Predictors of long-term social functioning in young people with emerging severe mental illness and social disability: a systematic review and secondary analysis of data from the PRODIGY trial

Rammou, Aikaterini (2025) Predictors of long-term social functioning in young people with emerging severe mental illness and social disability: a systematic review and secondary analysis of data from the PRODIGY trial. Doctoral thesis, University of East Anglia.

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Abstract

Background
Young people experiencing emerging severe mental illness and social disability are at heightened risk for enduring impairments in social functioning. However, predictors of long-term functional outcomes remain poorly understood, particularly across diagnoses. This thesis aimed to identify predictors of social functioning in youth with significant mental health difficulties and social disability.

Method
This thesis comprised two components: (1) a systematic review of longitudinal studies on predictors of socio-occupational functioning in individuals aged 16–25 with complex and/or severe mental illness; and (2) an empirical study examining functioning trajectories and associated baseline predictors through secondary data analysis.

Results
The systematic review identified 24 studies. Consistent predictors of poor functioning included negative symptoms, cognitive impairment, vocational disengagement, and duration of untreated psychosis. In contrast, evidence for demographic and biological predictors was limited and inconsistent. Building on these findings, the empirical study used data from the PRODIGY trial, a multi-site randomised controlled trial evaluating Social Recovery Therapy in young people with emerging severe mental illness and social disability. Latent class growth analysis identified three distinct social functioning trajectories over 24 months: stable low, moderate improvement, and increasing overactive. Higher levels of avolition and being Not in Education, Employment, or Training (NEET) at baseline significantly predicted membership in the stable low functioning group. 2

Conclusion
This thesis examined the course and predictors of long-term social functioning in young people with emerging severe mental illness, using a transdiagnostic lens. Findings highlight NEET status and negative symptoms, particularly avolition, as key markers of risk for persistent social disability. This disability extends beyond psychotic disorders and often persists despite receiving mental health care, underscoring the need for early, targeted, function-focused care. These findings support a shift in youth mental health care toward prioritising social recovery alongside symptom management to promote sustained and meaningful outcomes.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Nicola Veasy
Date Deposited:	27 Oct 2025 15:18
Last Modified:	27 Oct 2025 15:18
URI:	https://ueaeprints.uea.ac.uk/id/eprint/100795
DOI:

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