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The Role of Social Isolation in the Relationships Between Psychosis and Suicidal Ideation

  • Lindsay A. BorhneimerEmail author
  • Juliann Li
  • Vitalis Im
  • Madeline Taylor
  • Joseph A. Himle
Original Paper
  • 15 Downloads

Abstract

Social isolation relates to worse mental health outcomes, including lower quality of life, depression, and both suicidal ideation and attempt. Among individuals experiencing symptoms of psychosis, suicide is a leading cause of death and data show greater isolation relates to increased negative symptoms as compared to individuals with strong support systems. While isolation has been linked with negative symptoms in the literature, less is known about its relationships with positive symptoms of psychosis (e.g., hallucinations and delusions), particularly within the context of a general population-based sample. This study examined the relationships between hallucinations, delusions, depression, social isolation, and suicidal ideation. Participants were involved in the cross-sectional Collaborative Psychiatric Epidemiology Surveys (CPES) including a large general population-based sample of households in the United States between 2001 and 2003. Participants (n = 12,195) included adults over the age of 18 in the United States, all of whom completed a psychosis assessment. Hopelessness was measured using The Calgary Depression Scale for Schizophrenia (CDSS), hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS), and social isolation by three PANSS items (keeping to self, feeling awkward in social settings, preferring to be alone), all at baseline. Data were analyzed in Mplus 8 using structural equation modeling. As hallucinations, delusions, and depression independently increased, on average there were associated increases in social isolation and the likelihood of experiencing suicidal ideation. Social isolation also related to greater suicidal ideation and ultimately functioned as a mediator. With suicide being a leading cause of death for individuals experiencing psychosis, the mediating role of social isolation in the relationships between hallucinations, delusions, depression, and suicidal ideation speaks towards the importance of social support and skills training as important treatment targets in practice.

Keywords

Social isolation Suicidal ideation Psychosis Hallucinations Delusions Structural equation modeling 

Notes

Acknowledgements

This study used the Inter-university Consortium for Political and Social Research’s (ICPSR) Collaborative Psychiatric Epidemiology Surveys (CPES; Alegria et al., 2001–2003). The contents of this article are solely the responsibility of the authors and does not necessarily represent the views of ICPSR.

References

  1. Alegria, M., Jackson, J. S., Kessler, R. C., & Takeuchi, D. (2007). Collaborative psychiatric epidemiology surveys (CPES), 2001–2003 [United States]. Ann Arbor, MI: Inter-university Consortium for Political and Social Research.Google Scholar
  2. Alegria, M., Takeuchi, D., Canino, G., Duan, N., Shrout, P., Meng, X. L., …, Vera, M. (2004). Considering context, place and culture: The National Latino and Asian American Study. International Journal of Methods in Psychiatric Research, 3(4), 208–220.PubMedPubMedCentralCrossRefGoogle Scholar
  3. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.Google Scholar
  4. Andersson, L. (1998). Loneliness research and interventions: A review of the literature. Aging and Mental Health,2(4), 264–274.CrossRefGoogle Scholar
  5. Barut, J. K., Dietrich, M. S., Zanoni, P. A., & Ridner, S. H. (2016). Sense of belonging and hope in the lives of persons with schizophrenia. Archives of Psychiatric Nursing,30(2), 178–184.PubMedCrossRefPubMedCentralGoogle Scholar
  6. Bellack, A. S., Mueser, K. T., Gingerich, S., & Agresta, J. (2004). Social skills training for schizophrenia: A step-by-step guide. New York: Guilford.Google Scholar
  7. Bornheimer, L. A. (2018). Suicidal ideation in first-episode psychosis (FEP): Examination of symptoms of depression and psychosis among individuals in an early phase of treatment. Suicide and Life-Threatening Behavior,49, 423–431.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Bornheimer, L. A., & Jaccard, J. (2017). Symptoms of depression, positive symptoms of psychosis, and suicidal ideation among adults diagnosed with schizophrenia within the clinical antipsychotic trials of intervention effectiveness. Archives of Suicide Research,21(4), 633–645.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Bromet, E. J., Nock, M. K., Saha, S., Lim, C. C., Aguilar-Gaxiola, S., Al-Hamzawi, A., …, de Girolamo, G. (2017). Association between psychotic experiences and subsequent suicidal thoughts and behaviors: A cross-national analysis from the World Health Organization World Mental Health Surveys. JAMA Psychiatry74(11), 1136–1144.PubMedPubMedCentralCrossRefGoogle Scholar
  10. Cacioppo, J. T., & Hawkley, L. C. (2003). Social isolation and health, with an emphasis on underlying mechanisms. Perspectives in Biology and Medicine,46(3), S39–S52.PubMedCrossRefGoogle Scholar
  11. Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006). Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging,21(1), 140.PubMedCrossRefGoogle Scholar
  12. Connell, M., Betts, K., McGrath, J. J., Alati, R., Najman, J., Clavarino, A., …, Scott, J. G. (2016). Hallucinations in adolescents and risk for mental disorders and suicidal behaviour in adulthood: Prospective evidence from the MUSP birth cohort study. Schizophrenia Research176(2–3), 546–551.PubMedCrossRefGoogle Scholar
  13. De Leo, D., & Spathonis, K. (2003). Do psychosocial and pharmacological interventions reduce suicide in schizophrenia and schizophrenia spectrum disorders? Archives of Suicide Research,7, 353–374.CrossRefGoogle Scholar
  14. de Sousa, P., Spray, A., Sellwood, W., & Bentall, R. P. (2015). ‘No man is an island’. Testing the specific role of social isolation in formal thought disorder. Psychiatry Research,230(2), 304–313.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Deniro, D. A. (1995). Perceived alienation in individuals with residual-type schizophrenia. Issues in Mental Health Nursing,16(3), 185–200.PubMedCrossRefPubMedCentralGoogle Scholar
  16. Depp, C. A., Moore, R. C., Perivoliotis, D., Holden, J. L., Swendsen, J., & Granholm, E. L. (2016). Social behavior, interaction appraisals, and suicidal ideation in schizophrenia: The dangers of being alone. Schizophrenia Research,172(1–3), 195–200.PubMedPubMedCentralCrossRefGoogle Scholar
  17. Dickens, A. P., Richards, S. H., Greaves, C. J., & Campbell, J. L. (2011). Interventions targeting social isolation in older people: A systematic review. BMC Public Health,11(1), 647.PubMedPubMedCentralCrossRefGoogle Scholar
  18. Eglit, G. M., Palmer, B. W., A’verria, S. M., Tu, X., & Jeste, D. V. (2018). Loneliness in schizophrenia: Construct clarification, measurement, and clinical relevance. PLoS ONE,13(3), e0194021.PubMedPubMedCentralCrossRefGoogle Scholar
  19. Fisher, H. L., Caspi, A., Poulton, R., Meier, M. H., Houts, R., Harrington, H., …, Moffitt, T. E. (2013). Specificity of childhood psychotic symptoms for predicting schizophrenia by 38 years of age: A birth cohort study. Psychological Medicine43(10), 2077–2086.PubMedPubMedCentralCrossRefGoogle Scholar
  20. Fujita, J., Takahashi, Y., Nishida, A., Okumura, Y., Ando, S., Kawano, M., …, Arai, T. (2015). Auditory verbal hallucinations increase the risk for suicide attempts in adolescents with suicidal ideation. Schizophrenia Research168(1–2), 209–212.PubMedCrossRefGoogle Scholar
  21. Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine,31(2), 189–195.PubMedCrossRefGoogle Scholar
  22. Gilbert, P. (2001). Evolutionary approaches to psychopathology: The role of natural defenses. Austrailan and New Zealand Journal of Psychiatry,35(1), 17–27.CrossRefGoogle Scholar
  23. Gilbert, P. (2006). Evolution and depression: Issues and implications. Psychological Medicine,36(3), 287–297.PubMedCrossRefGoogle Scholar
  24. Goldsmith, S. K., Pellmar, T. C., Kleinman, A. M., & Bunney, W. E. (2002). Reducing suicide: A national imperative. Washington, DC: National Academies Press.Google Scholar
  25. Hamilton, N. G., Ponzoha, C. A., Cutler, D. L., & Weigel, R. M. (1989). Social networks and negative versus positive symptoms of schizophrenia. Schizophrenia Bulletin,15(4), 625–633.PubMedCrossRefGoogle Scholar
  26. Harrop, C., Ellett, L., Brand, R., & Lobban, F. (2015). Friends interventions in psychosis: A narrative review and call to action. Early Intervention in Psychiatry,9(4), 269–278.PubMedCrossRefGoogle Scholar
  27. Hawton, A., Green, C., Dickens, A. P., Richards, S. H., Taylor, R. S., Edwards, R., …,Campbell, J. L. (2011). The impact of social isolation on the health status and health-related quality of life of older people. Quality of Life Research20(1), 57–67.PubMedCrossRefGoogle Scholar
  28. Hersen, M., & Sturmey, P. (Eds.). (2012). Handbook of evidence-based practice in clinical psychology, adult disorders (Vol. 2). Hoboken: Wiley.Google Scholar
  29. Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science,10(2), 227–237.PubMedCrossRefGoogle Scholar
  30. Hor, K., & Taylor, M. (2010). Suicide and schizophrenia: A systematic review of rates and risk factors. Journal of Psychopharmacology,24(4 Suppl), 81–90.PubMedCrossRefGoogle Scholar
  31. Hultman, C. M., Wieselgren, I. M., & Öhman, A. (1997). Relationships between social support, social coping and life events in the relapse of schizophrenic patients. Scandinavian Journal of Psychology,38(1), 3–13.PubMedCrossRefGoogle Scholar
  32. Jackson, J. S., Torres, M., Caldwell, C. H., Neighbors, H. W., Nesse, R. M., Taylor, R. J., …, Williams, D. R. (2004). The National Survey of American Life: A study of racial, ethnic and cultural influences on mental disorders and mental health. International Journal of Methods in Psychiatric Research, 13(4), 196–207.PubMedCrossRefGoogle Scholar
  33. Kasckow, J., Felmet, K., & Zisook, S. (2011). Managing suicide risk in patients with schizophrenia. CNS Drugs,25(2), 129–143.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Kelleher, I., Devlin, N., Wigman, J. T., Kehoe, A., Murtagh, A., Fitzpatrick, C., et al. (2014). Psychotic experiences in a mental health clinic sample: Implications for suicidality, multimorbidity and functioning. Psychological Medicine,44(8), 1615–1624.PubMedCrossRefGoogle Scholar
  35. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 593–602.PubMedCrossRefGoogle Scholar
  36. Kessler, R. C., & Üstün, T. B. (2004). The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research,13(2), 93–121.PubMedCrossRefGoogle Scholar
  37. Kjelby, E., Sinkeviciute, I., Gjestad, R., Kroken, R. A., Løberg, E. M., Jørgensen, H. A, …, Johnsen, E. (2015). Suicidality in schizophrenia spectrum disorders: The relationship to hallucinations and persecutory delusions. European Psychiatry, 30, 830–836.PubMedCrossRefGoogle Scholar
  38. Kopelowicz, A., Liberman, R. P., & Zarate, R. (2006). Recent advances in social skills training for schizophrenia. Schizophrenia Bulletin,32(Suppl 1), S12–S23.PubMedPubMedCentralCrossRefGoogle Scholar
  39. Kurtz, M. M., & Mueser, K. T. (2008). A meta-analysis of controlled research on social skills training for schizophrenia. Journal of Consulting and Clinical Psychology,76, 491–504.PubMedCrossRefGoogle Scholar
  40. Lamster, F., Lincoln, T. M., Nittel, C. M., Rief, W., & Mehl, S. (2017). The lonely road to paranoia. A path-analytic investigation of loneliness and paranoia. Comprehensive Psychiatry,74, 35–43.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., et al. (2017). An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health,152, 157–171.PubMedCrossRefPubMedCentralGoogle Scholar
  42. Liberman, R. P., Mueser, K. T., Wallace, C. J., Jacobs, H. E., Eckman, T., & Massel, H. K. (1986). Training skills in the psychiatrically disabled: Learning coping and competence. Schizophrenia Bulletin,12, 631–647.PubMedCrossRefPubMedCentralGoogle Scholar
  43. Lim, M. H., & Gleeson, J. F. (2014). Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness. Frontiers in Psychiatry,5, 154.PubMedPubMedCentralCrossRefGoogle Scholar
  44. Lim, M. H., Gleeson, J. F., Alvarez-Jimenez, M., & Penn, D. L. (2018). Loneliness in psychosis: A systematic review. Social Psychiatry and Psychiatric Epidemiology,53(3), 221–238.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Lim, M. H., Gleeson, J. F., Jackson, H. J., & Fernandez, K. C. (2014). Social relationships and quality of life moderate distress associated with delusional ideation. Social Psychiatry and Psychiatric Epidemiology,49(1), 97–107.PubMedCrossRefPubMedCentralGoogle Scholar
  46. Macdonald, E. M., Hayes, R. L., & Baglioni Jr, A. J. (2000). The quantity and quality of the social networks of young people with early psychosis compared with closely matched controls. Schizophrenia Research,46(1), 25–30.PubMedCrossRefPubMedCentralGoogle Scholar
  47. MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods,7(1), 83.PubMedPubMedCentralCrossRefGoogle Scholar
  48. Maggini, C., & Raballo, A. (2006). Exploring depression in schizophrenia. European Psychiatry,21(4), 227–232.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Matthews, T., Danese, A., Wertz, J., Ambler, A., Kelly, M., Diver, A., …, Arseneault, L. (2015). Social isolation and mental health at primary and secondary school entry: A longitudinal cohort study. Journal of the American Academy of Child & Adolescent Psychiatry54(3), 225–232.CrossRefGoogle Scholar
  50. Morgan, V. A., Waterreus, A., Jablensky, A., Mackinnon, A., McGrath, J. J., Carr, V., …, Galletly, C. (2012). People living with psychotic illness in 2010: The second Australian national survey of psychosis. Australian & New Zealand Journal of Psychiatry46(8), 735–752.CrossRefGoogle Scholar
  51. Mucheru, D., Hanlon, M. C., Campbell, L., McEvoy, M., & MacDonald-Wicks, L. (2017). Social dysfunction and diet outcomes in people with psychosis. Nutrients,9(1), 80.PubMedCentralCrossRefPubMedGoogle Scholar
  52. Mueser, K. T., Deavers, F., Penn, D. L., & Cassisi, J. E. (2013). Psychosocial treatments for schizophrenia. Annual Review of Clinical Psychology,9, 465–497.PubMedCrossRefGoogle Scholar
  53. Pennell, B. E., Bowers, A., Carr, D., Chardoul, S., Cheung, G. Q., Dinkelmann, K., …, Torres, M. (2004). The development and implementation of the national comorbidity survey replication, the national survey of American life, and the national Latino and Asian American survey. International Journal of Methods in Psychiatric Research, 13(4), 241–269.PubMedCrossRefGoogle Scholar
  54. Pfammatter, M., Junghan, U. M., & Brenner, H. D. (2006). Efficacy of psychological therapy in schizophrenia: Conclusions from meta-analyses. Schizophrenia Bulletin,32(Suppl. 1), S64–S68.PubMedPubMedCentralCrossRefGoogle Scholar
  55. Raeburn, T., Schmied, V., Hungerford, C., & Cleary, M. (2016). The use of social environment in a psychosocial clubhouse to facilitate recovery-oriented practice. BJPsych open,2(2), 173–178.PubMedPubMedCentralCrossRefGoogle Scholar
  56. Rico-Uribe, L. A., Caballero, F. F., Martín-María, N., Cabello, M., Ayuso-Mateos, J. L., & Miret, M. (2018). Association of loneliness with all-cause mortality: A meta-analysis. PLoS ONE,13(1), e0190033.PubMedPubMedCentralCrossRefGoogle Scholar
  57. Saha, S., Scott, J. G., Johnston, A. K., Slade, T. N., Varghese, D., …, McGrath, J.J. (2011). The association between delusional-like experiences and suicidal thoughts and behavior. Schizophrenia Research, 132, 197–202.PubMedCrossRefPubMedCentralGoogle Scholar
  58. Sharifi, V., Eaton, W. W., Wu, L. T., Roth, K. B., Burchett, B. M., & Mojtabai, R. (2015). Psychotic experiences and risk of death in the general population: 24–27 year follow-up of the Epidemiologic Catchment Area study. The British Journal of Psychiatry,207(1), 30–36.PubMedPubMedCentralCrossRefGoogle Scholar
  59. Sibitz, I., Amering, M., Unger, A., Seyringer, M. E., Bachmann, A., Schrank, B., …, Woppmann, A. (2011). The impact of the social network, stigma and empowerment on the quality of life in patients with schizophrenia. European Psychiatry26(1), 28–33.PubMedCrossRefPubMedCentralGoogle Scholar
  60. Sprecher, S., Treger, S., Wondra, J. D., Hilaire, N., & Wallpe, K. (2013). Taking turns: Reciprocal self-disclosure promotes liking in initial interactions. Journal of Experimental Social Psychology,49(5), 860–866.CrossRefGoogle Scholar
  61. Tarrier, N., Gooding, P., Pratt, D., Kelly, J., Awenat, Y., & Maxwell, J. (2013). Cognitive behavioural prevention of suicide in psychosis: A treatment model. New York: Routledge.CrossRefGoogle Scholar
  62. Velthorst, E., Meijer, C., & Investigators, G. R. O. U. P. (2012). The association between social anhedonia, withdrawal and psychotic experiences in general and high-risk populations. Schizophrenia Research,138(2–3), 290–294.PubMedCrossRefGoogle Scholar
  63. Velthorst, E., Nieman, D. H., Becker, H. E., van de Fliert, R., Dingemans, P. M., Klaassen, R., …, Linszen, D. H. (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research, 109(1–3), 60–65.PubMedCrossRefGoogle Scholar
  64. Wang, H. T., Huang, F. L., Hu, Z. L., Zhang, W. J., Qiao, X. Q., Huang, Y. Q., …, Li, C. Q. (2017). Early-life social isolation-induced depressive-like behavior in rats results in microglial activation and neuronal histone methylation that are mitigated by minocycline. Neurotoxicity Research, 31(4), 505–520.PubMedCrossRefGoogle Scholar
  65. Wasserman, D., Wasserman, J., Rozanov, V., & Sokolowski, M. (2009). Depression in suicidal males: Genetic risk variants in the CRHR1 gene. Genes, Brain and Behavior,8(1), 72–79.CrossRefGoogle Scholar
  66. Williams, J. M. G. (1997). Cry of pain. Harmondsworth: Penguin.Google Scholar
  67. Williams, J. M. G. (2001). The cry of pain. London: Penguin.Google Scholar
  68. Williams, J. M. G., Crane, C., Barnhofer, T., & Duggan, D. S. (2005). Psychology and suicidal behaviour: Elaborating the entrapment model. Oxford: Oxford University Press.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Lindsay A. Borhneimer
    • 1
    Email author
  • Juliann Li
    • 1
  • Vitalis Im
    • 1
  • Madeline Taylor
    • 1
  • Joseph A. Himle
    • 1
    • 2
  1. 1.School of Social WorkUniversity of MichiganAnn ArborUSA
  2. 2.Department of PsychiatryUniversity of MichiganAnn ArborUSA

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