Orygen, National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.
School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia.
Early Interv Psychiatry. 2019 Jun;13(3):477-487. doi: 10.1111/eip.12507. Epub 2017 Oct 27.
People with psychosis are at risk of social exclusion. Research is needed in this area due to the lack of direct measurement of social inclusion, which becomes salient in adolescence and is relevant to first-episode psychosis (FEP; the onset of which typically occurs during or shortly after adolescence). Social inclusion may be impacted by impaired social cognition and social functioning, which are related features observed in psychosis. The aim of this study was to explore interrelationship(s) between social cognition, social functioning and social inclusion in FEP while controlling for symptomatology (positive, negative and depressive symptoms) and demographic characteristics.
A series of cross-sectional hierarchical multiple regressions were conducted to examine whether: social cognition (theory of mind, emotion recognition) predicted social functioning; social functioning predicted social inclusion, and whether social functioning mediated the relationship between social cognition and social inclusion in people aged 15 to 25 (M = 20.49, SD = 2.41) with FEP (N = 146). Age, sex, premorbid IQ, positive and negative psychotic symptoms and depression were control variables.
Poor facial emotion recognition (β = -.22, P < .05) and negative symptoms (β = -.45, P < .001) predicted lower social functioning. Role-specific social functioning (ie, current employment) predicted greater social inclusion (β = .17, P < .05). Higher depression symptomatology predicted lower social inclusion (β = -.43, P < .001). Social functioning did not mediate the relationship between social cognition and inclusion. Psychotic symptoms were unrelated to social inclusion.
Employment and depression may influence social inclusion somewhat independently of psychotic symptomatology in FEP. Inferences should be viewed with caution given this study did not involve longitudinal data.
精神病患者面临社会排斥的风险。由于缺乏对社会包容的直接衡量，因此需要在这一领域进行研究，而社会包容在青少年时期变得尤为突出，且与首发精神病（FEP；其发病通常发生在青少年时期或之后不久）相关。社会包容可能会受到受损的社会认知和社会功能的影响，这些是精神病中观察到的相关特征。本研究的目的是在控制症状（阳性、阴性和抑郁症状）和人口统计学特征的情况下，探讨 FEP 中社会认知、社会功能和社会包容之间的相互关系。
进行了一系列横断面层次多重回归，以检验以下情况：社会认知（心理理论、情绪识别）是否预测社会功能；社会功能是否预测社会包容，以及社会功能是否在 15 至 25 岁（M=20.49，SD=2.41）FEP 患者（N=146）的社会认知和社会包容之间的关系中起中介作用。年龄、性别、前病智商、阳性和阴性精神病症状和抑郁是控制变量。
较差的面部情绪识别（β=-.22，P<.05）和阴性症状（β=-.45，P<.001）预测社会功能较低。特定角色的社会功能（即当前就业）预测更高的社会包容（β=.17，P<.05）。较高的抑郁症状预测较低的社会包容（β=-.43，P<.001）。社会功能并没有在社会认知和包容之间的关系中起中介作用。精神病症状与社会包容无关。
就业和抑郁可能在一定程度上独立于 FEP 中的精神病症状影响社会包容。鉴于本研究没有涉及纵向数据，因此应谨慎得出结论。
