![]() 20 Loneliness may also perpetuate negative beliefs about oneself and other people, which may in turn increase the frequency of paranoid thoughts. For example, loneliness may directly increase anxiety and depression 10 which in turn may exacerbate symptoms of psychosis. There are several possible mechanisms linking loneliness to psychotic symptoms such as hallucinations. 17, 18 Interested readers may consult Hawkley and Cacioppo for a comprehensive review of loneliness. 14 Loneliness has also been related to an increased tendency to experience subclinical and clinical hallucinations 15, 16 and to nonclinical paranoid thinking. Loneliness has been associated with depression and suicide ideation, 10 lower life satisfaction, 11 elevated blood pressure levels, 12 increased stress hormone levels, 13 and compromised immune system. 8 While social isolation can be measured objectively, loneliness is a subjective emotional state of the individual, which may be present in individuals with large social networks, and absent in isolated individuals with minimal social contact. ![]() Loneliness is an unpleasant and distressing experience resulting from a perceived deficiency in the quantity or quality of one’s social relationships. ![]() ![]() 7 This is of particular relevance, as objective features of social support are related but distinct from these more subjective aspects of social relationships. The majority of studies examining social support in psychosis have concentrated on quantitative features of the social network such as size and reciprocity instead of more functional aspects such as loneliness or satisfaction with relationships. 6 A self-perpetuating cycle of exclusion may develop, whereby the disorder limits connections and support, which then leads to a removal of important buffers, thereby increasing risk of relapse and causing an escalation of psychotic episodes, further social disengagement, and so forth. 3, 4Īlthough feelings of loneliness and social isolation are generally thought to reflect the negative impact of psychotic experiences, 5 more recently it has been reported that loneliness may also play a causal role in the development of psychotic experiences. People with psychosis often struggle to develop and preserve functioning relationships, have limited social networks and restricted access to social support outside of what is provided by mental health services. 1 Stain et al 2 report that as many as 80% of adults with a diagnosis of psychosis in Australia endorsed feeling lonely in the past 12 months. People with psychotic disorders frequently feel lonely and many expect to be lonely in the future. Further studies are needed to determine the causal status of this relationship, but this robust finding should be considered in clinical practice and treatment provision for those with psychotic disorders. Results indicate that there is a significant positive relationship between loneliness and psychosis. Whether loneliness was assessed by a single-item or a more comprehensive measure had no moderating effect on the estimate. A moderate association between psychosis and loneliness was observed ( k = 13, N = 15 647, r =. Thirteen studies were included, providing data from 15 647 participants. Study and outcome quality were assessed using adapted versions of the Agency for Healthcare Research and Quality (AHRQ) tool and GRADE approach, respectively. A random effects meta-analysis was used to compute a pooled estimate of the correlation between loneliness and psychotic symptoms. A search of electronic databases was conducted (PsychINFO, MEDLINE, EMBASE, and Web of Science). The primary aim of the current study is to provide a systematic review and meta-analysis of the association between loneliness and psychotic symptoms in people with psychosis. Loneliness may be related to psychotic symptoms but a comprehensive synthesis of the literature in this area is lacking.
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