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The impact of family environment on self-esteem and symptoms in early psychosis.

ABSTRACT: Expressed emotion (EE) and self-esteem (SE) have been implicated in the onset and development of paranoia and positive symptoms of psychosis. However, the impact of EE on patients' SE and ultimately on symptoms in the early stages of psychosis is still not fully understood. The main objectives of this study were to examine whether: (1) patients' SE mediated the effect of relatives' EE on patients' positive symptoms and paranoia; (2) patients' perceived EE mediated the effect of relatives' EE on patients' SE; (3) patients' SE mediated between patients' perceived EE and patients' symptomatology; and (4) patients' perceived EE and patients' SE serially mediated the effect of relatives' EE on patients' positive symptoms and paranoia. Incipient psychosis patients (at-risk mental states and first-episode of psychosis) and their respective relatives completed measures of EE, SE, and symptoms. Findings indicated that: (1) patients' perceived EE mediated the link between relatives' EE and patients' negative, but not positive, SE; (2) patients' negative SE mediated the effect of patients' perceived EE on positive symptoms and paranoia; (3) the association of relatives' EE with positive symptoms and paranoia was serially mediated by an increased level of patients' perceived EE leading to increases in negative SE; (4) high levels of patients' distress moderated the effect of relatives' EE on symptoms through patients' perceived EE and negative SE. Findings emphasize that patients' SE is relevant for understanding how microsocial environmental factors impact formation and expression of positive symptoms and paranoia in early psychosis. They suggest that broader interventions for patients and their relatives aiming at improving family dynamics might also improve patients' negative SE and symptoms.

SUBMITTER: Hinojosa-Marques L

PROVIDER: S-EPMC8021173 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundNo studies have examined the association between self-esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self-esteem relate to daily-life paranoia across at-risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self-esteem and paranoia were examined.DesignThis study used a multilevel, cross-sectional design.MethodsOne-hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self-esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self-esteem were also collected.ResultsGlobal momentary and trait self-esteem, and their positive and negative dimensions, were related to daily-life paranoia in both ARMS and FEP groups. Conversely, implicit self-esteem was not associated with daily-life paranoia in either group. Anxiety negatively moderated the association between positive self-esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self-esteem and higher paranoia.ConclusionsDifferent types, measures and dimensions of self-esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily-life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions.Practitioner pointsDifferent measures (trait and momentary) and dimensions (positive and negative) of explicit self-esteem are distinctly related to paranoia across risk and first-episode stages of psychosis. Explicit, but not implicit, self-esteem is associated with real-life paranoia in incipient psychosis. Anxiety boosted the association of poor self-esteem and paranoia ideation in daily-life. Social closeness, but feeling cared for by others in particular, interacts with self-esteem tempering the expression of paranoia in real life.

Project description:BackgroundExposure to childhood trauma is associated with an increased risk of developing and maintaining psychotic symptoms later in life. Self-esteem might be an important psychological process underlying the association between childhood trauma and psychosis, but there is only limited evidence to support this claim, especially in daily life.ObjectiveIn this study, we aimed to investigate whether exposure to childhood trauma (physical, emotional, and sexual abuse and physical and emotional neglect) moderates the cross-sectional and temporal associations between self-esteem and psychotic experiences in patients with psychotic disorders, their first-degree relatives, and controls.MethodsWe assessed momentary self-esteem and psychotic experiences in daily life using the experience sampling method in 139 patients with psychotic disorders, 118 first-degree relatives of patients with psychotic disorders, and 111 controls. Childhood trauma was measured using the Childhood Trauma Questionnaire. We fitted linear mixed models and added two-way and three-way interaction terms to test the hypotheses.ResultsThe association between momentary self-esteem and psychotic experiences in daily life was modified by prior exposure to high versus low levels of several types of childhood trauma, that is, physical (χ22=24.9, family-wise error-corrected P<.001) and sexual abuse (χ22=15.9, P<.001) and physical neglect (χ22=116.7, P<.001). Specifically, momentary self-esteem was associated with more intense psychotic experiences in patients exposed to high versus low levels of physical neglect, in relatives exposed to high versus low levels of physical abuse, and in relatives and controls exposed to high versus low levels of sexual abuse. When investigating temporal order, the results showed no evidence that childhood trauma modified the temporal associations between self-esteem at tn-1 and psychotic experiences at tn or those between psychotic experiences at tn-1 and self-esteem at tn.ConclusionsThe association between self-esteem and psychotic experiences in daily life was found to be stronger in those exposed to high versus low levels of several types of childhood trauma (ie, physical abuse, sexual abuse, and physical neglect).

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The impact of family environment on self-esteem and symptoms in early psychosis.

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