Lonely children more likely to experience psychosis, new study finds

A new study suggests that children who felt lonely for more than 6 months before the age of 12 are more likely to experience an episode of psychosis than children who did not, with women more affected than men.

Psychosis refers to a collection of symptoms that affect a person’s mind, where there has been some loss of contact with reality.[1] During an episode of psychosis, a person may have difficulty recognising what is real and what is not.[1] Symptoms of psychosis include hallucinations, delusions and confused thoughts.[2] In some instances, psychosis may be a symptom of other mental health conditions, such as schizophrenia, bipolar disorder, or severe depression.[1] Symptoms of schizophrenia are often categorised as positive (any change in behaviour or thoughts, such as hallucinations or delusions), negative (where people appear to withdraw from the world around them).[3]

Loneliness is defined as the subjective feeling of distress associated with a lack of meaningful relationships, regardless of the amount of social contact, whereas social isolation is defined as the objective lack of social contact or support.

In an observational, case-control study, researchers assessed loneliness in children with the question "Have you ever felt lonely for more than 6 months before the age of 12" and differentiated this from social isolation by using the ‘peer relationships’ item from the Premorbid Adjustment Scale. The study sample comprised 285 patients who had experienced their first episode of psychosis and 261 controls.

Key findings from the study include:

• Loneliness in childhood was associated with an increased likelihood of experiencing a psychotic episode (adjusted odds ratio; aOR: 2.17, 95% CI [1.40-3.51], p=.002) and this association remained significant after controlling for objective social isolation in childhood (aOR:2.70, IC 95% [1.58-4.62], p<.001).
• The association between loneliness and experiencing a psychotic episode was stronger in women (aOR:4.74, 95% CI [2.23-10.05], p<.001) than in men (aOR:1.17, IC 95% [0.63-2.19], p=.623).
• In women who had experienced a psychotic episode, loneliness in childhood was associated with a significantly reduced likelihood of being diagnosed with schizophrenia spectrum disorders (aOR:0.155, 95% CI [0.048-0.506], p=.002) relative to other forms of psychosis.
• In those who had experienced a psychotic episode, loneliness in childhood was associated with a greater severity of positive psychotic symptoms as well as affective symptoms (disturbance of mood) and worse functioning.

Dr Covadonga Díaz-Caneja of the Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain, said “There is increasing evidence of the negative health and social consequences of loneliness in adults, but much less is known about the long-term effects of loneliness in young people. Despite their preliminary nature, our results suggest that childhood loneliness may serve as an early risk factor for later psychotic disorders and support its role as a potential target for preventive mental health interventions from an early age. This may be especially relevant considering that childhood loneliness is a prevalent phenomenon that appears to be increasing in recent years”.

“This study offers valuable insight into the association between childhood loneliness and first-episode psychosis. With the rise of digitalisation and social isolation, loneliness has become a pervasive issue affecting young individuals. The compelling findings of this study, which establish a direct connection between childhood loneliness and the onset of psychosis, highlight a concerning trend and underscore the importance of addressing social connectedness and emotional well-being from an early age,” said Professor Andrea Fiorillo, President Elect of the European Psychiatric Association.

The European Congress of Psychiatry takes place from 6-9 April 2024 in Budapest, Hungary, and represents Europe’s largest congress dedicated to psychiatry, with over 4000 participants: epa-congress.org.

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Notes to editors

Association between loneliness in childhood and first-episode psychosis (O0102)

Introduction: Evidence from observational and genetic studies suggests a bidirectional relationship between loneliness and psychosis. To our knowledge, no previous study has assessed the association between loneliness in childhood and first-episode psychosis (FEP).

Objectives: We aimed to assess the association between loneliness in childhood and the odds of FEP and clinical variables of interest (i.e., diagnosis and clinical and functional severity) in FEP and to explore gender differences in this association.

Methods: This was an observational, case-control study, based on the AGES-CM cohort, a longitudinal prospective study including patients with FEP ages 7-40, their first-degree relatives, and an age- and sex-matched sample of controls in seven university hospitals in the region of Madrid. We assessed loneliness in childhood with the question "Have you ever felt lonely for more than 6 months before the age of 12" and objective social isolation with the peer relationships item from the childhood subscale of the Premorbid Adjustment Scale. We conducted logistic and linear regression analyses to assess the association between childhood loneliness and i) the odds of presenting a FEP and ii) clinical variables of interest (diagnosis and scores on positive, negative, general, depressive, and manic symptoms and functioning), while adjusting for demographic variables.

Results: The study sample comprised 285 patients with FEP (32.6% female, age 24.50 ± 6.2 years) and 261 controls (48.7% female, age 25.93 ± 5.5 years). Loneliness in childhood was associated with increased odds of FEP (adjusted odds ratio; aOR: 2.17, 95% CI [1.40-3.51], p=.002). This association remained significant after controlling for objective social isolation in childhood (aOR:2.70, IC 95% [1.58-4.62], p<.001). The effect of the association was stronger in females (aOR:4.74, 95% CI [2.23-10.05], p<.001) than in males (aOR:1.17, IC 95% [0.63-2.19], p=.623). In females with FEP, loneliness in childhood was significantly associated with increased odds of receiving a diagnosis of other psychosis (aOR:0.155, 95% CI [0.048-0.506], p=.002) relative to a schizophrenia spectrum disorders  (SSD) diagnosis. In the FEP sample, loneliness in childhood was associated with greater severity of positive and affective symptoms and worse functioning.

Conclusions: Loneliness in childhood is associated with increased odds of FEP and clinical variables of interest. This suggests the potential role of this phenotype as an early risk marker for psychosis that could help guide targeted interventions.

Disclosure of interest: None declared.

About the European Psychiatric Association

With active individual members in as many as 88 countries and 44 National Psychiatric Association Members who represent more than 78,000 European psychiatrists, the European Psychiatric Association is the main association representing psychiatry in Europe. The EPA’s activities address the interests of psychiatrists in academia, research and practice throughout all stages of career development. The EPA deals with psychiatry and its related disciplines and focuses on the improvement of care for the mentally ill as well as on the development of professional excellence. More information: https://www.europsy.net/

References

[1] Understanding psychosis. National Institute of Mental Health. Available at: www.nimh.nih.gov/health/publications/understanding-psychosis (Accessed: February 2024).

[2] Psychosis symptoms. NHS choices. Available at: www.nhs.uk/mental-health/conditions/psychosis/symptoms/ (Accessed: February 2024).

[3] Schizophrenia symptoms. NHS choices. Available at: www.nhs.uk/mental-health/conditions/schizophrenia/symptoms/ (Accessed: February 2024).