A systematic review and meta-analysis of the association between stress reactivity and psychosis

Objective: Emotional stress reactivity may be a mediating factor in the association between trauma and psychosis. This review aimed to i) identify, summarise and critically evaluate the link between emotional stress reactivity and psychotic experiences ii) examine evidence for a ‘dose-response’ relationship between stress reactivity and psychosis in the wider psychosis phenotype (i.e. sub-clinical symptoms). Method: Electronic database searches (PsychINFO, MEDLINE, EMBASE) were conducted for studies which investigated the link between stress reactivity and psychosis, psychotic symptoms, or a vulnerability to developing psychosis (wider phenotype). Cross-sectional, experimental and experience sampling method study designs were eligible for inclusion. Results: 45 eligible articles were identified (N participants= 8830). Meta-analysis (k=4, n=383) showed increases in emotional stress reactivity was associated with higher negative affect in response to event-related stress, in those with psychosis compared to controls (mean difference in beta coefficients = 0.05, 95% CI 0.02 to 0.08, p=0.004). However, this difference was small with a considerable degree of heterogeneity (p=.001, I² = 81%) so results should be interpreted with caution. Narrative synthesis showed that increased emotional stress reactivity was associated with psychosis and subclinical psychotic experiences across all study designs, however, findings were inconsistent across studies. Conclusions: The results show emotional stress reactivity is associated with both clinical and subclinical psychosis symptoms. Overall, the evidence suggests that the link between emotional stress reactivity and psychosis and emotional stress reactivity is plausible mediator between trauma and psychosis. Further longitudinal research is needed to assess this.