Social exclusion in schizophrenia: Psychological and cognitive consequences

Social isolation and cognitive function in patients with schizophrenia: A two years follow-up study

Cognitive impairment is a core characteristic of schizophrenia. Social isolation has been linked to impaired cognitive function among the general population. In this longitudinal study, we examined the association between social isolation and cognitive function among inpatients with schizophrenia. Two waves of data (2019 and 2021) were collected from chronic psychiatric wards. A total of 166 inpatients completed all measurements at baseline and follow-up. Social isolation was measured by incorporating the frequency of social contact and participation, while cognitive functions were assessed by the Taiwan version of the Montreal Cognitive Assessment (MoCA-T). We used multiple linear regression to evaluate the link between baseline social isolation and cognitive function. For the total sample, social isolation was significantly related to poor language abilities (β = -0.17, p = 0.013) and delayed recall (β = -0.15, p = 0.023). Sex-stratified analysis showed that social isolation was significantly related to poor global cognitive function (β = -0.14, p = 0.021) and domain-specific cognitive functions including language abilities (β = -0.26, p = 0.003) and delayed recall (β = -0.19, p = 0.045) in male inpatients. No significant association was found between social isolation and global cognitive function or any cognitive domain (all ps > 0.05) for females. All associations were independent of loneliness and other covariates. These findings suggested that social isolation could predict poor subsequent cognitive function in inpatients with schizophrenia, especially in males. Interventions aimed at enhancing social connections could potentially improve cognitive function in this population.

Examining the effects of diagnostic awareness, positive symptoms, and negative symptoms on stigmatizing attitudes and social exclusion towards schizophrenia

BACKGROUND

Social exclusion towards schizophrenia can occur as a response to symptom presentations and/or diagnostic knowledge. The present study examined stigma towards schizophrenia as a function of diagnostic awareness, positive symptoms, and negative symptoms.

METHODS

559 participants were presented with one of eight vignettes depicting an individual in a social situation based on a 2 (label: present, absent) x 2 (positive symptoms: present, absent) x 2 (negative symptoms: present, absent) design. Participants then completed various measures of social exclusion and stigmatizing attitudes.

RESULTS

A significant three-way interaction between positive symptoms, negative symptoms, and a diagnostic label was found for stigmatizing attitudes such that knowledge of diagnosis was associated with less stigma when symptoms were present but resulted in more stigma when symptoms were absent. A significant interaction between diagnostic label and negative symptoms was found on social distance such that knowledge of diagnosis increased desire for social distance when negative symptoms were present.

CONCLUSION

Diagnostic awareness increases stigmatizing attitudes and social distance when symptoms are not present. However, when contextualized with the presence of symptoms, diagnostic awareness may reduce exclusion by providing an explanation for those symptoms. Determining when and to whom to disclose one's diagnosis may be helpful to improve social functioning in schizophrenia.

The impact of social exclusion on impulsive buying behaviour of consumers on online platforms: Samples from China

Social exclusion is a common phenomenon in modern social life that has significant negative effects on those who were excluded. The excluded may adopt strategic impulsive consumption behaviors in order to gain a sense of belonging and repair social relations, and the rapid development of online shopping platforms has intensified the occurrence of impulsive purchasing behaviors. Therefore, the internal mechanism between the two needs to be clarified. This study utilised SPSS 26.0, Mplus8.0 and HLM6.08 to analyse the data from 417 questionnaires, focused on exploring the internal mechanism between social exclusion and impulsive buying behaviour, and yielded the following conclusions. (1) Social exclusion is positively correlated with impulsive purchasing behaviour. (2) Relative deprivation plays a mediating role between social exclusion and impulsive buying behaviour. (3) The need to belong plays an intermediary role between social exclusion and impulsive buying behaviour. (4) Self-control plays a moderating role between social exclusion and impulsive buying behaviour. These conclusions could provide a basis for enterprises to formulate rational marketing strategies and create consumer demand.

The Influence of Social Exclusion on High School Students' Depression: A Moderated Mediation Model

Purpose

High school students face various pressures such as academic and interpersonal relationships, which can easily lead to depression. Social exclusion is one of the important influencing factors for adolescent depression, but there is still limited research on the mechanisms of the impact that social exclusion has on depression. Therefore, this study aimed to explore the effect of social exclusion on depression among high school students, as well as the mediating role of thwarted belongingness and the moderating role of cognitive reappraisal.

Methods

Researchers assessed 1041 high school students using the Center for Epidemiologic Studies Depression Scale (CES-D), Adolescent Social Exclusion Scale, Interpersonal Needs Scale, and Emotion Regulation Scale.

Results

(1) Social exclusion was negatively associated with cognitive reappraisal (r = -0.224, p < 0.001), and positively associated with thwarted belongingness and depression (r = 0.657, 0.490, p <0.001). Thwarted belongingness was positively associated with depression (r = 0.617, p <0.001), and negatively associated with cognitive reappraisal (r = -0.325, p <0.001). Cognitive reappraisal was negatively associated with depression (r = -0.280, p < 0.01). (2) Social exclusion could directly predict depression, 95% CI [0.08, 0.21]. Thwarted belongingness played a partial mediating role between social exclusion and depression, 95% CI [0.30, 0.40]. (3) Cognitive reappraisal moderated the predictive effect of thwarted belongingness on depression.

Conclusion

Social exclusion can influence depression through thwarted belongingness and cognitive reappraisal, and educators can reduce depression by decreasing thwarted belongingness and promoting the use of cognitive reappraisal strategies by high school students.

Social Cognition and Other Determinants of Perceived Social Support in Individuals With Serious Mental Illness

ABSTRACT

Social support provides protective effects for those with serious mental illness (SMI), but these effects may be attenuated by factors that hinder positive perceptions of support. Improved understanding of social support and its determinants may hold relevance for clinical interventions and provide avenues to promote recovery and improve functioning. The present study is a cross-sectional, correlational analysis investigating the relationships among social cognition (Mayer-Salovey-Caruso Emotional Intelligence Test-Managing Emotions subscale), social anxiety (Liebowitz Social Anxiety Scale), negative symptoms (Scale for the Assessment of Negative Symptoms), and perceived social support (Interpersonal Support Evaluation List) among individuals with SMI. Data were analyzed for 59 participants from a psychosocial rehabilitation treatment study at a public, urban academic-affiliated medical center in the Midwest. Bivariate Pearson correlations revealed statistically significant associations among perceived social support and social cognition (total perceived social support, p < 0.05; appraisal support, p < 0.01), negative symptoms (appraisal support, p < 0.05), and social anxiety (self-esteem support, p < 0.05). Further, multiple linear regression revealed social cognition remained a significant predictor of perceived social support ( p < 0.05) when controlling for social anxiety and negative symptoms. Overall findings suggest a correlative relationship between social cognition and perceived social support. Conclusions, limitations, and future directions are discussed.

Correlates of Social Isolation in Forensic Psychiatric Patients with Schizophrenia Spectrum Disorders: An Explorative Analysis Using Machine Learning

The detrimental effects of social isolation on physical and mental health are well known. Social isolation is also known to be associated with criminal behavior, thus burdening not only the affected individual but society in general. Forensic psychiatric patients with schizophrenia spectrum disorders (SSD) are at a particularly high risk for lacking social integration and support due to their involvement with the criminal justice system and their severe mental illness. The present study aims to exploratively evaluate factors associated with social isolation in a unique sample of forensic psychiatric patients with SSD using supervised machine learning (ML) in a sample of 370 inpatients. Out of >500 possible predictor variables, 5 emerged as most influential in the ML model: attention disorder, alogia, crime motivated by ego disturbances, total PANSS score, and a history of negative symptoms. With a balanced accuracy of 69% and an AUC of 0.74, the model showed a substantial performance in differentiating between patients with and without social isolation. The findings show that social isolation in forensic psychiatric patients with SSD is mainly influenced by factors related to illness and psychopathology instead of factors related to the committed offences, e.g., the severity of the crime.

The design and process of a family and community-based intervention for relapse prevention in people living with schizophrenia in Iran

BACKGROUND

People living with schizophrenia (PLS) suffer frequent relapse accompanied by emergency room visits, premature mortality, lower quality of life and a substantial social and economic burden on families and health systems. There is a dearth of community-based relapse prevention interventions (RPIs) in Iran.

AIMS

To determine an ideal model for a community-based RPIs for PLS.

METHODS

A qualitative study with 27 experts in Iran was carried out to understand the ideal RPIs for PLS and the key components of such interventions.

RESULTS

In 16 semi-structured interviews and 8 group-discussions, the participants identified six major stages of family and community-based RPIs including preparation, social mobilization, local team formation, design an RPI, implementing the RPI, participatory monitoring, and evaluation of the RPI.

CONCLUSIONS

Given the suboptimal healthcare systems and lack of professionals and services, PLS in Iran may benefit from family and community-based RPIs. Our findings warrant pilot testing of such initiatives across developing communities like Iran to improve health outcomes of PLS.

Social exclusion in psychotic disorders: An interactional processing model

Psychotic disorders are among the most highly stigmatized mental disorders, and individuals with psychosis experience significant exclusion from the community. Stigma reduction programs have done little to reduce social exclusion of individuals with psychosis, and there are significant limitations to the traditional stigma model as it applies to social exclusion. Herein, we present the Interactional Processing Model (IPM) of social exclusion towards individuals with psychosis. The IPM considers social exclusion to be the result of two interacting pathways with additional consideration for a feedback loop through which social exclusion sets in motion natural behavioural responses of individuals with psychosis that inadvertently perpetuates exclusion. The IPM considers initial social exclusion to be the result of an interaction between these two pathways. The first path aligns with the traditional stigma model and consists of the community becoming aware that an individual is diagnosed with a psychotic disorder and then excluding the individual based on pre-existing, generalized knowledge about the disorder. The second path to exclusion involves the observation of atypical behaviours from the individual, and generation of an individualized exclusion response. We provide initial empirical support for the IPM of social exclusion, outline testable hypotheses stemming from the model, and discuss implications for novel ways to consider both societal stigma reduction and personalized intervention.

Altered immediate behavioral response to partial social exclusion: A cross-diagnostic study in patients with borderline personality disorder and persistent depressive disorder

Borderline personality disorder (BPD) and persistent depressive disorder (PDD) are related to interpersonal dysfunction which might become particularly apparent in situations of social exclusion (SE). While emotional responses to SE have been widely explored, behavioral data in clinical samples are lacking. In this cross-diagnostic study, we applied a variant of the Cyberball paradigm to investigate the dynamic behavioral response to partial SE in BPD and PDD. BPD patients (n = 36), PDD patients (n = 34) and age and gender matched healthy controls (HC) (total n = 70) played experimental (i.e. partial SE Cyberball) and control (i.e. inclusion only) conditions in randomized order. While all groups tended to increase ball tosses towards the excluder in response to SE, this behavioral turn was significantly lower in PDD (p = .03, d = -.30) and trendwise in BPD patients (p = .06, d = -.28). Thus, an altered immediate response to partial SE was observed in BPD and PDD, in addition to the emotional reactions. This study supports the hypothesis of a behavioral coping with SE in BPD and PDD that might be problematic in the long run and provides an experimental paradigm for future research on interpersonal dysfunction.

Coping Strategies, Anxiety and Depression in OCD and Schizophrenia: Changes during COVID-19

BACKGROUND

The main aim was to examine changes in coping strategies, anxiety and depression in obsessive-compulsive and schizophrenia patients during COVID-19, in addition to controlling the influence of intolerance to uncertainty and experiential avoidance.

METHOD

The first time, the study comprised (15-30 April 2020) 293 patients, 113 of whom were diagnosed with obsessive-compulsive disorder, 61 with schizophrenia and 119 healthy controls, aged 13-77 years (M = 37.89, SD = 12.65). The second time (15-30 November), the study comprised 195 participants (85 obsessive-compulsive patients, 42 schizophrenic patiens and 77 healthy controls participants). The evaluation was carried out through an online survey.

RESULTS

The clinical groups worsened over time in cognitive coping, anxiety and depression, while the control group only worsened in depression. Intergroup differences in anxiety, depression and coping strategies were maintained, highlighting the use of some maladaptive strategies (avoidance, spiritual) in clinical groups. Experiential avoidance and tolerance for uncertainty mainly affected coping.

CONCLUSIONS

The duration of COVID-19 not only produced changes in anxiety and depression in clinical groups but also in coping strategies to face this pandemic and its consequences.

Social exclusion and rejection across the psychosis spectrum: A systematic review of empirical research

Social exclusion and rejection have deleterious effects on psychological well-being. Research documents the negative effects of social exclusion and rejection on psychiatric problems like depression, social anxiety disorder, and non-suicidal self-injury. Additionally, prior research suggests that individuals with and at-risk for psychosis spectrum disorders may also be negatively affected by exclusion and rejection. Moreover, those on the psychosis spectrum may be at an even greater risk to experience social exclusion due to poor social functioning and the stigma surrounding the disorder. This systematic review aimed to investigate how individuals across the psychosis spectrum respond to social exclusion and rejection. We systematically searched PubMed and PsycINFO databases to identify studies that met the following eligibility criteria: 1) investigated social exclusion or rejection, 2) targeted a psychosis-related sample or symptoms, and 3) was an empirical study. 13 studies satisfied our eligibility criteria and were subsequently reviewed. Despite methodological variation and samples spanning the psychosis spectrum, the majority of the literature supports the conclusion that those with psychosis spectrum disorders report similar levels of exclusion-induced distress compared to healthy controls, but process and cope with exclusion differently, both behaviorally and neurobiologically.