Secular changes in the relation between social factors and depression: a study of two birth cohorts of Swedish septuagenarians followed for 5 years

Characterizing the momentary association between loneliness, depression, and social interactions: Insights from an ecological momentary assessment study

Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and ∼2.5h and ∼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention.

Has the UK Campaign to End Loneliness Reduced Loneliness and Improved Mental Health in Older Age? A Difference-in-Differences Design

OBJECTIVE

To estimate the impact of the UK nationwide campaign to End loneliness on loneliness and mental health outcomes among older people in England.

DESIGN

Quasi-experimental design, namely, a difference-in-differences approach.

SETTING

Local authorities across England.

PARTICIPANTS

Older adults aged 65 and over participating in waves 4-8 (2008-2017) of the English Longitudinal Study of Aging (ELSA) and waves 1-9 (2009-2019) of the UK Household Longitudinal Study (UKHLS).

MAIN OUTCOME MEASURES

Loneliness was measured through the UCLA Loneliness scale. A social isolation scale with components of household composition, social contact and participation was constructed. Mental health was measured by The Centre for Epidemiological Studies of Depression (CES-D) score, the General Health Questionnaire (GHQ-12) score, and the Short-Form-12 Mental Component Summary (SF-12 MCS) score.

RESULTS

There was no evidence of change in loneliness scores over the study period. Difference-in-differences estimates suggest that explicitly developed and implemented antiloneliness strategies led to no change in loneliness scores (estimate = 0.044, SE = 0.085), social isolation caseness (estimate = 0.038, SE = 0.020) or levels of depressive symptoms (estimate = 0.130, SE = 0.165). Heterogeneity analyses indicate that antiloneliness strategies produced little impact on loneliness or mental health overall, despite small reductions in loneliness and increases in social engagement among well-educated and higher-income older adults. The results were robust to various sensitivity and robustness analyses.

CONCLUSIONS

Antiloneliness strategies implemented by local authorities have not generated a significant change in loneliness or mental health in older adults in England. Generating changes in loneliness in the older population might require longer periods of exposure, larger scope of intervention or more targeted strategies.

Neuropeptide Y gene variants and Agreeableness: interaction effect with the birth cohort and the serotonin transporter promoter polymorphism

OBJECTIVE

Neuropeptide Y (NPY) is a powerful regulator of anxious states, including social anxiety, but evidence from human genetic studies is limited. Associations of common gene variants with behaviour have been described as subject to birth cohort effects, especially if the behaviour is socially motivated. This study aimed to examine the association of NPY rs16147 and rs5574 with personality traits in highly representative samples of two birth cohorts of young adults, the samples having been formed during a period of rapid societal transition.

METHODS

Both birth cohorts (original n = 1238) of the Estonian Children Personality Behaviour and Health Study (ECPBHS) self-reported personality traits of the five-factor model at 25 years of age.

RESULTS

A significant interaction effect of the NPY rs16147 and rs5574 and birth cohort on Agreeableness was found. The T/T genotype of NPY rs16147 resulted in low Agreeableness in the older cohort (born 1983) and in high Agreeableness in the younger cohort (born 1989). The C/C genotype of NPY rs5574 was associated with higher Agreeableness in the younger but not in the older cohort. In the NPY rs16147 T/T homozygotes, the deviations from average in Agreeableness within the birth cohort were dependent on the serotonin transporter promoter polymorphism.

CONCLUSIONS

The association between the NPY gene variants and a personality domain reflecting social desirability is subject to change qualitatively in times of rapid societal changes, serving as an example of the relationship between the plasticity genes and environment. The underlying mechanism may involve the development of the serotonergic system.

Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources

BACKGROUND

Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community.

OBJECTIVE

This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults.

METHODS

A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources.

RESULTS

The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services.

CONCLUSIONS

A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources.

Cross-sectional study of the association of social relationship resources with Staphylococcus aureus colonization in naturally occurring social groups along the US/Mexico border

Asymptomatic carriage of Staphylococcus aureus is a major risk factor for subsequent clinical infection. Diminishing returns from mitigation efforts emphasize the need to better understand colonization, spread, and transmission of this opportunistic pathogen. While contact with other people presents opportunities for pathogen exposure and transmission, diversity of social connections may be protective against pathogens such as the common cold. This study examined whether social relationship resources, including the amount and diversity of social contacts, are associated with S. aureus colonization. Participants were community members (N = 443; 68% Hispanic) in naturally occurring social groups in southwestern Arizona. Four types of social relationships and loneliness were assessed, and samples from the skin, nose and throat were obtained to ascertain S. aureus colonization. Overall S. aureus prevalence was 64.8%. Neither the amount nor the diversity of social contacts were associated with S. aureus colonization. The concurrent validity of the social relationship assessments was supported by their moderate intercorrelations and by their positive association with self-rated health. The results suggest that the association of social network diversity and susceptibility to the common cold does not extend to S. aureus colonization. Conversely, colonization prevalence was not higher among those with more social contacts. The latter pattern suggests that social transmission may be relatively infrequent or that more intimate forms of social interaction may drive transmission and colonization resulting in high community prevalence of S. aureus colonization. These data inform communicable disease control efforts.

Are social isolation and loneliness associated with cognitive decline in ageing?

Objective

Social isolation and loneliness are associated with poor health (immunity, inflammation, etc.) in ageing. The purpose of this scoping review was to investigate the link between social isolation, loneliness (as distinct constructs, in contrast to previous published work) and cognition in cognitively healthy older adults.

Method

We followed PRISMA-ScR guidelines. Our search, conducted between January 2017 and April 2021, yielded 2,673 articles, of which, twelve longitudinal studies were finally identified as meeting the inclusion criteria. Multiple cognitive functions (short-term and episodic memory, attention, and global cognitive functioning) were measured.

Results

The results showed that both social isolation and loneliness were associated with poor cognition in ageing, with depression as a possible mediator between loneliness and poor cognition. Some studies also suggested that the link between social isolation, loneliness and cognitive decline may be bidirectional.

Conclusion

We conclude that both social isolation and loneliness may have a different impact on cognition. While depression may be an important mediator between loneliness and cognitive decline, the lack of cognitive stimulation may be a greater mediator between social isolation and cognitive health.

Older people with severe loneliness have an atrophied thalamus, hippocampus, and entorhinal cortex

OBJECTIVES

Loneliness has been shown to increase the risk of dementia. However, it is unclear why greater loneliness is associated with greater susceptibility to dementia. Herein, we aimed to examine the morphological characteristics of the brain associated with loneliness in older people concerned about cognitive dysfunction.

METHODS

In this retrospective study, 110 participants (80 with amnestic mild cognitive impairment, and 30 cognitively healthy individuals) were included. Participants were assessed using the revised University of California at Los Angeles (UCLA) loneliness scale and had undergone magnetic resonance imaging. Spearman correlation analysis and Mann-Whitney U tests were used to examine the clinical factors associated with loneliness. Multiple regression was performed to examine the relationship between the revised UCLA loneliness scale score and regional gray matter (GM) volume on voxel-based morphometry.

RESULTS

The revised UCLA loneliness scale scores were not significantly correlated with age, sex, or mini-mental state examination (MMSE) scores. Multiple regression using age, sex, MMSE score, and total brain volume as covariates showed negative correlations of the revised UCLA loneliness scale scores with the grey matter volume in regions centered on the bilateral thalamus, left hippocampus and left parahippocampal gyrus, and left entorhinal area.

CONCLUSIONS

Subjective loneliness was associated with decreased GM volume in the bilateral thalamus, left hippocampus, and left entorhinal cortex of the brain in the older people, thereby providing a morphological basis for the increased risk of dementia associated with greater loneliness.

Loneliness and the onset of new mental health problems in the general population

PURPOSE

Loneliness is associated with poor health including premature mortality. There are cross-sectional associations with depression, anxiety, psychosis, and other mental health outcomes. However, it is not known whether loneliness is causally linked with the new onset of mental health problems in the general population. Longitudinal studies are key to understanding this relationship. We synthesized evidence from longitudinal studies investigating the relationship between loneliness and new onset of mental health problems, in the general population.

METHOD

We systematically searched six electronic databases, unpublished sources, and hand-searched references, up to August 2021. We conducted a meta-analysis of eight independent cohorts and narrative synthesis of the remaining studies.

RESULTS

We included 32 studies, of which the majority focused on depression. Our narrative synthesis found most studies show loneliness at baseline which is associated with the subsequent new onset of depression. The few studies on anxiety and self-harm also showed a positive association. Our meta-analysis found a pooled adjusted odds ratio of 2.33 (95% CI 1.62-3.34) for risk of new onset depression in adults who were often lonely compared with people who were not often lonely. This should be interpreted with caution given evidence of heterogeneity.

CONCLUSION

Loneliness is a public mental health issue. There is growing evidence it is associated with the onset of depression and other common mental health problems. Future studies should explore its impact across the age range and in more diverse populations, look beyond depression, and explore the mechanisms involved with a view to better informing appropriate interventions.

Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature

Social prescribing is a means by which clinical services can link individuals who have psychological, social and/or practical needs with non-clinical services within their local community. There is a lack of empirical evidence investigating whether social prescribing helps such individuals and which interventions are the most effective and accepted by them to address their loneliness. This meta-synthesis aimed to synthesise findings from qualitative studies exploring experiences of people (of any age) who participated in any social prescribing intervention aimed at loneliness and/or social isolation to ascertain whether they felt it helped address loneliness/isolation and the potential mechanisms by which this might occur. We conducted a systematic search of 5 electronic databases and 4 other databases that would yield grey literature in April 2021 to identify qualitative articles on this topic written in English or French. We assessed the quality of the included studies using recognised tools, and synthesised findings using the approach of thematic analysis. We identified 19 records analysed (e.g. journal articles) from 18 studies meeting inclusion criteria. Our analysis identified three themes: (1) increased sense of wellbeing (with six subthemes), (2) factors that engendered an ongoing desire to connect with others, and (3) perceived drawbacks of social prescribing. These themes illustrate the benefits and difficulties people perceive in social prescribing programmes addressing loneliness and social isolation, with an overall balance of more benefits than drawbacks in social prescribing participation. However, given the unhelpful aspects of social prescribing identified by some participants, greater thought should be given to potential harms. Moreover, further qualitative and quantitative research is needed to better understand mechanisms and effectiveness, and how different components of social prescribing might be best matched to individual participants.

The longitudinal association between loneliness and depressive symptoms in the elderly: a systematic review

OBJECTIVE

Loneliness and the onset of depression in old age are growing problems related to the greater life expectancy nowadays. This review investigated the longitudinal association between loneliness and depressive symptoms in the elderly.

DESIGN

A comprehensive search was conducted using three databases (Scopus, PsycInfo, and PubMed) combing for empirical studies published up until July 2020. A total of 4.549 abstracts and 221 full-text articles were assessed. Three authors independently reviewed titles and abstracts; disagreements were resolved by consensus.

RESULTS

Ten studies were included in the final review. We identified two categories of studies based on the outcome considered in each article: 1) the longitudinal effect of loneliness on depressive symptoms and 2) the clinical course of depression and its association with loneliness. All the articles reported a significant and positive association between loneliness and depressive symptoms in their longitudinal design research, ranging from an odds ratio of 0.41 to 17.76. The heterogeneity regarding the effect size in the analyses can be explained by the multifactorial design implemented by most of the studies included.

CONCLUSIONS

Future research should investigate the moderators' role and how it may influence the longitudinal association between loneliness and depression over the years.

Accuracy of 12 short versions of the Geriatric Depression Scale to detect depression in a prospective study of a high-risk population with different levels of cognition

OBJECTIVES

To determine the accuracy of 12 previously validated short versions of the Geriatric Depression Scale (GDS) to detect major depressive disorder (MDD) in a high-risk population with and without global cognitive impairment.

DESIGN

Cross-sectional study.

SETTING

Five hospitals, Western Sweden.

PARTICIPANTS

Older adults (age ≥70 years, n = 60) assessed at a home visit 1 year after hospital care in connection with suicide attempt.

MEASUREMENTS

Depression symptoms were rated using the established 15-item GDS. Eleven short GDS versions identified by a recent systematic review were derived from this administered version. Receiver operating characteristic curves and area under the curve (AUC) for the identification of MDD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, were obtained for each version. The Youden Index optimal criterion was used to determine the appropriate cutoffs. Analyses were repeated after stratification by cognitive status (Mini Mental State Examination score ≤24 and >24) for the best performing GDS short versions and the established 15-item GDS.

RESULTS

The 7-item GDS according to Broekman et al. (), with a cutoff 3, was the most accurate among the 12 short versions (AUC 0.90, 95% confidence interval 0.80-1.00), identifying MDD with sensitivity 88% and specificity 81%. The cutoff score remained consistent in the presence of global cognitive impairment, which was not the case for the standardized 15-item GDS.

CONCLUSION

The Broekman 7-item GDS had high accuracy to detect MDD in this prospective clinical cohort at high risk for MDD. Further testing of GDS short versions in diverse settings is required.

The association between loneliness and depressive symptoms among adults aged 50 years and older: a 12-year population-based cohort study

BACKGROUND

Loneliness is experienced by a third of older adults in the UK and is a modifiable potential risk factor for depressive symptoms. It is unclear how the association between loneliness and depressive symptoms persists over time, and whether it is independent of related social constructs and genetic confounders. We aimed to investigate the association between loneliness and depressive symptoms, assessed on multiple occasions during 12 years of follow-up, in a large, nationally representative cohort of adults aged 50 years and older in England.

METHODS

We did a longitudinal study using seven waves of data that were collected once every 2 years between 2004 and 2017, from adults aged 50 years and older in the English Longitudinal Study of Ageing (ELSA). The exposure was loneliness at baseline (wave two), measured with the short 1980 revision of the University of California, Los Angeles Loneliness Scale (R-UCLA). The primary outcome was a score indicating severity of depression measured at six subsequent timepoints (waves three to eight), using the eight-item version of the Centre for Epidemiologic Studies Depression Scale (CES-D). Analyses were linear multilevel regressions, before and after adjusting for social isolation, social support, polygenic risk scores, and other sociodemographic and health-related confounders. The secondary outcome was depression diagnosis, measured using a binary version of the CES-D.

FINDINGS

4211 (46%) of 9171 eligible participants had complete data on exposure, outcome, and confounders, and were included in our complete case sample. After all adjustments, a 1-point increase in loneliness score was associated with a 0·16 (95% CI 0·13-0·19) increase in depressive symptom severity score (averaged across all follow-ups). We estimated a population attributable fraction for depression associated with loneliness of 18% (95% CI 12-24) at 1 year of follow-up and 11% (3-19) at the final follow-up (wave eight), suggesting that 11-18% of cases of depression could potentially be prevented if loneliness were eliminated. Associations between loneliness and depressive symptoms remained after 12 years of follow-up, although effect sizes were smaller with longer follow-up.

INTERPRETATION

Irrespective of other social experiences, higher loneliness scores at baseline were associated with higher depression symptom severity scores during 12 years of follow-up among adults aged 50 years and older. Interventions that reduce loneliness could prevent or reduce depression in older adults, which presents a growing public health problem worldwide.

FUNDING

National Institute on Aging and a consortium of UK Government departments coordinated by the National Institute for Health Research.

The experience of loneliness among young people with depression: a qualitative meta-synthesis of the literature

BACKGROUND

Young people have a higher prevalence of loneliness than other age groups, and they are also at risk of depression. Quantitative studies describe a bidirectional association between loneliness and depression, but there is limited understanding of how these influence each other. Little is known about the experience of loneliness among young people with depression. Qualitative approaches may help understand the relationship between loneliness and depression among young people, and how to intervene to improve outcomes. We aimed to conduct a meta-synthesis to understand the complex inter-relationship between loneliness and depression among young depressed people by synthesising evidence from a systematic review of qualitative studies.

METHODS

We conducted a meta-synthesis of qualitative studies capturing experiences of loneliness among young people with depression. We systematically searched six electronic databases for selected search terms, critically appraised eligible studies, and analysed the data from included studies using the approach of thematic synthesis. We used feedback from an inter-disciplinary research workshop to improve reflexivity.

RESULTS

Our inclusion criteria identified fourteen studies. Our analysis identified four themes: (1) social withdrawal due to poor mental health, (2) non-disclosure of depression contributing to social distance, (3) the desire to connect, and (4) paradoxes of loneliness and depression. These themes illustrated a range of pathways between depression and loneliness, and a sense of how these might be mutually reinforcing. Our findings suggest that where depressed individuals engage in certain behaviours (withdrawing; not confiding) for a range of reasons, this can lead to feelings of loneliness, an awareness of which worsens their mood, thus perpetuating their depression.

CONCLUSIONS

Young people with depression experience loneliness as an insurmountable distance between themselves and others. Our findings identified non-disclosure of depression, and the debilitating nature of the depressive symptomatology, as factors perpetuating a vicious cycle of loneliness and depression. They suggest that approaches to tackling the problem might include helping young people communicate about their depression to trusted friends and educating their social networks in how to support them. The wider research literature suggests that cognitive interventions may have a role in shifting maladaptive cognitions about their social world.

Low Mood and Risk of Dementia: The Role of Marital Status and Living Situation

OBJECTIVE

This study aims to explore whether low mood is related to an increased dementia risk in two cohorts of older adults of different generations, and whether marital status and living situation modify this association.

METHODS

Participants (≥70 years), free from dementia and living at home, were identified from two population-based studies: the Kungsholmen Project (KP; n = 1,197) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; n = 1,402). Low mood was obtained by self-report (KP and SNAC-K) at baseline in 1987-89 (KP) and 2001-04 (SNAC-K). Incident dementia cases were ascertained over 9 years, using the same diagnostic procedures and comparable criteria for the two cohorts (DSM-III-R in KP and DSM-IV-TR in SNAC-K). Hazard ratios (HR) were derived from Cox proportional hazards models.

RESULTS

Those having low mood at baseline were at higher risk of dementia in both cohorts combined (HR: 1.2, 95% confidence interval (CI): 1.0-1.4) than those without low mood. However, an increased risk was detected only in those who did not have a partner (HR: 1.5, 95% CI: 1.2-1.9), or lived alone (HR: 1.5, 95% CI: 1.2-1.9), but not among those who had a partner or lived with someone (HR: 0.8, 95% CI: 0.5-1.2).

CONCLUSION

Marital status and living situation have the potential to buffer the detrimental effects of low mood on dementia onset. Thus, specific attention from health care should target individuals having low mood and who do not have a partner or live alone.

Internet use and self-rated health among Swedish 70-year-olds: a cross-sectional study

Background

The Internet is increasingly becoming an infrastructure for a number of services, both commercial, public (including health related) and personal. Using the internet have the potential to promote social interaction and social connectedness by upholding social networks and social contacts. However, Internet use is lower in older adults compared to other age groups. This digital divide is considered a risk to the health of older adults since it limits their participation in society, access and use of relevant health related information and services. This study focuses on whether there is an association between Internet use and self-rated health.

Method

A cross-sectional population-based sample of 70-year-olds from The Gothenburg H70 Birth Cohort Study (n = 1136) was examined in 2014–16. All data was collected using structured interviews and questionnaires. Differences in proportions were tested with chi-square test and ordinary least square regression analysis was used to estimate the relationship between Internet use and self-rated health controlling for health factors, hearing and visual impairment, and social contacts.

Results

There is a relationship between more frequent Internet use and good self-rated health (unstandardized β 0.101 p < 0.001), and the effect remained after adjusting for all covariates (unstandardized β 0.082 p < 0.001). Our results also show that, in comparison to health factors, Internet use is of minor importance to the SRH of older adults, since adding these improved the explanatory power of the model by approximately 400% (from 0.04 to 0.18).

Conclusion

Although the direction of the relationship between more frequent interne use and better self-rated health is undetermined in the present study, it can be suggested that using the Internet informs and educates older adults, strengthening their position as active and engaged participants of society. It can also be suggested that those using the Internet report less loneliness and a possibility to establish new computer-mediated relationships within online communities. Further research needs to examine what aspects of Internet use, and in what contexts such positive perceptions arise.

Comparisons of the discrepancy between loneliness and social isolation across Ireland and Sweden: findings from TILDA and SNAC-K

PURPOSE

Loneliness may have different cultural meanings in different countries. This may manifest as differing levels of Social Asymmetry-the discrepancy between loneliness and social isolation. Since loneliness is thought to be low in Sweden relative to more southerly countries, we hypothesised that more number of individuals would also fall into the "discordant robust" category of Social Asymmetry, i.e. that more individuals in Sweden would have lower loneliness levels relative to social isolation than in Ireland. We also explored the clinical relevance of Social Asymmetry in both countries, by examining its association with cognitive functioning.

METHODS

We derived Social Asymmetry metrics in two representative cohort studies: the Irish Longitudinal Study on Ageing (TILDA) and the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K). Data pertaining to a dementia-free sample of 4565 Irish participants and 3042 Swedish participants, all aged over 60 years, were analysed using a multilevel modelling approach, with country as a higher-order variable.

RESULTS

Contrary to the expected, more individuals in Ireland were "discordant robust" than in Sweden. We also found evidence for superior performance in global cognitive functioning among those in the "discordant robust" category relative to those in the discordant susceptible (i.e. those with higher levels of loneliness than social isolation) category, β = 0.61, p < .001, across both countries.

CONCLUSIONS

Irish older adults may be more robust to the impact of social isolation on loneliness than those in the Swedish cohort. Social Asymmetry was related to cognitive functioning in both countries, suggesting that Social Asymmetry is a clinically relevant construct.

Social isolation, loneliness and health in old age: a scoping review

The health and well-being consequences of social isolation and loneliness in old age are increasingly being recognised. The purpose of this scoping review was to take stock of the available evidence and to highlight gaps and areas for future research. We searched nine databases for empirical papers investigating the impact of social isolation and/or loneliness on a range of health outcomes in old age. Our search, conducted between July and September 2013 yielded 11,736 articles, of which 128 items from 15 countries were included in the scoping review. Papers were reviewed, with a focus on the definitions and measurements of the two concepts, associations and causal mechanisms, differences across population groups and interventions. The evidence is largely US-focused, and loneliness is more researched than social isolation. A recent trend is the investigation of the comparative effects of social isolation and loneliness. Depression and cardiovascular health are the most often researched outcomes, followed by well-being. Almost all (but two) studies found a detrimental effect of isolation or loneliness on health. However, causal links and mechanisms are difficult to demonstrate, and further investigation is warranted. We found a paucity of research focusing on at-risk sub-groups and in the area of interventions. Future research should aim to better link the evidence on the risk factors for loneliness and social isolation and the evidence on their impact on health.

The impact and measurement of social dysfunction in late-life depression: an evaluation of current methods with a focus on wearable technology

OBJECTIVE

Depression is known to negatively impact social functioning, with patients commonly reporting difficulties maintaining social relationships. Moreover, a large body of evidence suggests poor social functioning is not only present in depression but that social functioning is an important factor in illness course and outcome. In addition, good social relationships can play a protective role against the onset of depressive symptoms, particularly in late-life depression. However, the majority of research in this area has employed self-report measures of social function. This approach is problematic, as due to their reliance on memory, such measures are prone to error from the neurocognitive impairments of depression, as well as mood-congruent biases.

METHOD

Narrative review based on searches of the Web of Science and PubMed database(s) from the start of the databases, until the end of 2015.

RESULTS

The present review provides an overview of the literature on social functioning in (late-life) depression and discusses the potential for new technologies to improve the measurement of social function in depressed older adults. In particular, the use of wearable technology to collect direct, objective measures of social activity, such as physical activity and speech, is considered.

CONCLUSION

In order to develop a greater understanding of social functioning in late-life depression, future research should include the development and validation of more direct, objective measures in conjunction with subjective self-report measures. Copyright © 2016 John Wiley & Sons, Ltd.

Social support and protection from depression: systematic review of current findings in Western countries

BACKGROUND

Numerous studies report an association between social support and protection from depression, but no systematic review or meta-analysis exists on this topic.

AIMS

To review systematically the characteristics of social support (types and source) associated with protection from depression across life periods (childhood and adolescence; adulthood; older age) and by study design (cross-sectional v cohort studies).

METHOD

A systematic literature search conducted in February 2015 yielded 100 eligible studies. Study quality was assessed using a critical appraisal checklist, followed by meta-analyses.

RESULTS

Sources of support varied across life periods, with parental support being most important among children and adolescents, whereas adults and older adults relied more on spouses, followed by family and then friends. Significant heterogeneity in social support measurement was noted. Effects were weaker in both magnitude and significance in cohort studies.

CONCLUSIONS

Knowledge gaps remain due to social support measurement heterogeneity and to evidence of reverse causality bias.

Determinants of sexual activity in four birth cohorts of Swedish 70-year-olds examined 1971-2001

INTRODUCTION

Knowledge about determinants of sexual activity in older adults in the general population is limited. Human senescence has been delayed by a decade, and people are reaching old age in better health.

AIM

The aim of this study was to investigate determinants of sexual activity in four birth cohorts of non-demented 70-year-olds examined in 1971-1977 and 1992-2001.

MAIN OUTCOME MEASURE

The main outcome measure was sexual activity (defined as intercourse) during the past year.

METHODS

The study is based on cross-sectional data from four population samples of 70-year-olds from Gothenburg, Sweden (N = 1,407) systematically sampled from the Swedish population register.

RESULTS

In the time periods 1971-1972 and 2000-2001, sexual activity among men increased from 47% to 66%, and in women from 12% to 34%. Sexual activity was related to positive attitude toward sexuality, sexual debut before age 20, having a very happy relationship, having a physically and mentally healthy partner, self-reported good global health, interviewer-rated good mental health, being married/cohabiting, satisfaction with sleep, and drinking alcohol more than three times a week. Having an older partner, diabetes mellitus, coronary heart disease, higher physical health-sum score, and depression were related to less sexual activity. Interaction effects for birth cohort, with stronger positive associations in 1971-1972, were found for positive attitude toward sexuality, strong desire at age 20-30, premarital sexuality, having a younger partner, self-reported good global health, interviewer-rated good global mental health, overweight, and satisfaction with sleep. Having an older partner and depression showed stronger negative associations in the 1970s. Physical health-sum score showed a stronger negative association in 1992-2001.

CONCLUSIONS

We found that determinants of sexual activity in older people are numerous and varied, and change over time. It is thus important that health professionals and others take a holistic approach when dealing with sexual problems in older adults. Sexual aging should be part of health care and medical education. Clinicians should be trained to ask older patients about sexual concerns.