Social Withdrawal, Loneliness, and Health in Schizophrenia: Psychological and Neural Mechanisms

Associations between social isolation, withdrawal, and depressive symptoms in young adults: a cross-sectional study

BACKGROUND

Social isolation and withdrawal, particularly among young people, have become significant social issues, raising concerns about mental health disorders. This study explores the association between social isolation, withdrawal, and depressive symptoms in young adults, focusing on sex differences and underlying factors.

METHODS

Data from 5,513 participants in the Seoul Government Survey on Socially Isolated and Withdrawn Young Adults were included in this study. Social isolation and withdrawal were measured based on levels of emotional or physical isolation and the amount of time spent at home instead of attending work or school. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-9) scale. Multiple and multinomial logistic regression analyses were performed to investigate the associations between social isolation, withdrawal, and depression.

RESULTS

Socially isolated young adults demonstrated a strong association with depression (isolation only: Male, odds ratio [OR] 2.06, 95% confidence interval [CI] 1.38-3.08; Female, OR 2.95, 95% CI 2.06-4.95; isolation including withdrawal: Male, OR 2.56, 95% CI 1.11-5.89; Female, OR 2.40, 95% CI 1.04-5.57). However, withdrawal alone did not show any significant association. As depressive symptoms intensified (PHQ-9 ≥ 20), the association with social isolation strengthened (Male, OR 6.50, 95% CI 3.23-13.08; Female, OR 6.82, 95% CI 3.43-13.58). Prolonged isolation (≥ 3 years) was strongly associated with depression (Male, OR 2.91, 95% CI 1.76-4.79; Female, OR 6.04, 95% CI 3.58-10.20).

CONCLUSION

Among young adults, the association between social isolation and depression intensifies with prolonged isolation and increased symptom severity, while withdrawal alone has no such effect. This highlights the importance of addressing social isolation and related issues in mental health interventions for young adults.

A unified pathogenic hypothesis for mental disorders based on schismogenesis

Major Depressive Disorder, Bipolar Disorder, and Schizophrenia, share significant genetic, epigenetic, and phenotypic overlap, manifesting as dimensional psychopathology and convergent neuroimaging findings. These shared features have led to various models exploring common underlying pathophysiological mechanisms, including excitatory-inhibitory imbalance, the triple network model, network analysis, and social disconnection. While these models offer valuable insights, a unifying framework remains elusive. Schismogenesis, a transdisciplinary construct, is proposed to reconcile divergent perspectives on mental health conditions. Characterized by positive feedback loops leading to functional dissociation due to insufficient inhibitory control, complementary schismogenesis results in rigid hyperactivation and hypoactivation within neural, cognitive, and social networks, compromising system flexibility. This pathological process underlies the core features of Major Depressive Disorder, Bipolar Disorder, and Schizophrenia, depending on its location within networks. The schismogenesis hypothesis suggests that when individuals are overwhelmed by excessive stress or tension, they may experience a breakdown or disconnection to prevent irreversible damage, reflecting evolutionary adaptations. Importantly, the potential reversibility of schismogenesis, particularly through interventions that facilitate system reintegration, suggests promising therapeutic avenues for further exploration.

What Is Social Connection in the Context of Human Need: An Interdisciplinary Literature Review

The U.S. Surgeon General made an impactful declaration in the 2023 advisory on America's loneliness and social isolation epidemic that social connection, or human relationships, is a human need equivalent to water, food, and shelter. After witnessing the impact of social isolation measures during the COVID-19 pandemic, there is a global urgency to better understand social connection in public health responses. However, meaningfully effective interventions for social isolation or loneliness have yet to be identified, and the consensus that social connection is an equivalent human need is unclear. To understand what social connection, oxygen, water, food, and shelter have in common regarding population health, we conducted an interdisciplinary literature review between September 2021 and October 2024, seeking to find commonalities between research literature advocating social connection as a human need critical to survival and key concepts across population health disciplines that explain how oxygen, water, food, and shelter function as human needs. We integrated the concepts of evolution, resource, environment, ecosystem, exposure science, embodiment, homeostasis, allostatic load theory, and interdisciplinary from 44 core publications to develop a unified conceptual model and definition for social connection as a human need. We believe a holistic understanding of social connection within the shared context of oxygen, water, food, and shelter can better support health researchers across a variety of disciplines to find common ground in developing evidence-based interventions within public health.

Loneliness is associated with different structural brain changes in schizophrenia spectrum disorders and major depression

BACKGROUND

Loneliness, distress from having fewer social contacts than desired, has been recognized as a significant public health crisis. Although a substantial body of research has established connections between loneliness and various forms of psychopathology, our understanding of the neural underpinnings of loneliness in schizophrenia spectrum disorders (SSD) and major depressive disorder (MDD) remains limited.

METHODS

In this study, structural magnetic resonance imaging (sMRI) data were collected from 57 SSD and 45 MDD patients as well as 41 healthy controls (HC). Loneliness was measured with the German version of the University of California, Los Angeles Loneliness Scale (UCLA-LS). We used FreeSurfer v7.2 for automated parcellation of cortical regions.

RESULTS

SSD patients showed reduced cortical volume and thickness in fronto-parietal and temporal regions when compared to HC (p < 0.05, Benjamini-Hochberg (BH) corr.). In SSD, volume of the right superior temporal gyrus was associated with UCLA-LS total score (p = 0.030; BH corr.). MDD patients showed reduced cortical volume and thickness in fronto-parietal regions (p < 0.05, BH corr.). In MDD, cortical thickness of the right superior parietal cortex was associated with UCLA-LS total score (p = 0.038; BH corr.).

CONCLUSION

Our study suggests a different neural signature of loneliness in patients with SSD and MDD, comprising temporal and parietal regions responsible for social and attentive processing. Identifying neurobiological mechanisms underlying loneliness is critical for understanding its role in severe mental illnesses and identifying potential therapeutic targets.

Exploring the Experience of Loneliness among People Living with Schizophrenia: A Qualitative Study

BACKGROUND

People living with schizophrenia or schizoaffective disorder are at heightened risk for experiencing loneliness, which is associated with negative health, quality of life, and symptom-specific outcomes.

AIMS

This study aimed to better understand the experience of loneliness among adults living with schizophrenia or schizoaffective disorder.

METHODS

Using a semi-structured interview guide, researchers interviewed twelve participants living with schizophrenia or schizoaffective disorder. Interview topics included the contexts of loneliness, hopes related to living a life less impacted by loneliness, and coping strategies. Researchers used conventional content analysis to analyze interview data and generate themes.

RESULTS

The research team identified four themes from the interview data: emotional disconnection, social anxiety leading to loneliness, unmet needs within social networks, and lacking companionship. Participants had a variety of hopes for the future, including increasing the quality of their relationships and improving their sense of self-efficacy. Participants described a variety of coping strategies, ranging from individual (e.g. leveraging technology, using cognitive reframing techniques) to systems-level (e.g. local clubhouses and walkable neighborhoods).

CONCLUSIONS

Participants have identified several priorities and coping strategies to reduce loneliness that can be integrated with current models of loneliness to develop interventions that are meaningful and effective for this population.

Social Effort Discounting Reveals Domain-General and Social-Specific Motivation Components

BACKGROUND

Social motivation is crucial for healthy interpersonal connections and is impaired in a subset of the general population and across many psychiatric disorders. However, compared with nonsocial (e.g., monetary) motivation, social motivation has been understudied in quantitative behavioral work, especially regarding willingness to exert social effort. We developed a novel social effort discounting task, paired with a monetary task to examine motivational specificity. We expected that social task performance would relate to general motivation and also show selective relationships with self-reported avoidance tendencies and with sociality.

METHODS

An analyzed sample of 397 participants performed the social and nonsocial effort discounting task online, along with self-report measures of various aspects of motivation and psychiatric symptomatology.

RESULTS

Social and nonsocial task motivation correlated strongly (ρ = 0.71, p < .001). Both social and nonsocial task motivation related similarly to self-reported general motivation (social, β = 0.16; nonsocial, β = 0.13) and to self-reported approach motivation (social, β = 0.14; nonsocial, β = 0.11), with this common effect captured by a significant main effect across social and nonsocial conditions. Significant condition interaction effects supported a selective relationship of social task motivation with self-reported sociality and also with avoidance motivation.

CONCLUSIONS

Our novel social effort discounting task revealed both domain-general and social-specific components of motivation. In combination with other measures, this approach can facilitate further investigation of common and dissociable neurobehavioral mechanisms to better characterize normative and pathological variation and develop personalized interventions targeting specific contributors to social impairment.

Factors encouraging participation in social activities after hospital discharge in people with severe mental illness who received occupational therapy

Introduction

Occupational therapy (OT), a vital part of psychiatric rehabilitation, encourages participation in social activities, which is critical for the recovery of people with severe mental illnesses (SMI). However, the effects of OT on the subsequent social activities of patients with SMI have not been fully clarified. We aimed to identify the factors that encourage post-discharge social activity participation among patients with SMI who received OT.

Method

Patients who underwent OT at the Kyorin University Hospital between April 2016 and March 2020 were retrospectively examined for baseline data during hospitalization and social activity status 1 year after discharge. Occupational support, group adaptation, artistic activities, and exercise programs were considered. Activities requiring social interaction were defined as social activities, including employment, schooling, sheltered work, and volunteer work. Multiple logistic regression analyses using demographic and medical data, prehospitalization social activity status, and OT participation rates as independent variables were used to examine the factors encouraging social activity participation after discharge. Decision tree analysis was conducted to identify patients who specifically needed to increase OT participation.

Results

Of 524 eligible patients, 247 were included in the study. The number of patients who were socially active at admission and after discharge was 116 and 188, respectively. Multiple logistic regression analyses revealed that the following factors were likely to encourage social activity participation after discharge: higher rates of OT participation to facilitate group adaptation (OR = 1.015, 95% CI 1.003-1.027), being socially active at admission (OR = 4.557, 95% CI 2.155-9.637), and no marital history (OR = 0.293, 95% CI 0.130-0.661). Decision tree analysis showed that for patients who were socially inactive at admission and had a history of marriage, increasing OT participation to 52.6% or higher may ensure social activity participation after discharge.

Conclusions

This study identified patients whose social participation after discharge could be boosted by OT that facilitates group adaptation. Our findings would facilitate the development of individualized add-on rehabilitation based on the effects of real-world OT practices.

Challenges in replication: Does amygdala gray matter volume relate to social network size?

In this work, we tried to replicate and extend prior research on the relationship between social network size and the volume of the amygdala. We focused on the earliest evidence for this relationship (Bickart et al., Nature Neuroscience 14(2), 163-164, 2011) and another methodologically unique study that often is cited as a replication (Kanai et al., Proceedings of the Royal Society B: Biological Sciences, 279(1732), 1327-1334, 2012). Despite their tight link in the literature, we argue that Kanai et al. (Proceedings of the Royal Society B: Biological Sciences, 279(1732), 1327-1334, 2012) is not a replication of Bickart et al. Nature Neuroscience 14(2), 163-164 (2011), because it uses different morphometric measurements. We collected data from 128 participants on a 7-Tesla MRI and examined variations in gray matter volume (GMV) in the amygdala and its nuclei. We found inconclusive support for a correlation between measures of real-world social network and amygdala GMV, with small effect sizes and only anecdotal evidence for a positive relationship. We found support for the absence of a correlation between measures of online social network and amygdala GMV. We discuss different challenges faced in replication attempts for small effects, as initially reported in these two studies, and suggest that the results would be most helpful in the context of estimation and future meta-analytical efforts. Our findings underscore the value of a narrow approach in replication of brain-behavior relationships, one that is focused enough to investigate the specifics of what is measured. This approach can provide a complementary perspective to the more popular "thematic" alternative, in which conclusions are often broader but where conclusions may become disconnected from the evidence.

Physical activity and prevention of mental health complications: An umbrella review

The potential of physical activity in preventing mental health issues has garnered interest among health professionals. We conducted a systematic umbrella review of evidence supporting the relationship between physical activity and the prevention of mental health complications. Our findings revealed a significant association between higher physical activity levels and reduced risk of depression (OR = 0.77, 95% CI 0.72 - 0.82). This association was consistent across various age groups, sex, and geographical regions. Interestingly, low and moderate-intensity physical activity showed the most significant protective effects against depression (low-intensity: OR = 0.81, 95% CI: 0.75-0.56; moderate-intensity: OR = 0.79, 95% CI: 0.72-0.87). Our analysis also showed significant associations between higher physical activity levels and prevention of anxiety disorders (OR = 0.71, 95% CI: 0.61-0.82). However, the evidence regarding the association between physical activity and psychosis/schizophrenia risk was less clear. These findings underscore the physical activity's potential as a preventative measure against mental health complications, highlighting the importance of promoting physical activity in mental health interventions.