Abstract
PurposeSubjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.MethodsThree databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.ResultsIn total, 30 RCTs met the review’s inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants’ characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.ConclusionThe evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.
Highlights
Subjective social isolation and objective social isolation are conceptually distinct [1] and often only moderately correlated [2]
Nineteen trials had fewer than 100 participants
A tendency not to clearly specify primary outcomes in earlier trials meant that some of the trials meeting our criteria were broad socially oriented programmes in which social isolation measures were among a number of outcomes
Summary
Subjective social isolation and objective social isolation are conceptually distinct [1] and often only moderately correlated [2]. Social support that is perceived as sufficient is associated with less severe psychiatric symptoms, higher functioning, better personal recovery, greater self-esteem and empowerment, and improved quality of life [26] These associations between subjective and objective social isolation and poorer outcomes [27–30] make interventions designed to alleviate social isolation of high interest. Our paper adds to knowledge from Masi’s review by providing an up-to-date synthesis of interventions for loneliness in people with mental health problems, using a typology of interventions targeting loneliness and related constructs recently developed by Mann and her team [39] This typology distinguishes among the following: (1) interventions involving changing maladaptive cognitions about others (e.g. cognitive-behavioural therapy or reframing); (2) social skills training and psychoeducation programmes (e.g. family psychoeducation therapy); (3) supported socialisation (e.g. peer support groups, social recreation groups); and (4) wider community approaches (e.g. social prescribing and asset-based community development approaches). These community approaches maximise individuals’ engagement with social resources and/or aim to develop social resources at the level of whole communities
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