Social identity and psychosis: Explaining elevated rates of psychosis in migrant populations

� 2016 John Wiley & Sons Ltd A substantial body of literature suggests that migrants are at greater risk of developing psychotic symptoms, such as paranoia, compared to non-migrants. To date, researchers have been unable to identify the primary cause of this effect, finding scarce support for biological, diagnostic, and economic explanations. Social determinants have received little empirical attention in this domain, which we assert is a critical gap in the literature. Here, we propose that the social identity approach offers a framework to help explain the elevated rates of psychosis among migrants, and in turn inform policies and interventions to address this important mental health issue. We propose that cultural identities play a central role in mitigating the psychological precursors of psychosis and that disidentification and social disconnection subsequent to migration could initiate or exacerbate psychosis for multiple generations. We draw together research from social and clinical psychology to detail a social identity approach to psychosis in migrant populations, and make recommendations for future research

Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis

Background. The quality of the therapeutic alliance (TA) has been invoked to explain the equal effectiveness of different psychotherapies, but prior research is correlational, and does not address the possibility that individuals who form good alliances may have good outcomes without therapy. Method. We evaluated the causal effect of TA using instrumental variable (structural equation) modelling on data from a three-arm, randomized controlled trial of 308 people in an acute first or second episode of a non-affective psychosis. The trial compared cognitive behavioural therapy (CBT) over 6 weeks plus routine care (RC) v. supportive counselling (SC) plus RC v. RC alone. We examined the effect of TA, as measured by the client-rated CALPAS, on the primary trial 18-month outcome of symptom severity (PANSS), which was assessed blind to treatment allocation. Results. Both adjunctive CBT and SC improved 18-month outcomes, compared to RC. We showed that, for both psychological treatments, improving TA improves symptomatic outcome. With a good TA, attending more sessions causes a significantly better outcome on PANSS total score [effect size −2.91, 95% confidence interval (CI) −0.90 to −4.91]. With a poor TA, attending more sessions is detrimental (effect size +7.74, 95% CI +1.03 to +14.45). Conclusions. This is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental. These effects may extend to other therapeutic modalities and disorders

Social Identity and Psychosis: Associations and Psychological Mechanisms

Humans possess a basic need to belong and will join groups even when they provide no practical benefit. Paranoid symptoms imply a disruption of the processes involved in belonging and social trust. Past research suggests that joining social groups and incorporating those groups into one’s identity (social identification) promotes positive self-views and better physical and mental health. However, no research has investigated whether social identity is associated with paranoia, nor the mechanisms by which this effect may emerge. Here, we examined the relationship between social identity and mental health (paranoia, auditory verbal hallucinations [AVHs], and depression), and tested the mediating role of self-esteem. In study 1, we analyzed data collected from 4319 UK residents as part of the NIHR CLAHRC NWC Household Health Survey. Study 2 comprised data collected from 1167 students attending a large UK university. The studies provided convergent evidence that social identification reduces symptoms of paranoia and depression by furnishing people with self-esteem. There was no consistent effect of social identification on AVHs. People developing mental health assessments, treatments, and policies are encouraged to consider the notion that joining and identifying with social groups may reduce people’s risk of paranoia and depression

PhD of clinical psychology (research course)

The research in this thesis on hallucinations, with both clinical and non- clinical samples, explores the relationships between hallucinations, reality discrimination biases, suggestibility, dissociative experiences and inner speech qualities. The thesis comprises 5 studies that tested: first, the impact of suggestibility on signal detection performance (a measure of reality discrimination); second, the relationships between hallucination proneness/hallucinations, suggestibility and dissociation when and when not controlling for the confounding effects of symptoms that frequently covary with hallucinations (i.e., paranoia and depression); third, the associations between hallucinations and childhood trauma, taking into account the mediating role played by dissociative process and qualities of inner speech. The studies were conducted in the UK and Saudi Arabia, allowing a demonstration that the findings are valid cross-culturally. One main finding is that hallucination proneness and hallucinations are associated with reality discrimination deficits (i.e., signal detection biases) as reported in many previous studies, and also with suggestibility and dissociation even after controlling for comorbidity. However, the reality discrimination deficits of hallucination-prone individuals and hallucinating patients were influenced by context (suggestions). The results of the correctional analyses revealed strong relationships between hallucinations and hallucination proneness with childhood trauma, especially sexual abuse. In addition, dissociative experiences and other people in inner speech mediated this relationship. Findings from students and patients in Saudi Arabia were similar to those obtained from students and patients in the UK in previous research, and to the findings from UK students in the present series of studies. The clinical implications of the findings are discussed

Childhood maltreatment and problematic social media use: The role of attachment and depression

Childhood maltreatment is associated with many maladaptive outcomes. This study sought to examine the association between childhood maltreatment and problematic social media use using a cross-sectional sample of young adults aged 17–25 years (n = 1029). Specifically, we studied whether the relationship is mediated through (i) attachment anxiety, (ii) attachment avoidance, or (iii) both attachment dimensions operating in series with depressive symptoms. Results revealed that a history of childhood maltreatment was significantly associated with more problematic social media use. Both anxious and avoidant attachment dimensions independently mediated the relationship between childhood maltreatment and problematic use of social media, but in opposing directions. Avoidant attachment was associated with less problematic social media use, whilst anxious attachment was associated with more problematic social media use. Avoidant attachment and depressive symptoms in series accounted for part of the relationship between childhood maltreatment and problematic social media use. Anxious attachment and depressive symptoms in series fully mediated the relationship between childhood maltreatment and problematic social media use. The results suggest that childhood maltreatment may influence social media use directly, but also indirectly. People experiencing depressive symptoms may overuse social media in an attempt to alleviate their distress. However, causality cannot be established with the current design

Home Is Where You Hang Your Hat: Host Town Identity, But Not Hometown Identity, Protects Against Mental Health Symptoms Associated with Financial Stress

Debt and financial insecurity are associated with stress, low self-worth, and poor health. Joining and identifying with social groups (social identification) promotes better health and higher self-esteem. Here, we examined whether identifying with one's local neighborhood protected people from developing mental health symptoms associated with financial stress. We analyzed data from a general population survey (Study 1, N = 4319) and a student mental health survey (Study 2, N = 612) conducted in the North West of England. We administered measures of financial stress, self-esteem, neighborhood identity, and mental health, and conducted moderated mediation analyses to test our predictions. Study 1 (population survey) demonstrated that stronger identification with one's local neighborhood attenuated the adverse effects of financial stress on self-esteem and subsequent mental health. Study 2 (student survey) showed that strong host town identities buffered students from mental health symptoms related to financial stress. Strong hometown identities, however, showed no buffering effect. The findings suggest that one way financial stress impacts mental health is by eroding self-esteem. Identifying with one's current place of residence appears to disrupt this pathway, while identifying with one's previous place of residence does not provide the same psychological protection. Read More: https://guilfordjournals.com/doi/10.1521/jscp.2018.37.3.15

Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic

BACKGROUND: The COVID-19 pandemic has created an unprecedented global crisis, necessitating drastic changes to living conditions, social life, personal freedom and economic activity. No study has yet examined the presence of psychiatric symptoms in the UK population under similar conditions. AIMS: We investigated the prevalence of COVID-19-related anxiety, generalised anxiety, depression and trauma symptoms in the UK population during an early phase of the pandemic, and estimated associations with variables likely to influence these symptoms. METHOD: Between 23 and 28 March 2020, a quota sample of 2025 UK adults aged 18 years and older, stratified by age, gender and household income, was recruited by online survey company Qualtrics. Participants completed standardised measures of depression, generalised anxiety and trauma symptoms relating to the pandemic. Bivariate and multivariate associations were calculated for demographic and health-related variables. RESULTS: Higher levels of anxiety, depression and trauma symptoms were reported compared with previous population studies, but not dramatically so. Anxiety or depression and trauma symptoms were predicted by young age, presence of children in the home, and high estimates of personal risk. Anxiety and depression were also predicted by low income, loss of income and pre-existing health conditions in self and others. Specific anxiety about COVID-19 was greater in older participants. CONCLUSIONS: This study showed a modest increase in the prevalence of mental health problems in the early stages of the pandemic, and these problems were predicted by several specific COVID-related variables. Further similar surveys, particularly of those with children at home, are required as the pandemic progresses

COVID‐19‐related anxiety predicts somatic symptoms in the UK population

This study aimed to estimate the association between anxiety associated with COVID‐19 and somatic symptoms, using data from a large, representative sample (N = 2,025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID‐19 were significantly associated with general somatic symptoms and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalized anxiety disorder (GAD), pre‐existing health problems, age, gender, and income. This is the first evidence that anxiety associated with COVID‐19 makes a unique contribution to somatization, above and beyond the effect of GAD

The Authoritarian Dynamic During the COVID-19 Pandemic: Effects on Nationalism and Anti-Immigrant Sentiment

Research has demonstrated that situational factors such as perceived threats to the social order activate latent authoritarianism. The deadly COVID-19 pandemic presents a rare opportunity to test whether existential threat stemming from an indiscriminate virus moderates the relationship between authoritarianism and political attitudes toward the nation and out-groups. Using data from two large nationally representative samples of adults in the United Kingdom (N = 2,025) and Republic of Ireland (N = 1,041) collected during the initial phases of strict lockdown measures in both countries, we find that the associations between right-wing authoritarianism (RWA) and (1) nationalism and (2) anti-immigrant attitudes are conditional on levels of perceived threat. As anxiety about the COVID-19 pandemic increases, so too does the effect of RWA on those political outcomes. Thus, it appears that existential threats to humanity from the COVID-19 pandemic moderate expressions of authoritarianism in society