There was a marked trend for isolated patients to exhibit higher levels of depression , the pooled standardised mean difference being 1 . 28 ( 95 % CI 0 . 47 to 2 . 09 ) and anxiety 1 . 45 ( 95 % CI 0 . 56 to 2 . 34 ) , although both had high levels of heterogeneity , and worse outcomes for a range of care - related factors but with significant variation