Social support and three-year symptom and admission outcomes for first episode psychosis
Introduction
Social support has been found to predict course and treatment outcome in a diverse set of illnesses (eg., Broadhead et al., 1983, Frasure-Smith et al., 2000, Leserman et al., 2000, Reifman, 1995). In the field of mental health there is considerable evidence of social support having a protective role with respect to depression (eg. Avison, 1996, Lewinsohn et al., 1994, Monroe, 1983). Although cross-sectional studies of patients with schizophrenia have reported relationship between better social support and higher quality of life and functional status (eg., Howard et al., 2000, Koivumaa-Honkanen et al., 1999, Lam and Rosenheck, 2000), there have been few prospective studies of the effect of social support in psychotic disorders. One might expect social support to be of particular importance with reference to psychotic disorders given that there is evidence that the course of psychotic illness is influenced by environmental stressors (eg., Corcoran et al., 2003, Norman and Malla, 1993); and research showing that in other populations social support can reduce stressors and/or buffer the effects of any stressors which do occur (eg., Cohen et al., 2000, Cohen and Wills, 1985).
Up to this point, two papers (Erikson et al., 1989, Erikson et al., 1998) have examined the prognostic significance of social support in a study of first episode patients. Erikson et al. (1989) found that higher levels of support from acquaintances, as reported by patients at time of initiating treatment, predicted better occupational and social functioning 18 months later. Subsequently, Erikson et al. (1998) found that for patients with schizophrenia, perceived support from non-family members at the time of onset was positively correlated with scores on the DSM III-AXIS V scale of occupational and social functioning after five years of treatment.
It is also of interest to examine the capacity of social support to predict symptom outcomes and hospitalization rates and to assess the extent to which any relationship between social support and treatment outcome could potentially reflect the confounding influence of other variables. In their work, Erikson and his colleagues found that the predictive power of social support on functioning was not reflecting differences in baseline adaptive functioning, premorbid social adjustment, age of onset or sex of the individual. The examination of such potential confounds is important in establishing whether outcome may really be varying as a result of a potentially malleable factor such as social support or as the result of other patient characteristics that cannot be changed. Interest in prognostic indicators that might be open to intervention has resulted in recent interest in duration of untreated psychosis (DUP), and there is evidence that DUP is, at least sometimes, related to treatment outcome (Malla et al., 2002, Norman and Malla, 2001). Given that there is evidence that those with more social support may seek treatment for psychosis more promptly (Drake et al., 2000, Kalla et al., 2002, Malla et al., 2004), it is important to examine the extent to which any relationship between social support and illness course could actually be explained by differences in DUP.
In the present paper we examine longitudinal data collected in a first episode program to assess the extent to which social support predicts symptom reduction and likelihood of re-hospitalization over the first three years of treatment. In addition, we examine whether any such relationship found between social support and illness course can be explained by confounds such as initial severity of symptoms, gender, premorbid adjustment, age of onset, or duration of untreated psychosis.
Section snippets
Participants
Subjects were 113 patients of the Prevention and Early Intervention Program for Psychoses (PEPP) in London, Ontario, Canada. These patients were recruited into a prospective study to assess the outcomes for patients treated in the program during the period March 1997 to March 2001. At the time of the analyses being reported here, an additional 43 patients who had originally been recruited had withdrawn prior to completion of three-year follow-up. We compared the 113 for whom three-year
Sample
Table 1 summarizes characteristics of the sample. Of the 113 patients, 87 (77%) were male. The mean age was 25.8 years with a range between 15 and 47. The diagnostic breakdown of the sample indicates that the vast majority of patients were suffering from schizophrenia spectrum disorders. Forty-seven individuals (44.2%) had not completed high school; 29 (25.6%) had only completed high school and the remainder (34 or 30.1%) had at least some post-secondary education. Eighty-seven (77%) were
Discussion
The findings of this study indicate that provider ratings of social support are predictive of level of positive symptoms three years after initiation of treatment and number of hospital admissions over those three years. Furthermore, this relationship appears to be independent of potential confounds such as gender, age of onset, duration of untreated illness and premorbid adjustment. This is the only study of which we are aware that has related social support specifically to level of positive
Acknowledgement
This research was supported by operating grants from the Canadian Institutes of Health Research.
References (36)
- et al.
One year outcome in first-episode psychosis: influence of DUP and other predictors
Schizophr. Res.
(2002) The Scale for the Assessment of Negative Symptoms (SANS)
(1983)The Scale for the Assessment of Positive Symptoms (SAPS)
(1984)Social networks as risk and protective factors for onset and recurrence of mental disorders
Curr. Opin. Psychiatr.
(1996)- et al.
A new patient focused index for measuring quality of life in persons with severe and persistent mental illness
Qual. Life
(1993) - et al.
Quality of life in schizophrenia
- et al.
The epidemiological evidence for a relationship between social support and health
Am. J. Epidemiol.
(1983) - et al.
Measurement of premorbid adjustment in chronic schizophrenia
Schizophr. Bull.
(1982) - et al.
Stress, social support and the buffering hypothesis
Psychol. Bull.
(1985) - et al.
Social Support Measurement and Intervention
(2000)
The stress cascade and schizophrenia: etiology and onset
Schizophr. Bull.
Causes and consequences of duration of untreated psychosis in schizophrenia
Br. J. Psychiatry
The role of social relationships in the course of first-episode schizophrenia and affective psychosis
Am. J. Psychiatry
Social support predicts 5-year outcome in first-episode schizophrenia
J. Abnorm. Psychology
Determinants of medication compliance in schizophrenia: empirical and clinical findings
Schizophr. Bull.
Structured clinical interview of DSM-IV axis I
New York: Disorders (SCID-1) Clinical Version
Social support, depression and mortality during the first year after myocardial infarction
Circulation
Social networks and functional status in patients with psychosis
Acta Psychiatr. Scand.
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