Causal pathways to social and occupational functioning in the first episode of schizophrenia: Uncovering unmet treatment needs

Kathleen Miley, Piper Meyer-Kalos, Sisi Ma, David J. Bond, Erich Kummerfeld, Sophia Vinogradov

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5 Scopus citations


Background We aimed to identify unmet treatment needs for improving social and occupational functioning in early schizophrenia using a data-driven causal discovery analysis. Methods Demographic, clinical, and psychosocial measures were obtained for 276 participants from the Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) trial at baseline and 6-months, along with measures of social and occupational functioning from the Quality of Life Scale. The Greedy Fast Causal Inference algorithm was used to learn a partial ancestral graph modeling causal relationships across baseline variables and 6-month functioning. Effect sizes were estimated using a structural equation model. Results were validated in an independent dataset (N = 187). Results In the data-generated model, greater baseline socio-affective capacity was a cause of greater baseline motivation [Effect size (ES) = 0.77], and motivation was a cause of greater baseline social and occupational functioning (ES = 1.5 and 0.96, respectively), which in turn were causes of their own 6-month outcomes. Six-month motivation was also identified as a cause of occupational functioning (ES = 0.92). Cognitive impairment and duration of untreated psychosis were not direct causes of functioning at either timepoint. The graph for the validation dataset was less determinate, but otherwise supported the findings. Conclusions In our data-generated model, baseline socio-affective capacity and motivation are the most direct causes of occupational and social functioning 6 months after entering treatment in early schizophrenia. These findings indicate that socio-affective abilities and motivation are specific high-impact treatment needs that must be addressed in order to promote optimal social and occupational recovery.

Original languageEnglish (US)
JournalPsychological medicine
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
This work was supported by National Institute of Mental Health Grants 1R03MH117254-01A1, P50MH119569, and 1F31MH124278. Additionally, this research was supported by the National Institutes of Health' National Center for Advancing Translational Sciences, Grants TL1R002493 and UL1TR002494. EK received support for this work from the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funding Information:
Drs. Ma and Kummerfeld and Ms. Miley report no financial relationships with commercial interests. Dr Meyer-Kalos has received consulting fees from the NAVIGATE program for first episode psychosis and Dr Bond has received consulting fees and/or research grants from Alkermes PLC, Myriad Genetics, and NuBiyota. Dr Vinogradov serves on the Scientific Advisory Boards for the following organizations: Mindstrong, Inc., Alkermes, Inc., and Psyberguide. She also has scientific collaborations with scientists at PositScience, Inc.

Publisher Copyright:
Copyright © The Author(s), 2021. Published by Cambridge University Press.


  • Early schizophrenia
  • causal discovery
  • functional outcomes
  • machine learning
  • motivation
  • social cognition


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