The association between psychosocial stress, interpersonal sensitivity, social withdrawal and psychosis relapse: a systematic review

Abstract

Psychosis is associated with a high risk of relapse, with 67% of clients relapsing within one year following a first episode. In light of the high personal, social, and healthcare costs of the illness, it is paramount to understand the risk factors associated with psychosis relapse. The current systematic review aims to critically review the role of psychosocial stress in psychosis relapse in individuals with an established psychotic disorder. This review systematically searched Ovid (PsycINFO, EMBASE, MEDLINE) literature databases from inception until 28th February 2022. Sixteen studies were eligible for inclusion. Most studies found that individuals with psychosis demonstrate high levels of psychosocial stress and are more likely to be socially withdrawn compared to healthy controls or other clinical presentations. Most studies reported a statistically significant association between psychosocial stress and psychosis relapse, as well as between social withdrawal and psychosis relapse. However, no studies examined the association between high levels of interpersonal sensitivity and psychosis relapse. Individuals with psychosis tend to experience high levels of psychosocial stress and social withdrawal, and these appear to increase the risk of psychosis relapse. Due to high levels of heterogeneity within the literature, we could only conduct a narrative synthesis of the findings. Future studies would benefit from employing a meta-analytic approach.

Fig. 1. FEP Relapse Model: A causal model linking psychosocial stress, interpersonal sensitivity, and social withdrawal with the risk of psychosis relapse.

We propose the following Psychosis Relapse Model. This model suggests that a combination of psychosocial stress, social withdrawal, and interpersonal sensitivity increase risk for psychosis relapse and could be targets of preventive strategies.

Fig. 2

PRISMA Flow Diagram.