The impact of the built environment on loneliness: A systematic review and narrative synthesis

Impact of Long COVID-19 on Health Outcomes Among Adults With Preexisting Cardiovascular Disease and Hypertension: A Systematic Review

Background

This review summarizes the impact of long COVID (LC) on the health of adults with preexisting cardiovascular disease (CVD) and hypertension.

Methods

We searched Medline, Web of Science (Core Collection), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), without language restrictions, for articles published from December 1, 2019 through October 10, 2023, to ensure all relevant studies were captured. We included studies that enrolled adults (aged ≥18 years) diagnosed with CVD prior to COVID-19 infection whose infection was subsequently determined to be LC per the World Health Organization definition. We excluded studies with adults diagnosed with CVD concurrent with or subsequent to COVID-19 or with those who solely self-reported LC. We used a custom-built data extraction form to collect a range of study characteristics. Study quality was assessed using modified versions of the National Heart, Lung, and Blood Institute quality-assessment tools.

Results

A total of 13,779 studies were identified; 53 were included in the final analysis. Of these, 27 were of good quality and 26 were of fair quality. Health outcomes consisted of the presence of prolonged symptoms of LC (n = 29), physiological health outcomes (n = 20), lifestyle behaviours (n = 19), psycho-social outcomes (n = 13), CVD complications (n = 5), and death and hospital readmission (n = 5). Thirty-four studies incorporated 2 or more outcomes, and 19 integrated only 1.

Conclusions

Given the significant impact of LC among individuals with preexisting CVD, specially tailored clinical management is needed for members of this population. Additional studies on the impact of LC among those with CVD and other underlying conditions also would be beneficial.

Predictors of male loneliness across life stages: an Australian study of longitudinal data

BACKGROUND

Despite growing recognition of loneliness as a global public health concern, research on its occurrence and precipitants among men across different life stages remains limited and inconclusive. This study aims to address this gap by investigating the prevalence and predictors of loneliness among a large, representative data set of Australian adult men.

METHODS

The study used longitudinal data from waves 2-21 of the Household, Income and Labour Dynamics in Australia (HILDA) Survey, including men aged 15-98. Estimating linear fixed effects regressions that account for unobserved time-invariant individual heterogeneity, a single-item measure of loneliness was regressed on a set of selected explanatory variables over different parts of the life course.

RESULTS

Increased social isolation, romantic partnership dissolution, having a long-term disability, and stronger beliefs that the man, rather than the woman, should be the breadwinner of the household, are associated with greater loneliness. Frequent social connection, having a romantic partner, and high neighbourhood satisfaction are protective against loneliness. The findings also reveal several differences in the predictors of loneliness over the life course. Job security is especially important for younger men, whereas for older men volunteering and less conservative gender role attitudes are important factors that can decrease loneliness.

CONCLUSIONS

The results emphasise the need to consider age-specific factors and societal expectations in understanding and addressing loneliness amongst men. Additionally, the findings underscore the importance of raising awareness about the impact of societal norms and expectations on men's mental health. The results offer valuable insights for policymakers, healthcare providers, and researchers to develop effective strategies and support systems to combat loneliness and promote well-being among men.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

Geographically specific associations between county-level socioeconomic and household distress and mortality from drug poisoning, suicide, alcohol, and homicide among working-age adults in the United States

Background

Mortality rates from drug poisoning, suicide, alcohol, and homicide vary significantly across the United States. This study explores localized relationships (i.e., geographically specific associations) between county-level economic and household distress and mortality rates from these causes among working-age adults (25-64).

Methods

Mortality data were from the National Vital Statistics System for 2014-2019. County-level socioeconomic distress (poverty, employment, income, education, disability, insurance) and household distress (single-parent, no vehicle, crowded housing, renter occupied) were from the 2009-2013 American Community Survey. We conducted Ordinary Least Squares (OLS) regression to estimate average associations and Geographically Weighted Regression (GWR) to estimate localized spatial associations between county-level distress and working-age mortality.

Results

In terms of national average associations, OLS results indicate that a one standard deviation increase in socioeconomic distress was associated with an average of 6.1 additional drug poisoning deaths, 3.0 suicides, 2.1 alcohol-induced deaths, and 2.0 homicides per 100,000 population. A one standard deviation increase in household distress was associated with an average of 1.4 additional drug poisonings, 4.7 alcohol-induced deaths, and 1.1 homicides per 100,000 population. However, the GWR results showed that these associations vary substantially across the U.S., with socioeconomic and household distress associated with significantly higher mortality rates in some parts of the U.S than others, significantly lower rates in other parts of the U.S., and no significant associations in others. There were also some areas where distress overlapped to influence multiple causes of death, in a type of compounded disadvantage.

Conclusions

Socioeconomic and household distress are significant and substantial predictors of higher rates of drug poisoning mortality, suicide, alcohol-induced deaths, and homicide in specific regions of the U.S. However, these associations are not universal. Understanding the place-level factors that contribute to them can inform geographically tailored strategies to reduce rates from these preventable causes of death in different places.

The contribution of objective and perceived crime to neighbourhood socio-inequity in loneliness

Loneliness tends to be more prevalent in socioeconomically disadvantaged neighbourhoods, yet few studies explore the environmental differences contributing to area-based inequity in loneliness. This study examined how perceived and objective crime contributed to differences in loneliness between advantaged and disadvantaged neighbourhoods. The study used cross-sectional data from 3749 individuals aged between 48 and 77 years, residing in 200 neighbourhoods in Brisbane, Australia. We found that participants in disadvantaged neighbourhoods reported higher levels of loneliness and perceived crime, and the most disadvantaged neighbourhoods also had highest prevalence of objective crime. However, while perceived and objective crime were positively correlated with loneliness, only perceived crime accounted for socio-economic inequity in loneliness. Consequently, perceived crime plays an important role in addressing loneliness in disadvantaged communities and requires equitable resourcing for multiple strategies that aim to decrease crime and increase perceived safety.

Loneliness among older adults who have experienced homelessness: qualitative findings from the HOPE HOME study

Background

Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging. We know little about loneliness among older adults who have experienced homelessness. We aimed to describe the loneliness experience among older adults who have experienced homelessness and the individual, social, and structural conditions that shaped these loneliness experiences.

Methods

We purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants' perceived social support and social isolation. We conducted qualitative content analysis.

Results

Twenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants' loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: 1) "lonely - distressed", characterized by physical impairment and severe isolation; 2) "lonely - rather be isolated", reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; 3) "lonely - transient", as a result of aging, acceptance and grieving; and 4) "not lonely" - characterized by stability and connection despite having experienced homelessness.

Conclusions

Loneliness is a complex and heterogenous social phenomenon, with older adults who have experienced homelessness exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.

Social-ecological factors influencing loneliness and social isolation in older people: a scoping review

There are growing calls from researchers and policy makers to redefine loneliness and social isolation (SI) as public health issues, and to move towards a transdisciplinary, systems-based approach, due to their association with significant health risks, particularly in older people. Research about loneliness and SI in older people has typically adopted a narrow focus, evaluating effects of individual and inter-personal factors on these experiences. Less is known about the community and societal influences that may be used to inform public health interventions. We conducted a scoping review applying Joanna Briggs Institute methodology and the social-ecological model framework in order to: i) identify the available evidence for the influence of the community and societal factors on loneliness and SI as experienced by older people; ii) examine how quantitative research about community- and societal-level factors of loneliness and SI in the older population is conducted; and iii) identify current knowledge gaps in relation to the use of the social-ecological model in this area. A total of 52 articles from 30 countries met the inclusion criteria, including 33 observational studies, primarily cross-sectional (88%), and 19 interventions, mostly (89%) pre-post evaluations. The majority of included articles measured loneliness only (n = 34, 65%), while 11 measured both loneliness and SI (21%). To measure these outcomes validated scales were frequently used. Eighteen community/societal factors were investigated in relation to loneliness and/or SI, most commonly neighbourhood safety, access to public third-places and cultural practices. Three societal-level interventions were found: two campaigns to reduce ageism and one which explored the impact of free public transport. Community-based interventions were either educational or enlisted volunteers to foster connections. There is a need for longitudinal studies to better understand the mechanisms through which community- and societal- level factors affect loneliness and SI, which in turn will guide interventions that utilise the social-ecological framework for these issues.

Urban green space and mental health among people living alone: The mediating roles of relational and collective restoration in an 18-country sample

Rates of living alone, especially in more urbanised areas, are increasing across many industrialised countries, with associated increases in feelings of loneliness and poorer mental health. Recent studies have suggested that access to nature (e.g. parks and green spaces) can reduce the stressors associated with loneliness, partly through providing opportunities to nurture personal relationships (relational restoration) and engage in normative community activities (collective restoration). Such associations might vary across different household compositions and socio-demographic or geographical characteristics, but these have not been thoroughly tested. Using data collected across 18 countries/territories in 2017-2018, we grouped urban respondents into those living alone (n = 2062) and those living with a partner (n = 6218). Using multigroup path modelling, we tested whether the associations between neighbourhood greenspace coverage (1-km-buffer from home) and mental health are sequentially mediated by: (a) visits to greenspace; and subsequently (b) relationship and/or community satisfaction, as operationalisations of relational and collective restoration, respectively. We also tested whether any indirect associations varied among subgroups of respondents living alone. Analyses showed that visiting green space was associated with greater mental well-being and marginally lower odds of using anxiety/depression medication use indirectly, mediated via both relationship and community satisfaction. These indirect associations were equally strong among respondents living alone and those living with a partner. Neighbourhood green space was, additionally, associated with more visits among respondents living with a partner, whereas among those living alone, this was sensitive to the green space metric. Within subgroups of people living alone, few overall differences were found. Some indirect pathways were, nevertheless, stronger in males, under 60-year-olds, those with no financial strain, and residents in warmer climates. In conclusion, supporting those living alone, as well as those living with a partner, to more frequently access their local greenspaces could help improve mental health via promoting relational and collective restoration.

Loneliness as Cause

While loneliness has been linked to various mental and physical health problems, the sense in which loneliness is a cause of these conditions has so far attracted little philosophical attention. This paper aims to fill this gap by analyzing research on health effects of loneliness and therapeutic interventions through current approaches to causality. To deal with the problem of causality between psychological, social, and biological variables, the paper endorses a biopsychosocial model of health and disease. I will investigate how three main approaches to causality used in psychiatry and public health apply to loneliness: interventionism, mechanisms, and dispositional theories. Interventionism can specify whether loneliness causes specific effects, or whether a treatment works, incorporating results from randomized controlled trials. Mechanisms help explain how loneliness brings about negative health effects, spelling out psychological processes involved in lonely social cognition. Dispositional approaches help stress particular features of loneliness connected to negative social interactions, such as defensiveness. I will conclude by showing that previous research alongside emerging approaches to health effects of loneliness lend themselves to analysis in terms of the causal models under discussion.

Neighbourhood socio-economic disadvantage and loneliness: the contribution of green space quantity and quality

Disadvantaged areas experience higher levels of loneliness than advantaged areas, though studies rarely identify environmental determinants of neighbourhood inequity in loneliness. We studied the contribution of the quantity and quality of green space to neighbourhood inequity in loneliness in three buffer sizes (400 m, 800 m, 1600 m), using cross-sectional data from 3778 individuals aged 48-77 years old living in 200 neighbourhoods in Brisbane, Australia. Levels of loneliness were significantly higher in disadvantaged neighbourhoods, and these neighbourhoods had less green space and less access to quality green space. However, there was no evidence that neighbourhood disparities in green space contributed to the association between neighbourhood disadvantage and loneliness. Possible methodological and substantive reasons for this result are discussed.