Together alone: Social dysfunction in neuropsychiatric disorders

Ilja Maria Josephien Saris

    Research output: PhD ThesisPhD-Thesis - Research and graduation internal

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    In chapter 2, we examined social functioning among 2952 NESDA-participants (healthy controls N=650, individuals remitted from anxiety and/or depressive disorder N=621, patients with anxiety disorder only N=540, depressive disorder only N=393 or comorbid anxiety and depressive disorders N=748) using affective and behavioral indicators. We found significant social dysfunction in patients with anxiety disorders, and to an even higher degree in those with depressive disorders, and most prominently in patients with comorbid anxiety and depressive disorders. In addition, our study also showed that both affective and behavioral aspects of social dysfunction were compromised, with affective aspects being the more severely impaired in all groups as compared to healthy controls. The affective indicators loneliness and perceived social disability, in addition to the behavioral indicator social network size, showed the largest effect sizes for the patients with comorbid anxiety and depression, as compared to healthy controls (Cohen’s d ranging from 0.81- 1.76). We also described that even after remission of affective psychopathology, residual impairments in social functioning tended to remain in social network size, social support, loneliness, and perceived social disability. Importantly, we also established that perceived social disability among patients is predictive of a depressive and/or anxiety diagnosis as much as two years later. Chapter 3 describes social dysfunction in schizophrenia and Alzheimer’s disease patients (N=164) using behavioral and affective indicators of social dysfunction. Building on the findings of the NESDA study described above, we used perceived social disability and loneliness as affective indicators of social dysfunction, and we added a rater-perceived social disability questionnaire. The individual subscales of the Social Functioning Scale and its total score were used as behavioral indicators of social dysfunction. In this PRISM sample, both SZ (N=56) and AD (N=50) patients exhibited more social dysfunction when compared with age- and sex matched HC participants (HC younger N=29; HC older N=28). As compared to HC, both behavioral and affective social functioning were poorer in SZ patients (Cohens d’s 0.81-1.69), whereas AD patients exhibited poorer behavioral social function (Cohen’s d’s 0.65-1.14). Comparing the patient groups exclusively, we found that the behavioral aspects of social functioning were fairly similar, with the affective indices being less favorable for the SZ patients, who were found to have greater feelings of loneliness and perceived social disability than did the AD patients. Chapter 4 examines whether DMN connectional integrity among MDD patients (N=74) covaries with individual scores on an integrated social dysfunction composite, composed of behavioral and affective features. Building on findings described above, we used the network size as behavioral indicator and we used perceived social disability and loneliness as our affective indicators of social dysfunction. The analyses cautiously linked greater social dysfunction among MDD patients to diminished DMN connectivity, specifically within the rostromedial prefrontal cortex and posterior superior frontal gyrus. These effects were most prominent when high and low social dysfunctioning MDD groups were compared, with the dimensional effects being more subtle. In chapter 5, we explored DMN integrity as a function of social dysfunction among SZ (N=48) and AD (N=47) patients, as well as age-matched healthy controls (HC; N=55). Social dysfunction was operationalized using the SFS as behavioral indicator of social dysfunction and loneliness as an affective indicator. Our analyses interestingly showed that affective and behavioral indicators of social dysfunction are independently associated with diminished DMN connectional integrity, specifically within rostromedial prefrontal subterritories of the DMN. The combined average effect of these indicators on diminished DMN connectivity was even more pronounced (both spatially and statistically), comprising large sections of rostromedial and dorsomedial prefrontal cortex.
    Original languageEnglish
    Awarding Institution
    • Vrije Universiteit Amsterdam
    • Penninx, B.W.J.H., Supervisor
    • Aghajani, M., Co-supervisor, External person
    Award date13 Oct 2021
    Place of Publications.l.
    Print ISBNs9789090350721
    Publication statusPublished - 13 Oct 2021


    • Social dysfunction, affective disorders, schizophrenia, Alzheimer's disease, Default Mode Network


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