Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety

  • Oliver Sündermann
  • Juliana Onwumere
  • Fergus Kane
  • Craig Morgan
  • Elizabeth Kuipers
Original Paper



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.


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.


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).


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.


Social networks Loneliness Anxiety Confidant First-episode psychosis 



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)).

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Oliver Sündermann
    • 1
    • 2
  • Juliana Onwumere
    • 2
  • Fergus Kane
    • 2
  • Craig Morgan
    • 3
  • Elizabeth Kuipers
    • 2
  1. 1.South London Maudsely NHS Foundation Trust, Anxiety Disorders Residential UnitBethlem Royal HospitalLondonUK
  2. 2.Department of Psychology, Institute of PsychiatryKing’s College LondonLondonUK
  3. 3.Psychological Medicine, Institute of PsychiatryKing’s College LondonLondonUK

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