Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Victoria Bell; Eva Velthorst; Jorge Almansa; Inez Myin-Germeys; Sukhi Shergill; Anne-Kathrin Fett

doi:10.1016/j.scog.2023.100282

Do loneliness and social exclusion breed paranoia? An experience sampling investigation across the psychosis continuum

Schizophr Res Cogn. 2023 Mar 24:33:100282. doi: 10.1016/j.scog.2023.100282. eCollection 2023 Sep.

Authors

Victoria Bell¹, Eva Velthorst², Jorge Almansa³, Inez Myin-Germeys⁴, Sukhi Shergill^{1

5

6}, Anne-Kathrin Fett^{1

3}

Affiliations

¹ Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
² GGZ Noord-Holland-Noord, Heerhugowaard, the Netherlands.
³ Department of Psychology, City, University of London, London, UK.
⁴ Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium.
⁵ Kent and Medway Medical School, Canterbury, UK.
⁶ Kent and Medway NHS and Social Care Partnership Trust, Maidstone, UK.

Abstract

Background: The role of loneliness and social exclusion in the development of paranoia is largely unexplored. Negative affect may mediate potential associations between these factors. We investigated the temporal relationships of daily-life loneliness, felt social exclusion, negative affect, and paranoia across the psychosis continuum.

Method: Seventy-five participants, including 29 individuals with a diagnosis of non-affective psychosis, 20 first-degree relatives, and 26 controls used an Experience Sampling Method (ESM) app to capture the fluctuations in loneliness, feelings of social exclusion, paranoia, and negative affect across a 1-week period. Data were analysed with multilevel regression analyses.

Results: In all groups, loneliness and feelings of social exclusion were independent predictors of paranoia over time (b = 0.05, p < .001 and b = 0.04, p < .05, respectively). Negative affect predicted paranoia (b = 0.17, p < .001) and partially mediated the associations between loneliness, social exclusion, and paranoia. It also predicted loneliness (b = 0.15, p < .0001), but not social exclusion (b = 0.04, p = .21) over time. Paranoia predicted social exclusion over time, with more pronounced effects in controls (b = 0.43) than patients (b = 0.19; relatives: b = 0.17); but not loneliness (b = 0.08, p = .16).

Conclusion: Paranoia and negative affect worsen in all groups following feelings of loneliness and social exclusion. This highlights the importance of a sense of belonging and being included for mental well-being. Loneliness, feeling socially excluded, and negative affect were independent predictors of paranoid thinking, suggesting they represent useful targets in its treatment.

Keywords: Experience sampling; Loneliness; Negative affect; Paranoia; Social exclusion.