Abstract
Purpose
To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia.
Method
Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted.
Results
One-third of the sample (34 %) had no confidant [95 % CI (18.4, 50.0 %)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 < rs < 0.60). The association between loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p < 0.001).
Conclusions
Even at first episode, a large proportion of people with psychosis have poor perceived support, no confidant and report several lonely days a week. Patients without a confidant appear to be more susceptible to feeling lonely and anxious. Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.
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Notes
Paranoia was broadly defined as “feeling a sense of threat” and clarified whenever participants were unclear to the terms.
References
Norman RMG, Malla AK, Manchanda R et al (2005) Social support and three-year symptom and admission outcomes for first episode psychosis. Schizophr Res 80(2):227–234
Gayer-Anderson C, Morgan C (2012) Social networks, support and early psychosis: a systematic review. Epidemiol Psychiatr Sci 1(1):1–16
Macdonald EM, Jackson HJ, Hayes RL et al (1998) Social skill as determinant of social networks and perceived social support in schizophrenia. Schizophr Res 29(3):275–286
Veling W, Hoek HW, Wiersma D, Mackenbach JP (2010) Ethnic identity and the risk of Schizophrenia in ethnic minorities: a case-control study. Schizophr Bull 36(6):1149–1156
Song YY, Kim KR, Park JY et al (2011) Associated factors of quality of life in first-episode Schizophrenia patients. Psychiatr Invest 8(3):201–206
Macdonald EM, Hayes RL, Baglioni AJ (2000) The quantity and quality of the social networks of young people with early psychosis compared with closely matched controls. Schizophr Res 46(1):25–30
Pruessner M, Iyer SN, Faridi K et al (2011) Stress and protective factors in individuals at ultra-high risk for psychosis, first episode psychosis and healthy controls. Schizophr Res 129(1):29–35
Tempier R, Balbuena L, Lepnurm M, Craig TKJ (2013) Perceived emotional support in remission: results from an 18-month follow-up of patients with early episode psychosis. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/00127-013-0701-3
Peplau LA, Perlman D (1982) Loneliness: a sourcebook of current theory, research, and therapy. John Wiley Sons Inc, New York
Asher SR, Paquette JA (2003) Loneliness and peer relations in childhood. Curr Dir Psychol Sci 12(3):75–78
Schumaker JF, Shea JD, Monfries MM, Groth-Marnat G (1993) Loneliness and life satisfaction in Japan and Australia. J Psychol 127(1):65–71
Heinrich LM, Gullone E (2006) The clinical significance of loneliness: a literature review. Clin Psychol R 26(6):695–718
DeNiro DA (1995) Perceived alienation in individuals with residual-type Schizophrenia. Issues Ment Health Nurs 16(3):185–200
Neeleman J, Power MJ (1994) Social support and depression in three groups of psychiatric patients and a group of medical controls. Soc Psychiatry Psychiatr Epidemiol 29(1):46–51
Meltzer H, Bebbington P, Dennis M et al (2012) Feelings of loneliness among adults with mental disorder. Soc Psychiatry Psychiatr Epidemiol 48(1):5–13
Fromm-Reichmann F (1959) Loneliness. Psychiatry 22:1–15
Green LR, Richardson DS, Lago T, Schatten-Jones EC (2001) Network correlates of social and emotional loneliness in young and older adults. Pers Soc Psychol Bull 27(3):281–288
Erickson DH, Beiser M, Iacono WG et al (1989) The role of social relationships in the course of first-episode schizophrenia and affective psychosis. Am J Psychiatry 146(11):1456–1461
Morgan C, Kirkbride J, Hutchinson G et al (2008) Cumulative social disadvantage, ethnicity and first-episode psychosis: a case-control study. Psychol Med 38(12):1701–1715
Thoits PA (2011) Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav 52(2):145
Lakey B, Orehek E (2011) Relational regulation theory: a new approach to explain the link between perceived social support and mental health. Psychol Rev 118(3):482
Freeman D, Garety PA (2003) Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behav Res Ther 41(8):923–947
Weeks DG, Michela JL, Peplau LA, Bragg ME (1980) Relation between loneliness and depression: a structural equation analysis. J Pers Soc Psychol 39(6):1238
Leary MR (1990) Responses to social exclusion: social anxiety, jealousy, loneliness, depression, and low self-esteem. J Soc Clin Psychol 9(2):221–229
Hawkley LC, Burleson MH, Berntson GG, Cacioppo JT (2003) Loneliness in everyday life: cardiovascular activity, psychosocial context, and health behaviors. J Pers Soc Psychol 85(1):105–120
Garety PA, Kuipers E, Fowler D et al (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31(2):189–195
Freeman D (2007) Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 27(4):425–457
Andreasen NC (1984) Scale for the Assessment of Positive Symptoms (SAPS). City of Iowa, Iowa City
Andreasen NC (1984) Scale for the Assessment of Negative Symptoms (SANS). City of Iowa, Iowa City
Jolley S, Garety PA, Ellett L et al (2006) A validation of a new measure of activity in psychosis. Schizophr Res 85(1):288–295
Radloff LS (1977) The CES-D scale: a self report depression scale for research in the general. Appl Psychol Meas 1(3):385–401
Winefield HR, Winefield AH, Tiggemann M (1992) Social support and psychological well-being in young adults: the multi-dimensional support scale. J Pers Assess 58(1):198–210
Rook KS (1987) Social support versus companionship: effects on life stress, loneliness, and evaluations by others. J Pers Soc Psychol 52(6):1132–1147
Onwumere J, Kuipers E, Bebbington P et al (2009) Patient perceptions of caregiver criticism in psychosis: links with patient and caregiver functioning. J Nerv Ment Dis 197(2):85–91
Lang PJ, Bradley MM, Cuthbert BN (1997) International affective picture system (IAPS): technical manual and affective ratings. NIMH Center for the Study of Emotion and Attention, Gainesville
Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Beh Res M 36(4):717–731
Sobel ME (1982) Asymptotic confidence intervals for indirect effects in structural equation models. Soc Method 13(1982):290–312
Preacher KJ, Leonardelli GJ (2001) Calculation for the Sobel test: an interactive calculation tool for mediation tests. Psychol Methods 7(1):83–104
Bengtsson-Tops A, Hansson L (2001) Quantitative and qualitative aspects of the social network in schizophrenic patients living in the community. Relationship to sociodemographic characteristics and clinical factors and subjective quality of life. Int J Soc Psychiatry 47(3):67–77
Cresswell CM, Kuipers L, Power MJ (1992) Social networks and support in long-term psychiatric patients. Psychol Med 22(4):1019–1026
Hamilton NG, Ponzoha CA, Cutler DL, Weigel RM (1989) Social networks and negative versus positive symptoms of schizophrenia. Schizophr Bull 15(4):625–633
Horan WP, Subotnik KL, Snyder KS, Nuechterlein KH (2006) Do recent-onset schizophrenia patients experience a “social network crisis”? Psychiatr 69(2):115–129
Cohen J (1988) Statistical power analysis for the behavioral sciences. Lawrence Erlbaum, Hillsdale
Forrester-Jones R, Carpenter J, Coolen-Schrjiner P et al (2012) Good friends are hard to find? The social networks of people with mental illness 12 years after deinstitutionalisation. J Ment Health 21(1):4–14
Ibarra-Rovillard M, Kuiper NA (2011) Social support and social negativity findings in depression: perceived responsiveness to basic psychological needs. Clin Psychol Rev 31(1):342–352
Jolley S, Garety P, Dunn G et al (2005) A pilot validation study of a new measure of activity in psychosis. Soc Psychiatry Psychiatr Epidemiol 40(11):905–911
Faccincani C, Mignolli G, Platt S (1990) Service utilisation, social support and psychiatric status in a cohort of patients with schizophrenic psychoses: a 7 year follow-up study. Schizophr Res 3(2):139–146
Kawachi I, Berkman LF (2001) Social ties and mental health. J Urban Health 78(3):458–467
Sündermann O, Onwumere J, Bebbington P, Kuipers E (2012) Social networks and support in early psychosis: potential mechanisms. Epidemiol Psychiat Sci 1(1):1–4
Acknowledgments
This work was supported by the Wellcome Trust (Grant number: WT087417) and the Department of Health via the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to South London and Maudsley NHS Foundation Trust (SLaM) and the Institute of Psychiatry at King’s College London. Craig Morgan is supported by funding from the Medical Research Council (Ref: G0500817), Wellcome Trust (Grant number: WT087417) and European Union (European Community’s Seventh Framework Program (grant agreement No. HEALTH-F2-2009-241909) (Project EU-GEI)).
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Sündermann, O., Onwumere, J., Kane, F. et al. Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety. Soc Psychiatry Psychiatr Epidemiol 49, 359–366 (2014). https://doi.org/10.1007/s00127-013-0754-3
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DOI: https://doi.org/10.1007/s00127-013-0754-3