Social Decline a Predictor of Conversion Outcome in High-Risk Individuals

Social decline may be an effective predictor of conversion outcome in clinically high-risk individuals.

Social decline can be an effective predictor of conversion outcome in clinically high-risk individuals, according to a study published in Schizophrenia Bulletin.

The study sought to validate the Global Functioning (GF) Scales (social and role) in a large sample of clinical high-risk individuals. This study utilized data acquired as part of the multisite North American Prodrome Longitudinal Study (n=1042) of which 764 participants were identified as clinical high-risk and 278 participants were identified as healthy controls, within the age range 12 to 35 years. A comprehensive baseline clinical assessment was conducted using the Structured Clinical Interview for DSM-IV (SCID-I), Structured Interview for Prodromal Syndromes (SIPS), Scale of Prodromal Symptoms (SOPS), the Calgary Depression Scale for Schizophrenia (CDSS), and Premorbid Adjustment Scale (PAS). Participants were assessed on the social and role functioning with the GF:Social and GF:Role scales. Demographics between the control and clinically high-risk participants were comparable, except the clinical high-risk group was slightly male dominant (P =.05).

The researchers showed control participants were older, more educated, and had “higher estimated premorbid and current IQ scores.” Clinically high-risk participants “had significantly higher levels of SOPS rated attenuated positive, negative, disorganized, general symptoms” and higher CDSS scores as well as lower Global Assessment of Functioning (GAF) scores. Both GF:Social and GF:Role scales showed no correlation between item and total scores on SOPS or CDSS within the clinical high-risk cohort. Correlational data varied between items. Over time, the clinical high-risk participants showed a consistent impairment in social and role functioning (<.001 for both). There was a trend difference in role functioning (P =.051) between converters and non-converters. In terms of the distribution of social decline, “a majority of the non-converters (57.4%) showed no social decline” compared with a lower proportion of converters (44.7%, P =.010). As for role decline, 45.6% of non-converters compared with 39.4% converters showed no decline in role.

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The authors noted the following 4 study limitations: first, lack of examination of the treatment impact on functioning changes over time; second, the lack of a single overall score from the GF scales; third, the lack of allowance for parsing of functionally-relevant components; and last, the timeframe (6-month assessment) of conversions.

These findings suggest in that social decline can be an effective predictor of conversion outcome in clinical high-risk individuals.

Dr. Cannon reports associations with the pharmaceutical industry. Please see original reference for a full list of author’s disclosures.


Carrión RE, Auther AM, McLaughlin D, et al. The Global Functioning: Social and Role scales—further validation in a large sample of adolescents and young adults at clinical high risk for psychosis [published online October 22, 2018]. Schizophr Bull. doi: 10.1093/schbul/sby126