An ecological momentary assessment of the dynamic relationship between microaggression, idea of reference and affects in patients with first-episode psychosis

Background: Microaggression is the subtler and milder form of stigma that may be faced by patients with psychosis in everyday life. Momentary affective states and referential ideations may play a role in the processing of microaggression. The current study examined the relationship between microaggression, momentary affective states, and Ideas of Reference (IoR) in patients with first-episode psychosis. Methods: Experience Sampling Method (ESM) with 28 time points across a two-week study period was adopted. All participants had face-to-face clinical assessment at baseline. ESM data was analysed using both multiple regression models and data-driven Causal Discovery Analysis (CDA), which provide both group level and individual level analysis. Thirty-six participants that completed at least 60% of the assessment time points were included for analysis. Results: The multilevel regressions suggested that IoR and negative affects were significantly associated with microaggression. There is also a trend to significance between positive affect and microaggression. The CDA identified two causal pathways leading to microaggressions. One pathway was having more negative affects (sad, stressed, irritable) leads to more IoR experience which then leads to microaggression. The other pathway was through reduced positive affects (happy and relaxed). High heterogeneity was shown in the causal pathways leading to microaggression when personal causal models were examined. Conclusion: These results suggested that negative affects and the presence of IoR may influence their perception of microaggressive experiences. The study allows a better understanding of the role of different factors in the processing of microaggression experiences and facilitates the development of tailored intervention strategies for individuals facing microaggression.