The Role of Hopelessness in the Relationships between Social Isolation, Hallucinations, and Delusions Among a First-Episode of Psychosis Sample

Background and Purpose: Social isolation is a common concern among individuals with schizophrenia, as studies have identified higher levels of hopelessness, minimal social networks, and reduced quality of social relationships as compared to the general population. Isolation has also been linked in the literature to greater symptoms of psychosis, with negative symptoms in particular, while less is known about its relationships with positive symptoms, namely hallucinations and delusions.  While more is known about these relationships within chronic illness, less is known within the context of first-episode psychosis (FEP).  This study aimed to examine the relationships between hallucinations, delusions, hopelessness, and social isolation among a sample of early-treatment-phase participants in the United States.

Methods: Data were obtained from the Recovery After an Initial Schizophrenia Episode project of National Institute of Mental Health’s Early Treatment Program. Participants were recruited from thirty-four clinical sites from 21 states in the US and included 404 adults between ages 15 and 40 with schizophrenia or other psychotic disorders based upon the DSM-IV. Hopelessness was measured using The Calgary Depression Scale for Schizophrenia (CDSS), hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS), and social isolation by the PANSS, all at baseline. Age, diagnosis based upon the DSM-IV, antipsychotic medication, and duration of untreated psychosis were included as covariates. Data were analyzed using structural equation modeling in Mplus 8. 

Results: Participants reported an average age of 24 years and most often identified as male (73%), White (54%), and non-Hispanic/Latino (82%).Participants most often had a diagnosis of schizophrenia (53%) and reported the experience of untreated psychosis for on average 6 months (SD=.72).  Model findings indicated that as hallucinations (b= .052, SE= .02, p < .05) and delusions (b= .108, SE= .03, p < .01)independently increased, on average there was an associated increase in hopelessness.  Increased hopelessness related to greater social isolation (b= .241, SE= .08, p < .01) and delusions were the only endogenous predictor that directly related to social isolation (b= .130, SE= .06, p < .05). 

Conclusions and Implications: Findings point towards the importance of assessing for and bolstering social networks and supports with potential use of social skills training programs. Considering the mediating role of hopelessness in the relationships between hallucinations, delusions, and social isolation, hopelessness is also an important treatment target in practice to be examined and treated as a potential symptom of depression. Lastly, given potential bidirectional relationships, future research is needed toexamine if positive symptoms of psychosis relate to greater isolation or if isolation exacerbates the positive symptoms.