Abstract
BackgroundLoneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. This qualitative study, which was carried out as part of a feasibility trial, aimed to understand what enables and hinders people with severe depression and/or anxiety under the care of secondary mental health services in the United Kingdom to participate in the Community Navigator programme, and make progress with feelings of depression, anxiety and loneliness. The programme consisted of up to ten meetings with a Community Navigator and three optional group sessions.MethodsSemi-structured interviews were carried out with participants (n = 19) shortly after programme completion. A co-produced two-stage qualitative approach, involving narrative and reflexive thematic analysis, was undertaken by members of the study’s working group, which included experts by experience, clinicians and researchers.ResultsThe narrative analysis showed that individuals have varied goals, hold mixed feelings about meeting other people and define progress differently. From the thematic analysis, six themes were identified that explained facilitators and challenges to participating in the programme: desire to connect with others; individual social confidence; finding something meaningful to do; the accessibility of resources locally; the timing of the programme; and the participant’s relationship with the Community Navigator.ConclusionsWe found that people with severe depression and/or anxiety supported by secondary mental health services may want to address feelings of loneliness but find it emotionally effortful to do so and a major personal challenge. This emotional effort, which manifests in individuals differently, can make it hard for participants to engage with a loneliness programme, though it was through facing personal challenges that a significant sense of achievement was felt. Factors at the individual, interpersonal and structural level, that enable or hinder an individual’s participation should be identified early, so that people are able to make the best use out of the Community Navigator or other similar programmes.
Highlights
Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems
Loneliness has been variously defined [5, 6] but is generally understood to be the distressing subjective state experienced when there is a gap between actual and desired social relations [7] and is not solely about being alone [8]. It is this focus on subjectivity, and the appraisal of one’s perceived relationship quality, that distinguishes loneliness from related concepts such as social isolation, which refers to a lack of contact with other people, often objectively measured by counting social ties [9]
This paper presents a co-produced qualitative analysis of the factors that appear to influence participation in the Community Navigator programme, which was developed to improve community connections and reduce feelings of loneliness among people with severe depression and/or anxiety [26]
Summary
Loneliness is associated with negative outcomes, including increased mortality and is common among people with mental health problems. A systematic review found that higher levels of loneliness predicts greater depression severity and lower rates of remission [18] and longitudinal work has shown that loneliness and depression are predictors of early death, among older men [19]. Taken together, this highlights the need for intervention
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