The intersection of structural social factors, loneliness, and social activity in individuals with psychotic disorders.

Background: People with psychotic disorders are disproportionately lonely, which is associated with negative health outcomes. Structural and subjective factors determine social connectedness, and ecological momentary assessment (EMA) enables simultaneous quantification of social activity. However, how structural factors (e.g., relationship status, living situation) and sociodemographic variables moderate the relationship between social activity and loneliness in psychosis is unknown.

Methods: N = 253 participants with a psychotic disorder completed the UCLA Loneliness Scale. Social activity was subsequently measured with EMA smartphone surveys 3×/day for 10 days. We assessed main effects of sociodemographic variables on structural factors, loneliness, and EMA-derived social activity (time alone, in interactions, at home). We then evaluated moderation effects of sociodemographic and structural factors on the relationship between loneliness and social activity.

Results: There were no main effects of sociodemographic or structural factors on loneliness. Unemployed participants answered more surveys at home. Those who were single, not Latino/a/x/e, and living alone answered more surveys alone. Not interacting with others was linked to having a schizophrenia spectrum disorder (vs. mood disorder with psychosis), being unemployed, being single, and living alone. Associations between loneliness and social activity were modest. Moderator analyses revealed stronger relationships between loneliness, being at home, and not interacting with others for older and financially dependent participants.

Conclusions: Relationships between loneliness and social activity may vary by structural factors in psychotic disorders. These findings suggest that researchers and clinicians should consider social context when measuring social activity. Interventions targeting social activity may more effectively reduce loneliness in subgroups of psychotic disorders.