The Path to Loneliness for Psychiatric Patients: A Qualitative Study of a Journey Marked by Pain, Hopelessness, Prosocial Signaling Deficits, and Coping Strategies That Are Not Effective.

Enduring loneliness has serious physical and mental health implications. Patients with mental health problems are at risk of experiencing problems related to loneliness. Therefore, it is important to increase knowledge about how loneliness is experienced and managed in this particular group. The aim of the study was to explore (1) psychiatric patients' experiences of different forms of loneliness, (2) associated problems, including difficulties with prosocial signaling, and (3) strategies used to combat loneliness, to better understand how loneliness affects psychiatric patients and how patients manage their loneliness. A total of 110 psychiatric patients were recruited at eight outpatient clinics in Region Stockholm for a larger study of loneliness. The first fifteen patients who also agreed to participate in the present substudy were invited to meet a trainee psychologist who conducted a semi-structured interview. A reflexive thematic analysis with a codebook approach was used to analyze the transcripts. The described experiences of loneliness were primarily examples of social and emotional loneliness with one prominent theme: "Hopelessly lonely". Associated problems were summarized in two themes: "The inevitable road to loneliness" and "Social signals are confusing and push others away". Regarding patients' strategies for combating loneliness, one theme emerged: "Using strategies that focus on the current moment". The results also included a total of sixteen subthemes. Loneliness was described as something painful that is inevitable and unchangeable, with a self-reinforcing loneliness loop leading to social and emotional loneliness, and as something that is intertwined with mental health problems. These results are in accordance with research. In addition, patients described a variety of prosocial signaling deficits and feelings of being disconnected from others. They also reported using strategies that primarily alleviated their immediate suffering when they were alone, rather than focusing on approaches with long-term effects on reducing loneliness, such as participating in social activities combined with effective social signaling. Future research should investigate whether increased awareness of social signaling, as well as social activities combined with improved prosocial signaling and strengthened self-belief, would constitute effective steps for patients to combat enduring loneliness. It also seems important to help patients reduce hopelessness related to loneliness.