McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK.
Division of Psychiatry, UCL, 149 Tottenham Court Road, London, W1T 7NF, UK.
BMC Psychiatry. 2020 Nov 26;20(1):565. doi: 10.1186/s12888-020-02961-x.
Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions.
Semi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study's working group, which included experts by experience, clinicians and researchers.
The narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant's relationship with the Community Navigator.
We found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual's participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.
孤独与负面结果相关，包括死亡率增加，并且在心理健康问题患者中很常见。这项定性研究是可行性试验的一部分，旨在了解在英国二级心理健康服务下接受治疗的重度抑郁和/或焦虑患者，有哪些因素能够促进他们参与社区导航员计划并改善抑郁、焦虑和孤独感，又有哪些因素会阻碍他们参与该计划。该计划包括与社区导航员最多进行十次会面，并可选参加三次小组会议。
在计划完成后不久，对参与者（n=19）进行了半结构化访谈。由研究工作组的成员进行了合作产生的两阶段定性方法，包括叙事和反思主题分析，该工作组的成员包括经验专家、临床医生和研究人员。
叙述性分析表明，个体的目标各不相同，对与他人会面持有复杂的感受，并且对进展的定义也不同。从主题分析中，确定了六个主题，这些主题解释了参与该计划的促进因素和挑战：与他人建立联系的愿望；个人社交信心；找到有意义的事情做；当地资源的可及性；计划的时间安排；以及参与者与社区导航员的关系。
我们发现，由二级心理健康服务支持的重度抑郁和/或焦虑患者可能希望解决孤独感，但发现这样做在情感上很费力，是一个重大的个人挑战。这种情感上的努力在个体中的表现方式各不相同，这使得参与者难以参与孤独感计划，但通过面对个人挑战，他们确实感受到了巨大的成就感。应尽早确定个体、人际和结构层面上促进或阻碍个人参与的因素，以便人们能够充分利用社区导航员或其他类似计划。
