The interplay among psychopathology, personal resources, context-related factors and real-life functioning in schizophrenia: stability in relationships after 4 years and differences in network structure between recovered and non-recovered patients

Abstract

Improving real-life functioning is the main goal of the most advanced integrated treatment programs in people with schizophrenia. The Italian Network for Research on Psychoses previously explored, by using network analysis, the interplay among illness-related variables, personal resources, context-related factors and real-life functioning in a large sample of patients with schizophrenia. The same research network has now completed a 4-year follow-up of the original sample. In the present study, we used network analysis to test whether the pattern of relationships among all variables investigated at baseline was similar at follow-up. In addition, we compared the network structure of patients who were classified as recovered at follow-up versus those who did not recover. Six hundred eighteen subjects recruited at baseline could be assessed in the follow-up study. The network structure did not change significantly from baseline to follow-up, and the overall strength of the connections among variables increased slightly, but not significantly. Functional capacity and everyday life skills had a high betweenness and closeness in the network at follow-up, as they had at baseline, while psychopathological variables remained more peripheral. The network structure and connectivity of non-recovered patients were similar to those observed in the whole sample, but very different from those in recovered subjects, in which we found few connections only. These data strongly suggest that tightly coupled symptoms/dysfunctions tend to maintain each other's activation, contributing to poor outcome in schizophrenia. Early and integrated treatment plans, targeting variables with high centrality, might prevent the emergence of self-reinforcing networks of symptoms and dysfunctions in people with schizophrenia.

Keywords: Schizophrenia; everyday life skills; functional capacity; internalized stigma; network analysis; personal resources; psychopathology; real-life functioning; recovery.

Figure 1

Network showing the associations among study variables at baseline (left) and follow‐up (right). Broken edges indicate inverse associations, full edges direct correlations. The thickness of an edge reflects the magnitude of the correlation. Att – attention, Avl – avolition, Dep – depression, Dis – disorganization, ELS – everyday life skills, EnS – service engagement, ExD – expressive deficit, FC – functional capacity, FCo – family cohesion, FEI – Facial Emotion Identification Test, Inc – number of incentives, Int – interpersonal relationships, MSC – Mayer‐Salovey‐Caruso Emotional Intelligence Test, PFu – perception of the future, Pos – positive symptoms, PrS – problem solving, PSe – perception of self, PSp – processing speed, SCo – social competence, SLe – visuospatial learning, Stg – stigma, Ta – The Awareness of Social Inference Test (TASIT), VLe – verbal learning, WMe – working memory, Wrk – work skills

Figure 2

Centrality measures of the study variables at baseline and follow‐up. Att – attention, Avl – avolition, Dep – depression, Dis – disorganization, ELS – everyday life skills, EnS – service engagement, ExD – expressive deficit, FC – functional capacity, FCo – family cohesion, FEI – Facial Emotion Identification Test, Inc – number of incentives, Int – interpersonal relationships, MSC – Mayer‐Salovey‐Caruso Emotional Intelligence Test, PFu – perception of the future, Pos – positive symptoms, PrS – problem solving, PSe – perception of self, PSp – processing speed, SCo – social competence, SLe – visuospatial learning, Stg – stigma, Ta – The Awareness of Social Inference Test (TASIT), VLe – verbal learning, WMe – working memory, Wrk – work skills

Figure 3

Network showing the associations among study variables among non‐recovered (left) and recovered (right) patients. Broken edges indicate inverse associations, full edges direct correlations. The thickness of an edge reflects the magnitude of the correlation. Att – attention, Avl – avolition, Dep – depression, Dis – disorganization, ELS – everyday life skills, EnS – service engagement, ExD – expressive deficit, FC – functional capacity, FCo – family cohesion, FEI – Facial Emotion Identification Test, Inc – number of incentives, Int – interpersonal relationships, MSC – Mayer‐Salovey‐Caruso Emotional Intelligence Test, PFu – perception of the future, Pos – positive symptoms, PrS – problem solving, PSe – perception of self, PSp – processing speed, SCo – social competence, SLe – visuospatial learning, Stg – stigma, Ta – The Awareness of Social Inference Test (TASIT), VLe – verbal learning, WMe – working memory, Wrk – work skills

Figure 4

Centrality measures among non‐recovered and recovered patients. Because some nodes are disconnected among recovered patients, closeness is always 0 by definition in this group. Att – attention, Avl – avolition, Dep – depression, Dis – disorganization, ELS – everyday life skills, EnS – service engagement, ExD – expressive deficit, FC – functional capacity, FCo – family cohesion, FEI – Facial Emotion Identification Test, Inc – number of incentives, Int – interpersonal relationships, MSC – Mayer‐Salovey‐Caruso Emotional Intelligence Test, PFu – perception of the future, Pos – positive symptoms, PrS – problem solving, PSe – perception of self, PSp – processing speed, SCo – social competence, SLe – visuospatial learning, Stg – stigma, Ta – The Awareness of Social Inference Test (TASIT), VLe – verbal learning, WMe – working memory, Wrk – work skills