Hafal Research Loneliness

This report is based on the results of a survey carried out by Hafal in February and March 2006. Drawing its respondents from amongst those who access its services around Wales, it highlights the impact of loneliness on its clients. This is an initial discussion of the findings, further analysis and recommendations will follow.

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• Background
• Results
  • What is loneliness?
  • Loneliness is having...
  • Experience of loneliness
  • Loneliness and severe mental illness
• Hafal Services
• Discussion

Background

There are many reasons why people may be affected by loneliness but there is little current research looking at the extent, the causes and the particular impact of loneliness on those with severe mental illness. Although twin studies have found that there may be a genetic predisposition for loneliness in the general population, there is much evidence to suggest that a major cause is social isolation. Most people need social contact for their physical and mental health. The persistently lonely are more stressed and more likely to fall ill than those who are not. They perceive the world as more threatening and have an increased risk for a range of physical illnesses from colds to heart disease.

Solitude can be a positive thing and is actively desired by many people at some point in their lives. There may also be a greater toleration for isolation amongst some people than others. Loneliness is likely to develop then if there is a discrepancy between the desired and actual level of contact. It is also important to consider the quality of contact and how people feel about their contact with others. For example, family contact may not be very satisfying as these are obligatory relationships. It is also possible to have contact with people but feel that the lack of common ground and understanding reduces the value of the interaction.

Various factors amongst the general population have been identified as contributing to reduced social contact and therefore loneliness. A couple oriented culture with rising numbers of divorces means that many people are without their main source of emotional support. Increased mobility and urbanisation disrupt social networks and make it difficult to meet potential friends and partners. New information technology is still attracting controversy over whether it reduces or increases social contact. Although sitting in front of a computer appears to be a solitary activity, it often involves social contact via email, bulletin boards, competitive gaming. Poverty is also linked to increased loneliness as there is less money to fund participation in social activities and it makes people feel isolated by their financial problems. Some people lack the skills to develop social relationships or are hampered by a lack of self-esteem.

The development of any kind of severe illness will have a huge impact on a person's life and is very likely to lead to reduced social contact. All the factors that increase loneliness amongst the general population combine with additional factors when someone has severe mental illness. Its onset and receiving the diagnosis is likely to make a person feel different, excluded from society and no longer a valued part of it as a result of the stigma attached to severe mental illness. This will make it more difficult to develop relationships especially when combined with the behaviour changes caused by the illness and/or the medication being taken.

The illness may also mean giving up work and living on less money, and changing location, all of which will reduce social contact. It is also difficult to maintain friendships and support networks during a period of crisis, even more so if it involves a stay in hospital. The unpredictable nature of the illness and its course make it difficult for friends and family members to accept, especially if they do not understand much about the illness. Explaining the illness and putting work into sustaining relationships when unwell is extremely difficult and the likelihood is that they will suffer as a result.

There is a very real danger of being trapped in a cycle of loneliness when someone is severely mentally ill. The onset and/or diagnosis has implications for dramatically reduced social contact, making people feel more lonely. Loneliness has been linked to depression and alcoholism which is likely to worsen the existing severe mental illness, thereby increasing loneliness further. The link with depression will clearly impact on bipolar disorder by making the depressed stages of the illness more severe. Its impact on schizophrenia is likely to be on the negative symptoms, such as lack of energy and loss of interest in life.

However, the effects of loneliness on severe mental illness have not been thoroughly investigated so Hafal has carried out a survey of service users and carers. It investigates how people with, or affected by, severe mental illness define loneliness, whether they've experienced it and how it affects the symptoms of severe mental illness. It also looks at opinion on user involvement at Hafal projects and services.

Results

480 people who access Hafal services completed a questionnaire on loneliness in their own time (see attached). The majority of respondents were service users (61%), most of the rest were carers (22%) and the remainder were unspecified. The gender balance was nearly equal - 222 men and 229 women (the remainder did not specify) and the majority were aged between 30 and 50 (55%).

What is loneliness?

A large section of the questionnaire focused on how loneliness is defined by determining what level of social contact was needed to avoid loneliness.

The majority of respondents (59%) thought that loneliness meant living alone and a similar number (55%) thought it meant not attending social activities. 28% thought it meant not working.

The next set of questions were a more direct measure of the frequency of social contact and how that relates to loneliness.

Nearly 60% of those who expressed an opinion thought they would be lonely if they didn't talk to anyone for more than 24 hours. Over 50% thought that they would feel lonely if they went more than 24 hours without seeing anyone. There was a small difference between men and women - men could tolerate a longer period of time without seeing someone than women: t = -1.937 (df 396) p 0.5

Respondents were also asked about the importance of certain elements in their lives and the lack of a close friend or a partner both scored highly as being causes for loneliness.

There were significant gender differences on two elements of this.

Loneliness is having...

Men were more likely than women to say that not having a partner meant they were lonely: t = 2.134 (df 449) p 0.3

Women were more likely to say that not having a close friend meant they were lonely: t = -4.061 (df 449) p <.001

There was also a significant difference between the responses of service users and the responses of carers and others on having a close friend.

Carers and others were more likely to say that not having a friend contributed to feeling lonely: t = 3.137 (df 438) p .002

Experience of loneliness

42% of respondents had been lonely in the past month and this went up to 50% when only service users were considered.

*those who answered this question

Most respondents answered this question and it was found that 20% of all respondents and 25% of service users, were either moderately or extremely lonely.

Loneliness and severe mental illness

A large majority (72%) said that loneliness made the symptoms of severe mental illness a great deal worse.

There was some difference between the responses of services users compared to those of carers and others.

* % of those who stated an opinion

Carers and others were more likely to think this than service users: t = -2.233 (df 427) p 0.3

Depression and negative symptoms were most likely to be stated as the specific symptoms made worse by loneliness. Nearly 200 also felt that paranoia was made worse by loneliness.

Hafal Services

Respondents were also asked for their opinion on Hafal services and the extent to which Hafal helps reduce loneliness.

A large majority of respondents felt that Hafal did involve users at all levels and over 80% felt that Hafal reduced loneliness.

Discussion

A series of informal focus groups will be held throughout Wales to contribute to further evaluation of this issue as part of Hafal week from the 26th to 30th June.

The results of these and this questionnaire will inform Hafal actions over the coming year and, after further analysis, will be followed up with a discussion of the results and a set of recommendations.

For more information please contact us at:

Hafal Head Office
Suite C2, William Knox House
Britannic Way
Llandarcy
Neath SA10 6EL
Tel: 01792 816 600
Fax: 01792 813 056
Email: hafal@hafal.org
Or visit our web-site: www.hafal.org