Examining Symptom Correlates of Personal Recovery Orientation in Early Psychosis Services: A Network Analysis Approach

Background:

Individuals entering early psychosis services often experience substantial fluctuation in symptomatology, functioning, and access to resources/services, resulting in low rates of recovery. While coordinated specialty care (CSC) seeks to remedy this disparity by providing an array of evidence-based interventions, the programmatic imperative of symptom reduction through pharmacotherapy and relapse prevention can place individuals within a “sick role”, overlooking the importance of empowerment and personal recovery (PR) on sustained wellbeing. Additionally, the emphasis on positive symptomatology neglects to comprehensively address affective and negative symptoms, which have demonstrable negative impacts on quality of life, social connection, and disability. CSC within the United States is characterized by high rates of dropout and disengagement, necessitating further examination and identification of clinical characteristics associated with service user satisfaction and positive treatment outcomes. Given the complex interplay of psychosis symptoms, this study sought to utilize a network analysis approach, exploring connections between symptoms across the spectrum of illness and multiple critical dimensions of PR orientation.

Methods:

Participants (N = 681) were selected from the EPINET national database, a multi-site study assessing early psychosis clients across more than 100 CSC clinics in 17 states. Assessments of symptomatology and PR were collected at baseline. The ‘bootnet’ package in R 4.4.2 was utilized to construct a gaussian graphical model (GGM), positioning symptom domains and PR components as nodes within a network with weighted ties (edges) demonstrating strength of association. Centrality indices were calculated to assess overall influence of nodes within the network structure. Bootstrap difference tests were utilized to determine stability and sensitivity of findings.

Results:

Visual inspection of the network identified four separate node clusters corresponding to PR items and three primary symptom branches (positive, negative, affective). Weighted edges indicated empowerment, past experiences, and self-efficacy subclusters within PR. Analysis of centrality indices for symptom domains detected significant strength and influence for affective symptomatology, as well as specific components of positive and negative symptoms (suspiciousness and avolition, respectively). Empowerment components of PR demonstrated significant influence within network structure.

Discussion:

The growing body of recovery research within psychosis posits clinical and personal recovery as distinct but complementary constructs, emphasizing the importance of providing services that address both processes. The resulting network structure indicates that targeting affective symptomatology through psychosocial intervention may cultivate personal recovery, augmenting existing CSC service provision. Additionally, the significant influence of empowerment demonstrates the importance of incorporating shared decision-making principles throughout the course of early intervention services, which could contribute to improving disproportionate rates of dropout and discharge. Further programmatic initiatives centering service users as the architects of their treatment experience is necessary to fully embody the essential CSC tenets of comprehensive and recovery-oriented care.