Childhood trauma, anhedonia, and educational attainment in drug-naïve first-episode schizophrenia spectrum disorders: a case-control study

Childhood trauma, anhedonia, and educational attainment have been associated with psychosis, but their independent associations with drug-naïve first-episode schizophrenia spectrum disorders (FESSD) remain unclear. We examined the associations of childhood trauma, anhedonia, and sociodemographic factors with FESSD case status and symptom severity in an drug-naïve sample. In this cross-sectional case-control study, 274 participants, including 107 individuals with FESSD and 167 healthy controls, were assessed for childhood trauma and anhedonia. Multivariable logistic regression was used to identify factors independently associated with case status, and linear regression examined symptom severity within the FESSD group. Childhood trauma was independently associated with higher odds of FESSD (odds ratio [OR] = 5.38, 95% confidence interval [CI] 2.85–10.16, P < 0.001), as was greater anhedonia (OR = 1.78, 95% CI 1.29–2.46, P < 0.001), whereas higher educational attainment was inversely associated with case status (OR = 0.55, 95% CI 0.39–0.77, P < 0.001). These associations remained directionally consistent in sensitivity analyses restricted to patients with illness duration ≤12 months and patients with duration of untreated psychosis (DUP) ≤ 12 months. Sensitivity analyses using the Dimensional Anhedonia Rating Scale (DARS) yielded consistent findings, with higher hedonic capacity associated with lower odds of FESSD (OR = 0.44, 95% CI 0.31–0.63, P < 0.001). Childhood trauma also demonstrated a dose–response association with case status, and the overall findings remained robust across sensitivity analyses. In exploratory within-patient analyses, higher SHAPS scores were nominally associated with greater PANSS negative symptom severity ( β = 0.22, 95% CI 0.03–0.41, unadjusted P = 0.027), but this association did not remain statistically significant after correction for multiple testing (FDR-adjusted P = 0.278). These findings identify childhood trauma as a retrospectively assessed developmental correlate and anhedonia as a contemporaneous clinical correlate of FESSD case status, while educational attainment shows an inverse association that may reflect both developmental and illness-related processes. However, these associations should not be interpreted as evidence of premorbid vulnerability or causality. Longitudinal studies are needed to establish their temporal relationships.