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Bornheimer LA, Li Verdugo J, Thompson S. Depression Mediates the Relationships between Hallucinations, Delusions, and Social Isolation in First-Episode Psychosis. SOCIAL WORK RESEARCH 2022; 46:332-341. [PMID: 36420428 PMCID: PMC9673164 DOI: 10.1093/swr/svac025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/12/2021] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
Social isolation is common among individuals with schizophrenia spectrum and other psychotic disorders. Research indicates that social isolation relates to poorer mental health outcomes, depression, and negative symptoms, with less known about its relationship with positive symptoms. This study examined depression as a mediator in the relationships between positive symptoms (i.e., hallucinations and delusions) and social isolation among an early treatment phase sample in the United States. Data were obtained from the Recovery After an Initial Schizophrenia Episode project of the National Institute of Mental Health's Early Treatment Program. Participants (N = 404) included adults between ages 15 and 40 in a first episode of psychosis. Data were analyzed using structural equation modeling in Mplus (Version 8). The study showed that delusions (b = .095, SE = 0.04, p < .05) and hallucinations (b = .076, SE = 0.03, p < .01) were directly related to depression, and that both delusions (b = .129, SE = 0.06, p < .05) and depression (b = .254, SE = 0.09, p < .05) were directly related to social isolation. Findings of this study determined that depression functioned as a mediator in the relationships between positive symptoms and social isolation. Targeting psychosis symptomatology and depression in treatment, improving social skills and social support networks, and considering the role of stigma in social isolation are of great importance in the prevention of poorer mental health outcomes.
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Affiliation(s)
- Lindsay A Bornheimer
- PhD, is an assistant professor, School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109-1106, USA
| | - Juliann Li Verdugo
- MSW, is a project coordinator, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
| | - Sara Thompson
- MSW, is a research assistant, School of Social Work, University of Michigan, Ann Arbor, MI, USA
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Bauer A, Stevens M, Purtscheller D, Knapp M, Fonagy P, Evans-Lacko S, Paul J. Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS One 2021; 16:e0251750. [PMID: 34015021 PMCID: PMC8136658 DOI: 10.1371/journal.pone.0251750] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/02/2021] [Indexed: 11/18/2022] Open
Abstract
Social support is a well-recognised protective factor for children's mental health. Whilst many interventions exist that seek to mobilise social support to improve children's mental health, not much is known about how to best do this. We sought to generate knowledge about the ways in which social support can be mobilised to improve children's mental health. We conducted a systematic review, which followed the principles of a realist synthesis. The following databases were searched: PubMed, CINAHL, Ovid MEDLINE, PsychINFO, EMBASE, Child and Adolescent Studies, EconLit and SocINDEX. Studies were included if the age of participants was between 0 and 18 years and they evaluated or described programme theories of interventions that sought to improve children's mental health by mobilising social support. Relevance and quality of studies were assessed, and data were extracted and analysed narratively. Thirty-three articles were included. Studies varied substantially with regard to the detail in which they described the processes of mobilising social support and expected mechanisms to improve children's mental health. Those that provided this detail showed the following: Intervention components included explaining the benefits of social support and relationships to families and modelling friendly relationships to improve social skills. Pathways to improved outcomes reflected bi-directional and dynamic relationships between social support and mental health, and complex and long-term processes of establishing relationship qualities such as trust and reciprocity. Parents' ability to mobilise social support for themselves and on behalf of children was assumed to impact on their children's mental health, and (future) ability to mobilise social support. Although interventions were considered affordable, some required substantial human and financial resources from existing systems. Mobilising social support for vulnerable children can be a complex process that requires careful planning, and theory-informed evaluations can have an important role in increasing knowledge about how to best address social support and loneliness in children.
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Affiliation(s)
- Annette Bauer
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, United Kingdom
- * E-mail:
| | - Madeleine Stevens
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, United Kingdom
| | - Daniel Purtscheller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Martin Knapp
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, United Kingdom
| | - Peter Fonagy
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, London, United Kingdom
| | - Jean Paul
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Kuranova A, Booij SH, de Jonge P, Jeronimus B, Lin A, Wardenaar KJ, Wichers M, Wigman JTW. Don't worry, be happy: Protective factors to buffer against distress associated with psychotic experiences. Schizophr Res 2020; 223:79-86. [PMID: 32473933 DOI: 10.1016/j.schres.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Around 6-7% of the general population report psychotic experiences (PEs). Positive PEs (e.g. hearing voices) may increase the risk of development of psychotic disorder. An important predictor of the transition to a psychotic disorder is secondary distress associated with PEs. We examined the moderating effect of potential protective factors on this secondary distress. METHODS Data come from 2870 individuals of the HowNutsAreTheDutch study. PEs were assessed with the Community Assessment of Psychic Experience (CAPE) questionnaire and were divided into three subdomains ("Bizarre experiences", "Delusional ideations", and "Perceptual anomalies"). Protective factors explored were having a partner, having a pet, benevolent types of humor, optimism and the high levels of personality traits emotional stability (reversed neuroticism), extraversion, openness to experience, conscientiousness, and agreeableness. We examined whether these protective factors moderated (lowered) the association between frequency of PEs and PE-associated distress. RESULTS Due to low prevalence of perceptual anomalies in the sample, this domain was excluded from analysis. No moderating effects were observed of protective factors on the association between bizarre experiences and distress. Having a partner and high levels of optimism, self-enhancing humor, openness, extraversion and emotional stability moderated the association between delusional ideations and secondary distress, leading to lower levels of distress. CONCLUSIONS Several protective factors were found to moderate the association between frequency and secondary distress of delusional ideations, with high levels of the protective factors being associated with lower levels of distress. A focus on protective factors could be relevant for interventions and prevention strategies regarding psychotic phenomena.
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Affiliation(s)
- Anna Kuranova
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands.
| | - Sanne H Booij
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; Department of Research and Education, Friesland Mental Health Care Services, Leeuwarden, the Netherlands; Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Peter de Jonge
- University of Groningen, Department of Developmental Psychology, Groningen, the Netherlands
| | - Bertus Jeronimus
- University of Groningen, Department of Developmental Psychology, Groningen, the Netherlands
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; Department of Research and Education, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
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Prochwicz K, Kłosowska J, Dembińska A. The Mediating Role of Stress in the Relationship Between Attention to Threat Bias and Psychotic-Like Experiences Depends on Coping Strategies. Front Psychiatry 2020; 11:307. [PMID: 32411023 PMCID: PMC7200982 DOI: 10.3389/fpsyt.2020.00307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/27/2020] [Indexed: 11/16/2022] Open
Abstract
AIM Recent studies have provided evidence that enhanced stress level is associated with the increase of psychotic symptoms in both clinical and non-clinical populations. It has also been demonstrated that cognitive biases contribute to psychotic experiences. However, it remains unclear whether the effect of cognitive biases and perceived stress on psychotic-like experiences (PLEs) is influenced by coping methods. In the present study we examined whether the relationship linking cognitive biases with PLEs is mediated by the level of stress and whether particular coping methods modify the relationship between stress and PLEs. METHODS The study sample consisted of 290 non-clinical subjects; study variables were assessed by questionnaires. Moderated mediation analyses were conducted. RESULTS Perceived stress was found to serve as a partial mediator in the relationship linking attention to threat (ATB) and external attribution biases (ETB) with psychotic-like experiences. Also, moderated mediation analysis revealed that the indirect effect of attention to threat bias on positive and depressive symptoms of psychotic-like experiences via perceived stress was stronger at higher levels of distraction seeking coping. Moreover, the indirect effect of ATB on depressive symptoms was moderated by task-oriented coping and emotion-oriented coping. Task-oriented coping also moderated the indirect effect of ETB on depression. CONCLUSION The findings imply that both perceived stress and coping styles are important factors affecting the association between cognitive biases and psychotic-like experiences.
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Affiliation(s)
| | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Krakow, Poland
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Lim MH, Gleeson JFM, Alvarez-Jimenez M, Penn DL. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2018; 53:221-238. [PMID: 29327166 DOI: 10.1007/s00127-018-1482-5] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 12/31/2017] [Indexed: 12/24/2022]
Abstract
PURPOSE The aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group. METHODS We adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis. RESULTS A total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem. CONCLUSIONS The relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).
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Affiliation(s)
- Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia.
| | - John F M Gleeson
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia
| | - Mario Alvarez-Jimenez
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - David L Penn
- School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.,Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA
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O'Connell BH, O'Shea D, Gallagher S. Mediating effects of loneliness on the gratitude-health link. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2016.04.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Meijer E, Schout G, Abma T. Am I My Brother's Keeper? Moral Dimensions of Informal Caregiving in a Neoliberal Society. HEALTH CARE ANALYSIS 2016; 25:323-337. [PMID: 26883126 PMCID: PMC5706478 DOI: 10.1007/s10728-016-0313-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Within the current Dutch policy context the role of informal care is revalued. Formal care activities are reduced and family and friends are expected to fill this gap. Yet, there is little research on the moral ambivalences that informal care for loved ones who have severe and ongoing mental health problems entails, especially against the backdrop of neoliberal policies. Giving priority to one’s own life project or caring for a loved one with severe problems is not reconciled easily. Using a case study we illustrate the moral ambivalences that persons may experience when they try to shape their involvement and commitment when a relative is in need. The case comes from a research project which explores whether it is possible to reduce coercive measures in psychiatry by organizing a Family Group Conference. The purpose of the article is to explore what theoretical concepts such as ‘communities of fate’, ‘communities of choice’ and ‘personal communities’ add in understanding how persons shape their involvement and commitment when a family member experiences recurrent psychiatric crises.
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Affiliation(s)
- Ellen Meijer
- Department of Medical Humanities, VU University Medical Centre, De Boelelaan 1117, 1081, HZ, Amsterdam, The Netherlands.
| | - Gert Schout
- Department of Medical Humanities, VU University Medical Centre, De Boelelaan 1117, 1081, HZ, Amsterdam, The Netherlands
| | - Tineke Abma
- Department of Medical Humanities, VU University Medical Centre, De Boelelaan 1117, 1081, HZ, Amsterdam, The Netherlands
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Lim MH, Gleeson JF. Social connectedness across the psychosis spectrum: current issues and future directions for interventions in loneliness. Front Psychiatry 2014; 5:154. [PMID: 25426081 PMCID: PMC4227483 DOI: 10.3389/fpsyt.2014.00154] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 10/21/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Michelle H Lim
- Brain and Psychological Sciences Centre, Swinburne University of Technology , Hawthorn, VIC , Australia
| | - John F Gleeson
- Australian Catholic University , Melbourne, VIC , Australia
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