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. 2024 Jun;59(6):989-1002.
doi: 10.1007/s00127-023-02540-x. Epub 2023 Aug 25.

Associations between social engagement, internalizing symptoms, and delusional ideation in the general population

Lauren M Hall  1 , Alexandra B Moussa-Tooks  2 , Julia M Sheffield  2
Affiliations

Associations between social engagement, internalizing symptoms, and delusional ideation in the general population

Lauren M Hall et al. Soc Psychiatry Psychiatr Epidemiol. 2024 Jun.

Abstract

Background: Delusions are a hallmark feature of psychotic disorders and lead to significant clinical and functional impairment. Internalizing symptoms-such as symptoms of depression, anxiety, and trauma exposure-are commonly cited to be related to delusions and delusional ideation and are often associated with deficits in social functioning. While emerging studies are investigating the impact of low social engagement on psychotic-like experiences, little work has examined the relationship between social engagement, internalizing symptoms, and delusional ideation, specifically.

Methods: Using general population data from the Nathan Kline Institute-Rockland (NKI-Rockland) database (N = 526), we examined the relationships between self-reported delusional ideation, internalizing symptoms, and social engagement and tested four indirect effect models to understand how these factors interrelate.

Results: Delusional ideation was significantly associated with both increased internalizing symptoms (r = 0.41, p < 0.001) and lower social engagement (r = - 0.14, p = 0.001). Within aspects of social engagement, perceived emotional support showed the strongest relationship with delusional ideation (r = - 0.17, p < 0.001). Lower social engagement was also significantly associated with increased internalizing symptoms (r = - 0.29, p < 0.001). Cross-sectional models suggest that internalizing symptoms have a significant indirect effect on the association between delusional ideation and social engagement.

Conclusions: These findings reveal that elevated delusional ideation in the general population is associated with lower social engagement. Elevated internalizing symptoms appear to play a critical role in reducing engagement, possibly exacerbating delusional thinking. Future work should examine the causal and temporal relationships between these factors.

Keywords: Delusional ideation; Internalizing symptoms; Psychotic-like experiences; Social engagement; Social functioning.

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Conflict of interest statement

Conflict of interest The authors have no relevant financial, non-financial, or competing interests to disclose.

Figures

Fig. 1
Fig. 1
Higher delusional ideation is significantly associated with lower social engagement (r = − 0.14, p = 0.001). Delusional ideation was measured using the Peters et al. Delusions Inventory Scale (PDI) and social engagement was measured through the Social Networking Questionnaire. Social Engagement scores represented as standardized residuals, controlling for age, sex, and race
Fig. 2
Fig. 2
Greater internalizing symptoms were significantly correlated with lower social engagement (r = − 0.29, p < 0.001) and increased delusional ideation (r = 0.41, p < 0.001). Internalizing symptoms composite score refers to a summation of one’s Beck Depression Inventory (BDI) scores, Trauma Symptom Checklist (TSC-40) scores, and the trait anxiety sub-score of the State-Trait Anxiety Inventory (STAI). Delusional ideation was measured using the Peters et al. Delusions Inventory Scale (PDI) and social engagement was measured through the Social Networking Questionnaire. Total PDI and Social Engagement scores represented as standardized residuals, controlling for age, sex, and race
Fig. 3
Fig. 3
Indirect effect models of the sample. All models controlled for age, sex and race. Social engagement is a significant indirect effect as well as a predictor variable
Fig. 4
Fig. 4
Indirect effect models of the sub-sample. All models controlled for age, sex and race. Internalizing symptoms is a significant indirect effect, regardless of the directionality
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