What gets in the way of social engagement in schizophrenia?

BACKGROUND: Social engagement-important for health and well-being-can be difficult for people with schizophrenia. Past research indicates that despite expressing interest in social interactions, people with schizophrenia report spending less time with others and feeling lonely. Social motivations and barriers may play an important role for understanding social engagement in schizophrenia. AIM: To investigate how people with schizophrenia describe factors that impede and promote social engagement. METHODS: We interviewed a community sample of people with (n = 35) and without (n = 27) schizophrenia or schizoaffective disorder about their social interactions with friends and family over the past week and planned social activities for the coming week. We reviewed the interview transcripts and developed a novel coding system to capture whether interactions occurred, who had initiated the contact, and frequency of reported social barriers (i.e., internal, conflict-based, logistical) and social motivations (i.e., instrumental, affiliative, obligation-based). We also assessed symptoms and functioning. RESULTS: People with schizophrenia were less likely than people without schizophrenia to have spent time with friends [t (51.04) = 2.09, P = 0.042, d = 0.51)], but not family. People with schizophrenia reported more social barriers than people without schizophrenia [F (1, 60) = 10.55, P = 0.002, ηp2 = 0.15)] but did not differ in reported social motivations. Specifically, people with schizophrenia reported more internal [t (45.75) = 3.40, P = 0.001, d = 0.83)] and conflict-based [t (40.11) = 3.03, P = 0.004, d = 0.73)] barriers than people without schizophrenia. Social barriers and motivations were related to real-world social functioning for people with schizophrenia, such that more barriers were associated with more difficulty in close relationships (r = -0.37, P = 0.027) and more motivations were associated with better community functioning (r = 0.38, P = 0.024). CONCLUSION: These findings highlight the importance of assessing first person accounts of social barriers and motivations to better understand social engagement in schizophrenia.