The role of motherhood, cognitive reserve, and trauma in 10-year functional outcomes after a first episode of psychosis

This prospective study included 125 women with non-affective FEP from the PAFIP cohort. Baseline assessments included motherhood status, CT, and CR (composite index of premorbid adjustment, estimated IQ, and education). Functional outcome at 10-year follow-up was measured with the Disability Assessment Scale (DAS) and dichotomized as good versus poor.

Logistic regression models examined independent and combined contributions of predictors, adjusting for age and relevant sociodemographic and clinical covariates. Exploratory moderation analyses tested interactions between motherhood, CR, and CT. Results: Higher CR consistently predicted greater likelihood of good functional outcome at 10 years (OR = 5.95, 95% CI 1.91–27.75, p = .008).

Pre-onset motherhood showed a trend toward favorable outcome (OR = 15.68, p = .054), whereas CT exposure was not significantly associated with long-term functioning. Older age at onset was associated with poorer functional outcomes. Moderation analyses did not reveal significant interactions between motherhood and CR or CT.

Conclusions: CR is a robust long-term predictor of functional recovery. Pre-onset motherhood may confer additional benefits, whereas CT did not predict global functioning. Findings highlight the importance of sex-specific, life-course, and cognitive factors for tailored interventions.

Keywords: First-episode psychosis; Motherhood; Cognitive reserve; Childhood adversity; Sex differences; Longitudinal cohort