CoChat
Sign Up
Cited by 46Schizophrenia research and treatmentMental Health and PsychiatryPsychiatric care and mental health services

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

Open access
de Winter, Lars, Couwenbergh, Chrisje, van Weeghel, Jaap, Hasson-Ohayon, Ilanit, Vermeulen, Jentien M., Mulder, Cornelis L., Boonstra, Nynke, Klaver, Kete M. +3 more·2022·Schizophrenia Research
DOI 10.1016/j.schres.2021.11.010
Open this paper in CoChat — free accountOpen PDF

Abstract

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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.schres.2021.11.010

Cites

0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • A significant decline in social functioning has been found across life domains such as work, societal roles and relationships.

    “and across life domains such as work, societal roles and relationships (de Winter et al. 2022).”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as de Winter et al. 2022

    The Discussion (page unavailable) reports medium improvement in overall social functioning and small improvement in vocational functioning, prosocial behavior and independence—not a significant decline across those domains. It reports no overall improvement in activities. (LLM, conf=0.89)

    Checked by a reasoning model — may be wrong.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 35

  1. Albert, N., Bertelsen, M., Thorup, A., Petersen, L., Jeppesen, P., Le Quack, P., Nordentoft, M., 2011. Predictors of recovery from psychosis: analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years. Schizophr. Res. 125 (2-3), 257-266.
  2. Alvarez-Jimenez, M., Gleeson, J.F., Henry, L.P., Harrigan, S.M., Harris, M.G., Killackey, E., Jackson, H.J., 2012. Road to full recovery: longitudinal relationship between symptomatic remission and psychosocial recovery in first-episode psychosis over 7.5 years. Psychol. Med. 42 (3), 595-606.
  3. Bellack, A.S., Green, M.F., Cook, J.A., Fenton, W., Harvey, P.D., Heaton, R.K., Patterson, T.L., 2006. Assessment of community functioning in people with schizophrenia and other severe mental illnesses: a white paper based on an NIMH- sponsored workshop. Schizophr. Bull. 33 (3), 805-822.
  4. Benjamini, Y., Hochberg, Y., 1995. Controlling the false discovery rate: a practical and powerful approach to multiple testing. Retrieved April 30, 2021, from J. R. Stat. Soc. Ser. B Methodol. 57 (1), 289-300. http://www.jstor.org/stable/2346101.
  5. Birchwood, M., Smith, J.O., Cochrane, R., Wetton, S., Copestake, S.O.N.J.A., 1990. The social functioning scale the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br. J. Psychiatry 157 (6), 853-859.
  6. Bliksted, V., Videbech, P., Fagerlund, B., Frith, C., 2017. The effect of positive symptoms on social cognition in first-episode schizophrenia is modified by the presence of negative symptoms. Neuropsychology 31 (2), 209.
  7. Böhning, D., Lerdsuwansri, R., Holling, H., 2017. Some general points on the I^2-measure of heterogeneity in meta-analysis. Metrika 80 (6-8), 685-695.
  8. Bond, G.R., Drake, R.E., Luciano, A., 2015. Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol. Psychiatr. Sci. 24 (5), 446-457.
  9. Bottlender, R., Strauß, A., Möller, H.J., 2010. Social disability in schizophrenic, schizoaffective and affective disorders 15 years after first admission. Schizophr. Res. 116 (1), 9-15.
  10. Breitborde, N.J., Srihari, V.H., Woods, S.W., 2009. Review of the operational definition for first-episode psychosis. Early Interv. Psychiatry 3 (4), 259-265.
  11. Burns-Lynch, B., Musa, E.B., 2016. An empirical study of the relationship between community participation, recovery, and quality of life of individuals with serious mental illnesses. Isr. J. Psychiatry Relat. Sci. 53 (1), 46.
  12. Cos ¸kun, E., Altun, Ö.S ¸., 2018. The relationship between the hope levels of patients with schizophrenia and functional recovery. Arch. Psychiatr. Nurs. 32 (1), 98-102.
  13. De Wolf, A.C., Tate, R.L., Lannin, N.A., Middleton, J., Lane-Brown, A., Cameron, I.D., 2012. The World Health Organization disability assessment scale, WHODAS II: reliability and validity in the measurement of activity and participation in a spinal cord injury population. J. Rehabil. Med. 44 (9), 747-755.
  14. Fervaha, G., Foussias, G., Agid, O., Remington, G., 2014. Impact of primary negative symptoms on functional outcomes in schizophrenia. Eur. Psychiatry 29 (7), 449-455.
  15. Frascarelli, M., Tognin, S., Mirigliani, A., Parente, F., Buzzanca, A., Torti, M.C., Fusar- Poli, P., 2015. Medial frontal gyrus alterations in schizophrenia: relationship with duration of illness and executive dysfunction. Psychiatry Res. Neuroimaging 231 (2), 103-110.
  16. Fusar-Poli, P., Rocchetti, M., Sardella, A., Avila, A., Brandizzi, M., Caverzasi, E., McGuire, P., 2015. Disorder, not just state of risk: meta-analysis of functioning and quality of life in people at high risk of psychosis. Br. J. Psychiatry 207 (3), 198-206.
  17. Gee, B., Hodgekins, J., Fowler, D., Marshall, M., Everard, L., Lester, H., Freemantle, N., 2016. The course of negative symptom in first episode psychosis and the relationship with social recovery. Schizophr. Res. 174 (1-3), 165-171.
  18. Górna, K., Jaracz, K., Jaracz, J., Kiejda, J., Grabowska-Fudala, B., Rybakowski, J., 2014. Social functioning and quality of life in schizophrenia patients-relationship with symptomatic remission and duration of illness. Psychiatr. Pol. 48 (2), 277-288.
  19. Hasson-Ohayon, I., Kravetz, S., Meir, T., Rozencwaig, S., 2009. Insight into severe mental illness, hope, and quality of life of persons with schizophrenia and schizoaffective disorders. Psychiatry Res. 167 (3), 231-238. https://doi.org/10.1016/j. psychres.2008.04.019. · DOI
  20. Heeramun-Aubeeluck, A., Liu, N., Fischer, F., Huang, N., Chen, F., He, L., Lu, Z., 2015. Effect of time and duration of untreated psychosis on cognitive and social functioning in chinese patients with first-episode schizophrenia: a 1-year study. Nord. J. Psychiatry 69 (4), 254-261.
  21. Higgins, J.P., Thompson, S.G., 2002. Quantifying heterogeneity in a meta-analysis. Stat. Med. 21 (11), 1539-1558.
  22. Lambert, M., Schimmelmann, B.G., Schacht, A., Karow, A., Wagner, T., Wehmeier, P.M., Naber, D., 2009. Long-term patterns of subjective wellbeing in schizophrenia: cluster, predictors of cluster affiliation, and their relation to recovery criteria in 2842 patients followed over 3 years. Schizophr. Res. 107 (2-3), 165-172.
  23. Leff, J., Sartorius, N., Jablensky, A., Korten, A., Ernberg, G., 1992. The international pilot study of schizophrenia: five-year follow-up findings. Psychol. Med. 22 (1), 131-145.
  24. Linscott, R.J., Van Os, J., 2013. An updated and conservative systematic review and meta-analysis of epidemiological evidence on psychotic experiences in children and adults: on the pathway from proneness to persistence to dimensional expression across mental disorders. Psychol. Med. 43 (6), 1133-1149.
  25. Lloyd, C., Waghorn, G., Best, M., Gemmell, S., 2008. Reliability of a composite measure of social inclusion for people with psychiatric disabilities. Aust. Occup. Ther. J. 55 (1), 47-56.
  26. Luther, L., Rosen, C., Cummins, J.S., Sharma, R.P., 2020. The multidimensional construct of resilience across the psychosis spectrum: evidence of alterations in people with early and prolonged psychosis. Psychiatr. Rehabil. J. 43 (3), 225-233.
  27. McGorry, P.D., Nelson, B., Goldstone, S., Yung, A.R., 2010. Clinical staging: a heuristic and practical strategy for new research and better health and social outcomes for psychotic and related mood disorders. Can. J. Psychiatry 55 (8), 486-497.
  28. Preston, N.J., 2000. Predicting community survival in early psychosis and schizophrenia populations after receiving intensive case management. Aust. N. Z. J. Psychiatry 34 (1), 122-128.
  29. Rymaszewska, J., Jarosz-Nowak, J., Kiejna, A., Kallert, T., Schützwohl, M., Priebe, S., Raboch, J., 2007. Social disability in different mental disorders. Eur. Psychiatry 22 (3), 160-166.
  30. Santesteban-Echarri, O., Paino, M., Rice, S., González-Blanch, C., McGorry, P., Gleeson, J., Alvarez-Jimenez, M., 2017. Predictors of functional recovery in first- episode psychosis: a systematic review and meta-analysis of longitudinal studies. Clin. Psychol. Rev. 58, 59-75.
  31. Świtaj, P., Anczewska, M., Chrostek, A., Sabariego, C., Cieza, A., Bickenbach, J., Chatterji, S., 2012. Disability and schizophrenia: a systematic review of experienced psychosocial difficulties. BMC Psychiatry 12 (1), 193.
  32. The Nordic Cochrane Centre, 2014. Review Manager (RevMan) [Computer Program]. Version 5.3, 2014. The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen.
  33. Van Os, J., Reininghaus, U., 2016. Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 15 (2), 118-124.
  34. Ventura, J., Subotnik, K.L., Gitlin, M.J., Gretchen-Doorly, D., Ered, A., Villa, K.F., Nuechterlein, K.H., 2015. Negative symptoms and functioning during the first year after a recent onset of schizophrenia and 8 years later. Schizophr. Res. 161 (2-3), 407-413.
  35. Wiersma, D., Wanderling, J., Dragomirecka, E., Ganev, K., Harrison, G., Der Heiden, W. A., Walsh, D., 2000. Social disability in schizophrenia: its development and prediction over 15 years in incidence cohorts in six european centres. Psychol. Med. 30 (5), 1155-1167.

Cited by

Sorted by citations

Authors
de Winter, L., Couwenbergh, C., van Weeghel, J., Hasson-Ohayon, I., Vermeulen, J. M., Mulder, C. L., Boonstra, N., Klaver, K. M., Oud, M., de Haan, L., & Veling, W.
Affiliations
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Erasmus MC (NL)
  • Stenden University of Applied Sciences (NL)
  • The Netherlands Cancer Institute (NL)
  • Trimbos Institute (NL)
  • University Medical Center Groningen (NL)
ORCID
Venue
Schizophrenia Research
Publisher
Elsevier BV
Published
2022-01
Volume
239
Pages
55-82
ISSN
0920-9964 (ISSN-L)
DOI
10.1016/j.schres.2021.11.010
OpenAlex
W3217719596
Cited by
46
References
59
Citations by year
2026: 10 · 2025: 10 · 2024: 9 · 2023: 13 · 2022: 4
FWCI
1.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Schizophrenia Research (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, cc-by)
  • Research portal (Tilburg University) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, cc-by)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, cc-by)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
social functioning, psychosis
MeSH terms
Social Interaction, Humans, Psychotic Disorders, Quality of Life, Schizophrenia, Social Adjustment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review