The Role of Social Isolation in the Relationships Between Psychosis and Suicidal Ideation

Social isolation relates to worse mental health outcomes, including lower quality of life, depression, and both suicidal ideation and attempt. Among individuals experiencing symptoms of psychosis, suicide is a leading cause of death and data show greater isolation relates to increased negative symptoms as compared to individuals with strong support systems. While isolation has been linked with negative symptoms in the literature, less is known about its relationships with positive symptoms of psychosis (e.g., hallucinations and delusions), particularly within the context of a general population-based sample. This study examined the relationships between hallucinations, delusions, depression, social isolation, and suicidal ideation. Participants were involved in the cross-sectional Collaborative Psychiatric Epidemiology Surveys (CPES) including a large general population-based sample of households in the United States between 2001 and 2003. Participants (n = 12,195) included adults over the age of 18 in the United States, all of whom completed a psychosis assessment. Hopelessness was measured using The Calgary Depression Scale for Schizophrenia (CDSS), hallucinations and delusions by the Positive and Negative Syndrome Scale (PANSS), and social isolation by three PANSS items (keeping to self, feeling awkward in social settings, preferring to be alone), all at baseline. Data were analyzed in Mplus 8 using structural equation modeling. As hallucinations, delusions, and depression independently increased, on average there were associated increases in social isolation and the likelihood of experiencing suicidal ideation. Social isolation also related to greater suicidal ideation and ultimately functioned as a mediator. With suicide being a leading cause of death for individuals experiencing psychosis, the mediating role of social isolation in the relationships between hallucinations, delusions, depression, and suicidal ideation speaks towards the importance of social support and skills training as important treatment targets in practice.