Loneliness in psychosis: a systematic review
The aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group.
We adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis.
A total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem.
The relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).
KeywordsLoneliness Perceived social isolation Psychosis Systematic review
We thank Dr. Robert Eres for the manuscript review.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interests.
- 1.Peplau L, Perlman D (1982) Perspectives on loneliness. In: Peplau L, Perlman D (eds) Loneliness: a sourcebook of current theory, research and therapy. Wiley, New York, pp 1–20Google Scholar
- 4.Cacioppo JT, Hawkley LC, Thisted RA (2010) Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol Aging 25:453. https://doi.org/10.1037/a0017216PubMedPubMedCentralCrossRefGoogle Scholar
- 9.Stain HJ, Galletly CA, Clark S, Wilson J, Killen EA, Anthes L, Campbell LE, Hanlon MC, Harvey C (2012) Understanding the social costs of psychosis: the experience of adults affected by psychosis identified within the second Australian National Survey of Psychosis. Aust N Z J Psychiatry 46:879–889. https://doi.org/10.1177/0004867412449060PubMedCrossRefGoogle Scholar
- 10.Morgan VA, Waterreus A, Jablensky A, Mackinnon A, McGrath JJ, Carr V, Bush R, Castle D, Cohen M, Harvey C, Galletly C, Stain HJ, Neil A, McGorry PD, Hocking B, Shah S, Saw S (2011) People living with psychotic illness 2010. Report on the second Australian national survey. Australian Government Department of Health and Ageing, Canberra. http://www.health.gov.au/internet/main/publishing.nsf/content/mental-pubs-p-psych10
- 14.Patterson TL, Goldman S, McKibbin CL, Hughs T, Jeste DV (2001) UCSD Performance-Based Skills Assessment: development of a new measure of everyday functioning for severely mentally ill adults. Schizophr Bull 27:235–245. https://doi.org/10.1093/oxfordjournals.schbul.a006870PubMedCrossRefGoogle Scholar
- 20.Varese F, Smeets F, Drukker M, Lieverse R, Lataster T, Viechtbauer W, Read J, van Os J, Bentall RP (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective-and cross-sectional cohort studies. Schizophr Bull 38:661–671. https://doi.org/10.1093/schbul/sbs050PubMedPubMedCentralCrossRefGoogle Scholar
- 28.Karow A, Pajonk FG, Reimer J, Hirdes F, Osterwald C, Naber D, Moritz S (2008) The dilemma of insight into illness in schizophrenia: self- and expert-rated insight and quality of life. Eur Arch Psychiatry Clin Neurosci 258:152–159. https://doi.org/10.1007/s00406-007-0768-5PubMedCrossRefGoogle Scholar
- 31.von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, STROBE Initiative (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499. https://doi.org/10.1016/j.ijsu.2014.07.013CrossRefGoogle Scholar
- 34.Świtaj P, Grygiel P, Anczewska M, Wciórka J (2015) Experiences of discrimination and the feelings of loneliness in people with psychotic disorders: the mediating effects of self-esteem and support seeking. Compr Psychiatry 59:73–79. https://doi.org/10.1016/j.comppsych.2015.02.016PubMedCrossRefGoogle Scholar
- 41.Tharayil DP (2007) Self, social, and family perceptions in relation to loneliness controlling for depression among individuals with schizophrenia. Internet J Ment Health 4:1–21Google Scholar
- 46.Ventura J, Green MF, Shaner A, Liberman RP (1993) Training and quality assurance with the Brief Psychiatric Rating Scale: ‘the drift busters’. Int J Methods Psychiatr Res 3:221–244Google Scholar
- 47.Andreasen NC (1984) Scale of the assessment of positive symptoms (SAPS). University of Iowa, Iowa CityGoogle Scholar
- 48.Andreasen NC (1984) Scale for the assessment of negative symptoms (SANS). University of Iowa, Iowa CityGoogle Scholar
- 56.Hudson W (1982) The clinical measurement package: a field manual. Dorsey Press, ChicagoGoogle Scholar
- 57.Schwarzer R, Jersusalem M (1995) Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M (eds) Measures in health psychology: a user’s portfolio. Casual and control beliefs. NFER-NELSON, Windsor, pp 35–37Google Scholar
- 59.Weiss RS (1973) Loneliness: the experience of emotional and social isolation. The MIT Press, CambridgeGoogle Scholar
- 66.Clark DM, Wells A (1995) A cognitive model of social phobia. In: Heimberg RG, Liebowitz MR, Hope DA, Schneider FR (eds) Social phobia: diagnosis, assessment, and treatment. Guilford Press, New York, pp 69–93Google Scholar
- 75.Bird V, Leamy M, Le Boutillier C, Williams J, Slade M (2011) REFOCUS: promoting recovery in community mental health services. Rethink, LondonGoogle Scholar
- 77.Gecas V (1989) The social psychology of self-efficacy. Annu Rev Social 15:291–316. https://doi.org/10.1146/annurev.so.15.080189.001451CrossRefGoogle Scholar
- 78.Freeman D, Garety P, Fowler D, Kuipers E, Dunn G, Bebbington P, Hadley G (1998) The London-East Anglia randomized controlled trial of cognitive-behaviour therapy for psychosis IV: self-esteem and persecutory delusions. Br J Clin Psychol 37:415–430. https://doi.org/10.1111/j.2044-8260.1998.tb01399.xPubMedCrossRefGoogle Scholar
- 79.Gumley A, Karatzias A, Power K, Reilly J, McNay L, O’Grady M (2006) Early intervention for relapse in schizophrenia: impact of cognitive behavioural therapy on negative beliefs about psychosis and self-esteem. Br J Clin Psychol 45:247–260. https://doi.org/10.1348/014466505X49925PubMedCrossRefGoogle Scholar
- 81.De Hert M, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, Detraux J, Gautam S, Möller HJ, Ndetei DM, Newcomer JW, Uwakwe R, Leucht S (2011) Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry 10:52–77. https://doi.org/10.1002/j.2051-5545.2011.tb00014.xCrossRefGoogle Scholar
- 82.Correll CU, Robinson DG, Schooler NR, Brunette MF, Mueser KT, Rosenheck RA, Marcy P, Addington J, Estroff SE, Robinson J, Penn DL, Azrin S, Goldstein A, Severe J, Heinssen R, Kane JM (2014) Cardiometabolic risk in patients with first-episode schizophrenia spectrum disorders: baseline results from the RAISE-ETP study. JAMA Psychiatry 71:1350–1363. https://doi.org/10.1001/jamapsychiatry.2014.1314PubMedCrossRefGoogle Scholar
- 97.Ruini C (2017) Positive interventions and their effectiveness with clinical populations. In positive psychology in the clinical domains. Springer International Publishing, Cham, pp 81–108. https://doi.org/10.1007/978-3-319-52112-1_4
- 100.Granholm E, Ben-Zeev D, Fulford D, Swendsen J (2013) Ecological momentary assessment of social functioning in schizophrenia: impact of performance appraisals and affect on social interactions. Schizophr Res 145:120–124. https://doi.org/10.1016/j.schres.2013.01.005PubMedPubMedCentralCrossRefGoogle Scholar
- 101.Garland EL, Fredrickson B, Kring AM, Johnson DP, Meyer PS, Penn DL (2010) Upward spirals of positive emotions counter downward spirals of negativity: insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology. Clin Psychol Rev 30:849–864. https://doi.org/10.1016/j.cpr.2010.03.002PubMedPubMedCentralCrossRefGoogle Scholar
- 104.Schrank B, Brownell T, Jakaite Z, Larkin C, Pesola F, Riches S, Tylee A, Slade M (2016) Evaluation of a positive psychotherapy group intervention for people with psychosis: pilot randomised controlled trial. Epidemiol Psychiatr Sci 25:235–246. https://doi.org/10.1017/s2045796015000141PubMedCrossRefGoogle Scholar