Lay Summary

We investigated associations between loneliness and mental health hospitalisation outcomes among patients receiving mental healthcare in South London and Maudsley NHS Foundation Trust (SLaM). We found that people with recorded loneliness had significantly high crisis episodes, emergency presentations and face to face contacts with SLaM. 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.

Background

Loneliness has been associated with worse outcomes for people with dementia, anxiety and psychosis. Loneliness disproportionately affects people with mental disorders, but associations with mental health outcomes in these groups remain less well understood.

Methods

Two cohorts were assembled from a large mental health records database covering a south London catchment area: Cohort 1 included patients receiving mental healthcare on 30th June 2012, and cohort 2 included patients receiving mental healthcare and a first recorded ICD-10 diagnosis from 1st January 2007 until 30th December 2019. Recorded loneliness was extracted using natural language processing and was evaluated against the following mental healthcare outcomes: i) crisis episodes; ii) emergency presentations; iii) all-cause mortality; iv) days of active referral per year, and v) face-to-face contacts per year.

Results

Loneliness was recorded within the last 2 years in 4,483 (16.7%) patients in the cohort 1 and fully adjusted models showed associations with crisis episodes (OR 1.17, 95% CI 1.07-1.29), emergency presentation (OR 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). In cohort 2, 13,023 (6.4%) patients had recorded loneliness within three months of their first diagnosis and fully adjusted models showed associations with crisis episode (OR 1.46, 1.38-1.53), emergency presentation (OR 1.23, 1.18-1.28), and face-to-face contacts per year (IRR 1.07, 1.06-1.08).

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. Improved clinical awareness of loneliness could increase the efficiency of signposting to services that specialise in loneliness in the voluntary sector or by social prescribing, though further research needs to be carried out to investigate the effectiveness of these interventions.