The Prevalence and Severity of Loneliness and Deficits in Perceived Social Support among people with “Complex Emotional Needs” (CEN): A Systematic Review

Abstract Background Loneliness and struggles with unmet social needs are a common experience among people with “Complex Emotional Needs” (CEN) who may be diagnosed with a ‘personality disorder’. Given the adverse effects of loneliness and poor perceived social support on physical and mental health, and the importance of a sense of belonging for recovery, a systematic review examining the prevalence/severity of loneliness and deficits in perceived social support among people with CEN is an essential step towards developing an intervention targeting the social needs of people with CEN. Method We conducted a systematic review synthesising quantitative data on the prevalence and severity of loneliness and deficits of perceived social support among people with CEN in comparison with other clinical groups and the general population. We searched Medline, Embase, PsycINFO, Web of Social Science, Google scholar and Ethos British Library from inception to December 2021. We conducted quality appraisals using the Joanna Briggs Critical appraisal tools and rated the certainty of evidence using the Grading of Recommendation, Assessment, Development and Evaluation approach. A narrative synthesis was used describing the direction and strength of associations prioritising high quality studies. Findings A final set of 70 studies are included in this review, most of which are cross-sectional studies (n=55), based in the United States (51%) and focused on community samples. Our review of evidence found that, across all types of ‘personality disorders’ (except ‘narcissistic personality’ traits), people with traits associated with ‘personality disorder’ or meeting criteria for a diagnosis of ‘personality disorder’, have higher levels of loneliness, low perceived relationship satisfaction, and poor social support compared to the general population and to other clinical samples such as people with depression or psychosis. The evidence also indicated that loneliness could play a role in exacerbating specific symptoms associated with CEN, such as self-harm, identity disturbances, and hallucinations. Conclusion The quality of evidence is judged as low quality. However, the adverse effects of loneliness on CEN symptoms and recovery suggests a need to co-develop psychosocial interventions targeting the social needs of people with CEN to improve quality of life and recovery outcomes.