Loneliness, Depressive Symptomatology, and Suicide Ideation in Adolescence: Cross-Sectional and Longitudinal Analyses

Association of loneliness with mental disorders in Korean adults: national mental health survey of Korea 2021

PURPOSE

Loneliness is a risk factor for mental and physical disorders. Rapid individualization, with increasing associated social burden, is a contributing factor to loneliness among Koreans. This study aimed to investigate the relationship between loneliness and mental disorders, as well as to determine whether long-term loneliness is a factor predicting the occurrence of mental disorders in adults.

METHODS

The National Mental Health Survey of Korea 2021, a nationally representative survey on mental disorders, was conducted. Responses from 5511 participants were collected using the Korean version of the Composite International Diagnostic Interview for Diagnostic and Statistical Manual of Mental Disorders fourth edition, Structured Clinical Interview for Internet Gaming Disorder, and the World Health Organization Adult Attention-deficit Hyperactivity Disorder (ADHD) self-report scale. Loneliness and its duration were investigated among these participants.

RESULTS

Loneliness was reported by approximately 2.9% of the general population. Loneliness was associated with an increased adulthood prevalence of alcohol use disorders, nicotine use disorders, depressive disorders, anxiety disorders, adult ADHD, and internet gaming disorders. Long-term loneliness was significantly associated with an elevated risk of alcohol use disorders, nicotine use disorders, depressive disorders, and anxiety disorders. Internet gaming disorder was associated with loneliness lasting > 1 year.

CONCLUSION

Various adult psychiatric disorders were associated with loneliness. The significant dose-effect relationship indicated the importance of early detection of and intervention for loneliness to reduce its negative consequences on mental health.

Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study

BACKGROUND

Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context.

METHODS

Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations.

RESULTS

Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (β = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (β = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts.

LIMITATIONS

The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting.

CONCLUSION

Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

Adverse Childhood Experiences Moderate the Relationship Between Pain and Later Suicidality Severity Among Youth: A Longitudinal High-Risk Cohort Study

Pain in adolescence can lead to the development of serious mental health issues, including suicidality. This risk may be strengthened among youth exposed to more adverse childhood experiences (ACEs; abuse, neglect, household challenges). This longitudinal study examined the role of ACEs in the relationship between pain and later suicidality onset and severity among a cohort of adolescents at risk for developing mental health problems. Participants were 139 healthy youth (Mage = 13.74 years, standard deviation = 1.56, 64% female) between the ages of 11 to 17 years, recruited based on parental history of depression or anxiety. Youth completed validated measures of internalizing symptoms, ACEs, and pain characteristics at baseline and follow-up diagnostic interviews 9 and/or 18 months later to assess for onset and severity of suicidality. After controlling for demographics, baseline internalizing symptoms, and ACEs, worse pain interference and increased ACEs at baseline predicted increased suicidality severity at follow-up. Moderation analyses revealed that there was a significant interaction between ACEs and pain interference and pain intensity. Increased pain interference (b = 7.65, P < .0001) or intensity (b = 6.96, P = .0003) was only associated with increased suicidality severity at follow-up in youth with high levels of ACEs. This study demonstrates that ACEs strengthen the relationship between pain and later suicidality severity among youth at risk of developing mental health problems. Findings underscore the critical need to adopt a trauma-informed lens to pediatric pain prevention and treatment (eg, screening for ACEs) and for the pain to be on the child's mental health agenda. PERSPECTIVE: This article provides evidence that, while pain is a risk factor for future increased suicidality severity, it is a particularly strong risk factor in youth who experienced increased childhood adversity. These results may help identify youth at greatest risk for suicidality.

Why do adolescents attempt suicide? Insights from leading ideation-to-action suicide theories: a systematic review

Suicide is a leading cause of death among adolescents, and recent suicide theories have sought to clarify the factors that facilitate the transition from suicide ideation to action. Specifically, the Interpersonal Theory of Suicide (IPTS), Integrated Motivational-Volitional Model (IMV), and Three Step Theory (3ST) have highlighted risk factors central to the formation of suicidal ideation and suicidal behaviors, which is necessary for suicide death. However, these models were initially developed and tested among adults, and given core socioemotional and neurodevelopmental differences in adolescents, the applicability of these models remains unclear. Directly addressing this gap in knowledge, this systematic review aimed to (1) describe the evidence of leading ideation-to-action theories (i.e., IPTS, IMV, 3ST) as they relate to suicide risk among adolescents, (2) integrate ideation-to-action theories within prevailing biological frameworks of adolescent suicide, and (3) provide recommendations for future adolescent suicide research. Overall, few studies provided a complete test of models in adolescent samples, and empirical research testing components of these theories provided mixed support. Future research would benefit from integrating neurodevelopmental and developmentally sensitive psychosocial frameworks to increase the applicability of ideation-to-action theories to adolescents. Further, utilizing real-time monitoring approaches may serve to further clarify the temporal association among risk factors and suicide.

Meaning-focused coping as a cultural process: A mixed quantitative and PhotoVoice study of adolescents with Arab backgrounds overcoming stigma and harassment

Poor mental health among U.S. adolescents has reach epidemic proportions, with those from the Middle East and North African region exhibiting increased risk for distress and suicide ideation. This mixed-methods study analyzes quantitative data from first- and second-generation Arab adolescents (n = 171) and qualitative data from a participatory study conducted with 11 adolescents of the same population to understand the role of cultural resources in coping. Drawing on the Intersectional Theory of Cultural Repertoires in Health, we show that: 1) cultural resources underlie meaning-making throughout coping; 2) coping strategies are inseparable from the influence of peer and familial relationships, as dictated through the social norms and other cultural resources; 3) collectively held repertoires of coping can promote belonging, affirm identity, and protect against discrimination; and 4) the outcomes of coping strategies, and the culturally informed meaning individuals make of these outcomes, influence their future coping behaviors.

Attributions of Loneliness-Life Story Interviews with Older Mental Health Service Users

There is growing evidence on the prevalence and impact of loneliness, particularly among older people. However, much less is known about the personal origins of loneliness and how it persists, or not, over an individual's life course. This study aimed to increase understanding of the personal experiences of loneliness among older adults across the life course. Central to this study was giving voice to the participants and allowing them to define loneliness, what it meant to them, and how it affected them throughout their lives. This qualitative study employed 18 life story interviews with older adults attending a mental health service. We explored their personal experiences of loneliness and the situations and factors associated with loneliness across the life course. We identified three distinct typologies of loneliness: those who experienced (1) chronic loneliness since childhood, (2) chronic loneliness after a life-changing event in midlife, and (3) loneliness which remained situational/transitional, never becoming chronic. This study found the seeds of chronic life course loneliness are often determined in childhood. Early detection and intervention may prevent situational loneliness from becoming chronic. More research is needed from a life course approach to help understand and address the causes and consequences of loneliness.

Trajectories of Loneliness During Adolescence Predict Subsequent Symptoms of Depression and Positive Wellbeing

There is a need to identify the outcomes of changes in loneliness during adolescence, and to consider this within a multidimensional framework of loneliness. This study considered the effects of different trajectories of change in Isolation Loneliness and in Friendship Loneliness upon both positive wellbeing and symptoms of depression. To achieve this, 1782 (43% female; 12.92 years old at the start of the study, SD = 1.60) young people took part in a longitudinal study with four data points across 2 years. Four Isolation Loneliness trajectories and five Friendship Loneliness trajectories were identified. Youth who experienced low levels of Isolation Loneliness that subsequently increased appear to be at particular risk for poor outcomes. Similarly, initially high levels of Friendship Loneliness that decreased rapidly, or which began at a low level and only increased marginally, seem to also be a risk. Loneliness is a multi-dimensional construct and its development during adolescence impacts upon young people's depressive symptomatology and positive mental wellbeing.

The relationship between loneliness and problematic social media usage in Chinese university students: a longitudinal study

BACKGROUND

A significant number of cross-sectional studies have explored the correlation between loneliness and problematic social media use. However, the causal relationship between these two key variables remains controversial, and the developmental relationship over time is unclear.

METHODS

We conducted a one-year longitudinal study with 538 Chinese college students using questionnaires and employing cross-lagged and latent growth models to investigate the causal relationship and developmental dynamics between loneliness and problematic social media use.

RESULTS

The results indicate that (a) loneliness and problematic social media use mutually and positively influence each other, establishing a bidirectional causal relationship; (b) Chinese college students experience a gradual increase in levels of loneliness and problematic social media use during their time in college; and (c) the intercept and slope of loneliness significantly and positively affect the intercept and slope of problematic social media use, and conversely, the intercept and slope of problematic social media use significantly and positively influence the intercept and slope of loneliness.

CONCLUSION

These findings reveal the longitudinal relationship between loneliness and problematic social media use among Chinese college students and offer insights for researchers and educators to intervene in college students' loneliness and problematic social media use from a developmental perspective.

The robust reciprocal relationship between loneliness and depressive symptoms among the general population: Evidence from a quantitative analysis of 37 studies

BACKGROUND

Loneliness has long been associated with depressive symptoms, but there is no evidence on the question of "which comes first". To help us to answer this question, this study conducted a meta-analysis using a cross-lagged formula to examine the reciprocal relations between loneliness and depressive symptoms, as well as potential moderators.

METHODS

The meta-analytic dataset consisted of 37 studies with sample sizes ranging from 52 to 5991. Effect sizes (including autoregressive effects and lagged coefficients) were included. We computed weighted mean effect sizes for the correlation effect and cross-lagged effect between loneliness and depressive symptoms. We also performed a meta-regression to investigate potential moderators.

RESULTS

The results showed that loneliness and depressive symptoms reciprocally predicted each other over time with similar effect sizes. There was no moderation of our overall effect size in either direction by time interval between measurements, the proportion of female participants, mean age of the sample, or type of measurement.

LIMITATIONS

Caution should be taken in drawing final conclusions about the relative strength of reciprocal effects between loneliness and depressive symptoms due to the potential influence of varied research focus in the included studies, which could affect the effect size.

CONCLUSIONS

These findings advance the study of the relationship between loneliness and depressive symptoms by providing evidence that the link between them is symmetrically reciprocal and robust, which may help clinicians to develop effective intervention methods.

A Short-Form Measure of Loneliness to Predict Depression Symptoms Among Adolescents

The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n = 1683; T 3, n = 1406). Items were reduced while preserving predictability. Follow-up confirmatory factor analyses and predictive models with the reduced and full PALs were then tested. A reduced six-item scale (PALs-6) preserved the two-factor structure of the PALs and showed strong prediction of very elevated depressive symptoms (Sensitivity = 0.70, Specificity = 0.78, AUC = 0.81); it was less successful in predicting future symptoms (Sensitivity = 0.67, Specificity = 0.64, AUC = 0.74). The PALs-6 provides a brief measure of adolescent loneliness for clinicians and researchers that also predicts very elevated levels of depression.

Adolescent Loneliness and Negative Affect during the COVID-19 Pandemic: The Role of Extraversion and Neuroticism

The COVID-19 pandemic had varied but significant effects on the lives of adolescents. This study aimed to examine the effects of extraversion and neuroticism on changes in loneliness and negative affect among adolescents during the pandemic. Longitudinal data were collected in three waves from 673 German adolescents and young adults (Mage = 16.8 years, SDage = 0.91; female = 59%), affected by local lockdowns. The data collection was one time before (T1) and two times during the pandemic (T2, T3). Change score models were used to assess the relationship between loneliness and negative affect with consideration of extraversion and neuroticism. Results showed that pre-pandemic loneliness was predictive of changes in negative affect during the pandemic, with higher loneliness predicting increases in negative affect. Negative affect did not predict later loneliness. Extraverts showed an increase in negative affect over time, particularly between pre-pandemic measurement and the first phase of the pandemic. Higher neuroticism appeared to have increased vulnerability for negative affect during the pandemic, as a rise in negative affect were found among these adolescents throughout the course of the pandemic. In conclusion, the study highlights the significant impact of the COVID-19 pandemic on the mental health of adolescents and suggests that managing the pandemic during this specific developmental period is a challenge.

Perceived entrapment predicts first-onset suicidal ideation: A longitudinal study among medical students in China

Introduction

The prevalence of suicidal ideation among medical students is high. Evidence indicates that feelings of entrapment are a predictor of suicidal ideation. In this study, we aimed to (1) investigate the prevalence of first-onset suicidal ideation among Chinese medical students and (2) explore the predictive effects of perceived entrapment on first-onset suicidal ideation.

Methods

This longitudinal study was conducted between 2018 and 2019 among 211 newly enrolled medical students in Shanghai. Using an anonymous questionnaire, we collected information on sociodemographic (sex, major, parents' income, and academic performance) and psychological (entrapment, depression, loneliness, defeat, social support, and interpersonal needs) variables as well as suicidal ideation. Participants were divided into four subgroups based on their exposure to entrapment (control, new-onset, reduced, and persistent). The primary outcome, first-onset suicidal ideation, was defined as suicidal ideation absent at baseline but present at follow-up.

Results

In total, 54.98% of participants (116/211) were women, and 76.78% (162/211) majored in clinical medicine. In the follow-up survey, 6.16% of participants (16/211) reported first-onset suicidal ideation, 17.54% (37/211) reported new-onset entrapment, and 12.80% (27/211) reported persistent entrapment during follow-up. Compared with the control group who reported no perceived entrapment at baseline and follow-up, participants who reported new-onset entrapment had the highest risk of new-onset suicidal ideation [odds ratio (OR) = 14.700, 95% confidence interval (CI) = 2.906-74.364; adjusted OR = 8.798; 95% CI = 1.588-48.757; multivariate OR = 8.238, 95% CI = 1.394-48.693).

Conclusion

New-onset entrapment can significantly predict suicidal ideation. Therefore, greater attention is needed for new-onset entrapment, such as intervention for suicidal ideation.

Hello Darkness, My Old Friend: Moderating a Random Intercept Cross-lagged Panel Model of Loneliness and Symptoms of Anxiety and Depression

The present study investigated the trait- and state-like associations between loneliness and symptoms of anxiety and depression during three years in middle to late adolescence. The moderating effect of gender and social self-efficacy was examined on the hypothesised model. The sample consisted of 1508 Norwegian upper secondary school students (61% female; mean age at T1 = 16.33; 52.9% high socioeconomic position; 70.6% Norwegian-born). We found 1) strong and positive trait- and state-like associations between loneliness and symptoms of anxiety and depression, 2) that anxiety and depressive symptoms consistently predicted later loneliness but not the other way around, 3) that gender moderated parts of the state-like associations between loneliness and symptoms of anxiety and depression, and 4) that social self-efficacy had no moderating effect on the longitudinal relationship between loneliness and anxiety and depressive symptoms. The present study might inform future research, theory development, and intervention strategies in middle to late adolescent samples.

Prevalence of loneliness and its correlates among patients with schizophrenia

BACKGROUND

There are limited data on loneliness and its correlates in patients with schizophrenia.

OBJECTIVE

To evaluate prevalence and correlates of loneliness in patients with schizophrenia, currently in clinical remission.

METHODOLOGY

A total of 160 patients of schizophrenia in clinical remission were assessed on UCLA Loneliness Scale, Positive and Negative syndrome scale, Calgary Depression Scale for Schizophrenia (CDSS), Internalized Stigma of Mental Illness Scale, Rosenberg Self-esteem Scale, Brief COPE, Beck's Hopelessness Scale, Brief Dyadic Scale of Expressed Emotions, and Self-report Quality of Life Measure.

RESULTS

The mean age of the study sample was 34.99 (SD = 9.13) years. The prevalence of loneliness in the study sample was 80%, with mean total UCLA-loneliness scale score of 30.04 (16.9).Compared to participants without loneliness, those with loneliness had had higher CDSS score, had poor quality of life, lower self-esteem, experienced higher level of stigma, more often used maladaptive coping strategies such as self-blaming and reported a higher level of hopelessness. In the correlation analysis, higher level of loneliness was associated higher severity of depression, higher level of stigma (except for stigma resistance) and discrimination, poorer quality of life, lower self-esteem, perception of a higher level of expressed emotions, higher use of maladaptive coping in the domains of behavioral disengagement, and self-blaming, and a higher level of hopelessness. In regression analysis, the maximum variance of loneliness was explained by quality of life score (29%), followed by hopelessness score (8.8%) and discrimination score (2%).

CONCLUSION

There is a high prevalence of loneliness in patients with schizophrenia, and there is a need to routinely evaluate the patients of schizophrenia for loneliness and address the same.

Head versus heart: social media reveals differential language of loneliness from depression

We study the language differentially associated with loneliness and depression using 3.4-million Facebook posts from 2986 individuals, and uncover the statistical associations of survey-based depression and loneliness with both dictionary-based (Linguistic Inquiry Word Count 2015) and open-vocabulary linguistic features (words, phrases, and topics). Loneliness and depression were found to have highly overlapping language profiles, including sickness, pain, and negative emotions as (cross-sectional) risk factors, and social relationships and activities as protective factors. Compared to depression, the language associated with loneliness reflects a stronger cognitive focus, including more references to cognitive processes (i.e., differentiation and tentative language, thoughts, and the observation of irregularities), and cognitive activities like reading and writing. As might be expected, less lonely users were more likely to reference social relationships (e.g., friends and family, romantic relationships), and use first-person plural pronouns. Our findings suggest that the mechanisms of loneliness include self-oriented cognitive activities (i.e., reading) and an overattention to the interpretation of information in the environment. These data-driven ecological findings suggest interventions for loneliness that target maladaptive social cognitions (e.g., through reframing the perception of social environments), strengthen social relationships, and treat other affective distress (i.e., depression).

Contribution of perceived loneliness to suicidal thoughts among French university students during the COVID-19 pandemic

Restrictive measures during the COVID-19 epidemic have led to increased levels of loneliness, especially among university students, although the influence on suicidal thoughts remains unclear. In this cross-sectional study of 1913 French university students, those with the highest level of loneliness had a fourfold increased risk of suicidal thoughts. Perceived loneliness should be incorporated into suicide risk assessment, and assistance in coping with loneliness should be considered as a means of reducing suicidal risk in vulnerable groups, like university students.

Back to Basics: Lifestyle Interventions for Adolescent Depression

LEARNING OBJECTIVES

After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand.

ABSTRACT

Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.

Determinants of Suicide Ideation in the Romanian Population

BACKGROUND

Suicide ideation and behaviors are directly linked to the risk of death by suicide. In Romania, as well as worldwide, increased suicide rates were observed in the recent past, more so in the context of the COVID-19 pandemic. The purpose of this study was to investigate the influence of psychosocial factors, quality of life (QOL), and loneliness dimensions and adverse life antecedents on suicide ideation (SI) and prolonged sadness (PS).

METHODS

This cross-sectional quantitative research study used a CATI data gathering method to investigate 1102 randomly selected individuals over 18 years of age regarding various determinants of SI and PS. Data were collected in June 2021. Descriptive, inferential, and multivariate statistics were used for data analysis.

RESULTS

SI was negatively correlated with all the assessed psychosocial factors, more significantly with family relationships, wealth, health, social relationships, and affective life. Stronger correlations were observed when investigating the state of prolonged sadness, sex, and affective lives along with health and income, which were more influential. SI was negatively correlated with QOL and positively correlated with adverse life events and total loneliness scores. Lesser educated youngsters with reduced overall happiness and a history of depression, self-harm, and trauma were at greater risk of developing SI.

CONCLUSIONS

This is the first national study exploring the suicide ideation and prolonged sadness in relation to psychosocial factors, quality of life, and adverse life events. These results have important implications for suicide prevention programs, which should be designed in accordance with similar studies.

Leave Me Alone With Your Symptoms! Social Exclusion at the Workplace Mediates the Relationship of Employee's Mental Illness and Sick Leave

Although a substantial part of employees suffers from a mental illness, the work situation of this population still is understudied. Previous research suggests that people with a mental illness experience discrimination in the workplace, which is known to have detrimental effects on health. Building on the stereotype content model and allostatic load theory, the present study investigated whether employees with a mental illness become socially excluded at the workplace and therefore show more days of sick leave. Overall, 86 employees diagnosed with a mental disorder were interviewed and completed online-surveys. Path analyses supported the hypotheses, yielding a serial mediation: The interview-rated severity of the mental disorder had an indirect effect on the days of sick leave, mediated by the symptomatic burden and the social exclusion at the workplace. In the light of the costs associated with absenteeism the present paper highlights the harmfulness of discrimination. Organizations and especially supervisors need to be attentive for signs of exclusion within their teams and try to counteract as early as possible.

The longitudinal interplay of depressive symptoms and loneliness: causal effects work in both directions and decay to zero before six years

Objective: Prior research on the longitudinal associations between depressive symptoms and loneliness has conflated between-person and within-person effects, resulting in confusion over causal influences. The present study used the random-intercept cross-lagged panel model (RI-CLPM) to disentangle between-person from within-person sources of variance.Method: The study used a representative sample of adults older than 40 years from the German Ageing Survey (DEAS). To examine the influence of time lag on the strength of the predictive paths, analyses were conducted with lags of 3 and 6 years.Results: The results showed that, at the within-person level, auto-regressive and cross-lagged paths were significant with lag length of 3 years but not 6 years.Conclusion: It can be concluded that there is a reciprocal relationship between the variables that operates at intervals shorter than 6 years. However, the stable trait-like components of the variables account for much of the covariance between them. Recommendations include paying more attention to the factors that contribute to the stability of the 2 variables across time and situation in addition to short-term and symptom-focused interventions.

Association between loneliness, self-esteem and outcome of life satisfaction in Norwegian adolescents aged 15-21

AIMS

Adolescence is an important developmental stage for understanding the role of perceived loneliness and self-esteem on life satisfaction. This study investigated the association between loneliness, self-esteem and the outcome of life satisfaction, as well as potential interaction effects in association with life satisfaction, in a sample of Norwegian adolescents.

METHODS

The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. Data were collected in September 2016. The participants reported scores on the five-item Satisfaction with Life Scale, the 10-item Rosenberg Self-Esteem Scale and one item assessing loneliness. Control variables included sex, age, perceived family economy, parents' education, place of birth and perceived bullying. The data were analysed with descriptive and multiple linear regression analysis.

RESULTS

A significant negative and moderately strong association was found between loneliness and life satisfaction, where the association was stronger for girls than for boys. Self-esteem showed a significant positive and strong association with life satisfaction; however, no significant interaction effect was found.

CONCLUSIONS

The findings show the significant role of both loneliness and self-esteem in association with adolescents' perception of life satisfaction. The findings support promoting self-esteem, belongingness and social integration in all daily life contexts for adolescents to support their life satisfaction.

The Effect of Loneliness in Psychological and Behavioral Profile among High School Students in Spain

Loneliness is a distressing feeling that can be a barrier to a student’s development and affect their mental health. This research aimed to analyse the effects of loneliness on psychological and behavioral factors among students aged 12–19 years in Spain. Loneliness, experiential avoidance, psychological inflexibility, physical activity, mobile phone use, and smoke habits were analysed in a sample of 110 men and 122 women assigned into two groups depending on their loneliness levels: higher loneliness group (HLG) and lower loneliness group (LLG). Results showed that experimental avoidance and psychological inflexibility were related with loneliness (r = 0.471; p = 0.000). Experiential avoidance and psychological inflexibility were higher in HLG than LLG. Regarding the use of mobile phones and smoking habits, LLG presented significantly higher values than HLG. Higher age correlated with lower loneliness values (r = −0.155; p = 0.017). The present research found how students with higher loneliness presented higher experiential avoidance and psychological inflexibility and lower age, use of mobile phone, and smoking habits. These findings reveal the importance of considering multiple social behaviours when examining adolescent mental health factors.

Linking childhood emotional neglect to adolescents' parent-related loneliness: Self-other differentiation and emotional detachment from parents as mediators

BACKGROUND

The detrimental role of childhood emotional neglect (CEN) on long-term affective and social development has received increasing attention in the literature. Individuals who were emotionally neglected during their childhood are more prone to feeling isolated and excluded by their parent during adolescence. However, little is known about the mediating processes underlying this association.

OBJECTIVE

This study investigated whether self-other differentiation (SOD) and emotional detachment from parents mediate the link between CEN and parent-related loneliness.

METHOD AND PARTICIPANTS

A sample of 535 high school students aged 13-18 years (63.6% female; M_age = 16.21; SD = 1.40) completed questionnaires regarding demographics, CEN, SOD, emotional detachment, and parent-related loneliness.

RESULTS

After controlling for demographic covariates, structural equation modeling (SEM) showed that (a) CEN was positively associated with parent-related loneliness (β = 0.64, p < .001), (b) SOD did not mediate the relationship between CEN and parent-related loneliness (β = -0.01, p = .142), (c) emotional detachment partially mediated the relationship between CEN and parent-related loneliness (β = 0.16, p < .001), and (d) SOD and emotional detachment partially and sequentially mediated the link between CEN and parent-related loneliness, albeit with a small effect size (β = 0.02, p = .027).

CONCLUSIONS

The findings underscore the significance of the link between CEN and parent-related loneliness in adolescence. Moreover, our results suggest that some adolescents with a history of CEN have difficulties in establishing clear boundaries between "self" and "other" and tend to engage in emotionally detached relationships with their parents, which may lead them to feel more parent-related loneliness. Clinical implications and directions for future research are discussed.

Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness

INTRODUCTION

Loneliness is prevalent and associated with negative health outcomes in young people. Our understanding of how it can be best addressed is limited. This systematic review aims to assess the acceptability and effectiveness of interventions to reduce and prevent loneliness and social isolation in young people.

METHODS

Six bibliographic databases were searched; references of included studies were screened for relevant literature. A pre-defined framework was used for data extraction. Quality appraisal was performed using the Mixed Method Appraisal Tool. Data were synthesised narratively.

RESULTS

9,358 unique references were identified; 28 publications from 16 interventions met the inclusion criteria. The majority of interventions were high intensity, individual or small group interventions, often targeted at specific 'at risk' populations. While 14 interventions were associated with a statistically significant reduction in loneliness or social isolation, the heterogeneous measures of loneliness, small sample sizes, short periods of follow-up and high attrition rates limit evidence on effectiveness. Interventions implemented in more general populations of young people appeared more acceptable than those in specific 'at risk' populations.

CONCLUSION

High intensity interventions are unlikely to be feasible at a population level. Further work is required to develop and evaluate theoretically-informed loneliness interventions for young people that reach wider audiences.

Factors Related to Mental Health During the COVID-19 Lockdown in Spain

The COVID-19 disease has forced governments to adopt exceptional measures. The lockdown decreed in Spain in 2020 required citizens to stay confined at home, which might have affected their mental health. The objective is to identify factors that influenced adults' mental health during this period. A sample of 3,508 adults from the Spanish general population completed an online survey that collected sociodemographic data and information about daily planning and activities, healthy habits, loneliness, coping humor and mental health. Data were analyzed using Structural Equation Modeling. According to the results, the proposed model showed good fit values, and latent variables explained 30% of the variance in mental health. Loneliness, coping humor, healthy habits, age and gender had a significant weight in the prediction of mental health during lockdown. Area of residence, number of days of confinement and number of people in the household were not related to mental health. This study addresses the effect of COVID-19 and social distancing measures by identifying risk and protective factors for the development of mental health difficulties. There is a need to target specific and early interventions aimed at mitigating the psychological impact of the pandemic while increasing well-being, especially in more vulnerable groups.

Psychological Maltreatment and Loneliness in Adolescents: Social Ostracism and Affective Experiences

Psychological maltreatment is an important public health concern that has been linked with a variety of negative psychosocial consequences and adjustment problems in childhood to adulthood. The purpose of the current study sought to explore the direct and indirect associations between psychological maltreatment, social ostracism, affective experiences, and loneliness among high school Turkish adolescents. Participants were comprised of 791 adolescents attending three public high schools in Turkey. Students were mostly male with a mean age of 16.35 (SD = 1.09) years. Findings from the analyses indicated that social ostracism mediated the relationship between psychological maltreatment and both positive and negative affective experiences. Social ostracism and affective experiences mediated the effect of psychological maltreatment on adolescent feelings of loneliness. Results of the present study suggest that social ostracism and affective experiences are important mechanisms that may help to understand the impacts of psychological maltreatment on adolescent feelings of loneliness.

Stressful events and adolescents' suicidal ideation during the COVID-19 epidemic: A moderated mediation model of depression and parental educational involvement

This study examined the association between stressful events and adolescents' suicidal ideation and determined the roles of depression as a mediator and parental educational involvement as a moderator during the COVID-19 epidemic. Survey data from a sample of 1595 Chinese adolescents and their parents were subjected to path analysis. The results indicated that stressful events of the COVID-19 epidemic were significantly positively associated with adolescents' suicidal ideation, and this association was mediated by depression. In addition, adolescents' parental educational involvement significantly moderated the path from depression to suicidal ideation. These results highlight the importance of identifying the underlying key mechanisms that moderate the mediated paths between stressful events and adolescents' suicidal ideation during the COVID-19 epidemic. The findings also provide implications for parents and education staff regarding the importance of improving parental educational involvement to prevent adolescents' suicidal ideation during the COVID-19 epidemic.

Loneliness, social relationships, and mental health in adolescents during the COVID-19 pandemic

Loneliness is a common experience in adolescence and is related to a range of mental health problems. Such feelings may have been increased by social distancing measures introduced during the COVID-19 pandemic. We aimed to investigate the effect of loneliness, social contact, and parent relationships on adolescent mental health during lockdown in the UK. Young people aged 11-16 years (n = 894) completed measures of loneliness, social contact, parent-adolescent relationships, and mental health difficulties during the first 11 weeks of lockdown and one-month later (n = 443). We examined cross-sectional associations and longitudinal relationships between loneliness, social contact, and parent relationships and subsequent mental health. Adolescents who reported higher loneliness had significantly higher symptoms of mental health difficulties during lockdown. We found that adolescents who had closer relationships with their parents reported significantly less severe symptoms of mental health difficulties and lower levels of loneliness. We also found that adolescents who spent more time texting others reported higher symptoms of mental health difficulties. Our hypothesis that loneliness would predict poorer mental health one month later was not supported. Time spent texting others at baseline was significantly associated with higher hyperactivity at follow-up, and closeness to parents was significantly associated with lower psychological distress at follow-up. We conclude that while loneliness was associated with greater mental health difficulties at baseline, it did not predict increased mental health difficulties one month later. Moreover, existing mental health problems significantly predicted later increase, thereby highlighting the importance of continuing support for vulnerable people.

Identifying Variables That Predict Depression Following the General Lockdown During the COVID-19 Pandemic

This study aimed to define the psychological markers for future development of depression symptoms following the lockdown caused by the COVID-19 outbreak. Based on previous studies, we focused on loneliness, intolerance of uncertainty and emotion estimation biases as potential predictors of elevated depression levels. During the general lockdown in April 2020, 551 participants reported their psychological health by means of various online questionnaires and an implicit task. Out of these participants, 129 took part in a second phase in June 2020. Subjective loneliness during the lockdown rather than objective isolation was the strongest predictor of symptoms of depression 5 weeks later. Younger age and health related worry also predicted higher non-clinical levels of depression and emotional distress. The results support the diathesis-stress model, which posits that a combination of preexisting vulnerabilities along with stressors such as negative life events are among the factors affecting the development of psychopathology. Moreover, our results correspond with those of previous studies conducted worldwide during the COVID-19 pandemic. Taken together, these findings call for focusing on psychological factors, especially among younger people, to identify individuals at risk for future development of depression and to promote new strategies for prevention.

Examining temporal interactions between loneliness and depressive symptoms and the mediating role of emotion regulation difficulties among UK residents during the COVID-19 lockdown: Longitudinal results from the COVID-19 psychological wellbeing study

BACKGROUND

Longitudinal studies examining the temporal association between mental health outcomes during the COVID-19 outbreak are needed. It is important to determine how relationships between key outcomes, specifically loneliness and depressive symptoms, manifest over a brief timeframe and in a pandemic context.

METHOD

Data was gathered over 4 months (March - June 2020) using an online survey with three repeated measures at monthly intervals (N = 1958; 69.8% females; Age 18-87 years, M = 37.01, SD = 12.81). Associations between loneliness, depression symptoms, and emotion regulation difficulty were tested using Pearson's product moment correlations, and descriptive statistics were calculated for all study variables. Cross-lagged structural equation modelling was used to examine the temporal relationships between variables.

RESULTS

The longitudinal association between loneliness and depressive symptoms was reciprocal. Loneliness predicted higher depressive symptoms one month later, and depressive symptoms predicted higher loneliness one month later. The relationship was not mediated by emotion regulation difficulties. Emotion regulation difficulties and depressive symptoms were also reciprocally related over time.

LIMITATIONS

Limitations include the reliance on self-report data and the non-representative sample. There was no pre-pandemic assessment limiting the conclusions that can be drawn regarding the mental health impact of the COVID-19 crisis.

CONCLUSIONS

Loneliness should be considered an important feature of case conceptualisation for depression during this time. Clinical efforts to improve mental health during the pandemic could focus on interventions that target either loneliness, depression, or both. Potential approaches include increasing physical activity or low-intensity cognitive therapies delivered remotely.

Social Disconnectedness, Loneliness, and Mental Health Among Adolescents in Danish High Schools: A Nationwide Cross-Sectional Study

Background: Previous research has suggested that social disconnectedness experienced at school is linked to mental health problems, however, more research is needed to investigate (1) whether the accumulation of various types of social disconnectedness is associated with risk for mental health problems, and (2) whether loneliness is a mechanism that explains these associations. Methods: Using data from the Danish National Youth Study 2019 (UNG19), nation-wide cross-sectional data from 29,086 high school students in Denmark were analyzed to assess associations between social disconnectedness experienced at school (lack of classmate support, lack of teacher support, lack of class social cohesion, and not being part of the school community) and various mental health outcomes, as well as the mediating role of loneliness for each type of disconnectedness. Multilevel regression analyses were conducted to assess the associations. Results: Descriptive analyses suggest that 27.5% of Danish high school students experience at least one type of social disconnectedness at school. Each type of social disconnectedness was positively associated with mental health problems (depression symptoms, anxiety symptoms, stress, sleep problems, suicidal ideation, non-suicidal self-injury, eating disorder, body dissatisfaction, and low self-esteem) and negatively associated with mental well-being. In all cases, loneliness significantly mediated the associations. We found a clear dose-response pattern, where each addition in types of social disconnectedness was associated with (1) stronger negative coefficients with mental well-being and (2) stronger positive coefficients with mental health problems. Conclusion: Our results add to a large evidence-base suggesting that mental health problems among adolescents may be prevented by promoting social connectedness at school. More specifically, fostering social connectedness at school may prevent loneliness, which in turn may promote mental well-being and prevent mental health problems during the developmental stages of adolescence. It is important to note that focusing on single indicators of school social connectedness/disconnectedness would appear to be insufficient. Implications for practices within school settings to enhance social connectedness are discussed.

Daily Parent-Adolescent Digital Exchanges

The present study tracked adolescents via mobile phones to describe how parents and their adolescent children are using digital technologies in daily life (i.e. facilitating warmth and behavioral control), and whether these uses are associated with the quality of offline parent-adolescent interactions and with adolescents' mental health. A sample of young adolescents (N = 388; mean age 13.37) completed a 14-day ecological momentary assessment in 2016- 2017, reporting on their daily digital contact and offline interactions with their parents and their mental health. Adolescents reported using texting and calling to communicate somewhat infrequently with their parents (i.e., on 29% of days), but days with more digital contacts (for both warmth and behavioral control) were also more likely to be characterized by more positive offline interactions with parents. Furthermore, adolescents struggling with mental health symptoms across the study period reported using texts/calls more frequently to seek out parent support, and parents were more likely to do text/call "check ins" on young people who were experiencing more behavioral problems. Results highlight the potential for digital communication devices to be used as tools in fostering parent-adolescent connection, support provision, and behavioral control in the digital era.

The role of perceived loneliness and sociodemographic factors in association with subjective mental and physical health and well-being in Norwegian adolescents

AIMS

Adolescence is a particularly salient period for understanding the role of perceived loneliness for subjective health and well-being. This study investigated sociodemographic differences (sex, age, self-reported socio-economic status (SES)) in loneliness and associations between sociodemographic factors, loneliness and self-rated health (SRH), subjective health symptoms, symptoms of depression/anxiety and mental well-being (MWB) in a sample of Norwegian adolescents.

METHODS

The study was based on a cross-sectional sample of 1816 adolescents aged 15-21 years. The participants reported scores on an 11-item scale assessing subjective health complaints (SHC), one item each assessing SRH and loneliness, the 10-item version of the Hopkins Symptom Checklist and the seven-item version of the Warwick-Edinburgh Mental Well-Being Scale. SES was assessed using perceived family economy and parents' education. Data were analysed with descriptive, comparative and multiple linear regression analyses.

RESULTS

The multivariate results showed that boys scored significantly higher on MWB than girls did, whereas girls scored significantly higher on loneliness, depression/anxiety and SHC. Perceptions of poorer family finances were significantly associated with higher levels of SHC and depression/anxiety, lower levels of MWB and more negative SRH. Loneliness showed significant positive associations with depression/anxiety and SHC, and significant negative associations with MWB and SRH. A significant moderation effect of sex by loneliness was found in association with depression/anxiety, with stronger associations for girls.

CONCLUSIONS

The findings in this study support the significant roles of sex, perceptions of family finances and loneliness in association with adolescent's subjective mental and physical health and well-being, especially mental health.

Peer network Status and Depressive Symptoms Among Early Adolescents: Testing the Mediating Effects of Metaperception and Loneliness

Previous research shows that deficits in social relationships increase the risk of depression. This study tests the hypothesis that among early adolescents, their status in their peer network (likeability/dislikeability) will be associated with depressive symptoms but only indirectly, through the subjective perception of this status (positive/negative metaperception) and loneliness (feeling of social isolation). Data were collected using sociometric methods and self-report scales from 388 students aged 12–13. Path analysis was applied to verify the hypothesized relationships between the study variables. The findings indicate that: (1) status in the peer network and its perception affect depressive symptoms only indirectly, through loneliness; (2) depressive symptoms depend directly on loneliness alone; (3) status in the peer network does not directly translate into loneliness—its effect is mediated by metaperception; (4) the negative dimension of the peer network status indirectly affects both loneliness and depressive symptoms more strongly than the positive one. The main limitation of the research is its cross-sectional design, which precludes definite conclusions about the direction of the relationships observed. The results obtained help to clarify the complex mechanisms through which objective status in the peer network, its subjective perception and feelings of loneliness contribute to the severity of depressive symptoms among early adolescents. On the practical side, the findings highlight the importance of developing and implementing interventions targeting both the objective and subjective aspects of social relations for the prevention of depression in this age group.

The Double Jeopardy of Feeling Lonely and Unimportant: State and Trait Loneliness and Feelings and Fears of Not Mattering

There have been recent concerns about an "epidemic of loneliness" during the pandemic, given the pervasiveness of loneliness in the population and its harmful effects on health and well-being. Therefore, it is important to establish the correlates of loneliness. The purpose of the current study was to explore how loneliness relates to a construct termed mattering, which is the feeling of being important to other people. Mattering was assessed with multiple measures in the current study (e.g., mattering in general, fears of not mattering, and mattering to peers). A sample of 172 female psychology undergraduate students aged 18-25 years completed self-report measures of general mattering, mattering to peers, anti-mattering, fear of not mattering, and state and trait loneliness. As predicted, lower levels of both general mattering and mattering to peers were associated with higher state loneliness. Higher feelings of anti-mattering (feelings of being invisible and insignificant to others) and fears of not mattering were associated with greater trait loneliness, as well as a reduced sense of mattering to friends. The findings illustrate that feeling as though one does not matter to others (i.e., feeling insignificant and unimportant) is associated with increased state and trait loneliness among young women. Implications are discussed for loneliness theory and how these results can enhance both clinical understanding and practice.

Fear of Loneliness: Development and Validation of a Brief Scale

This research aims to develop and validate a Spanish version of The Brief Scale of Fear of Loneliness (BSFL). Participants were 1385 youth and adults, 347 from a pilot sample and 1032 from the final version, whose ages were in the range of 18 to 40 years. Two instruments, the Rosenberg Self-Esteem Scale and the De Jong Gierveld Loneliness Scale, in their Peruvian versions, were used to support the relationship with other variables. Results show that the BSFL should be interpreted as a one-dimensional measure, the same ones that were examined at the exploratory level and verified at the confirmatory moment (RMSEA < 0.08, CFI > 0.95), and its reliability is considered good (ω > 0.88). In addition, the quality of the item content was reviewed by six expert judges for relevance and validity, with Aiken’s V being greater than 0.70. It is concluded that the BSFL is a valid and precise short instrument that can be used in future research studies.

Teacher support and the social classroom environment as predictors of student loneliness

This study examined the relationships between students’ perceptions of teacher support, the social classroom environment, school loneliness, and possible gender differences among 2099 first year upper secondary school students in Norway. Data were collected in the fall (t1) and spring (t2) of the school year. Results from structural equation modelling (SEM) analyses showed that perceived emotional and instrumental teacher support were directly related to students’ perceptions of the social classroom environment, and indirectly to student loneliness through the social classroom environment. While for boys, both types of teacher support were significantly related to these variables, only emotional teacher support was of significance to girls. The strongest contributing factor to students’ school loneliness was their perceptions of the social classroom environment. Some implications of this study are that a positive social classroom environment is an important safeguard against student loneliness, and that teachers can aid in preventing loneliness among students through facilitating a positive social environment in the class.

Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

OBJECTIVE

Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents.

METHOD

For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance.

RESULTS

A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time at which loneliness was measured and between 0.25 and 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness.

CONCLUSION

Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.

Effects of Social Isolation and Loneliness in Children with Neurodevelopmental Disabilities: A Scoping Review

Loneliness and social isolation have negative consequences on physical and mental health in both adult and pediatric populations. Children with neurodevelopmental disabilities (NDD) are often excluded and experience more loneliness than their typically developing peers. This scoping review aims to identify the type of studies conducted in children with NDD to determine the effects of loneliness and/or social isolation. Three electronic databases (Ovid MEDLINE, EMBASE, PsychINFO) were searched from inception until 5 February 2019. Two independent reviewers screened the citations for inclusion and extracted data from the included articles. Quantitative (i.e., frequency analysis) and qualitative analyses (i.e., content analysis) were completed. From our search, 5768 citations were screened, 29 were read in full, and 12 were included. Ten were case-control comparisons with cross-sectional assessment of various outcomes, which limited inference. Autism spectrum disorder, attention-deficit/hyperactivity disorder, and learning disorder were the most commonly studied NDD. This review showed that loneliness among children with NDD was associated with negative consequences on mental health, behaviour, and psychosocial/emotional development, with a likely long-term impact in adulthood. Lack of research in this area suggests that loneliness is not yet considered a problem in children with NDD. More studies are warranted using prospective designs and a larger sample size with a focus on the dynamic aspect of loneliness development.

Smartphone App to Address Loneliness Among College Students: Pilot Randomized Controlled Trial

BACKGROUND

Loneliness is a widespread and significant problem on college campuses. Prolonged loneliness in young adulthood is a risk factor for concurrent and future mental health problems and attrition, making college a critical time for support. Cognitive and behavioral interventions show promise for decreasing loneliness and can be widely disseminated through technology.

OBJECTIVE

This pilot randomized controlled trial was conducted to examine the initial efficacy, feasibility, and desirability of a smartphone app, Nod, designed to deliver cognitive and behavioral skill-building exercises to reduce loneliness during the transition to college.

METHODS

First-year college students (N=221, mean age 18.7 years, 59% female) were recruited online during incoming student orientation, and randomized to either receive immediate access to Nod (experimental group, n=100) or access after 4 weeks (control group, n=121). The app delivered skills via fully automated (1) "social challenges," suggested activities designed to build social connections; (2) reflections, brief cognitive reframing exercises; and (3) student testimonials that encouraged a growth mindset toward social connection building. Main intention-to-treat analyses were used to compare the conditions on self-assessed loneliness, depressive symptoms, and other mental health and college adjustment outcomes at week 4, controlling for baseline values on those variables. Analyses were also performed to test the hypothesis that the treatment benefits would be particularly pronounced for participants with heightened psychological vulnerability at baseline (ie, higher baseline depressive symptoms and loneliness).

RESULTS

Retention was 97% at week 4, and participants viewed an average 36.7 pages of app content. There were no significant condition differences in loneliness at week 4 (F1, 211=0.05, P=.82; ηp2 <.001). However, there was a significant condition-by-baseline depression interaction to predict week-4 loneliness (F1,209=9.65, P=.002; ηp2 =.04). Simple slope analyses indicated that baseline depression positively predicted week-4 loneliness among control participants (r=0.30, t209=3.81, P<.001), but not among experimental participants (r=-0.09, t209=-0.84, P=.40), suggesting that Nod buffered participants with high baseline depression scores from experiencing heightened midquarter loneliness. Similarly, there were no significant condition differences in other week-4 outcomes. However, moderation by baseline vulnerability was found for week-4 depressive symptoms, sleep quality, and indices of college adjustment (eg, perceived social support and campus belonging).

CONCLUSIONS

Although Nod exposure did not impact outcomes for the full sample, these results provide initial evidence of its benefit for vulnerable students. The results of this trial suggest that cognitive and behavioral skills delivered via a mobile app can buffer psychologically vulnerable college students against heightened loneliness and depressive symptoms, as well as other negative college adjustment outcomes. Future work will aim to improve upon app engagement, and to address loneliness among other key populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04164654; https://clinicaltrials.gov/ct2/show/NCT04164654.

Internalizing Problems in Adolescence: Linking Loneliness, Social Anxiety Symptoms, and Depressive Symptoms Over Time

Adolescents are particularly vulnerable to experiencing loneliness, social anxiety symptoms, and depressive symptoms. These internalizing problems often co-occur but, until now, it remains unclear how they are associated over time. Insight in these temporal sequences is important to enhance our understanding of how internalizing problems arise and may reinforce each other over time. To examine these temporal sequences, three samples of adolescents were used: Sample 1 consisted of 1,116 adolescents (48.97% girls, M_age = 13.59), Sample 2 of 1,423 adolescents (52.42% girls, M_age = 13.79), and Sample 3 of 549 adolescents (62.66% girls, M_age = 14.82). Adolescents filled out well-established self-report measures of loneliness, social anxiety symptoms, and depressive symptoms during regular school hours at three measurement occasions with a 1-year interval. Meta-analytic techniques were used to estimate the average true effects across three-variable autoregressive cross-lagged models in the three samples. In addition, indirect effects and gender differences in the temporal associations were explored in all three samples. The results suggest that social anxiety symptoms play a crucial role as potential antecedent of emerging feelings of loneliness and depression in adolescence. In addition, in line with theoretical expectations, our results suggest the presence of a vicious cycle between adolescents' feelings of loneliness and social anxiety symptoms. The indirect effects were inconsistent across samples and no gender differences were found. These findings shed more light on the unique temporal relationships among different internalizing problems. Clinical interventions should target social anxiety symptoms to prevent feelings of loneliness and vice versa.

Direct and Indirect Associations Between Loneliness and Thoughts of Self-Harm Among a Clinical Sample of Older Adults With Serious Mental Illness

This cross-sectional study examines the relationships of loneliness and depressive symptoms to thoughts of self-harm among a clinical sample (n = 150) of older adults (M = 58.42 years, SD = 5.86 years; male, 55.3%; African American, 61.3%) with serious mental illness (SMI) receiving publicly funded, community-based psychiatric rehabilitation services. Participants completed the De Jong Gierveld Loneliness Scale, Multidimensional Scale of Perceived Social Support, Patient Health Questionnaire 9, and Geriatric Depression Scale-Short Form. Mediation analyses tested the association of loneliness with thoughts of self-harm through depressive symptoms and were adjusted for social support and demographic variables. The direct association of loneliness with thoughts of self-harm was mediated by depressive symptoms; indirect associations of overall and emotional loneliness to thoughts of self-harm were significant. Findings suggest the need for clinicians to reduce feelings of loneliness among older adults with SMI as a means of partially ameliorating depressive symptoms and thoughts of self-harm.

Loneliness, adolescence, and global mental health: Soledad and structural violence in Mexico

In this article, we call into question recent public health claims that loneliness is a problem of epidemic proportions. Current research on this topic is hindered by an overreliance on limited survey data and by paradigmatic imbalance that delineates the study of loneliness to psychological, cognitive, neuroendocrinological and immunological effects, social functioning, physical health, mortality, and gene effects. The article emphasizes that scientific approaches to the phenomena of loneliness are more appropriately conceived and investigated as inherently matters for social, relational, cultural, and contextual analysis of subjective experience. Studies of loneliness and possible relationships to mental health status require investigations of social, environmental, and institutional structures as well as families, peers, friends, counselors, and health providers. This article takes a step in this direction through examining the lived experience of 35 high school students and their families living under conditions of social adversity in Tijuana, B.C., Mexico, with attention to anxiety and depression. Utilizing ethnographic interviews, observations, and psychological screening tools, we provide an overview for the group and illustrate the interrelations of subjective experience and social environment through a case study. These data reveal the vital role of understandings of loneliness, depression, and anxiety from the perspectives of adolescents themselves. We conclude that future studies of loneliness are best informed by in-depth data on subjective experience in relation to social features to advance understandings within the field of global mental health and allied fields.

Loneliness, Social Anxiety Symptoms, and Depressive Symptoms in Adolescence: Longitudinal Distinctiveness and Correlated Change

Loneliness, social anxiety symptoms, and depressive symptoms are internalizing problems that are highly intertwined and often co-occur during adolescence. This overlap and co-occurrence raises the question whether three different labels are used for the same underlying phenomenon. The present study adopts a comprehensive approach to this issue by investigating the development of the three phenomena simultaneously. Specifically, this study aimed to investigate (1) the developmental trend for all three internalizing problems separately, (2) whether they are best described by a single developmental trend, (3) how they co-develop across adolescence, and (4) gender differences in this co-development. The analyses were run in three three-wave longitudinal samples of adolescents with one-year intervals in order to verify the robustness of the findings. Sample 1 (roughly ages 15, 16, and 17) comprised 549 adolescents (63% girls), and Samples 2 and 3 (roughly ages 13, 14, and 15) comprised 811 adolescents (46% girls) and 1101 adolescents (52% girls), respectively. Latent growth curve modeling for the three phenomena separately showed either small increases or stable patterns. A comparison of a Multiple Indicator Latent Growth Model (MILGM) with a Parallel Process Latent Growth Curve Modeling (PPLGCM) showed that the three internalizing problems followed unique, but related, developmental trends across adolescence. The intercepts of the three phenomena were positively correlated with one another in all samples and increases in loneliness were associated consistently with increases in social anxiety symptoms. Only in Sample 3 evidence was found for a similar association between loneliness and depressive symptoms and between social anxiety symptoms and depressive symptoms. Except for differences in initial levels, gender differences in the development of the three problems were limited. Overall, the results of the present study clearly indicate that the three internalizing problems are longitudinally distinct from one another, but co-develop across adolescence.

Loneliness as a predictor of suicidal ideation and behaviour: a systematic review and meta-analysis of prospective studies

BACKGROUND

Suicide and suicidal behaviour are global health concerns with complex aetiologies. Given the recent research and policy focus on loneliness, this systematic review aimed to determine the extent to which loneliness predicts suicidal ideation and/or behaviour (SIB) over time.

METHODS

A keyword search of five major databases (CINHAL, Medline, PsychArticles, PsychInfo and Web of Knowledge) was conducted. Papers for inclusion were limited to those using a prospective longitudinal design, written in English and which measured loneliness at baseline and SIB at a later time-point.

RESULTS

After duplicates were removed, 947 original potential papers were identified, with 22 studies meeting the review criteria. Meta-analysis revealed loneliness was a significant predictor of both suicidal ideation and behaviour and there was evidence that depression acted as a mediator. Furthermore, studies which consisted of predominantly female participants were more likely to report a significant relationship, as were studies where participants were aged 16-20 or >55 years at baseline.

LIMITATIONS

There was considerable variability in measures, samples and methodologies used across the studies. Middle-aged adults were under-represented, as were individuals from minority ethnic backgrounds. All studies were conducted in countries where self-reliance and independence (i.e. individualism) are the cultural norm.

CONCLUSIONS

Loneliness predicts later SIB in select populations. However, due to the heterogeneity of the studies further research is needed to draw more robust conclusions. Suicide death also needs to be included as an outcome measure. A focus on more collectivist countries is also required.