Do Recent-Onset Schizophrenia Patients Experience a “Social Network Crisis”?

Department of Psychiatry and Biobehavioral Sciences at the University of California, 300 Medical Plaza, Los Angeles, CA 90095-6968, USA.
Psychiatry Interpersonal & Biological Processes (Impact Factor: 3.05). 02/2006; 69(2):115-29. DOI: 10.1521/psyc.2006.69.2.115
Source: PubMed


It has been proposed that the onset of schizophrenia creates a social network crisis, resulting in a dramatic deterioration of social resources during the period immediately following a first hospitalization from essentially normal pre-hospitalization levels. To evaluate this proposal, recent onset patients (n = 89) completed comprehensive assessments that examined their social networks in the 12 months prior to first hospitalization and, in a subset of patients (n = 34), at a 15-month follow-up. Cross-sectional relationships to social functioning and symptoms were examined at both time points. Compared to existing research, at the initial assessment patients were characterized by several network disturbances, including small network size, a high proportion of family members, and highly dense interconnections among network members; these disturbances generally remained moderately to highly stable at follow-up. Smaller social networks were related to poor current and premorbid social functioning and aspects of clinical functioning, particularly at the 15-month follow-up assessment. Thus, this first repeated assessment of social network characteristics in the early course of schizophrenia does not support the social network crisis concept. Instead, results suggest that functionally relevant social network disturbances often exist by the time of first hospitalization in schizophrenia.

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    • "From an offline clinical perspective, the reasons for deficits in the social support networks of people with a diagnosis of schizophrenia centre on the behavioural characteristics of the patients themselves [14]. One purported thesis is that people with a diagnosis of schizophrenia experience a “social network crisis” at onset of symptoms [15] (although a longitudinal study found that gender, economic status and activity in the labour market were more important predictors of social network diversity [16]). One study found that individuals with a diagnosis of schizophrenia with greater 'social skills’ had larger social networks, although interestingly participants did not feel that they received greater support than did people with smaller social networks or more negative symptoms of schizophrenia [17]. "
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    • "While remission from positive symptoms is often rapidly achieved following the first episode (Lieberman et al. 2003; Schooler et al. 2005), social dysfunction is a significant issue from the very early phases (Addington et al. 2008). Service users tend to become isolated very quickly after onset and their social contacts may become restricted to paid mental health professionals and a few close family members (Macdonald, Hayes & Baglioni, 2000; Macdonald, Sauer, Howie & Albiston 2005; Horan et al. 2006; Berry, Wearden & Barrowclough, 2007; Stanghellini & Ballerini, 2007). "
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    • "For instance, parents invest many resources in their children with the expectation that the reward will come later in their lives (Antonucci and Akiyama 1987; Neufeld and Harrison 1995). Because of this, close kin relations are more likely to endure in the face of increased caregiver burden and the strains it puts on caregivers (Adams and Bleizsner 1995; see also Horan et al. 2006). Bound by normative obligations to provide care or by affection for the recipient, family members may be unable or reluctant to withdraw care or stop contact (Stoller and Pugliesi 1991). "
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