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Yaniv-Rosenfeld A, Savchenko E, Netzer M, Elalouf A, Nitzan U. Socio-demographic Predictors of Hospitalization Duration Among Patients with Borderline Personality Disorder. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01388-w. [PMID: 38814421 DOI: 10.1007/s10488-024-01388-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/31/2024]
Abstract
Borderline personality disorder (BPD) is a complex psychopathology associated with high service utilization rates. In turn, the hospitalization of BPD patients is a controversial challenge for mental health professionals. Prior literature has identified certain socio-demographic factors as linked to an increased risk of BPD. In this study, we examined the possible connection between these socio-demographic factors and hospitalization duration. We analyzed 1077 hospitalization records of 200 BPD-diagnosed patients. Patients' gender, age, education level, employment and marital statuses, and living arrangement were statistically significantly linked with hospitalization duration. Specifically, female gender, age twenty or below, no high-school diploma (or, to a lesser extent, a diploma with no academic education), unemployment status and/or patients who live with parents are strongly associated with longer hospitalizations compared to male gender, older patients, more educated, married/divorced status and/or those who do not live with their parents. Additionally, the results point to a weak, albeit statistically significant, temporal pattern with more advanced hospitalizations generally aligning with the duration of their preceding ones, while being slightly shorter. In order to prevent potentially unnecessary prolonged and regressive hospitalizations, an estimation of the expected hospitalization duration should be explicitly considered when setting hospitalization goals and plans.
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Affiliation(s)
- Amit Yaniv-Rosenfeld
- Shalvata Mental Health Care Center, Hod Hasharon, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Department of Management, Bar-Ilan University, Ramat-Gan, Israel.
| | | | - Maya Netzer
- Department of Information Science, Bar-Ilan University, Ramat-Gan, Israel
| | - Amir Elalouf
- Department of Management, Bar-Ilan University, Ramat-Gan, Israel
| | - Uri Nitzan
- Shalvata Mental Health Care Center, Hod Hasharon, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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2
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Laustsen LM, Ejlskov L, Chen D, Lasgaard M, Gradus JL, Østergaard SD, Grønkjær MS, Plana-Ripoll O. Interaction between mental disorders and social disconnectedness on mortality: a population-based cohort study. Br J Psychiatry 2024:1-8. [PMID: 38708564 DOI: 10.1192/bjp.2024.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Despite the recognised importance of mental disorders and social disconnectedness for mortality, few studies have examined their co-occurrence. AIMS To examine the interaction between mental disorders and three distinct aspects of social disconnectedness on mortality, while taking into account sex, age and characteristics of the mental disorder. METHOD This cohort study included participants from the Danish National Health Survey in 2013 and 2017 who were followed until 2021. Survey data on social disconnectedness (loneliness, social isolation and low social support) were linked with register data on hospital-diagnosed mental disorders and mortality. Poisson regression was applied to estimate independent and joint associations with mortality, interaction contrasts and attributable proportions. RESULTS A total of 162 497 individuals were followed for 886 614 person-years, and 9047 individuals (5.6%) died during follow-up. Among men, interaction between mental disorders and loneliness, social isolation and low social support, respectively, accounted for 47% (95% CI: 21-74%), 24% (95% CI: -15 to 63%) and 61% (95% CI: 35-86%) of the excess mortality after adjustment for demographics, country of birth, somatic morbidity, educational level, income and wealth. In contrast, among women, no excess mortality could be attributed to interaction. No clear trends were identified according to age or characteristics of the mental disorder. CONCLUSIONS Mortality among men, but not women, with a co-occurring mental disorder and social disconnectedness was substantially elevated compared with what was expected. Awareness of elevated mortality rates among socially disconnected men with mental disorders could be of importance to qualify and guide prevention efforts in psychiatric services.
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Affiliation(s)
- Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Linda Ejlskov
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Mathias Lasgaard
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark; and Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jaimie L Gradus
- Boston University School of Public Health, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Søren Dinesen Østergaard
- Department of Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Marie Stjerne Grønkjær
- Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark; and National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
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3
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Parmar M, Ma R, Attygalle S, Herath MD, Mueller C, Stubbs B, Stewart R, Perera G. Associations between recorded loneliness and adverse mental health outcomes among patients receiving mental healthcare in South London: a retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02663-9. [PMID: 38622311 DOI: 10.1007/s00127-024-02663-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in groups affected remain less well understood. METHOD A cohort of patients receiving mental healthcare on 30th June 2012 was assembled from a large mental health records database covering a south London catchment area. Recorded loneliness within the preceding 2 years was extracted using natural language processing and outcomes were measured between 30th June 2012 until 30th December 2019, except for survival which applied a censoring point of 6th December 2020 according to data available at the time of extraction. The following mental healthcare outcomes: (i) time to first crisis episode; (ii) time to first emergency presentation; (iii) all-cause mortality; (iv) days active to service per year; and (v) face-to-face contacts per year. RESULTS Loneliness was recorded in 4,483 (16.7%) patients in the study population and fully adjusted models showed associations with subsequent crisis episode (HR 1.17, 95% CI 1.07-1.29), emergency presentation (HR 1.30, 1.21-1.40), days active per year (IRR 1.04, 1.03-1.05), and face-to-face contacts per year (IRR 1.28, 1.27-1.30). Recorded loneliness in patients with substance misuse problems was particularly strongly associated with adverse outcomes, including risk of emergency presentation (HR 1.68, 1.29-2.18) and mortality (HR 1.29, 1.01-1.65). CONCLUSION Patients receiving mental healthcare who are recorded as lonely have a higher risk of several adverse outcomes which may require a need for higher service input.
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Affiliation(s)
- Mayur Parmar
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | - Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
| | | | - Maaheshi Deepika Herath
- Ministry of Health Sri Lanka, Colombo, Sri Lanka
- Faculty of Life and Health Sciences, School of Medicine, Ulster University, Belfast, Northern Ireland
| | - Christoph Mueller
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Gayan Perera
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (King's College London), De Crespigny Park, Box 92, London, SE5 8AF, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
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McCormick BP, Brusilovskiy E, Nagata S, Townley G, Snethen G, Salzer MS. The Role of Acceptance in Everyday Loneliness Among Adults with Serious Mental Illness. Community Ment Health J 2024; 60:308-316. [PMID: 37498513 DOI: 10.1007/s10597-023-01172-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023]
Abstract
There is a high prevalence of loneliness among adults with serious mental illness (SMI) with most research focusing on stable contributing factors. This study sought to identify the role of dispositional loneliness and internalized stigma, as well as the momentary feelings of acceptance on experiential loneliness among adults with SMI. Data were collected using ecological momentary assessment via smart phones, and 89 adults with a SMI were included. Hierarchical linear modeling was used to identify the role of dispositional and experience factors in experiential loneliness. Findings indicated that (a) dispositional internalized stigma, (b) being at home, (c) being alone and, (d) a cross-level interaction between dispositional loneliness and feelings of acceptance best fit the data. The relationship of acceptance to experiential loneliness was strongest among the most lonely. Supporting people with SMI to develop social connections contributing to their relational value may enhance feelings of acceptance and reduce loneliness.
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Affiliation(s)
- Bryan P McCormick
- Department of Health & Rehabilitation Sciences, Temple University, 1700 N. Broad St., Suite 304, Philadelphia, PA, 19122, USA.
| | - Eugene Brusilovskiy
- Department of Social & Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Shinichi Nagata
- Faculty of Health and Sport Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Gretchen Snethen
- Department of Health & Rehabilitation Sciences, Temple University, Philadelphia, PA, USA
| | - Mark S Salzer
- Department of Social & Behavioral Sciences, Temple University, Philadelphia, PA, USA
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Georgescu MF, Beydoun MA, Ashe J, Maino Vieytes CA, Beydoun HA, Evans MK, Zonderman AB. Loneliness, Dementia Status, and Their Association with All-Cause Mortality Among Older US Adults. J Alzheimers Dis 2024; 99:753-772. [PMID: 38701144 DOI: 10.3233/jad-231359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background Loneliness, dementia, and mortality are interconnected. Objective We aimed at understanding mediating pathways and interactions between loneliness and dementia in relation to mortality risk. Methods The study tested bi-directional relationships between dementia, loneliness, and mortality, by examining both interactions and mediating effects in a large sample of older US adults participating in the nationally representative Health and Retirement Study. Out of≤6,468 older participants selected in 2010, with mean baseline age of 78.3 years and a follow-up time up to the end of 2020, 3,298 died at a rate of 64 per 1,000 person-years (P-Y). Cox proportional hazards and four-way decomposition models were used. Results Algorithmically defined dementia status (yes versus no) was consistently linked with a more than two-fold increase in mortality risk. Dementia status and Ln(odds of dementia) were strongly related with mortality risk across tertiles of loneliness score. Loneliness z-score was also linked to an elevated risk of all-cause mortality regardless of age, sex, or race or ethnicity, and its total effect (TE) on mortality was partially mediated by Ln(odds of dementia), z-scored, (≤40% of the TE was a pure indirect effect). Conversely, a small proportion (<5%) of the TE of Ln(odds of dementia), z-scored, on mortality risk was explained by the loneliness z-score. Conclusions In sum, dementia was positively associated with all-cause mortality risk, in similar fashion across loneliness score tertiles, while loneliness was associated with mortality risk. TE of loneliness on mortality risk was partially mediated by dementia odds in reduced models.
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Affiliation(s)
- Michael F Georgescu
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
| | - Jason Ashe
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
| | - Christian A Maino Vieytes
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
| | - Hind A Beydoun
- U.S. Department of Veterans Affairs, VA National Center on Homelessness Among Veterans, Washington, DC, USA
- Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michele K Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, Intramural Research Program, NIA/NIH/IRP, Baltimore, MD, USA
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6
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Stewart R, Chaturvedi J, Roberts A. Natural language processing - relevance to patient outcomes and real-world evidence. Expert Rev Pharmacoecon Outcomes Res 2024; 24:5-9. [PMID: 37874661 DOI: 10.1080/14737167.2023.2275670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 10/26/2023]
Affiliation(s)
- Robert Stewart
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jaya Chaturvedi
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Angus Roberts
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Boettcher J, Radzuweit D, Mey M, Rauch P, Kogler A, Barkmann C, Goth K, Hohmann S, Bindt C, Voelker U. "Alone Again, Naturally": Mental Health Problems, Level of Personality Functioning, Social Withdrawal and Loneliness in Adolescents Admitted as Acute Inpatients in the Aftermath of the COVID-19 Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1743. [PMID: 38002834 PMCID: PMC10670466 DOI: 10.3390/children10111743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 10/22/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
(1) Background: Adolescents admitted as acute inpatients belong to a particularly psychosocially vulnerable population. This study aimed to examine the clinical characteristics of an affected population in Germany using a theory-based approach. (2) Methods: We assessed the mental health problems, levels of personality functioning, and the severity of social withdrawal and loneliness in n = 62 adolescents admitted to an acute psychiatric inpatient unit. Cases were investigated cross-sectionally utilizing standardized psychometric questionnaires from the perspective of the patients and clinical experts. (3) Results: Mental health, level of impaired personality functioning, social withdrawal, and loneliness were all positively associated with the need for acute admission. Further analyses revealed that the level of personality functioning fully mediated the positive association between social withdrawal and mental health problems. In contrast, level of personality functioning only partially mediated the positive association between loneliness and mental health problems. (4) Conclusions: Our results suggest that more impairment in personality functioning might lead to poorer mental health when adolescents socially withdraw in the aftermath of the COVID-19 pandemic. Loneliness, social withdrawal, and the level of personality functioning may help identifying essential characteristics of adolescents admitted to acute psychiatric inpatient units and guide the development of specific interventions.
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Affiliation(s)
- Johannes Boettcher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Dennis Radzuweit
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Marie Mey
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Philipp Rauch
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas Kogler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Kirstin Goth
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinics, 4002 Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University Clinics Saarland, 66421 Homburg, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Ursula Voelker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
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Contribution of perceived loneliness to suicidal thoughts among French university students during the COVID-19 pandemic. Sci Rep 2022; 12:16833. [PMID: 36207381 PMCID: PMC9540057 DOI: 10.1038/s41598-022-21288-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
Restrictive measures during the COVID-19 epidemic have led to increased levels of loneliness, especially among university students, although the influence on suicidal thoughts remains unclear. In this cross-sectional study of 1913 French university students, those with the highest level of loneliness had a fourfold increased risk of suicidal thoughts. Perceived loneliness should be incorporated into suicide risk assessment, and assistance in coping with loneliness should be considered as a means of reducing suicidal risk in vulnerable groups, like university students.
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9
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Sleight AG, Myers JS, Cook-Wiens G, Baynes R, Jo MY, Asher A. Loneliness as a risk factor for cancer-related cognitive impairment: a secondary data analysis from the Haze study. Disabil Rehabil 2022:1-4. [PMID: 35760769 DOI: 10.1080/09638288.2022.2089738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to investigate the association between loneliness and cancer-related cognitive impairment (CRCI) in a cohort of breast cancer survivors. METHODS Female breast cancer survivors (stage I-III) reporting cognitive impairments 2 months to 5 years after chemotherapy (n = 61) participated in a prospective, nonblinded, waitlist-controlled pilot study. The intervention was a tailored cognitive rehabilitation program. Data were collected pre-/post-intervention. Loneliness was measured using the UCLA Loneliness Scale. Perceived cognitive function was measured using two subscales of the FACT-Cog and two PROMIS - Applied Cognition short forms. Spearman correlation coefficients were calculated to determine the relationship between loneliness and perceived cognitive function (PCF). RESULTS Participants' loneliness severity was correlated with diminished PCF across all cognitive measures (Spearman r= -0.63 FACT-Cog Perceived Cognitive Impairment, p < 0.0001; r= -0.6 FACT-Cog Perceived Cognitive Abilities, p < 0.0001; r= -0.49 PROMIS Cognitive Ability, p = 0.0002; r = 0.50 PROMIS General Concerns, p = 0.0002). Loneliness scores significantly decreased following participation in the cognitive rehabilitation program in intervention participants as compared to wait-list controls [-5.0 ± 7.24, 95% CI (-8.06, -1.94), p = 0.0025]. CONCLUSIONS Perceived loneliness was significantly and consistently correlated with PCF. The intervention may have served a dual purpose in both addressing cognitive deficits and loneliness. Additional research dedicated to understanding the association between loneliness and cognitive function, as well as screening for and addressing loneliness in clinical oncology settings, may be warranted. IMPLICATIONS FOR REHABILITATIONScreening for and addressing loneliness in oncology rehabilitation settings is warranted.Rehabilitation professionals are well-positioned to screen for and address loneliness during clinic visits as part of routine cancer rehabilitation care.Group settings may be appropriate for addressing cancer-related cognitive impairment in rehabilitation, as these groups may serve the dual purpose of addressing cognitive impairment and loneliness simultaneously.
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Affiliation(s)
- Alix G Sleight
- Dept. of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Center for Integrated Research in Cancer and Lifestyle (CIRCL), Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Jamie S Myers
- University of Kansas School of Nursing, Kansas City, KS, USA
| | - Galen Cook-Wiens
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rachel Baynes
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Arash Asher
- Dept. of Physical Medicine and Rehabilitation, Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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10
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Greig F, Perera G, Tsamakis K, Stewart R, Velayudhan L, Mueller C. Loneliness in older adult mental health services during the COVID-19 pandemic and before: Associations with disability, functioning and pharmacotherapy. Int J Geriatr Psychiatry 2021; 37:10.1002/gps.5630. [PMID: 34614534 PMCID: PMC8646648 DOI: 10.1002/gps.5630] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/29/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Loneliness is associated with psychiatric morbidity. Restrictions placed on the population during the first COVID-19 lockdown may have disproportionately affected older adults, possibly through increasing loneliness. We sought to investigate this by examining loneliness in referrals to mental health of older adults (MHOA) services during the first UK COVID-19 lockdown. METHODS Referrals to MHOA services from a large South London catchment area were identified for the 16-week period of the UK lockdown starting in March 2020 and for the corresponding period in 2019. A natural language processing algorithm identified loneliness in the patients' records. We applied logistic regression models adjusted for age, gender, ethnicity and diagnosis, to examine associations of loneliness in the study population. RESULTS 1991 referrals were identified, 56.9% of whom were female, with a mean age of 77.9 years. Only 26.9% occurred during the 2020 lockdown, but with a higher prevalence of loneliness (22.0 vs. 17.7%, p = 0.028). In the whole sample, loneliness was associated with non-accidental self-injury (Odds ratio [OR]: 1.65), depressed mood (OR: 1.73), psychotic symptoms (OR: 1.65), relationship problems (OR: 1.49), problems with daytime activities (OR: 1.36), and antidepressant use (OR: 2.11). During lockdown, loneliness was associated with non-accidental self-injury (OR: 2.52), problem drinking or drug-taking (OR 2.33), and antidepressant use (OR 2.10). CONCLUSIONS Loneliness is associated with more severe symptoms of affective illness, worse functional problems and increased use of antidepressant medication in older adults. During lockdown, loneliness in referrals to MHOA services increased and was associated with increased risk-taking behaviour. Loneliness is a potential modifiable risk factor for mental illness, and efforts to minimise it in older adults should be prioritised as we emerge from the pandemic.
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Affiliation(s)
- Flora Greig
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Gayan Perera
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Second Department of PsychiatryNational and Kapodistrian University of Athens‘Attikon’ University General HospitalAthensGreece
| | - Robert Stewart
- South London and Maudsley NHS Foundation TrustLondonUK
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Latha Velayudhan
- South London and Maudsley NHS Foundation TrustLondonUK
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Christoph Mueller
- South London and Maudsley NHS Foundation TrustLondonUK
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
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