced at least one PLE within the past year [
2]. In contrast, Adewuya et al. found that 10.5% of adolescents in Lagos had clinically significant PLEs, based on the 16-item version of the Prodromal Questionnaire [
3]. In the Chinese context, according to the 8-item Positive Subscale of the Community Assessment of Psychic-Experiences (CAPE-P8), Sun et al. revealed that 20.7% of adolescents and young adults suffered from frequent PLEs during their lifetime [
4]. Using the same instrument, namely CAPE-P8, a recent study showed that nearly half of the junior and senior high school students (49.3%) had at least one episode of PLE within a month and 15.4% of adolescents had frequent PLEs [
5]. In general, the prevalence rate of PLEs increased from age 13 to 24, with a substantial peak during late adolescence [
6]. Meanwhile, PLEs are considered as a predictive indicator of many mental health illnesses. PLEs are associated with an increased risk of mental disorders, as well as significant impairments in social functioning [
1]. For instance, PLEs in early life are related to an improved chance of later psychotic disorders [
7], mood disorder [
8], self-harm or suicidal behavior [
9], and increased mental health service use [
10]. Given the prevalence of PLEs and their deleterious impact on future individual well-being, it is necessary to investigate influential factors for PLEs, particularly in late adolescence (e.g., college students), to provide crucial information for early mental health interventions.
The pathogenesis of PLEs is a complex process influenced by various factors, including environmental and genetic factors [
11,
12]. Childhood trauma is proven to be one of the environmental factors that can contribute to PLEs [
13,
14]. Childhood trauma encompasses a range of adverse events occurring in childhood, including but not limited to neglect and abuse, and may lead to mental health problems across the lifespan [
15]. Substantial clinical and epidemiological studies offered compelling evidence that those who have experienced childhood trauma are more likely to sustain PLEs [
4,
16,
17]. Research has also indicated a positive relationship between childhood trauma and PLEs among college students [
18‐
20].
Undoubtedly, resilience is a crucial protective factor for an individual’s mental health and has been given various meanings by scholars in previous studies. For some, resilience is considered as an outcome [
21], a process [
22], and a modifiable personal quality [
23]. Given this, previous studies on childhood trauma and psychopathology have raised a host of modalities (i.e., mediating or moderating) through which resilience is related to poor mental health. This view coincides with the results of a recent meta-analysis, which showed that resilience is both a mediator and moderator of the correlation between childhood trauma and depression [
24]. Specifically, when resilience is understood as an intermediate process, wherein an individual presents a positive adaptation to stress, crisis, and adversity [
25], it may be the link between childhood trauma and psychological problems. For instance, several studies indicated that resilience mediated the relationship between childhood trauma and mental health problems [
26,
27]. While in some studies, resilience was also found to act as a moderator to alleviate the negative effects of childhood trauma on individual mental health [
28,
29]. From the perspective of the risk-protective theory, resilience can play a buffering role in psychological distress to compensate for stressors [
30]. To conclude, current research on the role of resilience in the association between childhood trauma and PLEs is limited, particularly among adolescents and young adults.
Given the above, college students were investigated in this study to explore the associations linking childhood trauma, resilience, and PLEs. Our major hypotheses are: (1) childhood trauma is positively significantly associated with PLEs among college students; (2) resilience mediates the childhood trauma-PLEs link; (3) resilience moderates the childhood trauma-PLEs association.
Discussion
The present study aimed to deepen our understanding of how childhood trauma may be linked to PLEs by testing the mediating and moderating roles of resilience with a sample of college students. Our findings supported the hypothesis, indicating that resilience might mediate the effect of childhood trauma on PLEs, and also moderate the relationship of childhood trauma with PLEs.
In this sample, 42.2% of college students have had at least one PLE in the past month, which is lower than the finding with the same measure of Chinese junior and senior high school students (49.3%) [
5]. Only 4.8% of college students have frequent PLEs. PLEs are infrequent for most adolescents who experienced them [
46,
47]. In addition, PLEs were negatively associated with age and grade. In fact, 75 ∼ 90% of PLEs are temporary in adolescents, resolving or even disappearing with age, and only a small proportion would develop into persistent conditions [
1].
Consistent with previous studies [
18‐
20], childhood trauma was positively associated with PLEs. This relationship can be explained by several theories, including the genetic predisposition hypothesis, stress-vulnerability model, and attachment theory [
48]. The psychosis proneness-persistence-impairment model [
1] indicated that genetic factors may interact with environmental risk during childhood (e.g., early trauma), which could result in traits such as biological and psychological sensitization. These traits can potentially contribute to the persistence of PLEs with adverse outcomes. Additionally, structural and functional brain alterations and basic neurocognitive deficits caused by childhood trauma led to increased vulnerability to PLEs [
13,
49‐
51].
In line with previous studies [
20,
52], resilience was negatively associated with PLEs. Resilience has been regarded as a protective factor against poor mental health; better resilience facilitates remission of PLEs [
53]. Our results indicated that resilience moderates the association between childhood trauma and PLEs, which is in line with previous studies. For instance, Dale et al. concluded that resilience has a moderating effect between childhood sexual abuse and depression among women with and at risk for HIV [
54]. Sleijpen et al. also found a moderating effect of resilience between potentially traumatic events and mental health problems and life satisfaction in refugees and adolescents [
55]. The finding also supported the risk-protective theory [
30] that resilience can paly a buffering role in mental health to compensate for negative stressors. The results of simple slope analysis also suggested that the effect of childhood trauma on PLEs significantly varied at levels of resilience. More specifically, these findings revealed that having experience of childhood trauma, college students with a higher level of resilience developed less frequency of PLEs, while those with a lower level of resilience developed a greater frequency of PLEs. In brief, with higher resilience, the association between childhood trauma and PLEs became weaker.
Our results also proved that resilience was a partial mediator between childhood trauma and PLEs. The results corresponded to previous studies that resilience played a mediating role between early traumatic life events and PLEs in young adults [
56]. In Ungar’ s opinion, resilience is the ability of adolescents to navigate towards health-maintaining resources they needed in the context of adversity [
57]. Higher resilience may enable people to leverage their personal positive resources [
58] and successfully adapt to adversity [
59]. Individuals who are better able to cope with adversity or stressful events exhibit fewer psychological problems [
60]. By contrast, individuals who have experienced major childhood trauma may change their attitude toward the world (i.e., pessimistic, helpless, and hopeless), unable to adapt to adversity well and may develop many mental disorders [
61].
This study also showed signiciatnt mediating and moderating effects of resilience both in the relationship between childhood trauma and DEs/ HEs. Interestingly, our findings suggest that resilience paly a slightly stronger mediating role on childhood trauma - DEs link, while paly a stronger moderating role on childhood trauma - HEs associatioin. This result may reflect a greater direct effect of resilience on DEs, but for HEs, resilience has a primarily indirect effect by moderating childhood trauma. However, in one of our previous studies, we showed that the moderating role of resilience in sleep distrbance and DEs see little difference from that between sleep distrbance and HEs [
52]. Further research is therefore necessary to explore the role of resilience on DEs and HEs.
This study has several limitations that need to be noted. First, all the measures used in the current study were self-reported, which may lead to recall bias of history of childhood trauma and frequency of PLEs. Second, this study is based on a cross-sectional survey, which may limit the inference of causality. Moreover, the current study examined the effects of overall childhood trauma on PLEs, without differentiating types of trauma. Different subtypes of childhood trauma may have different impacts on PLEs [
62], which should be explored in the following studies by recruiting more participants. Third, our data were collected through online sources, exclusively focusing on students from a single university. Consequently, caution is advised when interpreting the accuracy and representativeness of the data. Moreover, it shall be noted that our data might be influenced by the COVID-19 pandemic since its associated stresses may increase the severity of PLEs [
20,
63]. Finally, several important confounder factors that may affect the study findings, such as current negative life events and depressive symptoms, have not been considered.
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