At-risk mental state for psychosis in help-seeking young people: an investigation into underlying affective and interpersonal risk factors
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Date
01/07/2016Author
Semedo, Daniela Sofia De Freitas
Metadata
Abstract
Background: Considering recent advances in the field of early detection and
intervention in young people with increased levels of psychotic symptoms seeking
help, this thesis proposes that early attachment insecurity triggers an inability to
regulate emotional distress, to engage in positive interpersonal interactions with
others, to use adaptive coping mechanisms and to manage social support
appropriately. These constructs appear to be linked to psychosis; however,
considering continuity between subthreshold psychotic symptoms and the later
development of psychosis, it is vital to understand if these underlying affective and
interpersonal mechanisms increase the risk of psychosis in help-seeking young
people.
Objectives: This study was cross-sectional and investigated the following research
questions: 1) Does attachment insecurity signpost the risk of developing psychosis?
2) Do coping strategies, interpersonal difficulties, social support and emotional
distress have an indirect effect on the relationship between attachment insecurity and
the risk of developing psychosis?
Methods: A total of 76 help-seeking young people were recruited from Community
Mental Health Services in Edinburgh. All participants completed a number of
questionnaires exploring their coping strategies, interpersonal problems, perceived
social support and emotional distress. A semi-structured interview was undertaken,
to assess their socio-demographic background. The Comprehensive Assessment of
At-Risk Mental States was administered and coded to assess their risk of psychosis
and associated psychopathology, while path analysis was used to analyse the data
and to address the research questions.
Results: The profile of help-seeking young people in this sample (n=76) was made
up of individuals with a moderate degree of difficulties in relation to coping
strategies employed to manage stress and interpersonal problems dealing with others,
moderate levels of emotional distress and discrepancies between their ideal and
received social support. From the total help-seeking sample, the attachment
dimensions anxiety and avoidance were relatively high. These young people were
found to have had mild, psychotic-like experiences, especially in the domains
associated with unusual thought content and perceptual abnormalities. When
considering the subgroup of help-seeking young people with an at-risk mental state
(ARMS) (n=46), the results revealed that this group had high levels of difficulties in
interpersonal relationships, relied on non-productive coping strategies, presented
emotional distress levels of clinical importance and also had discrepancies in their
ideal and received social support. From the subsample of help-seeking young people
with an ARMS the attachment dimensions anxiety and avoidance were reasonably
high. These young people were found to have had moderately severe psychotic
experiences, especially in the domains associated with unusual thought content and
perceptual abnormalities. Path analysis revealed that attachment insecurity directly
predicted psychotic symptoms in the total sample but not in the subgroup of young
people with an ARMS. Emotional distress played a partially moderating role
between attachment insecurity and the severity and distress associated with
disorganised speech and perceptual abnormalities in the total sample but not when
considering only those with an ARMS, while interpersonal problems did not mediate
the relationship between attachment insecurity and the risk of psychosis in either
group. Discrepancies between ideal and received social support fully mediated the
relationship between attachment insecurity and the distress associated with
disorganised speech in the total sample but not when considering those with an
ARMS. The tendency to use less adaptive coping strategies was found to mediate
directly the relationship between attachment anxiety and the distress associated with
perceptual abnormalities in young people with an ARMS, albeit not in the total
sample.
Discussion: The clinical and theoretical implications of these results are discussed
within the clinical staging model for intervention in psychosis. The findings strongly
indicate that clinicians should take into consideration the mechanisms of attachment,
coping strategies and social support, as well as the deleterious effects of associated
emotional distress, when working with young people with increased levels of
psychotic symptoms.