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The onset of a psychotic illness in late adolescence or early adulthood can heighten the challenges associated with redefining familial roles and navigating peer group relationships during this pivotal developmental phase (MacDonald, Sauer, Howie, & Albiston, 2005). Research has demonstrated the significance of peers to young adults (Arnett, 2000), yet the social networks of individuals recently diagnosed with schizophrenia tend to be smaller and comprised of higher proportions of family members than non-patients (Horan, Subotnik, Snyder, & Nuechterlein, 2006). These social network differences highlight the potential importance of the family environment as part of the context within which individuals with schizophrenia manage their illness. Evidence from research using vulnerability-stress models suggests that the adverse effects of environmental stressors, such as stressful life events, are modulated by the social-environmental context of the affected individual (Ventura, Nuechterlein, Lukoff, & Hardesty, 1989). The present study examined the relationship between schizophrenia patients’ perceptions of their family environment and perceptions of their ability to cope with stressful life events during the first year of their illness.
Data from 87 patients were collected as part of the longitudinal Developmental Processes in Schizophrenic Disorders project (see (Nuechterlein, et al., 1992; Nuechterlein, et al., 2008) and are presented in Table 1. Patients completed a subjective appraisal of their ability to cope with individual life events elicited by the Psychiatric Epidemiology Research Interview for Life Events (PERI-LE) (Dohrenwend, Askenasy, Krasnoff, & Dohrenwend, 1978). They also completed the 90-item self-report Family Environment Scale - Form R (FES-R) (Moos & Moos, 1981), which asks participants to describe the social environment of their family as they see it. A life event appraisal rating based on how successfully patients felt that they handled a life event was calculated by aggregating patient appraisal ratings of all events within a content domain covered by the PERI-LE.
The PERI-LE distinguishes between platonic friendships (e.g. Social Activities domain) and intimate romantic relationships (e.g. Relationships domain). Results from this study show that different family environment dimensions correlate with perceptions of coping in each of these content domains. Pearson correlation coefficients indicated that patients felt they handled stressful life events in the platonic friendship domain better if they perceived their families to be higher in cohesion (r = .38, p < .01), expressiveness (r = .32, p < .05), independence (r = .37, p < .01), and organization (r = .32, p < .05) and lower in conflict (r = −.30, p < .05). Studies with non-psychiatric populations report that these same dimensions are associated with young adults’ self-confidence and social competence (Moos & Moos, 2009), suggesting that certain family environment variables can influence social self-efficacy regardless of whether an individual has schizophrenia. In contrast, patients felt they handled problematic romantic relationship events better if they perceived their families to be lower on achievement orientation (r = −.31, p < .05) and control (r = −.26, p < .05). Perhaps families help their relatives maintain a sense of confidence in managing problems with an intimate partner if they make fewer immediate demands on them to pursue goals related to job and school advancement. In sum, this study adds to the literature on how people experience social relationships during recovery from first-episode psychosis by discovering significant relationships between perceptions of the family environment and coping efforts for problems that arise in social relationships with friends and intimate partners.
Limitations of the study include the use of a cross-sectional design with correlational analyses, which make it difficult to make causal inferences. Future studies should evaluate the effects of family environment perceptions and coping with social stressors longitudinally.
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Denise Gretchen-Doorly, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Nicole R Detore, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Joseph Ventura, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Gerhard Hellemann, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Kenneth L. Subotnik, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
Keith H. Nuechterlein, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, and Department of Psychology, University of California, Los Angeles.