Modelling the interplay between childhood adversity, recent stressful life events and perceived social support in pathways to an 'ultra-high risk' (UHR) of developing psychosis

• Main Author: Kalu, Ukwuori-Gisela
• Other Authors: Valmaggia, Lucia Rita ; Byrne, Majella ; Stahl, Daniel Richard
• Published: King's College London (University of London) 2018
• Subjects: 150
• Online Access: https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.762375

Background. There is strong evidence that supportive social relationships are associated with positive outcome variables in individuals with a long-standing psychotic disorder. Furthermore, evidence suggests that the social relationship deficits characteristic of psychosis are already apparent in the very early stages of the disorder. However, so far no comprehensive answer has emerged to the question of whether supportive social relationships have similar positive effects at psychosis onset, and which qualitative and functional aspects of support are attributed to these effects. A systematic review of the literature was therefore conducted to establish what is currently known about the relationship between perceived social support and outcomes in early psychosis. Method. Medline, Embase and PyschINFO were searched for studies investigating perceived social support in ‘ultra-high risk’ (UHR) and first episode psychosis samples using the expressions (‘schizophreni*’ or ‘psychosis’ or ‘psychotic disorder’) and (‘first episode’) and (‘ultra high risk’ or ’UHR’ or ‘clinical high risk’ or ‘at risk mental state’ or ‘ARMS’) and (‘social support’). Findings were synthesised using non-quantitative approaches. Results. At total of 3006 citations were screened and 11 studies were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons between the studies. Nonetheless, the existing literature suggests perceived social support has protective effects on service user outcome. These effects may be a function of support from friends and confidantes rather than from family members, and emotional support may be more important than practical support. Conclusion. Perceived social support appears to have beneficial effects on symptom severity, functioning, and levels of remission and quality of life in early psychosis. There is a need for more robust and comparable studies that employ valid and reliable measures of perceived social support and its multidimensional domains to evaluate the effects further and determine the specific mechanisms responsible for these effects. Future studies should also address possible mediating and moderating effects of perceived social support on known risk factors for psychosis.