Ayden Jordan, Bracho-Ponce María-José, Ajayi Julia, Hanson Sarah, Gracey Fergus
Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK.
Centro de Estudios en Neurociencia Humana y Neuropsicología, Universidad Diego Portales, Santiago, Chile.
Health Expect. 2025 Oct;28(5):e70420. doi: 10.1111/hex.70420.
During recovery from an acquired brain injury (ABI), social isolation is a common experience that can lead to adverse outcomes. Although social connection is known to play a critical role in alleviating these effects, the ways in which ABI survivors experience and prioritise connection and isolation are not well understood. This review aims to understand how these concepts are perceived, identify the valued outcomes, and examine the social contexts that shape these experiences.
Peer-reviewed qualitative articles published before January 2025 were identified from a search of six databases and additional complementary searches. These encompassed the terms 'acquired brain injury', 'social connection and/or isolation' and 'qualitative'. Of 4651 papers identified, 37 were included. Each paper was categorised for the analytic process according to its relevance, resonance and rigour, with rigour assessed using the JBI standardised critical appraisal instrument. Thomas and Harden's 'thematic synthesis' framework was used to generate a metasynthesis rooted in a critical realist philosophy.
Social isolation is a widespread issue characterised by loss, which originates from ABI-related impairments that hinder social engagement. Communication difficulties, stigma and other structural barriers exacerbate feelings of disconnection. Key elements of social connection included understanding, acceptance, emotional support, reciprocity and shared experiences. Relationships that embodied these qualities provided a sense of belonging, security and purpose, which encouraged individuals to redefine their identity and values, alleviating feelings of isolation.
This review demonstrates that social connection and isolation post-ABI stem from a variety of complex interpersonal and environmental factors. Future research should prioritise measuring and enhancing meaningful connections by focusing on relational quality, accessibility, and reducing systemic barriers, including stigma.
The project's focus was developed in consultation with members of the public who have lived experience with an ABI. A PPI member also supported the entire review process.
在后天性脑损伤（ABI）恢复期间，社交孤立是一种常见现象，可能导致不良后果。尽管社交联系在减轻这些影响方面起着关键作用，但ABI幸存者体验社交联系并对其与社交孤立进行优先级排序的方式尚未得到充分理解。本综述旨在了解这些概念是如何被感知的，确定有价值的结果，并审视塑造这些体验的社会背景。
通过检索六个数据库及其他补充检索，确定了2025年1月之前发表的同行评审定性文章。检索词包括“后天性脑损伤”“社交联系和/或孤立”以及“定性”。在检索到的4651篇论文中，纳入了37篇。根据每篇论文的相关性、共鸣性和严谨性对其进行分类，严谨性使用JBI标准化批判性评价工具进行评估。采用托马斯和哈登的“主题综合”框架，以批判实在论哲学为基础进行元综合。
社交孤立是一个普遍存在的问题，其特征是丧失，源于阻碍社交参与的与ABI相关的损伤。沟通困难、污名化和其他结构性障碍加剧了脱节感。社交联系的关键要素包括理解、接纳、情感支持、互惠和共同经历。体现这些特质的关系提供了归属感、安全感和目标感，鼓励个体重新定义自己的身份和价值观，减轻孤立感。
本综述表明，ABI后的社交联系和孤立源于各种复杂的人际和环境因素。未来的研究应优先通过关注关系质量、可及性以及减少包括污名化在内的系统性障碍来衡量和增强有意义的联系。
该项目的重点是在与有ABI生活经历的公众成员协商后确定的。一名公众参与和介入成员也支持了整个综述过程。
