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Loneliness among male adults living with schizophrenia: Investigating the association with functionality and symptom severity
*Corresponding author: Sojan Antony, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India. sojan47@gmail.com
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Received: ,
Accepted: ,
How to cite this article: Shibin F, Antony S, Shreedevi AU, Mahadevan J, Reddi VSK. Loneliness among male adults living with schizophrenia: Investigating the association with functionality and symptom severity. J Neurosci Rural Pract. 2026;17:S77-83. doi: 10.25259/JNRP_387_2025
Abstract
Objectives:
Loneliness is an emotional state and an experience consequent to social isolation. Differences in the person’s quality and quantity of both anticipated and actual social relationships contribute to loneliness. The higher prevalence of loneliness noted in persons with schizophrenia adversely affects multiple domains and outcomes. However, the impact on functionality and symptom severity consequent to loneliness remains limited. This study attempts to understand the relationship between loneliness, functionality, and symptom severity in schizophrenia.
Materials and Methods:
A cross-sectional study design was used. Males above 18 years of age and with a minimum duration of 2 years of illness were included in the study. Persons with comorbid psychiatric conditions, substance use disorder (except nicotine), and without the capacity to consent were excluded. Positive and Negative Syndrome Scale (PANSS) was used to measure the symptom severity, functionality was measured using World Health Organization Disability Assessment Schedule 2.0, while loneliness was measured using University of California, Los Angeles loneliness scale 3.0. Sixty-four participants who sought outpatient treatment were selected, and quantitative data analysis was done.
Results:
The mean age of onset of the illness was 25.66 ± 7.16, the PANSS score was 44.92 ± 10.15, the dysfunction score was 50.92 ± 10.97, and the loneliness score was 47.14 ± 7.60. There was a significant positive correlation of loneliness with symptom severity, functional impairment, and prolonged unemployment. Multiple regression indicated that functional status and duration of unemployment are predictors of loneliness in schizophrenia.
Conclusion:
Psychosocial interventions focusing on functional recovery and vocational engagement influence the loneliness level in schizophrenia, further resulting in symptom reduction and overall recovery.
Keywords
Loneliness
Occupational functioning
Psychopathology
Schizophrenia
Sociodemographic factors
INTRODUCTION
Loneliness is considered the signal or an aversive state that motivates the individual to take action or repair their social connectedness when there is a lack of or a break in their social life.[1,2] However, chronic or prolonged loneliness leads to hypervigilance to social threats and social motivation, resulting in behavioral social withdrawal.[2,3] Loneliness is the subjective feeling of social isolation resulting from the difference in the person’s quality and quantity of anticipated and actual social relationships.[4,5] The World Health Organization declared loneliness a crucial public health concern, which significantly affects the physical and mental health of the affected individual.[2]
People with schizophrenia are more prone to experience loneliness due to the stigma and disability.[3] Loneliness is highly prevalent among individuals with schizophrenia, with studies reporting rates as high as 80%,[6] which could be attributed to the inability to identify the need for more social relationships due to the negative symptoms, maladaptive beliefs about the social world or hypervigilance to social threats due to positive symptoms.[7]The increased prevalence of loneliness in schizophrenia leads to increased perceived stress, reduced physical and mental well-being, optimism, and life satisfaction, along with increased morbidity and mortality, increased prevalence of suicide, clinical exacerbations of positive symptoms, impaired cognitive functioning, stigma, unemployment, and poor quality of life, inadequate social support systems, and reduced healthcare services accessibility.[3,6,8-10] Loneliness is a treatable condition and can result in improvement in well-being and recovery, and enhanced personal, emotional, and cognitive functioning in schizophrenia.[7,11]
Functionality is the person’s ability to manage, accomplish, and find fulfilment in performing their social roles, engage in self-care, and participate in leisure or recreational activities, while unemployment occurs when the person is not engaging in any vocation. The impaired social functioning in schizophrenia causes loneliness, which further affects the neurocognitive functioning and ultimately the occupational and overall functionality.[12,13] Engagement in more meaningful relationships and active social participation helps in removing the barriers for social interaction and thus enhancing the social connectedness; this can help in addressing the loneliness in schizophrenia.[12]
Main psychosocial interventions for addressing loneliness in the general population have limited effectiveness when applied to people with schizophrenia. Researchers are currently exploring the area of loneliness in schizophrenia and interventions to address it; however, there is less research on this area. Functionality in schizophrenia is widely studied, and various evidence-based interventions are present for enhancing functionality. Previous studies had found an interconnection between loneliness and functionality in schizophrenia; however, there are fewer studies which primarily investigate this relationship. Establishing an association between functionality and loneliness in schizophrenia helps in planning and implementing effective psychosocial interventions to address the loneliness, thus improving the bio-psycho-social recovery. Considering the high incidence rate, early onset of illness, and poor premorbid and social functioning in males with schizophrenia, the current study focuses only on that population.[14,15]
MATERIALS AND METHODS
The study follows a cross-sectional study design and aims to investigate the relationship between loneliness, functionality, and symptom severity among persons living with schizophrenia. The objectives of the study were (1) to identify the correlation of loneliness in persons with schizophrenia with their clinical and functional factors and (2) to determine the predictors of loneliness in persons with schizophrenia with respect to their symptom severity and functionality. During the preparation of this work, the author utilized Grammarly, Zotero, and ChatGPT to refine the text, verify grammar, and manage references. After using this tool/service, the author reviewed and edited the content as needed and takes full responsibility for the content of the published article.
Study design
Male persons with a minimum 2-year diagnosis of schizophrenia, aged 18 years and above, with no comorbid mental illness and substance use disorder (except nicotine), who took treatment from the tertiary healthcare center and could consent, were selected for the study. Written informed consent was collected from all the participants after ensuring their autonomy and confidentiality. The sample size was estimated for linear regression analysis using GPower (Version 3.1), assuming a power of 0.7, a Type I error of 5%, an effect size of 0.39, and three predictors, yielding an estimated sample size of 62.[16] Using consecutive sampling, 104 participants were screened, and 64 were selected for the study. The participants were selected from those who sought outpatient services from April 2024 to December 2024. The participants were screened using the University of California, San Diego Brief Assessment of Capacity to Consent,[17]diagnostic interview for anxiety, mood, and obsessive-compulsive disorder (OCD) and related neuropsychiatric disorders[18] and alcohol, smoking, and substance involvement screening test[19] for capacity to consent and comorbid psychiatric conditions. A semi-structured interview was used to collect the sociodemographic details and clinical details, the positive and Negative Syndrome Scale (PANSS) for schizophrenia[20] for assessing symptom severity, the World Health Organization Disability Assessment Scale 2.0[21] for determining functionality, and the University of California, Los Angeles (UCLA) Loneliness (Version 3)[22] for assessing the current feeling of loneliness. The UCLA loneliness scale is a widely used questionnaire designed to measure subjective feelings of loneliness.
Statistics
The quantitative data were analyzed using IBM Statistical Package for the Social Sciences Statistics, version 25 (IBM Corp., Armonk, NY).[23] Descriptive statistics were used to explain the sociodemographic and clinical variables. An analysis of variance test was conducted to determine the mean loneliness score among participants, taking into account their sociodemographic and clinical factors, after verifying the homogeneity of variables using the Levene test. The Pearson correlation test was used to identify the correlation between variables, while Spearman’s rank correlation test was employed for variables that were not normally distributed. A multiple regression test was used to determine the predictors of loneliness in persons with schizophrenia.
RESULTS
The mean age of the participants was 37.18 ± 9.23 years, with a mean age of onset of illness of 25.66 ± 7.16 years and a mean total duration of illness of 11.83 ± 7.60 years. The participants’ mean total years of education was 10.81 ± 5.00 years, and the mean years of unemployment was 3.67 ± 5.11 years. The mean scores of the variables indicated that the participants had a moderate level of functional impairment, with a mean low level of functionality score of 50.92 ± 10.97. The loneliness score was 47.14 ± 7.60, corresponding to a moderately high rate of loneliness and mild symptom severity, as indicated by a PANSS score of 44.92 ± 10.15. Table 1 explains the mean scores of the variables.
| Variables | Mean (standard deviation) |
|---|---|
| Sociodemographic variables | |
| Age | 37.18±9.23 |
| Years of education | 10.81±5.00 |
| Years of unemployment | 3.67±5.11 |
| Clinical variables | |
| Age of onset of illness | 25.66±7.16 |
| Total illness duration (in years) | 11.83±7.60 |
| Duration of untreated illness | 0.41±0.99 |
| Number of hospitalizations | 1.17±1.86 |
| Duration of stay in rehabilitation (in months) | 0.03±0.25 |
| Loneliness | 47.14±7.60 |
| Functionality | |
| Understanding and communicating | 9.84±3.13 |
| Getting around | 5.52±1.15 |
| Self-care | 4.23±0.61 |
| Getting along with people | 8.47±3.00 |
| Life activities – household | 6.52±2.58 |
| Life activities – work | 5.98±2.52 |
| Participation in society | 12.42±4.05 |
| Functional disability | 50.92±10.97 |
| Symptom severity | |
| Positive symptoms score | 9.83±3.06 |
| Negative symptoms score | 12.20±4.25 |
| General psychopathology score | 22.89±4.28 |
| PANSS total | 44.92±10.15 |
PANSS: Positive and Negative Syndrome Scale
The statistical analysis revealed that the participants were predominantly educated to higher secondary level, unemployed, unmarried, and had rural backgrounds with lower socioeconomic status. The clinical profile assessment revealed that most participants were compliant with treatment and lacked insight into their illness. The analysis of the mean loneliness scores across sociodemographic factors indicated that unemployed participants had significantly higher levels of loneliness (p < 0.01). It was also noted that loneliness was higher in participants residing in urban domiciles, belonging to middle socioeconomic status, and having poor insight into the illness. Table 2 presents the sociodemographic and clinical details of the participants, along with the mean loneliness scores for each.
| Variables | Frequency (n=64) | Loneliness score | F-value |
|---|---|---|---|
| Education | |||
| Not formally educated | 6 (9.38) | 46.33±10.15 | 0.41 |
| Primary schooling | 11 (17.19) | 48.54±6.09 | |
| Higher secondary Schooling | 30 (46.88) | 46.80±7.26 | |
| Graduation | 10 (15.62) | 48.80±7.36 | |
| Post-graduation | 7 (10.94) | 44.71±10.34 | |
| Employment | |||
| Unemployed | 25 (39.06) | 50.88±6.00 | 4.31** |
| Daily wage earner | 20 (31.25) | 45.70±7.20 | |
| Seasonal job | 3 (4.69) | 33.67±9.02 | |
| Government job | 1 (1.56) | 49.00±0.00 | |
| Private | 13 (20.31) | 45.54±7.09 | |
| Student | 2 (3.12) | 44.50±6.36 | |
| Domicile | |||
| Rural | 35 (54.69) | 46.43±6.15 | 1.35 |
| Urban | 11 (17.19) | 50.54±10.37 | |
| Semi-urban | 18 (28.12) | 46.54±8.14 | |
| Marital status | |||
| Unmarried | 37 (57.81) | 47.54±8.25 | 0.12 |
| Married | 25 (39.06) | 46.64±6.99 | |
| Divorced/separated | 2 (3.12) | 46.00±1.41 | |
| Socioeconomic status | |||
| Lower | 55 (85.94) | 46.89±6.72 | 0.94 |
| Middle | 8 (12.50) | 49.75±12.49 | |
| Higher | 1 (1.56) | 40.00±0.00 | |
| Living arrangement | |||
| Family of origin | 37 (57.81) | 47.54±8.27 | 0.49 |
| Family of procreation | 19 (29.69) | 47.74±6.60 | |
| Alone | 1 (1.56) | 40.00±0.00 | |
| With others | 2 (3.12) | 45.50±2.12 | |
| Both families of origin and procreation | 5 (7.81) | 44.00±8.28 | |
| Compliance with treatment | |||
| Present | 45 (70.3) | 46.13±8.02 | 1.60 |
| Absent | 2 (3.12) | 46.00±2.83 | |
| Occasional | 17 (26.56) | 49.94±6.22 | |
| Insight | |||
| Present | 7 (10.94) | 45.57±10.03 | 0.21 |
| Absent | 37 (57.81) | 46.00±2.83 | |
| Partial | 20 (21.25) | 47.75±5.83 | |
The correlation test showed a statistically significant positive correlation between prolonged years of unemployment and functional disability, loneliness, and symptom severity. Table 3 presents the correlation between variables, revealing a statistically significant positive correlation between years of unemployment, functional disability, loneliness, and symptom severity.
| Key variables | Years of unemployment | Functional disability | Loneliness | Positive symptom | Negative symptom | PANSS |
|---|---|---|---|---|---|---|
| Age of onset | −0.05 | −0.04 | 0.17 | −0.09 | 0.05 | −0.02 |
| Years of unemployment | 0.27* | 0.43** | 0.54** | 0.34** | 0.53** | |
| Functional disability | 0.61** | 0.55** | 0.69** | 0.74** | ||
| Loneliness | 0.38** | 0.53** | 0.55** |
Table 4 presents the results of the multiple linear regression analysis, which explains 42.7% of the variance in levels of loneliness, corresponding to a moderate amount of variance, with 60 residual degrees of freedom and a p < 0.01, indicating that the model is statistically significant. The regression model stated that both functional disability and years of unemployment are substantial predictors of loneliness in persons with schizophrenia, while symptom severity is not. Multicollinearity was assessed using the variance inflation factor, with all values <5.
| Variables | Unstandardized B | Standard error | t-value | p-value | 95% Confidence interval (CI) for B | |
|---|---|---|---|---|---|---|
| Lower bound | Upper bound | |||||
| Intercept | 28.48 | 3.89 | 7.31 | <0.01 | 20.69 | 36.27 |
| Symptom severity | 0.006 | 0.12 | 0.05 | 0.96 | −0.24 | 0.25 |
| Functional disability | 0.33 | 0.10 | 3.14 | <0.01 | 0.12 | 0.54 |
| Years of unemployment | 0.45 | 0.17 | 2.68 | <0.01 | 0.11 | 0.78 |
The results with the p-value less than 0.05 was considered as statistically significant.
DISCUSSION
Loneliness is a highly prevalent and critical phenomenon among the adult population, associated with severe physiological and psychological consequences.[24] The current study aimed to find the interrelationship between loneliness and functionality and symptom severity among persons living with schizophrenia. The findings found that there was moderately high loneliness in schizophrenia, which is consistent with the findings of previous studies, which stated that there is a high prevalence of loneliness in schizophrenia.[6,11,25] Loneliness is also associated with increased perceived stress, depression, anxiety, and internalized stigma due to the illness.[6,26,27] It was revealed that there is a strong and significant positive correlation between loneliness and functional disability, prolonged periods of unemployment, and high symptom severity. Similar findings were previously reported in other studies that a higher degree of loneliness occurred in persons with schizophrenia with functional impairment and more severe symptomatology.[3,6,26,28-30] This highlights that loneliness is a multidimensional and complex phenomenon, integrating biological, psychological, and social perspectives.[1,24]
A significant interrelation was found between loneliness and symptom severity; however, it was not identified as a predictor of loneliness in the multiple regression analysis. This suggests that the relationship between loneliness and symptom severity may be indirect and shared with other variables in the analysis. In particular, functional disability and prolonged unemployment, since both of them are strongly associated with symptom severity, accounted for a substantial proportion of variance in loneliness. This emphasizes that loneliness in schizophrenia is not merely the consequence of the symptoms or a deficit due to the illness, but rather a distinct challenge with a clinically significant effect.[2,3] Thus, loneliness in schizophrenia is a distinct psychosocial construct rather than merely a direct consequence of psychopathology.
There is a bidirectional relationship between loneliness and psychotic symptoms, where loneliness triggers the psychotic symptoms.[29] However, the presence of predominant positive or negative symptoms in schizophrenia does not indicate that they are lonely. The social avoidance due to the persecutory symptoms is considered a safety behavior,[31] while motivation and social behavior in negative symptoms would not lead to subjective feelings of loneliness.[2] Loneliness affects help-seeking and healthcare utilization in the individual, thus leading to clinical exacerbation and repeated hospitalizations.[3,6,32]
Findings of multiple regression analysis indicated that functional impairment and prolonged unemployment were significant predictors of loneliness in schizophrenia. Similar findings were previously reported where work was considered a protective factor for loneliness, and a high level of loneliness was found to be more prevalent in populations from lower socioeconomic status and persons with mental illnesses.[13,33] These findings emphasize the socio-environmental dimension of loneliness, where lower socioeconomic status, social discrimination, absence of a social support system, and difficulty in building social connections affect the functionality and vocational capacity and opportunities of persons with schizophrenia.[34,35]
Findings of the study revealed that people with schizophrenia have impaired social cognition, difficulty in understanding and communicating with others, inadequate social skills, and difficulty in getting along with people and fully participating in society. These cognitive and social skills are essential for building social relationships, and deficits in them lead to loneliness.[6,34] Along with the socio-environmental approach, the association of functionality with loneliness is explained by Maslow’s hierarchy of needs, which states that the lack or absence of social belongingness will trigger loneliness in the individual as a warning signal to motivate them to fulfil the social need.[1,36] The functional impairment due to poor social cognition and social skills in schizophrenia results in loneliness, which is a distressing feeling leading to a perception that the quantity and quality of the social relationships are not meeting their social needs.[37]
Unemployment was found to be a significant predictor of loneliness in schizophrenia. The current study participants were mainly unemployed or daily wage earners with a longer period of unemployment, thus predicting higher loneliness. Socio-environmental factors, such as lower education, rural domicile, and lower socioeconomic status, also influence the availability and accessibility of resources for vocational engagement, thereby affecting loneliness outcomes.[9]Employment or work not only provides financial security and social status but also helps in functional recovery by providing opportunities for building hope and self-esteem, satisfaction in life, social inclusion, and social interaction, which are essential for addressing loneliness in schizophrenia.[3,13,28]
Loneliness is a multidimensional phenomenon, and the high prevalence of loneliness affects the recovery and mental and physical well-being of the person by leading to non-compliance with treatment, clinical exacerbation, decreased self-esteem, increased internal stigma, lower self-efficacy for community life, heightened perceived stress, comorbid depression, anxiety and paranoia, and high risk for comorbid physical conditions such as hypertension, heart disease, Alzheimer’s disease, impaired immune system, and lifespan reduction by an average of 20 years lower than the general population.[2,3,6,13] Previous studies suggested that psychosocial interventions such as psychoeducation, problem-solving, social skill training, and social connections were used to address loneliness.[33] Routine assessment of loneliness should be integrated into clinical evaluations, and interventions must go beyond symptom management to include strategies for enhancing social participation and functional independence. The effective and tailor-made implementation of psychiatric social work interventions focusing on loneliness would help in improving the wellness of persons with schizophrenia, thus enhancing their symptoms, functional and social recovery, and remission.
Strengths of the study
The study addressed an underexplored area by examining the association between loneliness, functionality, and symptom severity in persons with schizophrenia
A multidimensional approach was adopted to understand loneliness by incorporating clinical, functional, and sociodemographic factors
It went beyond correlation to identify significant predictors (low functionality and prolonged unemployment) through the regression analysis
Findings have strong clinical relevance, highlighting modifiable factors that can be achieved through psychosocial interventions, especially focusing on vocational rehabilitation and functional recovery
By focusing on male patients in an Indian tertiary care context, the study adds valuable cultural and contextual insights to global literature.
Limitations of the study
The sample size was relatively small, so the generalizability of the findings is limited
The study only included male participants, so the findings cannot be extended to females or other gender populations
The participants were mostly higher-functioning individuals, those who had the capacity to consent and had lower symptom severity
As this is a cross-sectional study, the participants’ functionality and feelings of loneliness before the onset of the illness could not be described. Consequently, casual relationships between the illness-related variables and these outcomes cannot be inferred
The data were collected from a single tertiary healthcare center, limiting the cultural generalizability of findings
The regression analysis did not account for potential confounders, including the sociodemographic and clinical factors, which may have influenced the observed associations.
Recommendations for future research
A longitudinal study could be conducted to better understand the causal effect relationship between low levels of functionality, loneliness, and symptom severity in schizophrenia
A larger sample study, including the female population and participants from diverse socio-cultural backgrounds, will help to understand the association of the study variables with sociodemographic variables
Intervention studies focusing on enhancing functionality and tackling loneliness can help in improving the symptom severity and overall health of persons with schizophrenia.
CONCLUSION
Functionality in schizophrenia is widely studied, whereas loneliness in this population is still being explored. Despite the high prevalence of functional disability and subjective feelings of loneliness in schizophrenia, the association between the variables was not previously explored. This study found a significant association between functional disability, loneliness, and higher symptom severity, thus indicating that the conventional psychosocial interventions for persons with schizophrenia needed modification and should be tailor-made by incorporating interventions for improving functionality and reducing loneliness. Prompt addressing of loneliness in schizophrenia will result in symptom reduction and functional recovery, enhanced self-esteem, and improved social connections and relationships.
Ethical approval:
The research/study was approved by the Institutional Review Board at the Institute Ethics Committee, National Institute of Mental Health and Neuro Sciences, approval number NIMH/A&E-SA3-262/Ph.D/PSW/FSC/2023-24, dated 20th February 2024.
Declaration of patient consent:
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given consent for clinical information to be reported in the journal. The patient understands that the patient’s names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The authors confirm that they have used artificial intelligence (AI)-assisted technology for reference management, sentence paraphrasing, and for grammar checking.
Financial support and sponsorship: This study was financially supported by the University Grants Commission Senior Research Fellowship, New Delhi, India.
References
- Evolutionary mechanisms for loneliness. Cogn Emot. 2014;28:3-21.
- [CrossRef] [PubMed] [Google Scholar]
- Social motivation in schizophrenia: How research on basic reward processes informs and limits our understanding. Clin Psychol Rev. 2018;63:12-24.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in schizophrenia: Construct clarification, measurement, and clinical relevance. PLoS One. 2018;13:e0194021.
- [CrossRef] [PubMed] [Google Scholar]
- The intensity and correlates of the feelings of loneliness in people with psychosis. Compr Psychiatry. 2016;70:190-9.
- [CrossRef] [PubMed] [Google Scholar]
- Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness. Front Psychiatry. 2014;5:154.
- [CrossRef] [PubMed] [Google Scholar]
- Prevalence of loneliness and its correlates among patients with schizophrenia. Int J Soc Psychiatry. 2023;69:906-15.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in psychotic disorders and its association with cognitive function and symptom profile. Schizophr Res. 2015;169:268-73.
- [CrossRef] [PubMed] [Google Scholar]
- The prevalence and impact of risk factors for ethnic differences in loneliness. Eur J Public Health. 2016;26:977-83.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in psychosis: A meta-analytical review. Schizophr Bull. 2018;44:114-25.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness and its association with health service utilization in people with a psychotic disorder. Schizophr Res. 2020;223:105-11.
- [CrossRef] [PubMed] [Google Scholar]
- An ecological examination of loneliness and social functioning in people with schizophrenia. J Abnorm Psychol. 2021;130:899-908.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in patients with schizophrenia. Taiwan J Psychiatry. 2021;35:59.
- [CrossRef] [Google Scholar]
- A glimpse of gender differences in schizophrenia. Gen Psychiatr. 2022;35:e100823.
- [CrossRef] [PubMed] [Google Scholar]
- Gender differences in schizophrenia and first-episode psychosis: A comprehensive literature review. Schizophr Res Treatment. 2012;2012:916198.
- [CrossRef] [PubMed] [Google Scholar]
- Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behav Res Methods. 2009;41:1149-60.
- [CrossRef] [PubMed] [Google Scholar]
- A new brief instrument for assessing decisional capacity for clinical research. Arch Gen Psychiatry. 2007;64:966-74.
- [CrossRef] [PubMed] [Google Scholar]
- Psychometric properties of a structured diagnostic interview for DSM-5 anxiety, mood, and obsessive-compulsive and related disorders. Assessment. 2018;25:3-13.
- [CrossRef] [PubMed] [Google Scholar]
- The alcohol, smoking and substance involvement screening test (ASSIST): Development, reliability and feasibility. Addict. 2002;97:1183-94.
- [CrossRef] [PubMed] [Google Scholar]
- The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987;13:261-76.
- [CrossRef] [PubMed] [Google Scholar]
- Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0) Geneva: World Health Organization; 2010.
- [Google Scholar]
- UCLA loneliness scale (Version 3): Reliability, validity, and factor structure. J Pers Assess. 1996;66:20-40.
- [CrossRef] [PubMed] [Google Scholar]
- IBM SPSS Statistics 25 Step by Step: A Simple Guide and Reference. (15th ed). London: Routledge, Taylor and Francis Group; 2019.
- [CrossRef] [Google Scholar]
- Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness. J Clin Diagn Res. 2014;8:WE01-4.
- [CrossRef] [PubMed] [Google Scholar]
- The relationship between internalized stigma and loneliness in patients with schizophrenia. Perspect Psychiatr Care. 2020;56:168-74.
- [CrossRef] [PubMed] [Google Scholar]
- Depressive and anxiety symptoms among schizophrenia patients. J Affect Disord. 2024;362:749-54.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in the general population: Prevalence, determinants and relations to mental health. BMC Psychiatry. 2017;17:97.
- [CrossRef] [PubMed] [Google Scholar]
- A network analysis on the relationship between loneliness and schizotypy. J Affect Disord. 2022;311:148-56.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness and related factors among people with schizophrenia in Japan: A cross-sectional study. J Psychiatr Ment Health Nurs. 2016;23:399-408.
- [CrossRef] [PubMed] [Google Scholar]
- Acting on persecutory delusions: The importance of safety seeking. Behav Res Ther. 2007;45:89-99.
- [CrossRef] [PubMed] [Google Scholar]
- An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review. J Psychiatr Ment Health Nurs. 2023;30:1170-91.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in young adults during the first wave of COVID-19 lockdown: Results from the multicentric COMET study. Front Psychiatry. 2021;12:788139.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness in schizophrenia and its possible correlates. An exploratory study. Psychiatry Res. 2016;246:211-7.
- [CrossRef] [PubMed] [Google Scholar]
- Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Ann Behav Med. 2010;40:218-27.
- [CrossRef] [PubMed] [Google Scholar]