Feeling out of place: a qualitative study on pathways from social adversities to early psychosis

Socioenvironmental adversities play an important role in psychosis aetiology, yet the pathways that link them to psychosis development remain poorly understood. This qualitative study explored how individuals with early psychosis make sense of psychosis its emergence in relation to socioenvironmental circumstances across their life course.

Twenty-one participants were recruited from an outpatient early intervention service in the Netherlands. They participated in semi-structured biographical interviews. Interviews were analysed inductively using thematic analysis.

Participants' (12 men; 11 first or second generation immigrants; aged 20-34 years; 2 months-5.5 years since first psychosis treatment) life stories were marked by a sense of insecurity and out-of-placeness in the world, which they connected to childhood experiences of rejection and loneliness, as well as to difficulties in finding their place in school and work. Participants also highlighted losing a sense of themselves (or not feeling present as themselves) throughout the years preceding psychosis onset. This they connected to childhood environments that felt unsafe, and to stress and overwhelming external stimuli in adulthood. Disruptions shortly before onset, such as a relationship breakup, were described as culminating these experiences into a sense of seeing no path forward.

Our findings illustrate how participants connected socioenvironmental circumstances across their life course to psychosis through experiences that preceded psychosis onset, sometimes by many years. The evolvement of these pre-onset experiences throughout the biographical contexts of patients' lives warrants further in-depth research. Attending to these pre-onset experiences may help clinicians to find resonance with patients' understanding of their difficulties.