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Kamp KS, Moskowitz A, Due H, Spindler H. Are Sensory Experiences of One's Deceased Spouse Associated with Bereavement-Related Distress? OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:895-915. [PMID: 35384752 DOI: 10.1177/00302228221078686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Following late-life spousal bereavement, sensory and quasi-sensory experiences of the deceased (SED) are commonly reported. This longitudinal study examined SED among 310 older widowed adults 6-10 (T1) and 18-20 (T2) months post loss. Reports of SED in the first 6-10 months after loss were associated with higher symptom levels of prolonged grief, post-traumatic stress, and loneliness at T1. Experiencers of SED were more likely to experience symptoms of prolonged grief and post-traumatic stress above cut-off scores at T1. Importantly, only a minority of the experiencers of SED displayed these elevated levels of bereavement-related distress. In addition, employing multi-level-modeling, a similar trajectory of decreasing bereavement-related distress over time was found for both experiencers and non-experiencers of SED. We argue that SED may be one of several potential reactions to bereavement, which should not be seen as an indicator of grief complications per se.
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Affiliation(s)
- Karina S Kamp
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | | | - Helena Due
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark
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2
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Paul C, Schöttker B, Hartmann M, Friederich HC, Brenner H, Wild B. Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study. Int J Geriatr Psychiatry 2024; 39:e6113. [PMID: 38877644 DOI: 10.1002/gps.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.
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Affiliation(s)
- Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
- DZPG German Centre for Mental Health-Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
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Matsuoka T, Ismail Z, Imai A, Shibata K, Nakamura K, Nishimura Y, Rubinstein E, Uchida H, Mimura M, Narumoto J. Relationship between Loneliness and Mild Behavioral Impairment: Validation of the Japanese Version of the MBI Checklist and a Cross-Sectional Study. J Alzheimers Dis 2024; 97:1951-1960. [PMID: 38306041 PMCID: PMC10894585 DOI: 10.3233/jad-230923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/03/2024]
Abstract
Background Mild behavioral impairment (MBI) and loneliness are associated with cognitive decline and an increased risk of dementia. Objective Our aim was to examine the validity of the Japanese version of the MBI checklist (MBI-C) and investigate the relationship between loneliness and MBI. Methods The participants in this cross-sectional study included 5 cognitively normal persons and 75 persons with mild cognitive impairment. MBI-C and the revised University of California at Los Angeles loneliness scale (LS) were used to assess MBI and loneliness, respectively. Diagnostic performance of MBI-C was examined using receiver operating characteristic analysis. The relationship between MBI-C and LS was examined using multiple linear regression in 67 subjects who were assessed with both scales, with MBI-C total or domain score as the dependent variable and LS as the independent variable, adjusted for age, gender, living situation, presence of visual and hearing impairment, and Mini-Mental State Examination score. Results Per the Youden index, in this mostly MCI sample, the optimal MBI-C cut-off score was 5.5 with sensitivity 0.917 and specificity 0.949. In multiple linear regression analysis, LS score was detected as a significant predictor of MBI-C total scores, and MBI-C decreased motivation, affective dysregulation, and abnormal thought and perception scores. Conclusions The caregiver-rated Japanese MBI-C has excellent diagnostic performance. Loneliness is associated with a greater MBI burden, especially in the decreased motivation, affective dysregulation, and abnormal thought and perception domains. Interventions for loneliness in older people may have the potential to improve MBI.
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Affiliation(s)
- Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Psychiatry, NHO Maizuru Medical Center, Maizuru, Japan
| | - Zahinoor Ismail
- Departments of Psychiatry, Clinical Neurosciences, and Community Health Sciences, Hotchkiss Brain Institute and O’BrienInstitute for Public Health, University of Calgary, Calgary, Canada
- NIHR Exeter Biomedical Research Centre, University of Exeter, UK
| | - Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keisuke Shibata
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaeko Nakamura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yukihide Nishimura
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ellen Rubinstein
- Department of Sociology and Anthropology, North Dakota State University, Fargo, ND, USA
| | - Hiroyuki Uchida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Karska J, Pszczołowska M, Gładka A, Leszek J. Correlations between Dementia and Loneliness. Int J Mol Sci 2023; 25:271. [PMID: 38203442 PMCID: PMC10779072 DOI: 10.3390/ijms25010271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
This review describes associations between dementia and loneliness on the neurobiological and epidemiological levels according to the recent body of literature. The aim of this study was to highlight major lines of research in this field. Sociocognitive skills and social interactions present complex interdependencies with dementia which may be explained by two theories. According to the first one, not sufficiently engaging in social or cognitive activities results in brain atrophy. The second one claims that brain neurogenesis and synaptic density are being increased by social connections. The relationship between loneliness and dementia could be mediated by sensory loss, including hearing and visual impairment, as well as depression and psychotic symptoms. Loneliness itself might cause a depletion in sensory and cognitive stimulation which results in a decrease in neural reserve. Certain changes in the structures of the brain caused by loneliness were found in imaging examination. Loneliness appears to be a crucial risk factor for dementia in recent times due to the modern lifestyle and consequences of the outbreak of COVID-19. Additional studies are required to understand more completely the key tenets of this topic and therefore to improve the prevention and treatment of dementia.
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Affiliation(s)
- Julia Karska
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367 Wrocław, Poland; (J.K.)
| | | | - Anna Gładka
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367 Wrocław, Poland; (J.K.)
| | - Jerzy Leszek
- Department of Psychiatry, Wrocław Medical University, Pasteura 10, 50-367 Wrocław, Poland; (J.K.)
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Boehlen FH, Heider D, Schellberg D, Hohls JK, Schöttker B, Brenner H, Friederich HC, König HH, Wild B. Gender-specific association of loneliness and health care use in community-dwelling older adults. BMC Geriatr 2023; 23:502. [PMID: 37605106 PMCID: PMC10441715 DOI: 10.1186/s12877-023-04201-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Loneliness in older adults is common, particularly in women. In this article, gender differences in the association of loneliness and health care use are investigated in a large sample of community-dwelling older adults. METHODS Data of 2525 persons (ages 55-85 years)-participants of the fourth follow- up (2011-2014) of the ESTHER study- were analyzed. Loneliness and health care use were assessed by study doctors in the course of a home visit. Gender-specific regression models with Gamma-distribution were performed using loneliness as independent variable to predict outpatient health care use, adjusted for demographic variables. RESULTS In older women, lonely persons were shown to have significantly more visits to general practitioners and mental health care providers in a three-month period compared to less lonely persons (p = .005). The survey found that outpatient health care use was positively associated with loneliness, multimorbidity, and mental illness in older women but not in older men. Older men had significantly more contact with inpatient care in comparison to women (p = .02). CONCLUSIONS It is important to consider gender when analyzing inpatient and outpatient health care use in older persons. In older women loneliness is associated with increased use of outpatient services.
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Affiliation(s)
- Friederike Hildegard Boehlen
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Dirk Heider
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Dieter Schellberg
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johanna Katharina Hohls
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, 69120, Heidelberg, Germany
- Network Aging Research, Heidelberg University, 69115, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Andersen LN, Stochkendahl MJ, Roessler KK. En route to flourishing - a longitudinal mixed methods study of long-term unemployed citizens in an interdisciplinary rehabilitation program. BMC Public Health 2022; 22:675. [PMID: 35392873 PMCID: PMC8988354 DOI: 10.1186/s12889-022-13060-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interdisciplinary rehabilitation programmes (IRP) are used in municipality settings to assist unemployed citizens with complex health and/or life issues. Individually tailored IRP activities help people develop their personal working life skills and increase their chances of re-entering the work force. The aims of this paper were to describe citizens' wellbeing in terms of health aspects, explore the impact of stressful life events on wellbeing and obtain understanding of how IRP activities affect the participants' development towards future employment. METHODS A mixed methods exploratory approach has been used. For data collection a quantitative longitudinal survey (baseline and 1-year follow-up) and qualitative interviews were conducted. Descriptive statistics were used for the analysis of survey data, while the data material from interviews was analysed using directed content analysis. Results were discussed with the theory of flourishing as a framework to develop understanding. RESULTS At baseline, 146 respondents (71% females) filled in the survey and seven participants were interviewed. The analysis of survey data and interviews revealed five themes: (1) Stressful life events, (2) Positive emotions - how IRP-activities positively impacted wellbeing and physical capacity, (3) Appreciation of engagement, (4) Relationships, and (5) Meaning and optimal functioning. Results showed that IRP participants from the outset experienced high general pain intensity as well as distress, anxiety and depression. Life events relating both to physical health and work life were significant for their wellbeing. IRP activities supported participants' positive development towards future employment in ways that were specific to each individual. CONCLUSIONS From this study it can be derived that participants' development took place around self-acceptance, acceptance by others, physical capacity, psychological resources and capacity to balance engagement to cultivate the best version of themselves. In future programmes, it may be emphasized that participants' interest may be an important driver for wellbeing and future employment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02641704, date of registration December 29, 2015.
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Affiliation(s)
- Lotte Nygaard Andersen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Mette Jensen Stochkendahl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Chiropractic Knowledge Hub, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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8
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Liu I, Huang YJ, Wang LK, Tsai YH, Hsu SL, Chang CJ, Li YH, Hsiao YC, Chen CY, Wann SR. Dual trajectories of loneliness and depression and their baseline correlates over a 14-year follow-up period in older adults: Results from a nationally representative sample in Taiwan. Int J Older People Nurs 2021; 16:e12410. [PMID: 34379889 DOI: 10.1111/opn.12410] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/30/2021] [Accepted: 07/12/2021] [Indexed: 11/28/2022]
Abstract
AIMS To explore the codevelopment between loneliness and depression in older adults, and to identify its potential baseline individual, family and extrafamilial correlates. BACKGROUND The number of older adults around the world has steadily increased over the last decades. Later life is a particularly vulnerable life stage due to multiple unfavourable conditions, and mental health in this stage appears to become an inescapable issue. Previous research has found the cross-sectional association between loneliness and depression, but their codevelopment has been understudied. Therefore, exploring the codevelopment and its correlates has significant implications for prevention and healthcare professionals. DESIGN A longitudinal follow-up study. METHODS The study used nationally representative data over a 14-year follow-up period from the Taiwan Longitudinal Study on Ageing focused on Taiwanese aged 60 years and above (n = 4049). Group-based trajectory modelling, group-based dual-trajectory modelling and multinomial logistic regression were the primary analytical methods. RESULTS We identified three distinct dual trajectories of loneliness and depression: longitudinal low-frequency lonely depressed (29.3%), longitudinal moderate-frequency lonely depressed (59.4%) and longitudinal high-frequency lonely depressed (11.3%). After considering several demographic and background characteristics, difficulty in physical functioning, number of physical symptoms and diseases, sleep quality and number of child deaths were found to be significantly associated. CONCLUSION Across the three identified dual-trajectory groups, they all showed a stable loneliness frequency pattern over time; however, the moderate-frequency group and high-frequency group both had a trajectory of increasing depression. It seems that depression tends to change over time in a worsening direction, especially for those with a certain frequency of loneliness. Furthermore, differences in individual and family correlates were found across the groups. IMPLICATIONS FOR PRACTICE Interventions focusing on the specific factors may help hinder coexisting loneliness and depression, and have implications for developing health promotion strategies and chronic disease care plans.
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Affiliation(s)
- I Liu
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan
| | - Yu-Jen Huang
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Liang-Kai Wang
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Yi-Hsuan Tsai
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Sheng-Lun Hsu
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Chun-Jui Chang
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Ying-Hsien Li
- Department of Family Medicine, Wan Fang Hospital, Taipei Medical University, Taiwan
| | - Yi-Chen Hsiao
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taiwan.,Institute of Health and Welfare Policy, School of Medicine, National Yang-Ming University, Taiwan
| | - Chun-Yuan Chen
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taiwan.,Biostatistics Center, Wan Fang Hospital, Taipei Medical University, Taiwan.,Research Institute and Centre for Global Child Health, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Canada
| | - Shue-Ren Wann
- Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung, Taiwan.,Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
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Westergaard ML, Lau CJ, Allesøe K, Andreasen AH, Jensen RH. Poor social support and loneliness in chronic headache: Prevalence and effect modifiers. Cephalalgia 2021; 41:1318-1331. [PMID: 34162255 DOI: 10.1177/03331024211020392] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore the prevalence of poor social support and loneliness among people with chronic headache, and how these might be effect modifiers in the relationships between chronic headache and stress, medication overuse, and self-rated health. BACKGROUND Poor social support and loneliness are consistently linked to worse health outcomes. There are few epidemiologic studies on their effect on headache. METHODS The Danish Capital Region Health Survey, a cross-sectional survey, was conducted in 2017. Participants were asked about headache, pain medication use, social support, loneliness, perceived stress, and self-rated health. Data were accessed from sociodemographic registers. Logistic regression analyses were performed to test for effect modification. RESULTS The response rate was 52.6% (55,185 respondents) and was representative of the target population. People with chronic headache were more likely to report poor social support and loneliness compared to those without chronic headache (p < 0.0001 for both). Odds ratios for the combination of chronic headache and poor social support were very high for stress (odds ratio 8.1), medication overuse (odds ratio 21.9), and poor self-rated health (odds ratio 10.2) compared to those without chronic headache and with good social support. Those who reported both chronic headache and loneliness had a very high odds ratio for stress (odds ratio 14.4), medication overuse (odds ratio 20.1), and poor self-rated health (odds ratio 15.9) compared to those without chronic headache and low loneliness score. When adjusted for sociodemographic factors, poor social support and loneliness were not significant effect modifiers in almost all these associations. Loneliness was a significant effect modifier in the association between chronic headache and medication overuse, but exerted greater effect among those who did not report they were lonely. CONCLUSION Poor social support and loneliness were prevalent among people with chronic headache. The combination of chronic headache and poor social support or loneliness showed higher odds ratios for stress, medication overuse, and poor self-rated health compared to those with good social support and low loneliness scores. The effect of loneliness in the relationship between chronic headache and medication overuse warrants further study.
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Affiliation(s)
| | - Cathrine Juel Lau
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Karen Allesøe
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark.,Department of Occupational and Social Medicine, Copenhagen University Hospital Holbæk, Holbæk, Denmark
| | - Anne Helms Andreasen
- Center for Clinical Research and Prevention, Bispebjerg og Frederiksberg Hospital, Frederiksberg, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet‒Glostrup, University of Copenhagen, Glostrup, Denmark
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10
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Pinedo González R, Palacios Picos A, de la Iglesia Gutiérrez M. "Surviving the Violence, Humiliation, and Loneliness Means Getting High": Violence, Loneliness, and Health of Female Sex Workers. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:4593-4614. [PMID: 30084291 DOI: 10.1177/0886260518789904] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sex workers are particularly vulnerable to violence, isolation, and stigmatization. This study uses the theory of loneliness to explore the relations among violence, self-esteem, loneliness, health, and drug use. Specifically, this study tested a model in which loneliness mediates the relationship between situational (violence) and characterological (self-esteem) loneliness factors and physical and psychological health and drug abuse. The study sample consisted of 146 sex workers from one region of Spain, recruited through the purposive sampling method. Partial least squares (PLS) path modeling has been employed to test the hypothesis. The findings of this study suggest that two kinds of violence (physical and psychological) have a direct and positive influence on loneliness, so that higher levels of violence increase loneliness, while self-esteem has a protector role on loneliness. Loneliness has a direct and negative impact on psychological and physical health, and determines an increase in drug use, which, in turn, decreases both physical and psychological health. The results support, among other points, that policy makers and sex worker service programs need to be aware of how loneliness plays a role in the health and risk behavior of sex workers. Society has an important role to improve sex workers' health and minimize their risk behavior.
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11
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Sun W, Matsuoka T, Oba H, Narumoto J. Importance of loneliness in behavioral and psychological symptoms of dementia. Int J Geriatr Psychiatry 2021; 36:540-546. [PMID: 33091165 DOI: 10.1002/gps.5450] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/26/2020] [Accepted: 10/18/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Loneliness is considered to be a crucial factor in mental health of elderly people. However, the effects of loneliness on behavioral and psychological symptoms of dementia (BPSD) have not been fully examined. The aim of this study was to investigate whether loneliness in patients with dementia is related to BPSD. METHODS A total of 152 patients with dementia were assessed using the Neuropsychiatric Inventory (NPI-12) and the revised University of California at Los Angeles (UCLA) loneliness scale. Spearman correlation analysis and Mann-Whitney U-tests were used to examine factors associated with the revised UCLA loneliness scale. Logistic regression analysis with a forced entry method was performed to identify risk factors for BPSD. RESULTS The revised UCLA loneliness scale score was not significantly associated with age, years of education, mini-mental state examination (MMSE) score, gender, living status, visual impairment, hearing impairment, and marital status. However, this score was a significant predictor of NPI delusion and hallucination subscale scores and Geriatric Depression Scale-15 score. The MMSE score was a significant predictor of NPI anxiety and apathy subscale scores. CONCLUSIONS Loneliness is a risk factor for BPSD, especially for depressive symptoms and psychosis. Paying attention to loneliness in patients with dementia will help medical staff to intervene in psychiatric symptoms of these patients at an early stage.
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Affiliation(s)
- Weiyi Sun
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hikaru Oba
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.,Graduate School of Human Sciences, Osaka University, Osaka, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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12
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Varga TV, Bu F, Dissing AS, Elsenburg LK, Bustamante JJH, Matta J, van Zon SK, Brouwer S, Bültmann U, Fancourt D, Hoeyer K, Goldberg M, Melchior M, Strandberg-Larsen K, Zins M, Clotworthy A, Rod NH. Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans. THE LANCET REGIONAL HEALTH. EUROPE 2021; 2:100020. [PMID: 33870246 PMCID: PMC8042675 DOI: 10.1016/j.lanepe.2020.100020] [Citation(s) in RCA: 131] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In response to the COVID-19 pandemic, governments around the world instituted various public-health measures. Our project aimed to highlight the most significant similarities and differences in key mental-health indicators between four Western and Northern European countries, and identify the population subgroups with the poorest mental-health outcomes during the first months of the pandemic. METHODS We analysed time-series survey data of 205,084 individuals from seven studies from Denmark, France, the Netherlands, and the UK to assess the impact of the pandemic and associated lockdowns. All analyses focused on the initial lockdown phase (March-July 2020). The main outcomes were loneliness, anxiety, and COVID-19-related worries and precautionary behaviours. FINDINGS COVID-19-related worries were consistently high in each country but decreased during the gradual reopening phases. While only 7% of the respondents reported high levels of loneliness in the Netherlands, percentages were higher in the rest of the three countries (13-18%). In all four countries, younger individuals and individuals with a history of mental illness expressed the highest levels of loneliness. INTERPRETATION The pandemic and associated country lockdowns had a major impact on the mental health of populations, and certain subgroups should be closely followed to prevent negative long-term consequences. Younger individuals and individuals with a history of mental illness would benefit from tailored public-health interventions to prevent or counteract the negative effects of the pandemic. Individuals across Western and Northern Europe have thus far responded in psychologically similar ways despite differences in government approaches to the pandemic. FUNDING See the Funding section.
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Affiliation(s)
- Tibor V. Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Feifei Bu
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Agnete S. Dissing
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Leonie K. Elsenburg
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Joel J. Herranz Bustamante
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | - Joane Matta
- Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, 94800 Villejuif, France
| | - Sander K.R. van Zon
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ute Bültmann
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Daisy Fancourt
- Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Klaus Hoeyer
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Marcel Goldberg
- Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, 94800 Villejuif, France
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP), Equipe de Recherche en Epidémiologie Sociale (ERES), Paris, France
| | | | - Marie Zins
- Inserm, Population-based Epidemiological Cohorts Unit, UMS 011, 94800 Villejuif, France
- Faculté de Médecine, Université de Paris, 75006 Paris
| | - Amy Clotworthy
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Naja H. Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Vyas MV, Watt JA, Yu AYX, Straus SE, Kapral MK. The association between loneliness and medication use in older adults. Age Ageing 2021; 50:587-591. [PMID: 32931548 DOI: 10.1093/ageing/afaa177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Loneliness is common in older adults, and it is associated with unhealthy behaviours, including substance use. We evaluated the association between loneliness and self-reported use of opioids and benzodiazepines in older adults. METHODS We used data from the Canadian Community Health Survey's 'Healthy Aging' sub-survey and included adults 65 years or older who administered their own medications. We classified individuals as lonely if they scored 6 or more on the three -item University of California, Los Angeles's Loneliness Scale. We used multinomial logistic regression models, adjusting for demographics and self-reported comorbidities, to describe the association between loneliness and daily or occasional use of opioids, benzodiazepines and non-opioid analgesics. We also explored the association between loneliness and polypharmacy. RESULTS Our cohort included 15,302 older adults, of whom 2,096 (13.7%) were classified as lonely. Daily use of opioids (4.1%) and benzodiazepines (1.7%) were less common than daily use of non-opioid analgesics (33.9%). Lonely older adults had higher daily use of opioids (odds ratio [OR] 1.61, 1.31-1.98) and benzodiazepines (OR 1.66, 1.21-2.28), but not non-opioid analgesics (OR 1.05, 0.92-1.19). Loneliness was not associated with occasional use of opioids, benzodiazepines or non-opioid analgesics in older adults, but was associated with polypharmacy (OR 1.27, 1.06-1.52). CONCLUSIONS Loneliness in older adults is associated with increased daily use of opioids and benzodiazepines. Further research should evaluate patient- and physician-level factors that mediate this association, and develop strategies to mitigate loneliness and its attendant adverse outcomes.
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Affiliation(s)
- Manav V Vyas
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jennifer A Watt
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Amy Y X Yu
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Sharon E Straus
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Moira K Kapral
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Canada
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Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. The Impact of Resilience and Extraversion on Psychological Distress, Loneliness, and Boredom During the COVID-19 Pandemic: A Follow-Up Study Among the General Population of Tyrol, Austria. Front Psychiatry 2021; 12:777527. [PMID: 34867560 PMCID: PMC8632804 DOI: 10.3389/fpsyt.2021.777527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background: The Covid-19 pandemic and related measures represent an enormous burden on mental health. The aim of this study was to investigate longitudinal changes in psychological distress, loneliness, boredom, and resilience over the course of the pandemic and to examine the associations between resilience and extraversion at baseline (summer 2020) and psychological distress, loneliness, and boredom at 5-month-follow-up. Methods: Residents of Tyrol (≥18a) completed an online survey on psychological distress, loneliness, boredom, resilience, and extraversion by using the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Multidimensional State Boredom Scale-Short Form (MSBS-SF), the Resilience Scale, and the Extraversion subscale of the Big Five Inventory. Results: Of the 961 baseline participants, 384 took part in the follow-up survey. The percentage of study participants with striking psychological distress remained the same. Similarly, resilience did not change from baseline to follow-up, whereas the number of those experiencing moderate loneliness increased significantly. In contrast, at follow-up, severe loneliness was detected in significantly less people. Boredom decreased significantly over time. A moderate negative association was detected between baseline resilience and psychological distress, loneliness, and boredom at follow-up, and a weak but still significant negative association between extraversion and these outcomes. Discussion: These findings indicate that a subset of the general population consistently suffers from high levels of psychological distress and point to the protective effects of resilience and extraversion in this context. They reemphasize the importance of prevention and mitigation strategies to address these public health problems.
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Affiliation(s)
- Franziska Tutzer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, General Hospital of Bolzano, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Chernova
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Division of Psychiatry I, Medical University Innsbruck, Innsbruck, Austria
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Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. Psychological Distress, Loneliness, and Boredom Among the General Population of Tyrol, Austria During the COVID-19 Pandemic. Front Psychiatry 2021; 12:691896. [PMID: 34177672 PMCID: PMC8222609 DOI: 10.3389/fpsyt.2021.691896] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/17/2021] [Indexed: 12/31/2022] Open
Abstract
Background: COVID-19-related mental health problems are considered a public health challenge. The aim of this study was to investigate psychological distress, loneliness, and boredom among the general population of the federal state of Tyrol, Austria. Methods: Residents of Tyrol aged ≥ 18 years were recruited via dissemination of a link through social media and other advertisements and invited to complete an online survey from June 26th to August 20th, 2020. Next to the collection of sociodemographic and COVID-19 related variables the Brief Symptom Checklist (BSCL), the Three-Item Loneliness Scale (TILS), and the Multidimensional State Boredom Scale-Short Form (MSBS-SF) were used to assess psychological distress, loneliness, and boredom. Results: 961 participants took part in the survey (68.3% woman). Of these, 14.4% were burdened from psychological distress (BSCL), 22.6% reached a TILS score ≥ 7 and were therefore classified as severely lonely, and boredom levels lay by a mean of 25.9 ± 11.0 points in the MSBS-SF (range: 7-56). Women, singles, low-income people as well as those who were unemployed were significantly more often affected by all of the selected outcomes compared to the remaining sample and they had significantly more frequently consumed alcohol or other substances since the outbreak of the pandemic in order to feel better. In addition, young and middle-aged adults were particularly burdened by loneliness and boredom. Discussion: Our findings identify vulnerable groups and factors associated with higher psychological distress, loneliness, and boredom in the context of the pandemic. In order to prevent mental health problems it will be critical to identify options of maintaining social contacts and remaining active despite pandemic-related restrictions.
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Affiliation(s)
- Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Central Hospital, Sanitary Agency of South Tyrol, Bolzano, Italy
| | - Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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Leon-Gonzalez R, Rodriguez-Artalejo F, Ortola R, Lopez-Garcia E, Garcia-Esquinas E. Social Network and Risk of Poor Sleep Outcomes in Older Adults: Results from a Spanish Prospective Cohort Study. Nat Sci Sleep 2021; 13:399-409. [PMID: 33762861 PMCID: PMC7982710 DOI: 10.2147/nss.s288195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/15/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Not having social support has been associated with poor sleep, but most prospective studies were based on social support in the workplace, did not account for baseline sleep characteristics or did not assess sleep duration. Moreover, no previous research has evaluated the relationship between social network and sleep outcomes in an older Spanish population. METHODS 1444 individuals aged ≥60 years were followed between 2012 and 2015. At baseline (2012), a poor social network index (SNI) was computed by summing the following dichotomous indicators: not being married; living alone; not having daily contact with family, friends or neighbors; being alone ≥8h/day; lacking someone to go for a walk with; not having emotional support; lacking instrumental support. Higher values in SNI indicate less social support. In 2012 and 2015, information was collected on sleep duration (hours/day) and on symptoms of sleep disturbance: bad overall sleep; difficulty falling asleep, awakening during nighttime, early awakening with difficulty getting back to sleep, use of sleeping pills, feeling restless in the morning, being asleep at daytime, and having an Epworth Sleepiness Scale>10. Poor sleep duration was defined as short (<6 h) or long (>9 h) nighttime sleep, and poor sleep quality as having ≥4 indicators of sleep disturbance. Linear or logistic regression models were used to assess the relationship of SNI with changes in sleep duration and in number of sleep disturbance indicators, or with the risk of developing poor nighttime sleep or poor sleep quality. RESULTS Compared to individuals in the lowest (best) quartile of the SNI in 2012, those in the second, third and fourth quartiles, respectively, displayed a mean (95%confidence interval [95% CI]) change of 2.32 (-7.58-12.22), -2.70 (-13.19-7.79) and -13.04 (-23.41- -2.67) minutes in sleep duration from 2012 to 2015; p for trend=0.02. A 1-point increase in the SNI at baseline was associated with an increased risk of short nighttime sleep (Odds Ratio [OR] and 95% CI: 1.22 (1.05-1.42)), poor sleep quality (OR: 1.13; 95% CI: 1.00-1.30), and of the indicator of sleep disturbance "early awakening with difficulty getting back to sleep" (OR: 1.20; 95% CI: 1.07-1.35). CONCLUSION A poorer social network is associated with a higher risk of short sleep and poor sleep quality in older adults.
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Affiliation(s)
- Rocio Leon-Gonzalez
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute, CEI Uam+csic, Madrid, Spain
| | - Rosario Ortola
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Esther Lopez-Garcia
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,IMDEA Food Institute, CEI Uam+csic, Madrid, Spain
| | - Esther Garcia-Esquinas
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid/IdiPAZ, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Nielsen T, Friderichsen IS, Rayce SB. Classification of loneliness using the T-ILS: Is it as simple as it seems? Scand J Psychol 2020; 62:104-115. [PMID: 33320357 DOI: 10.1111/sjop.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
Student well-being is a growing issue in higher education, and assessment of the prevalence of conditions as loneliness is therefore important. In higher education and population surveys the Three-Item Loneliness Scale (T-ILS) is used increasingly. The T-ILS is attractive for large multi-subject surveys, as it consists of only three items (derived from the UCLA Loneliness Scale). Several ways of classifying persons as lonely based on T-ILS scores exist: dichotomous and trichotomous classification schemes and use of sum scores with rising levels indicating more loneliness. The question remains whether T-ILS scores are comparable across the different population groups where they are used or across groups of students in the higher education system. The aim was to investigate whether the T-ILS suffers from differential item functioning (DIF) that might change the loneliness classification among higher education students, using a large sample just admitted to 22 different academy profession degree programs in Denmark (N = 3,757). DIF was tested relative to degree program, age groups and gender. The framework of graphical loglinear Rasch models was applied, as this allows for adjustment of sum scores for uniform DIF, and thus for assessment of whether DIF might change the classification. Two items showed DIF relative to degree program and gender, and adjusting for this DIF changed the classification for some subgroups. The consequences were negligible when using a dichotomous classification and larger when using a trichotomous classification. Therefore, trichotomous classification should be used with caution unless suitable adjustments for DIF are done prior to classification.
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Affiliation(s)
- Tine Nielsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Signe Boe Rayce
- The Danish Center for Social Science Research, Copenhagen, Denmark
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18
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Nguyen TT, Lee EE, Daly RE, Wu TC, Tang Y, Tu X, Van Patten R, Jeste DV, Palmer BW. Predictors of Loneliness by Age Decade: Study of Psychological and Environmental Factors in 2,843 Community-Dwelling Americans Aged 20-69 Years. J Clin Psychiatry 2020; 81:20m13378. [PMID: 33176072 PMCID: PMC7953851 DOI: 10.4088/jcp.20m13378] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 07/21/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Loneliness is a prevalent and serious public health problem due to its effects on health, well-being, and longevity. Understanding correlates of loneliness is critical for guiding efforts toward the development of evidence-based strategies for prevention and intervention. Considering that patterns of association between age and loneliness vary, the present study sought to examine age-related differences in risk and protective factors for loneliness. METHODS Correlates of loneliness were examined through a large web-based survey of 2,843 participants (aged 20-69 years) from across the United States from April 10, 2019, through May 10, 2019. Participants completed the 4-item UCLA Loneliness Scale, San Diego Wisdom Scale (with the following subscales measuring components of wisdom: Prosocial Behaviors, Emotional Regulation, Self-Reflection, Acceptance of Divergent Values, Decisiveness, and Social Advising), and other scales measuring psychosocial variables. Multivariate regression analyses were conducted to identify the best model of loneliness and examine potential age-related differences. RESULTS Age demonstrated a nonlinear quadratic relationship with loneliness (Wald statistic = 5.48, P = .019); levels were highest in the 20s and lowest in the 60s with another peak in the mid-40s. Across all decades, loneliness was associated with not having a spouse or partner (P < .001), sleep disturbance (P < .02), lower prosocial behaviors (P < .001), and smaller social network (P < .001). Lower social self-efficacy (P < .001) and higher anxiety (P < .005) were associated with worse loneliness in all age decades, except the 60s. Loneliness was uniquely associated with decisiveness in the 50s (P = .012) and with education (P = .046) and memory complaints (P = .013) in the 60s. CONCLUSIONS Our findings identify several potentially modifiable targets related to loneliness, including several aspects of wisdom and social self-efficacy. Differential predictors at different decades suggest a need for a personalized and nuanced prioritizing of prevention and intervention targets.
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Affiliation(s)
- Tanya T Nguyen
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Ellen E Lee
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Rebecca E Daly
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
| | - Tsung-Chin Wu
- Department of Mathematics, University of California San Diego, La Jolla, California, USA
| | - Yi Tang
- Newcomb-Tulane College, Tulane University, New Orleans, Louisiana, USA
| | - Xin Tu
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Ryan Van Patten
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
| | - Dilip V Jeste
- University of California San Diego, 9500 Gilman Drive #0664, La Jolla, CA 92023-0664.
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Department of Neurosciences, University of California San Diego, La Jolla, California, USA
| | - Barton W Palmer
- Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, California, USA
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA
- Veterans Affairs San Diego Healthcare System, San Diego, California, USA
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Boehlen FH, Freigofas J, Herzog W, Meid AD, Saum KU, Schoettker B, Brenner H, Haefeli WE, Wild B. Evidence for underuse and overuse of antidepressants in older adults: Results of a large population-based study. Int J Geriatr Psychiatry 2019; 34:539-547. [PMID: 30623499 DOI: 10.1002/gps.5047] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/29/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Depression is common among elderly people. However, diagnosis and adequate treatment is frequently difficult. Research on underuse and overuse of antidepressants in elderly persons is scarce. This study investigates the utilization and appropriateness of pharmacological and psychological depression treatment in a large cohort of community-dwelling adults. METHODS A subsample of 3117 participants (aged 55-85 y) of the third follow-up (2008-2010) of the large population-based German ESTHER study was included. Depression was assessed using the eight-item Patient Health Questionnaire (PHQ-8). In the course of a home visit, study doctors collected complete information on medication. Logistic regression analyses were conducted to determine the relationship of depression with both underuse and overuse of antidepressants. The analyses were then adjusted for socioeconomic variables, psychosomatic comorbidities, and motivation to seek help. RESULTS One hundred sixty-three participants (5.2%; 95% confidence interval [CI], 4.5-6.1) fulfilled the criteria for major depression. Underuse of antidepressants was present in 126 depressed participants (77.3%; 70.1-83.5). Persons who were motivated to seek help, who had an established depression diagnosis, or who were taking more than five different medications had lower odds of underuse. Anxiety was associated with higher odds for underuse. Overuse of antidepressants (prescription without clinical indication) was found in 96 cases (41.7%; 35.3-48.4) of all antidepressant prescriptions. CONCLUSIONS Depression treatment in older adults is frequently insufficient; it appears to depend on diagnosis as well as the patients' motivation to seek help. Education regarding the diagnosis of depression in the elderly as well as guidelines for appropriate treatment is needed.
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Affiliation(s)
- Friederike H Boehlen
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Freigofas
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Wolfgang Herzog
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Ben Schoettker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Medical University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital Heidelberg, Heidelberg, Germany
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20
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Wild B, Herzog W, Schellberg D, Böhlen F, Brenner H, Saum KU, Maatouk I. A short intervention targeting psychosomatic care in older adults with complex health care needs-results of a randomized controlled trial. Int J Geriatr Psychiatry 2019; 34:272-279. [PMID: 30370681 DOI: 10.1002/gps.5017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/05/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The aim of this randomized controlled trial (RCT) was to assess the efficacy of a short intervention targeting psychosomatic care in older adults with complex health care needs. METHODS Participants were recruited in the frame of the 11-year follow-up of a large population-based study by means of the INTERMED interview. The INTERMED interview is an integrative assessment method to identify bio-psycho-social health care needs. Persons with high health care needs (interview score ≥ 17) were invited to take part. Participants were randomized with a 1:1 ratio to a control and an intervention group. The intervention group received a home visit conducted by a doctor trained in psychosomatic medicine. The primary hypothesis stated that the intervention group would have a better outcome with respect to health related quality of life (HRQOL) measured by the 12-item short-form health survey (mental component score, MCS) 6 months after randomization (T1). Secondary outcomes were physical HRQOL, health care needs, depression, anxiety, and somatic symptom severity. RESULTS In total, 175 participants were included. At the three-year follow-up (T2), 97 participants (55.4%) were included. At T1, we did not find a difference regarding MCS between the intervention and control groups. At T2, the intervention group showed significantly lower health care needs compared with the control group. Regarding HRQOL, depression, and somatic symptom severity the two groups did not differ at T2. CONCLUSIONS The primary hypothesis was not confirmed. However, results indicate that a short intervention with complex patients could lead to reduced bio-psycho-social health care needs.
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Affiliation(s)
- Beate Wild
- Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Wolfgang Herzog
- Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Dieter Schellberg
- Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Friederike Böhlen
- Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.,Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Kai-Uwe Saum
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Imad Maatouk
- Medical University Hospital, Department of General Internal Medicine and Psychosomatics, Heidelberg, Germany
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Polenick CA, Cotton BP, Bryson WC, Birditt KS. Loneliness and Illicit Opioid Use Among Methadone Maintenance Treatment Patients. Subst Use Misuse 2019; 54:2089-2098. [PMID: 31232142 PMCID: PMC6803066 DOI: 10.1080/10826084.2019.1628276] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Loneliness has been linked to greater substance use, especially among women. Yet little is known about how loneliness is associated with treatment outcomes for patients with opioid use disorder (OUD). Objectives: We evaluated how patient reports of using illicit opioids (i.e. heroin or non-prescription pain medications) are linked to perceptions of loneliness in a sample of adults receiving methadone maintenance treatment (MMT), and whether this link varies by gender. Methods: Participants for this cross-sectional observational study included 371 MMT patients aged 18 and older drawn from four opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a self-administered survey assessing sociodemographic and health information, loneliness, illicit opioid use, and MMT characteristics. Logistic regressions were estimated to examine the link between patient odds of illicit opioid use in the past month and perceived loneliness. Results: Patient gender moderated the association between illicit opioid use and loneliness such that severe loneliness was associated with higher odds of using illicit opioids among women (OR = 3.00, 95% CI [1.19, 7.57], p=.020) but lower odds of using illicit opioids among men (OR = 0.35, 95% CI [0.14, 0.87], p=.024), accounting for age, marital status, work status, depressive symptoms, and MMT characteristics (treatment episode, treatment duration, and methadone dose). Conclusions/importance: This study underscores the importance of considering loneliness in the management of OUD. Routine clinical care and treatment may benefit from strategies to build and sustain social connections that support long-term recovery among MMT patients.
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Affiliation(s)
- Courtney A Polenick
- Department of Psychiatry, University of Michigan , Ann Arbor , Michigan , USA.,Program for Positive Aging, University of Michigan , Ann Arbor , Michigan , USA.,Institute for Social Research, University of Michigan , Ann Arbor , Michigan , USA.,Institute for Healthcare Policy and Innovation, University of Michigan , Ann Arbor , Michigan , USA
| | | | - William C Bryson
- Department of Psychiatry, Oregon Health and Sciences University , Portland , Oregon , USA
| | - Kira S Birditt
- Institute for Social Research, University of Michigan , Ann Arbor , Michigan , USA
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Predictors of antidepressant use in the English population: analysis of the Adult Psychiatric Morbidity Survey. Ir J Psychol Med 2018; 37:15-23. [DOI: 10.1017/ipm.2018.19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ObjectivesThe rate of antidepressant use in the United Kingdom has outpaced diagnostic increases in the prevalence of depression. Research has suggested that personal and socioeconomic risk factors may be contributing to antidepressant use. To date, few studies have addressed these possible contributions. Thus, this study aimed to assess the relative strength of personal, socioeconomic and trauma-related risk factors in predicting antidepressant use.MethodsData were derived from the Adult Psychiatric Morbidity Survey (n=7403), a nationally representative household sample of adults residing in England in 2007. A multivariate binary logistic regression model was developed to assess the associations between personal, socioeconomic and trauma-related risk factors and current antidepressant use.ResultsThe strongest predictor of current antidepressant use was meeting the criteria for an ICD-10 depressive episode [odds ratio (OR)=9.04]. Other significant predictors of antidepressant use in this analysis included English as first language (OR=3.45), female gender (OR=1.98), unemployment (OR=1.82) and childhood sexual abuse (OR=1.53).ConclusionsSeveral personal, socioeconomic and trauma-related factors significantly contributed to antidepressant use in the multivariate model specified. These findings aid our understanding of the broader context of antidepressant use in the United Kingdom.
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"Where are all the lonely people?" A population-based study of high-risk groups across the life span. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1373-1384. [PMID: 27571769 DOI: 10.1007/s00127-016-1279-3] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/13/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Loneliness is a prevalent and urgent public health issue. Optimal planning of community approaches to loneliness requires a differentiated understanding of loneliness across the life span. We identified groups at high risk of loneliness by exploring the relationship between loneliness and socio-demographic and health-related factors across multiple age groups. METHODS This was a combined population-based questionnaire survey and register data study based on a representative sample, including 33,285 Danish individuals aged 16-102 years. Loneliness was measured using the Three-Item Loneliness Scale. RESULTS The relation between loneliness and age took a shallow U-shaped distribution. Ethnic minority status, receiving disability pensions or being unemployed, living alone, prolonged mental disorder, and psychiatric treatment were strongly associated with severe loneliness. Socio-demographic and health-related factors were associated with an increased risk of severe loneliness in specific age groups. Being female, having a low educational level and living in a deprived area were only associated with loneliness in adolescence/emerging adulthood. Receiving disability pensions and living alone (i.e., divorced), on the other hand, were strongly associated with loneliness in early and middle adulthood and young-old age. CONCLUSION Ethnic minority status, living alone, and prolonged mental disorder may well be key factors in determining the generic level of loneliness in a given population. Other conditions are associated with an increased risk of severe loneliness in specific age groups and may moderate the age-loneliness relation. These findings may help to identify populations within communities at risk of loneliness and thereby support the implementation of policies and public health interventions across the life span.
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