Loneliness in Aging with Schizophrenia

近年来，人们对“孤独流行病”的认识和关注有所增加。 老年人和其他普通人群的发病率更高，但在精神分裂症患者中患病率更高。 孤独是医学共病、认知功能障碍、功能减退的重要危险因素 能力、更低的幸福感和更早的死亡率。与孤独相关的死亡风险是 肥胖，相当于每天抽15支烟。值得注意的是，许多相关的有害影响 孤独与精神分裂症和衰老的症状相似。这种趋同引发了一个问题： 孤独是否显著导致健康、认知和功能能力的缺陷， 中老年精神分裂症患者的生理功能和幸福感。建议数 该项目是第一个全面研究孤独的性质、纵向稳定性和有害影响的项目 精神分裂症患者。鉴于最近对精神分裂症的概念是一种系统性疾病，导致 加速衰老，以及孤独可能在一生中演变的方式，是这项研究的重点 将关于孤独对中老年精神分裂症患者(n=120)随年龄的影响 以及年龄相仿的非精神病学对照(NC)受试者(n=90)。这项研究采用了纵向的 突发设计，面对面访问，并在基线、6个月和12个月评估关键变量。七个人 三次主要研究访问后的几天，基于智能手机的生态瞬时评估 (EMA)将被用来实时测量孤独、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联，以及 这些联系与社会孤立和抑郁症状无关。另一个主要目标是 确定持续6个月和12个月的孤独与生物学水平和模式的关联 健康标记物、医疗合并症、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，而且 持续的孤独将与更差的健康和其他结果的生物学标志相关联。我们也 预计随着年龄的增长，这些联系将会增加。急性发作之间的稳定性和时间关系 使用EMA实时测量孤独感、社会活动和情绪，以及这些模式与 来自标准面对面测量的那些也将被评估。这个项目的数据将填补一个关键的 对经验数据的未得到满足的需求，以指导预防和减少有害物质工作的内容和重点 患有精神分裂症的老年人的生物学和长期健康结果以及幸福感下降。 总而言之，这项研究代表着在进一步努力实现更有效的、 中年人孤独及其不良反应的个体化综合防治 以及患有精神分裂症的老年人。

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.