Investigating the roles of loneliness and clinician- and self-rated depressive symptoms in predicting the subjective quality of life among people with psychosis

Marta Anczewska,Jacek Wciórka,Piotr Świtaj,Anna Chrostek,Paweł Grygiel

doi:10.1007/s00127-017-1470-1

Abstract

PurposeTo examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis.MethodsThis cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data.ResultsBoth loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms.ConclusionsTherapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

Highlights

Loneliness is a subjective, negative experience resulting from a mismatch between the desired and actual quantity and/or quality of one’s social relationships
Existing studies have identified diverse clusters of factors that may contribute to this greater severity of loneliness in psychosis, including anhedonia and subjective thought disorder [5], positive symptoms [8], depression and poor self-reported social cognition [7], experiences of discrimination, diminished self-esteem and unwillingness to seek social support [9], internalized stigma, weak social support, restricted social network, poor interpersonal competence and a high number of psychiatric inpatient admissions [6], living arrangement and low levels of social support and participation in the community
The data from this study provide evidence that higher levels of loneliness strongly predict worse subjective quality of life (QoL) in people with psychotic disorders, even after controlling for socio-demographics, clinical factors, and most importantly, depression

Summary

Introduction

Loneliness is a subjective, negative experience resulting from a mismatch between the desired and actual quantity and/or quality of one’s social relationships. It is not synonymous with social isolation, which concerns the objective characteristics of the situation and refers to the absence of relationships with other people [1]. [10], or low scores on measures of self-efficacy for community life, self-esteem, social network and community integration [11] Despite these findings, there are indications that people with psychotic disorders may find it difficult to report loneliness or to mention that this is a need to be met by mental health services, possibly because the experience of socialization is stressful for them [12]. There are studies indicating that loneliness and depressive symptoms influence one another reciprocally [23, 24]

Methods

Results

Conclusion