Adverse childhood experiences (ACEs), including abuse, neglect and household challenges, have been linked to various mental health outcomes, including psychosis and bipolar symptoms. Research indicates a 57–80% increased risk of psychosis among individuals exposed to ACEs.

This study examines the relationship between ACEs and psychotic/bipolar symptoms in Kenyan adolescents, assessing resilience as a potential moderator or mediator.

This cross-sectional study was conducted in Nairobi and Kiambu counties, Kenya. A total of 1972 youth, aged 14–25 years, were recruited and completed questionnaires focusing on ACEs (Trauma and Distress Scale), psychosis/bipolar symptoms (Washington Early Recognition Center Affectivity and Psychosis screen) and resilience (Adult Resilience Measure +16). Descriptive statistics, Pearson correlation and multiple linear regression were used to assess the relationships between ACEs and psychosis/bipolar symptoms. SPSS Process macro was employed to examine the moderating/mediating role of resilience.

Emotional abuse and physical abuse were significantly associated with higher psychosis and bipolar symptoms (P < 0.001). Emotional neglect negatively impacted bipolar symptoms (P = 0.042). Resilience moderated the relationship between sexual abuse and psychosis, but not bipolar symptoms. Mediation analysis showed that resilience partially mediated the relationships between sexual abuse and both psychosis and bipolar symptoms.

ACEs, particularly emotional and physical abuse, are significant predictors of psychosis and bipolar symptoms in Kenyan youth. Resilience may play a key role in moderating and mediating these relationships, particularly in cases of sexual abuse. Developing resilience-focused interventions could help mitigate the long-term effects of ACEs on mental health.

Subthreshold psychotic and bipolar experiences are common in major depressive disorder (MDD). However, it is unknown if effectiveness of psychotherapy is altered in depressed patients who display such features compared with those without. The current paper aimed to investigate the impact of the co-presence of subclinical psychotic experiences and subclinical bipolar symptoms on the effectiveness of psychological treatment, alone or in combination with pharmacotherapy.

In a naturalistic study, patients with MDD (n = 116) received psychological treatment (cognitive behavioural therapy or interpersonal psychotherapy) alone or in combination with pharmacotherapy. Depression and functioning were assessed six times over 2 years. Lifetime psychotic experiences and bipolar symptoms were assessed at the second time point.

Subclinical psychotic experiences predicted more depression over time (β = 0.20, p < 0.002), non-remission [odds ratio (OR) 7.51, p < 0.016] and relapse (OR 3.85, p < 0.034). Subthreshold bipolar symptoms predicted relapse (OR 1.16, p < 0.037).

In general, subclinical psychotic experiences have a negative impact on the course and outcome of psychotherapy in MDD. Effects of subclinical bipolar experiences were less prominent.