Schizophrenia Research 254 (2023) 199–207 Contents lists available at ScienceDirect Schizophrenia Research journal homepage: www.elsevier.com/locate/schres A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem Manel Monsonet a, b, Amad Amedy c, Thomas R. Kwapil b, Neus Barrantes-Vidal a, d, * a Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain b Department of Psychology, University of Illinois at Urbana-Champaign, United States of America c Department of Psychology, Vanderbilt University, United States of America d CIBER de Salud Mental, Instituto de Salud Carlos III, Spain A R T I C L E I N F O A B S T R A C T Keywords: The quantity and quality of social contacts have been related to self-esteem, and both social relationships and Social connectedness self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with Schizotypy self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures Paranoia of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social Self-esteem Loneliness contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect Experience sampling effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizo­ typy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings un­ derscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional out­ comes of psychosis. 1. Introduction Murphy et al., 2018; Tiernan et al., 2014). Additionally, previous studies that tracked symptom dynamics in participants with varying levels of Paranoia is among the most prevalent symptom of psychosis across expression of paranoia found that low levels of self-esteem predicted the schizotypy continuum (e.g., Coid et al., 2013; Horton et al., 2014; subsequent paranoia throughout daily life (Monsonet et al., 2022; Moutoussis et al., 2007; Zhang et al., 2014). Schizotypy refers to the Thewissen et al., 2011). Despite the well-established link between self- expression of the underlying vulnerability for schizophrenia-spectrum esteem and paranoia, various other socio-environmental factors seem disorders that can be observed across a wide range of clinical, subclin­ to be implicated in both the development of paranoia (Bentall et al., ical, and personality phenomenology (Kwapil and Barrantes-Vidal, 2012; Freeman et al., 2011; Selten et al., 2013) and self-esteem (Haslam 2015). Cognitive models of paranoia theorize that negative attribu­ et al., 2009; Jetten et al., 2015; Tajfel and Turner, 1979). tions about the self may play a crucial role in driving paranoid delusions As human beings are fundamentally social animals, a primary need is (e.g., Bentall et al., 2001; Freeman et al., 2002). Previous reviews have to seek a sense of belonging through meaningful social relationships shown that paranoia is associated with negative self-esteem in both (Baumeister and Leary, 1995; Maslow, 1943); this universal process clinical and non-clinical populations (Kesting and Lincoln, 2013; drives social connectedness. Social connectedness is a broad and * Corresponding author at: Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Edifici B, Universitat Autònoma de Barcelona, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, Spain. E-mail address: neus.barrantes@uab.cat (N. Barrantes-Vidal). https://doi.org/10.1016/j.schres.2023.03.006 Received 26 May 2022; Received in revised form 11 January 2023; Accepted 3 March 2023 Available online 15 March 2023 0920-9964/© 2023 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/). M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 multifaceted construct defined by the strength of interpersonal re­ time and in the normal context of daily life, thus increasing ecological lationships rather than by the mere number of relationships one has. validity and avoiding retrospective bias (Myin-Germeys et al., 2009, Thus, social connectedness refers to the subjective and experiential as­ 2018).To our knowledge, no previous studies have investigated how the pects of social relationships, that is, the feeling of having a psychological interplay between social connectedness and self-esteem may impact bond with other individuals or groups and the sense of belonging paranoia and other psychosis spectrum traits and experiences in in­ (Haslam et al., 2015). Therefore, the general term of social connectedness dividuals with different levels of expression across the schizotypy involves other related constructs such as social identification, social continuum. support, loneliness or perceived social isolation, belongingness, etc. Therefore, the primary goal of this study was to investigate whether (Cruwys et al., 2014). In contrast, social contact simply quantifies the self-esteem mediates the association of social connectedness with number of social interactions without considering the subjective psy­ paranoia in a nonclinical sample oversampled for elevated schizotypy. A chological aspects of those interactions. It is relevant to examine both schematic representation to illustrate the interplay between social the quantity and quality aspects of social relationships because subjec­ connectedness, self-esteem, and paranoia is presented in Fig. 1. It was tive perceptions of social relationships, such as loneliness, are only hypothesized that self-esteem would mediate the pathway from poor weakly related to number of social interactions (Cornwell and Waite, social connectedness to paranoia. We also examined whether self- 2009; Hawkley et al., 2003; Reinhardt et al., 2006). Thus, people can esteem mediates the pathway between the number of social in­ feel socially disconnected irrespective of the amount of time they spend teractions and paranoia to differentiate between the quantity and alone. quality aspects of social relationships. Furthermore, this study also Social connectedness through membership of multiple meaningful investigated whether this mechanistic pathway is applicable to other groups can promote well-being and self-esteem (e.g., Berkman and positive psychotic-like experiences (PLE) such as ideas of reference, Glass, 2000; Greenaway et al., 2016; Jetten et al., 2015). Furthermore, it magical ideation, perceptual aberration, and AVH. We also extended has been linked to general mental health (Saeri et al., 2018), psychosis research in this area by including negative PLE as an outcome variable. (Lim et al., 2018; Michalska da Rocha et al., 2018), and specifically to Thus, one of the secondary aims of the present study was to examine for paranoia (Chau et al., 2019; Lamster et al., 2017; Lim et al., 2016; the first time whether self-esteem mediated the pathway between social McIntyre et al., 2016). Growing evidence suggests that social connect­ connectedness and negative PLE. Since other mechanistic pathways edness has an impact on self-esteem (e.g., Ludwig et al., 2020; Rosen­ have been established for AVH (Pilton et al., 2015) and negative berg, 1979; Thomas et al., 2017), and self-esteem on paranoia (e.g., symptoms (Rector et al., 2005), we did not expect that self-esteem would Monsonet et al., 2020; Thewissen et al., 2008). However, to our mediate the pathways from social connectedness to AVH and negative knowledge, few previous studies have investigated how the interaction PLE. In contrast, given the associations found between social support between social connectedness and self-esteem may impact paranoia. and self-esteem with positive PLE other than paranoia (Monsonet et al., Kesting et al. (2013) found that a decrease in self-esteem mediated the 2022), some evidence of mediation on these pathways would be ex­ impact of social exclusion on subsequent paranoia in an experimental pected. Finally, a significant novel addition of this study is that the study with nonclinical participants. McIntyre et al. (2021) did not find mediational model was tested using two different approaches: 1) that self-esteem was implicated in the association between British retrospective psychometric trait-like measures, and 2) prospective and identification and paranoia among people from African and African- contextualized repeated momentary measurements of social connect­ Caribbean backgrounds. However, McIntyre et al. (2017) found that edness, self-esteem and PLE using ESM. self-esteem mediated the association between social identification and paranoia in the general population and concluded that having solid 2. Methods group ties buffers paranoia by bolstering personal self-esteem. They also found unexpected evidence of an indirect pathway between social 2.1. Participants and procedure connectedness and auditory-verbal hallucinations (AVH) through self- esteem, albeit in only one of their two samples. Thus, it remains to be The sample used in this study belongs to the Barcelona Longitudinal investigated whether this mechanism is exclusive to paranoia or applies Investigation of Schizotypy Study (BLISS; Barrantes-Vidal et al., 2013a). to AVH. Likewise, it would be critical to examine these putative path­ The initial sample of participants at T1 consisted of 589 unselected ways in their natural context of occurrence, exploring the moment-to- college students from Universitat Autonòma de Barcelona. In order to moment interaction of individuals with their environment. Experience have continuous distributions of scores on the schizotypy dimensions sampling methodology (ESM) provides an ideal method for such in­ with an adequate representation of high scorers, we invited at T2 all 189 vestigations as it involves the assessment of mental experiences in real- participants who had standard scores based upon sample norms of at Fig. 1. Diagram of the hypothesized interplay between social connectedness, self-esteem, and paranoia. 200 M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 least 1.0 on the positive or negative schizotypy factors from the Wis­ negative schizotypy traits and PLE were measured with the WSS: the consin Schizotypy Scales (WSS; Kwapil et al., 2008), the suspiciousness Perceptual Aberration Scale assesses psychotic-like bodily distortions subscale of the Schizotypal Personality Questionnaire (SPQ; Raine, and perceptual experiences; the Magical Ideation Scale taps belief in 1991), or the positive symptom subscale of the Community Assessment invalid causation; the Revised Social Anhedonia Scale measures schizoid of Psychic Experiences (CAPE; Stefanis et al., 2002), and 150 randomly asociality; and the Physical Anhedonia Scale assesses deficits in sensory selected participants who had standard scores <1.0 on each of these and aesthetic pleasure. Finally, nonclinical AVH were measured using a measures. Two hundred fourteen participants completed in-depth as­ single item from the Dissociative Experience Scale (DES; Bernstein and sessments at T2 (a detailed description of this sample can be found in Putnam, 1986): “Some people sometimes find that they hear voices in­ Barrantes-Vidal et al., 2013a,b). At T3 and T4, due to funding con­ side their head that tell them to do things or comment on things that they straints, we invited a reduced subsample to participate that retained the are doing.” This item was rated on a 10-point scale ranging from “never” original distribution of scores. Finally, at T5 (3.2 years later) we sought to “always.” to contact all participants assessed at T2 (n = 214) and successfully reassessed 169 (79 % of target sample; mean age = 28.01, SD = 2.41, 80 2.2.2. ESM measures % female) with self-report and ESM measurements. The present study ESM is a structured diary technique that assesses mental experiences used data from participants assessed at T5, when measures of social and contextual factors in daily life, offering several advantages to connectedness were collected. Please note that participants' assessment traditional assessment procedures (Hektner et al., 2007; Shiffman et al., was conducted before the beginning of the COVID-pandemic; therefore, 2008). Several studies have employed ESM across the schizotypy con­ potential social isolation experienced during the pandemic did not affect tinuum demonstrating its validity and reliability (Barrantes-Vidal et al., the results of the study. Participants provided informed consent at each 2013a; Kwapil et al., 2020; Reininghaus et al., 2016; Thewissen et al., assessment, and ethical approval was granted by the Ethics Committee 2011). Participants used a smartphone that randomly signalled them 8 of the Universitat Autònoma de Barcelona (Comissió d'Ètica en times daily (between 10 am and 10 pm) for seven days to complete brief l'Experimentació Animal i Humana (CEEAH); number 701H-JS; htt questionnaires. Items were rated on a 7-point Likert scale ranging from p://www.recerca.uab.es/ceeah/). “not at all” to “very much”. Of the initial sample, 10 participants were excluded from the ESM analyses due to invalid data, leaving a final 2.2. Measures sample of 159 participants in the ESM study. Indices of momentary social connectedness, self-esteem, paranoia 2.2.1. Psychometric measures and other positive PLE were created. Within- and between-person reli­ Several components of social connectedness were measured with ability for ESM indices were computed following Geldhof et al. (2014). self-reported measures. Perceived social support was measured with the The social connectedness index consists of four items: “Right now I feel Multidimensional Scale of Perceived Social Support (MSPSS; Zimet lonely” reversed, “Right now I feel that others care about me,” “Right et al., 1988). It contains12 items scored on a 7-point Likert scale ranging now I feel accepted by others,” and “Right now I feel that I have someone from “Very strongly disagree” to “Very strongly agree”, with higher to rely on” (within alpha = 0.55, between alpha = 0.89). The self-esteem scores indicating greater social support (Cronbach's α = 0.92). Perceived index comprises: “Right now I feel good about myself”, “Right now I feel loneliness was measured with the Three-Item Loneliness Scale (TILS; guilty or ashamed” reversed, and “Right now I can cope” (within alpha Hughes et al., 2004), a short questionnaire developed from the Revised = 0.52, between alpha = 0.83). The paranoia index comprised: “Right UCLA Loneliness Scale (Russell et al., 1980) enquiring about how often now I feel I have to be on my guard,” “Right now I feel like I can't trust participants feel they lack companionship, feel left out, and isolated others,” and “Right now I suspect I am being thought or talked badly from others. Items are scored on a 3-point Likert scale: “Almost never,” about” (within alpha = 0.42, between alpha = 0.86). Two separate “Part of the time,” and “Often,” with higher scores reflecting greater indices, perceptual PLE and cognitive PLE, were used to assess other perceived loneliness (Cronbach's α = 0.72). Two out of the three items of positive PLE. Perceptual PLE included “Right now my sight or hearing the subscale “Social & Leisure” of the Social Adjustment Scale-self report seem strange or unusual,” and “Right now familiar things seem strange short version (SAS-SR: Short; Weissman, 2007) were also used in this or unusual” (within alpha = 0.29, between alpha = 0.95), whereas the study. Item 10 “How many friends have you seen or been in contact with cognitive PLE index comprised “Right now my thoughts are strange or (e.g., on the telephone, via e-mail, etc.) in the last 2 weeks?” was unusual” and “Right now I have difficulty controlling my thoughts” employed as a direct measure of social contact. Item 11 “How often have (within alpha = 0.38, between alpha = 0.59). Finally, to capture you felt lonely and wished for more friends during the last 2 weeks?” negative PLE, we used the item, “Right now I have no thoughts or provided a proxy measure of perceived loneliness with a desire for emotions”. having more social connectedness, that is, social longing. Responses to each item were based on a five-point Likert scale, where higher scores 2.3. Statistical analysis indicate higher levels of social contact and desired friendship. Since item 12 “How often have you felt bored in your spare time during the last two Unilevel mediation analyses were performed using PROCESS v3.3 weeks?” does not directly tap social connectedness, it was not employed (Hayes, 2018). Simple mediation analyses examined the indirect effect in this study. of social connectedness on paranoia, as well as other PLE, via self- Trait self-esteem was measured using the 10-item Rosenberg Self- esteem. Mediation is demonstrated by significant indirect coefficients. Esteem Scale (RSES; Rosenberg, 1965). Each item consisted of re­ Bootstrapping with 10,000 resamples was used to generate 95 % bias- sponses based on a 4-point Likert scale ranging from “Strongly disagree” corrected confidence intervals. Mediation analyses were considered to “Strongly agree.” The scale included both positive (i.e., “I am able to significant when zero was not included within the 95 % bias-corrected do things as well as most people”) and negative items (i.e., “I feel that I confidence intervals. am a failure”), and higher scores indicated greater self-esteem (Cron­ ESM data have a multilevel structure in which ESM ratings (level 1 bach's α = 0.88). data) are nested within participants (level 2 data). It has been shown Multiple measures were used to tap psychosis spectrum traits and that Multilevel Structural Equation Models (MSEMs) have several ad­ experiences. Paranoid ideation and ideas of reference were measured vantages over traditional multilevel modeling for mediation in nested using the SPQ 8-item Suspiciousness (SPQ-S; Cronbach's α = 0.70) and data (Preacher et al., 2011). Thus, MSEMs were employed using Mplus the 9-item Ideas of Reference (SPQ-I; Cronbach's α = 0.69) subscales. For Version 8 (Muthén and Muthén, 2010). Following the recommendation both subscales, each item was answered true (1) or false (0), and higher of the developers of Mplus, we fit the models of interest using Bayesian scores reflected greater presence of these experiences. Positive and estimation and posterior credible intervals (comparable to frequentist- 201 M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 based confidence intervals) for the parameter estimates were used to anhedonia. The only exception was the association of social longing and determine statistical significance (Asparouhov and Muthén, 2019). All social anhedonia, which was mediated by self-esteem. variables analyzed in this study were level 1 data (repeated daily-life Regarding direct effects, low social support is associated with greater ratings). Separate multilevel mediation models were conducted to levels of paranoia, ideas of reference, and physical and social anhedonia. examine the within-person direct and indirect effects of social Loneliness and isolation with social longing were positively associated connectedness (predictor variables) on paranoia and other PLE (crite­ with paranoia, ideas of reference, perceptual aberration, and social rion variables), through self-esteem (mediator variable). anhedonia, but only loneliness was associated with physical anhedonia. This study used a unilevel and multilevel cross-sectional designs. Finally, social contact was only inversely associated with physical and social anhedonia. No more significant association was found. 3. Results 3.2. Multilevel mediation analyses Table 1 provides descriptive data for the variables used in the study. Pearson's correlations among the measures of the study are shown in Results of simple multilevel mediation models are presented in Fig. 3 Supplementary Table S1. and Table 3. There was an indirect effect of momentary social connectedness on momentary paranoia via self-esteem, indicating that 3.1. Unilevel mediation analyses higher levels of momentary social connectedness were related to higher levels of momentary self-esteem, and this was associated with decreased Fig. 2 and Table 2 displays the results of the unilevel mediation paranoia in daily-life. Similarly, self-esteem mediated the association of models. There were significant indirect effects of perceived social sup­ social connectedness and cognitive PLE in daily-life. In contrast, self- port on paranoia via self-esteem; that is, self-esteem mediated the as­ esteem did not mediate the pathway from social connectedness to sociation between perceived social support and paranoia. Self-esteem perceptual PLE. Finally, there was no evidence of an indirect effect of also mediated the pathway from loneliness with social longing to momentary social connectedness on negative PLE through self-esteem. paranoia, but not from loneliness per se or social contact to paranoia. Thus, the pathways from social connectedness to negative and percep­ The same pattern of indirect effects emerged for ideas of reference and tive PLE in daily-life are not explained by the effect of momentary self- magical ideation. Thus, self-esteem mediates the pathways from social esteem. support and social longing, but not the pathways from loneliness and Regarding direct effects, social connectedness was negatively asso­ low social contact to ideas of reference and magical ideation. Finally, no ciated with paranoia, and negative PLE in daily-life, but it was not significant indirect effects between any of the social connectedness significantly related to cognitive and perceptive PLE. measures and AVH or perceptual aberration through self-esteem were found. Similarly, self-esteem did not mediate the pathways from any of 4. Discussion the social connectedness measures to physical anhedonia or social The present study examined the interplay between social connect­ Table 1 edness, self-esteem, and paranoia employing two different approaches: Means (standard deviations) and score ranges for the measures of the study. traditional psychometric measures and momentary measures assessed in real-life and real-time. Overall, the results indicate that the strength and Mean (S. Observed score Possible score D.) range range subjective quality, but not the frequency, of social relationships are associated to greater levels of positive self-esteem, and that this is Psychometric-trait measures RSES (self-esteem) 22.4 (5.10) 2–30 0–30 associated with lower levels of paranoid ideation. In other words, it MSPSS (social support) 73.3 13–84 12–84 suggests that social connectedness protects against paranoia by (11.24) furnishing people with positive attributions of the self. Additionally, we TILS (loneliness) 3.9 (1.22) 3–8 3–9 extended research in this area by examining whether self-esteem also SAS it 10 (social contact) 3.8 (0.90) 1–5 1–5 mediated the pathways between social connectedness and other positive SAS it 11 (social 4.6 (0.64) 2–5 1–5 longing) and negative PLE. As predicted, findings indicate that self-esteem also SPQ-S Suspiciousness 1.4 (1.57) 0–8 0–8 mediated the pathways from social connectedness to other cognitive PLE SPQ-I Ideas of reference 1.4 (1.65) 0–7 0–9 (ideas of reference, magical ideation, and momentary cognitive PLE), WSS- Magical Ideation 0.8 (1.22) 0–7 0–15 but not to perceptual PLE (perceptual aberration, AVH, and momentary WSS-Social Anhedonia 1.5 (2.42) 0–14 0–15 WSS-Physical 2.0 (1.89) 0–10 0–15 perceptual PLE). Finally, we did not find any evidence that self-esteem Anhedonia mediated the link between social connectedness and negative PLE WSS-Perceptual 0.2 (0.99) 0–9 0–15 (physical anhedonia, social anhedonia, and momentary negative PLE). aberration The consistency of results across both levels of analyses, retrospective DES it 27 (AVH) 0.2 (1.88) 0–2 0–10 and contextualized in daily-life, provides convergent evidence into how meaningful social relationships, or lack thereof, can influence paranoia ESM measures and other cognitive PLE through self-esteem. Usable 38.4 (7.57) 25–56 0–56 Self-esteem index 5.74 (0.69) 2.8–7 1–7 Self-esteem mediated the pathways from social support and loneli­ Social connectedness 5.83 (0.82) 3.3–7 1–7 ness mixed with unmet social longing to paranoia, but not between mere index loneliness and paranoia. Although we found a strong association be­ Paranoia index 1.27 (0.42) 1–4.1 1–7 tween loneliness and paranoia, consistent with previous reports (e.g., Cognitive PLE index 1.10 (0.21) 1–2.3 1–7 Badcock et al., 2015; Lim et al., 2018), it seems that this association is Perceptive PLE index 1.03 (0.10) 1–1.9 1–7 Positive PLE index 1.08 (0.26) 1–3.9 1–7 better explained by other factors, such as negative-other schemas Negative PLE 1.15 (0.42) 1–3.7 1–7 (Lamster et al., 2017), anxiety (Sündermann et al., 2014), and depres­ sion (Jaya et al., 2016). Self-esteem also mediates the link between ex­ Note. RSES: Rosenberg Self-Esteem Scale; MSPSS: Multidimensional Scale of Perceived Social Support; TILS; Three-Item Loneliness Scale; SAS: Social periences of discrimination and loneliness (Świtaj et al., 2015). Overall, Adjustment Scale; SPQ: Schizotypal Personality Questionnaire; WSS: Wisconsin these findings indicate that self-esteem is not implicated in the pathways Schizotypy Scales; DES: Dissociative Experience Scale; AVH: Auditory-verbal from loneliness to positive symptoms, but is implicated in the pathways hallucinations; ESM: Experience Sampling Methodology; PLE: Psychotic-like that drive loneliness. Similarly, self-esteem mediated associations of experiences. social support and loneliness with unmet social longing, but not mere 202 M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 Fig. 2. Diagrams of hypothesized pathways examined in the study (unilevel analyses with retrospective measures). Note. AVH: Auditory-verbal hallucinations. loneliness, to ideas of reference and magical ideation. Two conclusions identification may disrupt the ability to establish trusting social re­ can be drawn from these findings. First, it seems that this mechanistic lationships, which limits a person's perceived ability to interact effec­ pathway is not exclusive to paranoia, but can be applied to other tively and increases the likelihood of developing paranoid ideation cognitive PLE. Second, the different profile of results found for some of (Greenaway et al., 2019). Therefore, distrustful thoughts can be seen to the social connectedness measures employed provides further supports result from person-environmental interactions in which individuals the relevance of examining the nuances between distinct aspects of this become disconnected from meaningful social groups. Indeed, socially construct. Thus, we found similar results for social support and desire for isolated individuals have reduced options to discuss their experiences social longing, as well as social identification (McIntyre et al., 2017), with others, which limits the opportunity to disconfirm their paranoid another construct under the scope of social connectedness. However, in ideation (Freeman, 2007). our study pathways from loneliness were not mediated by self-esteem, As hypothesized, we did not find any evidence that self-esteem me­ which suggests differences among loneliness and the other subcon­ diates the pathways from social connectedness to AVH and perceptual structs related to social connectedness. Indeed, it has been theorized that aberration. Interestingly, this was consistent across all measures loneliness and social support reflect opposite poles of human connect­ employed to assess social connectedness and perceptual PLE, including edness (Newcomb, 1990). Recently, a five-dimension conceptual the analyses performed in the realm of daily life. This finding clarifies framework of social connectedness in mental disorders has been pro­ the mixed results reported by McIntyre et al. (2017), who found that posed (e. g., Hare-Duke et al., 2019; Haslam et al., 2015). The oper­ self-esteem mediated the link between social identification and AVH in ationalization of such complex construct should facilitate the one sample but not in the other. Similarly, self-esteem was not involved examination of how different dimensions/subconstructs of social in the pathways from social connectedness to negative PLE, supporting connectedness impact on expression and development of symptoms. that this mechanistic pathway seems to be unique for positive-like Results with ESM data provided further support that self-esteem symptoms related to distortions in thought content (i.e., paranoia, mediates the association of social connectedness with paranoia (and ideas of reference, magical thinking, etc.). The lack of a mediating role of other cognitive PLE) in the realm of daily-life. It is argued that social self-esteem for negative PLE was also consistent across trait-like and connectedness is related to paranoia because a lack of social momentary measures and all measures of social connectedness. The only 203 M. Monsonet et al. Table 2 Unilevel mediation analyses examining the indirect effects of measures of social connectedness on psychosis spectrum personality traits and experiences. SPQ-Suspiciousness SPQ- Ideas of reference DES-item 24 (AVH) Raw parameter estimate (SE) 95 % bias-corrected CI Raw parameter estimate (SE) 95 % bias-corrected CI Raw parameter estimate (SE) 95 % bias-corrected CI Social support Total effect ¡0.044 (0.010) ¡0.064 to ¡0.024 ¡0.034 (0.011) ¡0.056 to ¡0.012 0.019 (0.013) − 0.007 to 0.044 Direct effect ¡0.033 (0.010) ¡0.053 to ¡0.012 ¡0.024 (0.011) ¡0.047 to ¡0.002 0.021 (0.014) − 0.006 to 0.048 Indirect effect ¡0.012 (0.005) ¡0.023 to ¡0.005 ¡0.010 (0.004) ¡0.020 to ¡0.003 − 0.003 (0.004) − 0.014 to 0.003 Loneliness & social longing Total effect 0.861 (0.174) 0.518 to 1.204 0.748 (0.188) 0.376 to 1.191 0.072 (0.226) − 0.375 to 0.519 Direct effect 0.634 (0.183) 0.273 to 0.995 0.575 (0.201) 0.178 to 0.972 0.071 (0.246) − 0.414 to 0.556 Indirect effect 0.227 (0.091) 0.080 to 0.451 0.173 (0.084) 0.029 to 0.364 0.001 (0.053) − 0.114 to 0.100 Loneliness Total effect 0.643 (0.085) 0.476 to 0.811 0.566 (0.095) 0.378 to 0.752 0.012 (0.120) − 0.225 to 0.248 Direct effect 0.566 (0.099) 0.371 to 0.762 0.521 (0.111) 0.303 to 0.740 0.005 (0.141) − 0.273 to 0.283 Indirect effect 0.077 (0.053) − 0.016 to 0.197 0.044 (0.066) − 0.094 to 0.165 0.007 (0.042) − 0.069 to 0.101 Social contact Total effect − 0.171 (0.133) − 0.433 to 0.091 0.082 (0.141) − 0.196 to 0.360 0.229 (0.161) − 0.547 to 0.090 Direct effect − 0.106 (0.126) − 0.354 to 0.143 0.138 (0.137) − 0.132 to 0.408 0.229 (0.163) − 0.550 to 0.092 Indirect effect − 0.065 (0.049) − 0.177 to 0.019 − 0.055 (0.045) − 0.165 to 0.014 0.001 (0.012) − 0.019 to 0.031 204 WSS Magical Ideation WSS Perceptual Aberration WSS Physical Anhedonia WSS Social Anhedonia Raw paramet. estimate 95 % bias-corrected Raw paramet. estimate 95 % bias-corrected Raw paramet. estimate 95 % bias-corrected Raw paramet. estimate 95 % bias-corrected (SE) CI (SE) CI (SE) CI (SE) CI Social support Total effect − 0.013 (0.008) − 0.029 to 0.004 ¡0.015 (0.007) ¡0.029 to ¡0.002 ¡0.046 (0.013) ¡0.071 to ¡0.021 ¡0.099 (0.015) ¡0.128 to ¡0.069 Direct effect − 0.007 (0.009) − 0.024 to 0.011 − 0.014 (0.007) − 0.028 to 0.001 ¡0.049 (0.013) ¡0.075 to ¡0.023 ¡0.092 (0.016) ¡0.123 to ¡0.061 Indirect effect ¡0.006 (0.004) ¡0.017 to ¡0.001 − 0.002 (0.002) − 0.005 to 0.002 0.003 (0.005) − 0.004 to 0.016 − 0.007 (0.007) − 0.018 to 0.009 Loneliness & social longing Total effect 0.234 (0.146) − 0.055 to 0.523 0.368 (0.117) 0.137 to 0.598 0.041 (0.228) − 0.410 to 0.492 0.899 (0.284) 0.339 to 1.459 Direct effect 0.105 (0.157) − 0.205 to 0.415 0.360 (0.128) 0.110 to 0.610 0.086 (0.248) − 0.404 to 0.575 0.663 (0.304) 0.063 to 1.264 Indirect effect 0.129 (0.075) 0.010 to 0.318 0.008 (0.040) − 0.076 to 0.078 0.045 (0.090) − 0.137 to 0.216 0.236 (0.129) 0.003 to 0.505 Loneliness Total effect 0.161 (0.077) 0.009 to 0.314 0.233 (0.061) 0.112 to 0.354 0.226 (0.120) − 0.011 to 0.462 0.656 (0.146) 0.368 to 0.945 Direct effect 0.079 (0.090) − 0.098 to 0.256 0.260 (0.072) 0.118 to 0.401 0.278 (0.140) 0.001 to 0.555 0.571 (0.171) 0.233 to 0.908 Schizophrenia Research 254 (2023) 199–207 Indirect effect 0.083 (0.055) − 0.025 to 0.196 − 0.027 (0.035) − 0.104 to 0.035 − 0.052 (0.071) − 0.188 to 0.097 0.085 (0.101) − 0.108 to 0.297 Social contact Total effect 0.068 (0.106) − 0.140 to 0.276 0.045 (0.086) − 0.124 to 0.215 ¡0.389 (0.161) ¡0.706 to ¡0.072 ¡0.859 (0.198) ¡1.250 to ¡0.468 Direct effect 0.099 (0.104) − 0.106 to 0.305 0.059 (0.086) − 0.112 to 0.229 ¡0.387 (0.162) ¡0.708 to ¡0.067 ¡0.800 (0.196) ¡1.186 to ¡0.414 Indirect effect − 0.031 (0.030) − 0.105 to 0.009 − 0.013 (0.018) − 0.062 to 0.009 − 0.002 (0.023) − 0.054 to 0.045 − 0.059 (0.052) − 0.181 to 0.023 Note. AVH: Auditory-verbal hallucinations; SPQ: Schizotypal Personality Questionnaire; DES: Dissociative Experience Scale; CI: Confidence interval; Significant effects are presented in bold. M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 Fig. 3. Diagrams of hypothesized pathways examined in the study (multilevel analyses with momentary daily-life measures). Note. PLE: Psychotic-like experiences. experimental or ESM time-lagged studies. An alternative hypothesis not Table 3 tested in this study would be that negative PLEs and schizotypy would Multilevel mediation analyses examining the indirect effects of social connect­ drive poor social connectedness rather than vice versa (as assessed in edness on paranoia and other PLE via self-esteem. this paper). Future longitudinal or time-lagged ESM studies are needed Pathways Estimate S.D. 95 % CI to explore whether these potential pathways operate in both directions, SC ➔ SE ➔ Paranoia from social connectedness to negative PLE and from negative PLE to Total effect ¡0.142 0.014 ¡0.168 to ¡0.116 social connectedness. It could be other external factors not addressed in Direct effect 0.010 ¡0.115 to ¡0.075 the present study that may affect the interplay between the variables ¡0.097 Indirect effect ¡0.045 0.009 ¡0.065 to ¡0.027 SC ➔ SE ➔ Cognitive PLE analyzed. Furthermore, gender differences in the composition of the Total effect ¡0.035 0.009 ¡0.053 to ¡0.019 sample may also limit the generalizability of findings. Finally, social Direct effect − 0.006 0.006 − 0.018 to 0.007 contact was assessed with a single item and only self-report measures Indirect effect ¡0.029 0.007 ¡0.045 to ¡0.018 (retrospective and momentary) were employed in the present study. SC ➔ SE ➔ Perceptive PLE Total effect ¡0.012 0.004 ¡0.020 to ¡0.005 Additional observed-based rating of the measures employed would have Direct effect − 0.009 0.004 − 0.017 to 0.000 allowed for a more differentiated view and a clear interpretation of the Indirect effect − 0.004 0.003 − 0.010 to 0.003 results. SC ➔ SE ➔ Negative PLE In summary, the interaction between social connectedness and self- Total effect 0.010 ¡0.062 to ¡0.025 esteem seems to be critical for paranoia as well for other forms of ¡0.044 Direct effect ¡0.042 0.010 ¡0.061 to ¡0.023 Indirect effect − 0.002 0.005 − 0.012 to 0.009 cognitive distortions. Overall, this study supports the protective role that sound social bonds can have on paranoia and other positive symptoms, Note. SC: Social connectedness index; SE: Self-esteem index; PLE: Psychotic-like highlighting the relevance of the interplay between psychosocial aspects experiences; CI: Confidence interval; Significant direct and indirect effects are (appraisals of social context and self-esteem) in the development of presented in bold. psychosis. The interplay between social connectedness and self-beliefs (self-efficacy and self-esteem) also impacted on social functioning in exception was the association of social longing and social anhedonia, first-episode of psychosis patients (González-Blanch et al., 2020). Thus, which was partly explained by lower levels of self-esteem. Altogether, addressing the inadequacies of social connectedness is a major thera­ the symptom-specific approach establishes a more comprehensive pic­ peutic target as they can substantially affect not only self-esteem but also ture of how social connectedness could drive specific symptoms of symptomatic and functional outcomes of psychosis. Meaningful social psychosis and the role that self-esteem has in the potential pathways to relationships protect against physical and mental ill health, including specific symptom development or exacerbation. depression and paranoia (Cruwys et al., 2013; Haslam et al., 2009; Finally, none of the pathways from social contact (frequency of social McIntyre et al., 2021; Sani et al., 2017), a phenomenon referred to as the interactions) to paranoia or positive and negative PLE were explained by “social cure” (Jetten et al., 2012). This is especially relevant considering self-esteem. Additionally, low social contact only had significant asso­ that pharmacological treatments do not improve psychosocial disabil­ ciations with physical and social anhedonia, but not with paranoia or ities and actually can worsen symptoms like asociality, avolition or any other positive PLE. This is in line with a recent meta-analysis that anhedonia (Correll and Schooler, 2020; Kirschner et al., 2017). Moving found that social network size was unassociated with positive symptoms forward, it is critical to address the complexity of the social connect­ (Degnan et al., 2018). Overall, these findings highlight the relevance of edness construct to better understand the key social determinants of separately examining the quality and quantity of social relationships, psychosis and, thereby, being able to devise more refined psychosocial since the strength and the subjective quality of social relationships, that interventions and shape supportive social contexts that prevent the is, social connectedness, would be the key ingredient acting as a pro­ development of mental disorders (Jeste and Pender, 2022). tective factor for mental disorders. Although frequency of social contact Supplementary data to this article can be found online at https://doi. could also provide valuable information (Macdonald et al., 2000; Tee org/10.1016/j.schres.2023.03.006. et al., 2022) and, of course, it can be related to the quality of social relationships, studying the subjective appraisals (sense of belonging, References loneliness, perceived social support, social identification) may be critical to better understand the social determinants of psychosis. Asparouhov, T., Muthén, B., 2019. Latent variable centering of predictors and mediators The present study is not without limitations. The cross-sectional in multilevel and time-series models. Struct. Equ. Model. 26 (1), 119–142. https:// design limits causal inferences, which require longitudinal, doi.org/10.1080/10705511.2018.1511375. 205 M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 Badcock, J.C., Shah, S., Mackinnon, A., Stain, H.J., Galletly, C., Jablensky, A., Morgan, V. J. Pers. Soc. Psychol. 85 (1), 105–120. https://doi.org/10.1037/0022- A., 2015. Loneliness in psychotic disorders and its association with cognitive 3514.85.1.105. function and symptom profile. Schizophr. Res. 169 (1–3), 268–273. https://doi.org/ Hayes, A.F., 2018. Introduction to Mediation, Moderation, and Conditional Process 10.1016/j.schres.2015.10.027. Analysis: A Regresssion-based Approach, second ed. The Guilford Press, New York. Barrantes-Vidal, N., Chun, C.A., Myin-Germeys, I., Kwapil, T.R., 2013a. Psychometric Hektner, J.M., Schmidt, J.A., Csikszentmihalyi, M., 2007. Experience Sampling Method: schizotypy predicts psychotic-like, paranoid, and negative symptoms in daily life. Measuring the Quality of Everyday Life. SAGE Publications, Thousand Oaks. J. Abnorm. Psychol. 122 (4), 1077–1087. https://doi.org/10.1037/a0034793. Horton, L.E., Barrantes-Vidal, N., Silvia, P.J., Kwapil, T.R., 2014. Worries about being Barrantes-Vidal, N., Gross, G., Sheinbaum, T., Mitjavila, M., Ballespí, S., Kwapil, T.R., judged versus being harmed: disentangling the association of social anxiety and 2013b. Positive and negative schizotypy are associated with prodromal and paranoia with schizotypy. PLoS One 9 (6). https://doi.org/10.1371/journal. schizophrenia-spectrum symptoms. Schizophr. Res. 145 (1–3), 50–55. https://doi. pone.0096269. org/10.1016/j.schres.2013.01.007. Hughes, M.E., Waite, L.J., Hawkley, L.C., Cacioppo, J.T., 2004. A short scale for Baumeister, R.F., Leary, M.R., 1995. The need to belong: desire for interpersonal measuring loneliness in large surveys: results from two population-based studies. attachments as a fundamental human motivation. Psychol. Bull. 117 (3), 497–529. Res. Aging 26 (6), 655–672. https://doi.org/10.1177/0164027504268574. https://doi.org/10.1037/0033-2909.117.3.497. Jaya, E.S., Hillmann, T.E., Reininger, K.M., Gollwitzer, A., Lincoln, T.M., 2016. Bentall, R.P., Corcoran, R., Howard, R., Blackwood, N., Kinderman, P., 2001. Persecutory Loneliness and psychotic symptoms: the mediating role of depression. Cognit. Ther. delusions: a review and theoretical integration. Clin. Psychol. Rev. 21 (8), Res. 41 (1), 106–116. https://doi.org/10.1007/s10608-016-9799-4. 1143–1192. https://doi.org/10.1016/s0272-7358(01)00106-4. Jeste, D.V., Pender, V.B., 2022. Social determinants of mental health: recommendations Bentall, R.P., Wickham, S., Shevlin, M., Varese, F., 2012. Do specific early-life adversities for research, training, practice, and policy. JAMA Psychiatry 79 (4), 283–284. lead to specific symptoms of psychosis? A study from the 2007 the adult psychiatric https://doi.org/10.1001/jamapsychiatry.2021.4385. morbidity survey. Schizophr. Bull. 38 (4), 734–740. https://doi.org/10.1093/ Jetten, J., Branscombe, N.R., Haslam, S.A., Haslam, C., Cruwys, T., Jones, J.M., Cui, L., schbul/sbs049. Dingle, G., Liu, J., Murphy, S.C., Thai, A., Walter, Z., Zhang, A., 2015. Having a lot of Berkman, L.F., Glass, T., 2000. Social integration, social networks, social support, and a good thing: multiple important group memberships as a source of self-esteem. PLoS health. In: Berkman, L.F., Kawachi, I. (Eds.), Social Epidemiology. Oxford University One 10 (5), e0124609. https://doi.org/10.1371/journal. pone.0124609. Press, New York, pp. 158–162. Jetten, J., Haslam, C., Haslam, S.A., 2012. The Social Cure: Identity, Health and Well- Bernstein, E.M., Putnam, F.W., 1986. Development, reliability, and validity of a Being. Psychology Press, London. dissociation scale. J. Nerv. Ment. Dis. 174 (12), 727–735. https://doi.org/10.1097/ Kesting, M.-L., Lincoln, T.M., 2013. The relevance of self-esteem and self-schemas to 00005053-198612000-00004. persecutory delusions: a systematic review. Compr. Psychiatry 54 (7), 766–789. Chau, A., Zhu, C., So, S.H., 2019. Loneliness and the psychosis continuum: a meta- https://doi.org/10.1016/j.comppsych.2013.03.002. analysis on positive psychotic experiences and a meta-analysis on negative psychotic Kesting, M.-L., Bredenpohl, M., Klenke, J., Westermann, S., Lincoln, T.M., 2013. The experiences. Int. Rev. Psychiatry 31 (5–6), 471–490. https://doi.org/10.1080/ impact of social stress on self-esteem and paranoid ideation. J. Behav. Ther. Exp. 09540261.2019.1636005. Psychiatry 44 (1), 122–128. https://doi.org/10.1016/j.jbtep.2012.07.010. Coid, J.W., Ullrich, S., Kallis, C., Keers, R., Barker, D., Cowden, F., Stamps, R., 2013. The Kirschner, M., Aleman, A., Kaiser, S., 2017. Secondary negative symptoms - a review of relationship between delusions and violence: findings from the East London first mechanisms, assessment and treatment. Schizophr. Res. 186, 29–38. https://doi. episode psychosis study. JAMA Psychiatry 70 (5), 465–471. https://doi.org/ org/10.1016/j.schres.2016.05.003. 10.1001/jamapsychiatry.2013.12. Kwapil, T.R., Barrantes-Vidal, N., 2015. Schizotypy: looking back and moving forward. Cornwell, E.Y., Waite, L.J., 2009. Measuring social isolation among older adults using Schizophr. Bull. 41 (Suppl. 2) https://doi.org/10.1093/schbul/sbu186. multiple indicators from the NSHAP study. J. Gerontol. B. Psychol. Sci. Soc. Sci. 64 Kwapil, T.R., Barrantes-Vidal, N., Silva, P.J., 2008. The dimensional structure of the (Suppl. 1), i38–i46. https://doi.org/10.1093/geronb/gbp037. Wisconsin Schizotypy Scales: factor identification and construct validity. Schizophr. Correll, C.U., Schooler, N.R., 2020. Negative symptoms in schizophrenia: a review and Bull. 34 (3), 444–457. https://doi.org/10.1093/schbul/sbm098. clinical guide for recognition, assessment, and treatment. Neuropsychiatr. Dis. Treat. Kwapil, T.R., Kemp, K.C., Mielock, A., Sperry, S.H., Chun, C.A., Gross, G.M., Barrantes- 16, 519–534. https://doi.org/10.2147/NDT.S225643. Vidal, N., 2020. Association of multidimensional schizotypy with psychotic-like Cruwys, T., Dingle, G., Haslam, C., Haslam, S.A., Jetten, J., Morton, T.A., 2013. Social experiences, affect, and social functioning in daily life: comparable findings across group memberships protect against future depression, alleviate depression samples and schizotypy measures. J. Abnorm. Psychol. 129 (5), 492–504. https:// symptoms and prevent depression relapse. Soc. Sci. Med. 98, 179–186. https://doi. doi.org/10.1037/abn0000522. org/10.1016/j.socscimed.2013.09.013. Lamster, F., Lincoln, T.M., Nittel, C.M., Rief, W., Mehl, S., 2017. The lonely road to Cruwys, T., Haslam, S.A., Dingle, G.A., Haslam, C., Jetten, J., 2014. Depression and paranoia. A path-analytic investigation of loneliness and paranoia. Compr. social identity. Personal. Soc. Psychol. Rev. 18 (3), 215–238. https://doi.org/ Psychiatry 74, 35–43. https://doi.org/10.1016/j.comppsych.2016.12.007. 10.1177/1088868314523839. Lim, M.H., Rodebaugh, T.L., Zyphur, M.J., Gleeson, J.F., 2016. Loneliness over time: the Degnan, A., Berry, K., Sweet, D., Abel, K., Crossley, N., Edge, D., 2018. Social networks crucial role of social anxiety. J. Abnorm. Psychol. 125 (5), 620–630. https://doi.org/ and symptomatic and functional outcomes in schizophrenia: a systematic review and 10.1037/abn0000162. meta-analysis. Soc. Psychiatry Psychiatr. Epidemiol. 53 (9), 873–888. https://doi. Lim, M.H., Gleeson, J., Alvarez-Jimenez, M., Penn, D.L., 2018. Loneliness in psychosis: a org/10.1007/s00127-018-1552-8. systematic review. Soc. Psychiatry Psychiatr. Epidemiol. 53 (3), 221–238. https:// Freeman, D., 2007. Suspicious minds: the psychology of persecutory delusions. Clin. doi.org/10.1007/s00127-018-1482-5. Psychol. Rev. 27 (4), 425–457. https://doi.org/10.1016/j.cpr.2006.10.004. Ludwig, K.A., Nye, L.N., Simmons, G.L., Jarskog, L.F., Pinkham, A.E., Harvey, P.D., Freeman, D., Garety, P.A., Kuipers, E., Fowler, D., Bebbington, P.E., 2002. A cognitive Penn, D.L., 2020. Correlates of loneliness among persons with psychotic disorders. model of persecutory delusions. Br. J. Clin. Psychol. 41 (4), 331–347. https://doi. Soc. Psychiatry Psychiatr. Epidemiol. 55 (5), 549–559. https://doi.org/10.1007/ org/10.1348/014466502760387461. s00127-019-01789-5. Freeman, D., McManus, S., Brugha, T., Meltzer, H., Jenkins, R., Bebbington, P., 2011. Macdonald, E.M., Hayes, R.L., Baglioni Jr., A.J., 2000. The quantity and quality of the Concomitants of paranoia in the general population. Psychol. Med. 41 (5), 923–936. social networks of young people with early psychosis compared with closely https://doi.org/10.1017/S0033291710001546. matched controls. Schizophr. Res. 46 (1), 25–30. https://doi.org/10.1016/s0920- Geldhof, G.J., Preacher, K.J., Zyphur, M.J., 2014. Reliability estimation in a multilevel 9964(00)00024-4. confirmatory factor analysis framework. Psychol. Methods 19, 72–91. https://doi. Maslow, A.H., 1943. A theory of human motivation. Psychol. Rev. 50 (4), 370–396. org/10.1037/a0032138. https://doi.org/10.1037/h0054346. González-Blanch, C., Medrano, L., Bendall, S., D’Alfonso, S., Cagliarini, D., McEnery, C., McIntyre, J.C., Elahi, A., Barlow, F.K., White, R.G., Bentall, R.P., 2021. The relationship O'Sullivan, S., Valentine, L., Gleeson, J.F., Alvarez-Jimenez, M., 2020. The role of between ingroup identity and paranoid ideation among people from African and social relatedness and self-beliefs in social functioning in first-episode psychosis: are African Caribbean backgrounds. Psychol. Psychother. 94 (1), 16–32. https://doi. we overestimating the contribution of illness-related factors? Eur. Psychiatry 63 (1), org/10.1111/papt.12261. e92. https://doi.org/10.1192/j.eurpsy.2020.90. McIntyre, J.C., Elahi, A., Bentall, R.P., 2016. Social identity and psychosis: explaining Greenaway, K.H., Cruwys, T., Haslam, S.A., Jetten, J., 2016. Social identities promote elevated rates of psychosis in migrant populations. Soc. Pers. Psychol. Compass 10, well-being because they satisfy global psychological needs. Eur. J. Soc. Psychol. 46, 619–633. https://doi.org/10.1111/spc3.12273. 294–307. https://doi.org/10.1002/ejsp.2169. McIntyre, J.C., Wickham, S., Barr, B., Bentall, R.P., 2017. Social identity and psychosis: Greenaway, K.H., Haslam, S.A., Bingley, W., 2019. Are “they” out to get me? A social associations and psychological mechanisms. Schizophr. Bull. 44 (3), 681–690. identity model of paranoia. Group Process. Intergr. Relat. 22 (7), 984–1001. https:// https://doi.org/10.1093/schbul/sbx110. doi.org/10.1177/1368430218793190. Michalska da Rocha, B., Rhodes, S., Vasilopoulou, E., Hutton, P., 2018. Loneliness in Hare-Duke, L., Dening, T., de Oliveira, D., Milner, K., Slade, M., 2019. Conceptual psychosis: a meta-analytical review. Schizophr. Bull. 44 (1), 114–125. https://doi. framework for social connectedness in mental disorders: systematic review and org/10.1093/schbul/sbx036. narrative synthesis. J. Affect. Disord. 245, 188–199. https://doi.org/10.1016/j. Monsonet, M., Kwapil, T.R., Barrantes-Vidal, N., 2020. Deconstructing the relationships jad.2018.10.359. between self-esteem and paranoia in early psychosis: an experience sampling study. Haslam, C., Cruwys, T., Haslam, S.A., Jetten, J., 2015. Social connectedness and health. Br. J. Clin. Psychol. 59 (4), 502–522. https://doi.org/10.1111/bjc.12263. In: Pachana, N.A. (Ed.), Encyclopedia of Geropsychology. Springer, Singapore, Monsonet, M., Kwapil, T.R., Barrantes-Vidal, N., 2022. A time-lagged study of predictors pp. 2174–2182. of paranoia and psychotic-like experiences in daily life across the schizotypy Haslam, S.A., Jetten, J., Postmes, T., Haslam, C., 2009. Social identity, health and well continuum. J. Psychopathol. Clin. Sci. 131 (1), 98–108. https://doi.org/10.1037/ being: an emerging agenda for applied psychology. Appl. Psychol. 58 (1), 1–23. abn0000726. https://doi.org/10.1111/j.1464-0597.2008.00379.x. Moutoussis, M., Williams, J., Dayan, P., Bentall, R.P., 2007. Persecutory delusions and Hawkley, L.C., Burleson, M.H., Berntson, G.G., Cacioppo, J.T., 2003. Loneliness in the conditioned avoidance paradigm: towards an integration of the psychology and everyday life: cardiovascular activity, psychosocial context, and health behaviors. 206 M. Monsonet et al. Schizophrenia Research 254 (2023) 199–207 biology of paranoia. Cogn. Neuropsychiatry 12 (6), 495–510. https://doi.org/ Selten, J.P., van der Ven, E., Rutten, B.P., Cantor-Graae, E., 2013. The social defeat 10.1080/13546800701566686. hypothesis of schizophrenia: an update. Schizophr. Bull. 39 (6), 1180–1186. https:// Murphy, P., Bentall, R.P., Freeman, D., O’Rourke, S., Hutton, P., 2018. The paranoia as doi.org/10.1093/schbul/sbt134. defence model of persecutory delusions: a systematic review and meta-analysis. Shiffman, S., Stone, A.A., Hufford, M.R., 2008. Ecological momentary assessment. Annu. Lancet Psychiatry 5, 913–929. https://doi.org/10.1016/S2215-0366(18)30339-0. Rev. Clin. Psychol. 4 (1), 1–32. https://doi.org/10.1146/annurev. Muthén, L.K., Muthén, B.O., 1998–2010. Mplus User's Guide, sixth ed. Muthén & clinpsy.3.022806.091415. Muthén, Los Angeles. Stefanis, N.C., Hanssen, M., Smirnis, N.K., Avramopoulos, D.A., Evdokimidis, I.K., Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W., Stefanis, C.N., Verdoux, H., van Os, J., 2002. Evidence that three dimensions of Reininghaus, U., 2018. Experience sampling methodology in mental health research: psychosis have a distribution in the general population. Psychol. Med. 32 (2), new insights and technical developments. World Psychiatry 17 (2), 123–132. 347–358. https://doi.org/10.1017/s0033291701005141. https://doi.org/10.1002/wps.20513. Sündermann, O., Onwumere, J., Kane, F., Morgan, C., Kuipers, E., 2014. Social networks Myin-Germeys, I., Oorschot, M., Collip, D., Lataster, J., Delespaul, P., van Os, J., 2009. and support in first-episode psychosis: exploring the role of loneliness and anxiety. Experience sampling research in psychopathology: opening the black box of daily Soc. Psychiatry Psychiatr. Epidemiol. 49 (3), 359–366. https://doi.org/10.1007/ life. Psychol. Med. 39 (9), 1533–1547. https://doi.org/10.1017/ s00127-013-0754-3. S0033291708004947. Świtaj, P., Grygiel, P., Anczewska, M., Wciórka, J., 2015. Experiences of discrimination Newcomb, M.D., 1990. Social support by many other names: towards a unified and the feelings of loneliness in people with psychotic disorders: the mediating conceptualization. J. Soc. Pers. Relat. 7 (4), 479–494. https://doi.org/10.1177/ effects of self-esteem and support seeking. Compr. Psychiatry 59, 73–79. https://doi. 0265407590074005. org/10.1016/j.comppsych.2015.02.016. Pilton, M., Varese, F., Berry, K., Bucci, S., 2015. The relationship between dissociation Tajfel, H., Turner, J.C., 1979. An integrative theory of intergroup conflict. In: Austin, W. and voices: a systematic literature review and meta-analysis. Clin. Psychol. Rev. 40, G., Worchel, S. (Eds.), The Social Psychology of Intergroup Relations. Brooks/Cole, 138–155. https://doi.org/10.1016/j.cpr.2015.06.004. Monterey, CA, pp. 33–37. Preacher, K.J., Zhang, Z., Zyphur, M.J., 2011. Alternative methods for assessing Tee, H., Chevalier, A., Webber, M., Xanthopoulou, P., Priebe, S., Giacco, D., 2022. Who mediation in multilevel data: the advantages of multilevel SEM. Struc. Equ. Model. wants more social contacts? A cross-sectional study of people with psychotic 18, 161–182. https://doi.org/10.1080/10705511.2011.557329. disorders in England. Schizophr. Res. 240, 46–51. https://doi.org/10.1016/j. Raine, A., 1991. The SPQ: a scale for the assessment of schizotypal personality based on schres.2021.11.047. DSM-III-R criteria. Schizophr. Bull. 17 (4), 555–564. https://doi.org/10.1093/ Thewissen, V., Bentall, R.P., Lecomte, T., van Os, J., Myin-Germeys, I., 2008. schbul/17.4.555. Fluctuations in self-esteem and paranoia in the context of daily life. J. Abnorm. Rector, N.A., Beck, A.T., Stolar, N., 2005. The negative symptoms of schizophrenia: a Psychol. 117 (1), 143–153. https://doi.org/10.1016/10.1037/0021- cognitive perspective. Can. J. Psychiatr. 50 (5), 247–257. https://doi.org/10.1177/ 843x.117.1.143. 070674370505000503. Thewissen, V., Bentall, R.P., Oorschot, M., Campo, A.J., van Lierop, T., van Os, J., Myin- Reinhardt, J.P., Boerner, K., Horowitz, A., 2006. Good to have but not to use: differential Germeys, I., 2011. Emotions, self-esteem, and paranoid episodes: an experience impact of perceived and received support on well-being. J. Soc. Pers. Relat. 23 (1), sampling study. Br. J. Clin. Psychol. 50 (2), 178–195. https://doi.org/10.1348/ 117–129. https://doi.org/10.1177/0265407506060182. 014466510X508677. Reininghaus, U., Gayer-Anderson, C., Valmaggia, L., Kempton, M.J., Calem, M., Thomas, J., Bentall, R.P., Hadden, L., Ohara, L., 2017. Ethnic identity and paranoid Onyejiaka, A., Hubbard, K., Dazzan, P., Beards, S., Fisher, H.L., Mills, J.G., thinking: implicit out-group preference and language dominance predict paranoia in McGuire, P., Craig, T.K., Garety, P., van Os, J., Murray, R.M., Wykes, T., Myin- Emirati women. J. Behav. Ther. Exp. Psychiatry 56, 122–128. https://doi.org/ Germeys, I., Morgan, C., 2016. Psychological processes underlying the association 10.1016/j.jbtep.2016.10.004. between childhood trauma and psychosis in daily life: an experience sampling study. Tiernan, B., Tracey, R., Shannon, C., 2014. Paranoia and self-concepts in psychosis: a Psychol. Med. 46 (13), 2799–2813. https://doi.org/10.1017/S003329171600146X. systematic review of the literature. Psychiatry Res. 216 (3), 303–313. https://doi. Rosenberg, M., 1965. Society and the Adolescent Self-image. Princeton University Press, org/10.1016/j.psychres.2014.02.003. Princeton, N. J. Weissman, M., 2007. Social Adjustment Scale – Self-report: Short (SAS-SR: Short) & Rosenberg, M., 1979. Conceiving the Self. Basic Books, New York. Social Adjustment Scale – Self-report: Screener (SAS-SR: Screener) Technical Russell, D., Peplau, L.A., Cutrona, C.E., 1980. The revised UCLA loneliness scale: Manual. Multi-Health Systems, Toronto, OT. concurrent and discriminant validity evidence. J. Pers. Soc. Psychol. 39 (3), Zhang, T., Li, H., Woodberry, K.A., Seidman, L.J., Zheng, L., Li, H., Zhao, S., Tang, Y., 472–480. https://doi.org/10.1037//0022-3514.39.3.472. Guo, Q., Lu, X., Zhuo, K., Qian, Z., Chow, A., Li, C., Jiang, K., Xiao, Z., Wang, J., Saeri, A.K., Cruwys, T., Barlow, F.K., Stronge, S., Sibley, C.G., 2018. Social connectedness 2014. Prodromal psychosis detection in a counseling center population in China: an improves public mental health: investigating bidirectional relationships in the New epidemiological and clinical study. Schizophr. Res. 152 (2–3), 391–399. https://doi. Zealand attitudes and values survey. Aust. N. Z. J. Psychiatry 52 (4), 365–374. org/10.1016/j.schres.2013.11.039. https://doi.org/10.1177/0004867417723990. Zimet, G.D., Dahlem, N.W., Zimet, S.G., Farley, G.K., 1988. The multidimensional scale Sani, F., Wakefield, J.R., Herrera, M., Zeybek, A., 2017. On the association between of perceived social support. J. Pers. Assess. 52 (1), 30–41. https://doi.org/10.1207/ greater family identification and lower paranoid ideation among non-clinical s15327752jpa5201_2. individuals: evidence from Cypriot and Spanish students. J. Soc. Clin. Psychol. 36 (5), 396–418. https://doi.org/10.1521/jscp.2017.36.5.396. 207