Trajectories of loneliness and objective social isolation and associations between persistent loneliness and self-reported personal recovery in a cohort of secondary mental health service users in the UK
Open accessAbstract
Background: Loneliness is a frequent and distressing experience among people with mental health problems. However, few longitudinal studies have so far investigated the trajectories of loneliness and objective social isolation, and the extent to which both issues may impact mental health outcomes among mental health service users. Therefore, this study aims to describe the trajectories of loneliness and objective social isolation and their associations with self-rated personal recovery among people leaving crisis resolution teams (CRTs). Methods: A total of 224 participants receiving care from CRTs (recruited for a large multi-site randomised controlled trial) were included in this longitudinal cohort study. They completed the eight-item University of California at Los Angeles Loneliness Scale (ULS-8), Lubben-Social Network Scale (LNSN-6), and the Questionnaire about the Process of Recovery (QPR) (primary outcome) at baseline, 4- and 18-month follow-up, as well as baseline sociodemographic and clinical variables. Results: We compared groups who were persistently lonely (at all time points), intermittently lonely (at one or two time points) and never lonely. After adjusting for all potential confounders and baseline predictive variables, persistent severe loneliness was associated with worse personal recovery at 18-month follow-up compared with the never lonely (reference group) (coef. = − 12.8, 95% CI -11.8, − 3.8,p < .001), as was being intermittently lonely (coef. = − 7.8, 95% CI -18.8, − 6.8, p < .001). The persistently objectively social isolated group (coef. = − 9.8, 95% CI -15.7, − 3.8,p = .001) also had poorer self-rated recovery at 18-month follow-up than those who were not socially isolated at any timepoint (i.e., reference category). Conclusion: Results suggest that both persistent loneliness and objective social isolation are associated with poorer self-rated recovery following a crisis, compatible with a causal relationship. These findings suggest a potential role for interventions aimed at alleviating loneliness and objective social isolation in improving recovery outcomes for people with mental health symptoms. Increased awareness of both issues among health practitioners is also warranted.
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Chronic loneliness is closely associated with depressive symptoms, maladaptive social cognition, and poor recovery following a mental health crisis.
“As a potential stressor, chronic loneliness is closely associated with depressive symptoms, maladaptive social cognition, and poor recovery following a mental health crisis.82–84”
From A Longitudinal Study of Loneliness Before the End of the COVID-19 Pandemic: Trajectories, Predictors, and Impact on Chinese Adolescent Mental Health (2024) · cites this paper as [84]
The Results and Discussion report that persistent severe loneliness was associated with poorer self-rated recovery 18 months after a mental health crisis. The Introduction links loneliness and social isolation generally to depressive symptoms, but describes maladaptive cognitive biases only as possible factors in persistent loneliness; it does not establish the claimed close association with maladaptive social cognition. (LLM, conf=0.85)
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“84 Researchers have suggested that transient loneliness may serve an evolutionary purpose by prompting people to reestablish connections for the sake of survival and genetic continuity.”
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- Authors
- Ma, R., Wang, J., Lloyd-Evans, B., Marston, L., & Johnson, S.
- Affiliations
- King's College London (GB)
- Fudan University (CN)
- University College London (GB)
- St Pancras Hospital (GB)
- Corresponding author
- Johnson, Sonia
- Venue
- BMC Psychiatry
- Published
- 2021-08-23
- Volume
- 21
- Issue
- 1
- Pages
- 421-421
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC8381487
- OpenAlex
- W3154881508
- Cited by
- 30
- References
- 49
- Citations by year
- 2026: 6 · 2025: 5 · 2024: 12 · 2023: 3 · 2022: 4
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- UK Research and Innovation (ES/S004440/1)
- National Institute for Health and Care Research (RP-PG-0109-10078)
- Economic and Social Research Council (ES/S004440/1)
- Programme Grants for Applied Research (RP-PG-0109-10078)
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- loneliness, objective social isolation, social networks, personal recovery, crisis resolution teams, mental health service users
- MeSH terms
- United Kingdom, Humans, Loneliness, Longitudinal Studies, Mental Health Services, Social Isolation, Cohort Studies, Self Report
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