The Relationship Among The Aggressive Behavior, Hostile Attribution Bias And Childhood Trauma In Schizophrenic Patients

Objective Aggressive behavior in schizophrenic patients often happens in departmentof psychiatry, which is a serious threat to other patients, families and health care workers.In recent years, research has paid much attention to exploring the reasons andpreventions of patients’ aggressive behavior. Recent research shows that the mainpredictors of patients’ aggressive behavior include hostile attribution bias, childhoodtrauma and positive symptoms, and so on. Among these, attribution style is an advancedsocial cognitive function, and its relationship between childhood trauma experience andadulthood psychological problems was confirmed in general population studies, but it isstill unknown what is the role hostile attribution bias plays in schizophrenic patientsbetween childhood trauma experience and aggressive behavior. This study assumes thatthere are some correlations among aggressive behavior, hostile attribution bias andchildhood trauma, and hostile attribution bias may mediate the relationship betweenchildhood trauma and aggressive behavior. The aim of the study is to explore therelationship among the aggressive behavior, hostile attribution bias and childhood traumain schizophrenic patients. In addition, the Ambiguous Intentions Hostility Questionnaire(AIHQ) was revised into Chinese and its reliability and validity were tested.Methods In study one,135patients with schizophrenia were tested with ModifiedOvert Aggression Scale (MOAS), the Chinese-version of the Ambiguous IntentionsHostility Questionnaire (AIHQ-C) and Childhood Trauma Questionnaire (CTQ).According to the score of the MOAS, the patients were divided into the aggressive group(n=58) and the non-aggressive group (n=77). The hostile attribution bias and the childhood trauma were compared between the two groups, and correlation andhierarchical regression analysis were used to research the relationships of the variables.In study two,303healthy subjects and202schizophrenic patients were asked tocomplete the AIHQ-C along with measures of Paranoia Scale (Pa). Two weeks later,110healthy subjects and70schizophrenic patients who were randomly selected from thetotal sample completed the AIHQ-C again to compute the test-retest reliability. Thecriterion-related validity was evaluated by correlating the AIHQ-C with Pa.Results In study one, Compared with the non-aggressive patients, the aggressive patientshad significantly higher AIHQ-C total hostility bias score (6.27±1.20vs5.90±0.97,P<0.05), total blame bias score (8.04±1.97vs6.91±2.10, P<0.01) and total aggressionbias score (6.17±1.02vs5.59±1.04, P<0.01). Correlation analysis showed that theMOAS score, AIHQ scores and the total score of CTQ were significantly positivelycorrelated each other (r=0.171~0.350, P<0.05~0.01). Regression analysis indicated thehostile attribution bias directly predicted the aggressive behavior（β=0.342, P<0.05）andcompletely mediated the relationship between the childhood trauma and the aggressivebehavior. In study two,(1) the Cronbach α coefficient of total Hostility Bias(THB), totalBlame Bias(TBB) and total Aggression Bias(TAB) for the AIHQ-C was0.78,0.94,0.84(P<0.01) respectively, and the Cronbach α coefficient of Hostility Bias（HB）, BlameBias（BB）and Aggression Bias（AB）for each situation of the AIHQ-C was between0.51and0.90. The test-retest reliability of THB, TBB and TAB for the AIHQ-C was0.71,0.73,0.68(P<0.01) respectively, and the test-retest reliability of HB,BB and AB for eachsituation of the AIHQ-C was between0.48and0.73.(2) Pa was positively correlatedwith THB、TBB and TAB (r=0.51,0.37,0.41, P<0.01,respectively) and the correlationcoefficients of HB、BB and AB for each situation of the AIHQ-C with Pa was between0.23and0.52. The results indicated that the AIHQ-C had good criterion-related validity.(3) schizophrenic patients had higher scores of the AIHQ-C than the healthy subjects, itsuggested that the AIHQ-C had good discriminant validity. Conclusion Study one shows that the aggressive behavior in schizophrenic patients isassociated with the experience of childhood trauma and the attribution style, and thechildhood trauma indirectly influences the aggressive behavior by the mediating of thehostile attribution bias. Study two indicates that The AIHQ-C has good reliability andvalidity in application to Chinese people.