- Open Access
Mediating role of impaired wisdom in the relation between childhood trauma and psychotic-like experiences in Chinese college students: a nationwide cross-sectional study
BMC Psychiatry volume 22, Article number: 655 (2022)
The association between childhood trauma (CT) and psychotic-like experiences (PLEs) is well-established. Many previous studies have recognized wisdom as a protective factor for mental health, but its role in the relation between CT and PLEs remains unknown. We aimed to investigate the mediating effect of wisdom in the above association among Chinese college students.
We conducted a nationwide survey covering 9 colleges across China and recruited a total of 5873 students using online questionnaires between September 14 and October 18, 2021. Convenience sampling was adopted. We employed the San Diego Wisdom Scale (SD-WISE), the Childhood Trauma Questionnaire (CTQ-28), and the 15-item Positive Subscale of the Community Assessment of Psychic Experiences (CAPE-15) to measure the wisdom, CT and PLEs, respectively. Descriptive, correlation, and mediation analysis were utilized.
The positive correlation between CT and PLEs was well-replicated among college students (Pearson’s r = 0.30, p < 0.001). Wisdom was negatively associated with CT (Pearson’s r = − 0.46, p < 0.001) and frequency of PLEs (Pearson’s r = − 0.25, p < 0.001). Total wisdom scores partially mediated the relationship between cumulative childhood trauma, neglect, abuse and PLEs, separately. The mediated model respectively explained 21.9%, 42.54% and 18.27% of the effect of CT on PLEs. Our model further suggested that childhood trauma could be related to PLEs through decreasing the following wisdom components: decisiveness, emotional regulation and prosocial behavior.
For the first time, our results suggested that impaired wisdom played a role in the translation from childhood adversity to subclinical psychotic symptoms, implicating wisdom as a possible target for early intervention for psychosis among young individuals. Longitudinal work is warranted to verify the clinical implications.
Childhood trauma (CT) or adversity is defined as the physical, sexual, or emotional abuse or neglect of a child, especially by parents or other caregivers. CT is a serious, worldwide public health problem which is closely related to the mental health of the youth . Studies have shown that CT is associated with diverse mental illnesses including major depressive disorder , bipolar disorder  and psychosis [4,5,6], indicating a broad association of CT with psychopathology rather than with a single disorder. In the non-clinical population, CT has also been demonstrated to be associated with numerous mental health problems, including the well-studied psychotic-like experiences (PLEs) .
PLEs are generally considered to resemble positive symptoms which including delusions and hallucinations of psychotic disorders but do not reach the threshold of clinical diagnosis [8,9,10,11,12]. It is suggested that those who reported PLEs have a higher risk of developing clinical psychosis . Previous studies [14,15,16] have been conducted on the relationship between CT and psychosis, all of which indicated that CT was associated with an increased risk for psychosis spectrum. Consequently, tackling the mechanism between CT and PLEs carries undeniable significance, considering the PLEs as a possible risk state for clinical psychosis and other psychiatric disorders [17,18,19,20].
Multiple factors have contributed to the relationship between CT and subsequent PLEs so far. Psychological and cognitive factors, for example, aberrant salience and self-disturbances  have been found to be mediators of the relationship between CT and PLEs in the general population. There are also studies showing the disruption in sleep dissociation , ontological insecurity , stress sensitivity  and cognitive vulnerability  involved in this relationship. Moreover, cognitive biases play important roles in the relationship between childhood traumatic events and the development of PLEs in non-clinical young adults . These previous works provided important insights into the mechanism between CT and PLEs, but many of them adopted community-based approach and often included a small sample, which limited the generalizability of their results. Further investigation into the mediating factors, especially those suitable for interventions, in the association between CT and PLEs is warranted.
Wisdom, a neurobiological personality trait, which includes emotional regulation, self-reflection, prosocial behavior, decisiveness, social advice, and tolerance and spirit for different values [26,27,28], is an ancient psychological construct with a long history . Empirical research of wisdom has been widely conducted since the 1970s. Moreover, it has been shown that increasing in wisdom can ease a number of mental health problems by means of improved personal well-being and happiness , but negatively associated with adverse physical and mental outcomes [31, 32], suggesting a protective role of wisdom to health. Furthermore, several studies showed that childhood maltreatment was significantly associated with some aspects of wisdom, for instance, prosocial behaviors  and emotional regulation , and predicted less self-reflection . The commonly applied tools to measure wisdom includes the Self-Assessed Wisdom Scale (SAWS) , the Three-Dimensional Wisdom Scale (3D-WS) [37, 38] and the San Diego Wisdom Scale (SD-WISE) . Of note, the SD-WISE, including six dimensions of wisdom, is the first wisdom measuring tool developed by psychiatrists and based on possible wisdom-related neurobiological mechanisms after reviewing many cases with brain lesions . Some aspects of wisdom were previously found to be related to psychosis risks. For instance, self-reflection was similarly impaired in participants with psychosis proneness compared to patients with clinical psychosis . The cognitive model of psychosis suggests that multiple form of cognitive biases, such as jump to conclusion and aberrant salience, played important roles in the maintenance of psychotic symptoms . Difficulties with emotion regulation was found to be associated with the frequency and distress caused by psychotic experiences . However, the association of PLEs and other components of wisdom, such as decisiveness, were still understudied.
Previous studies have found that childhood trauma has been shown to predict the onset and persistence of PLEs [43, 44] and is associated with some dimensions of wisdom as previously mentioned. According to previous research, wisdom can exert profound positive effects on life satisfaction , which is closely related to individual’s well-being  and mental health . Proposed hypothesis highlighted that higher levels of specific components of wisdom may help alleviate the negative effects of physical decline , further improve personal happiness. Furthermore, some aspects of wisdom, such as emotional regulation and self-cognition have been studied as mediators in the relation between CT and PLEs [49, 50] by damaging the concurrent psychopathology .
Further, given that wisdom is amenable to interventions  and plays an important role in an individual’s mental health , it is still unclear whether wisdom can reduce the emergence of distressing PLEs, especially among those impacted by childhood trauma. Meanwhile, studies that specifically investigate the role of wisdom in the mental health of college students are still lacking. College students are in their early stage of adulthood, which is the main risk age stage of psychotic disorders . For this reason, examining the role of wisdom in the relation between CT and PLEs might implicate possible targets for the early prevention of clinical psychosis among those suffered from childhood adversity.
In the current study, we addressed the above concerns and recruited a large sample of college students from 9 universities across China to investigate the mediating role of wisdom in the association between CT and PLEs in early adulthood. Specifically, we explored several hypotheses and expected to see: (1) the positive correlation between CT and PLEs is well-replicated in Chinese college students. (2) total wisdom and its different components have protective effects for PLEs and are negatively correlated with CT and PLEs. (3) wisdom moderated the relation between CT and the frequency of PLEs. We further explored this moderation of six putative components of wisdom on the relation between childhood trauma (neglect and abuse) and PLEs to better implicate future intervention for psychosis in young adulthood.
A set of online questionnaires was built using the Questionnaire Star Platform (www.wjx.com). The online-based questionnaires were distributed to students through social media platforms by the school officers of different institutions, which included university students from Changsha in Hunan Province, Guangzhou in Guangdong Province, Nanning in Guangxi Province, Ganzhou in Jiangxi Province, Shijiazhuang in Hebei Province, Urumqi in Xinjiang Uygur Autonomous Region, Hohhot in Inner Mongolia Autonomous Region, Jining in Shandong Province and Qiqihar in Heilongjiang Province. The nine universities have a total undergraduate population of about 130,000. Among them, a total of 5993 undergraduates were recruited for this study. Participants who had been diagnosed with any psychiatric diseases (120 cases) were excluded, leaving a total N = 5873 (98.0% retained) completed surveys that were used for descriptive analyses.
Childhood trauma questionnaire (CTQ)
The Chinese version of the Childhood Trauma Questionnaire (CTQ) was administered to assess traumatic events during childhood [53, 54], a 28-item self-report inventory assessing five types of traumas experienced by a child or teenager: emotional abuse, physical abuse, sexual abuse, emotional neglect and physical neglect. Items were scored on a scale of 1–5 (1 = never to 5 = always). Total and subscale scores were calculated, with higher scores indicating higher severity of childhood trauma. In the present study, the CTQ total score displayed good internal consistency (Cronbach’s α = 0.869).
15-item Positive subscale of the community assessment of psychic experiences (CAPE-P15)
CAPE-P15 is designed to measure the frequency and distress associated with commonly-reported psychotic experiences . The scale has 15 items covering the following three domains: persecutory ideation (PI), bizarre experiences (BEs), and perceptual abnormalities (PAs) [56,57,58]. The CAPE-15 has two subscales: the frequency of PLEs and their associated distress. The frequency subscale was adopted in our work. Each item is marked on a scale of 1–4, from 1 = never to 4 = almost always. The Chinese version of CAPE-P15 has shown good reliability . The total frequency score of each subject was computed and showed good internal consistency (Cronbach’s α = 0.908).
San Diego wisdom scale (SD-WISE)
SD-WISE is consisted of 24 items, assessing human wisdom from the following six domains: social advising (insight), emotional regulation, prosocial behaviors, self-reflection, acceptance of divergent perspectives (tolerance), and decisiveness . A greater score on the SD-WISE corresponds to greater levels of wisdom (total score range = 1–5). We validated the six-factor structure of SD-WISE using a sample of 900 college students in a prior study. The relevant article is currently being under review for publication. The Chinese version of the SD-WISE in this sample has good reliability (Cronbach’s α = 0.781).
First, descriptive analyzes (N = 5873) were performed to describe the sample characteristics. Second, Pearson’s correlation was conducted between three variables to explore the bivariate interrelation between CT, PLEs and wisdom. Third, we examined the role of wisdom in the relationship between CT and PLEs. Participants with missing values in demographic data were eliminated from the analysis, leaving a total of 5835 individuals for correlation and mediation analysis. Considering abuse and neglect may contribute to PLEs in different manner, separate mediation models between CT and PLEs were also established for two traumatic domains . According to Baron and Kenny [60, 61], a mediation model includes the following four steps, the first step is to check the independent variable (CT) whether has an influence on the final outcome (frequency score of PLEs). The second step is the effect between the independent variable (CT) and the proposed mediator (wisdom). The third step is to assess the relationship between the proposed mediator (wisdom) and the dependent (frequency score of PLEs) after control the independent variable (CT). The last step is to check if the effect between the independent (CT) and the dependent variable (frequency score of PLEs) is reduced (= partial mediation) after controlling the proposed mediator (wisdom). According to the procedures outlined by Baron and Kenny, the mediating effect is established only when the second and the third steps are statistically significant, the 95% CI did not contain zero, and the last steps are less significant.
We hypothesized that wisdom is negatively associated with CT and PLEs, and wisdom further affect the relationship between CT and PLEs. Three mediation models were performed to examine the role of wisdom in the relation between total subtypes (cumulative childhood trauma, childhood abuse and childhood neglect) of CT and the frequency of PLEs. Moreover, we built separate mediation analysis to assess the effects of six wisdom components on the relation between the cumulative trauma and PLEs frequency, for different wisdom factors may have different effects on the association between CT and PLEs. In addition, compared to men, women are at significantly higher risk of certain forms of trauma, such as sexual abuse [62, 63]. Further, sex has been investigated differences in the expression of PLEs between males and females. Females also seem to be more likely to show positive symptoms such as hallucinations and age was reported to associated with the wisdom level [64, 65]. To avoid the potential confounding effects, sex and age were considered as covariates in the mediation analysis. The significance effect of the third step was derived based on a bias-corrected bootstrap confidence interval (CI) based on 5000 bootstraps, which were reported if 95% CI did not cover zero.
One hundred and twenty participants were excluded for self-reported and any history of mental illnesses, a total of 5873 adolescents entered descriptive analysis. The mean age of our participants was 19.36 (S.D. = 1.486) and 57.33% were females. Other details of our sample’s characteristics were presented in Table 1.
Correlation results showed that cumulative childhood trauma (r = 0.30, P < 0.001), childhood neglect (r = 0.21, P < 0.001) and childhood abuse (r = 0.29, P < 0.001) were all significantly positively correlated with the frequency of PLEs, while the total score of CTQ was also negatively related to SD-WISE (r = − 0.46, p < 0.001) and its subscales. Meanwhile, negative correlations were observed between PLEs and SD-WISE total score (r = − 0.25, p < 0.001), as well as the components of wisdom. Details of the coefficients were presented in Table 2.
Cumulative childhood trauma to PLEs
As displayed in Fig. 1, the effect of cumulative trauma on PLEs was 0.1059 (SE = 0.0042, 95% CI [0.0976, 0.1142]), the effect of wisdom on PLEs after control CT was 0.0122 (SE = 0.0027, 95% CI [0.0068, 0.0173]) and the effect of CT on PLEs after control wisdom was 0.0827 (SE = 0.0047, 95% CI [0.0735, 0.0918]), which became less but did not cross zero, indicated that wisdom partially mediated the relationship between cumulative childhood trauma and PLEs. In addition, the ratio of investigating effect over the effect of cumulative trauma on PLEs was 21.9%. We noticed that decisiveness (SE = 0.0007, 95% CI (0.0039, 0.0068)), emotional regulation (SE = 0.0019, 95% CI (0.0234, 0.0311)) and prosocial behavior (SE = 0.0024, 95% CI (0.0085, 0.0179)) were all significant mediators.
Childhood neglect to PLEs
The effect of childhood neglect on PLEs was 0.1448 (SE = 0.0080, 95%CI [0.1291,0.1605]) and the effect of Childhood neglect on PLEs after control wisdom was 0.0832 (SE = 0.0091, 95%CI [0.0653, 0.1010]), which did not cover zero, wisdom partly mediated the relationship between childhood neglect and PLEs. The mediated model explained 42.54% of the model effect. Similarly, we noticed that decisiveness (SE = 0.0014, 95% CI (0.0066, 0.0120)), emotional regulation (SE = 0.0038, 95% CI (0.0488, 0.0634)) and prosocial behavior (SE = 0.0049, 95% CI (0.0222, 0.0413)) were all significant mediators.
Childhood abuse to PLEs
The effect of childhood abuse on PLEs was 0.1598 (SE = 0.0067, 95% CI [0.1426,0.1729] and the effect of Childhood abuse on PLEs after control wisdom was 0.1306 (SE = 0.0069, 95% CI [0.1117, 0.1440]) on, which did not cover zero, wisdom partly mediated the relationship between childhood abuse and PLEs. The mediating model explained 18.27% of the model effect. Consistently with previous, decisiveness (SE = 0.0010, 95% CI (0.0048, 0.0087)), emotional regulation (SE = 0.0024, 95% CI (0.0239, 0.0332)) and prosocial behavior (SE = 0.0027, 95% CI (0.0114, 0.0219)) were all significant mediators.
To the best of our knowledge, this is the first study to determine the role of wisdom on the relationship between CT and PLEs in a multicenter non-clinical student sample. Specifically, we reported three important findings, first, participants with more trauma reported higher score of PLEs and lower score of wisdom. Second, wisdom was found significantly negatively correlated with CT and PLEs. Third, we found that the association between CT and the occurrence of PLEs can be mediated by decreased wisdom level.
The relationship between childhood maltreatment and psychotic symptoms has been well-established. In line with previous studies [25, 68,69,70], we replicated the positive correlation between CT and PLEs in Chinese university students, further validating the connection between early childhood trauma and psychosis risks. Moreover, we identified the mediating role of decisiveness, prosocial behavior, emotional regulation and total score of wisdom in the relationship between CT and PLEs. All in all, our results support the assumption that deficits in wisdom are significantly impact on the pathway between CT and PLEs, which are in line with some previous studies [34, 71]. The research expanded on previous findings by investigating the mediating role of wisdom in a large multicenter sample of Chinese university students. What’s more, in accord with previous research [72,73,74,75], we discovered that specific aspects of wisdom were significant mediators in the relationship between CT and PLEs. Since our study also revealed that wisdom was inversely correlated with PLEs, we considered that exposure to traumatic events in childhood leads to psychotic symptoms by reducing individual cognitive function or emotion regulation, further impact on wisdom level. Our results implicated that the experience of traumatic life events during childhood may have a strong influence on the wisdom level in adulthood, thus increasing the frequency of psychotic experiences.
The significant effect of the wisdom alleviated the impact of CT on PLEs can be understood by an ancient mechanism [30, 49]. The component of wisdom, such as prosocial behavior and emotional regulation, improves with critical life experiences, which contributes to increase wisdom, further protecting individual mental health and reducing the occurrence of mental disorders. Treatment goals of trauma therapies or intervention for people at high risk of mental disorders is the raising of wisdom.
Regarding the model of childhood neglect - wisdom - PLEs and childhood abuse - wisdom - PLEs, we both found significant partial mediation. Compared to childhood neglect, we observed that childhood abuse was particularly associated with PLEs, indicating that the type of trauma could be relevant for the development of PLEs.
Our findings may have important clinical implications. Considering that wisdom is the quality of a possible trait can be enhanced , which may be beneficial for enhancing the mental health of population with traumatic experiences in which all markers should be extensively assessed. Consequently, targeted interventions to enhance wisdom may have the potential to reduce the impact of early childhood adversity on the emergence of PLEs, and even lower the social burden of psychosis considering PLEs as a risk factor to clinical psychosis.
Limitations should be considered in our research. First, in this research, 38 participants were excluded due to missing data, which may cause potential selection bias. Second, the cross-sectional nature of our study limited the inference of causal relationship, further longitudinal design is warranted to verify the role of wisdom in psychosis risk studies. Furthermore, the self-report measures may limit the precise positioning of PLEs.
To conclude, our findings indicate that wisdom could play a role in psychosis proneness among non-clinical college students exposed to childhood trauma, and further emphasize the relevance of assessing and boosting wisdom when working with individuals who are in a vulnerable stage for mental health problems.
The datasets used and/or analyzed in the current study are available from corresponding authors on reasonable request.
the San Diego Wisdom Scale.
the Childhood Trauma Questionnaire.
the 15-item Positive Subscale of the Community Assessment of Psychic Experiences.
the Self-Assessed Wisdom Scale.
the Three-Dimensional Wisdom Scale.
Nelson CA, et al., Adversity in childhood is linked to mental and physical health throughout life. BMJ (Clinical research ed.), 2020. 371: p. m3048.
Yap MBH, et al., Parental factors associated with depression and anxiety in young people: a systematic review and meta-analysis. Journal of affective disorders, 2014. 156.
Marangoni C, Hernandez M, Faedda GL. The role of environmental exposures as risk factors for bipolar disorder: A systematic review of longitudinal studies. J Affect Disord. 2016;193:165–74.
Fusar-Poli P. The Clinical High-Risk State for Psychosis (CHR-P), Version II. Schizophr Bull. 2017;43(1):44–7.
Morgan C, Gayer-Anderson C. Childhood adversities and psychosis: evidence, challenges, implications. World psychiatry: official journal of the World Psychiatric Association (WPA), 2016. 15(2).
Fusar-Poli P, et al. Deconstructing vulnerability for psychosis: Meta-analysis of environmental risk factors for psychosis in subjects at ultra high-risk. Eur psychiatry: J Association Eur Psychiatrists. 2017;40:65–75.
Andorko ND, et al. Association between sleep, childhood trauma and psychosis-like experiences. Schizophr Res. 2018;199:333–40.
Lee K-W, et al., A systematic review on definitions and assessments of psychotic-like experiences. Early intervention in psychiatry, 2016. 10(1).
Yung AR, et al. Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Aust N Z J Psychiatry. 2009;43(2):118–28.
Kelleher I, Cannon M. Psychotic-like experiences in the general population: characterizing a high-risk group for psychosis. Psychol Med. 2011;41(1):1–6.
Armsden GC, Greenberg MT. The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc. 1987;16(5):427–54.
Vanore M, Mazzucato V, Siegel M. ‘Left behind’ but not left alone: parental migration & the psychosocial health of children in Moldova. Social science & medicine (1982), 2015. 132: p. 252–260.
Poulton R, et al. Children’s self-reported psychotic symptoms and adult schizophreniform disorder: a 15-year longitudinal study. Arch Gen Psychiatry. 2000;57(11):1053–8.
Gibson LE, Alloy LB, Ellman LM. Trauma and the psychosis spectrum: A review of symptom specificity and explanatory mechanisms. Clinical Psychology Review, 2016. 49.
McKay MT, et al. Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies. Acta psychiatrica Scandinavica. 2021;143(3):189–205.
Misiak B, et al. Toward a unified theory of childhood trauma and psychosis: A comprehensive review of epidemiological, clinical, neuropsychological and biological findings. Neurosci Biobehav Rev. 2017;75:393–406.
Dominguez MDG, et al. Evidence that onset of clinical psychosis is an outcome of progressively more persistent subclinical psychotic experiences: an 8-year cohort study. Schizophr Bull. 2011;37(1):84–93.
Healy C, et al. Childhood and adolescent psychotic experiences and risk of mental disorder: a systematic review and meta-analysis. Psychol Med. 2019;49(10):1589–99.
McGrath JJ, et al., The Bidirectional Associations Between Psychotic Experiences and DSM-IV Mental Disorders. The American journal of psychiatry, 2016. 173(10).
Sullivan SA, et al. A Population-Based Cohort Study Examining the Incidence and Impact of Psychotic Experiences From Childhood to Adulthood, and Prediction of Psychotic Disorder. Am J Psychiatry. 2020;177(4):308–17.
Gawęda Ł, Göritz AS, Moritz S. Mediating role of aberrant salience and self-disturbances for the relationship between childhood trauma and psychotic-like experiences in the general population. Schizophr Res. 2019;206:149–56.
Marlowe NI, Nicholson Perry K, Lee J. Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like experiences. J Clin Psychol. 2020;76(3):440–60.
Rauschenberg C, et al. Stress sensitivity as a putative mechanism linking childhood trauma and psychopathology in youth’s daily life. Acta psychiatrica Scandinavica. 2017;136(4):373–88.
Jaya ES, Ascone L, Lincoln TM. Social Adversity and Psychosis: The Mediating Role of Cognitive Vulnerability. Schizophr Bull. 2017;43(3):557–65.
Frydecka D, et al. Effects of interactions between variation in dopaminergic genes, traumatic life events, and anomalous self-experiences on psychosis proneness: Results from a cross-sectional study in a nonclinical sample. Eur Psychiatry. 2020;63(1):e104.
Jeste DV, Harris JC. Wisdom–a Neurosci perspective JAMA. 2010;304(14):1602–3.
Lee EE, et al. Outcomes of Randomized Clinical Trials of Interventions to Enhance Social, Emotional, and Spiritual Components of Wisdom: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2020;77(9):925–35.
Jeste DV, et al. The New Science of Practical Wisdom. Perspect Biol Med. 2019;62(2):216–36.
Jeste DV, Vahia IV. Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: focus on the Bhagavad Gita. Psychiatry. 2008;71(3):197–209.
Webster JD, Westerhof GJ, Bohlmeijer ET. Wisdom and mental health across the lifespan. J Gerontol B Psychol Sci Soc Sci. 2014;69(2):209–18.
Ardelt M, Jeste DV. Wisdom and Hard Times: The Ameliorating Effect of Wisdom on the Negative Association Between Adverse Life Events and Well-Being. The journals of gerontology. Ser B, Psychological sciences and social sciences, 2018. 73(8): 1374–83.
Van Patten R, et al. Assessment of 3-dimensional wisdom in schizophrenia: Associations with neuropsychological functions and physical and mental health. Schizophr Res. 2019;208:360–9.
Bevilacqua L, et al. Adverse childhood experiences and trajectories of internalizing, externalizing, and prosocial behaviors from childhood to adolescence. 112: Child Abuse & Neglect; 2021. p. 104890.
Gruhn MA, Compas BE. Effects of maltreatment on coping and emotion regulation in childhood and adolescence: A meta-analytic review. 103: Child Abuse & Neglect; 2020. p. 104446.
Heinonen E, et al. Associations of early childhood adversities with mental disorders, psychological functioning, and suitability for psychotherapy in adulthood. Psychiatry Res. 2018;264:366–73.
Leeman TM, et al., An evaluation of the factor structure of the Self-Assessed Wisdom Scale (SAWS) and the creation of the SAWS-15 as a short measure for personal wisdom. Int Psychogeriatr, 2021: p. 1–11.
García-Campayo J, et al. Exploring the Wisdom Structure: Validation of the Spanish New Short Three-Dimensional Wisdom Scale (3D-WS) and Its Explanatory Power on Psychological Health-Related Variables. Front Psychol. 2018;9:692.
Fung SF, Chow EO, Cheung CK. Development and Evaluation of the Psychometric Properties of a Brief Wisdom Development Scale. Int J Environ Res Public Health, 2020. 17(8).
Thomas ML, et al. Individual differences in level of wisdom are associated with brain activation during a moral decision-making task. Brain Behav. 2019;9(6):e01302.
Modinos G, et al. Self-reflection and the psychosis-prone brain: an fMRI study. Neuropsychology. 2011;25(3):295–305.
Livet A, et al. Cognitive biases in individuals with psychotic-like experiences: A systematic review and a meta-analysis. Schizophr Res. 2020;222:10–22.
Osborne KJ, et al. Investigating the association between emotion regulation and distress in adults with psychotic-like experiences. Psychiatry Res. 2017;256:66–70.
Bechdolf A, et al. Experience of trauma and conversion to psychosis in an ultra-high-risk (prodromal) group. Acta psychiatrica Scandinavica. 2010;121(5):377–84.
Fisher HL, et al. Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC birth cohort. Schizophr Bull. 2013;39(5):1045–55.
Ardelt M, Wisdom and life satisfaction in old age. The journals of gerontology. Series B, Psychological sciences and social sciences, 1997. 52B(1): p. P15-P27.
Thomas ML, et al., Abbreviated San Diego Wisdom Scale (SD-WISE-7) and Jeste-Thomas Wisdom Index (JTWI). Int Psychogeriatr, 2021: p. 1–10.
Kunzmann U, Baltes PB. Wisdom-related knowledge: affective, motivational, and interpersonal correlates. Personal Soc Psychol Bull. 2003;29(9):1104–19.
Jeste DV, Oswald AJ. Individual and Societal Wisdom: Explaining the Paradox of Human Aging and High Well-Being. Psychiatry, 2014.
Hopfinger L, et al. Emotion regulation mediates the effect of childhood trauma on depression. J Affect Disord. 2016;198:189–97.
Fusar-Poli P, et al. Comorbid depressive and anxiety disorders in 509 individuals with an at-risk mental state: impact on psychopathology and transition to psychosis. Schizophr Bull. 2014;40(1):120–31.
Worthy DA, et al. With age comes wisdom: decision making in younger and older adults. Psychol Sci. 2011;22(11):1375–80.
Häfner H, Heiden W. Epidemiology of schizophrenia. Can J Psychiatry. 1997;42(2):139–51.
Bernstein DP, et al., Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child abuse & neglect, 2003. 27(2): pp. 169–90.
Wenqing F, Yu SY, Xingfu H, Li Z, Ying R, Yanqing L. Z., Initial reliability and validity of childhood Truama Questinnaire (CTQ-SF) apllied in Chinese college students. Chin J Clin Psychol. 2005;13(1):40–2.
Capra C, et al. Brief screening for psychosis-like experiences. Schizophr Res. 2013;149(1–3):104–7.
Bukenaite A, et al. Usefulness of the CAPE-P15 for detecting people at ultra-high risk for psychosis: Psychometric properties and cut-off values. Schizophr Res. 2017;189:69–74.
Núñez D, et al. Internal structure of the Community Assessment of Psychic Experiences-Positive (CAPE-P15) scale: Evidence for a general factor. Schizophr Res. 2015;165(2–3):236–42.
Wen ZB. Ye., The mediation analysis: methods and models development. Adv Psychol Sci. 2014;22(05):731–45.
Sun M, et al. Psychometric properties of the 15-item positive subscale of the community assessment of psychic experiences. Schizophr Res. 2020;222:160–6.
Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Personal Soc Psychol. 1986;51(6):1173–82.
Fairchild AJ, McDaniel HL. Best (but oft-forgotten) practices: mediation analysis. Am J Clin Nutr. 2017;105(6):1259–71.
Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–92.
Tiwari A, Gonzalez A. Biological alterations affecting risk of adult psychopathology following childhood trauma: A review of sex differences. Clin Psychol Rev. 2018;66:69–79.
Ardelt M, Gerlach KR, Vaillant GE. Early and Midlife Predictors of Wisdom and Subjective Well-Being in Old Age. J Gerontol B. 2018;73(8):1514–25.
Lim KTK, Yu R. Aging and wisdom: age-related changes in economic and social decision making. Front Aging Neurosci. 2015;7:120.
Hayes AF, Preacher KJ. Statistical mediation analysis with a multicategorical independent variable. Br J Math Stat Psychol. 2014;67(3):451–70.
Preacher KJ, Hayes AF, SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior research methods, instruments, & computers: a journal of the Psychonomic Society, Inc, 2004. 36(4): p. 717–731.
Kelleher I, et al. Associations between childhood trauma, bullying and psychotic symptoms among a school-based adolescent sample. Br J psychiatry: J mental Sci. 2008;193(5):378–82.
Bhavsar V, et al. Childhood abuse and psychotic experiences - evidence for mediation by adulthood adverse life events. Epidemiol Psychiatr Sci. 2019;28(3):300–9.
Cristóbal-Narváez P, et al. Impact of Adverse Childhood Experiences on Psychotic-Like Symptoms and Stress Reactivity in Daily Life in Nonclinical Young Adults. PLoS ONE. 2016;11(4):e0153557.
Yu G, Li S, Zhao F. Childhood maltreatment and prosocial behavior among Chinese adolescents: Roles of empathy and gratitude. 101: Child abuse & neglect; 2020. p. 104319.
Woodrow A, et al. Decision-making ability in psychosis: a systematic review and meta-analysis of the magnitude, specificity and correlates of impaired performance on the Iowa and Cambridge Gambling Tasks. Psychol Med. 2019;49(1):32–48.
Ludwig L, Werner D, Lincoln TM. The relevance of cognitive emotion regulation to psychotic symptoms - A systematic review and meta-analysis. Clin Psychol Rev. 2019;72:101746.
Raposa EB, Laws HB, Ansell EB. Prosocial Behavior Mitigates the Negative Effects of Stress in Everyday Life. Clin Psychol science: J Association Psychol Sci. 2016;4(4):691–8.
Krifa I, et al., Mental Health during COVID-19 Pandemic: The Role of Optimism and Emotional Regulation. International journal of environmental research and public health, 2022. 19(3).
This work was supported by the National Natural Science Foundation of China (grant number: 82071506, 2020).
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All of the participants signed informed consent before the survey. All methods of the study were carried out in accordance with the Declaration of Helsinki. The study was approved by the ethics committee of the Second Xiangya Hospital of Central South University (2016/036).
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The authors declare that they have no competing interests.
CTQ-28-Sum (Cumulative Trauma) – total score of the CTQ; Neglect – a summary of physical and emotional neglect subscales of the CTQ; Abuse – a summary of sexual, physical and emotional abuse subscales of the CTQ; SD-WISE- total score of the SD-WISE; CAPE-P15- total score of the frequency subscales of the PLEs.
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Zhang, J., Liu, Z., Long, Y. et al. Mediating role of impaired wisdom in the relation between childhood trauma and psychotic-like experiences in Chinese college students: a nationwide cross-sectional study. BMC Psychiatry 22, 655 (2022). https://doi.org/10.1186/s12888-022-04270-x
- Childhood trauma
- Mediating effect
- Psychotic-like experiences