Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Jan 19, 2021; 11(1): 13-26
Published online Jan 19, 2021. doi: 10.5498/wjp.v11.i1.13
What gets in the way of social engagement in schizophrenia?
Lauren P Weittenhiller, Megan E Mikhail, Jasmine Mote, Timothy R Campellone, Ann M Kring
Lauren P Weittenhiller, Megan E Mikhail, Jasmine Mote, Timothy R Campellone, Ann M Kring, Department of Psychology, University of California, Berkeley, CA 94720, United States
Megan E Mikhail, Department of Psychology, Michigan State University, East Lansing, MI 48824, United States
Jasmine Mote, Department of Occupational Health, Tufts University, Medford, MA 02155, United States
Author contributions: Mote J, Campellone TR, and Kring AM were involved in the conception of the study; Weittenhiller LP, Mikhail ME, and Kring AM contributed to the study design and coding manual development; Weittenhiller LP and Mikhail ME conducted didactic trainings and managed coding implementation; Weittenhiller LP performed the analyses and wrote the initial drafts of the manuscript with significant contributions made by Kring AM; all authors edited and approved the final version of the manuscript.
Supported by National Science Foundation Graduate Research Fellowship Program, No. 1752814.
Institutional review board statement: The study was approved by the University of California, Berkeley Institutional Review Board.
Informed consent statement: All study participants provided informed written consent.
Conflict-of-interest statement: None declared.
Data sharing statement: Data available on request from the corresponding author at
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Lauren P Weittenhiller, MA, Academic Research, Department of Psychology, University of California, 2121 Berkeley Way No. 1650, Berkeley, CA 94720, United States.
Received: October 23, 2020
Peer-review started: October 23, 2020
First decision: December 4, 2020
Revised: December 16, 2020
Accepted: December 27, 2020
Article in press: December 27, 2020
Published online: January 19, 2021

Social engagement-important for health and well-being-can be difficult for people with schizophrenia. Past research indicates that despite expressing interest in social interactions, people with schizophrenia report spending less time with others and feeling lonely. Social motivations and barriers may play an important role for understanding social engagement in schizophrenia.


To investigate how people with schizophrenia describe factors that impede and promote social engagement.


We interviewed a community sample of people with (n = 35) and without (n = 27) schizophrenia or schizoaffective disorder about their social interactions with friends and family over the past week and planned social activities for the coming week. We reviewed the interview transcripts and developed a novel coding system to capture whether interactions occurred, who had initiated the contact, and frequency of reported social barriers (i.e., internal, conflict-based, logistical) and social motivations (i.e., instrumental, affiliative, obligation-based). We also assessed symptoms and functioning.


People with schizophrenia were less likely than people without schizophrenia to have spent time with friends [t (51.04) = 2.09, P = 0.042, d = 0.51)], but not family. People with schizophrenia reported more social barriers than people without schizophrenia [F (1, 60) = 10.55, P = 0.002, ηp2 = 0.15)] but did not differ in reported social motivations. Specifically, people with schizophrenia reported more internal [t (45.75) = 3.40, P = 0.001, d = 0.83)] and conflict-based [t (40.11) = 3.03, P = 0.004, d = 0.73)] barriers than people without schizophrenia. Social barriers and motivations were related to real-world social functioning for people with schizophrenia, such that more barriers were associated with more difficulty in close relationships (r = -0.37, P = 0.027) and more motivations were associated with better community functioning (r = 0.38, P = 0.024).


These findings highlight the importance of assessing first person accounts of social barriers and motivations to better understand social engagement in schizophrenia.

Keywords: Social engagement, Schizophrenia, Social motivation, Social barriers

Core Tip: We examined factors that may impede and promote social engagement in schizophrenia. We coded social barriers and motivations from transcribed negative symptoms interviews. We found that barriers, such as conflicts with other people or negative beliefs about the self, were prominent in schizophrenia. Interestingly, when explicitly prompted, people with schizophrenia reported interest in and motivation for social interactions. Nevertheless, social barriers may get in the way of them following through.