Researchers have developed a promising new framework for studying the link between social disconnection and poor physical health in people living with serious mental illnesses (SMI). Drawing on published research from animal models and data from the general population, this framework builds on existing social isolation and loneliness models by integrating insights from evolutionary and cognitive theories. This research was supported by the Office of Behavioral and Social Sciences Research and the National Institute of Mental Health.

What were the researchers studying and why?

One of the most challenging aspects of living with SMI is difficulties with social perception, motivation, and social behaviors. These difficulties can lead to social withdrawal and loneliness, outcomes that can contribute to poor heart health and early death. However, researchers have an incomplete understanding of how differences in the brain functions in people living with SMIs impact the connection between their social perception and self-reported, lived experience of social withdrawal, isolation, or loneliness.

How did the researchers conduct the study?

Researchers from Boston University and Harvard Medical School conducted a selective narrative review of studies addressing social withdrawal, isolation, loneliness, and health in SMI.

Their review highlighted evidence indicating differences in brain activity between people experiencing loneliness and those who are not, particularly in regions associated with social cognitive processes. Additionally, neuroimaging studies have shown increased activation in brain areas responsible for risk assessment among lonely individuals.

Furthermore, the researchers discussed findings suggesting that individuals experiencing loneliness, who perceive others negatively and exhibit signs of psychopathology, may misinterpret social cues, leading to social disconnection. Over time, this social disconnection can prompt a defensive response to social situations, further reducing motivation for social interaction.

What did the study results show?

Based on a synthesis of recent findings that indicate a causal relationship between loneliness and nervous system responses in the human body that cause inflammation and reduce immunity, the authors developed a testable model of the psychological and neural mechanisms of social disconnection in SMI. They hypothesize that people living with SMI are more likely to experience high levels of chronic psychological stress and therefore, more likely to experience persistently high levels of physiological inflammation. Stress and inflammation biomarkers can serve as indicators of an unmet need for social connection. Health providers and caregivers could use these indicators to provide social support and connection to those experiencing this need.

What is the potential impact of these findings?

The authors suggest that once their hypothesis has been rigorously tested and verified, new methods to improve health outcomes for people living with SMI may be developed, including potential “just-in-time” digital interventions through mobile devices. The authors also suggest that people living with SMI and experiencing loneliness can receive interventions that address any potential negative beliefs they hold about rejection, thus interrupting the cycle of social isolation.

Citation:
Fulford D, Holt DJ. Social Withdrawal, Loneliness, and Health in Schizophrenia: Psychological and Neural Mechanisms. Schizophr Bull. 2023 Sep 7;49(5):1138-1149. doi: 10.1093/schbul/sbad099. PMID: 37419082; PMCID: PMC10483452.