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J Med Internet Res. 2019 Jun 28;21(6):e13957. doi: 10.2196/13957.

Social Media and Social Functioning in Psychosis: A Systematic Review.

Author information

Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway.
Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway.
Norsk Lærer Akademi, University College, Bergen, Norway.
School of Medicine, Yale University, New Haven, CT, United States.
Institution for Social and Policy Studies, Yale University, New Haven, CT, United States.
Network for Medical Sciences, Faculty of Health, University of Stavanger, Stavanger, Norway.
Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, Oslo, Norway.
School of Social and Health Sciences, Leeds Trinity University, Leeds, United Kingdom.
Department of Psychosocial Science, University of Bergen, Bergen, Norway.
Contributed equally



Individuals with psychosis are heavy consumers of social media. It is unknown to what degree measures of social functioning include measures of online social activity.


To examine the inclusion of social media activity in measures of social functioning in psychosis and ultrahigh risk (UHR) for psychosis.


Two independent authors conducted a search using the following electronic databases: Epistemonikos, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, MEDLINE, Embase, and PsycINFO. The included articles were required to meet all of the following criteria: (1) an empirical study published in the English language in a peer-reviewed journal; (2) the study included a measure of objective or subjective offline (ie, non-Web-mediated contact) and/or online social functioning (ie, Web-mediated contact); (3) the social functioning measure had to be used in samples meeting criteria (ie, Diagnostic and Statistical Manual of Mental Disorders or International Classification of Diseases) for a psychotic disorder or UHR for psychosis; and (4) the study was published between January 2004 and February 2019. Facebook was launched as the first large-scale social media platform in 2004 and, therefore, it is highly improbable that studies conducted prior to 2004 would have included measures of social media activity.


The electronic search resulted in 11,844 distinct articles. Full-text evaluation was conducted on 719 articles, of which 597 articles met inclusion criteria. A total of 58 social functioning measures were identified. With some exceptions, reports on reliability and validity were scarce, and only one measure integrated social media social activity.


The ecological validity of social functioning measures is challenged by the lack of assessment of social media activity, as it fails to reflect an important aspect of the current social reality of persons with psychosis. Measures should be revised to include social media activity and thus avoid the clinical consequences of inadequate assessment of social functioning.


International Prospective Register of Systematic Reviews (PROSPERO) CRD42017058514;


assessment; measures; psychosis; schizophrenia; social functioning; social media; systematic review

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