Social inclusion profiles in first episode psychosis and their links to social cognition and symptoms: A cluster analysis approach.

backgroundMany young people with first episode psychosis (FEP) experience challenges in key areas of social inclusion, including housing, finances, employment or education, and social relationships. However, there is diversity in these challenges, and it is unclear how social inclusion relates to potentially modifiable treatment factors such as social cognition. Here we aimed to identify distinct social inclusion profiles using cluster analysis and examine their associations with social cognition and other clinical factors.

methods145 young people (aged 15-25) who had experienced a FEP completed assessments of demographics, clinical symptomology, social inclusion, functioning, quality of life (QoL), and social cognition. K-means cluster analyses identified social inclusion subgroups. Kruskal-Wallis and Wilcoxon rank-sum post-hoc tests were used to compare subgroups on psychosocial factors and multinomial regression models were used to examine whether social cognition was associated with the subgroups, controlling for clinical factors.

resultsThree clusters emerged: low inclusion/low participation (LI-LP), moderate inclusion/low participation (MI-LP), and high inclusion/high participation (HI-HP). Social cognition was not associated with subgroup membership. LI-LP had greater depressive and less expressive negative symptoms than both other subgroups, and more severe motivation/pleasure negative symptoms than HI-HP.

conclusionDistinct FEP subgroups with varying subjective and objective social inclusion, shaped by external psychosocial and clinical factors were revealed. The findings highlight the need for holistic and personalised care to improve social inclusion for individuals with FEP and suggest that targeting depressive and motivational negative symptoms may be potential avenues to achieve this.