Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Schizophr Bull. 2021 Aug 21;47(5):1218-1242. doi: 10.1093/schbul/sbab026.
Social anxiety is common in psychosis and associated with impaired functioning, poorer quality of life, and higher symptom severity. This study systematically reviewed factors maintaining social anxiety in people with attenuated, transient, or persistent psychotic experiences. Other correlates of social anxiety were also examined. MEDLINE, Embase, CENTRAL, and PsycINFO were searched for relevant literature up to October 19, 2020. Forty-eight articles were eligible for narrative synthesis: 38 cross-sectional studies, 8 prospective studies, 1 uncontrolled trial, and 1 qualitative study. From 12060 participants, the majority was general population (n = 8771), followed by psychosis samples (n = 2532) and those at high risk of psychosis (n = 757). The methodological quality and risk of bias were assessed using the Mixed Methods Appraisal Tool. Ninety percent of studies were rated as high to very-high quality. Poorer quality studies typically failed to adequately control for confounds and provided insufficient information on the measurement validity and reliability. Prominent psychological factors maintaining social anxiety included self-perceptions of stigma and shame. Common correlates of social anxiety included poorer functioning and lower quality of life. In conclusion, stigma and shame could be targeted as a causal mechanism in future interventional studies. The integration of findings from this review lead us to propose a new theoretical model to guide future intervention research.
社交焦虑在精神病中很常见，与功能障碍、生活质量下降和症状严重程度升高有关。本研究系统地回顾了在有减轻、短暂或持续精神病体验的人群中维持社交焦虑的因素。同时还检查了社交焦虑的其他相关因素。截至 2020 年 10 月 19 日，在 MEDLINE、Embase、CENTRAL 和 PsycINFO 上搜索了相关文献。48 篇文章符合叙事性综合分析的标准：38 项横断面研究、8 项前瞻性研究、1 项非对照试验和 1 项定性研究。从 12060 名参与者中，大多数是一般人群（n=8771），其次是精神病样本（n=2532）和精神病高危人群（n=757）。使用混合方法评估工具评估了方法学质量和偏倚风险。90%的研究被评为高质量到非常高质量。质量较差的研究通常未能充分控制混杂因素，并且对测量的有效性和可靠性提供的信息不足。维持社交焦虑的主要心理因素包括对耻辱感和羞耻感的自我认知。社交焦虑的常见相关因素包括功能障碍和生活质量下降。总之，耻辱感和羞耻感可能是未来干预研究中的一个因果机制。本综述的结果综合起来，为我们提出了一个新的理论模型，以指导未来的干预研究。
