Clinical and demographic characteristics associated with residual symptom severity in remitted first-episode psychosis

Background Although 40%–60% of patients with schizophrenia achieve symptomatic remission, residual symptoms often persist. Negative symptoms are associated with poorer functioning and quality of life. Determinants of residual symptom severity in remitted first-episode psychosis remain insufficiently understood, and identifying these factors may inform interventions to reduce burden. Methods We conducted a cross-sectional analysis using data from HAMLETT, a multicentre randomised controlled trial of remitted first-episode psychosis patients. The primary measure was the Positive and Negative Syndrome Scale (PANSS). Additional measures were the negative PANSS subscale and Global Assessment of Functioning (GAF). Associations with clinical and demographic characteristics were examined using linear regression analyses. Results 368 participants (70% male, 30% female) were analysed. Mean ( SD ) total PANSS, negative PANSS subscale, and GAF scores were 44.9 (10.2), 12.2 (4.2), and 64.7 (12.0), respectively. Only socioeconomic status (SES) was significantly associated with clinical measures: higher SES was associated with lower total PANSS ( B = −0.077, 95% CI [−0.107, −0.047], p < .001), lower negative PANSS subscale ( B = −0.137, 95% CI [−0.183, −0.090], p < .001), and higher GAF ( B = 4.57, 95% CI [2.89, 6.24], p < .001). No other significant associations were observed. Conclusions Within a remitted first-episode psychosis population, we found that a lower socioeconomic status was associated with more residual symptoms and poorer functioning. This finding underscores the importance of addressing social determinants of health in early psychosis care, even after symptomatic remission. Future longitudinal research should test whether addressing socioeconomic needs improves outcomes in remitted first-episode psychosis.