Skip to main content
    • Aa
    • Aa

Social networks, support and early psychosis: a systematic review

  • C. Gayer-Anderson (a1) and C. Morgan (a1)

There is strong evidence that those with a long-standing psychotic disorder have fewer social contacts and less social support than comparison groups. There is less research on the extent of social contacts and support prior to or at the onset of psychosis. In the light of recent evidence implicating a range of social experiences and contexts at the onset of psychosis, it is relevant to establish whether social networks and support diminished before or at the time of onset and whether the absence of such supports might contribute to risk, either directly or indirectly. We, therefore, conducted a systematic review of this literature to establish what is currently known about the relationship between social networks, support and early psychosis.


We identified all studies investigating social networks and support in first episode psychosis samples and in general population samples with measures of psychotic experiences or schizotype by conducting systematic searches of electronic databases using pre-defined search terms and criteria. Findings were synthesized using non-quantitative approaches.


Thirty-eight papers were identified that met inclusion criteria. There was marked methodological heterogeneity, which limits the capacity to draw direct comparisons. Nonetheless, the existing literature suggests social networks (particularly close friends) and support diminished both among first episode samples and among non-clinical samples reporting psychotic experiences or with schizotype traits, compared with varying comparison groups. These differences may be more marked for men and for those from minority ethnic populations.


Tentatively, reduced social networks and support appear to pre-date onset of psychotic disorder. However, the substantial methodological heterogeneity among the existing studies makes comparisons difficult and suggests a need for more robust and comparable studies on networks, support and early psychosis.

Corresponding author
*Address for correspondence: Charlotte Gayer-Anderson, PhD, Box 33, Section of Social Psychiatry, Health Service and Population Research Department, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, England. (Email:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

K Alptekin , H Ulas , BB Akdede , M Tumuklu , Y Akvardar (2009). Prevalence and risk factors of psychotic symptoms: in the city of Izmir, Turkey. Social Psychiatry and Psychiatric Epidemiology 44, 905910.

CC Beels (1981). Social support and schizophrenia. Schizophrenia Bulletin 7, 5872.

CC Beels , L Gutwirth , J Berkeley , E Struening (1984). Measurements of social support in schizophrenia. Schizophrenia Bulletin 10, 399411.

JJ Blanchard , LM Collins , M Aghevli , WW Leung , AS Cohen (2011). Social anhedonia and schizotypy in a community sample: The Maryland Longitudinal Study of Schizotypy. Schizophrenia Bulletin 37, 587602.

T Brugha , R Jenkins , P Bebbington , H Meltzer , G Lewis , M Farrell (2004). Risk factors and the prevalence of neurosis and psychosis in ethnic groups in Great Britain. Social Psychiatry and Psychiatric Epidemiology 39, 939946.

TS Brugha (2010). Social support. In Principles of Social Psychiatry, 2nd edn (ed. C. Morgan and D. Bhugra ), pp. 461476. Wiley–Blackwell: Oxford.

TS Brugha , E Sturt , B MacCarthy , J Potter , T Wykes , P Bebbington (1987). The interview measure of social relationships: the description and evaluation of a survey instrument for assessing personal social resources. Social Psychiatry 22, 123128.

J Buchanan (2004). Social support and schizophrenia: a review of the literature. Archives of Psychiatric Nursing 9, 6876.

AT Chakraborty , KJ McKenzie , S Hajat , SA Stansfeld (2010). Racism, mental illness and social support in the UK. Social Psychiatry and Psychiatric Epidemiology 45, 11151124.

C Cohen , J Sokolovsky (1979). Schizophrenia and social networks. Schizophrenia Bulletin 4, 546560.

RE Dangelmaier , NM Docherty , T Akamatsu (2006). Psychosis proneness, coping, and perceptions of social support. American Journal of Orthopsychiatry 76, 1317.

M Dunn , C O'Driscoll , D Dayson , W Wills , J Leff (1990). The TAPS Project 4: an observational study of the social life of long-stay patients. British Journal of Psychiatry 157, 842848, 852.

P Fearon , C Morgan (2006). Environmental factors in schizophrenia: the role of migrant studies. Schizophrenia Bulletin 32, 405408.

L Flyckt , M Mattsson , G Edman , R Carlsson , J Cullberg (2006). Predicting 5-year outcome in first-episode psychosis: construction of a prognostic rating scale. Journal of Clinical Psychiatry 67, 916924.

D Freeman , M Gittins , K Pugh , A Antley , M Slater , G Dunn (2008 a). What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences 38, 11211132.

D Freeman , K Pugh , A Antley , M Slater , M Slater , P Bebbington , M Gittens , G Dunn , E Kuipers , D Fowler , P Garety (2008 b). Virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry, 192, 258263.

D Freeman , K Pugh , P Garety (2008 c). Jumping to conclusions and paranoid ideation in the general population. Schizophrenia Research, 102, 254260.

T Harris , GW Brown , R Robinson (1999 b). Befriending as an intervention for chronic depression among women in an inner city. 2: Role of fresh-start experiences and baseline psychosocial factors in remission from depression. British Journal of Psychiatry 174, 225232.

K Heller , RW Swindle , L Dusenbury (1986). Component social support processes: comments and integration. Journal of Consulting and Clinical Psychology 54, 466470.

A Hodges , M Byrne , E Grant , E Johnstone (1999). People at risk of schizophrenia. Sample characteristics of the first 100 cases in the Edinburgh High-Risk Study. British Journal of Psychiatry 174, 547553.

WP Horan , KL Subotnik , KS Snyder , KH Nuechterlein (2006). Do recent-onset schizophrenia patients experience a “social network crisis”? Psychiatry 69, 115129.

WP Horan , SA Brown , JJ Blanchard (2007). Social anhedonia and schizotypy: the contribution of individual differences in affective traits, stress, and coping. Psychiatry Research 149, 147156.

R Isele , J Merz , M Malzacher , J Angst (1985). Social disability in schizophrenia: the controlled prospective Burgholzli study II. Premorbid living situation and social adjustment – comparison with a normal control sample. European Archives of Psychiatry and Neurological Sciences 234, 348356.

HJ Jackson , PD McGorry , P Dudgeon (1995). Prodromal symptoms of schizophrenia in first-episode psychosis: prevalence and specificity. Comprehensive Psychiatry 36, 241250.

R Jenkins , J Mbatia , N Singleton , B White (2010). Prevalence of psychotic symptoms and their risk factors in urban Tanzania. International Journal of Environmental Research and Public Health [Electronic Resource] 7, 25142525.

P Jeppesen , L Petersen , A Thorup , M Abel , J Ohlenschlaeger , T Christensen , G Krarup , P Jorgensen , M Nordentoft (2008). The association between pre-morbid adjustment, duration of untreated psychosis and outcome in first-episode psychosis. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences 38, 11571166.

O Kalla , J Aaltonen , J Wahlstrom , V Lehtinen , I Garcia Cabeza , M Gonzalez de Chavez (2002). Duration of untreated psychosis and its correlates first-episode psychosis in Finland and Spain. Acta Psychiatrica Scandinavica 106, 265275.

FR Lipton , CI Cohen , E Fischer , SE Katz (1981). Schizophrenia: a network crisis. Schizophrenia Bulletin 7, 144151.

E Macdonald , R Hayes , A Baglioni (2000). The quantity and quality of the social networks of young people with early psychosis compared with closely matched controls. Schizophrenia Research 46, 2530.

R Mallett , J Leff , D Bhugra , D Pang , JH Zhao (2002). Social environment, ethnicity and schizophrenia. Social Psychiatry and Psychiatric Epidemiology 37, 329335.

C Morgan , H Fisher , G Hutchinson , J Kirkbride , TK Craig , K Morgan , P Dazzan , J Boydell , GA Doody , PB Jones , RM Murray , J Leff , P Fearon (2009). Ethnicity, social disadvantage and psychotic-like experiences in a healthy population based sample. Acta Psychiatrica Scandinavica 119, 226235.

C Morgan , M Charalambides , G Hutchinson , R Murray (2010). Migration, ethnicity and psychosis: toward a socio-developmental model. Schizophrenia Bulletin 36, 655664.

MP O'Brien , JL Gordon , CE Bearden , SR Lopez , A Kopelowicz , TD Cannon (2006). Positive family environment predicts improvement in symptoms and social functioning among adolescents at imminent risk for onset of psychosis. Schizophrenia Research 81, 269275.

V Peralta , MJ Cuesta , A Martinez-Larrea , JF Serrano , M Langarica (2005). Duration of untreated psychotic illness: the role of premorbid social support networks. Social Psychiatry and Psychiatric Epidemiology 40, 345349.

ME Procidano , K Heller (1983). Measures of perceived social support from friends and from family: three validation studies. American Journal of Community Psychology, 11, 124.

M Pruessner , SN Iyer , K Faridi , R Joober , AK Malla (2011). Stress and protective factors in individuals at ultra-high risk for psychosis, first episode psychosis and healthy controls. Schizophrenia Research 129, 2935.

UA Reininghaus , C Morgan , J Simpson , P Dazzan , K Morgan , GA Doody , D Bhugra , J Leff , R Murray , P Fearon , TK Craig (2008). Unemployment, social isolation, achievement-expectation mismatch and psychosis: findings from the AESOP study. Social Psychiatry and Psychiatric Epidemiology 43, 743751.

RK Salokangas (1996). Living situation and social network in schizophrenia – a prospective 5-year follow-up study. Nordic Journal of Psychiatry 50, 3542.

RK Salokangas (1997). Living situation, social network and outcome in schizophrenia: a five-year prospective follow-up study. Acta Psychiatrica Scandinavica 96, 459468.

IG Sarason , HM Levine , RB Basham , BR Sarason (1983). Assessing social support: the social support questionnaire. Journal of Personality and Social Psychiatry 44, 127139.

D Schuldberg , SB Karwacki , GL Burns (1996). Stress, coping, and social support in hypothetically psychosis-prone subjects. Psychological Reports 78, 12671283.

TL Schuschter , RC Kessler , RH Aseltine (1990). Supportive interactions, negative interactions, and depressed mood. American Journal of Community Psychology 18, 423438.

YY Song , KR Kim , JY Park , SY Lee , JI Kang , E Lee , SK An , JS Kwon (2011). Associated factors of quality of life in first-episode schizophrenia patients. Psychiatry Investigation 8, 201206.

SA Stansfeld , MG Marmot (1992). Deriving a survey measure of social support: the reliability and validity of the close persons questionnaire. Social Science and Medicine 35, 10271035.

E Susser , S Scwartz , A Morabia , EJ Bromet (2006). Psychiatric Epidemiology: Searching for the Causes of Mental Disorder. Oxford University Press: Oxford.

P Thoits (1982). Conceptual, methodological, and theoretical problems in studying social support as a buffer against life stress. Journal of Health and Social Behaviour 23, 145159.

A Thorup , L Petersen , P Jeppesen , J Ohlenschlaeger , T Christensen , G Krarup , P Jorgensen , M Nordentoft (2006). Social network among young adults with first-episode schizophrenia spectrum disorders: results from the Danish OPUS trial. Social Psychiatry and Psychiatric Epidemiology 41, 761770.

CC Tolsdorf (1976). Social networks, support, and coping: an exploratory study. Family Process 15, 407417.

SR Uzenoff , KC Brewer , DO Perkins , DP Johnson , KT Mueser , DL Penn (2010). Psychological well-being among individuals with first-episode psychosis. Early Intervention in Psychiatry 4, 174181.

J van Os , G Kenis , B Rutten (2010). The environment and schizophrenia. Nature 468, 203212.

W Veling , HW Hoek , D Wiersma , JP Mackenbach (2010). Ethnic identity and the risk of schizophrenia in ethnic minorities: a case-control study. Schizophrenia Bulletin 36, 11491156.

NJ Wiles , S Zammit , P Bebbington , N Singleton , H Meltzer , G Lewis (2006). Self-reported psychotic symptoms in the general population: results from the longitudinal study of the British National Psychiatric Morbidity Survey. British Journal of Psychiatry 188, 519526.

RK Willhite , TA Niendam , CE Bearden , J Zinberg , MP O'Brien , TD Cannon (2008). Gender differences in symptoms, functioning and social support in patients at ultra-high risk for developing a psychotic disorder. Schizophrenia Research 104, 237245.

GD Zimet , NW Dahlem , SG Zimet , GK Farley (1988). The multidimensional scale of perceived social support. Journal of Personal Assessment 52, 3041.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 9
Total number of PDF views: 191 *
Loading metrics...

Abstract views

Total abstract views: 673 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd September 2017. This data will be updated every 24 hours.