Neighbourhood characteristics and social isolation of people with psychosis: a multi-site cross-sectional study

Abstract

Purpose People with psychosis are vulnerable to social isolation, which is associated with worse clinical outcomes. In general populations, people living in areas with higher population density have more social contacts, while those living in more socially deprived and fragmented areas are less satisfied with their relationships. We assessed whether and how neighbourhood factors are associated with social contacts and satisfaction with friendships for people with psychosis. Methods We carried out a cross-sectional study including people with psychosis aged 18–65 years in urban and rural sites in England. Population density and social deprivation and fragmentation indexes were described within Lower Level Super Output Areas (LSOA). Their associations with participants’ social contacts and satisfaction with friendships were tested with negative binomial and ordinal regression models, respectively. Results We surveyed 511 participants with psychotic disorders. They had a median of two social contacts in the previous week (interquartile range [IQR] = 1–4), and rated satisfaction with friendships as 5 out of 7 (Manchester Short Assessment of Quality of Life; IQR = 4–6). Higher population density was associated with fewer social contacts (Z-standardised relative risk [RR] = 0.88; 95% CI = 0.79–0.99, p = 0.03), but not with satisfaction with friendships (RR = 1.08; 95% CI = 0.93–1.26, p = 0.31). No associations were found for social contacts or satisfaction with friendships with social deprivation or fragmentation indexes. Conclusions Clinicians in urban areas should be aware that their patients with psychosis are more socially isolated when more people live around them, and this could impact their clinical outcomes. These findings may inform housing programmes.

Psychiatric emergencies during, after, and before the COVID-19 lockdown: what happened to our patients? A naturalistic observational study

“…The reduction of ED access for subjects with SMI during the lockdown and post-lockdown confirms evidence of other studies and could be explained by the fact that patients affected by psychotic disorders were already suffering from social isolation before the lockdown, thus movement restrictions and social distancing might have initially less affected them [ 16 ]. It is interesting to note that higher population density was found to be associated with fewer social contacts in patients with psychosis [ 34 ]; thus we might argue that social isolation in psychosis is not related to the availability of social contact, rather than to psychopathological characteristics of SMI. It might be argued that in the most severe psychopathological conditions such as schizophrenia, it might be more distressing the return to “normal” life and deal with social relationships than the lockdown [ 35 ].…”

Psychiatric emergencies during, after, and before the COVID-19 lockdown; what happened to our patients? A naturalistic observational study

“…The reduction of ED access for subjects with SMI during the lockdown and post-lockdown con rms evidence of other studies and could be explained by the fact that patients affected by psychotic disorders were already suffering from social isolation before the lockdown, thus movement restrictions and social distancing might have initially less affected them (Itrat et al 2020). It is interesting to note that higher population density was found to be associated with fewer social contacts in patients with psychosis [34]; thus we might argue that social isolation in psychosis is not related to the availability of social contact, rather than to psychopathological characteristics of SMI. It might be argued that in the most severe psychopathological conditions such as schizophrenia, it might be more distressing the return to "normal" life and deal with social relationships than the lockdown [35].…”

An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review

“…Giacco et al (2021) presents a different perspective, finding no significant correlation between social deprivation and loneliness in people with severe mental illness ( N = 511). The UK study suggests that prejudice and discrimination against people with severe mental illness contributed to their perceived social unattractiveness as potential social partners, rather than social deprivation.…”

“…Most study participants were recruited from community mental health services (14), medical centres (1), rural and urban mental health services (1), and forensic community services (1). The sample size ranged from 31 to 399 among quantitative and mixed papers (Chang et al, 2014; Cruwys et al, 2014; Giacco et al, 2021; Killaspy et al, 2014; Ma et al, 2021; Mezey et al, 2013; Saavedra et al, 2018; Sheridan et al, 2015; Shioda et al, 2016; Świtaj et al, 2014; Wang et al, 2020; Weiner et al, 2010), and 8–20 in the qualitative papers (Barut et al, 2016; Evans, 2010; Ludwig et al, 2022; Topor et al, 2016). An integrated summary of the included research is presented in Table 2.…”

“…Most papers (14/17) relied on semi‐structured interviews, self‐reports, and questionnaires. These methods were used to gather data on participants' physical and mental health, social interactions and well‐being, depression or anxiety, and daily function capabilities (Anderson et al, 2015; Barut et al, 2016; Cruwys et al, 2014; Evans, 2010; Giacco et al, 2021; Ludwig, 2022, Ma et al, 2021; Mezey et al, 2013; Saavedra et al, 2018; Sheridan et al, 2015; Shioda et al, 2016; Świtaj et al, 2014; Topor et al, 2016; Weiner et al, 2010). Other papers (3/17) used face to face interviews to collect socio‐demographic, onset/duration of illness, and admissions data (Chang et al, 2014; Killaspy et al, 2014; Wang et al, 2020).…”