Research and analysis

Disability, loneliness and relationships: a thematic report

Published 17 July 2025

Alex Bacon, Adam Hyland, Scarlett James, Nicki Martin, Georgie O’Brien, Preethi Premkumar, Shaminder Takhar, Piers Wilkinson

Diversity and Ability, London South Bank University

1. Executive summary

This report explores the lived experiences of disabled people regarding relationships, loneliness, and connectedness in the UK. Building on the findings from systematic literature review conducted by the University of Leeds Centre for Disability Studies and Disability Rights UK, the aim of this qualitative literature review was to:

• identify disabled people’s preferences in forming social networks and relationships
• understand any barriers they may face and the impact of them
• review any improvements to schemes, designs, adaptations and services

1.1 Methodology

There were 158 sources from the wider evidence base that covered themes of families and the private sphere. These sources were quality assessed to ensure they:

• used a qualitative methodology
• used participant samples that consisted of disabled adults as defined under the Equality Act (2010)
• must explore the experiences of loneliness, including its risk factors, barriers and impacts or connectedness, including its facilitators of disabled adults

Exclusion criteria for studies followed the principle of the social model which is “nothing about us without us”. Articles or reports were excluded if they:

• only included the voices of parents, carers or advocates of disabled adults
• lacked lived experience of disabled adults or based on statistical analysis
• were review articles, methodological articles, commentaries book chapters or case studies
• were written in a foreign language

From the 158 articles or reports, 58 were excluded, leaving 100 articles or reports to analyse. This evidence formed the basis of the thematic review on disability, loneliness, and relationships for this report.

1.2 Summary of findings

Across 10 themes, we identified that disabled people experience a variety of barriers. These can make it hard to establish and maintain relationships, and can lead to social isolation and loneliness. However, the review focuses on lived experience research, and limitations include small sample sizes and limited peer review. Lived experience research gives us a better, but far from complete, understanding of the issues faced by disabled people and people with health conditions in relation to relationships with family and friends.

The findings highlight that disabled people:

• often have smaller networks than non-disabled people and are more dependent on these networks, which can lead to alternate definitions of friendship
• face an increasing dependency on their network – outside of family and service workers, these networks often include relationships with people similar to themselves
• are regularly made to feel as an ‘other’ by social perceptions and therefore do not feel they fit in – as a result, disabled people can internalise negative societal perceptions and self-isolate
• experience disparities in perceptions, such as for people who acquired their impairment compared with other disabled people
• navigate additional barriers in relationships regarding roles, often balancing ‘traditional’ non-disabled roles with aspects of caregiving and increased dependency, especially for partner and parent/child relationships
• value sexual identity as much as their non-disabled peers, but face stigma about their sexual expression – they can face heightened stigma if they identify as LGBTQ+ and therefore, due to their dependency on their smaller networks, are not able to explore their sexuality or gender identity in the same ways as non-disabled people
• seek greater independence and autonomy within their lives, and significantly face the assumption of incompetence by non-disabled people, to the detriment of all relationships
• are not afforded the same access to education and information on sexual health, sexual wellbeing, family planning and relationships

Suggested improvements regularly included:

• training and support for caregivers and service professionals to give a greater understanding of disabled people’s lives
• initiatives to break down social perceptions and stigma
• significant changes to existing services to improve access to education, information, social opportunities, and other communities

Overall, the findings suggest that while legislative protections and conventions promote the rights of disabled people, the lived realities are overwhelmingly different. For example, a disabled person’s preference for socialising is less of a factor than whether they can access the opportunities to socialise in the first place. The qualitative research landscape also disproportionately uses participants from institutional, clinical, and service-orientated settings, and does not fully reflect the diversity of the disabled community.

2. Overview

This report presents selected findings from a wider review of the evidence on disabled people’s lived experience in the UK. It was commissioned by the Cabinet Office’s Disability Unit and conducted by London South Bank University and Diversity and Ability in 2023.

3. Introduction

Good relationships are important for the wellbeing of disabled people. The relationships that disabled people have with their parents, siblings, partners, children and friends can help them to achieve their goals and satisfy their basic needs for self-actualisation.^{[footnote 1]} However, people can feel lonely when their need to belong is not satisfied and when social relationships are perceived as unsatisfying.^{[footnote 2]} Good relationships from a close relative can be achieved through effective communication, social support and access to physical resources and services. In contrast, poor relationships can be linked to the criticism, hostility, warmth and overprotectiveness from a close relative.^{[footnote 3]} Loneliness has also been found to relate to greater perceived family stress due to anger and irritability during the COVID-19 lockdown.^{[footnote 4]} 

Twice as many disabled people reported feeling lonely during the COVID-19 pandemic than non-disabled people.^{[footnote 5]} More recently, four times as many disabled people reported being lonely than non-disabled people.^{[footnote 6]} Loneliness is associated with family stress due to parental conflict and maternal control that correspond to criticism and excessive praise.^{[footnote 7][footnote 8]} 

Understanding relationships at various stages of development, from childhood to parenthood, can improve how disabled people see the social world and fulfil their basic needs.

The quality of relationships can differ by disability, such as a physical or mental impairment following trauma, degenerative conditions and dementia, or congenital impairments. For instance, harmonious marriages sustain happiness and longevity in patients with chronic illness.^{[footnote 9]} Befriending through the voluntary service sector can satisfy the unmet needs of patients with dementia living in residential care homes, such as overcoming loneliness, bereavement and absence of loved ones.^{[footnote 10]} 

Disabled people are expected to be afforded protection against direct and indirect discrimination under the Equality Act (2010), respected for privacy and family life, to marry and have freedom of expression under the Human Rights Act (1998). These Acts promote the rights to education, independent living, employment, and adequate standard of living under the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). While these rights, legislative acts, and conventions promote  the idea of equality of experience and opportunity, the reality of the lived experience for disabled people can differ greatly. 

This report explores how disabled people establish and maintain relationships and connectedness, or experience loneliness. Analysis of existing literature found 10 broad themes: 

• familial networks
• service networks
• health and disability management
• social perceptions
• community preference
• relationship roles
• self-expression and identity
• independence and autonomy
• representation and participation
• education and information access 

It is important to understand what the barriers are for disabled people, how they may be interwoven within their experiences, and how they are experienced in the themes defined below. Isolating these barriers does not reflect how they compound and exacerbate each other and their inherent cyclical nature. Through understanding disabled people’s own preference for relationships and socialising, we can achieve equity of access that is no different from non-disabled people. 

4. Methodology

In order to identify studies for inclusion in this review, a systematic search of qualitative literature was undertaken through the use of key search terms based on the focus of this review and additional terms associated with disability and categories of impairment types.^{[footnote 11]} The systematic review searched for evidence on “the lived experience of ‘people with impairments’ in their encounters with disabling barriers”. The literature was systematically searched for studies conducted in the UK concerning the lived experience of disabled people in the UK since 2010. 

The systematic review covered literature between 2010 and 2021. This resulted in over 14,500 records consisting of articles, books and reports. The systematic review included reports in journal articles and commissioned reports through known sources, and a call to stakeholders for published evidence. The search and selection criteria led to inclusion of 1,380 records and 158 records fell within the ‘Family and private sphere’ theme. These 158 records on families and the private sphere formed the basis of the meta-thematic review on disability, loneliness, and relationships in this report. These 158 articles or reports were then quality assessed.

The inclusion criteria for studies were that:

• they used a qualitative methodology, such as interviews, focus groups, open answer surveys 
• participant samples consisted of disabled adults as defined under the Equality Act (2010) which was that individuals have “a physical or mental impairment that has a substantial and long-term negative effect on their ability to do normal daily activities” –  whether people used the label of ‘disabled’ was not a deciding criterion, as many people within many communities do not regard themselves as “disabled”, for example, some neurodiverse and autistic people prefer to refer to themselves as neurodiverse
• they must explore the experiences of loneliness, including its risk factors, barriers and impacts or connectedness, including its facilitators of disabled adults

Exclusion criteria for studies followed the disabled community principle of the social model which is “nothing about us without us”. 

Articles or reports were excluded if: 

• they only included the voices of parents, carers and advocates of disabled adults
• they lacked lived experience of disabled adults or were based predominantly on statistical analysis
• they were review articles, methodological articles, commentaries, book chapters and case studies
• they were written in a foreign language 

Studies were appraised on the following criteria, being weighted equally out of 5 for a total score of 20, with the intention to exclude studies that scored less than or equal to 5:

• How has knowledge or understanding of loneliness, connectedness or companionship been extended by the research?
• Are participants and their voices adequately represented?
• Is there a good balance of breadth and depth of data?
• Is the research methodology fit for purpose?

It became clear that an exclusionary approach would result in studies that were significantly under-representative of the disabled community, so we took an approach of inclusion over exclusion. This meant that if there was a potentially valuable insight into an underrepresented subgroup of the disabled community, it was reconsidered for inclusion. This was based on whether the study significantly extended research on underrepresented disabled adults and their lived experiences related to knowledge or understanding of loneliness, connectedness or companionship. From the 158 articles or reports, 58 were excluded (Appendix 1), leaving 100 articles or reports to thematically analyse. To help with the appraisal and analysis of the studies, Scholarcy, the assistive technology software, was used. 

5. Analysis of the included studies

The explanation of each theme consisted of a brief introduction in relation to the topic of disability and loneliness, an overview of barriers identified and their impacts, and any recommendations from the literature itself. 

Each theme explains facts from the qualitative research reviewed within each theme, using direct quotes to better reflect the tone and experiences. You can read a full interpretation of the findings in the ‘Discussion’ section. 

5.1 Family networks

A core theme was the importance of family relationships and support networks. The literature considered the impact of these relationships on the formation, continuation and connectedness of additional friendships and partner relationships, sometimes highlighting the likelihood of social isolation. 

Given the proximity, temporal and support potential of family members, we were not surprised to find that family relationships were frequently found to occupy much of a disabled person’s relationships. However, despite their prevalence, family relationships were not always seen as a preferred type of relationship for disabled people. Many disabled participants expressed positive themes associated with their family relationships, such as being loved and valued and the sense of belonging and feeling connected. There was an overarching subtheme of dependency, with family relationships being a critical factor in nurturing connectedness and autonomy through building additional relationships. Such relationships were important in the success with which disabled people could participate in the wider society and avoid social isolation.^{[footnote 12][footnote 13][footnote 14]}

Subtheme: Family dependency

The evidence highlighted how it is common for disabled people to rely on their family and friends as a carer either, directly or indirectly when navigating access for social activities, education or employment.^{[footnote 15]} This theme is covered further in the theme of ‘relationship roles’. Family dependency was also associated with many of the barriers that disabled people experienced. These include: 

• control and authority over frequency and type of socialising opportunities and engagement level
• length and stability of non-familial relationships and their connectedness with these relationships being conditional on the family’s approval or disapproval
• intersectional inequalities in approval of the disabled person’s partners, friends, community engagement, and concern over their safety, particularly for disabled women’s access to reproductive healthcare

Changes were recommended to improve the quality and variety of disabled people’s relationships, and reduce isolation and loneliness. These included additional resources to improve access to local communities and provide more opportunities for relationships to develop. The literature often touched on the importance of social care hours, and the reliance on social care to reduce the barriers from families over the disabled person’s access to community initiatives that could increase socialising opportunities.^{[footnote 16][footnote 17][footnote 18]} It also highlighted the value of carers and social care in providing transport due to inaccessible public and community transport services, and the role that a lack of accessible options can play in creating isolation, particularly noted by participants when cuts had been made to previous services.^{[footnote 19][footnote 20][footnote 21][footnote 22]} LGBTQ+ disabled people experienced loneliness and isolation since they could not ask their families for support to meet and interact with people within the LGBTQ+ community. This was evident in 2 studies where families might not allow this, and the person with intellectual disabilities could be rejected or punished outright for their identity.^{[footnote 23][footnote 24]}

5.2 Service networks

External services play a valuable role in supporting disabled people, with experiences ranging from social care, recreational activities and healthcare to community initiatives. It is clear that disabled people often rely on external services for opportunities to develop relationships, social networks and connectedness. The level of involvement of external services in developing these relationships depends on need, impairment category and environment, and the barriers expressed by disabled people. 

The provision of services is necessary for disabled people to thrive. However, the experiences of people with intellectual and communication impairments reflected restrictive influences, and control over both their preferences and opportunities to develop relationships.^{[footnote 25][footnote 26]} This issue is further explored under the theme of ‘independence and autonomy’. There was almost no opportunity for spontaneity in building relationships among disabled people. This was due to their need to plan around service support, leading to challenges with maintaining these relationships. For example, blind or visually impaired participants expressed frustration with services due to receiving little support or engagement around activities that were of interest. Blind or visually impaired participants also experienced challenges with sight-guides when finding friends or family.^{[footnote 27]} Service professionals were frequently seen to put pressure on people to conform to their views of acceptable behaviour or activities. This need to conform was particularly true of LGBTQ+ disabled people, with some professionals even withdrawing support for activities they disagreed with.^{[footnote 28][footnote 29]}

Equally, many disabled people expressed good relationships with specific individual service professionals, such as long-term carers. Some people with learning disabilities considered these relationships on a similar level to close friends or family members. There is value in service users developing and maintaining a strong relationship with the person supporting them.^{[footnote 30][footnote 31][footnote 32]} This point is further explored within the subtheme of ‘social capital’. There is also evidence that the relationships can become fraught. This can include differences of opinion with duty of care and the disabled person being silenced, which can later disrupt the development of social networks.^{[footnote 33][footnote 34]}

Service networks can be vital lifelines against social isolation and loneliness. However, the literature recommends the need for critical steps in ensuring that the service is a supportive resource rather than a restrictive and controlling one. Clinical considerations include training service professionals on the nature of power differentials that occur when someone relies on them for support.^{[footnote 35][footnote 36]} The literature also recommends practical interventions to protect disabled people from service professionals stepping beyond a supportive resource into a controlling one. Finally, much of the literature indicated a strong desire of many participants to shift support away from health risks towards social development and to allow disabled service users to make informed choices, even if that might end up being a poor choice.^{[footnote 37][footnote 38][footnote 39][footnote 40]} 

5.3 Health and impairment management

It is already well established that disabled people experience numerous obstacles that can limit their capacity to engage in activities and interests that are typically enjoyed by others. 

The findings established this limited access to activities and interests as a core challenge for disabled people, especially with building and maintaining lasting relationships.^{[footnote 41][footnote 42]}

The direct management of someone’s health was split into 2 prominent subthemes, namely social capital and acquired impairment. 

Subtheme 1: Social capital

Social capital refers to the resources and support available to people through their social networks, since our relationships can be an asset for access to other resources and improve wellbeing. With the time and limitations on capacity to engage with their social networks, disabled people are already known to have comparatively less social capital than nondisabled people. The shared experiences of disabled people participants indicated lost resources by managing their impairment or health.^{[footnote 43]} This could mean that a disabled person struggles to maintain their social network, and loses social capital. This could lead to a further reduction in their resources to engage with and maintain their social networks and relationships.^{[footnote 44][footnote 45]} Practitioners were identified as “key sources of social capital, providing bonding and bridging connections in particular, despite overall providing fewer resources than other relationship types” (Sweet and others, 2018, 313). Similarly, other literature indicates that supporting disabled people with managing their impairment both directly and indirectly results in greater bonding and bridging connections, reducing social isolation and loneliness.^{[footnote 46][footnote 47]}

Subtheme 2: Acquired impairment 

People who have acquired an impairment face barriers to managing their health. These barriers vary in their impact on the impairment according to several factors, such as type of impairment, and age and social capital. This heightened lived experience of disability was linked to the greater sense of change as a result of being able to make comparisons before and after they had acquired their impairment. This was best described by Salas and colleagues (2018, 1168):

A main issue described by participants is a drastic change in social life after the injury, characterised by the loss of friends from before the accident. Most attendees described that, after acquiring the brain injury, their friends supported them for a while but soon “vanished” or “dumped” them.

The change in capacity and ability to engage in the activities and interests of previous relationships posed a challenge for people who had acquired an impairment. The challenges posed by changing the level of engagement in the activities was found to result in the breakdown of the relationships. Experiences of feeling abandoned, isolated, and lonely were common, even when both parties in a “broken down” relationship comprehended the reasons. As such, the impact of the broken relationships resulted in a greater likelihood of self-isolation and disengagement with building new relationships, particularly for those who had experienced a stroke, acquired a chronic brain injury and individuals with Parkinson’s disease.^{[footnote 48][footnote 49][footnote 50]} 

Recommendations for mitigating the impact of the challenges included:

• greater support from practitioners delivering services to disabled people having a disabled person’s social network allow the person to engage more with the support services
• better infrastructure for the wider society to deliver more accessible activities
• greater awareness of existing accessible activities for disabled and nondisabled people to do together^{[footnote 51][footnote 52]} ,

5.4 Social perceptions

Some people with impairments described experiencing negative social perceptions and assumptions when trying to socialise. These perceptions create social barriers, which lead to greater isolation, alienation, and exclusion from social networks, activities, and opportunities. The literature regularly reported that disabled people felt that they did not “fit in” or “belong”, and it was difficult for them to be accepted and find value in social networks because of their impairment or health condition. Particularly, they perceived feeling being outside what others consider “normal” and had a desire for disability to be seen as “normal”.^{[footnote 53]} The lack of inclusion and participation can cause and exacerbate mental health problems, low self-esteem, and a sense of isolation, which further perpetuates negative social stigma and discrimination.^{[footnote 54][footnote 55][footnote 56]} Two subthemes were identified – an internalised self-isolation, and an external desire to be considered “normal”. 

Subtheme 1: Self-isolation

The lack of suitable social networks for disabled people heightens the feelings of loneliness and social isolation. This can lead to a cycle of anxiety, lack of confidence, and social withdrawal. Self-isolation can make it challenging to establish meaningful friendships and relationships, and even impact on existing relationships, as described by Brooks and colleagues (2019, p. 329):

“Negative stigmatising experiences with others reduced the trust people had in those around them and contributed to a sense of vulnerability in the relationships that respondents had with other humans.”

These attitudes can lead to feelings of self-doubt, low self-esteem, and internalised disablism, which make it difficult for disabled people to feel comfortable in social situations and reduce interest in socialising, leading to self-isolation.^{[footnote 57][footnote 58][footnote 59][footnote 60]} 

Subtheme 2: What is normal?

The idea of disability being outside of what is “normal” affects disabled people’s sense of self and their interactions with non-disabled people. The qualitative literature suggested that this led to people who had previously had negative experiences, such as bullying or infantilisation, express a preference to build relationships within their own community.^{[footnote 61][footnote 62][footnote 63]} 

This point is further explored within the theme of ‘community preference’. 

Homophily is a person’s tendency to associate and bond with similar others. Developing a social network outside of homophilic groups was difficult because disabled people struggled to predict how people would react to or engage with their impairment. This often led to masking behaviour in an attempt to better fit what they perceived as normal – this was particularly common among autistic women.^{[footnote 64]}   Some disabled people would consider masking behaviour to be an acceptable way to navigate stigma and biases from first impressions. However, this was an area of contention for other people across the literature, including those with learning disabilities.^{[footnote 65][footnote 66]} Generally, there were 2 approaches. One was for people wanting to appear as what they perceived to be “normal”, while another was for people to push against this approach in frustration and to challenge what is normal. The success of either approach was indeterminable.^{[footnote 67]} Instead, recommendations concentrated on supporting people to access more opportunities, and communities to develop social networks. Additionally, challenging perceptions in favour of normalising disability can help to dispel negative stereotypes. Challenging perceptions can also break down the barriers to fully participating in society, and develop social networks that are mutually rewarding and go beyond just being accepted.^{[footnote 68][footnote 69]}   

5.5 Community preference

Establishing the relationships beyond family structures or networks and support workers comes with unique challenges. Disabled people often find it easier to make friendships or relationships within the disabled community.^{[footnote 70]} This is more common for disabled people as their peers have similar lived experiences, and are better able to understand how to provide emotional support for each other when facing barriers or symptoms. An example can be found in the autism community, which has its own culture and sense of identity and belonging.

Liz: As time went on he said to me that ‘yeah it’s autism’ (…) And. I never knew that (…) I was glad that he said something (…) Because now for the, I’ve, friends, other friends with autism so I know exactly how to relate to them (…) Because autism and Down’s Syndrome, like I have (…) Have different, they are different disabilities but roughly, some aspects are about the same. (Mason and others, 2013, p. 113)

Often, however, this may not be a disabled person’s preference. It may stem from anxieties regarding past abuse and stigmatisation from outsiders. It may even come from a more general sense of lacking belonging within the larger society. This can make relationships harder to form, and this barrier will only be overcome by a greater overall societal understanding of disability.

It is important to recognise the benefits of homophily for disabled people and why they may choose it themselves. Support workers should not assume that disabled people will always have more successful homophilic relationships. They should help to encourage authentic connections within and outside of someone’s disabled peers. Also people with mental health impairments explained that homophilic relationships were the only friendships to be promoted and encouraged within specific services.^{[footnote 71][footnote 72]}  This bias towards supporting certain types of relationships can create a false sense of building genuine relationships, and does not help to improve connectedness. An exception is when support services support relationships within communities in secure mental health units or with chronic mental health difficulties.^{[footnote 73][footnote 74][footnote 75]} These relationships are shunned as problematic and challenging and actively discouraged, even though they live together and can be the only way to cultivate new relationships outside of family networks. 

5.6 Relationship roles

Disability can often require a great deal of management and co-operation within intimate relationships. This puts greater pressure on the people within those relationships to navigate their roles delicately, and it makes it harder to meet both sets of needs. Barriers that some disabled people face are the increased dependency on those closest to them, such as partners and children, and there can be an overlap between these roles and that of a caregiver. 

“Without a life of her own, Rita felt she was unable to contribute to their relationship as she once had and was beginning to ‘‘close down’’; she was becoming a patient and was experiencing disconnecting within her married relationship.” (Taylor, 2015: p367)

This negotiation of roles poses a much greater challenge for couples and families where the disabled person becomes disabled later in life or during the relationship. Disabled people must adjust to a decrease in autonomy, a new sense of identity, as well as managing their health. Their family must adjust to the likelihood of their relative becoming quite a different person and have to assist them a great deal more.^{[footnote 76][footnote 77]} This means a renegotiation of roles that may have been really well established in the past. 

Couples where one partner became disabled, such as after a stroke or brain injury, describe a decrease in sexuality and attraction linked to a lack of distinction between being a partner and a carer. For example, in a study with married couples in which one person had experienced a stroke, 2 related themes of working out care and rethinking marriage were revealed. Loss of intimacy due to loss of sexual attraction contributed to a feeling of disconnection.^{[footnote 78][footnote 79]} It is indicated that establishing some tasks as only being done by support workers, such as showering and undressing, can mitigate this and restore a sense of sexuality within couples.^{[footnote 80][footnote 81]} The conflict within the partners of disabled people between them wanting to help and protect their partner, but also wanting to support them to be independent, causes rifts in many couples.^{[footnote 82]}  It is a delicate balance to negotiate and can leave the disabled person feeling infantilised or abandoned, and the partner feeling unseen, and unappreciated. However, couples routinely and successfully adopted strategies to find this balance.^{[footnote 83][footnote 84][footnote 85]} 

Within parent-child relationships where the parent became disabled, 3 themes were repeated – guilt, grief, and a loss of power from role-reversal.^{[footnote 86][footnote 87]} The disabled parents internalise feelings of inadequacy as they are unable to interact and engage with their children as they had done before. This is then expressed as guilt – they feel their child is missing out on these interactions and they mourn the intimate moments they feel they will not have with them. Within all dynamics, there is a distinctive male-female gendered lens through which roles are negotiated. Disabled partners and fathers continually felt emasculated when unable to live up to the patriarchal expectations of husbands and fathers to provide for their families. This loss of social capital is intrinsically tied to their identities.^{[footnote 88][footnote 89]} The literature also revealed that in relationships involving a disabled man, elements of a parent-child relationship dynamic are adopted.^{[footnote 90]} 

5.7 Self-expression and identity

Disabled people’s self-expression and identity is a complex issue that is strongly linked to someone’s experiences of loneliness, relationships, and connectedness. The literature expressed the common barriers that anyone could experience when finding their place within society, and determining who they prefer to be with in their social network.^{[footnote 91][footnote 92]} It was highlighted that disabled people face unique challenges in forming and expressing their identity. The literature on this theme was vast and covered the complex subject of disability, self-expression and identity. However, 2 clear subthemes emerged – the expression, and development, of sexual identity. 

Subtheme: Sexual identity

Sexual identity is integral to a person’s sense of self and impacts their ability to form and maintain relationships. Regardless of the type of impairment that the literature focused on, disabled people frequently shared experiences of stigma and discrimination when it came to sexual expression.^{[footnote 93][footnote 94][footnote 95]} This often came from the simplistic assumption that disabled people are universally asexual, an implicit assumption of carers and other disability practitioners that played out as the prohibition of sexual expression. However, understanding and accepting one’s sexual identity encourages connectedness through the building of healthy relationships that are based on mutual respect and understanding.^{[footnote 96][footnote 97][footnote 98]} Many people said that their social and professional networks assumed that because they were disabled, they were also asexual or incapable of participating in sexual activities. This led to feelings of frustration, shame and embarrassment, leading to a lack of confidence and self-esteem in relationships,^{[footnote 99]} ultimately giving rise to disabled people avoiding relationships altogether,^{[footnote 100][footnote 101]} and in other cases self-harm.^{[footnote 102]} 

In particular, the barriers created by the experience of some carers could be especially disabling, best highlighted by Wilkinson and colleagues (2015, p. 99): 

“These included: carers’ views of young people as non-sexual or ‘child-like’; the struggle to receive (or in the case of carers, provide) accessible sex education and support; mutual embarrassment about discussing sexuality; and carers inhibiting sexual exploration in order to manage risk.”

The barriers which inhibit the exploration and development of someone’s sexual identity impact certain disability groups and disabled people with more than one marginalised identity more than others. Disabled people with a learning disability, mental health condition, or neurodiversity with day-to-day involvement of practitioners or carers were particularly susceptible to being restricted or stopped from expression of sexual interest or autonomy.^{[footnote 103][footnote 104][footnote 105]} The intersectional impact of this vulnerability was greater if they were also part of the LGBTQ+ community or within an institutionalised or assisted care environment.^{[footnote 106][footnote 107]}  

Improved training for professionals was recommended to help break down these specific barriers. Particular emphasis was given to education on navigating sexual expression in a way that encourages a disabled person’s right to family, education, privacy, and safety from abuse. Training and policy interventions were recommended to reduce the risk of personal views of professionals and carers inhibiting disabled people from developing romantic and sexual relationships, in line with their orientation and right to family.^{[footnote 108]}  

5.8 Independence and autonomy

For disabled people, independence refers to one’s own ability to carry out their daily activities, make decisions, and participate in social, political and economic life without unnecessary hindrance. Autonomy refers to the capacity for self-determination, and the ability to make informed choices based on personal values. The literature revealed many broad concerns relating to disabled people’s preferences in socialising, relationships and service settings. We have listed some findings relevant to independence and autonomy, before explaining specific findings in response to the issue of ‘community access’.

Firstly, a main concern is to encourage informed choices for disabled people. Studies note the lack of autonomy in areas such as contraception,^{[footnote 109]} bereavement,^{[footnote 110]} and romantic relationships.^{[footnote 111][footnote 112][footnote 113][footnote 114]} Support can and should be provided here without undermining the person’s identity and agency.^{[footnote 115][footnote 116]}  This point should be stressed and is clear across many of the barriers identified in the literature. 

Promoting interdependence in relationships themselves is also important. Responses suggest a need to balance both care and support mechanisms, while recognising the individual desire for autonomy and independence.^{[footnote 117][footnote 118]}  

Ensuring that disabled people are not underestimated or overprotected is imperative. This can be improved by allowing people to maintain their independence and self-determination in service and relationship settings. For example, Sullivan et. al (2016: p179) note that “being assumed to be incapable typically resulted in participants not being given the opportunity to be independent.”

Subtheme: Assumed incompetence 

The disabled community are challenged by their assumed incompetence. This has direct implications for their relationships. This assumed incompetence creates distance within parent-child relationships due to conflict over weaponised duty of care. Parental rights are not respected strongly for disabled people, particularly those with mental health conditions and learning disabilities, as discussed in the evidence:^{[footnote 119][footnote 120]}

“People assume I’m not safe or trustworthy; They come in guns blazing (reflecting participants feeling that professionals were being overly protective); I am judged; and Others make decisions (reflecting a view that other people made decisions about their children and they were not consulted).” (Jeffery and others, 2013, p. 4)

Assumed incompetence influences how others communicate with disabled people. Often, disabled people are ignored, patronised and talked down to. This impacts their access to information and instils feelings of exclusion.^{[footnote 121][footnote 122]} Within the context of parent-child relationships, this often means that new parents do not receive the correct care and information after birth, support in raising their children, and guidance if their child is removed.^{[footnote 123][footnote 124][footnote 125]}

Assumed incompetence intersects specifically with stigmatisation around LGBTQ+ relationships. Specifically, that LGBTQ+ relationships can be challenging and therefore, support workers overstep to care for disabled LGBTQ+ people based on their assumption that they must be protected. This restricts people from accessing spaces and communities that would support their sexual expression.^{[footnote 126][footnote 127][footnote 128][footnote 129]}

5.9 Representation and participation

Challenges in recruiting and adequately representing the target community was a recurring theme among most studies.^{[footnote 130]} Studies often cited the small sample sizes and unrepresentative nature of participants, and there was a common theme with how participants were recruited. The use of clinical settings and institutional care environments to recruit participants, and the systemic use of clinical terminology within the qualitative surveys, resulted in findings and recommendations that emphasised clinical interventions. The literature also identified people’s experiences of clinical interventions as alienating and disenfranchising, particularly among disabled women. The discussion of the findings included literature noting the conflicting experiences of participants, partly in response to the line of enquiry, but also as a result of the clinical environments. In many studies, recommendations for both future research, policy, and clinical development centred on disabled individuals feeling poorly understood, and the potential contribution of this to their heightened isolation. The discussion of findings acknowledged the detrimental effect of such alienation on disabled people’s relationships with professionals.^{[footnote 131][footnote 132][footnote 133]}  

Subtheme: communication

Disabled people who use alternative forms of communication, such as sign language, Makaton, or other assistive technology, were routinely excluded from participation. This was due to the qualitative research methodologies. There is often an implicit assumption that verbal communication is the gold standard when undertaking qualitative research. The studies would even identify and, therefore, were aware of the impact of communication barriers experienced by disabled people. The studies acknowledged how communication barriers could impede the process of building connections and bonds with others and could increase the likelihood of further social isolation and loneliness.^{[footnote 134][footnote 135]} The few studies which did include disabled people with alternative communication needs found that this subset of the disabled community experienced extreme barriers when engaging with others including frustration, feeling isolated, even when around other community members.^{[footnote 136]} Feeling sufficiently represented within research could raise awareness of these issues. It could strengthen the recommendations for ways to increase participant resilience when experiencing those barriers. 

Many researchers are not trained in the methods of non-verbal communication, and interpreters offer their own interpretations of the views expressed by the disabled people who they support. Funding for accessibility measures can also be limited. Some studies did have additional funding or expertise to include non-verbal communication. The findings of those studies highlighted the need for future research to take steps to improve the non-verbal communication as a mode of engaging participants. Otherwise, the development of interventions for social isolation and loneliness will perpetuate rather than reduce its impact.^{[footnote 137][footnote 138]} 

5.10 Education and information access

A barrier for disabled people in building connectedness is their limited access to information. This generalised restriction of access to sex education and relationship education can be down to 2 factors. Support workers’ own stigmas and lack of understanding of disability and consent often translate into enforcing abstinence on disabled people, and refusing to engage with and provide meaningful resources and advice. This is particularly seen within the LGBTQ+ disabled community whose intersecting identities both have attached stigmas.^{[footnote 139][footnote 140][footnote 141]}  

The evidence shows that there can be an assumed asexuality of disabled people, particularly those with learning disabilities. This means that support workers place little to no importance on encouraging good sexual wellbeing practices.

“Because I have a disability, people felt I didn’t have a right to a sex life. They made me feel self-conscious. I felt I had a right—we all have a right to be treated the same.” Questionnaire respondent, 20s (Wiseman and Ferrie, 2020, p. 322)

There is a profound lack of existing guidance and policy on sex education. Should support workers wish to assist service users with advice, few resources are available. Restriction of access to meaningful sex education leads to a lack of understanding of concepts, such as consent and abuse. Such restriction effectively demonstrates to disabled people that they are not considered to be equal citizens. This makes disabled people more vulnerable to abuse.^{[footnote 142][footnote 143][footnote 144]} Equally, sex is an important expression of people’s identity and expression of intimacy. A limited opportunity for such intimacy affects the ways in which disabled people can connect. Education benefits disabled people by encouraging them to engage with elements of their identity beyond their impairment, and gives them a safe place to explore sex and connectedness.^{[footnote 145][footnote 146]} 

The education on sex, reproductive health and family planning for disabled communities is poor and prioritises pregnancy prevention. It assumes disabled people are heterosexual, and is offered more regularly to disabled men. Improved services for disabled people need to account for a complex range of support needs and enable effective and impactful use of support.

6. Discussion

This meta-thematic analysis delivers meaningful insights from the voices of disabled participants into how loneliness interacts with disability, and how disabled people form and maintain relationships and stay connected. For many disabled people, management of their health and the impairment itself is a priority. The time, energy and financial elements for managing their health has a significant impact on disabled people’s social capital. Exercising this social capital and bonding can place a strain on relationships.^{[footnote 147]} Particularly in cases where roles are renegotiated, disabled people find that their partners and families balance this dynamic with aspects of caregiving.^{[footnote 148]} 

Almost every article touched on the lack of autonomy due to the barriers that disabled people face every day. These barriers are often intertwined and exacerbated by each other, creating cycles that can feel unbreakable. Disabled people are excluded by spaces not made for them. This includes:  

• autistic people being unable to participate in LGBTQ+ events due to sensory difficulties^{[footnote 149]} 
• wheelchair users not having safe and accessible transport^{[footnote 150]} 
• spaces not having suitable toilet facilities, such as lighting for those with mobility issues^{[footnote 151]} 

This exclusion of disabled people in space design contributes to their lack of autonomy and encourages dependency on their caregivers, be that family or support workers. In turn, their dependency on this small network of people can mean that some disabled people, specifically adults with learning disabilities, may perceive friendships to mean something different, such as relationships with support workers and family members, rather than a more general understanding of friendships, that is relationships outside of this inner circle.^{[footnote 152]}

Social perceptions and the large-scale lack of understanding around disability creates spaces for stigma around disability and disabled relationships.^{[footnote 153]} This often means that disabled people have had many past experiences with abuse, bullying and feeling isolated.^{[footnote 154]} This anxiety influences their ability to feel safe within the larger population. The biases of the wider society and disabled people’s management of these biases could reinforce disabled people’s negative perception of themselves and cause internalised disablism.^{[footnote 155]} Overall, this contributes to their dependence on their network which, alongside inaccessible spaces, adds further to disabled people’s lack of social capital. This further exacerbates their dependence on their network. 

Lack of independence, autonomy and social perceptions directly impact the access to social mobility. The infantilisation of disabled people creates an image of disabled people as a group that is largely asexual.^{[footnote 156]} This distinct lack of education prevents them from engaging in safe intimacy practices and withholds connectedness from many disabled people. 

When considering all these factors, it leads to the understanding that the relationships that disabled people tend to form and maintain outside of these networks are mostly homophilic.^{[footnote 157]} These communities provide a safe space based on a shared understanding.^{[footnote 158]} This provision is based on the premise that disabled people are seen, understood and feel connected. More often, they are actively disenfranchised from social culture. It is evident that this is not a preference for homophilic relationships but a result of exclusion and disconnection from those not facing the barriers of disability. Disabled people’s preference for friendships and relationships are largely similar to those of non-disabled people^{[footnote 159]} which are to spend time with people with shared interests and activities. When disabled people are given the same resources and access as non-disabled people, their relationships and networks are similar to those of non-disabled people.

Education surrounding sex and family planning in specific disabled contexts for both disabled people themselves and their caregivers, be that family or support workers, would increase autonomy, strengthen identity and reduce isolation. It is important that training provided to support workers reflects input of disabled people and their voices. People with acquired brain injuries, for example, cited greater success in relationships and friendships with positive support from their networks, hence connectedness should be made a greater priority within all disabled contexts.^{[footnote 160]} 

Creating spaces and methods of transport that incorporate universal design and achieve accessibility will further reduce dependency on disabled people’s networks and allow them to better maintain relationships without unwanted interference. As the basis of this report literature being qualitative research into lived experiences of disabled people, the future development of services, spaces and policy suggested by any of the analysed research should consult disabled people and their experiences, continuing to be guided by ‘nothing about us without us’ international disabled community ethos and guided by the research principles of the papers analysed within this review.  

7. Limitations

Disparities in the representation of disabled communities, settings, and intersectional identities were noticeably present within the literature analysed. There was a significant lack of participants with the following characteristics: 

• ethnic minoritiestransgender people
• disabled people in employment 
• different socioeconomic backgrounds or class

Disabled people with a learning disability were overrepresented within the literature but underrepresented with regards to care settings. They were overwhelmingly in institutional and assisted living settings, with few participants coming from community care or independent living settings. This was similar for participants with traumatic brain injuries, mental health conditions, and visual impairment. This was likely due to the common recruitment practice of contacting secure settings for participant involvement. This is a limitation that occurs when only focusing on lived experience secondary data due to small sample sizes and limited peer review. Because of this, generalisations of the experiences of disability become difficult to make as they are unique to the individual, and vary among protected characteristics and impairment types. Therefore, this lived experience research gives us a better, but far from complete, understanding of the issues faced by disabled people and people with health. Understanding this limitation, we attempted an inclusion over exclusion approach.

Qualitative articles or reports were assessed to mitigate the high likelihood of only a minority of disability groups being represented within this meta-thematic analysis. However, the findings presented may not be as robust as when only including “high quality” qualitative studies. The detail of the lived experiences and potential for new insights into relationships of disabled people that would otherwise have been at risk of being excluded, gave a better representation of the variety and disparity of experiences that disabled people face about relationships, loneliness, and connectedness. The lived experiences of disabled people varied between the included studies. Yet, the findings did not appear to impact the validity of the disabled people’s experiences, and helped to meet the initial research objectives.

8. Conclusion

Disabled people have protected and promoted rights under the Equality Act (2010), Human Rights Act (1998), and the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD). These include:

• the respect for disabled people 
• the right to have a private life 
• the right to marry and have a family 
• the right to education 
• protection from discrimination 

This analysis has explored disabled people’s preferences in socialising, and relationships, and the barriers and impacts associated with loneliness and isolation. If these rights are being protected and promoted, we could expect to see disabled people’s experiences and barriers as similar to those of non-disabled people. However, this review has highlighted that disabled people experience many barriers that play a significant role in their likelihood and experience of isolation and loneliness. The evidence suggests that disabled people’s preferences for socialising and relationships are not based on sharing common interests, but on their environment, the communities and spaces they can access, the type of support they receive, and who supports them. The findings suggest that while there may be legislative protections and conventions that promote the rights of disabled people, the lived realities are overwhelmingly different. A disabled person’s preference for socialising is less of an issue – the greater issue is whether they can access the opportunities to socialise in the first place. Finally, the qualitative research landscape disproportionately involved participants from institutional, clinical, and service-orientated settings, and does not fully reflect the diversity of the disabled community. 

9. Appendix 1: Articles and reports

List of the 158 articles and reports included in the meta-thematic analysis. References beginning with an asterisk (*) were excluded from the analysis.

Abbott, D. ‘Nudge, nudge, wink, wink: love, sex and gay men with intellectual disabilities - a helping hand or a human right?’. Journal of Intellectual Disability Research 2013: volume 57, pages 1079-87.

*Action For Children. It starts with hello: a report looking into the impact of loneliness in children, young people and families 2017: Watford, Action for Children.

All-Party Parliamentary Group On Loneliness. A connected recovery: findings of the APPG on loneliness inquiry 2021: London, All-Party Parliamentary Group on Loneliness

Anderson, S., Keating, N. and Wilson, D. Reconciling Marriage and Care after Stroke. Canadian Journal on Aging 2017: volume 36, pages 386-401.

Anderson, S, Keating, N and Wilson, D. ‘Staying married after stroke: a constructivist grounded theory qualitative study’. Topics in Stroke Rehabilitation 2017: volume 24, pages. 479-87.

Andrew, J., Wilkinson, H. and Prior, S. ‘Guid times wi the bad times’: The meanings and experiences of befriending for people living alone with dementia. Dementia 2021. 

*Atkin, C. and Kroese, B. S. Exploring the experiences of independent advocates and parents with intellectual disabilities, following their involvement in child protection proceedings. Disability & Society 2021.

Bates, C., Terry, L. and Popple, K. Partner Selection for People with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2017: volume 30, pages 602-611.

Bates, C. ‘“It’s nothing to be ashamed of, I’m like, I’m bisexual and I love women, I like men” - Being a bisexual person with an intellectual disability’. Journal of Bisexuality 2020: volume 20, pages 493-513.

Bates, C, Terry, L and Popple, K. ‘The importance of romantic love to people with learning disabilities’. British Journal of Learning Disabilities 2017: volume 45, pages 64-72.

Bates, C., Terry, L. and Popple, K. The importance of romantic love to people with learning disabilities. British Journal of Learning Disabilities 2017: volume 45, pages 64-72

Bates, C., Terry, L. and Popple, K. Supporting people with learning disabilities to make and maintain intimate relationships. Tizard Learning Disability Review 2017: volume 22, pages 16-23.

Batty, R., McGrath, L. and Reavey, P. Embodying limb absence in the negotiation of sexual intimacy. Sexualities 2014: volume 17, pages 686-706.

*Boardman, F. K. The expressivist objection to prenatal testing: the experiences of families living with genetic disease. Social Science & Medicine 2014: volume 107, pages 18-25 

*Boardman, F. K. and Hale, R. How do genetically disabled adults view selective reproduction? Impairment, identity, and genetic screening. Molecular Genetics & Genomic Medicine 2018: volume 6, pages 941-956.

Box, M. and Shawe, J. The experiences of adults with learning disabilities attending a sexuality and relationship group: “I want to get married and have kids”. Journal of Family Planning & Reproductive Health Care 2014: volume 40, page 82-88

Boyle, G. Still a woman’s job: the division of housework in couples living with dementia. Families Relationships and Societies 2013: volume 2, pages 5-21.

Brooks, H., Rushton, K., Lovell, K., McNaughton, R. and Rogers, A. ‘He’s my mate you see’: a critical discourse analysis of the therapeutic role of companion animals in the social networks of people with a diagnosis of severe mental illness. Medical Humanities 2019: volume 45, pages 326.

Brown, S. D., Reavey, P., Kanyeredzi, A. and Batty, R. Transformations of self and sexuality: psychologically modified experiences in the context of forensic mental health.  Health 2014: volume 18, pages 240-60.

*Burns, J. and Davies, D. Same-Sex Relationships and Women with Intellectual Disabilities. Journal of Applied Research in Intellectual Disabilities 2011: volume 24, pages 351-360.

Butler, V., Thomas, G., Chapman, K., Evans, C., Magwood, C., Millett, R., Varley, S., Vaughan, P., Venner, L. and Wheeler, M. Young people and friendships: what matters to us? 2018: Swansea, Disability Wales/CARP Collaborations  

Cammidge, S. L., Duff, A. J. A., Latchford, G. J. and Etherington, C. When Women with Cystic Fibrosis Become Mothers: Psychosocial Impact and Adjustments. Pulmonary Medicine 2016.

Chapman, M., Adams, M., Barber, A. and others Going for GOLD! Greater Manchester Growing Older with Learning Disabilities: an inclusive research project to reduce social isolation amongst older adults with learning disabilities. 2020. Manchester, Manchester Metropolitan University.

Chin, N. P., Cuculick, J., Starr, M., Panko, T., Widanka, H. and Dozier, A. Deaf mothers and breastfeeding: do unique features of deaf culture and language support breastfeeding success? Journal of Human Lactation 2013: volume 29, page 564-571.

Coleman-Smith, R. S., Smith, R., Milne, E. and Thompson, A. R. ‘Conflict versus Congruence’: A Qualitative Study Exploring the Experience of Gender Dysphoria for Adults with Autism Spectrum Disorder. Journal of Autism & Developmental Disorders 2020, volume 50, pages 2643-2657.

Connerty, T. J., Roberts, R. and Sved Williams, A. Managing Life, Motherhood and Mental Health After Discharge from a Mother-Baby Unit: An Interpretive Phenomenological Analysis. Community Mental Health Journal 2016 : volume 52 , pages 954-963.

*Connerty, T. J., Roberts, R. and Sved Williams, A. Managing Life, Motherhood and Mental Health After Discharge from a Mother-Baby Unit: An Interpretive Phenomenological Analysis. Community Mental Health Journal 2016: volume 52, pages 954-963.

*Cook, A., Ogden, J. and Winstone, N. The experiences of learning, friendship and bullying of boys with autism in mainstream and special settings: A qualitative study. British Journal of Special Education 2016: volume 43, pages 250-271.

Dada, S., Tonsing, K. and Goldbart, J. Friendship Experiences of Young Adults Who Use Augmentative and Alternative Communication. International Journal of Disability, Development and Education 2020: 1-25.

Dandy, E., Knibbs, J. and Gilbey, F. ‘Mad, sad and bad’ to ‘Dad’: care-experienced men’s experiences of fatherhood. Adoption & Fostering 2020: volume 44, pages 285-300.

de Jager, J., Cirakoglu, B., Nugter, A. and van Os, J. Intimacy and its barriers: A qualitative exploration of intimacy and related struggles among people diagnosed with psychosis. Psychosis-Psychological Social and Integrative Approaches 2017: volume 9, pages 301-309.

De Souza, L. and Frank, A. O. Patients’ experiences of the impact of chronic back pain on family life and work. Disability and Rehabilitation 2011: volume 33, pages 310-318.

Deacon, L. The loss: conceptualising biographical experiences of disability, social isolation and emotional loneliness in North-East England. Social Work and Social Sciences Review 2019: volume 20, pages 68-87.

Dinwoodie, R., Greenhill, B. and Cookson, A. ‘Them Two Things are What Collide Together’: Understanding the Sexual Identity Experiences of Lesbian, Gay, Bisexual and Trans People Labelled with Intellectual Disability. Journal of Applied Research in Intellectual Disabilities 2020: volume 33, pages 3-16.

*Dolman, C., Jones, I. and Howard, L. M. Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Archives of Women’s Mental Health 2013: volume 16, pages 173-196.

*Donovan, J. Childbirth Experiences of Women With Autism Spectrum Disorder in an Acute Care Setting.  Nursing for Women’s Health 2020: volume 24, pages 165-174.

Earle, S. and Blackburn, M. Young adults with life-limiting or life-threatening conditions: sexuality and relationships support. BMJ Supportive & Palliative Care 2021: volume 11, pages 163-169.

Edwards, A. R., Daisley, A. and Newby, G. The experience of being a parent with an acquired brain injury (ABI) as an inpatient at a neuro-rehabilitation centre, 0-2 years post-injury. Brain Injury 2014: volume 28, pages 1700-10.

*Elderton, A., Clarke, S., Jones, C. and Stacey, J. Telling our story: a narrative therapy approach to helping lesbian, gay, bisexual and transgender people with a learning disability identify and strengthen positive self-identity stories. British Journal of Learning Disabilities 2014: volume 42, pages 301-307.

*English, B., Tickle, A. and das Nair, R. Views and Experiences of People with Intellectual Disabilities Regarding Intimate Relationships: A Qualitative Metasynthesis.Sexuality and Disability 2017:  volume 36, pages 149-173.

Equality and Human Rights Commission. Is Britain Fairer? Evidence paper series: domain H: individual, family and social life. 2015: Manchester, Equality and Human Rights Commission.

*Ferguson-Coleman, E., Johnston, A., Young, A., Brown, F., de Sainte Croix, R. and Redfern, P. How do we know what we don’t know? Exploring Deaf people’s experiences of supporting their Deaf family member living with dementia. Dementia 2020: volume 19, pages 1381-1396.

*Field, N., Mercer, C. H., Sonnenberg, P., and others Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).The Lancet 2013: volume 382, pages 1830-1844.

Fish, R. Friends and family: regulation and relationships on the locked ward. Disability & Society 2016: volume 31, pages 1385-1402.

Fish, R. ‘They’ve said I’m vulnerable with men’: Doing sexuality on locked wards. Sexualities 2016: volume 19, pages 641-658.

Fitzgerald, C. and Withers, P. ‘I don’t know what a proper woman means’: what women with intellectual disabilities think about sex, sexuality and themselves. British Journal of Learning Disabilities 2013: volume 41, pages 5-12.

*Fixsen, A.  Communitas in Crisis: An Autoethnography of Psychosis Under Lockdown. Quality Health Research 2021.

Forrester-Jones, R., Carpenter, J., Coolen-Schrijner, P., Cambridge, P., Tate, A., Hallam, A., Beecham, J., Knapp, M. and Wooff, D. Good friends are hard to find? The social networks of people with mental illness 12 years after deinstitutionalisation. Journal of Mental Health 2012: volume 21, pages 4-14.

*France, E. F., Locock, L., Hunt, K., Ziebland, S., Field, K. and Wyke, S. Imagined futures: how experiential knowledge of disability affects parents’ decision making about fetal abnormality. Health Expectations 2012: volume 15, pages 139-56.

*Franks, Wendy L. M., Crozier, Kenda E. and Penhale, Bridget L. M. Women’s mental health during pregnancy: A participatory qualitative study. Women & Birth 2017:  volume 30, pages e179-e187.

Freeman, J., Gorst, T., Gunn, H. and Robens, S. A non-person to the rest of the world: experiences of social isolation amongst severely impaired people with multiple sclerosis. Disability Rehabilitation 2020: volume42, pages 2295-2303.

Giesbers, S. A. H., Hendriks, A. H. C., Hastings, R. P., Jahoda, A., Tournier, T. and Embregts, P. Family-based social capital of emerging adults with and without mild intellectual disability. Journal of Intellectual Disability Research 2020: volume 64, pages 757-769.

Gillespie, A., Murphy, J. and Place, M. Divergences of perspective between people with aphasia and their family caregivers. Aphasiology 2010: volume 24, pages 1559-1575.

*Gould, S. and Dodd, K. ‘Normal people can have a child but disability can’t’: the experiences of mothers with mild learning disabilities who have had their children removed. British Journal of Learning Disabilities 2014: volume 42, pages 25-35.

Grace, N., Greenhill, B. and Withers, P. They just said inappropriate contact. What do service users hear when staff talk about sex and relationships? Journal of Applied Research in Intellectual Disabilities 2020: volume 33, pages 39-50.

Hall, J., Hundley, V., Collins, B., Irel and , J. Dignity and respect during pregnancy and childbirth: a survey of the experience of disabled women. BMC Pregnancy & Childbirth 2018: volume 18, pages 328.

*Holdsworth, E., Trifonova, V., Tanton, C., Kuper, H., Datta, J., Macdowall, W. and Mercer, C. H. Sexual behaviours and sexual health outcomes among young adults with limiting disabilities: findings from third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Open 2018: volume 8, pages e019219.

*Holt, L., Bowlby, S. and Lea, J. “Everyone knows me?…. I sort of like move about”: The friendships and encounters of young people with Special Educational Needs in different school settings. Environment and Planning A: Economy and Space 2017: volume 49, pages 1361-1378.

*Homeyard, C., Montgomery, E., Chinn, D. and Patelarou, E. Current evidence on antenatal care provision for women with intellectual disabilities: A systematic review. Midwifery 2016: volume 32, pages 45-57.

Hunter, R., Parry, B. and Thomas, C. Fears for the future: A qualitative exploration of the experiences of individuals living with multiple sclerosis, and its impact upon the family from the perspective of the person with MS. British Journal of Health Psychology 2021: volume 26, pages 464-481.

*Husain, N., Cruickshank, K., Husain, M., Khan, S., Tomenson, B. and Rahman, A. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. Journal of Affective Disorders 2012: volume 140, pages 268-76.

Jamieson, R., Theodore, K. and Raczka, R. Becoming a mother: Supported decision-making in context. Journal of Intellectual Disabilities 2016: volume 20, pages 313-328.

Jeffery, D., Clement, S., Corker, E., Howard, L. M., Murray, J. and Thornicroft, G. Discrimination in relation to parenthood reported by community psychiatric service users in the UK: a framework analysis. BMC Psychiatry 2013: volume 13, pages 120.

Jones, M., Pietila, I., Joronen, K., Simpson, W., Gray, S. and Kaunonen, M. Parents with mental illness - a qualitative study of identities and experiences with support services. Journal of Psychiatric & Mental Health Nursing 2016: volume 23, pages 471-478.

Kanfiszer, L., Davies, F. and Collins, S.’I was just so different’: The experiences of women diagnosed with an autism spectrum disorder in adulthood in relation to gender and social relationships. Autism 2017: volume 21, pages 661-669.

*Kaspar, P. and Kroese, B. S. What makes a good mother? An interpretative phenomenological analysis of the views of women with learning disabilities. Women’s Studies International Forum 2017: volume 62, pages 107-115.

Kilkey, M and Clarke, H. Disabled men and fathering: opportunities and constraints. Community, Work & Family 2010: volume 13, pages 127-146.

Kock, E., Strydom, A., O’Brady, D. and Tantam, D. Autistic women’s experience of intimate relationships: the impact of an adult diagnosis. Advances in Autism 2019: volume 5, pages 38-49.

Koutsouris, G. Young people’s preferences for social interaction in terms of homophily and social inclusion: a critical discussion about respect. European Journal of Special Needs Education 2014: volume 29, pages 521-535.

Lafferty, A., McConkey, R. and Taggart, L. Beyond friendship: the nature and meaning of close personal relationships as perceived by people with learning disabilities. Disability & Society 2013: volume 28, pages 1074-1088.

Lee, Sally, Fenge, Lee-Ann and Collins, Bethan. Disabled people’s voices on sexual well-being. Disability & Society2019:volume35, pages303-325.

Lever Taylor, Billie, Mosse, Liberty and Stanley, N. Experiences of social work intervention among mothers with perinatal mental health needs. Health & Social Care in the Community 2019: volume 27, pages 1586-1596.

Liddiard, K. ‘I never felt like she was just doing it for the money’: Disabled men’s intimate (gendered) realities of purchasing sexual pleasure and intimacy. Sexualities 2014: volume 17, pages 837-855.

Liddiard, K. and Slater, J. ‘Like, pissing yourself is not a particularly attractive quality, let’s be honest’: Learning to contain through youth, adulthood, disability and sexuality. Sexualities 2017: volume 21, pages 319-333.

Lowe, N., Crawley, L., Wilson, C. and Waldron, B. ‘Lonely in my head’: The experiences of loneliness in individuals with brain injury. British Journal of Health Psychology 2021: volume 26, pages 444-463.

Lumsden, V., Kerr, S. and Feigenbaum, J. ‘It makes me not worthy to be a father from time to time’: the experiences of fathers with a diagnosis of borderline personality disorder. Journal of Family Studies 2018: volume 24, pages 109-125.

MacIntyre, G. and Stewart, A. For the record: the lived experience of parents with a learning disability - a pilot study examining the Scottish perspective. British Journal of Learning Disabilities 2012: volume 40, pages 5-14.

Malouf, R., McLeish, J., Ryan, S., Gray, R. and Redshaw, M. ‘We both just wanted to be normal parents’: a qualitative study of the experience of maternity care for women with learning disability. BMJ Open 2017: volume 7, pages e015526.

Marie Robinson, Z., Marsden, D., Abdulla, S. and Dowling, F. Supporting people with learning disabilities who identify as LGBT to express their sexual and gender identities. Learning Disability Practice 2020: volume 23, pages 24-31.

Mason, P., Timms, K., Hayburn, T. and Watters, C. How do people described as having a learning disability make sense of friendship?. Journal of Applied Research in Intellectual Disabilities 2013: volume 26, pages 108-118.

McCann, E. The sexual and relationship needs of people who experience psychosis: quantitative findings of a UK study. Journal of Psychiatric and Mental Health Nursing 2010: volume 17, pages 295-303.

*McCarthy, M., Bates, C., Elson, N., Hunt, S., Milne-Skillman, K. and Forrester-Jones, R. ‘Love makes me feel good inside and my heart is fixed’: What adults with intellectual disabilities have to say about love and relationships. Journal of Applied Research in Intellectual Disabilities 2021: volume 25, pages 25.

*McCarthy, M. Exercising choice and control - women with learning disabilities and contraception. British Journal of Learning Disabilities 2010: volume 38, pages 293-302.

McCarthy, M. ‘All I wanted was a happy life’: the struggles of women with learning disabilities to raise their children while also experiencing domestic violence. Journal of Gender-Based Violence 2019:volume 3, pages 101-118.

McConkey, R., Cassin, M.T., McNaughton, R. and Armstrong, E. Enhancing the social networks of adults with ASD: a low level community intervention. Advances in Autism 2021.

*McDermott, E., Gabb, J., Eastham, R. and Hanbury, A. Family trouble: Heteronormativity, emotion work and queer youth mental health. Health  2021: volume 25, pages 177-195.

McGarry, A., Stenfert K. B. and Cox, R. How Do Women with an Intellectual Disability Experience the Support of a Doula During Their Pregnancy, Childbirth and After the Birth of Their Child?. Journal of Applied Research in Intellectual Disabilities 2016: volume 29, pages 21-33.

*McGhee, J. and Hunter, S. The Scottish children’s hearings tribunals system: a better forum for parents with learning disabilities? Journal of Social Welfare and Family Law 2011: volume 33, pages 255-266.

McRitchie, R., McKenzie, K., Quayle, E., Harlin, M. and Neumann, K. How adults with an intellectual disability experience bereavement and grief: a qualitative exploration. Death Studies 2014: volume 38, pages 179-85.

*Meltzer, H., Bebbington, P., Dennis, M. S., Jenkins, R., McManus, S. and Brugha, T. S. Feelings of loneliness among adults with mental disorder. Social Psychiatry and Psychiatric Epidemiology 2013: volume 48, pages 5-13.

*Mencap. Learning Disability Week highlights isolation faced by young people with a learning disability. 2016: Mencap.

*Mencap People with a learning disability seven times as likely to be lonely this Christmas. 2019: Mencap.

Molden, H. A phenomenological investigation into the impact of parenthood: Giving a voice to mothers with visual impairment in the United Kingdom. British Journal of Visual Impairment 2014: volume 32, pages 136-147.

*Munro, E.R., Zonouzi, M., Fountain, R., Harris, J., Vale, D. Re-imagining social care services in co-production with disabled parents. 2018: Tilda Goldberg Centre for Social and Work and Social Care.

*National Development Team for Inclusion. Time to Talk: evaluation report. 2021: Bath, National Development Team for Inclusion.

*National Development Team for Inclusion. The right to a relationship: Addressing the barriers that people with learning disabilities face in developing and sustaining intimate and sexual relationships. 2019: National Development Team for Inclusion.

*Nguyen, A. Challenges for Women with Disabilities Accessing Reproductive Health Care Around the World: A Scoping Review. Sexuality and Disability 2020: volume 38, pages 371-388.

Northcott, S. and Hilari, K. Why do people lose their friends after a stroke? International Journal of Language and Communication Disorders 2011: volume 46, pages 524-34.

*Parrott, F. R., Macinnes, D. L. and Parrott, J. Mental illness and parenthood: being a parent in secure psychiatric care. Criminal Behaviour and Mental Health 2015:  volume25, pages 258-72.

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