Wang, Jingyi;
(2018)
Loneliness and mental health in a randomised controlled trial of a peer-provided self-management intervention for people leaving crisis resolution teams.
Doctoral thesis (Ph.D), UCL (University College London).
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Abstract
BACKGROUND: Loneliness is more prevalent among people with mental health problems than in the general population. However, loneliness has not been a particularly prominent focus in recent research on outcomes of mental illness. Loneliness interventions have also received little attention. AIMS: 1) To review literature for the definition and conceptual model of loneliness and its closely related concepts, and for well-developed measures of these concepts. 2) To systematically review the impact of loneliness and perceived social support on mental health outcomes 3) To explore the severity of loneliness among people leaving Crisis Resolution Teams (CRTs), and identify factors cross-sectionally associated with loneliness. 4) To determine whether loneliness at baseline predicts poor outcomes at 4-month follow-up, including overall symptom severity, affective symptoms, self-rated recovery and health-related quality of life. 5) To examine whether there is any difference in loneliness at 4-month follow-up between a peer-provided self-management intervention group and a control group in a randomised controlled trial. METHOD: A conceptual framework of loneliness and related concepts was developed and measures identified of main concepts. A systematic review of longitudinal studies examining the effect of loneliness and perceived social support on mental illness prognosis was conducted. The sample (n=399) was taken from patients participating in a research trial from CRTs. Participants in the trial intervention group were offered up to ten meetings by a peer support worker and a self-management workbook. Participants in the control group were only provided a self-management workbook. Respondents (n=310) completed the follow-up measurement four months after baseline. RESULTS: A model with five domains was proposed to incorporate all terms relating to loneliness. Well-developed measures assessing each domain or covering multi-domains were identified. Perceived social support and loneliness were associated with mental health outcomes. The severity of loneliness was high among people leaving CRTs. Greater loneliness was significantly associated with small social network size, limited social capital, severe affective symptoms and long-term mental illness history. Greater loneliness at baseline predicted poorer health-related quality of life at 4-month follow-up. Loneliness was also a better predictor of clinical outcomes than objective social isolation and social capital. Loneliness at follow-up was not significantly different between the intervention group and the control group. DISCUSSION Loneliness is an important issue in mental health service users. It could be a promising target to improve recovery for people with mental health problems. The efficacy of peer-provided self-management intervention on loneliness was not confirmed. More research is necessary to explore beneficial loneliness interventions so as to aid the development of recovery-oriented mental health services.
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