Understanding the social costs of psychosis: the experience of adults affected by psychosis identified within the second Australian national survey of psychosis

Abstract

BACKGROUND: Social inclusion is a key priority of the Fourth National Mental Health Plan for Australia (2009–2014), with strong evidence for its protective impact on mental health. Social integration has been associated with enhanced wellbeing for people with mental illnesses such as psychosis. OBJECTIVE: To explore the impact of psychosis on an individual’s social and community participation. METHOD: The second Australian national survey of psychosis was conducted across seven Australian sites. Semi-structured interviews with adults living with psychosis assessed mental health status, social and role functioning, life satisfaction and future goals. The cohort comprised 1825 adults with a psychotic illness (59.6% were male; 42.4% were aged 18–34 years; 31.5% had 12 years or more of education) of whom 32.7% had been employed in the past year. RESULTS: Most adults indicated experiencing loneliness (80.1%) and a need for more friends (48.1%). Men were more likely to have never had a long-term relationship (59.4% M, 33.2% F). Even though women were more likely to experience anxiety in social situations [(χ2(1) = 8.95, p < 0.01)], they were more likely to have attended a social activity in the past year [χ2(2) = 11.84, p < 0.01]. Just over half of the survey participants (56.7%) reported having daily or nearly daily contact with family members. In the past year, 69% had not attended any social activity and 43% described stigma as a barrier. Although 63.2% showed significant impairment in social functioning, only 29.5% had received help for this in the last year. Social isolation and loneliness were rated as major challenges by 37.2% of the cohort. CONCLUSIONS: Social isolation and dysfunction experienced by people with psychosis have not decreased since the last Australian national survey of people with psychosis. Alongside education and employment, social functioning and participation must be addressed to improve social inclusion for people with psychosis. Programs targeting social opportunities (befriending, peer support), social anxiety and social functioning for all stages of psychosis are warranted.