Prospective Relationships between Social Functioning and Insight in Recovery After a First Episode of Psychosis

Cheryl Y. S. Foo, PhD (1), Corinne Cather, PhD (1), Kim T. Mueser, PhD (1,2)

1. Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital;
2. Center for Psychiatric Rehabilitation, Department of Occupational Therapy, Boston University, Boston, MA, USA

Abstract

Background: Impairments in insight and social relationships are characteristic features of schizophrenia associated with worse outcomes. The NAVIGATE program is an evidence-based early intervention service (EIS) for first-episode psychosis (FEP) that improves psychiatric symptoms and social functioning to a greater extent than usual care. Little is known about the temporal relationships between improvements in symptoms and social functioning over the course of treatment.
Methods: We conducted cross-lagged panel analyses using structural equation modeling to evaluate the reciprocal associations between social functioning and insight, a strong correlate of positive symptom severity, among individuals with FEP (aged 15-40) receiving the first year of comprehensive early intervention (NAVIGATE; n=223) versus usual community care (CC; n=181) in a nationwide cluster randomized controlled trial (RAISE-ETP study). Participants completed clinical assessment, including of insight (single PANSS item) and social functioning, at baseline, 6- and 12-months.
Results: Across all participants, controlling for significant covariates, race and treatment group, baseline and 6-month social functioning was associated with subsequent improvements in insight, but not vice versa. When this relationship was evaluated separately in the NAVIGATE and CC groups, it was apparent in NAVIGATE, but not in CC. In the NAVIGATE group, controlling for race, 6-month social functioning was significantly associated with 12-month insight (β = -.157, p = .03) and baseline social functioning showed a marginally significant association with later insight (β = -.121, p = .07).
Conclusion: Improvement in social functioning was associated with subsequent improvement in insight, but not vice versa, in the first year of treatment following an initial episode of psychosis. Better social relationships may provide greater exposure to and understanding of others’ perspectives, which may foster greater insight into illness and self. Findings have clinical implications, suggesting that enhancing social functioning in early stages of intervention for FEP may have secondary positive effects in improving insight into psychotic illness and treatment needs.