Social adversity and loneliness in first episode psychosis

Social adversity-including poverty, trauma, and other adverse life experiences-is associated with higher risk of psychosis and poorer outcomes in schizophrenia spectrum disorders. Loneliness, the subjective experience of social disconnection, is also prevalent among people with psychosis; however, the extent to which social adversity contributes to loneliness in people with psychosis is relatively unknown.

In the current study, we developed a measurement model of social adversity and assessed associations with loneliness in 404 participants with First Episode Psychosis (FEP) enrolled in the Recovery After an Initial Schizophrenia Episode-Early Treatment Program. Loneliness was measured using five self-report items (e.g., "I often feel lonely because I have few close friends with whom to share my concerns."). We created a latent variable of social adversity that included trauma history (number of reported traumatic experiences), parental education, homelessness, contact with law enforcement, and deferral/food stamp receipt. We first evaluated our measurement model of social adversity, then estimated a path model of its relationship with loneliness, accounting for age, diagnosis, gender, and degree of recent social involvement. Models were fit at both baseline and six-month timepoints.

The measurement model of social adversity had acceptable fit, with adequate item loadings. At baseline, greater social adversity was associated with limited social involvement and higher self-reported loneliness, though the latter association was not statistically significant. At six months, greater social adversity was associated with significantly greater loneliness.

Social adversity may be an important contributor to loneliness in FEP. Such adversity could contribute to feelings of social disconnection by way of either limited opportunities for meaningful social contact, or perceived discrimination/stigma. Psychosocial treatment of FEP should incorporate an understanding of the impact of social adversity on important outcomes in this population.