Shame and trauma are critical to understanding the impacts of psychosis: Examining clinical correlates within a tertiary psychosis service cohort

Objective: This study aimed to examine the association of trauma exposure and shame on the clinical presentation of individuals experiencing psychosis (including suicidal behaviours). Methods: A retrospective audit of clinical data collected over a 4-year period from a tertiary psychosis service was conducted. All individuals accessing the service had experience of psychosis. Findings: Data from 201 individuals who completed assessments between 2020 and 2024 were analysed. Exposure to trauma was high, with all reporting experience of at least one traumatic event. Trauma related to psychosis symptoms (64.0%) and treatment experiences following psychosis (57.0%) were particularly prevalent. Exposure to lifespan trauma was positively related to the number of lifetime suicide attempts, r (90) = 0.22, p = 0.038. Higher levels of shame were associated with an increased frequency of current suicide ideation, External shame: (r(51)= 0.46, p < 0.001); Internal shame: (r(50) = 0.45, p < 0.001). Conclusions: These findings highlight different, though related, associations between suicidal behaviours with trauma exposure and shame. While trauma is associated with suicidal behaviours, shame is correlated with suicidal ideation, raising implications for assessment and intervention. Future work could examine whether suicide ideation in this group is influenced by psychological interventions that target shame.