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. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: J Psychiatr Res. 2021 Nov 3;144:441–447. doi: 10.1016/j.jpsychires.2021.11.001

Social Motivation and Behavior in First-Episode Psychosis: Unique Contributions to Social Quality of Life and Social Functioning

Aubrey M Moe a,b,*, David M Weiss b, Jacob G Pine a, Heather M Wastler a, Nicholas JK Breitborde a,b
PMCID: PMC8667854  NIHMSID: NIHMS1754770  PMID: 34749220

Abstract

Social functioning is diminished among people early in the course of psychotic illnesses, and is likely influenced by the negative symptoms that accompany these disorders, including changes in motivation and experience of pleasure. Though social impairments have a deleterious impact on functioning, socialization is a multifaceted behavior and little is known about how the various aspects may influence social functioning and social quality of life among people with first-episode psychosis. In the present study, we investigated the associations of specific aspects of social motivation and behavior with social functioning and social quality of life in a group of 54 young people (aged 15 to 35) with first-episode psychosis. Though different aspects of social motivation and behavior correlated positively with one another, social motivation for peer interactions was uniquely associated with social functioning and social quality of life – including when a broad measure of negative symptoms was considered within the same model. When these same associations were examined longitudinally, social motivation for peer interactions again emerged as a unique predictor of change in social functioning over 6 months. Our results suggest that the unique contribution of aspects of social motivation has implications for treatment, including the importance of developmentally-informed interventions to improve peer socialization in youth and young adults with psychosis.

Keywords: first-episode psychosis, social functioning, social motivation

1. Introduction

Psychotic disorders are serious illnesses marked by fluctuating psychiatric symptoms (e.g., auditory hallucinations and delusional thinking) that can be debilitating to those experiencing them. There has been increasing recognition of the utility of providing treatment to individuals early in the course of psychosis, as there is a “critical period” of several years following symptom onset (Birchwood et al., 1990) during which psychosocial (Killackey & Yung, 2007) and pharmacological (Robinson et al., 1999) interventions are particularly effective in reducing symptoms and promoting functional improvement. Proponents of early intervention have also recognized the importance of approaches to psychosocial care which aim not only to assist in management of psychiatric symptoms, but also provide support to young people in working toward desired social, occupational, and educational goals (Bertolote & McGorry, 2005; Breitborde et al., 2017).

Social functioning, which broadly encompasses a person’s ability to appropriately and effectively interact in the social world (Hooley, 2010), is robustly impaired among people with psychotic disorders (Blanchard et al., 1998). Social difficulties are evident even before the onset of psychotic symptoms (Niendam et al., 2006), and poor social functioning predicts conversion to psychosis among high-risk individuals (Addington et al., 2016; Carrion et al., 2021). Social impairment in psychosis contributes to fewer social relationships, loneliness, and greater social isolation (Eglit et al., 2018; Degnan et al., 2020; Horan et al., 2006) that can contribute to worsened psychotic symptoms, increased social anxiety, and suicidality (Badcock, Adery, & Park, 2020; Degnan et al., 2020; Fett et al., 2021; Green et al., 2018; Ventriglio et al., 2016). Low levels of social support are further predictive of both poorer functional outcome (Vázquez-Morejón, Rubio, & Vázquez-Morejón, 2018) and poorer quality of life among individuals with psychosis (Caron, Lecomte, Stip & Renaud, 2005). Quality of life, which extends beyond levels of an individual’s functional achievements to also include factors related to satisfaction with one’s involvement in various activities (Watson et al., 2018), is recognized as an important component of psychosocial function and outcome among individuals with psychosis (Malla & Payne, 2005). Research investigating social behavior in first-episode psychosis (FEP) has found that social support and a higher level of social skills are similarly related to better functional outcomes (Albert et al., 2011; Mattsson et al., 2008) and also predictive of lower symptom levels and fewer re-hospitalizations over 3 years (Norman et al., 2005). Of note, though young people with psychosis may have social networks dominated by family members and care providers (McGuire et al., 2020) and over 75% are not in a romantic relationship (Ajnakina et al., 2021), young people with FEP who have peer social relationships have better outcomes than those with only family social support (Bjornestad et al., 2016; Erickson et al., 1998; Reininghaus et al., 2008), suggesting that development of a peer social network may be particularly important.

Barriers to social functioning among young adults with psychosis are likely varied complex. First, given that psychotic disorders generally emerge in the late adolescent and early adult years (Häfner et al., 2003), individuals with FEP may experience disruptions in the normative developmental and interpersonal milestones that characteristically occur during this phase of life (Arnett, 2000) that then further hinder the formation and maintenance of social relationships (Moe & Breitborde, 2019). Other research suggests that cognition (Addington & Addington, 1999; Green et al., 2004), mood and anxiety symptoms (Chudleigh et al., 2011), social cognition (Fett et al., 2011), and deficient social skills (Mueser & Bellack, 1998) further contribute to poor social functioning in psychosis. Notably, an increased number of studies examining multiple predictors of social outcomes in young people with psychosis suggest that negative symptoms may be particularly important in understanding social functioning among these individuals (Rabinowitz et al., 2012; Robertson et al., 2014; Puig et al., 2017). Negative symptoms, which can include changes in motivation and reductions in expected pleasure or expressive behaviors, are common early in the course of psychosis (Thorup et al., 2005). Negative symptoms are treatment resistant (Millan et al., 2014), predictive of poor outcomes (McGlashan & Fenton, 1992), and detrimental to the development of a supportive social network (Hamilton et al., 1989). Apathy – a negative symptom characterized by diminished or lacking interest, drive, and energy – is prevalent in FEP (Faerden et al., 2009) and is predictive of poorer functioning even after treatment (Faerden et al., 2013). Amotivation, which describes impaired or lacking motivation, is a major component of apathy and other negative symptoms in people with psychosis (Foussias et al., 2009) that is of particular importance in understanding psychosocial functioning in FEP (Foussias, & Remington, 2010; Abplanalp, Mueser, & Fulford, 2021). Amotivation also accounts for a significant proportion of the variance in quality of life among people with psychosis (Fervaha et al., 2013).

Research focused on understanding negative symptoms and their influence on behavior among people with psychosis has been prevalent. Existing literature suggests that anhedonia, long-conceptualized as a negative symptom that significantly impairs one’s capacity to experience pleasure, may more accurately reflect deficits in the ability to anticipate pleasant experiences (i.e., anticipatory pleasure; Strauss & Gold, 2012) in a way that negatively impacts goal-directed behavior. Thus, low social motivation may reflect an impaired ability to anticipate enjoyable social interactions, despite intact in-themoment hedonic capacity. However, other research suggests that people with longerstanding psychosis have difficulty engaging in and sustaining effortful behavior more so than they have difficulties with predicting or anticipating pleasure (Gard et al., 2014). Though some recent research has noted similar patterns of difficulties in engaging in effortful behavior among people with FEP (Lui et al., 2016), studies investigating how motivational deficits impact social behavior specifically are more limited. Fulford, Piskulic, and colleagues (2018) found that while motivation and social functioning were correlated upon entry to a treatment program for FEP, baseline motivation was not predictive of social functioning 12 months later; however, this study utilized a global measure of motivation and not motivation for socialization specifically. Notably, as accumulating evidence suggest that motivation specifically for connecting with others and forming meaningful interpersonal relationships (i.e., social motivation) is a key contributor to social functioning in psychosis (Fulford, Campellone, et al., 2018), more targeted investigations of social motivation are warranted. Research with regard to social motivation in FEP has demonstrated that individuals with FEP are particularly impaired in their anticipation of positive social interactions and may be less willing to expend effort in maintaining social relationships when completing a computerized socialization task (Campellone et al., 2018). Collectively, existing research suggests that social motivation and behavior among young people with psychosis are likely multi-faceted. Thus, simultaneous measurement of various aspects of social motivation (e.g., motivation for interactions as well as recently experienced pleasure in and expected pleasure from social interactions) and the influence of these factors on social outcomes over time may be an important strategy to further clarify the nature of these relationships.

As the associations between specific aspects of social experience (i.e., motivation, frequency of pleasurable activities, and expectations about future enjoyable social experiences) and social outcomes are not well known, the goal of the present study was to investigate these relationships – using both cross-sectional and longitudinal analyses – in a sample of young people with first-episode psychosis. Social outcomes were assessed via measures of social and real-world functioning as well as social quality of life. As previous research indicates that social motivation is particularly relevant to psychosocial function among individuals with psychosis (Fulford, Campellone, et al., 2018), we hypothesized that all CAINS variables would be associated with baseline and longitudinal social functioning and social quality of life. Additionally, given previous research indicating that peer relationships may be particularly relevant to social outcomes in FEP, we further hypothesized that peer social motivation would be more strongly associated with social functioning and social quality of life than family social motivation.

2. Material and methods

2.1. Participants.

Fifty-four individuals with first-episode psychosis were recruited from the Ohio State University Early Psychosis Intervention Center (EPICENTER). Inclusion criteria for EPICENTER are (i) a diagnosis of a schizophrenia-spectrum disorder or affective disorder with psychotic features as confirmed by the Structured Clinical Interview for the DSM-5 (First et al., 2015), (ii) ages of 15–35, (iii) initial onset of positive symptoms within the past 5 years, and (iv) an estimated premorbid IQ >70. Participant demographics appear in Table 1. Individuals participating in EPICENTER have access to a multi-component treatment package of evidence-based services for FEP, including psychosocial services and medication management (Breitborde et al., 2015). Each individual selects the interventions they would like to participate in as part of a shared decision-making approach to care.

Table 1:

Participant Demographics and Descriptive Statistics

N = 54 Mean (Standard Deviation)
Age 21.67 (3.89)
Sex (%)
 Female 14 (26)
 Male 40 (74)
Race (%)
 Black 7 (13)
 Asian 6 (11)
 Caucasian 41 (76)
Ethnicity (%)
 Hispanic or Latino 1 (2)
 Non-Hispanic or Latino 53(98)
Psychotic Disorder Diagnosis (%)
 Schizophrenia 21 (39)
 Schizoaffective Disorder 10 (18.5)
 Bipolar Disorder with Psychosis 10 (18.5)
 Major Depression with Psychosis 2 (4)
 Unspecified Psychotic Disorder 11 (20)
Median Duration of Untreated 49.29 (66.14)
Psychosis in Weeks
CAINS
 Family Social Motivation 1.49 (1.06)
 Peer Social Motivation 1.61 (1.20)
 Social Frequency – Last Week 1.49 (1.38)
 Expected Social Frequency – Next Week 1.63 (1.32)
PANSS
 Positive Symptoms 14.83 (4.02)
 Negative Symptoms 17.96 (6.54)
 General Symptoms 34.88 (8.24)
Social Functioning Scale
 Total Score – Baseline 111.16 (24.83)
 Total Score – 6 Month Follow-up 123.57 (18.58)
Social Quality of Life
 Total Score – Baseline 54.65 (24.83)
 Total Score – 6 Month Follow-up 62.00 (18.58)
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2.2. Procedure.

Participants completed baseline measures of social motivation, psychiatric symptoms, social quality of life, and social functioning as part of their clinical care and prior to initiation of clinical intervention services. Social functioning and social quality of life measures were completed again 6 months after enrollment. Use of these data collected as part of usual care for research was approved by The Ohio State University Institutional Review Board.

2.3. Measures.

2.3.1. Social Motivation and Behavior.

All participants completed the Clinical Assessment Interview for Negative Symptoms (CAINS; Kring et al., 2013) to assess social motivation and behavior. The CAINS is an empirically-developed, interviewer-rated measure of negative symptoms designed to assess the underlying domains of motivation and pleasure in understanding experience, expectations, and behavior. All raters completed CAINS training and met inter-rater reliability criteria (ICC [absolute agreement] > 0.75) as compared to master ratings. All items are rated for a one week time period. Though the CAINS is designed to comprehensively assess negative symptoms, it has separate items assessing different aspects of motivation, experiential pleasure, and anticipated pleasure. Given our interest in understanding factors related to social engagement in the present study, we utilized 4 items assessing motivation for and frequency of engaging in pleasurable social activities:

  • Motivation for Close Family/Spouse/Partner Relationships (Family Social Motivation). This item assesses motivation for and interest in initiating interactions with family. Perceived value of close family bonds and closeness of family relationships can also influence scores. This item can be rated even if the individual reports no recent family contacts or interest in family relationships. Scores range from 0 to 4, with higher scores indicating greater motivational impairment.

  • Motivation for Close Friendships & Romantic Relationships (Peer Social Motivation). This item assesses motivation for and interest in contacting friends, initiating social contacts, and maintaining peer interactions. Beliefs about the perceived value of socializing with peers and peer interpersonal relationships also influence scores on this item. This item can be rated even if the individual reports no recent social contacts. Score range from 0 to 4, with higher scores indicating greater motivational impairments.

  • Frequency of Pleasurable Social Activities – Past Week. This item assesses the number of days the individual enjoyed social interaction in the past week. This can include interactions which are in-person or via other technology (e.g., phone, texting, social media). Scores range from 0 to 4, with lower scores indicating that pleasurable interactions occurred daily or almost every day, and higher scores indicating infrequent or lack of enjoyable social interactions.

  • Frequency of Expected Pleasurable Social Activities – Next Week. This item assesses participant expectations about the frequency of pleasurable social activities for the upcoming week. Ratings for this item are based on the total number of expected enjoyable activities, without regard for days on which the participants expects them to occur. Scores range from 0 to 4, with higher scores indicating anticipating few or no pleasurable social experiences.

2.3.2. Social Outcomes.

2.3.2.1. Social and Real-World Functioning.

Current social and real-world functioning was assessed using the Social Functioning Scale (SFS; Birchwood et al., 1990). This measure assesses functioning across several domains, including social and self-care behaviors as well as perceived competency to manage activities of daily living independently. Higher scores on the SFS are reflective of better functioning. In the present study, we utilized the total SFS score.

2.3.2.2. Social Quality of Life.

Participants provided subjective ratings of their social quality of life using social subscale from the World Health Organization Quality of Life Scale-Brief (WHOQOL Group, 1998) questionnaire. Higher scores on this measure indicate greater quality of life. The social QOL subscale includes 3 items which assess an individual’s current satisfaction with their interpersonal relationships, social support, and sexual activity.

2.3.3. Psychiatric Symptoms.

Current psychiatric symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS; Kay et al., 1987) interview. All raters completed training and met inter-rater reliability criteria (ICC [absolute agreement] > 0.75) as compared to master ratings. In the current study, we utilized symptom subscale scores (positive, negative, and general). Notably, the PANSS negative symptom subscale also includes an item measuring social interest and initiative (N4) that was highly correlated with CAINS scores in the present study (r = .427 – .608, p = .002 – < .001). To minimize overlap in measurement of social motivation when comparing negative symptom scores to CAINS scores, we excluded this single item from our negative symptom subscale score.

2.3. Statistical Analyses.

Bivariate correlations were obtained to investigate the associations between baseline CAINS scores, psychiatric symptoms, social QOL, and social functioning. We also examined associations between study variables and participant age and sex using bivariate correlations and a t-test. Next, we tested two cross-sectional multiple regression models predicting each baseline outcome (social QOL, SFS) with the four social motivation predictors from the CAINS (family social motivation, peer social motivation, pleasurable social activities in past week, and expected enjoyable social activities in the coming week). To investigate whether baseline social motivation scores were associated with changes in social functioning and social QOL at 6-month follow-up, we conducted two additional multiple regression models. In each model, outcome change scores (i.e., 6 month score – baseline score) were included as the dependent variable for either SFS score or social QOL score, as guided by statistical guidelines for assessing pretest-posttest change in observational longitudinal research (Farmus et al., 2019; Kim & Steiner, 2019; Rogosa, 1988), along with all 4 CAINS item scores as predictor variables. Finally, we performed exploratory follow-up regressions including PANSS negative symptoms in the model. Consistent with existing recommendations (Graham, 2009), missing data were addressed via multiple imputation. The fraction of missing information (λ) was considered trivial for all analyses (i.e., λ ≤ .200; Bodner, 2008).

3. Results

3.1. Bivariate Correlations and Demographics.

CAINS scores correlated negatively with SFS (r = −2.47 to −−.531) and social QOL (r = −1.63 to −.473), and SFS and social QOL scores were also significantly correlated (see Table 2). PANSS general and positive symptoms were positively correlated with some CAINS scores (r = .013 to .434), while PANSS negative symptoms were significantly correlated with each social motivation and behavior score from the CAINS (r = .375 to .435) as well as SFS score (r = −.331). Participant age and sex were not significantly associated with any CAINS variables, SFS scores, or social QOL scores.

Table 2:

Correlation Matrix for CAINS1 Scores, Social Functioning, Social Quality of Life, and Psychiatric Symptoms

Variables 1 2 3 4 5 6 7 8 9
1. CAINS Family Social Motivation –
2. CAINS Peer Social Motivation .584** –
3. CAINS Social Frequency .439** .388* –
4. CAINS Expected Frequency .359* .350* .726** –
5. Social Functioning (SFS2) −.497** −.531** −.319* −.247 –
6. Social Quality of Life −.473** −.431* −.163 −.317* .366* –
7. PANSS3 General Symptoms .434* .402* .269 .174 −.296 −.174 –
8. PANSS Positive Symptoms .211 .340* .013 −.025 −.215 −.121 .600** –
9. PANSS Negative Symptoms .435** .486** .332* .375* −.331* −.069 .468** .205 –
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*

Correlation is significant at the ≥ .05 level (2-tailed),

**

Correlation is significant at the ≥ .001 level (2-tailed).

1

CAINS = Clinical Assessment Interview for Negative Symptoms.

2

Social Functioning Scale.

3

Positive and Negative Syndrome Scale.

3.2. Cross-Sectional Multiple Regression Models.

Results from the first regression analysis indicated that peer social motivation was significantly associated with baseline SFS (B = −6.199, p = .020) while family social motivation, frequency of social activities, or expectation of social activities were not associated with baseline SFS. In the second regression, peer social motivation was significantly associated with baseline social QOL (B = −8.360, p = .018) as was expectation of pleasurable socialization (B = −6.656, p = .040), while family social motivation and frequency of social activities were not.

3.3. Longitudinal Multiple Regression Models.

We ran two additional regression models with each predicting either 6-month change scores for SFS or social QOL with baseline values of all four CAINS predictors present in each model. Results revealed that baseline peer social motivation significantly predicted changes in SFS (B = 16.006, p = .002) while no other CAINS predictors were significant in this model. None of the CAINS scores were significantly predictive of changes in social QOL.

3.4. Post-hoc Multiple Regression Models.

Given the strong associations observed between negative symptoms and our other variables of interest (i.e., social motivation and behavior scores and social functioning scores), we conducted follow-up cross-sectional and longitudinal multiple regression models that included the PANSS negative symptom score in the model. In each regression model, the addition of the negative symptom score did not change the overall pattern of results from the initial regression analyses (i.e., significant predictors remained significant and insignificant predictors remained insignificant).

4. Discussion

In the present study, aspects of social behavior and expectation were differentially associated with social quality of life and functioning at baseline and at 6 months. More specifically, at baseline peer social motivation was associated with both social functioning and social quality of life, while expectation of socialization in the coming week was associated with only social quality of life. Further, neither family social motivation nor the frequency with which someone had engaged in pleasurable social activities over the past week were associated with social functioning or social quality of life. When these same associations were assessed longitudinally, baseline peer social motivation was the only significant predictor of 6-month change in social functioning. None of the assessed aspects of social motivation and behavior were associated with changes in social quality of life. Negative symptoms were also significantly associated with all CAINS scores as well as social functioning scores. However, when global PANSS negative symptoms were also included in each model, the pattern of results remained unchanged. Given previous research noting the deleterious impact of negative symptoms on development and maintenance of social networks among people with severe mental illness (Hamilton et al., 1989), associations with social motivation and behavior are not surprising. However, the continued significance of specific social motivation variables in predicting social quality of life and social functioning when overall negative symptoms are included in the model underscores the relevance of this factor in understanding social outcomes.

The relative importance of motivation for peer socialization in predicting social functioning in the present study may be particularly relevant in understanding and addressing social difficulties among young people with psychosis. Consistent with previous research noting the benefit of extra-familial social support on outcomes in early psychosis (Erickson et al., 1998), our current findings suggest that motivation for engaging in peer interactions was more associated with changes in social functioning over time than motivation for family socialization. Further, motivation for peer interactions was also more associated with baseline social functioning than the actual frequency with which one has had recent pleasurable social experiences or even how often they expect to enjoy socializing in the near future. A similar pattern emerged for baseline associations of peer social motivation with social QOL, though expectation for social interactions was also relevant. Taken together, this pattern of results highlights the importance of understanding and considering an individual’s motivation for engaging in socialization and beliefs around the relevance of peer relationships when working with youth with FEP.

With replication and further study, the present results may have important implications for psychosocial treatment of FEP. In particular, our results suggest that interventions aimed at improving social functioning in young adults with psychosis may work best when they focus not only on increasing the frequency of social contacts or experiences, but also on the development of motivation for social behavior. Though family support for individuals with psychosis is a crucial factor in promoting recovery and wellness for individuals with FEP (International Early Psychosis Association Writing Group, 2005), our results suggest that targeting peer relationships may also be beneficial in this population. Given that psychotic illnesses tend to manifest during a developmental period of youth marked by exploration of identity and social roles (Arnett, 2000), young people with psychosis may face particular social challenges secondary to derailment of normative social milestones, experiences, or development of social-skills for forming and maintaining peer relationships (Moe & Breitborde, 2019). Thus, employing psychosocial approaches capable of addressing both social motivation and development of social-skills for peer relationships may be an important strategy, with recent pilot data from our lab further supporting the clinical promise of a peer-focused social intervention (Moe et al., 2021).

The present study does suffer from several notable limitations. First, our approach included multiple comparisons among a relatively small sample of individuals with FEP, and thus additional research with larger sample sizes is appropriate. Second, participants in our study were involved in EPICENTER services, and thus the extent to which our results generalize to individuals with FEP not engaged in care is unknown. Third, there is conceptual overlap between the CAINS social motivation and behavior items and the PANSS negative symptom scores that were included in our post-hoc regression analyses and thus we must interpret those results cautiously. Fourth, participant ratings on the some CAINS items (e.g., Frequency of Pleasurable Social Activity – Past Week) may be limited by the availability of recent social interactions. Fifth, though the CAINS items assess relevant aspects of social motivation among people with psychosis (i.e., social interest, experiential social pleasure, and anticipated social pleasure), other components of social motivation relevant to FEP were not assessed as part of the present study, including effort expenditure and reward learning (Campellone et al., 2018). Finally, given the preliminary nature of our study, our investigation did not assess all variables that may mediate, or moderate, or otherwise influence our observed associations between social motivation and behavior with social functioning and/or social quality of life. Thus, future research investigating the influence of various demographic (e.g., age, sex) or clinical variables (e.g., specific psychotic disorder diagnosis, psychiatric symptom levels) on these associations among a larger group of individuals with FEP may guide a more refined understanding of the interrelatedness of these constructs.

Of note, none of the aspects of social motivation assessed in the current study were predictive of changes in social quality of life, despite baseline associations with peer social motivation and expectations for social enjoyment. Notably, we used a broad social QOL measure that was not focused only on peer relationships. However it is possible that social motivational factors may be more distally predictive of social quality of life (i.e., at lengths of time greater than 6 months), though this may be clarified in future research.

Finally, though social motivation and frequency of enjoyed social behavior made different contributions to understanding quality of life and functioning, these variables were significantly correlated. The average CAINS social motivation scores for participants in the present study reflected a moderate deficit (i.e., considering interpersonal relationships somewhat important and with notable deficits in initiating and persisting in social interactions) per the CAINS guidelines (Kring et al., 2013), yet the behavior frequency scores reflected that the average participant reported experiencing pleasurable social interaction on more days than not during the past week. This pattern of results indicates that though individuals with first-episode psychosis experience a diminishment in overall social motivation and drive, they still (i) engage in social behavior, and (ii) tend to experience pleasure in social interactions. Thus, these results suggest that addressing social motivation early in the course of illness may be particularly crucial in that social resources are likely still available to these individuals. As the participants in this study also acknowledged experiencing pleasure when they did interact with others, they may also be more willing to engage in supported social-skills programs. Further, the presence of negative symptoms early in the illness – and the potential of these symptoms to significantly impact one’s ability to create and maintain social contacts during the stage of life when social networks are typically established or stabilized (Thorup et al., 2006) – also reinforce the need to make social relationships a focus of early intervention. Taken together, these possibilities highlight the importance of creating developmentally-appropriate social skills interventions for adolescents and young adults with psychosis to best meet the unique developmental needs of emerging adults.

In summary, although the present study does have a number of limitations, our findings refine the demonstrated influence of social factors on outcomes in psychosis (Brekke et al., 2005) and provides evidence for the unique contribution of peer social motivation to social quality of life and social functioning for individuals with FEP. The first-episode nature of our current sample also points toward the relevance of understanding social motivation for individuals early in the illness, and tailoring interventions around improving motivation and building awareness of the benefits of forming and maintaining social relationships.

Table 3:

Cross-Sectional Regression Models of CAINS1 Predictors and Social Functioning and Social Quality of Life

Outcome Predictor R 2 Adj. R2 F b 95% CI t p sr
SFS2 CAINS Family .329 .268 F(4, 49) = 5.390, p = .001 −6.199 [−14.168, 1.769] 1.533 .127 −.204
CAINS Peer −7.502 [1.55, 3.99] 2.337 .020* −.283
CAINS Past4 −1.792 [−0.04, 0.09] .528 .598 −.063
CAINS Exp5 .781 [0.07, 0.12] .236 .813 .028
sQOL3 CAINS Family .308 .248 F(4, 49) = 5.112, p = .002 −4.681 [−10.810, 1.448] 1.497 .134 −.181
CAINS Peer −8.360 [−15.275, −1.446] 2.370 .018* −.283
CAINS Past4 6.221 [−.130, 12.573] 1.920 .055 .226
CAINS Exp5 −6.656 [−13.012, −.299] 2.502 .040* −.243
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1

Clinical Assessment Interview for Negative Symptoms.

2

Social Functioning Scale.

3

Social Quality of Life.

4

Frequency of Pleasurable Social Activities – Past Week.

5

Frequency of Expected Pleasurable Social Activities – Next Week.

Note. Unstandardized coefficients reported. F statistics reflect the overall test of the model (accounting for all predictors).

Table 4:

Longitudinal Regression Models of CAINS1 Predictors and 6-Month Change in Social Functioning and Social Quality of Life

Outcome Predictor R 2 Adj. R2 F b 95% CI t p sr
SFS Change2 CAINS Family .386 .242 F(4, 49) = 2.667, p = .067 −8.882 [−21.243, 3.480] 1.457 .154 −.249
CAINS Peer 16.006 [6.075, 25.937] 3.247 .002* .521
CAINS Past4 9.150 [−.880, 19.180] 1.830 .073 .279
CAINS Exp5 −5.475 [−14.247, 3.297] 1.239 .218 −.172
sQOL Change3 CAINS Family .219 .036 F(4, 49) = 1.194, p = .349 −.522 [−15.330, 14.286] .072 .943 −.002
CAINS Peer 9.536 [−5.110, 24.182] 1.341 .192 .315
CAINS Past4 3.421 [−7.073, 13.914] .652 .517 .107
CAINS Exp5 −.473 [−8.943, 7.997] .110 .913 −.016
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1

Clinical Assessment Interview for Negative Symptoms.

2

Social Functioning Scale.

3

Social Quality of Life.

4

Frequency of Pleasurable Social Activities – Past Week.

5

Frequency of Expected Pleasurable Social Activities – Next Week.

Note. Unstandardized coefficients reported. F statistics reflect the overall test of the model (accounting for all predictors).

Footnotes

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Author Declarations of Interest: None

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