Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2020

Open Access 01-12-2020 | Research article

Loneliness as a predictor of outcomes in mental disorders among people who have experienced a mental health crisis: a 4-month prospective study

Authors: Jingyi Wang, Brynmor Lloyd-Evans, Louise Marston, Farhana Mann, Ruimin Ma, Sonia Johnson

Published in: BMC Psychiatry | Issue 1/2020

Login to get access

Abstract

Background

Loneliness has not until recently been a prominent focus in research on outcomes of mental illness. The aim of this study was to determine whether loneliness at baseline predicts poor outcomes at 4-month follow-up for individuals who have experienced mental health crises. The outcomes in this study included overall symptom severity, affective symptoms, self-rated recovery and health-related quality of life.

Methods

Our study reports a secondary analysis of data from a randomised controlled trial. The sample (n = 399) was taken from patients who received treatment from community crisis services. Respondents (n = 310) completed the follow-up measurement 4 months after baseline. Loneliness at baseline was assessed using an eight-item UCLA Loneliness Scale. The four mental health outcomes were measured at both baseline and follow-up. Two scales (or part thereof) assessed objective social isolation and neighbourhood social capital at baseline. Regression analyses were conducted to investigate longitudinal associations between loneliness at baseline and mental health outcomes at follow-up.

Results

Loneliness at baseline was associated with all four mental health outcomes at 4-month follow-up, adjusting for psychosocial, socio-demographic and clinical characteristics. A one-point higher loneliness score was associated with 0.74-point (95% CI 0.45, 1.02) and 0.34-point (95% CI 0.21, 0.47) increase in overall symptom severity score and affective symptoms score respectively, and with 1.08-point (95% CI -1.45, − 0.71) and 1.27-point (95% CI -1.79, − 0.75) decrease in self-rated recovery score and health-related quality of life score respectively. Loneliness was a better predictor of clinical outcomes than objective social isolation and social capital, even though the associations with clinical outcomes were reduced and no longer statistically significant following adjustment for their baseline values. A significant association with quality of life persisted after adjustment for its baseline score.

Conclusions

Greater loneliness at baseline predicted poorer health-related quality of life at follow-up. There were cross-sectional associations between loneliness and clinical outcomes, but their longitudinal relationship cannot be confirmed. Further research is needed to clearly establish their underpinning pathways. Reducing loneliness may be a promising target to improve recovery for mental health community crisis service users.
Appendix
Available only for authorised users
Literature
1.
Schwarzbach M, Luppa M, Forstmeier S, Konig HH, Riedel-Heller SG. Social relations and depression in late life-a systematic review. Int J Geriatr Psychiatr. 2014;29(1):1–21.CrossRef
2.
3.
Peplau L, Perlman D. Perspectives on loneliness. In: Peplau L, Perlman D, editors. Loneliness: A sourcebook of current theory, research, and therapy. New York: Wiley; 1982.
4.
Peplau LA, Perlman D: Blueprint for a social psychological theory of loneliness. In: Love and attraction. Edn. Edited by Cook M, Wilson G. Oxford, England: Pergamon; 1979.CrossRef
5.
Sermat V. Sources of loneliness. Essence. 1978;2(4):271–6.
6.
de Jong GJ, Tilburg T, Dvkstra PA. Loneliness and Social Isolation. In: Vangelisti A, Perlman D, editors. Cambridge handbook of personal relationships. Cambridge: Cambridge University Press; 2006. p. 485–500.
7.
Zavaleta D, Samuel K, Mills C: Social Isolation: A conceptual and Measurement Proposal. In: Working Paper: 67. Oxford: Oxford Poverty & Human Development Initiative (OPHI); 2014.
8.
Portes A. Social capital: its origins and applications in modern sociology. Annu Rev Sociol. 1998;24:1–24.CrossRef
9.
McKenzie K, Whitley R, Weich S. Social capital and mental health. Br J Psychiatry. 2002;181:280–3.PubMedCrossRef
10.
Wang JY, Lloyd-Evans B, Giacco D, Forsyth R, Nebo C, Mann F, Johnson S. Social isolation in mental health: a conceptual and methodological review. Soc Psychiatry Psychiatr Epidemiol. 2017;52(12):1451–61.PubMedPubMedCentralCrossRef
11.
Hawkley LC, Cacioppo JT. Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine. 2010;40(2):218–27.CrossRef
12.
Petitte T, Mallow J, Barnes E, Petrone A, Barr T, Theeke L. A systematic review of loneliness and common chronic physical conditions in adults. The open psychology journal. 2015;8(Suppl 2):113–32.PubMedPubMedCentralCrossRef
13.
Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7(7):20.CrossRef
14.
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–37.PubMedCrossRef
15.
Valtorta NK, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009–16.PubMedPubMedCentralCrossRef
16.
Hawkley LC, Thisted RA, Masi CM, Cacioppo JT. Loneliness predicts increased blood pressure: 5-year cross-lagged analyses in middle-aged and older adults. Psychol Aging. 2010;25(1):132–41.PubMedPubMedCentralCrossRef
17.
Jaremka LM, Andridge RR, Fagundes CP, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Arnold MW, Farrar WB, Yee LD, et al. Pain, depression, and fatigue: loneliness as a longitudinal risk factor. Health Psychol. 2014;33(9):948–57.PubMedCrossRef
18.
Lim MH, Gleeson JFM, Alvarez-Jimenez M, Penn DL. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2018;53(3):221–38.PubMedCrossRef
19.
da Rocha BM, Rhodes S, Vasilopoulou E, Hutton P. Loneliness in psychosis: a meta-analytical review. Schizophr Bull. 2018;44(1):114–25.CrossRef
20.
Meltzer H, Bebbington P, Dennis MS, Jenkins R, McManus S, Brugha TS. Feelings of loneliness among adults with mental disorder. Soc Psychiatry Psychiatr Epidemiol. 2013;48(1):5–13.PubMedCrossRef
21.
Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging. 2006;21(1):140–51.PubMedCrossRef
22.
Martens WHJ. Schizoid personality disorder linked to unbearable and inescapable loneliness. Eur J Psychiat. 2010;24(1):38–45.CrossRef
23.
Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE. Reducing suicide: a National Imperative. Washington, DC: National Academy Press; 2002.
24.
Tilvis RS, Kahonen-Vare MH, Jolkkonen J, Valvanne J, Pitkala KH, Strandberg TE. Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol Ser A-Biol Sci Med Sci. 2004;59(3):268–74.CrossRef
25.
Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, Tang YX, Bennett DA. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007;64(2):234–40.PubMedCrossRef
26.
Hawkley LC, Thisted RA, Cacioppo JT. Loneliness predicts reduced physical activity: Cross-Sectional & Longitudinal Analyses. Health Psychol. 2009;28(3):354–63.PubMedPubMedCentralCrossRef
27.
Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S. Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC psychiatry. 2018;18(1):156.PubMedPubMedCentralCrossRef
28.
Johnson S. Crisis resolution and home treatment teams: an evolving model. Adv Psychiatr Treat. 2013;19(2):115–23.CrossRef
29.
Johnson S, Mason O, Osborn D, Milton A, Henderson C, Marston L, Ambler G, Hunter R, Pilling S, Morant N, et al. Randomised controlled trial of the clinical and cost-effectiveness of a peer-delivered self-management intervention to prevent relapse in crisis resolution team users: study protocol. BMJ Open. 2017;7(10):13.
30.
Johnson S, Lamb D, Marston L, Osborn D, Mason O, Henderson C, Ambler G, Milton A, Davidson M, Christoforou M, et al. Peer-supported self-management for people discharged from a mental health crisis team: a randomised controlled trial. Lancet (London, England). 2018;392(10145):409–18.CrossRef
31.
32.
Ventura J, Green MF, Shaner A, Liberman RP. Training and quality assurance with the brief psychiatric rating-scale - the drift busters. Int J Methods Psychiatr Res. 1993;3(4):221–44.
33.
Bech P, Larsen JK, Andersen J. The BPRS - Pshchometric developments. Psychopharmacol Bull. 1988;24(1):118–21.PubMed
34.
Tarell JD, Schulz SC. Nursing assessment using the BRPS - a structured interview. Psychopharmacol Bull. 1988;24(1):105–11.PubMed
35.
Roncone R, Ventura J, Impallomeni M, Falloon IRH, Morosini PL, Chiaravalle E, Casacchia M. Reliability of an Italian standardized and expanded brief psychiatric rating scale (BPRS 4.0) in raters with high vs. low clinical experience. Acta Psychiatr Scand. 1999;100(3):229–36.PubMedCrossRef
36.
Dazzi F, Shafer A, Lauriola M. Meta-analysis of the brief psychiatric rating scale - expanded (BPRS-E) structure and arguments for a new version. J Psychiatr Res. 2016;81:140–51.PubMedCrossRef
37.
Neil S, Kilbride M, Pitt L, Welford M, Nothard S, Sellwood W, Morrison A. The questionnaire about the process of recovery (QPR): a measure developed in collaboration with service users. Psychosis. 2009;1:145–55.CrossRef
38.
Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol group. Ann Med. 2001;33(5):337–43.CrossRefPubMed
39.
Khanna R, Jariwala K, Bentley JP. Psychometric properties of the EuroQol five dimensional questionnaire (EQ-5D-3L) in caregivers of autistic children. Qual Life Res. 2013;22(10):2909–20.PubMedCrossRef
40.
Sonntag M, Konnopka A, Leichsenring F, Salzer S, Beutel ME, Herpertz S, Hiller W, Hoyer J, Joraschky P, Nolting B, et al. Reliability, validity and responsiveness of the EQ-5D in assessing and valuing health status in patients with social phobia. Health Qual Life Outcomes. 2013;11.PubMedPubMedCentralCrossRef
41.
42.
Wu CH, Yao G. Psychometric analysis of the short-form UCLA loneliness scale (ULS-8) in Taiwanese undergraduate students. Pers Individ Differ. 2008;44(8):1762–71.CrossRef
43.
Dogan T, Cotok NA, Tekin EG: Reliability and validity of the Turkish Version of the UCLA Loneliness Scale (ULS-8) among university students. In: 3rd World Conference on Educational Sciences. Volume 15, edn. Amsterdam: Elsevier Science Bv; 2011: 2058–2062.CrossRef
44.
Lubben J, Blozik E, Gillmann G, Iliffe S, Kruse WV, Beck JC, Stuck AE. Performance of an abbreviated version of the Lubben social network scale among three European community-dwelling older adult populations. Gerontologist. 2006;46(4):503–13.PubMedCrossRef
45.
Health Education Authority: Health and Lifestyles: a survey of the UK Population – Part 1. In. London: Health Education Authority; 1995.
46.
Fox-Wasylyshyn SM, El-Masri MM. Handling missing data in self-report measures. Res Nurs Health. 2005;28(6):488–95.PubMedCrossRef
47.
Newman DA. Missing data: five practical guidelines. Organ Res Methods. 2014;17(4):372–411.CrossRef
48.
Ferguson CJ. An effect size primer: a guide for clinicians and researchers. Prof Psychol-Res Pract. 2009;40(5):532–8.CrossRef
49.
van Beljouw IM, Verhaak PF, Cuijpers P, van Marwijk HW, Penninx BW. The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study. BMC psychiatry. 2010;10:86.PubMedPubMedCentralCrossRef
50.
Holvast F, Burger H, de Waal MM, van Marwijk HW, Comijs HC, Verhaak PF. Loneliness is associated with poor prognosis in late-life depression: longitudinal analysis of the Netherlands study of depression in older persons. J Affect Disord. 2015;185:1–7.PubMedCrossRef
51.
52.
van Beljouw IMJ, van Exel E, Gierveld JD, Comijs HC, Heerings M, Stek ML, Van Marwijk HWJ: “being all alone makes me sad”: loneliness in older adults with depressive symptoms. Int Psychogeriatr 2014, 26(9):1541–1551.
53.
Fleury MJ, Grenier G, Bamvita JM, Tremblay J, Schmitz N, Caron J. Predictors of quality of life in a longitudinal study of users with severe mental disorders. Health Qual Life Outcomes. 2013;11:1.CrossRef
54.
Chrostek A, Grygiel P, Anczewska M, Wciorka J, Switaj P. The intensity and correlates of the feelings of loneliness in people with psychosis. Compr Psychiatry. 2016;70:190–9.PubMedCrossRef
55.
Switaj P, Grygiel P, Anczewska M, Wciorka J. Loneliness mediates the relationship between internalised stigma and depression among patients with psychotic disorders. Int J Soc Psychiatry. 2014;60(8):733–40.PubMedCrossRef
56.
Switaj P, Grygiel P, Anczewska M, Wciorka J. Experiences of discrimination and the feelings of loneliness in people with psychotic disorders: the mediating effects of self-esteem and support seeking. Compr Psychiatry. 2015;59:73–9.PubMedCrossRef
57.
House JS, Umberson D, Landis KR. Structures and processes of social support. Annu Rev Sociol. 1988;14:293–318.CrossRef
58.
Segrin C, Passalacqua SA. Functions of loneliness, social support, health behaviors, and stress in association with poor health. Health Commun. 2010;25(4):312–22.PubMedCrossRef
59.
Mann F, Bone JK, Lloyd-Evans B, Frerichs J, Pinfold V, Ma RM, Wang JY, Johnson S. A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2017;52(6):627–38.PubMedPubMedCentralCrossRef
60.
Wen M, Wang GX. Demographic, psychological, and social environmental factors of loneliness and satisfaction among rural-to-urban migrants in Shanghai, China. Int J Comp Sociol. 2009;50(2):155–82.CrossRef
61.
Niedzwiedz CL, Richardson EA, Tunstall H, Shortt NK, Mitchell RJ, Pearce JR. The relationship between wealth and loneliness among older people across Europe: is social participation protective? Prev Med. 2016;91:24–31.PubMedCrossRef
62.
63.
Johnson S. Social interventions in mental health: a call to action. Soc Psychiatry Psychiatr Epidemiol. 2017;52(3):245–7.PubMedCrossRef
64.
Seddon JL, Birchwood M, Copello A, Everard L, Jones PB, Fowler D, Amos T, Freemantle N, Sharma V, Marshall M, et al. Cannabis use is associated with increased psychotic symptoms and poorer psychosocial functioning in first-episode psychosis: a report from the UK national EDEN study. Schizophr Bull. 2016;42(3):619–25.PubMedCrossRef
Metadata
Title
Loneliness as a predictor of outcomes in mental disorders among people who have experienced a mental health crisis: a 4-month prospective study
Authors
Jingyi Wang
Brynmor Lloyd-Evans
Louise Marston
Farhana Mann
Ruimin Ma
Sonia Johnson
Publication date
01-12-2020
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2020
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-020-02665-2

Other articles of this Issue 1/2020

BMC Psychiatry 1/2020 Go to the issue

Research article

Distant mood monitoring for depressive and bipolar disorders: a systematic review

Research article

Switching to Lurasidone following 12 months of treatment with Risperidone: results of a 6-month, open-label study

Research article

Gender difference in the association between education and schizophrenia in Chinese adults

Research article

Association of ocular diseases with schizophrenia, bipolar disorder, and major depressive disorder: a retrospective case-control, population-based study

Research article

Association between depression and healthcare expenditures among elderly cancer patients

Research article

Problematic internet use in children and adolescents: associations with psychiatric disorders and impairment