Interventions in ambulatory healthcare settings to reduce social isolation among adults aged 18-64: a systematic review

BACKGROUND

Social isolation is associated with increased all-cause and premature mortality, poor chronic disease management, and mental health concerns. Limited research exists on interventions addressing social isolation among individuals under 65 despite its increasing prevalence among young and middle-aged adults.

AIM

To identify interventions from the extant literature that address social isolation and loneliness in ambulatory healthcare settings in adults aged 18-64 and to identify elements of successful studies for future intervention design.

DESIGN & SETTING

Systematic review of interventions targeting social isolation in community-dwelling adults aged 18-64 within ambulatory healthcare settings.

METHOD

A search strategy was developed to identify relevant articles in the following databases: Ovid MEDLINE, Embase, EBM Reviews, Scopus, CINAHL, and PsychInfo. Data were extracted on study design and setting, intervention type, outcome related to social isolation/loneliness, and scale of measure used.

RESULTS

25 078 citations were identified and underwent title and abstract screening. 75 articles met our inclusion criteria and were synthesised, including an assessment of bias. Effective interventions were delivered in community health settings, incorporated a group component, and used digital technologies. They also addressed the association between mental health and social isolation using cognitive-behavioural therapy (CBT) approaches and enhanced self-management and coping strategies for chronic conditions through psycho-educational interventions.

CONCLUSION

Future research should prioritise adults living in low-income and middle-income countries, racialised individuals, as well as those with fewer educational opportunities. There is also a need to advance research in primary care settings, where longitudinal patient-provider relationships would facilitate the success of interventions.

Anger and psychological symptoms relationship: mediator role of maladaptive schemas

Trait anger is the strong predictor of various psychological symptoms like anxiety, depression, and hostility. Explaining how and why this relationship occurs is crucial to come up with more effective prevention and intervention strategies in the field. To this end, the current study aimed to reveal the mediating effect of early maladaptive schemas, which is the basic concept of schema therapy, on the relations of trait anger and psychological symptoms. Data was collected from 301 university students by using the measurement tools of Brief Symptom Inventory, Trait Anger Scale and Young Schema Scale. Findings revealed that trait anger positively predicted psychological symptoms. Secondly, a set of predictive models were prepared to detect the mediating effect of early maladaptive schemas. According to the analysis in the last stage, early maladaptive schemas fully mediated the relationship between trait anger and psychological symptoms.

Schema Therapy for Chronic Depression Associated with Childhood Trauma: A Case Study

Chronic depression lasting longer than 2 years is often undertreated. Research suggests that maladaptive cognitive schemas mediate the association between childhood trauma and later depression. Schema Therapy (ST) is an integrative treatment approach that targets maladaptive cognitive schemas through cognitive, behavioral, interpersonal, and experiential interventions. ST has been studied in patients with chronic depression with good results. The purpose of this case study is to detail how an ST treatment was used to treat chronic depression in a woman, “Amy,” with a childhood trauma history. Amy presented with a persistent depressive disorder that had lasted over 40 years. An ST approach was chosen in light of the chronicity of Amy’s symptoms and her childhood trauma history. Standardized measures including the Beck Depression Inventory were used to assess progress throughout treatment. We provide a comprehensive summary of the 22-session ST case conceptualization and treatment, through which Amy’s depressive symptoms evidenced a 73 percent reduction. Amy qualitatively reported reduced depressive rumination and avoidance behaviors as well as increased frequency of positive mood.

The Blending of Evidenced-Based Protocols in the Treatment of Borderline Personality Disorder

Borderline personality disorder (BPD) is regarded as one of the more difficult clinical presentations to treat, and psychotherapy provides the best outcomes for those suffering with BPD. Dialectical behavioral therapy (DBT) and schema-focused therapy (SFT) are two of the most common evidenced-based treatments for borderline pathology. While these treatments are often used individually, some theorists argue that blended approaches to care could provide more benefit to some clients than just one treatment package alone. The present case study illustrates a blended approach to the treatment of BPD. Specifically, DBT and SFT were used in consort to treat “Luisa,” a 34-year-old biracial woman of Caucasian and Hispanic descent who struggled with longstanding interpersonal distress, emotional lability, and identity disturbance. Her treatment course is described in detail, and the implications of this approach to care are discussed.