ORCID
https://orcid.org/0000-0002-6265-8698
Language
English (en)
Date of Award
5-15-2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Chair and Committee
Lisa Tabor Connor
Committee Members
Erin F. Foster, Jessica Kersey, Erin Moran, Quinn Tyminski
Abstract
Loneliness is an immense challenge facing the majority of Americans with Serious Mental Illness. Loneliness is linked to negative outcomes, including heart disease, reduced quality of life, and early mortality. Current loneliness interventions (e.g., social skills training, social support) do not effectively address all the complex factors that lead to loneliness in this population. More work is needed, therefore, to better understand how to optimally research and prevent loneliness among individuals with Serious Mental Illness, who experience unique barriers to social integration/participation and dwell in complex settings, such as permanent supportive housing. The presented dissertation aims to address current gaps in the body of loneliness research through the following aims: 1) Synthesize the state of the literature concerning social health during the transition from homelessness to permanent supportive housing, 2) Identify associations between clinical characteristics of individuals living with schizophrenia or schizoaffective disorder and the momentary experience of loneliness during everyday social participation, and 3) Understand the experience of loneliness and social participation from the perspectives of people living with schizophrenia or schizoaffective disorder and identify coping strategies used by consumers.
Our findings from the scoping review of Chapter Two demonstrated the underexamined nature of loneliness within the context of supportive housing research. A variety of custom-made or single-item social health assessment tools pointed to the need for advancements in defining and measuring social health constructs. Community living settings remain an important and exciting context for future loneliness research projects involving the Serious Mental Illness population.
Findings from the quantitative study described in Chapter Three revealed that people with schizophrenia or schizoaffective disorder participate in less structured (e.g., work or school) forms of social participation than the general population. Additionally, the results revealed an association between loneliness experienced during social participation and defeatist beliefs, providing support for contemporary theories of loneliness.
The themes from the qualitative study of Chapter Four characterized the unique experience of loneliness, as described by consumers living with schizophrenia or schizoaffective disorder. The study’s results identified four key descriptions of loneliness: emotional disconnection, social anxiety leading to and worsening loneliness, unmet needs within social networks, and lacking companionship. Participants identified a variety of activity-based, cognitive, environmental, spiritual, and technological coping strategies that can enhance existing loneliness interventions for the population of individuals living with schizophrenia or schizoaffective disorder.
Collectively, the studies in the present dissertation provide groundwork for future intervention development and testing by highlighting assessment tool needs, clinical associations, and consumer-based strategies. Additionally, the dissertation project identifies areas of future investigation to understand why some individuals with Serious Mental Illness experience increased loneliness during social participation, as well as the developmental course of loneliness-related health issues. Effective research partnerships with consumers and community-based organizations will be integral in addressing the enormous problem of loneliness that threatens the health and well-being of millions of adults with Serious Mental Illness.
DOI
https://doi.org/10.48765/62b3-wr65
Recommended Citation
Randolph, Samantha B., "Toward an Understanding of Loneliness and Social Participation in Serious Mental Illness" (2025). WUSM Theses and Dissertations – All Programs. 48.
https://digitalcommons.wustl.edu/all_etd/48
