Association Between Social and Role Functioning and Transition to Psychosis in the North American Prodrome Longitudinal Study Consortium

Schizophr Bull. 2026 Jul 3;52(4):sbaf258. doi: 10.1093/schbul/sbaf258.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Functional deficits during adolescence have proved to be important risk factors for later psychosis at 2 to 3-year follow-up. The aim of the current study was to evaluate whether social and role functioning in clinical high-risk (CHR) youth is associated with transition to psychosis.

STUDY DESIGN: Data from the North American Prodrome Longitudinal Studies (NAPLS 2, NAPLS 3) were combined with outcome data from the NAPLS Long-Term Follow-up study to assess the relationship between baseline social and role functioning and later transition to psychosis. Participants included 1474 CHR individuals from NAPLS 2 (n = 764) and NAPLS 3 (n = 710), of whom 198 (13%) are known to have transitioned to psychosis.

STUDY RESULTS: Individuals who later transitioned to psychosis had more severe positive and negative symptoms and poorer social and role functioning at baseline compared to those who did not. Higher baseline social and role functioning was significantly associated with a reduced hazard of transition (HR = 0.864, P = .0013; HR = 0.898, P = .0004, respectively), whereas a decline in social and in role functioning was significantly associated with an increased hazard of transition (HR = 1.229, P = .0013; HR = 1.124, P = .002, respectively).

CONCLUSIONS: These results underscore the significance of social and role functioning in predicting subsequent transition to psychosis in CHR participants, suggesting an underlying vulnerability that is possibly independent of clinical symptoms. Early intervention that includes a focus on social and role functioning in high-risk youth may reduce the risk of future functional disability and perhaps a later psychotic episode.

PMID:42580708 | DOI:10.1093/schbul/sbaf258