Loneliness in Aging with Schizophrenia

近年来，越来越多的人意识到和关注"孤独的流行病"， 老年人和其他一般人群中的患病率更高，但精神分裂症患者的患病率甚至更高。 孤独症是医学并发症、认知功能障碍、功能减退 能力，较低的幸福感和较早的死亡率。与孤独相关的死亡风险是 肥胖，相当于每天吸15支烟。值得注意的是，许多相关的有害影响 孤独感与精神分裂症和衰老有关。这种趋同提出了一个问题， 孤独是否会显著导致健康、认知和功能能力的缺陷， 生理功能和健康的中年和老年精神分裂症患者。拟议 该项目是第一个对孤独的性质、纵向稳定性和有害影响的全面研究。 精神分裂症考虑到最近精神分裂症被认为是一种系统性疾病， 加速老化，以及孤独感在生命过程中可能演变的方式，这是本研究的重点 将在中年和老年精神分裂症患者（n = 120）中研究孤独随年龄的影响， 以及年龄相当的非精神病学比较（NC）受试者（n = 90）。该研究采用了纵向 突发设计，在基线、6个月和12个月时进行面对面访视并评估关键变量。七 在三次主要研究访视后的几天，基于智能手机的生态瞬时评估 (EMA)将被用于实时测量孤独感、社交活动和情绪。我们的主要目标包括 确定精神分裂症和衰老与持续孤独的关系，以及 这些关联与社会孤立和抑郁症状无关。另一个主要目标是 确定6个月和12个月以上的持续孤独与生物学水平和模式之间的关系。 健康标志物、医学共病、认知功能障碍、功能能力和健康相关质量 生活假设预测精神分裂症与更严重和更持久的孤独有关， 持续的孤独将与健康和其他结果的更差生物标志物相关。我们也 预计这些联系会随着年龄的增长而增加。急性心肌梗死患者之间的稳定性和时间关系 使用EMA实时测量的孤独，社交活动和情绪，以及这些模式与 还将评估标准的面对面测量结果。该项目的数据将填补一个关键的 需要经验数据来指导预防和减少有害生物工作的内容和重点， 生物学和长期健康结果以及老年精神分裂症患者的幸福感下降。 总之，这项研究代表了一个重要的和创新的一步，进一步努力更有效， 中年人孤独及其不良影响的综合性、个体化防治 和老年精神分裂症患者。

In recent years there has been increased awareness and concern about the “epidemic of loneliness” among older adults and other general population, but the prevalence is even higher among people with schizophrenia. Loneliness is a significant risk factor for medical comorbidity, cognitive dysfunction, reduced functional capacity, lower well-being, and earlier mortality. The mortality risk associated with loneliness is double that for obesity, and equivalent to smoking 15 cigarettes per day. Notably, many of the deleterious effects associated with loneliness parallel those associated with schizophrenia and aging. This convergence raises a question of whether loneliness significantly contributes to the deficits in health, cognition and functional capacity, physiologic function, and well-being among middle-aged and older adults with schizophrenia. The proposed project is the first comprehensive study of the nature, longitudinal stability, and deleterious impact of loneliness in schizophrenia. Given recent conceptualizations of schizophrenia as a systemic disorder resulting in accelerated aging, and the manner in which loneliness may evolve over the life-course, the focus for this study will be on the effects of loneliness with age among middle-aged and older adults with schizophrenia (n=120) as well as age-comparable non-psychiatric comparison (NC) subjects (n=90). The study employs a longitudinal burst design, with in-person visits and assessments of key variables at baseline, 6-, and 12-months. For seven days following each of the three primary study visits, smartphone-based Ecological Momentary Assessment (EMA) will be used to measure loneliness, social activity, and mood in real-time. Our primary aims include determining the associations of schizophrenia and aging with persistent loneliness, and the degree to which the associations are independent of social isolation and depressive symptoms. The other primary aim is to determine the association of persistent loneliness over 6- and 12-months with levels and patterns of biological markers of health, medical comorbidity, cognitive dysfunction, functional capacity, and health-related quality of life. Hypotheses predict schizophrenia being associated with worse and more persistent loneliness, and that persistent loneliness will be associated with worse biological markers of health and other outcomes. We also expect these associations to increase with advancing age. Stability and temporal relationships between acute loneliness, social activity, and mood measured in real-time using EMA, and associations of these patterns with those from the standard in-person measures will also be assessed. The data from this project will fill a critical unmet need for empirical data to guide the content and focus of efforts to prevent and reduce deleterious biological and longer-term health outcomes and diminished well-being in older adults with schizophrenia. Together, this study represents a significant and innovative step in furthering efforts toward more effective, comprehensive, individualized prevention and treatment of loneliness and its adverse effects in middle-aged and older adults with schizophrenia.