Isolation and emotional wellbeing

1. Isolation and emotional wellbeing Dr James Warner CNWL Foundation Trust

2. I am alone nowspiraling into despairhere in the darkness Jill

3. Isolation causes depression

4. 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

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

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

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

8. Depression • Onset - 50% before the age of 40 years • Peak age of onset- 25-40 • May occur for the first time in late life • Risk increases in older people • Results in severe impairment of quality of life

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

10. Depressionsuicide • 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 60-75 • Men > women

11. Depressionrisk factors • Often no obvious cause • Isolation • Life events • Bereavement, unemployment • Medical illness • Parkinson’s disease, stroke, dementia • Genetics

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

13. Depressiontreatments • Cognitive behaviour therapy • 12-20 sessions • Tackle negative thoughts of depression • 80% recover • Antidepressant tablets • Once daily • Minimum 6 months • 80% recover

14. 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

15. 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

16. Symptoms of dementia • Cognitive symptoms • Memory • Orientation • Language • Judgement/thinking • Sequencing coordinated movements • Personality

17. Behavioural and psychological symptoms

18. 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

19. 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

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