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Loneliness in psychosis: a systematic review

Social Psychiatry and Psychiatric Epidemiology volume 53, pages 221–238 (2018)Cite this article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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).

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Notes

  1. This figure accounts for Chrostek et al. (2016) included a random sample of 20 000 controls from the general population.

  2. Pjescic et al. (2014) did not report % females for the psychiatric control sample and Tharayil (2007) recruited only men due to small sample of women who were also diagnosed with a psychotic disorder.

  3. Tharayil (2007) did not report the recruitment source for half of the sample.

  4. Although psychotic illness information such as duration of psychosis illness was not part of the study quality criteria, this information was included as the duration of psychotic illness is known to relate to poorer treatment outcomes for those with psychosis [39, 40]. Studies that examined loneliness severity with duration of psychotic illness [22, 31] reported no relationship between loneliness severity and psychotic illness duration.

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Acknowledgements

We thank Dr. Robert Eres for the manuscript review.

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Affiliations

  1. Centre for Mental Health, Swinburne University of Technology, Hawthorn, Victoria, 3122, Australia

    Michelle H. Lim

  2. School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia

    John F. M. Gleeson & David L. Penn

  3. Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Victoria, Australia

    Mario Alvarez-Jimenez

  4. Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia

    Mario Alvarez-Jimenez

  5. Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, Chapel Hill, NC, USA

    David L. Penn

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  1. Michelle H. Lim
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  2. John F. M. Gleeson
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  3. Mario Alvarez-Jimenez
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  4. David L. Penn
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Correspondence to Michelle H. Lim.

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Lim, M.H., Gleeson, J.F.M., Alvarez-Jimenez, M. et al. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 53, 221–238 (2018). https://doi.org/10.1007/s00127-018-1482-5

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  • DOI: https://doi.org/10.1007/s00127-018-1482-5

Keywords

  • Loneliness
  • Perceived social isolation
  • Psychosis
  • Systematic review