The Influence of Health Literacy and Social Support on Loneliness Among Patients With Severe Mental Illness in Rural Southwest China.

Yan Liu,Kyaien O Conner,Danping Liu,Mutian Qiao,Hongdao Meng

doi:10.3389/fpsyg.2021.564666

Abstract

Loneliness is an important risk factor for poor health outcomes among adults, especially among those with severe mental illnesses (SMIs). Existing research has shown that adults with SMIs often lack health literacy, which contributes to more restricted social networks and low levels of social support. The objective of this cross-sectional study was to examine the influence of health literacy and social support on the loneliness of patients with SMI in rural Southwest China. We recruited 300 patients with SMI in rural Southwest China between December, 2017 to May, 2018 via a multi-stage stratified random sampling approach. We used structural equation modeling (SEM) test the hypothesized relationships among the variables of the 270 patients who completed the survey. Results of the SEM showed that health literacy was both directly and indirectly associated with loneliness, with social support playing a mediating role. These findings suggest psychoeducation for SMI patients, and their informal caregivers, may offer beneficial effects toward reducing loneliness in this vulnerable population. Further, social support is another potential target for intervention development for improving patient outcomes.

Highlights

Patients with severe mental illness (SMI) are often described as a group of heterogeneous people who suffer from severe psychiatric disorders together with long-term mental disturbances such as schizophrenia, bipolar disorder, schizoaffective disorders, major recurrent depressive disorder and personality disorders (Jansen, 2018)
The current study examines the effect of health literacy and social support on loneliness among a sample of patients with SMI in China
In 270 SMI patients, 88.2% of SMI patients experienced moderate or more severe loneliness, which is significantly higher than Chinese older adults (19.6%) (Yang, 2020) and adults with a diagnosis of psychosis in Australia (80%) (Stain et al, 2012)

Summary

Introduction

Patients with severe mental illness (SMI) are often described as a group of heterogeneous people who suffer from severe psychiatric disorders together with long-term mental disturbances such as schizophrenia, bipolar disorder, schizoaffective disorders, major recurrent depressive disorder and personality disorders (Jansen, 2018). SMI patients may have fewer successful interactions or have limited social networks because deficiencies in certain social and personal functioning skills such as memory deficits and social anhedonia (Barkus and Badcock, 2019) They are often excluded socially because of societal stigma against individuals with psychiatric symptoms such as depression or paranoia (Schwartz and Gronemann, 2009). Individuals with SMI might internalize stigma of mental illness To be specific, they may feel that having psychopathology makes them perform oddly in social situations or that such performance will be embarrassing, perhaps they they will create negative affect like feeling inferior and steering clear of people because they have adopted beliefs in the larger society that SMI patients are subordinate to everyone else (Prince et al, 2018). Studies have found that patients’ subjective recovery from psychosis was significantly related to a decrease in loneliness (Roe et al, 2011), and that of adequate health literacy, social support, and social networks may reduce loneliness among SMI patients (Perese and Wolf, 2005)

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