Social contacts and loneliness in people with psychotic and mood disorders

doi:10.1016/j.comppsych.2015.12.008

Comprehensive Psychiatry

Volume 66, April 2016, Pages 59-66

https://doi.org/10.1016/j.comppsych.2015.12.008 Get rights and content

Abstract

Background

Social relations can be measured through: a) objective indicators, i.e. the number of social contacts in a given time interval or b) subjective indicators, i.e. feelings of loneliness. Comparing subjective and objective indicators in patients with psychotic and mood disorders may help to understand whether diagnosis-specific interventions should be designed for increasing their social relations. In this study we assessed social contacts outside home, work environments and mental health services, which may be increased by these interventions. We also explored feelings of loneliness which could influence readiness of patients to participate in interventions.

Methods

100 patients in outpatient mental health care were asked to: a) list their social contacts; b) report their feelings of loneliness on a validated five point Likert scale. Multiple logistic regression models were used to test associations of diagnostic categories with: a) having more than one social contact in the previous week; b) reporting at least moderate feelings of loneliness.

Results

Patients had on average 1.7 (SD = 1.7) social contacts in the previous week (median = 1.0); 77 patients reported at least moderate feelings of loneliness. Patients with psychotic disorders (n = 30) showed a statistical trend towards having just one or no contacts in the week before the assessment (Odds ratio, OR = 2.246, p = .087). Patients with mood disorders were more likely to report at least moderate feelings of loneliness (OR = 2.798; p < .05).

Conclusions

Patients with psychotic disorders, compared to those with mood disorders, may be less likely to report feeling lonely although they tend to have less social contacts. Strategies to enhance social relations of people with psychotic disorders may include approaches to increase patients' drive to establish new social contacts and to emotionally support them in this process.

Introduction

Social isolation can be defined as “living without companionship, social support, or social connectedness” [1]. It has been identified as a strong predictor of long-term morbidity and mortality in the general population, comparable to established risk factors such as hypertension, diabetes, smoking and excessive alcohol consumption [2], [3].

For people with severe mental disorders, social isolation may have further negative consequences. Having social relations can help these people cope with stressful factors which are potentially harmful for their mental health [4], increase appropriate help-seeking and provide benefits in terms of self-efficacy, self-esteem and morale [5].

Social relations may be measured using objective (or behavioral”) indicators, such as the reported number of social contacts in a given interval of time [6], [7] or subjective indicators, e.g. feelings of loneliness [8].

Severe mental disorders, such as psychotic and mood disorders may determine a risk of social isolation. For example, people experiencing persecutory delusions or auditory hallucinations may actively avoid social contacts [9], [10]. People with high levels of negative symptoms or depression may experience lack of drive and motivation to social contacts [11], [12], [13].

Given the negative long-term consequences of social isolation, a number of supported socialization interventions have been developed to increase social relations of people with severe mental disorders [14], [15], [16].

An assessment of both subjective and objective indicators of social isolation in the two core groups of people with severe mental disorders, i.e. people with psychotic and mood disorders, may inform further development of such interventions. We focused our evaluation on: a) social contacts outside home, work environments and mental health services which are a focus of those socialization interventions [14], [15], [16]; b) feelings of loneliness, which may influence readiness of patients to participate in such interventions.

Identifying potential differences between patients with psychosis and mood disorders may help to assess whether there is a need for diagnosis-specific strategies to increasing patients' social relations.

This study aimed to: a) assess objective (number of social contacts outside home, work and mental health services) and subjective (feelings of loneliness) indicators of social relations in people with psychotic and mood disorders, defined according to the International Classification of Disease (ICD)-10 categories (F20–29 and F30–39) [17]; b) compare those indicators between the two groups.

Specifically our research questions were:

a)
Is the number of social contacts outside home, work or care environments different between patients with psychotic disorders and those with mood disorders?
b)
Are there any differences in subjective feelings of loneliness between these two patient groups?

Section snippets

Sample

We assessed social contacts and feelings of loneliness in general adult psychiatry patients seen by two community mental health teams in the Newham borough of London. The study was exploratory and the variability of service users' responses to the questions was unknown. We estimated that a minimum of 30 patients per group would provide a sufficient estimate of the distribution of scores. Once we had recruited and interviewed 30 patients per diagnostic group, we stopped the recruitment.

Inclusion

Recruitment

235 patients accessed the outpatient clinics of the two community mental health teams visited during the recruitment period; 76 were excluded because of a primary diagnosis different from F20–29 or F30–39; 12 were deemed from the treating psychiatrists to have a too severe cognitive deterioration to participate in the study and consent; among the 147 eligible patients, 14 were not approached for participation by the psychiatrists; 33 refused to participate in the study, 14 of them because of

Main findings

Our findings suggest that patients with psychotic disorders are less likely to report feelings of loneliness than those with mood disorders, although they tend to have less social contacts.

Therefore, patients with psychotic disorders, in comparison to those with mood disorders, may be less likely to express their feelings of loneliness and to seek more social contacts, which may add to their risk of social isolation.

Strength and limitations

This was the first study comparing subjective and objective indicators of

Conclusions

The number of social contacts is very low for all severely mentally ill patients and they may benefit from interventions to increase social relations. Such interventions need to be preceded by an assessment of the reasons for which patients are socially isolated. Patients with psychotic disorders may be less likely to report social isolation, probably because the experience of socialization is particularly stressful for them. A proactive approach and emotional support during the socialization

Funding statement

We have received no external funding for this research.

Conflict of interest statement

The authors declare that no conflict of interest, financial or otherwise exists.

Acknowledgment

None.

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Social contacts and loneliness in people with psychotic and mood disorders

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Sample

Recruitment

Main findings

Strength and limitations

Conclusions

Funding statement

Conflict of interest statement

Acknowledgment

Clin Psychol Rev

Psychiatry Res

Clin Psychol Rev

Schizophr Res

Measuring social isolation in older adults: development and initial validation of the friendship scale

Soc Indic Res

Social relationships and mortality risk: a meta-analytic review

PLoS Med

Social isolation: a predictor of mortality comparable to traditional clinical risk factors

Am J Public Health

Friendship, social support, and health

Social networks and health: it's time for an intervention trial

J Epidemiol Community Health

Schizophrenia and social networks: ex-patients in the inner city

Schizophr Bull

Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study

J Nerv Ment Dis

Loneliness: human nature and the need for social connection

Passive/apathetic social withdrawal and active social avoidance in schizophrenia: difference in underlying psychological processes

J Nerv Ment Dis

Friendship in people with schizophrenia: a survey

Soc Psychiatry Psychiatr Epidemiol

Friends and symptom dimensions in patients with psychosis: a pooled analysis

PLoS One

Supported socialization for people with psychiatric disabilities: lessons from a randomized controlled trial

J Community Psychol

Befriending for mental health problems: processes of helping

Psychol Psychother-T