Relationships Between Employment and Loneliness in Psychosis
Francesca de Marneffe (1), Robert Sawdey (2), Nicole DeTore (2,3), Kim T Mueser (4)
1. Department of Psychiatry, Massachusetts General Hospital
2. Department of Occupational Therapy, Boston University
3. Department of Psychiatry, Harvard Medical School
4. Center for Psychiatric Rehabilitation, Boston University
Background: Loneliness is highly prevalent in people with psychotic disorders, but few interventions have been found to decrease loneliness in this population. While employment is generally associated with improvements in self-esteem and quality of life, the impact of employment on loneliness in those with psychosis has not been thoroughly investigated. Therefore, we evaluated whether obtaining competitive work is associated with reduced loneliness over time in people with psychotic disorders.
Methods: In 152 adults with a primary psychotic disorder, we assessed loneliness (single item from the Social Adjustment Scale-II), work functioning (employment status), psychotic symptoms (Positive and Negative Syndrome Scale), self-esteem (Rosenberg Self-Esteem Scale), social network (Social Support Network Inventory), and life satisfaction (Abbreviated Quality of Life Interview). We collected these measures at baseline, 6-, 12-, 18-, and 24-months.
Results: Baseline loneliness was significantly correlated with more severe positive (r=.38, p<.001) and depressive symptoms (r=.47, p<.001). Loneliness was also negatively correlated with overall quality of life (r=-.33, p<.001), self-esteem (r=-.37, p<.001), and number of social contacts (r=-.17, p=.037). Furthermore, loneliness at 24 months was associated with employment status at 24 months (X2=3.86, p=.049). To better understand the causal relationship between loneliness and employment, we plan to conduct two mixed effects linear regression models predicting loneliness at 6-, 12-, 18-, and 24-months, including baseline loneliness as a covariate and competitive work status (binary work status of yes/no at each follow-up assessment) as a time-varying covariate.
Conclusions: These results confirm associations between loneliness and other correlates of psychotic disorders previously reported in the literature, including more severe symptoms, lower quality of life and self-esteem, and more social dysfunction. While preliminary results show a possible relationship between work functioning and reduced loneliness at two years, the planned analyses will help us better understand the causal effects of employment on loneliness.