Associations between childhood trauma, cognitive function, and clinical symptoms in first-episode schizophrenia.

Background: Childhood trauma may influence clinical presentation in first-episode schizophrenia (FES), but its specific associations with cognitive function and clinical symptoms remain unclear. Methods: Seventy-one FES participants and 62 healthy controls were assessed using the Childhood Trauma Questionnaire (CTQ-SF), MATRICS Consensus Cognitive Battery (MCCB), Positive and Negative Syndrome Scale (PANSS), and Calgary Depression Scale (CDSS). Group comparisons, Spearman correlations, hierarchical regression, and mediation analyses (PROCESS macro) were performed. Results: FES participants reported significantly higher childhood trauma (except physical abuse) and performed worse on all MCCB domains (all *p* < 0.00625). Within the clinical group, those with childhood trauma (71.8%) showed nominally lower MCCB total scores (*p* = 0.042) and a trend toward higher negative symptoms (*p* = 0.083). Exploratory analyses indicated that physical neglect was associated with attention/vigilance (r = -0.54) and overall cognition (*r* = -0.69); physical abuse with social cognition (*r* = -0.54); sexual abuse with general psychopathology (*r* = 0.56). No independent associations of trauma subtypes were found in regression analyses. Attention/vigilance was significantly associated with negative symptoms (β = -0.43, *p* = 0.002) but did not mediate the trauma-symptom relationship. Conclusion: FES participants report more childhood trauma and exhibit widespread cognitive impairment, with physical neglect most strongly linked to attentional deficits. Attention/vigilance was associated with negative symptoms, suggesting that trauma-informed cognitive rehabilitation may have potential value.