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Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review

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Georgiades, A., Almuqrin, A., Rubinic, P., Mouhitzadeh, K., Tognin, S., Mechelli, A.·2023·Schizophrenia
DOI 10.1038/s41537-023-00362-zPMC PMC10276848
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Abstract

Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.

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  • The cognitive model of social functioning in psychosis proposes that childhood traumatic events such as physical, sexual and emotional abuse, and physical and emotional neglect, contribute to the formation of core beliefs such as negative self and other beliefs.

    “Our model proposes that childhood traumatic events such as physical, sexual, and emotional abuse, as well as physical and emotional neglect contribute to the formation of core beliefs such as ‘I am a failure, inferior, weak/vulnerable, worthless, and/or unlovable/unlikeable’ and others are ‘untrustworthy, dangerous, uncaring and/or unreliable’.”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Georgiades et al. 2023

  • According to the cognitive model of positive symptoms of psychosis and the Bio-Psychosocial Model of Transition to Psychosis, avoidance and social withdrawal, as well as psychosocial stress and interpersonal sensitivity, contribute to the onset and maintenance of psychosis symptoms.

    “According to the cognitive model of positive symptoms of psychosis (Garety et al. 2001) and the Bio‐Psychosocial Model of Transition to Psychosis (Georgiades et al. 2023), avoidance and social withdrawal, as well as psychosocial stress and interpersonal sensitivity, contribute to the onset and maintenance of psychosis symptoms.”

    From Social Functioning Interventions in Psychosis: A Systematic Review. (2025) · cites this paper as Georgiades et al. 2023

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Authors
Georgiades, A., Almuqrin, A., Rubinic, P., Mouhitzadeh, K., Tognin, S., & Mechelli, A.
Affiliations
King's College London (GB)
Corresponding author
Georgiades, A.
ORCID
Venue
Schizophrenia
Publisher
Springer Science and Business Media LLC
Published
2023-06-17
Volume
9
Issue
1
Pages
38-38
ISSN
2754-6993 (ISSN-L)
DOI
10.1038/s41537-023-00362-z
PMC
PMC10276848
OpenAlex
W4381085659
Cited by
58
References
24
Citations by year
2026: 24 · 2025: 18 · 2024: 12 · 2023: 4
FWCI
2.65
Type
journal article
Language
en
Open access
Licence
Locations
  • Schizophrenia (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
Funders
Medical Research Council (MR/S026428/1)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
  • Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
Keywords
psychosocial stress, interpersonal sensitivity, social withdrawal, clinical high risk for psychosis, transition to psychosis, daily hassles, trauma, emotional abuse, perceived discrimination, major life events

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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 ›

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