The role of social relatedness and self-beliefs in social functioning in first-episode psychosis: Are we overestimating the contribution of illness-related factors?

César González-Blanch,John F Gleeson,Lee Valentine,Daniela Cagliarini,Simon D’Alfonso,Mario Alvarez-Jimenez,Leonardo A Medrano,Sarah Bendall,Shaunagh O’Sullivan,Carla Mcenery

doi:10.1192/j.eurpsy.2020.90

Abstract

Numerous research studies have demonstrated an association between higher symptom severity and cognitive impairment with poorer social functioning in first-episode psychosis (FEP). By contrast, the influence of subjective experiences, such as social relatedness and self-beliefs, has received less attention. Consequently, a cohesive understanding of how these variables interact to influence social functioning is lacking. We used structural equation modeling to examine the direct and indirect relationships among neurocognition (processing speed) and social cognition, symptoms, and social relatedness (perceived social support and loneliness) and self-beliefs (self-efficacy and self-esteem) in 170 individuals with FEP. The final model yielded an acceptable model fit (χ2=45.48, comparative fit index=0.96; goodness of fit index=0.94; Tucker-Lewis index=0.94; root mean square error of approximation=0.06) and explained 45% of social functioning. Negative symptoms, social relatedness, and self-beliefs exerted a direct effect on social functioning. Social relatedness partially mediated the impact of social cognition and negative symptoms on social functioning. Self-beliefs also mediated the relationship between social relatedness and social functioning. The observed associations highlight the potential value of targeting social relatedness and self-beliefs to improve functional outcomes in FEP. Explanatory models of social functioning in FEP not accounting for social relatedness and self-beliefs might be overestimating the effect of the illness-related factors.

Highlights

Subsequent to experiencing a first-episode psychosis (FEP), many individuals show—regardless of whether or not the symptoms remit—remarkably stable long-term impairments in major areas of everyday life [1,2]
Based on a systematic review and meta-analysis, we have previously suggested that novel treatments targeting cognitive deficits may improve functional outcomes in FEP [5]
Our findings indicated that social relatedness and self-beliefs, together with social cognition and negative symptoms, explained 45% of the variance in social functioning

Summary

Introduction

Subsequent to experiencing a first-episode psychosis (FEP), many individuals show—regardless of whether or not the symptoms remit—remarkably stable long-term impairments in major areas of everyday life [1,2]. Functional impairments in various areas—including work or education, interpersonal relations, and self-care—are associated with high costs of care and decreased quality of life [3]. These areas represent a crucial therapeutic goal for people with FEP. Based on a systematic review and meta-analysis, we have previously suggested that novel treatments targeting cognitive deficits may improve functional outcomes in FEP [5]. A recent meta-analysis [6] showed only small-to-medium effect sizes for the relationship of neurocognition and social cognition with functional outcomes, explaining 9% of the total average variance; a significant proportion of the variance remains unexplained

Methods

Discussion

Conclusion