1. Introduction The Relationship between Neurocognitive Functioning and Childhood Abuse among Persons with SMI: Mediating Proximal and Distal Factors L. Felice Reddy, Ashley Wynne, and William D. Spaulding University of Nebraska-Lincoln Neurocognition is a significant predictor of outcome among persons with serious mental illness (SMI) (Liberman, 2008). The deficits exhibited by individuals with SMI have been found to improve significantly in the context of integrated treatment programs that include cognitive rehabilitation (Wykes, 2008). Numerous studies have concluded that persons with SMI and a history of child abuse tend to have more severe cognitive impairments than those with SMI and no abuse history (Lysaker et al, 2001). Extensive biological evidence indicates early life trauma may have a permanent impact on the developing brain. Rates of child sexual abuse (CSA) and child physical abuse (CPA) among persons with SMI have been found to range from 34%-60% (Darvez-Bornoz et al, 1995; Ross et al, 1994; Greenfield et al.,1994). Consumers with a history of CPA or CSA have more frequent suicide attempts (Read et al., 2001), earlier first psychiatric admissions, more frequent and longer duration of psychiatric hospitalizations, more time in seclusion, and receive more medication (Read, van Os, Morrison, & Ross, 2005). However, there is vast heterogeneity in cognitive and behavioral functioning among persons with SMI and a history of CA. Research needs to explore the mediating and moderating factors that interact throughout development in order to aid in more accurately predicting functional outcomes. This study is designed to examine potential precipitating factors of neurocognitve deficits as well as the behavioral and environmental mechanisms that facilitate neurocognitive improvements. Increased understanding of the complex relationship between traumatic events experienced in childhood and functional deficits in adulthood will vastly improve individualized assessment and treatment planning. Methods Participants: Data from 177 participants (Mean age= 40, SD= 12) at admission to an inpatient psychiatric rehabilitation program were used in the present analyses. Neurocognitive Measure:: Neurocognition was measured using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS; Randolph, 1998), using standard scores (Mean=100, SD=15). History of Childhood Abuse: Histories of childhood maltreatment (e.g. physical abuse, sexual abuse) were collected through medical chart reviews. Abuse was coded as present if CSA or CPA was documented to have occurred prior to age 18. All other historical variables were also collected from medical chart reviews. Data Analysis: Bivariate correlations and regression models indicated high colinearity among the variables of interest. In an attempt to elucidate the temporal paths among the predictors and potential mediation effects, a path analysis was performed on the variables of interest. Discussion This study provides empirical support for the theorized relationship between child abuse and neurocognitive functioning at the time of admission into an inpatient psychiatric rehabilitation program. As hypothesized, there are several paths and significant mediating variables involved in the longitudinal relationship between abuse and neurocognitive functioning. Abuse was not a significant predictor in the model when more proximal predictors were included. Significance testing of the variance accounted for by the full model in comparison with the reduced model revealed that the reduced model fit the data as well as the full model (W(11) = 8.5, p <.05). As hypothesized, initial correlations between the variables of interest showed that they were significantly related to one another. There were no extreme correlations, however, between predictor variables, suggesting that multicolinearity was not an issue (Mansfield & Helms, 1982). Our study provides evidence that a sizable portion of the variance in neurocognition (30%) can be explained by the proximal variables that have mediating and direct effects on the relationship between child abuse and neurocognitive functioning in adults with SMI at the time of admission to psychiatric rehabilitation. The results imply that the longitudinal pathways are heterogeneous and diverse, yet significant factors are identified in the model and should be considered important risk and resilience factors. It appears increased education may be a protective factor and age of onset may be a risk factor. Gender was added to the model as a predictor of abuse and should be considered in the interpretation of the results. There is a paucity of research examining the relationship between early life trauma and functional outcome among adults with SMI, especially with an emphasis on mediating variables and longitudinal study designs. Future research should expand on the current design by examining the different components of neurocognition (i.e. memory, attention, executive functions), as well as social cognition and other domains of functioning. Correlations between Variables of Interest (n = 177) Path Analysis Depicting all Direct and Total Effects Theory Trimmed Path Analysis with Significant Effects Included Gender: male=1, female=2; Child Abuse: Absent=1, Present=2; Axis II Diagnosis: Absent=1, Present=2 * p < 0.05 **p < 0.01 Visit the Severe Mental Illness Research Group website at the University of Nebraska-Lincoln: http://www.unl.edu/dsc