Lee Cheuk Ying, Ahmed Nafiso, Ikhtabi Sarah, Duffett Phoebe, Alhilow Yazan, Richardson Leonie, Pitman Alexandra, Lloyd-Evans Brynmor, Johnson Sonia
Division of Psychiatry, University College London, London, United Kingdom.
North London NHS Foundation Trust, London, United Kingdom.
PLoS One. 2024 Dec 31;19(12):e0315763. doi: 10.1371/journal.pone.0315763. eCollection 2024.
Loneliness can be a significant challenge for people living with psychosis. We currently lack evidence about how to help with this. Understanding the origins, experience, and impact of loneliness in this group is helpful in developing strategies to reduce it. We therefore aimed to conduct a meta-synthesis of the qualitative literature exploring the nature of loneliness, and the factors contributing to the development and maintenance of loneliness, among people living with psychosis.
We searched four electronic databases (MEDLINE, Embase, PsycINFO and Web of Science) for studies meeting pre-defined eligibility criteria. We adhered to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines, and appraised the quality of each eligible study using the Critical Appraisal Skills Programme (CASP) checklist. We conducted thematic synthesis to combine the included qualitative findings to generate key overarching themes.
We included 41 articles and our analysis generated six meta-themes: (1) loneliness in the form of disconnection, (2) a rejecting and stigmatising external world, (3) loneliness and acute psychotic episodes and symptoms, (4) thwarted longing for connection, (5) paradoxes of loneliness and psychosis, and (6) well-being embedded in the social world. Our findings suggest a vicious cycle in which loneliness, psychosis and social withdrawal can be mutually reinforcing. Reciprocity of and continuity in relationships were valued by those with psychosis, while self-stigma and experiences of rejection appeared to exacerbate loneliness and impede recovery.
Our meta-synthesis offers insights into how people living with psychosis are affected by loneliness. Tailored interventions are needed, which should focus on supporting people in overcoming internal barriers to connection and low self-esteem, challenging stigma and self-stigma, and linking people to social support according to needs and preferences.
孤独对患有精神病的人来说可能是一项重大挑战。目前我们缺乏关于如何应对这一问题的证据。了解这一群体中孤独的根源、体验和影响，有助于制定减少孤独的策略。因此，我们旨在对定性文献进行元综合分析，以探究精神病患者孤独的本质，以及导致孤独产生和持续存在的因素。
我们在四个电子数据库（MEDLINE、Embase、PsycINFO和Web of Science）中搜索符合预定义纳入标准的研究。我们遵循系统评价和元分析的首选报告项目（PRISMA）指南，并使用批判性评价技能计划（CASP）清单评估每项符合条件研究的质量。我们进行了主题综合分析，将纳入的定性研究结果结合起来，以生成关键的总体主题。
我们纳入了41篇文章，分析得出六个元主题：（1）以脱节形式存在的孤独，（2）排斥和污名化的外部世界，（3）孤独与急性精神病发作及症状，（4）对联系的渴望受挫，（5）孤独与精神病的悖论，（6）融入社会世界的幸福感。我们的研究结果表明存在一个恶性循环，即孤独、精神病和社交退缩可能相互强化。患有精神病的人重视人际关系中的互惠和连续性，而自我污名和被排斥的经历似乎会加剧孤独并阻碍康复。
我们的元综合分析为了解精神病患者如何受到孤独影响提供了见解。需要量身定制的干预措施，应侧重于支持人们克服建立联系的内在障碍和自卑心理，挑战污名和自我污名，并根据需求和偏好将人们与社会支持联系起来。
