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

Abstract

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, but qualitative approaches help understand the relationship between loneliness and depression, 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 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.

Adolescent perspectives on depression as a disease of loneliness: a qualitative study with youth and other stakeholders in urban Nepal

“…A recent qualitative study of adolescent depression in Brazil found that depression was characterized by "a feeling of detachment from others resulting from the sensation that usual interactions did not have the same meaning as before. " [20] It is also interesting that in a recent meta-synthesis of qualitative studies on adolescent depression from high-income countries (HIC), loneliness was found to be the most salient aspect of experience as well [47]. The findings from that review align with results of this current study in some key areas.…”

“…Adolescents from HIC shared similar strong feelings of wanting to be alone, and the inability or unwillingness to share their problems, which mirror the experiences of Nepali and Brazilian youth. Achterbergh and colleagues [47] also find that adolescents from HIC retain a desire to connect to others, especially friends, despite their feelings of loneliness. Although some Nepali adolescents spoke of desiring better relationships with their parents, most Nepali and Brazilian youth described avoidance of peer engagements.…”

Diagnosis concealment is associated with psychosocial outcomes in persons with multiple sclerosis

“…10 Consistent findings have been reported in non-MS populations, such as people living with HIV 11 or serious mental illness. 12,13 The present findings suggest a significant association between diagnosis concealment and loneliness in pwMS.…”

Intention to seek professional and non‐professional emotional help among Jewish young adults in Israel

“…Since after such disclosure people will generally continue to be in contact with these figures (Doblyte & Jiménez‐Mejías, 2017) it seems likely that they will not want to seek help from their social network. These findings strengthen the importance of educating the public on young adults mental health and the importance to seek help, in order to reduce stigma among young adult's social network and help young adults increase their trust in sharing their difficulties (Achterbergh, 2020; Griffiths et al., 2011).…”