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Cognitive Therapy and Research

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24.08.2016 | Original Article

Loneliness and Psychotic Symptoms: The Mediating Role of Depression

verfasst von: Edo S. Jaya, Tobias E. Hillmann, Klaus Michael Reininger, Anton Gollwitzer, Tania M. Lincoln

Erschienen in: Cognitive Therapy and Research | Ausgabe 1/2017

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Abstract

Psychotic symptoms have been shown to be associated with numerous social factors, such as migration and urban upbringing, of which one plausible common component is loneliness. This suggests a relationship between loneliness and positive psychotic symptoms. According to current cognitive models of psychosis, the relationship between loneliness and positive symptoms is likely to be explained by affective states. The current study examined the cross-sectional relationship between loneliness, depression, and positive symptoms in four separate community samples (combined N = 766) with regression based mediation analysis and network analysis. The results showed that depression completely mediated the relationship between loneliness and positive symptoms in three out of four samples. Partial mediation was found in one sample. Network analysis revealed that loneliness, depression, and positive symptoms clustered separately and that there was a unique connection between loneliness and items that assess paranoid beliefs, in the sense that loneliness was not found to be connected to other psychotic symptoms, such as hallucinations. As expected, loneliness is related to positive symptoms and depression played a strong role in explaining the association. Thus, early interventions of psychosis that target loneliness are likely to be beneficial, especially if these interventions additionally target depression. Furthermore, the specific connection of loneliness and paranoid beliefs supports the theory that specific adversity leads to specific psychotic symptoms.

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Anglina, D. M., Lightya, Q., Isaaca, K., & Ellmanb, L. M. (2013). Immigrant status, racial discrimination, and clinically high risk for psychosis among racial and ethnic minority youth. Comprehensive Psychiatry, 54(8), e15–e16. doi:10.1016/j.comppsych.2013.07.004.CrossRef

Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.1037/0022-3514.51.6.1173.CrossRefPubMed

Bentall, R. P., de Sousa, P., Varese, F., Wickham, S., Sitko, K., Haarmans, M., et al. (2014). From adversity to psychosis: Pathways and mechanisms from specific adversities to specific symptoms. Social Psychiatry and Psychiatric Epidemiology, 49(7), 1011–1022. doi:10.1007/s00127-014-0914-0.CrossRefPubMed

Borsboom, D., & Cramer, A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9(1), 91–121. doi:10.1146/annurev-clinpsy-050212-185608.CrossRefPubMed

Boydell, J., Bebbington, P., Bhavsar, V., Kravariti, E., van Os, J., Murray, R. M., et al. (2013). Unemployment, ethnicity and psychosis. Acta Psychiatrica Scandinavica, 127(3), 202–209. doi:10.1111/j.1600-0447.2012.01921.x.CrossRefPubMed

Brenner, K., Schmitz, N., Pawliuk, N., Fathalli, F., Joober, R., Ciampi, A., et al. (2007). Validation of the English and French versions of the Community Assessment of Psychic Experiences (CAPE) with a Montreal community sample. Schizophrenia Research, 95(1–3), 86–95. doi:10.1016/j.schres.2007.06.017.CrossRefPubMed

Buhrmester, M., Kwang, T., & Gosling, S. D. (2011). Amazon’s Mechanical Turk: A new source of inexpensive, yet high-quality, data? Perspectives on Psychological Science, 6(1), 3–5. doi:10.1177/1745691610393980.CrossRefPubMed

Cacioppo, J. T., Hawkley, L. C., & Thisted, R. A. (2010). Perceived social isolation makes me sad: Five year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago health, aging, and social relations study. Psychology and Aging, 25(2), 453–463. doi:10.1037/a0017216.CrossRefPubMedPubMedCentral

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), 140–151. doi:10.1037/0882-7974.21.1.140.CrossRefPubMed

Cantor-Graae, E., & Selten, J.-P. (2005). Schizophrenia and migration: A meta-analysis and review. American Journal of Psychiatry, 162(1), 12–24. doi:10.1176/appi.ajp.162.1.12.CrossRefPubMed

Choi, S. W., Schalet, B., Cook, K. F., & Cella, D. (2014). Establishing a common metric for depressive symptoms: Linking the BDI-II, CES-D, and PHQ-9 to PROMIS Depression. Psychological Assessment, 26(2), 513–527. doi:10.1037/a0035768.CrossRefPubMed

Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Mahwah, NJ: L. Erlbaum Associates.

Costantini, G., Epskamp, S., Borsboom, D., Perugini, M., Mõttus, R., Waldorp, L. J., et al. (2015). State of the aRt personality research: A tutorial on network analysis of personality data in R. Journal of Research in Personality, 54, 13–29. doi:10.1016/j.jrp.2014.07.003.CrossRef

Curtiss, J., & Klemanski, D. H. (2016). Taxonicity and network structure of generalized anxiety disorder and major depressive disorder: An admixture analysis and complex network analysis. Journal of Affective Disorders, 199, 99–105. doi:10.1016/j.jad.2016.04.007.CrossRefPubMed

Deniro, D. A. (1995). Perceived alienation in individuals with residual-type schizophrenia. Issues in Mental Health Nursing, 16(3), 185–200. doi:10.3109/01612849509006934.CrossRefPubMed

Epskamp, S., Cramer, A. O. J., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1–18.CrossRef

Fowler, D., Hodgekins, J., Garety, P., Freeman, D., Kuipers, E., Dunn, G., et al. (2012). Negative cognition, depressed mood, and paranoia: A longitudinal pathway analysis using structural equation modeling. Schizophrenia Bulletin, 38(5), 1063–1073. doi:10.1093/schbul/sbr019.CrossRefPubMed

Foygel, R., & Drton, M. (2010). Extended bayesian information criteria for gaussian graphical models. arXiv:1011.6640[math,Stat]. Retrieved from http://arxiv.org/abs/1011.6640

Freeman, D., Evans, N., Lister, R., Antley, A., Dunn, G., & Slater, M. (2014). Height, social comparison, and paranoia: An immersive virtual reality experimental study. Psychiatry Research, 218(3), 348–352. doi:10.1016/j.psychres.2013.12.014.CrossRefPubMedPubMedCentral

Freeman, D., & Garety, P. (2014). Advances in understanding and treating persecutory delusions: A review. Social Psychiatry and Psychiatric Epidemiology, 49(8), 1179–1189. doi:10.1007/s00127-014-0928-7.CrossRefPubMedPubMedCentral

Freeman, D., Garety, P. A., Bebbington, P. E., Smith, B., Rollinson, R., Fowler, D., et al. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. The British Journal of Psychiatry, 186(5), 427–435. doi:10.1192/bjp.186.5.427.CrossRefPubMed

Fried, E. I., Bockting, C., Arjadi, R., Borsboom, D., Amshoff, M., Cramer, A. O. J., et al. (2015). From loss to loneliness: The relationship between bereavement and depressive symptoms. Journal of Abnormal Psychology, 124(2), 256–265. doi:10.1037/abn0000028.CrossRefPubMed

Friedman, J., Hastie, T., & Tibshirani, R. (2008). Sparse inverse covariance estimation with the graphical lasso. Biostatistics, 9(3), 432–441. doi:10.1093/biostatistics/kxm045.CrossRefPubMed

Gayer-Anderson, C., & Morgan, C. (2013). Social networks, support and early psychosis: A systematic review. Epidemiology and Psychiatric Sciences, 22(02), 131–146. doi:10.1017/S2045796012000406.CrossRefPubMed

Gevonden, M. J., Selten, J. P., Myin-Germeys, I., de Graaf, R., ten Have, M., van Dorsselaer, S., et al. (2014). Sexual minority status and psychotic symptoms: Findings from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS). Psychological Medicine, 44(02), 421–433. doi:10.1017/S0033291713000718.CrossRefPubMed

Häfner, H., Maurer, K., Trendler, G., an der Heiden, W., Schmidt, M., & Könnecke, R. (2005). Schizophrenia and depression: challenging the paradigm of two separate diseases—A controlled study of schizophrenia, depression and healthy controls. Schizophrenia Research, 77(1), 11–24. doi:10.1016/j.schres.2005.01.004.CrossRefPubMed

Hanssen, M., Peeters, F., Krabbendam, L., Radstake, S., Verdoux, H., & van Os, J. (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology, 38(3), 149–154. doi:10.1007/s00127-003-0622-7.CrossRefPubMed

Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218–227. doi:10.1007/s12160-010-9210-8.CrossRefPubMed

Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

Hoffman, R. E. (2007). A social deafferentation hypothesis for induction of active schizophrenia. Schizophrenia Bulletin, 33(5), 1066–1070. doi:10.1093/schbul/sbm079.CrossRefPubMedPubMedCentral

Hofmann, S. G., Curtiss, J., & McNally, M. J. (2016). A complex network perspective on clinical science. Perspectives on Psychological Science. doi:10.1177/1745691616639283.

Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A short scale for measuring loneliness in large surveys. Research on Aging, 26(6), 655–672. doi:10.1177/0164027504268574.CrossRefPubMedPubMedCentral

Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8(5), 720–724. doi:10.1037/a0013237.CrossRefPubMed

Janssen, I., Hanssen, M., Bak, M., Bijl, R. V., Graaf, R. D., Vollebergh, W., et al. (2003). Discrimination and delusional ideation. The British Journal of Psychiatry, 182(1), 71–76. doi:10.1192/bjp.182.1.71.CrossRefPubMed

Kelly, B. D., O’Callaghan, E., Waddington, J. L., Feeney, L., Browne, S., Scully, P. J., et al. (2010). Schizophrenia and the city: A review of literature and prospective study of psychosis and urbanicity in Ireland. Schizophrenia Research, 116(1), 75–89. doi:10.1016/j.schres.2009.10.015.CrossRefPubMed

Kesting, M.-L., & Lincoln, T. M. (2013). The relevance of self-esteem and self-schemas to persecutory delusions: A systematic review. Comprehensive Psychiatry, 54(7), 766–789. doi:10.1016/j.comppsych.2013.03.002.CrossRefPubMed

Konings, M., Bak, M., Hanssen, M., van Os, J., & Krabbendam, L. (2006). Validity and reliability of the CAPE: A self-report instrument for the measurement of psychotic experiences in the general population. Acta Psychiatrica Scandinavica, 114(1), 55–61. doi:10.1111/j.1600-0447.2005.00741.x.CrossRefPubMed

Kramer, I., Simons, C. J. P., Wigman, J. T. W., Collip, D., Jacobs, N., Derom, C., et al. (2013). Time-lagged moment-to-moment interplay between negative affect and paranoia: New insights in the affective pathway to psychosis. Schizophrenia Bulletin,. doi:10.1093/schbul/sbs194.PubMedPubMedCentral

Lejuez, C. W., Hopko, D. R., Acierno, R., Daughters, S. B., & Pagoto, S. L. (2011). Ten year revision of the brief behavioral activation treatment for depression: Revised treatment manual. Behavior Modification, 35(2), 111–161. doi:10.1177/0145445510390929.CrossRefPubMed

Lincoln, T. M., Hohenhaus, F., & Hartmann, M. (2012). Can paranoid thoughts be reduced by targeting negative emotions and self-esteem? An experimental investigation of a brief compassion-focused intervention. Cognitive Therapy and Research, 37(2), 390–402. doi:10.1007/s10608-012-9470-7.CrossRef

Linscott, R. J., & van Os, J. (2013). An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: On the pathway from proneness to persistence to dimensional expression across mental disorders. Psychological Medicine, 43(6), 1133–1149. doi:10.1017/S0033291712001626.CrossRefPubMed

Marshall, M., & Rathbone, J. (2011). Early intervention for psychosis. Cochrane Database of Systematic Reviews, 2011(6), CD004718. doi:10.1002/14651858.CD004718.pub3.

Mehl, S. (2015, September 1). Emotionsfokussierte kognitive Verhaltenstherapie für Menschen mit Psychosen: Manual für Therapeutinnen und Therapeuten. Unpublished Manual, Marburg.

Meltzer, H., Bebbington, P., Dennis, M. S., Jenkins, R., McManus, S., & Brugha, T. S. (2012). Feelings of loneliness among adults with mental disorder. Social Psychiatry and Psychiatric Epidemiology, 48(1), 5–13. doi:10.1007/s00127-012-0515-8.CrossRefPubMed

Morgan, C., Kirkbride, J., Hutchinson, G., Craig, T., Morgan, K., Dazzan, P., et al. (2008). Cumulative social disadvantage, ethnicity and first-episode psychosis: A case–control study. Psychological Medicine, 38(12), 1701–1715. doi:10.1017/S0033291708004534.CrossRefPubMed

Moritz, S., & Larøi, F. (2008). Differences and similarities in the sensory and cognitive signatures of voice-hearing, intrusions and thoughts. Schizophrenia Research, 102(1–3), 96–107. doi:10.1016/j.schres.2008.04.007.CrossRefPubMed

Morrison, A. P. (2001). The interpretation of intrusions in psychosis: An integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29(03), 257–276. doi:10.1017/S1352465801003010.

Mossaheb, N., Becker, J., Schaefer, M. R., Klier, C. M., Schloegelhofer, M., Papageorgiou, K., et al. (2012). The Community Assessment of Psychic Experience (CAPE) questionnaire as a screening-instrument in the detection of individuals at ultra-high risk for psychosis. Schizophrenia Research, 141(2–3), 210–214. doi:10.1016/j.schres.2012.08.008.CrossRefPubMed

Myin-Germeys, I., Nicolson, N. A., Delespaul, P., et al. (2001). The context of delusional experiences in the daily life of patients with schizophrenia. Psychological Medicine, 31(03), 489–498. doi:10.1017/S0033291701003646.CrossRefPubMed

Nayani, T. H., & David, A. S. (1996). The auditory hallucination: A phenomenological survey. Psychological Medicine, 26(01), 177–189. doi:10.1017/S003329170003381X.CrossRefPubMed

Neeleman, J., & Power, M. J. (1994). Social support and depression in three groups of psychiatric patients and a group of medical controls. Social Psychiatry and Psychiatric Epidemiology, 29(1), 46–51. doi:10.1007/BF00796448.PubMed

Nuijten, M. B., Wetzels, R., Matzke, D., Dolan, C. V., & Wagenmakers, E.-J. (2014). A default Bayesian hypothesis test for mediation. Behavior Research Methods, 47(1), 85–97. doi:10.3758/s13428-014-0470-2.CrossRef

O’Driscoll, C., Laing, J., & Mason, O. (2014). Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clinical Psychology Review, 34(6), 482–495. doi:10.1016/j.cpr.2014.07.002.CrossRefPubMed

Pashler, H., & Wagenmakers, E.-J. (2012). Editors’ introduction to the special section on replicability in psychological science a crisis of confidence? Perspectives on Psychological Science, 7(6), 528–530. doi:10.1177/1745691612465253.CrossRefPubMed

Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. doi:10.1177/014662167700100306.CrossRef

Russell, D. W. (1996). UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66(1), 20–40. doi:10.1207/s15327752jpa6601_2.CrossRefPubMed

Schlier, B., Jaya, E. S., Moritz, S., & Lincoln, T. M. (2015). The Community Assessment of Psychic Experience measures nine clusters of psychosis-like experiences: A validation of the German version of CAPE. Schizophrenia Research,. doi:10.1016/j.schres.2015.10.034.

Schlier, B., Schmick, S., & Lincoln, T. M. (2014). No matter of etiology: Biogenetic, psychosocial and vulnerability-stress causal explanations fail to improve attitudes towards schizophrenia. Psychiatry Research, 215(3), 753–759. doi:10.1016/j.psychres.2013.12.056.CrossRefPubMed

Selten, J.-P., van der Ven, E., Rutten, B. P. F., & Cantor-Graae, E. (2013). The social defeat hypothesis of schizophrenia: An update. Schizophrenia Bulletin, 39(6), 1180–1186. doi:10.1093/schbul/sbt134.CrossRefPubMedPubMedCentral

Shapiro, D. N., Chandler, J., & Mueller, P. A. (2013). Using mechanical turk to study clinical populations. Clinical Psychological Science, 1(2), 213–220. doi:10.1177/2167702612469015.CrossRef

Stefanis, N. C., Hanssen, M., Smirnis, N. K., Avramopoulos, D. A., Evdokimidis, I. K., Stefanis, C. N., et al. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine, 32(2), 347–358.CrossRefPubMed

Sündermann, O., Onwumere, J., Kane, F., Morgan, C., & Kuipers, E. (2014). Social networks and support in first-episode psychosis: Exploring the role of loneliness and anxiety. Social Psychiatry and Psychiatric Epidemiology, 49(3), 359–366. doi:10.1007/s00127-013-0754-3.CrossRefPubMed

Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society: Series B (Methodological), 58(1), 267–288.

van Borkulo, C. D., Borsboom, D., Epskamp, S., Blanken, T. F., Boschloo, L., Schoevers, R. A., et al. (2014). A new method for constructing networks from binary data. Scientific Reports,. doi:10.1038/srep05918.PubMedPubMedCentral

van Rossum, I., Dominguez, M.-G., Lieb, R., Wittchen, H.-U., & van Os, J. (2011). Affective dysregulation and reality distortion: A 10-year prospective study of their association and clinical relevance. Schizophrenia Bulletin, 37(3), 561–571. doi:10.1093/schbul/sbp101.CrossRefPubMed

VanderWeele, T. J., Hawkley, L. C., & Cacioppo, J. T. (2012). On the reciprocal association between loneliness and subjective well-being. American Journal of Epidemiology, 176(9), 777–784. doi:10.1093/aje/kws173.CrossRefPubMedPubMedCentral

Weissman, M. M., Sholomskas, D., Pottenger, M., Prusoff, B. A., & Locke, B. Z. (1977). Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology, 106(3), 203–214.PubMed

Wolke, D., Lereya, S. T., Fisher, H. L., Lewis, G., & Zammit, S. (2014). Bullying in elementary school and psychotic experiences at 18 years: A longitudinal, population-based cohort study. Psychological Medicine, 44(10), 2199–2211. doi:10.1017/S0033291713002912.CrossRefPubMed

Zavos, H. M. S., Freeman, D., Haworth, C. M. A., McGuire, P., Plomin, R., Cardno, A. G., et al. (2014). Consistent etiology of severe, frequent psychotic experiences and milder, less frequent manifestations: a twin study of specific psychotic experiences in adolescence. JAMA Psychiatry, 71(9), 1049–1057. doi:10.1001/jamapsychiatry.2014.994.CrossRefPubMedPubMedCentral

Titel: Loneliness and Psychotic Symptoms: The Mediating Role of Depression
verfasst von: Edo S. Jaya
Tobias E. Hillmann
Klaus Michael Reininger
Anton Gollwitzer
Tania M. Lincoln
Publikationsdatum: 24.08.2016
Verlag: Springer US
Erschienen in: Cognitive Therapy and Research / Ausgabe 1/2017
Print ISSN: 0147-5916
Elektronische ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-016-9799-4

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Loneliness and Psychotic Symptoms: The Mediating Role of Depression

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