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Social anxiety within a network of mild delusional ideations, negative symptoms and insight in outpatients with early psychosis: A psychopathological path analysis

ABSTRACT Background and objectives: Social anxiety disorder is a common comorbidity in psychotic disorders and impacts significantly on functioning and recovery. Conflicting theories and evidence exist on its relationship with other psychopathologies. This study examined this complex network of relationship using path analysis. Design: Clinical assessment and self-report in a cross-sectional consecutive outpatient sample. Methods: Face-to-face interviews were conducted in 137 outpatients with early psychosis. A theoretical model of relationship between social anxiety, insight, persecutory delusions, ideas of reference, negative symptoms, and depression was tested using path analysis. Results: Clinically significant social anxiety was observed in 45% of this sample. The final model suggested a direct link between ideas of reference (standardized path coefficient, β = 0.26, p < 0.002) and negative symptoms (β = 0.29, p < 0.001) to social anxiety. Insight was related to both persecutory delusions and negative symptoms but had no direct relationship with social anxiety. The model has excellent goodness-of-fit (Chi-square 6.62, comparative fit index 1.00, root mean square error of approximation 0.00). Conclusions: This model provided a new framework for understanding the complex interplay between psychosis symptoms and social anxiety, which may be unique to outpatients with early psychosis and require further confirmatory research and targeted intervention strategies.