Mann Farhana, Bone Jessica K, Lloyd-Evans Brynmor, Frerichs Johanna, Pinfold Vanessa, Ma Ruimin, Wang Jingyi, Johnson Sonia
Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7BN, UK.
McPin Foundation, 32-36 Loman Street, London, SE1 0EH, UK.
Soc Psychiatry Psychiatr Epidemiol. 2017 Jun;52(6):627-638. doi: 10.1007/s00127-017-1392-y. Epub 2017 May 20.
There is growing evidence of significant harmful effects of loneliness. Relatively little work has focused on how best to reduce loneliness in people with mental health problems. We aim to present an overview of the current state of the art in loneliness interventions in people with mental health problems, identify relevant challenges, and highlight priorities for future research and implementation.
A scoping review of the published and grey literature was conducted, as well as discussions with relevant experts, to propose a broad classification system for types of interventions targeting loneliness.
We categorised interventions as 'direct', targeting loneliness and related concepts in social relationships, and 'indirect' broader approaches to well-being that may impact on loneliness. We describe four broad groups of direct interventions: changing cognitions; social skills training and psychoeducation; supported socialisation or having a 'socially-focused supporter'; and 'wider community approaches'. The most promising emerging evidence appears to be in 'changing cognitions', but, as yet, no approaches have a robust evidence base. Challenges include who is best placed to offer the intervention, how to test such complex interventions, and the stigma surrounding loneliness.
Development of clearly defined loneliness interventions, high-quality trials of effectiveness, and identifying which approaches work best for whom is required. Promising future approaches may include wider community initiatives and social prescribing. It is important to place loneliness and social relationships high on the wider public mental health and research agenda.
越来越多的证据表明孤独具有显著的有害影响。相对而言，很少有研究关注如何最好地减轻有心理健康问题者的孤独感。我们旨在概述针对有心理健康问题者的孤独干预措施的当前技术水平，识别相关挑战，并突出未来研究和实施的重点。
对已发表文献和灰色文献进行了范围综述，并与相关专家进行了讨论，以提出针对孤独干预类型的广泛分类系统。
我们将干预措施分为“直接”干预，即针对社会关系中的孤独感及相关概念，以及“间接”干预，即对幸福感采取的可能影响孤独感的更广泛方法。我们描述了四类直接干预措施：改变认知；社交技能培训和心理教育；支持性社交或拥有“以社交为重点的支持者”；以及“更广泛的社区方法”。最有前景的新证据似乎在于“改变认知”，但目前尚无任何方法有强有力的证据基础。挑战包括谁最适合提供干预、如何测试此类复杂干预措施以及围绕孤独感的污名化问题。
需要制定明确界定的孤独干预措施、进行高质量的有效性试验，并确定哪种方法最适合哪些人。未来有前景的方法可能包括更广泛的社区倡议和社会处方。将孤独感和社会关系置于更广泛的公众心理健康和研究议程的重要位置非常重要。
