Psychological and behavioral mechanisms linking childhood trauma profiles to voice-related distress in schizophrenia spectrum disorders: latent class, mediation, and conditional process analyses

Background Childhood traumas increase the risk of psychosis and voice-hearing. While trauma profiles have been identified in voice-hearers, pathways linking these to voice-related distress remain unclear. This study examined between-group differences in mediation by psychological and behavioral variables in profile–distress associations, with potential moderation by gender. Methods This cross-sectional study derived childhood trauma profiles via latent class analysis of Childhood Trauma Questionnaire (CTQ) scores from 266 voice-hearing Challenge trial participants with schizophrenia-spectrum diagnoses. Mediation analyses (structural equation modeling with bootstrapped 95% confidence intervals for indirect effects) tested between-group differences in indirect effects of negative voice content, persecutory beliefs about voices, voice power, voice relating style, negative self/other beliefs, emotion regulation, depression, and sleep disturbances in the association between childhood trauma profiles (exposure) and voice-related distress (outcome), with gender as a moderator. Hypotheses were preregistered on the Open Science Framework. Reporting followed AGReMA-guidelines. Results Three childhood trauma profiles were established: (1) ‘variable severity’ (n = 160), (2) ‘severe neglect and emotional abuse’ (n = 84), and (3) ‘severe poly-trauma’ (n = 22). Significant between-group differences in indirect effects were observed for persecutory beliefs about voices (1 < 3), voice power (1 < 3), and sleep disturbances (1 < 2). Age-adjustment revealed a between-group difference in indirect effect of negative self-beliefs (1 < 3). No moderation by gender was found. Conclusions This is the first investigation of mediators and moderators of childhood trauma profiles and voice-related distress in clinical voice-hearers. Findings suggest that trauma profiles may provide indicators of mediators potentially relevant to inform individualized formulation and therapy planning.