Evolution: the bridge between 'biological' and 'social' psychiatry
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Authors
Swanepoel, Annie
Abed, Riadh
Brar, Gurjot
John-Smith, Paul St
O'Connell, Henry
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Issue Date
01/03/2025
Type
Journal article
Language
Keywords
Mental Health
Alternative Title
Abstract
Background
Loneliness is associated with several physical and mental health problems, yet its costs to the healthcare system remain unclear.
Aims
The current study aimed to review literature on the health and social care impacts of loneliness, and review economic evaluations of loneliness interventions.
Method
We conducted a systematic review of studies published from 2008 to April 2025 by searching five bibliographic databases, grey literature and reference lists of systematic reviews. Studies estimating health and social care cost/expenditure, and on health resource utilisation, were included to assess the impact of loneliness on the health system. Return on investment, social return on investment and cost-effectiveness evaluations were included to assess the economic impact of loneliness interventions. We conducted quality appraisal and narrative synthesis of results.
Results
We included 53 studies. Eight estimated the healthcare cost/expenditure of loneliness, 33 reported healthcare resource use and 19 were economic evaluations of interventions. Findings relating to the cost/expenditure of loneliness and service use were inconsistent: some studies reported excess costs/expenditure and service use, whereas others found lower costs/expenditure and service use. Economic evaluation studies indicated that loneliness interventions can be cost-effective, but were not consistently cost-saving or effective in reducing loneliness.
Conclusions
Findings on the impact of loneliness on the healthcare system and economic evaluations of loneliness interventions were varied. Therefore, we cannot derive confident conclusions from this review. To address evidence gaps, future research relating to social care, younger populations, direct healthcare costs of loneliness and randomised controlled trials with long-term follow-ups should be prioritised.
Description
‘Biological’ and ‘social’ perspectives in psychiatry have exchanged dominance at different times in the history of our field and are sometimes erroneously viewed as being contrasting and mutually exclusive paradigms. We argue that the arbitrary ‘biological/social’ divide in psychiatry is misleading, unhelpful, and ultimately a false one. We propose that the evolutionary perspective provides a necessary framework and metatheory that can bridge this apparent schism in psychiatric thinking, providing novel and useful insights into how we can better assess, diagnose, and treat our patients.
Citation
Irish Journal of Psychological Medicine. 2025;42(1):3-5. doi:10.1017/ipm.2024.31
Publisher
License
Journal
Irish Journal of Psychological Medicine
Volume
42
Issue
1