J Korean Neuropsychiatr Assoc.  2014 Nov;53(6):394-401. 10.4306/jknpa.2014.53.6.394.

The Relationship between Social Exclusion and Paranoid Ideation: Analysis of Moderating and Mediating Effects of Depression and Self-Esteem

• Kim BN
• Lee HS
• Yi JS
• Lee HP

• KMID: 2383329
• DOI: http://doi.org/10.4306/jknpa.2014.53.6.394

Abstract

OBJECTIVES
The aim of this study was to investigate the relationship between social exclusion and paranoid ideation, and to explore moderating and mediating effects of depression and self-esteem in that relationship.
METHODS
Ninety seven neurosis patients receiving treatment in a psychiatric outpatient setting were selected. Social Exclusion Scale, Beck Depression Inventory, paranoia scale of Symptom Checklist-90-Revised, and Rosenberg Self-Esteem Scale were used for evaluation.
RESULTS
Social exclusion showed highly positive correlation with paranoid ideation, and had significant influence. Among three types of social exclusion, contempt, bullying, and isolation, only isolation showed significant influence on paranoid ideation. Depression showed a partial mediating effect on that relationship indicating that social exclusion affects paranoid ideation not only directly, but also indirectly. On the other hand, self-esteem showed no moderating or mediating effects on that relationship.
CONCLUSION
Depression mediates the influence of social exclusion on paranoid ideation. This finding provides an opportunity to decrease paranoid ideation of neurosis patients by not only prescription of antipsychotic agents but also therapeutic approach to social exclusion and depression. An experimental study to verify these findings seems to be needed.

Keyword

Social exclusion; Social isolation; Paranoia; Depression; Self-esteem

MeSH Terms

Antipsychotic Agents
Bullying
Depression*
Hand
Humans
Negotiating*
Outpatients
Paranoid Disorders
Prescriptions
Social Isolation
Antipsychotic Agents

Figure

• 

  Fig. 1 Analysis of structural equation model. *: p<0.05, ***: p<0.01.

Reference

1. Freeman D. Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev. 2007; 27:425–457.

2. Sadock BJ, Sadock VA. Kaplan & Sadock's synopsis of psychiatry: beavioral sciences/clinical psychiatry. Philadelphia, PA: Lippincott Williams & Wilkins;2007. p. 281.

3. Sims A. Symptoms in the Mind. 3rd ed. Oxford: Elsevier Limited;2009. p. 183p. 482p. 496–497.

4. Freeman D, Garety PA, Bebbington PE, Smith B, Rollinson R, Fowler D, et al. Psychological investigation of the structure of paranoia in a non-clinical population. Br J Psychiatry. 2005; 186:427–435.

5. Freeman D, Gittins M, Pugh K, Antley A, Slater M, Dunn G. What makes one person paranoid and another person anxious? The differential prediction of social anxiety and persecutory ideation in an experimental situation. Psychol Med. 2008; 38:1121–1132.

6. Johnson J, Horwath E, Weissman MM. The validity of major depression with psychotic features based on a community study. Arch Gen Psychiatry. 1991; 48:1075–1081.

7. van Os J, Verdoux H, Maurice-Tison S, Gay B, Liraud F, Salamon R, et al. Self-reported psychosis-like symptoms and the continuum of psychosis. Soc Psychiatry Psychiatr Epidemiol. 1999; 34:459–463.

8. Hamner MB, Frueh BC, Ulmer HG, Arana GW. Psychotic features and illness severity in combat veterans with chronic posttraumatic stress disorder. Biol Psychiatry. 1999; 45:846–852.

9. Johns LC, Cannon M, Singleton N, Murray RM, Farrell M, Brugha T, et al. Prevalence and correlates of self-reported psychotic symptoms in the British population. Br J Psychiatry. 2004; 185:298–305.

10. Freeman D. Delusions in the nonclinical population. Curr Psychiatry Rep. 2006; 8:191–204.

11. Freeman D, McManus S, Brugha T, Meltzer H, Jenkins R, Bebbington P. Concomitants of paranoia in the general population. Psychol Med. 2011; 41:923–936.

12. Bae H, Kim D, Kim YS, Oh DY. Symptomatic correlates of interpersonal trauma in outpatients with anxiety disorders. J Korean Neuropsychiatr Assoc. 2008; 47:548–554.

13. Kwack YS, Lee HS. Relation between abuse history and psychopathology in runaway sheltered adolescents. J Korean Acad Child Adolesc Psychiatry. 2006; 17:149–162.

14. Sun YP, Zhang B, Dong ZJ, Yi MJ, Sun DF, Shi SS. Psychiatric state of college students with a history of childhood sexual abuse. World J Pediatr. 2008; 4:289–294.

15. Read J, Argyle N. Hallucinations, delusions, and thought disorder among adult psychiatric inpatients with a history of child abuse. Psychiatr Serv. 1999; 50:1467–1472.

16. Fuchs T. Life events in late paraphrenia and depression. Psychopathology. 1999; 32:60–69.

17. Son JW, Kim EJ, Hong SD, Lee SH, Hong KEM. The preliminary study on the adolescent psychiatric patients that show the chracteristics of peer group neglect or rejection. J Child Adolesc Psychiatry. 2000; 11:240–251.

18. Shin SW, Kwon SW, Shin MS, Cho SC. A survey of the psychosis among school violence victims. J Child Adolesc Psychiatry. 2000; 11:124–143.

19. Kwon KJ, Lee HP. The effect of social exclusion on the perceived self-utility toward kin. Korean J Soc Psychol. 2009; 23:27–45.

20. Ellett L, Lopes B, Chadwick P. Paranoia in a nonclinical population of college students. J Nerv Ment Dis. 2003; 191:425–430.

21. Fowler D, Freeman D, Smith B, Kuipers E, Bebbington P, Bashforth H, et al. The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychol Med. 2006; 36:749–759.

22. Martin JA, Penn DL. Social cognition and subclinical paranoid ideation. Br J Clin Psychol. 2001; 40(Pt 3):261–265.

23. Bentall RP, Rowse G, Shryane N, Kinderman P, Howard R, Blackwood N, et al. The cognitive and affective structure of paranoid delusions: a transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Arch Gen Psychiatry. 2009; 66:236–247.

24. Freeman D, Dunn G, Garety PA, Bebbington P, Slater M, Kuipers E, et al. The psychology of persecutory ideation I: a questionnaire survey. J Nerv Ment Dis. 2005; 193:302–308.

25. Chadwick PD, Trower P, Juusti-Butler TM, Maguire N. Phenomenological evidence for two types of paranoia. Psychopathology. 2005; 38:327–333.

26. Derogatis LR. SCL-90-R, administration, scoring & procedures manual-I for the revised version. Baltimore: Johns Hopkins University School of Medicine;1977.

27. Kim KI, Kim JH, Won HT. Korean manual of Symptom Checklist-90-Revision. Seoul: Jung Ang Juk Sung Publisher;1984.

28. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561–571.

29. Rhee MK, Lee YH, Park SH, Sohn CH, Chung YC, Hong SK, et al. A standardization study of Beck Depression Inventory I-Korean version (K-BDI): reliability and factor analysis. Korean J Psychopathol. 1995; 4:77–95.

30. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press;1965.

31. Bentler PM. Comparative fit indexes in structural models. Psychol Bull. 1990; 107:238–246.

32. Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995; 117:497–529.

33. Freeman D, Garety PA. Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behav Res Ther. 2003; 41:923–947.

34. Garety PA, Hemsley DR. Delusions: Investigations into the psychology of delusional reasoning. Oxford: Oxford University Press;1994.

35. Gerhard T, Akincigil A, Correll CU, Foglio NJ, Crystal S, Olfson M. National trends in second-generation antipsychotic augmentation for nonpsychotic depression. J Clin Psychiatry. 2014; 75:490–497.

36. Mihanović M, Restek-Petrović B, Bodor D, Molnar S, Oresković A, Presecki P. Suicidality and side effects of antidepressants and antipsychotics. Psychiatr Danub. 2010; 22:79–84.

37. Dadić-Hero E, Ruzić K, Medved P, Tatalović-Vorkapić S, Graovac M. Antipsychotic side-effect-potential risk of patients rejecting their treatments. Psychiatr Danub. 2010; 22:105–107.

38. Voruganti L, Awad AG. Neuroleptic dysphoria: towards a new synthesis. Psychopharmacology (Berl). 2004; 171:121–132.

39. Gervin M, Browne S, Garavan J, Roe M, Larkin C, O'Callaghan E. Dysphoric subjective response to neuroleptics in schizophrenia: relationship to extrapyramidal side effects and symptomatology. Eur Psychiatry. 1999; 14:405–409.

40. Buis W. Patients' opinions concerning side effects of depot neuroleptics. Am J Psychiatry. 1992; 149:844–845.

41. Thewissen V, Myin-Germeys I, Bentall R, de Graaf R, Vollebergh W, van Os J. Instability in self-esteem and paranoia in a general population sample. Soc Psychiatry Psychiatr Epidemiol. 2007; 42:1–5.