Dominika A Osicka, Jiasi Hao, Natalia Tiles-Sar, Mariam P Ali, Richard Bruggeman, Lisette van der Meer, Behrooz Z Alizadeh
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引用次数: 0
Abstract
Background: Due to prior emphasis on clinical recovery in Schizophrenia Spectrum Disorder (SSD), improving social functioning (SF) was oftentimes neglected, with ⩽15% of patients achieving social recovery. Priorly, we and others have shown that life-course factors, including childhood adversities, play a role in the occurrence and severity of postmorbid SF impairments, highlighting the need to understand these factors for effective interventions.
Aim: This study investigates the mechanisms influencing SF in SSD and examines the causal roles of childhood trauma, premorbid adjustment, perceived stigma, self-esteem, and quality of life.
Methods: This longitudinal study utilized data of 1,057 SSD patients, with measures at baseline, 3 and 6-year follow-up, from the Genetic Risk and Outcome of Psychosis cohort, to unravel the causal mechanism underlying SF utilizing Structural Equation Modeling. Determinants were assessed using validated retrospective and self-report questionnaires. Model development and testing involved a multistage process, encompassing relationships exploration, fit evaluation and model comparison.
Results: We developed a probable causal model. Impaired premorbid adjustment emerged as a crucial factor, exerting negative influence on long-term SF, with a direct effect of β = -.252, p < .001 on SF at 3-year follow-up and β = -.056, p = .073 at 6-year follow-up. Childhood trauma exhibited a negative direct effect on SF at 3-year follow-up (β = -.087, p = .039), while demonstrating a substantial carry-over, indirect effect. Elevated perceived stigma negatively affected SF at 3-year follow-up (β = -.112, p = .008). The model explained 9.9% of SF variation at the 3-year follow-up and 54.3% at the 6-year follow-up.
Conclusions: While validation is necessary, we found a foundational basis for causal interpretation. Premorbid adjustment, childhood trauma, and perceived stigma are essential life-course factors shaping postmorbid SF in SSD. We recommend interventions covering both prevention and treatment for individuals with established symptoms-addressing childhood trauma, premorbid adjustment, and perceived stigma-to enhance long-term social outcomes and offer actionable insights for clinicians.
背景：由于先前强调精神分裂症谱系障碍（SSD）的临床康复，改善社会功能（SF）往往被忽视，有15%的患者实现社会康复。先前，我们和其他人已经表明，包括童年逆境在内的生命过程因素在病后SF损伤的发生和严重程度中发挥作用，强调需要了解这些因素以进行有效的干预。目的：本研究探讨影响SSD患者SF的机制，并探讨童年创伤、病前适应、感知耻感、自尊和生活质量的因果关系。方法：这项纵向研究利用1057名SSD患者的数据，包括基线、3年和6年随访，来自精神病遗传风险和结局队列，利用结构方程模型揭示SF的因果机制。采用有效的回顾性和自我报告问卷对决定因素进行评估。模型开发和测试是一个多阶段的过程，包括关系探索、拟合评估和模型比较。结果：我们建立了一个可能的因果模型。病前调节功能受损是影响远期SF的关键因素，其直接作用为β = -。252, p p =。073例，随访6年。在3年随访中，童年创伤对SF表现出负的直接影响（β = -）。087, p = .039)，同时显示出大量的结转间接效应。在3年随访中，耻辱感升高对SF有负向影响（β = -）。112, p = .008)。该模型解释了3年随访时9.9%的SF变异和6年随访时54.3%的SF变异。结论：虽然验证是必要的，但我们发现了因果解释的基础。病前适应、童年创伤和感知到的耻辱感是影响SSD患者病后SF的重要生命过程因素。我们建议对有症状的个体进行预防和治疗的干预——解决儿童创伤、病前调整和感知到的耻辱感——以提高长期的社会结果，并为临床医生提供可操作的见解。
期刊介绍：
The International Journal of Social Psychiatry, established in 1954, is a leading publication dedicated to the field of social psychiatry. It serves as a platform for the exchange of research findings and discussions on the influence of social, environmental, and cultural factors on mental health and well-being. The journal is particularly relevant to psychiatrists and multidisciplinary professionals globally who are interested in understanding the broader context of psychiatric disorders and their impact on individuals and communities.
Social psychiatry, as a discipline, focuses on the origins and outcomes of mental health issues within a social framework, recognizing the interplay between societal structures and individual mental health. The journal draws connections with related fields such as social anthropology, cultural psychiatry, and sociology, and is influenced by the latest developments in these areas.
The journal also places a special emphasis on fast-track publication for brief communications, ensuring that timely and significant research can be disseminated quickly. Additionally, it strives to reflect its international readership by publishing state-of-the-art reviews from various regions around the world, showcasing the diverse practices and perspectives within the psychiatric disciplines. This approach not only contributes to the scientific understanding of social psychiatry but also supports the global exchange of knowledge and best practices in mental health care.
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