Loneliness and socio-occupational functioning in psychosis: A systematic review

Loneliness is highly prevalent in psychosis and is associated with poorer clinical and quality-of-life outcomes. In nonclinical populations, loneliness is linked to a range of social and occupational difficulties. Difficulties with socio-occupational functioning (SOF) are common in psychosis and are consistently identified as a key recovery priority. However, the relationship between loneliness and SOF in psychosis remains unclear. A PROSPERO-registered systematic review was conducted. Database searches (PubMed, Scopus, PsycINFO and CINAHL) identified 1118 records, of which 15 met inclusion criteria and were synthesised narratively. Studies examined a range of SOF domains, including global, social, community and everyday functioning across various designs. Greater loneliness was generally associated with poorer SOF, although several studies reported non-significant relationships. Associations were clearest for social participation and community integration, while evidence for everyday functioning was more limited. Qualitative findings described reciprocal relationships between withdrawal, barriers to participation and feeling disconnected. Several psychosocial factors, including internalised stigma and social support, appeared to influence the loneliness-SOF relationship. Overall, the findings suggest that loneliness is associated with social and community aspects of functioning, although the relationship varies across measures and samples. Clarifying directionality and testing whether changes in loneliness and SOF influence one another should be priorities for future longitudinal and intervention research.