Changes in social functioning over the course of psychotic disorders–A meta-analysis

Lars de Winter*, Chrisje Couwenbergh, Jaap van Weeghel, Ilanit Hasson-Ohayon, Jentien M. Vermeulen, Cornelis L. Mulder, Nynke Boonstra, Kete M. Klaver, Matthijs Oud, Lieuwe de Haan, Wim Veling

*Corresponding author for this work

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In this meta-analysis we investigated changes in social functioning and its moderators in patients with a psychotic disorder but different durations of illness at baseline. We included longitudinal studies assessing the course of five domains of social functioning in patients with a psychotic disorder. Effect sizes of change between baseline and follow-up within these domains were analyzed in four subgroups based on durations of psychotic disorder at baseline: less than 2 years, between 2 and 5 years, between 5 and 10 years, and more than 10 years. The influence of baseline confounders was analyzed using meta-regression and sensitivity analysis. We included 84 studies analyzing 33,456 participants. We found a medium improvement (d = 0.60) in overall social functioning over time, with a greater improvement for studies investigating patients with a duration of illness of less than 5 years. We found minor improvement in specific domains of social functioning, such as vocational functioning (d = 0.31), prosocial behavior (d = 0.36), activities (d = 0.15), and independence (d = 0.25). Improvement in social functioning was associated with lower baseline levels of negative symptoms, higher baseline levels of quality of life, and, specifically, improved vocational functioning, with rehabilitation and combined treatment. Social functioning in patients with psychotic disorders improves over time, especially for patients with shorter illness durations. Reduction of negative symptoms and improving quality of life might reinforce improvement of social functioning.

Original languageEnglish
Pages (from-to)55-82
Number of pages28
JournalSchizophrenia Research
Publication statusPublished - Jan 2022

Bibliographical note

Funding Information:
None. Only the authors of this study worked on this manuscript. Therefore, no other acknowledgements are needed to be made. CRediT authorship contribution statement, Lars de Winter, MSc. Lars de Winter is a research officer working at Phrenos Center of Expertise for Severe Mental Illnesses and Amsterdam Medical Center in the Netherlands. He has extensive experience in research about the topics of psychiatric rehabilitation and psychosis and in conducting meta-analyses and systematic reviews. Lars de Winter is the corresponding author for this manuscript. Dr. Chrisje Couwenbergh. Chrisje Couwenbergh is a social scientist working at Phrenos Center of Expertise for Mental Illnesses. She studies different topics in the field of recovery oriented practice, rehabilitation and severe mental illnesses. Prof. Jaap van Weeghel, PhD. Jaap van Weeghel is a social scientist working at Phrenos Center of Expertise for Mental Illnesses. He is also emeritus professor at Tranzo Scientific Center for Care and Welfare, Department of Social and Behavioral Sciences, Tilburg University, The Netherlands. He studies various aspects of the recovery, rehabilitation and social inclusion of people with psychotic disorders or other severe mental illnesses. Prof. Ilanit Hasson-Ohayon, PhD. Ilanit Hasson-Ohayon is a rehabilitation psychologist and full professor at the department of psychology in Bar-Ilan University, Israel. She studies different psychological aspects of coping with illnesses and disabilities. Dr. Jentien Vermeulen. Jentien Vermeulen is a psychiatrist in training and post-doctoral researcher in the field of psychosis and addiction at the Amsterdam University Medical Centers, location AMC. She has a specific track record in the etiology, interventions and prevention of tobacco smoking and severe mental illness, both in research as in clinical practice. Prof. Dr. Cornelis Mulder. Cornelis Mulder is a psychiatrist and professor of public mental health. He is program leader of the Epidemiological and Social Research institute at Erasmus University Medical Centre, department of psychiatry, psychiatrist and teacher at Antes/Parnassia Psychiatric Institute. He is involved in research projects concerning help seeking behavior, motivation and compliance, dual diagnosis, victimisation, emergency psychiatry, assertive outreach, and coercion and has published over 200 (inter)national scientific articles (see pubmed), chapters and several books on these matters. Prof. Dr. Nynke Boonstra Nynke Boonstra is a mental health nurse practicioner at the early intervention service of KieN VIP and professor Healthcare and Innovation in Psychiatry at NHL Stenden University of Applied Science, the Netherlands. She studies various aspects of societal and personal recovery in patients with a psychotic disorder. Kete Klaver, MSc. Kete Klaver is neuropsychologist and PhD candidate at the Netherlands Cancer Institute in Amsterdam. Currently, she is conducting a randomized controlled trial into the effectiveness of a cognitive rehabilitation program for working cancer survivors. Matthijs Oud, MSc. Matthijs Oud is a research officer and is working at Trimbos Institute, the Netherlands. His main topic of research is conducting systematic reviews and meta-analyses on different topics of mental health care. Prof. Dr. Lieuwe de Haan. Lieuwe de Haan, is a psychiatrist and Professor of Psychiatry in Amsterdam Medical Center in the Netherlands. Prof. Dr. Lieuwe de Haan has extensive experience in different research topics, especially focused on early psychosis and schizophrena. Prof. Dr. Wim Veling. Wim Veling, MD, PhD, is a psychiatrist and adjunct Professor of Psychiatry in the Department of Psychiatry at University Medical Center Groningen, University of Groningen, the Netherlands. His research focuses on the social context of psychosis and other psychiatric disorders. He uses epidemiology and virtual reality as a tool for understanding of psychosocial mechanisms and treatment of psychiatric disorders.

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