Abstract
Introduction: Social dysfunction is a common symptom of several neuropsychiatric disorders. However, only in the last few years research began to systematically investigate clinical aspects of this relevant outcome. Interestingly, its distribution and link with other clinical variables is still unclear. This study investigated social dysfunction in 4 different cohorts of patients affected by mood disorders and schizophrenia to evaluate 1) the degree of social dysfunction in these populations; 2) the associations among social dysfunction and socio-demographic and psychopathological features. Methods: Data from 4 independent studies (CATIE, GSRD ES1, ES2 and ES3, STAR*D, STEP-BD) were investigated. Behavioural and affective indicators of social dysfunction were derived and operationalized from scales or questionnaire items related to the interaction with relatives, friends and significant people in patients affected by schizophrenia (N = 765) and mood disorders (N = 2278 + 1954 + 1829). In particular the social dysfunction indicator was derived from Sheehan Disability Scale (SDS) for GSRD sample, from the Work and Social Adjustment Scale (WSAS) for STAR*D sample, from the Life-Range of Impaired Functioning Tool (LRIFT) for STEP-BD sample, and from the Quality of Life Scale (QOLS) for CATIE sample. The distribution of social dysfunction was described and association with socio-demographic and psychopathological characteristics were analysed. Results: Social dysfunction indicators showed a broad distribution in all samples investigated. Consistently across studies, social dysfunction was associated with higher psychopathological severity (all samples except CATIE) and suicide risk (GSRD ES1 and ES2, STAR*D, and STEP-BD) that explain up to 47% of the variance, but also to lower education level (GSRD ES2, STAR*D, CATIE, and STEP-BD), poorer professional/work status (GSRD ES2 and ES3, STAR*D, CATIE, and STEP-BD), marital status (STAR*D and CATIE), age (younger age in GSRD ES1 and STAR*D, older age in CATIE), higher BMI (GSRD ES2 and ES3, and STEP-BD), and smoking (GSRD ES2 and ES3). Conclusion: Our results demonstrated that a significant percentage of patients affected by both mood disorders and schizophrenia shows relevant social dysfunction. Social dysfunction is related, but not completely explained by psychopathological severity. In several patients, it tends to persist also during remission state. Socio-demographic and lifestyle factors were also found to play a role and should therefore be taken into consideration in further studies investigating social dysfunction.
Highlights
Social dysfunction is a common symptom of several neuropsychiatric disorders
Taking into account these observations, it has been hypothesized that social dysfunction may represent a trans-diagnostic symptomatology domain (Cotter et al, 2018; Gur and Gur, 2016) which is sustained by pathogenic processes affecting the social brain, that are partially independent from the other consequences of the affecting disorder (Porcelli et al, 2018)
We showed the distribution in the total sample, in the sub-sample of less-severe patients, and in the subsample of remitted patients
Summary
Social dysfunction is a common symptom of several neuropsychiatric disorders. only in the last few years research began to systematically investigate clinical aspects of this relevant outcome. Among them is schizophrenia (SCZ), where various social impairments have been reported since the first descriptions of the disorder (e.g., Addington and Addington, 2008; Green et al, 2015), but it is common in mood disorders (Kupferberg et al, 2016; Van Rheenen and Rossell, 2014), anxiety disorders (Plana et al, 2014), eating disorders (Caglar-Nazali et al, 2014), borderline and antisocial personality disorders (Beeney et al, 2015; Jeung and Herpertz, 2014; Cotter et al, 2018), and Alzheimer's disease and other dementias (Dickerson, 2015; Havins et al, 2012) Taking into account these observations, it has been hypothesized that social dysfunction may represent a trans-diagnostic symptomatology domain (Cotter et al, 2018; Gur and Gur, 2016) which is sustained by pathogenic processes affecting the social brain, that are partially independent from the other consequences of the affecting disorder (Porcelli et al, 2018). Studies investigating social dysfunction across different neuropsychiatric disorders are still few and not comparable (Cotter et al, 2018)
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