Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety

Soc Psychiatry Psychiatr Epidemiol. 2014 Mar;49(3):359-66. doi: 10.1007/s00127-013-0754-3. Epub 2013 Aug 17.


Purpose: To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia.

Method: Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted.

Results: One-third of the sample (34%) had no confidant [95% CI (18.4, 50.0%)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 < rs < 0.60). The association between loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p < 0.001).

Conclusions: Even at first episode, a large proportion of people with psychosis have poor perceived support, no confidant and report several lonely days a week. Patients without a confidant appear to be more susceptible to feeling lonely and anxious. Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Affect
  • Anxiety / complications
  • Anxiety / psychology*
  • Cross-Sectional Studies
  • Depression
  • Female
  • Humans
  • Loneliness / psychology*
  • Male
  • Middle Aged
  • Paranoid Disorders / complications
  • Paranoid Disorders / psychology
  • Psychotic Disorders / complications
  • Psychotic Disorders / psychology*
  • Self Report
  • Social Support*