Associations between social engagement, internalizing symptoms, and delusional ideation in the general population

Abstract

Abstract Background: Delusions are a hallmark feature of psychotic disorders and lead to significant clinical and functional impairment. Internalizing symptoms— such as symptoms of depression, anxiety, and trauma exposure—are commonly cited to be related to delusions and delusional ideation and are often associated with deficits in social functioning. While emerging studies are investigating the impact of low social engagement on psychotic-like experiences, little work has examined the relationship between social engagement, internalizing symptoms, and delusional ideation, specifically. Methods: Using general population data from the Nathan Kline Institute-Rockland (NKI-Rockland) database (N=526), we examined the relationships between self-reported delusional ideation, internalizing symptoms, and social engagement and tested four indirect effect models to understand how these factors interrelate. Results: Delusional ideation was significantly associated with both increased internalizing symptoms (r=0.41, p<0.001) and lower social engagement (r=-0.14, p=0.001). Within aspects of social engagement, perceived emotional support showed the strongest relationship with delusional ideation (r=-0.17, p<0.001). Lower social engagement was also significantly associated with increased internalizing symptoms (r=-0.29, p<0.001). Cross-sectional models suggest that internalizing symptoms have a significant indirect effect on the association between delusional ideation and social engagement. Conclusions: These findings reveal that elevated delusional ideation in the general population is associated with lower social engagement. Elevated internalizing symptoms appear to play a critical role in reducing engagement, possibly exacerbating delusional thinking. Future work should examine the causal and temporal relationships between these factors.