The power of youth: Long-term differential effects of developmental functioning trajectory on social functioning, quality of life and personal recovery across the schizophrenia spectrum

Jiasi Hao; Genetic Risk and Outcome of Psychosis (GROUP) Investigators; Richard Bruggeman; Wim Veling; Behrooz Z Alizadeh

doi:10.1016/j.comppsych.2025.152637

The power of youth: Long-term differential effects of developmental functioning trajectory on social functioning, quality of life and personal recovery across the schizophrenia spectrum

Compr Psychiatry. 2025 Sep 29:143:152637. doi: 10.1016/j.comppsych.2025.152637. Online ahead of print.

Authors

Jiasi Hao¹; Genetic Risk and Outcome of Psychosis (GROUP) Investigators; Richard Bruggeman⁹, Wim Veling⁹, Behrooz Z Alizadeh¹⁰

Collaborators

Genetic Risk and Outcome of Psychosis (GROUP) Investigators:
Behrooz Z Alizadeh², Therese van Amelsvoort³, Wiepke Cahn⁴, Lieuwe de Haan⁵, Marieke van der Pluijm⁵, Claudia J P Simons⁶, Jim van Os⁷, Wim Veling⁸

Affiliations

¹ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands. Electronic address: j.hao@umcg.nl.
² University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands.
³ Maastricht University, Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute, Maastricht, the Netherlands.
⁴ Utrecht University, University Medical Center Utrecht, Department of Psychiatry, Brain Centre Rudolf Magnus, Utrecht, the Netherlands; Altrecht, General Mental Health Care, Utrecht, the Netherlands.
⁵ University of Amsterdam, Amsterdam University Medical Center, Department of Psychiatry, Amsterdam, the Netherlands; Arkin, Institute for Mental Health, Amsterdam, the Netherlands.
⁶ Maastricht University, Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience Research Institute, Maastricht, the Netherlands; GGzE Institute for Mental Health Care, Eindhoven, the Netherlands.
⁷ Utrecht University, University Medical Center Utrecht, Department of Translational Neuroscience, Brain Center Rudolf Magnus, Utrecht, the Netherlands; King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, United Kingdom; GGNet Mental Health, Apeldoorn, the Netherlands.
⁸ University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
⁹ Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
¹⁰ Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.

PMID: 41056790
DOI: 10.1016/j.comppsych.2025.152637

Abstract

Background: Compromised developmental functioning is frequently observed in patients with schizophrenia spectrum disorder (SSD) and is associated with poor outcomes, which remains understudied in individuals at varying risk of SSD. This study aimed to investigate the course of developmental functioning and its relationship with long-term outcomes within a population across the vulnerability spectrum of SSD. We hypothesized that developmental functioning negatively correlated with SSD vulnerability, and was positively associated with worse outcomes, regardless of disease status.

Methods: We used data of 1119 patients, 1059 siblings, and 586 controls from the Dutch Genetic Risk and Outcome in Psychosis (GROUP) cohort. Group-based trajectory modelling and linear mixed models were employed to investigate the course of developmental functioning (measured by the Premorbid Adjustment Scale) and its associations with the outcomes, including social functioning (SF), personal recovery (PR), and quality of life (QoL).

Results: In the combined sample, six developmental trajectories were identified: normal-stable (12.4 %), normal-slow decrease (12.3 %), mild-stable (46.9 %), all dominated by controls and siblings; and mild-rapid decrease (5.1 %), moderate-stable (16.5 %), and severe-slow decrease (6.8 %) more prevalent in patients. Compared to normal-stable, all other trajectories in developmental functioning were correlated with decreased SF; mild-rapid decrease and severe-slow decrease were linked to lower QoL. No association with PR was observed.

Conclusion: Impaired developmental functioning variably lowers prolonged SF and QoL but not PR. Potentially influenced by factors encompassing environment, cognition, resilience and disease status, this finding demands screening for developmental deviance among youths and early preventive interventions to achieve normal functioning through a public health salutogenic approach.

Keywords: Development; Functioning; Premorbid; Prevention; Psychosis; Public Health.