Differential relations of locus of control to perceived social stress among help-seeking adolescents at low vs. high clinical risk of psychosis
Introduction
Neurodevelopmental models of psychosis posit that social stress plays a key role in vulnerability to psychotic illness. These models suggest that constitutional abnormalities impacting the hypothalamic-pituitary-adrenal (HPA) and dopamine systems interact with normative neuromaturational events during adolescence to contribute to the disorder (Walker et al., 2008). This process may be accelerated by elevated perceptions of social stress, which are closely tied to HPA activity (Corcoran et al., 2003, Holtzman et al., 2013). To examine the role of perceived social stress in the development of psychosis, attention has recently been directed toward putatively prodromal adolescents at “clinical high-risk” (CHR). Elevated perceptions of stress are especially common among youth at CHR and are associated with illness presentation, course, and treatment. For example, perceived stress is related to emotional reactivity (Palmier-Claus et al., 2012), conversion to psychosis (Trotman et al., 2014) and psychosocial treatment gains among youth at CHR (O'Brien et al., 2015). Perceived social stress therefore may be an important component of the course and treatment of individuals at CHR.
Given that many promising interventions for CHR youth focus on emerging social cognitive deficits (e.g., CBT; French and Morrison, 2004), understanding the relation between social cognition and perceived social stress in this population may help treatment development. One factor capable of influencing perceived social stress may be an individual's locus of control (LOC). LOC identifies the degree to which individuals believe rewards and outcomes in life are brought about by their own actions (an internal LOC orientation) versus chance, fate, or some outside influence (an external LOC orientation; Rotter, 1966). LOC is related to the broader construct of attributional bias, or how individuals infer causes of particular events (Green et al., 2008). Perceptions of uncontrollability over one's social environment can invoke feelings of stress and tension (Pruessner and Baldwin, 2015), which in turn may exacerbate the emerging psychosis vulnerability among those at CHR. Consistent with this possibility, research with healthy populations has found that an external LOC is associated with greater levels of perceived stress (Khan et al., 2012), failure to habituate to repeated social stress, and disrupted structure and function of the neurohormonal stress response (Pruessner and Baldwin, 2015, Pruessner et al., 2005).
Although to our knowledge no studies have examined the relation between LOC and perceived social stress in the psychosis spectrum, an external LOC among people with schizophrenia is common and associated with unfavorable clinical features and outcomes (Bentall et al., 2001, Bentall and Kaney, 2005, Harrow et al., 2009). Scholars have also posited that interpreting thoughts as uncontrollable and external to the self is an important mechanism in the shift from the premorbid state to psychosis (Morrison, 2001). Nonetheless, despite the conceptual relevance of this possibility, studies examining LOC among those at CHR are few. The available literature generally suggests that youth at CHR possess an external control bias relative to healthy controls, and that these biases are associated with worse symptoms (Thompson et al., 2013), a lower quality of life (Schmidt et al., 2014), and less frequent use of adaptive coping strategies (Ruhrmann et al., 2008; although for an exception see DeVylder et al., 2013). When considered alongside findings that an external LOC is associated with increases in perceived stress and disruptions to the neurohormonal stress response among healthy participants (Pruessner and Baldwin, 2015, Pruessner et al., 2005), these cognitive biases and their associations with functioning among youth at CHR suggest that LOC may be a viable avenue for understanding individual differences in perceived social stress in this population.
This study aimed to examine associations between LOC and perceived social stress among adolescents at CHR in relation to a mixed clinical group of help-seeking control (HSC) participants. Although a large body of literature has demonstrated that adolescents at CHR experience disruptions in cognitive and stress-related domains relative to healthy peers, few studies have examined these domains in relation to same-aged individuals with non-CHR psychopathology. Such studies are clinically and etiologically informative as they allow researchers to identify unique features of the psychosis vulnerability and may inform treatment strategies aiming to modify these characteristics. We hypothesized that (1) participants at CHR would report a more external LOC and (2) more social stress than non-CHR HSC participants, and that (3) external LOC would be associated with elevated reports of perceived social stress in both groups. Given that youth at CHR are thought to be especially vulnerable to potentially stressful stimuli, we hypothesized that (4) the LOC-stress relation would be stronger in the CHR group.
Section snippets
Method
This study was conducted through the Strive for Wellness (SFW) clinic, an early identification, research, and treatment clinic focusing on individuals at CHR. The SFW clinic is located within the University of Maryland, Baltimore County's Youth FIRST Program, and the University of Maryland Medical Center (the site where institutional review board approval was obtained).
Results
Forty-five CHR and 65 HSC participants were included. The groups were compared on demographic and psychological (e.g., IQ and BASC-2) variables using chi-square tests for categorical variables and t-tests for continuous variables. Group values are depicted in Table 1. All variables demonstrated acceptable skewness and kurtosis (Curran et al., 1996). IQ estimates were comparable across groups (t[47] = 0.05) and were unrelated to LOC (r = − 0.08) or perceived social stress (r = − 0.03). Thus, IQ was not
Discussion
This study found that (1) adolescents at CHR reported a more external LOC and (2) more social stress than HSC participants; (3) an external LOC was associated with more perceived social stress, especially in the CHR group; and (4) perceived social stress was greater in the CHR group only at highly external, but not internal, levels of LOC.
Contributors
Authors Millman, Thompson, Demro, Reeves, and Schiffman designed and ran the study as well as wrote the protocol. Authors Millman and Weintraub managed the literature searches. Authors Millman, Bentley, and Pitts undertook the statistical analysis. Author Millman wrote the manuscript with conceptual and written assistance from authors Weintraub, Bentley, DeVylder, Mittal, and Schiffman. All authors contributed to and have approved the final manuscript.
Conflict of interest
All authors declare that they have no conflicts of interest.
Funding
This work was supported in part by funding from the Maryland Department of Health and Mental Hygiene, Behavioral Health Administration through the Center for Excellence on Early Intervention for Serious Mental Illness (OPASS# 14-13717G/M00B4400241).
Acknowledgements
There are no acknowledgements.
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