Understanding and addressing loneliness in people with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a common lung condition, affecting over three million people in the UK[1] and over 325 million people worldwide[2]. Common and disabling symptoms include breathlessness, cough and fatigue, which increasingly limit individuals' daily activities[3], and contribute to social isolation and loneliness[4]. Related to this, people with COPD are at increased risk of depression[5], and have almost twice the odds of dying by suicide than someone without the disease[6]. While medications, vaccinations, exercise- and self-management interventions can help people with COPD to manage their condition, the disease and its symptoms worsen over time there is currently no cure. Psychosocial support for people with COPD as they live and die with this disease is an essential clinical priority, yet there is still a lack of research in this area.

Throughout my PhD project I worked with people with COPD and frailty, and loneliness was raised a common concern by both research participants and service user representatives. For example, when exploring experiences of frailty and rehabilitation services[7], participants emphasised feelings of loneliness as their declining health limited their day-to-day activities, and how they often missed the social aspects of group rehabilitation when their programme came to an end. As I collaborated with additional service users to design a new approach, they again highlighted the need to address, and measure, social outcomes. While these influences led to a heightened focus on loneliness within my PhD work about COPD and frailty, it was clear that dedicated research is needed to fully address this important unmet need.

People with COPD have described feeling isolated and lonely in previous interview studies [7-10], and although population data is currently limited, it appears between 10-35% [11, 12] of people with COPD may be experiencing loneliness. People with chronic respiratory disease are likely at particular risk of loneliness: they face a shrinking social world due to the impacts of their symptoms on mobility. This is compounded by societal issues of stigma and shame due to perceptions of their illness as 'self-inflicted' and more recently negative public reactions to symptoms like cough due to associations with Covid-19[13]. Given evidence outside of lung disease showing that loneliness is associated with worse physical and psychological health, including putting people at higher risk of suicidal thoughts and behaviours[14], plus economic consequences due to lost productivity and increased healthcare utilisation[15], addressing these concerns is of upmost importance to society.

Within this fellowship, I aim to use the findings of my PhD as a bridge to a new, essential programme of work around loneliness and the wider psychosocial health of people with COPD. To consolidate my PhD and strengthen potential impact of this future work, my first two objectives are to improve my knowledge and research skills to support a future research career at the interface of psychology and respiratory health (objective 1), and to strengthen current and future impact opportunities through dissemination and networking with diverse stakeholders in respiratory psychology (objective 2). Activities to support these objectives include: structured training courses in behavioural science and statistics, mentoring by a health psychologist, a visit to international respiratory psychology experts, academic dissemination and networking through publications and conferences, and creating outputs specifically for policy-makers and the public. Alongside this, I will conduct further limited research on the role of loneliness in the physical and mental health of people with COPD through a secondary analysis of my PhD interview data (objective 3), and develop a competitive funding proposal to progress research in this area (objective 4).