Abstract
BackgroundRecent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, specifically for individuals diagnosed with psychosis (PSY). Furthermore, evidence highlighted a tight relationship between attachment style and social cognition abilities, a key PSY behavioral phenotype. The aim of this study is to generate a machine learning algorithm based on the perceived quality of parenting and attachment style-related features to discriminate between PSY and healthy controls (HC) and to investigate its ability to track PSY early stages and risk conditions, as well as its association with social cognition performance.MethodsPerceived maternal and paternal parenting, as well as attachment anxiety and avoidance scores, were trained to separate 71 HC from 34 PSY (20 individuals diagnosed with schizophrenia + 14 diagnosed with bipolar disorder with psychotic manifestations) using support vector classification and repeated nested cross-validation. We then validated this model on independent datasets including individuals at the early stages of disease (ESD, i.e. first episode of psychosis or depression, or at-risk mental state for psychosis) and with familial high risk for PSY (FHR, i.e. having a first-degree relative suffering from psychosis). Then, we performed factorial analyses to test the group x classification rate interaction on emotion perception, social inference and managing of emotions abilities.ResultsThe perceived parenting and attachment-based machine learning model discriminated PSY from HC with a Balanced Accuracy (BAC) of 72.2%. Slightly lower classification performance was measured in the ESD sample (HC-ESD BAC = 63.5%), while the model could not discriminate between FHR and HC (BAC = 44.2%). We observed a significant group x classification interaction in PSY and HC from the discovery sample on emotion perception and on the ability to manage emotions (both p = 0.02). The interaction on managing of emotion abilities was replicated in the ESD and HC validation sample (p = 0.03).ConclusionOur results suggest that parenting and attachment-related variables bear significant classification power when applied to both PSY and its early stages and are associated with variability in emotion processing. These variables could therefore be useful in psychosis early recognition programs aimed at softening the psychosis-associated disability.
Highlights
Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, for individuals diagnosed with psychosis (PSY)
The aim of this study is threefold: (i) to generate a parenting and attachment-based machine learning model which correctly discriminates between PSY and healthy controls (HC); (ii) to test whether this model could track the early stages of psychosis and/or risk conditions in independent samples; (iii) to investigate in both psychosis and its early stages the potential association between model’s performance and social cognition impairments
Validation samples Validation clinical sample ANOVA and χ2 revealed that early stages of disease (ESD) differed significantly from HC in terms of gender distribution (p = 0.007, Table 1B) and of social inference performance as measured by The Awareness of Social Inference Test (TASIT) sections "Methods" and "Results" (Table 3B), with ESD performing worse than HC
Summary
Recent views posited that negative parenting and attachment insecurity can be considered as general environmental factors of vulnerability for psychosis, for individuals diagnosed with psychosis (PSY). They are both characterized by strong and largely overlapping anomalies in neurocognition and social cognition [5, 6], as well as by thought disturbances [7] Given this evidence and the strong and long-lasting disability affecting individuals with psychosis (PSY), especially individuals suffering from schizophrenia or from bipolar disorder with psychotic manifestations, the identification of markers of disease to be targeted in early identification or prevention strategies aimed at softening the PSY-associated burden is becoming more and more crucial in the clinical psychology and personalized medicine fields. Given its association with affect regulation, it is not surprising that studies have consistently reported a significant association between attachment insecurity and social cognition impairments, a key characteristic of PSY [21, 22] Both negative parenting and attachment insecurity have been associated with reduced coping strategies and increased likelihood of emotional breakdowns [17]. Low parenting abilities, as well as attachment insecurity, have been previously considered as general environmental factors of vulnerability for mental illness [16] whose effects are amplified by other genetic and/or environmental factors [8, 23] within the psychosis risk pathways
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