Individual Socioeconomic Measures and Change in HoNOS Scores among Persons Attending Adult Community Mental Health Services.

Chronic Obstructive Pulmonary Disease (COPD) is an incurable condition that affects an estimated 480 million people worldwide (). Over 1 million people in the UK have a diagnosis of COPD, with a further estimated half million people living with the condition undiagnosed (). Common and disabling symptoms include breathlessness, cough, and fatigue, which tend to worsen over time. Treatments and supported self-management strategies are available to help people with COPD live as well as possible with their condition. However, many still experience psychological distress () and persistent limitations in daily activities (). Perhaps related to this, recent population-based evidence has shown that people with COPD are at greater risk of social isolation and loneliness (), report a reduced sense of belonging, and struggle to rely on others when experiencing high levels of stress (). Evidence predominantly from the United States suggests the pooled prevalence of loneliness in people with COPD is 32% (95% CI = 16%–48%,  = 4) (), while a nationally representative cohort study found one in six with COPD reported social isolation (). Several factors might contribute to these challenges with social connection. Across quantitative studies (; ; ), qualitative studies (; ), and systematic reviews (; ; ; ) exploring the lived experiences of people with COPD, participants have reported facing a shrinking social world due to the impacts of their symptoms and treatments (e.g. portable oxygen) on mobility and participation. This can be further compounded by societal issues of stigma and shame due to perceptions of their illness as “self-inflicted” due to associations with smoking (), and more recently negative public reactions to symptoms like cough due to associations with Covid-19 (). Despite the multidimensional impacts of COPD indicating the need for a biopsychosocial approach, and the potential benefits for furthering self-management, promoting person-centredness, and reducing psychological distress (), dedicated consideration of social elements is often missing from COPD research and care. This phenomenon is not new: the “social” in biopsychosocial has historically been neglected compared to its biological and psychological elements (; ). While there has been some qualitative exploration of the role of stigma in COPD, there is a dearth of studies explicitly focused on social connection. This is surprising, given known adverse impacts of social disconnection on health (; ), and the numerous times people with COPD have expressed this as an area of concern as part of broader studies (; ; ; ). The reverse is also true in the context of COPD, with higher levels of social support being linked to improved quality of life, mental health, and functional outcomes, but also less severe COPD ().