Isolation and emotional wellbeing Dr James Warner CNWL Foundation Trust

I am alone now spiraling into despair here in the darkness Jill

Isolation causes depression

7 secrets of depression Depression is: –Common –Often missed –Not hard to recognise (if you know what to look for) –Often severe –Often recurs –Costly (costs UK £17 billion in lost output) –Treatable

Symptoms of depression (principal features) Present for at least two weeks –Low mood- sustained and pervasive –Loss of enjoyment –Extreme fatigue

Symptoms of depression (physical) Diurnal variation of mood Sleep disturbance Change of appetite/weight Loss of libido physically slowed up Loss of memory

Symptoms of depression (psychological) Loss of concentration Loss of volition Guilt Hopelessness Worthlessness Suicidal ideation

Depression Onset - 50% before the age of 40 years Peak age of onset May occur for the first time in late life Risk increases in older people Results in severe impairment of quality of life

Depression -how common is it? At any time –3% of men –6% of women Lifetime risk –10% men –20% women

Depression suicide 15% will commit suicide 70% of all suicides are due to depression –Approximately 3000 suicides per year due to depression Peak risk of suicide = aged –Men > women

Depression risk factors Often no obvious cause Isolation Life events –Bereavement, unemployment Medical illness –Parkinson’s disease, stroke, dementia Genetics

Depression causes isolation People with depression –Feel less sociable –Have less energy –Have less motivation –Have lower self-confidence

Depression treatments Cognitive behaviour therapy –12-20 sessions –Tackle negative thoughts of depression –80% recover Antidepressant tablets –Once daily –Minimum 6 months –80% recover

Isolation causes dementia –Risk of developing Alzheimer’s disease over a 4-year period was more than doubled in lonely people compared to less lonely Isolation may cause dementia to progress more rapidly Wilson RS et al. Archives Gen Psych 2007

7 secrets of dementia Dementia is: –Common –Often missed –Not hard to recognise (if you know what to look for) –Costly (costs UK £23 billion a year) –Puts the individual at significant risk –Causes psychological distress as well as memory problems –Can be treated

Symptoms of dementia Cognitive symptoms –Memory –Orientation –Language –Judgement/thinking –Sequencing coordinated movements –Personality

Behavioural and psychological symptoms

Dementia leads to social isolation Many people with dementia and their carers complain that family and friends shun them 1/3 of people with dementia live alone People with dementia who live alone have less access to key services

Social isolation leads to physical changes Lonely people have: –Poor diet –Altered immune response –Changes to endocrine system –Higher blood pressure All of these may impact on emotional wellbeing

Conclusion Loneliness and the feeling of being unwanted is the most terrible poverty. Mother Theresa