Addressing Loneliness in Psychosis: A Rapid Realist Review of Multi-Level Interventions  — The Association Specialists
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  3. Addressing Loneliness in Psychosis: A Rapid Realist Review of Multi-Level Interventions 

Addressing Loneliness in Psychosis: A Rapid Realist Review of Multi-Level Interventions  (24199)

Annabelle AO Olsson 1 , Manuela MU Uribe 1 , Brynmor BL Lloyd-Evans 1 , Nafiso NA Ahmed 1 , Alina AU Unkelbach 1 , Sarah SI Ikhtabi 1 , Sharon SE Eager 1 , Alexandra AP Pitman 1 , Sonia SJ Johnson 1
  1. University College London, London, LONDON, United Kingdom

Background 

People living with psychosis experience disproportionately high levels of loneliness1, yet there is a lack of interventions specifically tailored to their needs2. Existing approaches often focus on individual-level change, overlooking the broader social, interpersonal, and structural factors that compound disconnection. Given the complex and intersecting drivers of loneliness in this population, including stigma, marginalisation, and reduced access to meaningful social roles3, addressing loneliness is not only a mental health concern but also a matter of health equity and social inclusion. A more nuanced understanding is essential to inform effective, scalable public health strategies. 

Methods
 
A rapid realist review4 was conducted to explore how, why, and in what contexts interventions may reduce loneliness in people with psychosis. The review synthesises findings from 48 peer-reviewed papers and is enriched by consultations with academic and clinical experts as well as lived experience advisors. Context–Mechanism–Outcome (CMO) configurations were developed to build a theory-driven framework of effective intervention strategies. 

Results
 
The review identified a broad range of intervention targets across four levels: individual (e.g. self-esteem, internalised stigma), interpersonal (e.g. relationship quality), community (e.g. social integration), and structural (e.g. housing stability). For each level, evidence- and theory-informed intervention strategies are proposed. Findings highlight the importance of intersectionality and support the development of personalised, co-produced, multilevel approaches that are responsive to the lived realities of people with psychosis.

Conclusions

This review offers actionable insights for designing interventions and public health policies that reduce loneliness, promote social inclusion, and advance health equity in this underserved population. While the evidence base draws primarily from high-income, Western contexts, the multilevel structure provides a transferable foundation for adapting strategies across diverse cultural and resource settings.

  1. Stain HJ, Galletly CA, Clark S, et al. Understanding the social costs of psychosis: the experience of adults affected by psychosis identified within the second Australian National Survey of Psychosis. Aust N Z J Psychiatry. 2012;46(9):879-889. doi:10.1177/0004867412449060
  2. Mann F, Bone JK, Lloyd-Evans B, Frerichs J, Pinfold V, Ma R, et al. A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems. Soc Psychiatry Psychiatr Epidemiol. 2017;52(6):627-638. doi:10.1007/s00127-017-1392-1
  3. Lim MH, Gleeson JFM, Alvarez-Jimenez M, Penn DL. Loneliness in psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2018;53(3):221-238. doi:10.1007/s00127-018-1482-5
  4. Saul JE, Willis CD, Bitz J, Best A. A time-responsive tool for informing policy making: rapid realist review. Implement Sci. 2013;8(1):103. doi:10.1186/1748-5908-8-103