Exploring comorbidity patterns of psychosis-related post-traumatic stress disorder and depression symptoms in stabilised hospitalised schizophrenia patients and relationships with sleep quality and quality of life: a latent profile analysis.
Kong L, Ma X, et al. • European journal of psychotraumatology • 2026
In hospitalised patients with schizophrenia, psychosis-related post-traumatic stress disorder and depression manifest in parallel patterns of low, moderate, or high severity rather than as distinct subtypes, with sleep quality progressively worsening as symptom severity increases.
Key Findings
Results
Latent profile analysis identified three distinct comorbidity profiles of PR-PTSD and depression symptoms in stabilised hospitalised schizophrenia patients.
The three-profile solution was identified as optimal among 482 stabilised inpatients with schizophrenia (PANSS total score < 60).
Profile 1: 'Low PR-PTSD/Low Depression' comprising 50.0% of patients.
Profile 2: 'Moderate PR-PTSD/Mild Depression' comprising 42.3% of patients.
Profile 3: 'High PR-PTSD/Moderate Depression' comprising 7.7% of patients.
Profiles reflected parallel severity across both PR-PTSD (intrusion, avoidance, arousal) and depression dimensions, rather than distinct symptom-dominant subtypes.
Results
History of coercive treatment and polypharmacy were significantly associated with membership in the high-symptom profile.
Multinomial logistic regression was used to identify clinical correlates of profile membership.
Both coercive treatment history and polypharmacy were statistically significant predictors of belonging to the 'High PR-PTSD/Moderate Depression' profile.
These findings highlight iatrogenic trauma and medication burden as clinically relevant factors in the highest-severity group.
The study population consisted of 482 stabilised inpatients assessed cross-sectionally.
Results
Sleep quality demonstrated a clear dose-response relationship with comorbidity severity, progressively worsening across the three profiles.
Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI).
The group difference in sleep quality across profiles was statistically significant (p < .001).
Sleep quality worsened progressively from the low-symptom to the high-symptom profile.
Sleep quality was described as 'a key differentiating factor and a potent transdiagnostic target for intervention.'
Results
Overall quality of life total scores did not differ significantly across the three comorbidity profiles.
Quality of life was assessed using the Schizophrenia Quality of Life Scale (SQLS).
The overall group difference in quality of life total scores did not reach statistical significance (p = .067).
ANOVA was used to compare quality of life differences across profile groups.
This contrasts with the significant differences observed for sleep quality across profiles.
Methods
The study sample consisted of 482 stabilised hospitalised schizophrenia patients assessed using standardised instruments for PR-PTSD, depression, sleep, and quality of life.
PR-PTSD symptoms were assessed with the Impact of Event Scale-Revised (IES-R), covering intrusion, avoidance, and arousal subscales.
Depression symptoms were assessed with the Self-Rating Depression Scale (SDS).
Stabilisation was operationalised as a PANSS total score < 60.
The study used a cross-sectional design.
Latent profile analysis (LPA) was the primary analytic method for identifying comorbidity profiles.
Discussion
Comorbid PR-PTSD and depression symptoms in schizophrenia manifest as parallel severity profiles rather than as distinct symptom-dominant subtypes.
All three identified profiles showed proportional elevation or reduction across both PR-PTSD and depression dimensions simultaneously.
No profile emerged in which one symptom cluster was markedly elevated while the other was low.
The authors describe this pattern as 'parallel severity profiles rather than distinct symptom-dominant subtypes.'
This finding has implications for how clinicians conceptualize and treat comorbid trauma and depression in schizophrenia.
What This Means
This research suggests that among people hospitalized with schizophrenia, symptoms of trauma-related stress (PTSD linked to the psychosis experience) and depression tend to occur together in three distinct severity groups: a low-symptom group (about half of patients), a moderate-symptom group (about 42%), and a high-symptom group (about 8%). Importantly, these groups showed balanced levels of both PTSD and depression symptoms rather than one type of symptom dominating over the other, suggesting these conditions rise and fall together in this population.
The research also found that patients in the most severe group were more likely to have a history of coercive treatment (such as involuntary procedures) and to be taking multiple medications (polypharmacy). This points to the potential role of traumatic healthcare experiences and complex medication regimens in worsening mental health outcomes. Additionally, sleep quality got progressively worse as symptom severity increased across the three groups, making poor sleep a potentially important and practical treatment target that cuts across both PTSD and depression.
This research matters because it highlights that trauma and depression in schizophrenia should be assessed and treated together rather than in isolation. It also raises awareness of how certain aspects of psychiatric care itself — such as forced treatment or complex medication regimens — may contribute to symptom burden, pointing toward the importance of trauma-informed approaches in hospital settings. Improving sleep quality may offer a practical entry point for helping patients across all severity levels.
Kong L, Ma X, Yang C, Hou X, Wang Y, Wu D. (2026). Exploring comorbidity patterns of psychosis-related post-traumatic stress disorder and depression symptoms in stabilised hospitalised schizophrenia patients and relationships with sleep quality and quality of life: a latent profile analysis.. European journal of psychotraumatology. https://doi.org/10.1080/20008066.2026.2629072