Premorbid social relationships and the course of schizophrenia in a 20-year follow-up study.

Objectives: An important dimension indicating a growing risk of psychosis outbreak and its subsequent unfavorable course is deteriorating social functioning, especially the lack of sufficient social relationships. The aim of the study was to evaluate the association of the quality of social contacts and the scope of support system before the onset of the illness with treatment outcomes in clinical and social dimension in various time intervals of the 20-year illness course.

Methods: During the first hospitalization, an 80-person group living in Krakow and suffering from schizophrenia was selected, diagnosed according to DSM-IV-TR criteria and examined six times: at admission and discharge during first hospitalization, after 3, 7, 12 and 20 years. The analysis involved 55 persons (69% of the group included to the study) who went through all the examinations over a period of 20 years. Two-factor analysis of variance was used with one grouping factor (social contacts) and one repeated measures factor (follow-ups) for the results of GAF, BPRS, DSM-III Axis V and a series of simple linear regressions for the associations between these outcome indicators and the Surtees' Index of Social Support.

Results: Satisfactory, positive contacts before the outbreak of the illness translated, especially after 20 years, into better general and social functioning and fewer symptoms, especially negative ones. Awider social support before the outbreak was associated with better general and social functioning of patients and lesser severity of general, positiveand negative symptoms; however, in this last case the effect disappeared after 20 years.

Conclusions: The quality and scope of social contacts before the outbreak of the illness, especially satisfactory relationship in non-familial milieu, are an important prognostic factor of amany-year beneficial clinical and social course of psychoses from the schizophrenia group.