The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

Ma, Ruimin; Mann, Farhana; Wang, Jingyi; Lloyd‐Evans, Brynmor; Terhune, James; Al-Shihabi, Ahmed; Johnson, Sonia

doi:10.1007/s00127-019-01800-z

Cited by 130 publications

(156 citation statements)

References 105 publications

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“…In the wider literature on approaches to addressing loneliness among people with mental health problems, changing cognitions to shift maladaptive cognitions is viewed as most promising, but lacks a robust evidence base [68]. Amongst trials of interventions to improve subjective and/or objective social isolation for people with mental health problems, again the most promising interventions include cognitive modification for subjective social isolation, as well as interventions with mixed strategies and supported socialisation for objective social isolation [69]. More research is needed to develop and assess the acceptability of interventions that address cognitions about social engagement among young people with mental health problems, before trialling them rigorously.…”

Section: Future Researchmentioning

confidence: 99%

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

Achterbergh

Pitman

Birken³

et al. 2020

BMC Psychiatry

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151

107

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Background: Young people have a higher prevalence of loneliness than other age groups, and they are also at risk of depression. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. Little is known about the experience of loneliness among young people with depression. Qualitative approaches may help understand the relationship between loneliness and depression among young people, and how to intervene to improve outcomes. We aimed to conduct a meta-synthesis to understand the complex interrelationship between loneliness and depression among young depressed people by synthesising evidence from a systematic review of qualitative studies. Methods: We conducted a meta-synthesis of qualitative studies capturing experiences of loneliness among young people with depression. We systematically searched six electronic databases for selected search terms, critically appraised eligible studies, and analysed the data from included studies using the approach of thematic synthesis. We used feedback from an inter-disciplinary research workshop to improve reflexivity. Results: Our inclusion criteria identified fourteen studies. Our analysis identified four themes: (1) social withdrawal due to poor mental health, (2) non-disclosure of depression contributing to social distance, (3) the desire to connect, and (4) paradoxes of loneliness and depression. These themes illustrated a range of pathways between depression and loneliness, and a sense of how these might be mutually reinforcing. Our findings suggest that where depressed individuals engage in certain behaviours (withdrawing; not confiding) for a range of reasons, this can lead to feelings of loneliness, an awareness of which worsens their mood, thus perpetuating their depression. Conclusions: Young people with depression experience loneliness as an insurmountable distance between themselves and others. Our findings identified non-disclosure of depression, and the debilitating nature of the depressive symptomatology, as factors perpetuating a vicious cycle of loneliness and depression. They suggest that approaches to tackling the problem might include helping young people communicate about their depression to trusted friends and educating their social networks in how to support them. The wider research literature suggests that cognitive interventions may have a role in shifting maladaptive cognitions about their social world.

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Section: Future Researchmentioning

confidence: 99%

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

Achterbergh

Pitman

Birken³

et al. 2020

BMC Psychiatry

Self Cite

151

107

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“…Participants recommended that increasing opportunities for social interactions and linking people back to their communities are potentially promising in alleviating loneliness for service users with early psychosis. These views are not fully in line with preliminary evidence indicating that addressing maladaptive cognitions might be more bene cial than increasing social participation for reducing feelings of loneliness (20,29,30). Digital technology was also seen as having potential for the alleviation of loneliness, with scope for online lives to be addressed more than at present in the work of EIS.…”

Section: Discussionmentioning

confidence: 93%

“…To date, an evidence-based intervention for loneliness in psychosis has not been developed (20,28,29).…”

Section: Introductionmentioning

confidence: 99%

“…Some strategies for loneliness have been developed in other populations and are a potential source for approaches to address loneliness among people with psychosis. While cognitive approaches show some promise, no interventions for loneliness have clearly demonstrated effectiveness, and only few have been tested with people with psychosis (29,30). Moreover, increasing social contact in itself might not be enough to reduce loneliness and improve personal and health outcomes in early psychosis (31).…”

Section: Introductionmentioning

confidence: 99%

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Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

Stefanidou

Wang

Morant

et al. 2020

Preprint

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Background: Loneliness is an important public health problem with established adverse effects on physical and mental health. Although, people with psychosis often experience high levels of loneliness, relatively little is known about the relationship between loneliness and early psychosis. Potential interventions to address loneliness might be easier to implement early in the illness when social networks and social skills may be more intact than at a later stage. We investigated the views of mental health practitioners about the context and causes of loneliness in people with early psychosis, and about potential interventions.Methods: Semi-structured face-to-face interviews were conducted with mental health practitioners (n=20). Participants were purposively recruited from four early intervention services for first-episode psychosis in the UK. Interviews were transcribed verbatim and thematic analysis was conducted.Results: Participants believed that the majority of service users with early psychosis experience feelings of loneliness. They often saw socially isolated and disconnected clients and believed them to be lonely, but rarely discussed loneliness explicitly in clinical interactions. A combination of symptoms, stigma and negative sense of self were believed to underpin loneliness. Participants could not identify any specific current interventions delivered by their services for tackling loneliness, but thought some routinely provided interventions, including social groups and psychological treatments, could be helpful. They favoured making a wider range of loneliness interventions available and believed that community agencies beyond mental health services should be involved to make these effective and feasible to deliver. They suggested social participation interventions without an explicit mental health focus as potentially promising and valued a co-produced approach to intervention development. Conclusions: This study suggests that loneliness is not routinely discussed in early intervention services, and a targeted strategy for tackling it is lacking. Co-produced, individualised community approaches, and interventions that target symptoms, stigma and negative self-schemas might be beneficial in alleviating loneliness for people with early psychosis. Empirical research is needed to develop and test such interventions.

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“…In the wider literature on approaches to addressing loneliness among people with mental health problems, changing cognitions to shift maladaptive cognitions is viewed as most promising, but lacks a robust evidence base (67). Amongst trials of interventions to improve subjective and/or objective social isolation for people with mental health problems, again the most promising interventions include cognitive modi cation for subjective social isolation, as well as interventions with mixed strategies and supported socialisation for objective social isolation (68). More research is needed to develop and assess the acceptability of interventions that address cognitions about social engagement among young people with mental health problems, before trialling them rigorously.…”

Section: Future Researchmentioning

confidence: 99%

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

Achterbergh

Pitman

Birken

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Young people have a higher prevalence of loneliness than other age groups, and they are also at risk of depression. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. Little is known about the experience of loneliness among young people with depression. Qualitative approaches may help understand the relationship between loneliness and depression among young people, and how to intervene to improve outcomes. We aimed to conduct a meta-synthesis to understand the complex inter-relationship between loneliness and depression among young depressed people by synthesising evidence from a systematic review of qualitative studies.Methods: We conducted a meta-synthesis of qualitative studies capturing experiences of loneliness among young people with depression. We systematically searched six electronic databases for selected search terms, critically appraised eligible studies, and analysed the data from included studies using the approach of thematic synthesis. We used feedback from an inter-disciplinary research workshop to improve reflexivity. Results: Our inclusion criteria identified fourteen studies. Our analysis identified four themes: (1) social withdrawal due to poor mental health, (2) non-disclosure of depression contributing to social distance, (3) the desire to connect, and (4) paradoxes of loneliness and depression. These themes illustrated a range of pathways between depression and loneliness, and a sense of how these might be mutually reinforcing. Our findings suggest that where depressed individuals engage in certain behaviours (withdrawing; not confiding) for a range of reasons, this can lead to feelings of loneliness, an awareness of which worsens their mood, thus perpetuating their depression. Conclusions: Young people with depression experience loneliness as an insurmountable distance between themselves and others. Our findings identified non-disclosure of depression, and the debilitating nature of the depressive symptomatology, as factors perpetuating a vicious cycle of loneliness and depression. They suggest that approaches to tackling the problem might include helping young people communicate about their depression to trusted friends and educating their social networks in how to support them. The wider research literature suggests that cognitive interventions may have a role in shifting maladaptive cognitions about their social world.

show abstract

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

Cited by 130 publications

References 105 publications

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

Loneliness in early psychosis: A qualitative study exploring the views of mental health practitioners in early intervention services

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

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