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Review
. 2023 Jun 17;9(1):38.
doi: 10.1038/s41537-023-00362-z.

Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

A Georgiades  1   2 , A Almuqrin  3 , P Rubinic  3 , K Mouhitzadeh  3 , S Tognin  3 , A Mechelli  3
Affiliations
Review

Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

A Georgiades et al. Schizophrenia (Heidelb). .

Abstract

Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.

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Conflict of interest statement

The authors declare no competing interests. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2. Bio-psychosocial model of transition to psychosis.
A conceptual framework for integrating the influence of biological, psychological, and social factors in the transition to psychosis.
See this image and copyright information in PMC

References

    1. Fusar-Poli P. The psychosis high-risk state a comprehensive state-of-the-art review. JAMA Psychiatry. 2013;70:1. doi: 10.1001/jamapsychiatry.2013.269. - DOI - PMC - PubMed
    1. Yung AR, et al. Mapping the onset of psychosis: the comprehensive assessment of at-risk mental states. Aust. N. Z. J. Psychiatry. 2005;39:964–971. doi: 10.1080/j.1440-1614.2005.01714.x. - DOI - PubMed
    1. Fusar-Poli P. The clinical high-risk state for psychosis (CHR-P), version II. Schizophr. Bull. 2017;43:44–47. doi: 10.1093/schbul/sbw158. - DOI - PMC - PubMed
    1. van Dongen J, Boomsma DI. The evolutionary paradox and the missing heritability of schizophrenia. Am. J. Med. Genet. B Neuropsychiatr. Genet. 2013;162B:122–136. doi: 10.1002/ajmg.b.32135. - DOI - PubMed
    1. Hilker R, et al. Heritability of schizophrenia and schizophrenia spectrum based on the Nationwide Danish Twin Register. Biol. Psychiatry. 2018;83:492–498. doi: 10.1016/j.biopsych.2017.08.017. - DOI - PubMed