A Proxy Approach to Family Involvement and Neurocognitive Function in First Episode of Non-Affective Psychosis: Sex-Related Differences

Abstract

Schizophrenia spectrum disorders (SSD) often show cognitive deficits (CD) impacting daily life. Family support has been shown to be protective against CD, yet the relationship between these in psychotic patients remains complex and not fully understood. This study investigated the association between a subdomain of family support, namely, family involvement (estimated through a proxy measure), cognitive functioning, and sex in first-episode psychosis (FEP) patients. The sample included 308 patients enrolled in the Program for Early Phases of Psychosis (PAFIP), divided into 4 groups based on their estimated family involvement (eFI) level and sex, and compared on various variables. Women presented lower rates of eFI than men (37.1% and 48.8%). Higher eFI was associated with better cognitive functioning, particularly in verbal memory. This association was stronger in women. The findings suggest that eFI may be an important factor in FEP patients' cognitive functioning. This highlights the importance of including families in treatment plans for psychotic patients to prevent CD. Further research is needed to better understand the complex interplay between family support, sex, and cognitive functioning in psychotic patients and develop effective interventions that target these factors.

Keywords: family centered care; family involvement; family support; first episode psychosis; gender roles; neurocognition; schizophrenia spectrum disorders; sex differences; women.

Figure 1

Family involvement study sample selection process.

Figure 2

Comparisons of neurocognitive deficit profiles were conducted among the four study groups; men with non-participant families (I); women with non-participant families (II); men with participant families (III); women with participant families (IV). The statistical normality assumption (Z = 0) serves as the central point, with larger areas indicating greater neurocognitive deficits. Relevant fully statistically significant differences: those discerned between the same-sex homologous groups (i.e., participant, and non-participant), are delineated below. Specifically, verbal memory was found to be significantly greater in women with participant families than women with non-participant families (p ≤ 0.005), while relevant trends are also noted, including those pertaining to working memory (women with participant families > women with non-participant families, p = 0.088) and motor dexterity (p = 0.079). All means of measurement can be found in Section 2.