Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study

Melike Karacam Dogan; Thanavadee Prachason; Laura Fusar-Poli; Claudia Menne-Lothmann; Jeroen Decoster; Ruud Van Winkel; Dina Collip; Philippe Delespaul; Marc De Hert; Catherine Derom; Evert Thiery; Nele Jacobs; Marieke Wichers; Bart P. F. Rutten; Jim Van Os; Lotta Katrin Pries; Sinan Guloksuz

doi:10.1192/j.eurpsy.2026.10173

Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study

Melike Karacam Dogan
, Thanavadee Prachason
, Laura Fusar-Poli
, Claudia Menne-Lothmann
, Jeroen Decoster
, Ruud Van Winkel
, Dina Collip
, Philippe Delespaul
, Marc De Hert
, Catherine Derom
, Evert Thiery
, Nele Jacobs
, Marieke Wichers
, Bart P. F. Rutten
, Jim Van Os
, Lotta Katrin Pries
, Sinan Guloksuz^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background
Sex differences in psychosis pathoetiology are insufficiently understood. This study explores how childhood adversity (CA) and coping mechanisms relate to psychosis expression (PE) across males and females in the general population.

Methods
Data from the TwinssCan project (males: n = 312; females: n = 478) were used. The Childhood Trauma Questionnaire assessed CA domains. The Utrecht Coping List assessed coping strategies. Psychosis expression was assessed using the Community Assessment of Psychic Experiences (CAPE). Mixed linear regression analyses examined sex-stratified associations of CAPE scores with CA, coping strategies, and their interactions.

Results
Emotional abuse (EA) was associated with increased total CAPE scores (T-CAPE), explaining the greatest variance among CA across sexes. Sex-specific effects showed that sexual abuse (SA) and physical abuse (PA) were linked to higher T-CAPE in females, whereas physical neglect (PN) was linked to higher T-CAPE in males. Passive-reacting was associated with increased T-CAPE, explaining the greatest variance among coping styles across both sexes. Sex-specific effects showed that, in females, seeking social support was linked to decreased T-CAPE, while emotional expression increased it. The only sex-shared interaction effect was between reassuring thoughts and emotional neglect (EN), associated with decreased T-CAPE. In females, social support (× PA/PN/EA), reassuring thoughts (× PA/PN), and palliative-reacting (× PN/PA) were associated with decreased T-CAPE, while passive-reacting (× EN) increased it. In males, avoidance (× SA/PA) and passive-reacting (× PN) were associated with increased T-CAPE.

Conclusions
Sex differences in the associations of PE with CA and coping underscore the necessity for sex-specific interventions that promote adaptive coping strategies.

Original language	English
Article number	e42
Number of pages	10
Journal	European Psychiatry
Volume	69
Issue number	1
DOIs	https://doi.org/10.1192/j.eurpsy.2026.10173
Publication status	Published - 20 Feb 2026

Keywords

Childhood adversity
Coping strategies
General population
Psychosis expression
Sex differences

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Karacam Dogan, M., Prachason, T., Fusar-Poli, L., Menne-Lothmann, C., Decoster, J., Van Winkel, R., Collip, D., Delespaul, P., De Hert, M., Derom, C., Thiery, E., Jacobs, N., Wichers, M., Rutten, B. P. F., Van Os, J., Pries, L. K., & Guloksuz, S. (2026). Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study. European Psychiatry, 69(1), Article e42. https://doi.org/10.1192/j.eurpsy.2026.10173

@article{09f5117957424e819f608e015e8a1376,

title = "Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study",

abstract = "Background Sex differences in psychosis pathoetiology are insufficiently understood. This study explores how childhood adversity (CA) and coping mechanisms relate to psychosis expression (PE) across males and females in the general population. Methods Data from the TwinssCan project (males: n = 312; females: n = 478) were used. The Childhood Trauma Questionnaire assessed CA domains. The Utrecht Coping List assessed coping strategies. Psychosis expression was assessed using the Community Assessment of Psychic Experiences (CAPE). Mixed linear regression analyses examined sex-stratified associations of CAPE scores with CA, coping strategies, and their interactions. Results Emotional abuse (EA) was associated with increased total CAPE scores (T-CAPE), explaining the greatest variance among CA across sexes. Sex-specific effects showed that sexual abuse (SA) and physical abuse (PA) were linked to higher T-CAPE in females, whereas physical neglect (PN) was linked to higher T-CAPE in males. Passive-reacting was associated with increased T-CAPE, explaining the greatest variance among coping styles across both sexes. Sex-specific effects showed that, in females, seeking social support was linked to decreased T-CAPE, while emotional expression increased it. The only sex-shared interaction effect was between reassuring thoughts and emotional neglect (EN), associated with decreased T-CAPE. In females, social support (× PA/PN/EA), reassuring thoughts (× PA/PN), and palliative-reacting (× PN/PA) were associated with decreased T-CAPE, while passive-reacting (× EN) increased it. In males, avoidance (× SA/PA) and passive-reacting (× PN) were associated with increased T-CAPE. Conclusions Sex differences in the associations of PE with CA and coping underscore the necessity for sex-specific interventions that promote adaptive coping strategies.",

keywords = "Childhood adversity, Coping strategies, General population, Psychosis expression, Sex differences",

author = "\{Karacam Dogan\}, Melike and Thanavadee Prachason and Laura Fusar-Poli and Claudia Menne-Lothmann and Jeroen Decoster and \{Van Winkel\}, Ruud and Dina Collip and Philippe Delespaul and \{De Hert\}, Marc and Catherine Derom and Evert Thiery and Nele Jacobs and Marieke Wichers and Rutten, \{Bart P. F.\} and \{Van Os\}, Jim and Pries, \{Lotta Katrin\} and Sinan Guloksuz",

year = "2026",

month = feb,

day = "20",

doi = "10.1192/j.eurpsy.2026.10173",

language = "English",

volume = "69",

journal = "European Psychiatry",

issn = "0924-9338",

publisher = "Cambridge University Press",

number = "1",

}

Karacam Dogan, M, Prachason, T, Fusar-Poli, L, Menne-Lothmann, C, Decoster, J, Van Winkel, R, Collip, D, Delespaul, P, De Hert, M, Derom, C, Thiery, E, Jacobs, N, Wichers, M, Rutten, BPF, Van Os, J, Pries, LK & Guloksuz, S 2026, 'Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study', European Psychiatry, vol. 69, no. 1, e42. https://doi.org/10.1192/j.eurpsy.2026.10173

TY - JOUR

T1 - Sex differences in the effect of childhood adversity and coping strategies on psychosis expression

T2 - A TwinssCan study

AU - Karacam Dogan, Melike

AU - Prachason, Thanavadee

AU - Fusar-Poli, Laura

AU - Menne-Lothmann, Claudia

AU - Decoster, Jeroen

AU - Van Winkel, Ruud

AU - Collip, Dina

AU - Delespaul, Philippe

AU - De Hert, Marc

AU - Derom, Catherine

AU - Thiery, Evert

AU - Jacobs, Nele

AU - Wichers, Marieke

AU - Rutten, Bart P. F.

AU - Van Os, Jim

AU - Pries, Lotta Katrin

AU - Guloksuz, Sinan

PY - 2026/2/20

Y1 - 2026/2/20

N2 - Background Sex differences in psychosis pathoetiology are insufficiently understood. This study explores how childhood adversity (CA) and coping mechanisms relate to psychosis expression (PE) across males and females in the general population. Methods Data from the TwinssCan project (males: n = 312; females: n = 478) were used. The Childhood Trauma Questionnaire assessed CA domains. The Utrecht Coping List assessed coping strategies. Psychosis expression was assessed using the Community Assessment of Psychic Experiences (CAPE). Mixed linear regression analyses examined sex-stratified associations of CAPE scores with CA, coping strategies, and their interactions. Results Emotional abuse (EA) was associated with increased total CAPE scores (T-CAPE), explaining the greatest variance among CA across sexes. Sex-specific effects showed that sexual abuse (SA) and physical abuse (PA) were linked to higher T-CAPE in females, whereas physical neglect (PN) was linked to higher T-CAPE in males. Passive-reacting was associated with increased T-CAPE, explaining the greatest variance among coping styles across both sexes. Sex-specific effects showed that, in females, seeking social support was linked to decreased T-CAPE, while emotional expression increased it. The only sex-shared interaction effect was between reassuring thoughts and emotional neglect (EN), associated with decreased T-CAPE. In females, social support (× PA/PN/EA), reassuring thoughts (× PA/PN), and palliative-reacting (× PN/PA) were associated with decreased T-CAPE, while passive-reacting (× EN) increased it. In males, avoidance (× SA/PA) and passive-reacting (× PN) were associated with increased T-CAPE. Conclusions Sex differences in the associations of PE with CA and coping underscore the necessity for sex-specific interventions that promote adaptive coping strategies.

AB - Background Sex differences in psychosis pathoetiology are insufficiently understood. This study explores how childhood adversity (CA) and coping mechanisms relate to psychosis expression (PE) across males and females in the general population. Methods Data from the TwinssCan project (males: n = 312; females: n = 478) were used. The Childhood Trauma Questionnaire assessed CA domains. The Utrecht Coping List assessed coping strategies. Psychosis expression was assessed using the Community Assessment of Psychic Experiences (CAPE). Mixed linear regression analyses examined sex-stratified associations of CAPE scores with CA, coping strategies, and their interactions. Results Emotional abuse (EA) was associated with increased total CAPE scores (T-CAPE), explaining the greatest variance among CA across sexes. Sex-specific effects showed that sexual abuse (SA) and physical abuse (PA) were linked to higher T-CAPE in females, whereas physical neglect (PN) was linked to higher T-CAPE in males. Passive-reacting was associated with increased T-CAPE, explaining the greatest variance among coping styles across both sexes. Sex-specific effects showed that, in females, seeking social support was linked to decreased T-CAPE, while emotional expression increased it. The only sex-shared interaction effect was between reassuring thoughts and emotional neglect (EN), associated with decreased T-CAPE. In females, social support (× PA/PN/EA), reassuring thoughts (× PA/PN), and palliative-reacting (× PN/PA) were associated with decreased T-CAPE, while passive-reacting (× EN) increased it. In males, avoidance (× SA/PA) and passive-reacting (× PN) were associated with increased T-CAPE. Conclusions Sex differences in the associations of PE with CA and coping underscore the necessity for sex-specific interventions that promote adaptive coping strategies.

KW - Childhood adversity

KW - Coping strategies

KW - General population

KW - Psychosis expression

KW - Sex differences

U2 - 10.1192/j.eurpsy.2026.10173

DO - 10.1192/j.eurpsy.2026.10173

M3 - Article

C2 - 41714187

SN - 0924-9338

VL - 69

JO - European Psychiatry

JF - European Psychiatry

IS - 1

M1 - e42

ER -

Sex differences in the effect of childhood adversity and coping strategies on psychosis expression: A TwinssCan study

Abstract

Keywords

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