Ikhtabi, Sarah; (2025) Exploring loneliness among people with Complex Emotional Needs (CEN) using mixed methods. Doctoral thesis (Ph.D), UCL (University College London).

Text Ikhtabi_10207334_thesis_id_removed.pdf Access restricted to UCL open access staff until 1 May 2026. Download (4MB)

Abstract

Background Loneliness is prevalent among people with complex emotional needs (CEN) who may have a diagnosis/traits of ‘personality disorder’. They report that addressing loneliness and social needs is highly valued for recovery. To help meet this need, my thesis aimed to develop an understanding of loneliness in the context of CEN, laying the groundwork for co-produced interventions to meet social needs. Methods and findings I used an iterative mixed-methods exploratory study-design: Study 1: I conducted a systematic review synthesising quantitative data on the prevalence/severity of loneliness and deficits in perceived social support among people with CEN. This identified substantial evidence that CEN is associated with higher levels of loneliness and poorer perceived social support compared to other clinical groups and the general population. Study 2: I conducted an in-depth qualitative interview study exploring experiences of loneliness among people with CEN from a range of sociodemographic backgrounds. Findings suggested loneliness is persistent and originates from negative childhood experiences. Loneliness appeared to worsen symptoms of CEN which in turn intensify loneliness. Experiences of discrimination or stigma are described as an additional barrier to achieving a sense of belonging. Group-based activities, healing relationships and psychological skills and emotional exploration are reported to help with loneliness. Study 3: I analysed cross-sectional data from the 2014 Adult Psychiatric Morbidity Survey, to investigate: 1) whether discrimination based on i) mental health and ii) sexuality modified the association between number of CEN traits and loneliness; and 2) whether loneliness modified the association between number of CEN traits and i) NSSH, ii) suicidal ideation, and iii) suicide attempts. I found that 1) people who endorsed a greater number of CEN traits are more likely to report feeling lonely, NSSH, suicidal ideation, and suicide attempts, and 2) people who are lonely who endorsed a greater number of CEN traits are more likely to report NSSH and suicidal ideation. However, I did not find evidence supporting any hypothesised effect modifiers for discrimination. Conclusion Bringing my findings together, informed by input from my lived experience collaborators, my thesis demonstrates the centrality of loneliness in the lives of people with CEN. This empirical work suggests that CEN is best understood through a relational lens and in the context of wider sociocultural and societal barriers such as discrimination and exclusionary practices; all of which create and maintain a sense of disconnection and loneliness. This work identifies a clear need to co-produce a psychosocial intervention targeting loneliness among people with CEN.

Download activity - last month

Export as XMLCSVJSON

Download activity - last 12 months

Export as XMLCSVJSON

Downloads by country - last 12 months

Export as JSONCSVXML

Archive Staff Only

View Item