Factors Associated With Loneliness: An Umbrella Review Of Observational Studies

Cultural Dimensions Moderate the Association between Loneliness and Mental Health during Adolescence and Younger Adulthood: A Systematic Review and Meta-Analysis

Cultural factors, such as country or continent, influence the relationship between loneliness and mental health. However, less is known about how cultural dimensions moderate this relationship during adolescence and younger adulthood, even if these dimensions manifest as country or continent differences. This study aims to examine the potential influence of Hofstede's cultural dimensions on this relationship using a three-level meta-analysis approach. A total of 292 studies with 291,946 participants aged 10 to 24 were included in this study. The results indicate that cultural dimensions, such as individualism vs. collectivism, indulgence vs. restraint, power distance, and long-term vs. short-term orientation, moderated the associations between loneliness and social anxiety, stress, Internet overuse, and negative affect. The association between loneliness and mental health was not moderated by cultural dimensions, such as masculinity and uncertainty avoidance. These findings suggest that culture's influence on the association between loneliness and mental health is based on a domain-specific mechanism.

Loneliness and associated factors among middle-aged and older adults: cross-sectional and longitudinal survey results from the HAALSI cohort in South Africa

OBJECTIVES

Longitudinal studies on chronic loneliness and before and during the COVID-19 pandemic are lacking in Africa. The study aimed to estimate the prevalence and associated factors of loneliness and chronic loneliness using cross-sectional and longitudinal data from middle-aged and older adults from rural South Africa.

METHOD

The analysis utilized data from the South African 7-year longitudinal Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) (analytic sample: n = 3,418, aged 40 years and older). Loneliness was assessed with a single and 3-item measure.

RESULTS

The proportion of loneliness was 19.5% in the 2021/2022 survey, the incidence of chronic loneliness (having loneliness in wave 2 and 3, and free of loneliness in wave 1) was 18.9%, and the 7-year incidence of loneliness was 41.0%. Comparing the 2019 (pre-COVID-19) to 2021/2022 (during COVID-19 pandemic) surveys participants experienced a significant reduction of loneliness. In cross-sectional and/or longitudinal analyses, we found that younger age, living alone, food insecurity, lack of social engagement, depressed mood, poor life satisfaction, poor sleep quality, impaired cognition, poor self-rated health, functional disability, underweight, obesity, and not living with HIV were associated with a higher prevalence, incidence and/or increases in loneliness.

CONCLUSION

One in five aging adults had acute or chronic loneliness. Several social, mental, and physical health factors were identified as associated with loneliness.

Prevalence of Four Types of Social Support and Their Relation to Mental Health among low-income U.S. Veterans: Implications for Community Health

To provide a comprehensive examination of different types of social support and associations with mental health among U.S. military veterans, a group vulnerable to psychosocial dysfunction. Using a nationally representative sample of 1,004 low-income U.S. veterans, this study examined the prevalence and mental health correlates of emotional, informational/tangible, positive social interaction, and affectionate social support. In the sample, 49-60% of participants perceived the four types of social support "most of the time" with the lowest prevalence being positive social interaction and the highest being affectionate support. Multivariable analyses found higher levels of all four types of social support were significantly associated with being married and greater mental health functioning. Some types of social support were uniquely associated with income level and positive screens for specific psychiatric disorders. Low social support is common among low-income U.S. veterans, and there is a need for community health interventions that target different types of social support to improve mental health and community integration.

Quality of Life and Loneliness Among American Military Veterans

ABSTRACT

Quality of life and loneliness are closely associated with mental and physical health outcomes. This relationship is particularly important in Veterans who experience elevated rates of disabilities, comorbidities, and chronic health conditions as compared with non-Veterans. In the present project, we use data from the Military Health and Well-Being Project ( n = 1469, 67.2% men, 32.3% women, 0.5% transgender, nonbinary, prefer not to say) to investigate the link between five domains of quality of life ( i.e. , general quality of life, physical health, psychological health, social relationships, and environment) with loneliness in American Military Veterans. Findings indicated that every domain of quality of life was negatively and significantly associated with loneliness ( r 's < -0.45, p 's < 0.001), such that quality of life decreased as loneliness increased. We further found, using linear regression, that quality social relationships (β = -0.385, t = -13.23), psychological functioning (β = -0.196, t = -5.28), and physical health (β = -0.133, t = -4.174) were related to low levels of loneliness. Taken together, these findings indicate that in this sample of Veterans 1) general quality of life, physical health, psychological health, social relationships, and environment are all strongly connected with loneliness, and 2) of these, social relationships, psychological health, and physical health seem to protect most against loneliness, with large robust effect sizes. We recommend that intervention and policy researchers continue to investigate and develop feasible, acceptable, and cost-effective ways to promote social relationships, psychological health, and physical health among Veterans. Data were collected during the COVID-19 pandemic, which may limit generalizability of these findings.

Socially isolated, but not lonely in lockdown: Exploring the role of reflective functioning as a protective factor in the early days of the COVID-19 pandemic in Germany

INTRODUCTION

Loneliness is a pressing public mental health issue. So far, there has been a paucity of investigations focused on the individual differences modulating this subjective feeling in the face of difficult circumstances, e.g., the COVID-19 pandemic. As such, the present study aimed to investigate the role of mentalization; given that the construct comprises reflection abilities that might be particularly relevant to the pandemic's interpersonal challenges.

METHODS

A survey representative of the German population was conducted from May to June 2020 (N = 2503). We examined mentalization, operationalized as reflective functioning (RF) and measured using the Mentalization Questionnaire (MZQ), both as a protective factor against loneliness on its own and as a moderator of the association of social isolation with loneliness.

RESULTS

Of the overall sample, 822 (32.8 %) individuals reported social isolation. Worse RF was moderately associated with higher levels of loneliness (r = 0.433, p < .001). A linear regression model (controlling for sociodemographic characteristics and general personality pathology) confirmed this positive association, but also indicated an interaction effect of RF and social isolation in the statistical prediction of loneliness. Stratified models showed that RF was a comparatively weaker statistical predictor of loneliness among the socially isolated.

DISCUSSION

This representative population study expanded our knowledge about the factors shaping loneliness in the population. RF emerged as a potentially modifiable protective influence. Further research needs to clarify the mechanisms through which it mitigates loneliness.

LIMITATIONS

The cross-sectional design does not give insight into the temporal association of RF and loneliness.

The longitudinal relation between loneliness and perceived stress: A structural equation modelling analysis of 10,159 individuals

AIMS

Prolonged loneliness and severe stress are increasingly recognised as public health concerns and considered risk factors for mental disorders, somatic illnesses and mortality. Loneliness and perceived stress also often co-occur; however, their longitudinal relation remains unclear. To the best of our knowledge, this is the first study aiming to investigate the longitudinal relation between loneliness and perceived stress independently of cross-sectional associations and time effects.

METHODS

Designed as a population-based cohort study with repeated measurements, the present study included individuals aged 16-80 years at baseline who participated in the Danish National Health Survey ('How are you?') in 2013 and 2017 (N = 10,159; response rate = 50%). Structural equation modelling was used to examine associations between loneliness and perceived stress in the total sample and across age groups (i.e., 16-29, 30-64 and 65-80 years).

RESULTS

The models indicated bidirectional relations between loneliness and perceived stress. The standardized cross-lagged path from loneliness to perceived stress (β: 0.12, 95% confidence interval (CI) (0.08, 0.16), p < 0.001) and from perceived stress to loneliness (β: 0.12, 95% CI (0.07, 0.16), p < 0.001) both corresponded to small effect sizes in the total sample. Additionally, the results indicated strong cross-sectional associations, especially among adolescents and young adults (16-29 years), and high temporal stability, especially among the elderly (65-80 years).

CONCLUSIONS

Loneliness and perceived stress mutually predict each other over time. The finding of both substantial bidirectional and cross-sectional associations demonstrates an interdependence between loneliness and perceived stress that may be relevant to consider in future interventions.

Time-varying living arrangements and suicide death in the general population sample: 14-year causal survival analysis via pooled logistic regression

AIMS

While past research suggested that living arrangements are associated with suicide death, no study has examined the impact of sustained living arrangements and the change in living arrangements. Also, previous survival analysis studies only reported a single hazard ratio (HR), whereas the actual HR may change over time. We aimed to address these limitations using causal inference approaches.

METHODS

Multi-point data from a general Japanese population sample were used. Participants reported their living arrangements twice within a 5-year time interval. After that, suicide death, non-suicide death and all-cause mortality were evaluated over 14 years. We used inverse probability weighted pooled logistic regression and cumulative incidence curve, evaluating the association of time-varying living arrangements with suicide death. We also studied non-suicide death and all-cause mortality to contextualize the association. Missing data for covariates were handled using random forest imputation.

RESULTS

A total of 86,749 participants were analysed, with a mean age (standard deviation) of 51.7 (7.90) at baseline. Of these, 306 died by suicide during the 14-year follow-up. Persistently living alone was associated with an increased risk of suicide death (risk difference [RD]: 1.1%, 95% confidence interval [CI]: 0.3-2.5%; risk ratio [RR]: 4.00, 95% CI: 1.83-7.41), non-suicide death (RD: 7.8%, 95% CI: 5.2-10.5%; RR: 1.56, 95% CI: 1.38-1.74) and all-cause mortality (RD: 8.7%, 95% CI: 6.2-11.3%; RR: 1.60, 95% CI: 1.42-1.79) at the end of the follow-up. The cumulative incidence curve showed that these associations were consistent throughout the follow-up. Across all types of mortality, the increased risk was smaller for those who started to live with someone and those who transitioned to living alone. The results remained robust in sensitivity analyses.

CONCLUSIONS

Individuals who persistently live alone have an increased risk of suicide death as well as non-suicide death and all-cause mortality, whereas this impact is weaker for those who change their living arrangements.

Factors associated with loneliness in middle-aged and older patients with breast cancer

Objective

Loneliness is associated with adverse mental and physical health conditions and increased mortality. In this study, we identified significant factors associated with loneliness in middle-aged and older patients with breast cancer (BC).

Methods

For this cross-sectional study, we enrolled 200 patients (aged from 20 to 60 years) with BC from two hospitals in Indonesia through convenience sampling. Demographic characteristics, distress symptoms (Symptom Distress Scale), social support (Multidimensional Scale of Perceived Social Support), frailty (Groningen Frailty Indicator), and loneliness (UCLA Loneliness Scale, version 3) were measured. Multivariate logistic regression was performed to identify significant factors associated with loneliness in our cohort.

Results

Loneliness risk was negatively correlated with social support but positively correlated with unemployment and frailty. Thus, the patients received a high level of social support (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92-0.99) and had a low risk of severe loneliness. By contrast, patients who were unemployed (OR: 4.00; 95% CI: 1.65-9.66) and those who had frailty (OR: 5.79; 95% CI: 2.50-13.42) had an elevated risk of severe loneliness.

Conclusions

Unemployment, social support, and frailty may significantly influence the risk of loneliness in patients with BC. Early and regular assessments of loneliness should be integrated in the care of these patients. Suitable strategies aimed at increasing social support and mitigating frailty may benefit middle-aged and older patients with BC, particularly unemployed patients, by reducing their risk of loneliness.

Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain

BACKGROUND

The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness.

METHODS

A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses.

RESULTS

The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced.

CONCLUSION

Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.

Young people's views on the acceptability and feasibility of loneliness interventions for their age group

BACKGROUND

Loneliness is a frequently reported problem for young people aged 16 to 24 years old. A variety of interventions have been developed (but in most cases not extensively evaluated) to try and tackle loneliness in this age group. These include interpersonal, intrapersonal, and social approaches that vary in their content and mechanisms of action. The current study aimed to qualitatively examine young peoples' views on the acceptability and feasibility of different loneliness interventions.

METHODS

Young people from 16 to 24 years old living in the United Kingdom who self-identified as having experienced loneliness were recruited to participate in this study. We conducted semi-structured qualitative interviews to assess their views on the acceptability and feasibility of loneliness interventions for their age group. Interviews were analysed using inductive reflexive thematic analysis.

RESULTS

Our analysis of 23 individual interview transcripts identified six themes. These related to the appropriate stage for intervention and how different types of strategies may be best suited to particular contexts; the key facilitators and barriers to engaging young people in an intervention; considerations for optimising the delivery of an intervention; divergent views on technology use in strategies to manage loneliness; the scope of an intervention and whether it takes a targeted or general approach; and the idea of combining different options within an intervention to allow tailoring to individual preferences and nature of loneliness.

CONCLUSIONS

These findings demonstrate the need for continued development of individualised interventions designed to help manage loneliness in this age group. Future loneliness strategies should be co-produced with young people to ensure that they suit the varying needs of this population.

A One-Arm Pilot Trial of a Telehealth CBT-Based Group Intervention Targeting Transdiagnostic Risk for Emotional Distress

The COVID-19 pandemic had a significant impact on mental health, straining an already overburdened healthcare system. A modular, transdiagnostic approach to treating psychopathology may be ideal to target common transdiagnostic risk factors for emotional distress and related disorders likely to be impacted by circumstances related to this once-in-a-lifetime environmental stressor. Anxiety sensitivity (AS), or fear of anxious arousal, intolerance of uncertainty (IU), or distress when confronted with uncertainty, and loneliness are three transdiagnostic risk factors impacted by the pandemic and robust predictors of emotional distress beyond that. We completed a pilot feasibility, acceptability, and utility trial of Coping Crew, our group, telehealth-delivered transdiagnostic treatment protocol in 17 participants who completed the intervention (M age = 22.00, SD = 4.46; 71% female). The intervention and study protocol were feasible to deliver and were rated as acceptable and useful to address intervention targets. Evidence was mixed regarding feasibility, acceptability, and usefulness of the mobile app component. Sixteen of 17 participants (94%) completed at least one survey a day on 80% of the days but only 6 participants (35%) completed at least 80% of the mobile app surveys delivered over the course of the intervention. Most participants rated use of the app as acceptable and relevant to psychological improvements made due to the intervention. Sizeable effect size reductions in transdiagnostic risk factors were found at post-intervention and maintained at 1- and 3-month follow-up, supporting next steps in the development of this modular transdiagnostic treatment.

The association between social connectedness and euthanasia and assisted suicide and related constructs: systematic review

BACKGROUND

Euthanasia and assisted suicide (EAS) requests are common in countries where they are legal. Loneliness and social isolation are modifiable risk factors for mental illness and suicidal behaviour and are common in terminal illness. Our objective was to summarise available literature to clarify whether these and related measures of social connectedness might contribute to requests for EAS.

METHODS

We conducted a pre-registered (PROSPERO CRD42019160508) systematic review and narrative synthesis of quantitative literature investigating associations between social connectedness and a) requested/actual EAS, b) attitudes towards EAS, and c) a desire for hastened death (DHD) by searching six databases (PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, Google Scholar) from inception to November 2022, rating eligible peer-reviewed, empirical studies using the QATSO quality assessment tool.

RESULTS

We identified 37 eligible studies that investigated associations with a) requested/actual EAS (n = 9), b) attitudes to EAS (n = 16), and c) DHD (n = 14), with limited overlap, including 17,359 participants. The majority (62%) were rated at medium/high risk of bias. Focussing our narrative synthesis on the more methodologically sound studies, we found no evidence to support an association between different constructs of social connectedness and requested or actual EAS, and very little evidence to support an association with attitudes to EAS or an association with DHD.

CONCLUSIONS

Our findings for all age groups are consistent with a those of a previous systematic review focussed on older adults and suggest that poor social connectedness is not a clear risk factor for EAS or for measures more distally related to EAS. However, we acknowledge low study quality in some studies in relation to sampling, unvalidated exposure/outcome measures, cross-sectional design, unadjusted analyses, and multiple testing. Clinical assessment should focus on modifying established risk factors for suicide and EAS, such as hopelessness and depression, as well as improving any distressing aspects of social disconnectedness to improve quality of life.

FUNDING

UKRI, NIHR.

Guidelines for evaluating and reporting social isolation and loneliness interventions

Given the unpleasant nature of social isolation and loneliness (SIL) and their negative effects on health and wellbeing, interventions are needed. However, persistent issues in the design, evaluation, and reporting of SIL interventions preclude conclusive evidence and commentary on the effectiveness of SIL interventions. Here, we propose guidelines for evaluating SIL interventions, firstly by operationalising them into two categories: (1) interventions aiming to reduce SIL as a primary outcome and (2) interventions aiming to improve non-SIL outcomes in the lives of individuals experiencing SIL. Secondly, we evaluate instruments for measuring SIL and research designs for studying intervention effectiveness. Thirdly, guidelines for reporting information about the intervention, study design, results, and discussion in SIL intervention studies are presented. These guidelines will help researchers to better and more consistently report on SIL interventions and improve comparability of SIL interventions, ultimately contributing to the improvement of interventions and to the mitigation of SIL.

Depressive symptoms and loneliness among early adolescents: a psychometric network analysis approach

BACKGROUND

Previous studies demonstrate a high prevalence of depression and loneliness among adolescents. Although they often co-occur, the relationship between symptoms of depression and loneliness remains poorly understood. This study investigates: (a) the symptoms of depression that are connected to loneliness; (b) the role played by loneliness in the network of depression symptoms; and (c) whether the method used to measure loneliness (single-item direct or multi-item indirect) affects the relationship of loneliness with depressive symptoms.

METHODS

Participants were 496 Polish adolescents (50.8% girls) aged 11 to 13, who completed: (a) the 10-item Major Depressive Disorder subscale of the Revised Child Anxiety and Depression Scale; (b) the 11-item De Jong Gierveld Loneliness Scale (indirect loneliness), and (c) a single direct question evaluating loneliness: 'I'm lonely'. Networks were estimated using a Gaussian Graphical Model.

RESULTS

Loneliness shows a direct relationship with three affective symptoms of depression: sadness, worthlessness, and anhedonia, which mediate relationships with somatic symptoms. In contrast to previous studies, loneliness has the lowest level of centrality among all elements of the network. The method used to assess loneliness did not significantly affect the connections between loneliness and depressive symptoms.

CONCLUSIONS

Loneliness and depression overlap since they are formed by the same cognitive biases and deficits in emotion regulation but differ in the level of generality. In loneliness, they have an interpersonal context, while symptoms of depression can be intrapersonal. This helps us to understand why cognitive interventions, as compared to those which are social, are more effective in reducing loneliness.

Global time trends of perceived loneliness among adolescents from 28 countries in Africa, Asia, and the Americas

BACKGROUND

Perceived loneliness in adolescence is associated with a plethora of adverse outcomes. However, data on its temporal trends are scarce. Therefore, we aimed to examine the temporal trend of perceived loneliness among school-going adolescents aged 12-15 years from 28 countries in Africa, Asia, and the Americas, where temporal trends of loneliness are largely unknown.

METHODS

Cross-sectional data from the Global School-based Student Health Survey 2003-2017 were analyzed. Perceived loneliness referred to feeling lonely most of the time or always in the past 12 months. Crude linear trends of perceived loneliness by country were assessed by linear regression models.

RESULTS

Data on 180,087 adolescents aged 12-15 years were analyzed [Mean (SD) age 13.7 (1.0) years; 51.4 % females]. The overall prevalence of perceived loneliness was 10.7 %. Among the 28 countries included in the study, significant increasing and decreasing trends were observed in six counties each, with stable trends found in 16 countries. The most drastic increase and decrease were observed in Egypt between 2006 (7.9 %) and 2011 (14.3 %), and in Samoa between 2011 (23.3 %) and 2017 (8.0 %), respectively. Stable trends with high prevalence across time were also common.

CONCLUSION

Our data suggest that perceived loneliness among adolescents is a global phenomenon, which has seen little improvement if any in recent years. It would be prudent to implement nationwide policies to combat loneliness globally.

Distress Symptoms of Old Age and Mild Cognitive Impairment are Two Distinct Dimensions in Older Adults Without Major Depression

Background

Studies in old adults showed bidirectional interconnections between amnestic mild cognitive impairment (aMCI) and affective symptoms and that adverse childhood experiences (ACE) may affect both factors. Nevertheless, these associations may be confined to older adults with clinical depression.

Aim

To delineate the relationship between clinical symptoms of aMCI and affective symptoms in older adults without major depression (MDD) or dysfunctions in activities of daily living (ADL).

Methods

This case-control study recruited 61 participants with aMCI (diagnosed using Petersen's criteria) and 59 older adults without aMCI and excluded subjects with MDD and ADL dysfunctions.

Results

We uncovered 2 distinct dimensions, namely distress symptoms of old age (DSOA), comprising affective symptoms, perceived stress and neuroticism, and mild cognitive dysfunctions, comprising episodic memory test scores, the total Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores. A large part of the variance (37.9%) in DSOA scores was explained by ACE, negative life events (health and financial problems), a subjective feeling of cognitive decline, and education (all positively). ACE and NLE have a highly significant impact on the DSOA score and are not associated with aMCI or its severity. Cluster analysis showed that the diagnosis of aMCI is overinclusive because some subjects with DSOA symptoms may be incorrectly classified as aMCI.

Conclusion

The clinical impact is that clinicians should carefully screen older adults for DSOA after excluding MDD. DSOA might be misinterpreted as aMCI.

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.

Correlates and trajectories of loneliness among community-dwelling older adults during the COVID-19 pandemic: A Canadian longitudinal study

The COVID-19 pandemic provided a unique opportunity to examine the contributions of social interaction and other non-social factors to loneliness among older adults in the context of confinement measures constraining opportunities for in-person social interactions. This study aims to identify groups of individuals with heterogeneous trajectories of loneliness during the COVID-19 pandemic and to explore the sociodemographic, health, psychological and social interaction-related factors associated with these trajectories. In this 12-month longitudinal study, 614 community-dwelling individuals aged 60+ years completed telephone-based interviews on four occasions between May 2020 and May 2021. Loneliness was evaluated using the three-item version of the UCLA Loneliness Scale. Multilevel modelling assessed average changes in loneliness over time. Group-based trajectory modelling was performed to identify distinct trajectories of loneliness over time. Multinomial logistic regressions were conducted to explore the predictors of these trajectories. On average, there was a curvilinear change in loneliness that tracked the stringency of the COVID-19-related confinement measures. In this convenience sample, three heterogeneous trajectories were identified: a stable-low (17.2%), a fluctuating-moderate (48.8%) and a sustained-elevated (34.0%) trajectory. Participants in the sustained-elevated loneliness trajectory were more likely to live alone and experience elevated psychological distress and greater COVID-19 perceived health threat compared to those in the stable-low trajectory. Participants in the fluctuating-moderate loneliness group were more likely to have multimorbidity, experience greater psychological distress, and have less frequent in-person interactions than the stable-low loneliness group. Assessing the combination of sociodemographic, health, psychological and social factors may help identify individuals at higher risk for chronic loneliness.

Adolescent loneliness across the world and its relation to school climate, national culture and academic performance

BACKGROUND

Loneliness during adolescence has adverse consequences for mental health, education and employment outcomes. Yet, we know little about common correlates of loneliness among adolescents, making intervention work difficult.

AIMS

In this study, we (1) explore individual-, school- and country-level correlates of loneliness to help identify potential intervention targets, and (2) examine the influence of loneliness on academic performance.

SAMPLE

A total of 518,210 students aged 15 years from 75 countries provided self-reported loneliness data.

RESULTS

Using multilevel modelling, we found individual-, school- and country-level correlates of self-reported school-based loneliness, and showed that loneliness negatively influenced academic performance.

CONCLUSIONS

Based on the findings, interventions that focus on enhancing social and emotional skills, increasing trust between teachers and students and changing school climate to be more inclusive are likely to be the most effective for adolescents; they should also be culturally sensitive.

Loneliness in the Norwegian adolescent population: prevalence trends and relations to mental and self-rated health

BACKGROUND

Loneliness has become a significant public health problem and should be addressed with more research over a broader period. This study investigates the variations in the prevalence of loneliness among a nationally representative study population of Norwegian adolescents over the last three decades and whether age, gender, self-rated health, and mental distress are associated with these changes.

METHODS

Adolescents aged 13-19 years completed the structured and validated questionnaires from the three waves of the Young-HUNT Study: 1995-1997, 2006-2008, and 2017-2019. Loneliness was measured with one item asking, 'Are you lonely?'. Hopkins Symptom Checklist-5 was used to measure mental distress (cut-off ≥ 2). Self-rated health was assessed by a single question 'How is your health at the moment?' Measures were provided by self-report. Descriptive analyses were stratified by age, gender, self-rated health, and mental distress. Linear-by-Linear association test across survey years was performed to test time trends of loneliness. Logistic regression was used to analyze the cross-sectional associations of self-rated health and mental distress with loneliness, adjusting for sociodemographic factors in all three waves of Young-HUNT.

RESULTS

Loneliness prevalence doubled from 5.9% in 1995/97 to 10.2% in 2017/19 in the total population sample. The highest loneliness prevalence and an increase from 8.9% in 1995/97 to 16.7% in 2017/19 was observed in girls of 16-19 years. Among mentally distressed adolescents, loneliness increased from 22.3% in 1995/97 to 32.8% in 2006/08 and lowered to 27% in 2017/19. Increasing loneliness prevalence was seen in those with poor self-rated health, i.e., 14.6% in 1995-97 and 26.6% in 2017-19. Mental distress and poor self-rated health were associated with higher odds of loneliness in each wave (p < 0.001).

CONCLUSION

The results highlight the increasing burden of loneliness in the Norwegian adolescent population, especially girls. Those with mental distress and poor self-rated health have a higher risk of experiencing loneliness. Thus, health-promoting upbringing environments for children and adolescents that support mutual affinity, social support, integration, and belongingness in adolescents' daily arenas are essential.

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.

Loneliness Is Associated With Problematic Internet Use but Not With the Frequency of Substance Use: A Czech Cross-Sectional Study

Objectives: This study aimed to assess the associations between loneliness and the frequency of substance use and problematic Internet use (PIU) in different age groups. Methods: Data were collected in April 2021 from a sample of 1,293 participants with main characteristics close to a nationally representative sample (mean age = 50.1 ± 15.4 years; 56% male). We measured loneliness with the Three-Item Loneliness Scale (TILS), PIU with the General Problematic Internet Use Scale-2 (GPIUS-2) and the frequency of drugs, alcohol, smoking or caffeine consumption. Spearman's correlation, the t-test, and one-way and multivariate linear regression models were used to analyze the data. Results: In our study, 43.8% of respondents reported moderate to severe levels of loneliness. Loneliness was associated with the severity of PIU [F (3, 1,277) = 15.25, p < 0.001], with higher loneliness corresponding to higher PIU. No significant relationship was found between loneliness and drugs, alcohol, smoking or caffeine consumption. Conclusion: Regardless of age, loneliness is associated with PIU but not with the frequency of substance use. Professional help for lonely people should focus on problematic Internet use in all age groups.

Impacts of grandparenting on older Chinese adults' mental health: a cross-sectional study

BACKGROUND

The practice of grandparenting has been growing in popularity worldwide, particularly in Asian societies. Nevertheless, there is a lack of thorough studies investigating the mental health effects of grandchild care on grandparents, particularly within the family context. The present study aimed to explore the impact of grandparenting on depressive symptoms in older Chinese adults, taking into account the functional role of intergenerational support.

METHODS

Using the China Longitudinal Aging Social Survey (CLASS, 2014 and 2018, N = 9,486), we employed the Pooled Ordinary Least Square method (POLS) to explore the association between depressive symptoms and grandparenting intensity as well as include the interaction terms to investigate the role of intergenerational support among grandparents aged from 60 to 80.

RESULTS

After adjusting for control variables, both non-intensive (-0.17; 95% CI: -0.30, -0.03) and intensive (-0.69; 95% CI: -0.95, -0.43) childcare, as well as giving financial support to adult children (-0.06; 95% CI: -0.08, -0.04) and emotional closeness with them (-0.94; 95% CI: -1.15, -0.72), were found to have a positive impact on the mental health of grandparents. Giving financial support (non-intensive: -0.04, 95% CI: -0.07, -0.01; intensive: -0.06, 95% CI: -0.13, -0.01) and providing instrumental support to adult children (non-intensive: -0.12, 95% CI: -0.24, -0.01; intensive: -0.19, 95% CI: -0.37, -0.02) moderated the association between grandparenting and the mental health of older adults, regardless of care intensity. However, the moderating role of receiving financial support (-0.07; 95% CI: -0.12, -0.02) only existed when non-intensive childcare was provided.

CONCLUSION

Grandchild care predicted better mental health in grandparents, mainly when they engaged in intensive grandparenting. Emotional closeness and providing financial support to adult children brought mental health benefits to grandparents involved in childcare. Giving financial support and providing instrumental support to adult children moderated the association between grandparenting and the mental health of older adults. However, the moderating role of receiving financial support from adult children only existed when non-intensive childcare was provided.

Time trends in loneliness from 1984 to 2019 among 27,032 older adults in Norway: A HUNT study

The aging population and increasing evidence of the detrimental health impacts of loneliness emphasize the importance of studying and predicting changes in loneliness prevalence among older adults. To understand and project changes in loneliness over time, we examined 35-year trends in adults aged 70 and older, considering factors such as sex, age, and living situation. Cross-sectional data from 27,032 home-dwelling adults aged 70 years and older who participated in at least one of the four Norwegian HUNT surveys from 1984 to 2019, and Norwegian population data from Statistics Norway were used for the analyses. Loneliness was self-reported, and the prevalence of loneliness was standardized to the Norwegian population at the survey year by age and sex. The results showed that the prevalence of loneliness significantly decreased between each survey. The higher categories of loneliness (a good amount, very much) decreased, from 11.4% (1995-97), 6.7% (2006-08), and 5.8% (2017-19). Across surveys, loneliness was significantly more common among women, the oldest, and those living alone. The prevalence of loneliness among the oldest adults living alone increased from 2006 to 2019. The gradual decline in loneliness observed from 1995 to 2019 coincided with notable societal changes in Norway. We estimated that the number of older adults experiencing loneliness in Norway could rise from 184,000 in 2020 to 286,000 in 2035, and potentially reach 380,000 in 2050.

Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review

BACKGROUND

Loneliness and social isolation are increasingly recognised as prevalent among people with mental health problems, and as potential targets for interventions to improve quality of life and outcomes, as well as for preventive strategies. Understanding the relationship between quality and quantity of social relationships and a range of mental health conditions is a helpful step towards development of such interventions.

PURPOSE

Our aim was to give an overview of associations between constructs related to social relationships (including loneliness and social isolation) and diagnosed mental conditions and mental health symptoms, as reported in systematic reviews of observational studies.

METHODS

For this umbrella review (systematic review of systematic reviews) we searched five databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Web of Science) and relevant online resources (PROSPERO, Campbell Collaboration, Joanna Briggs Institute Evidence Synthesis Journal). We included systematic reviews of studies of associations between constructs related to social relationships and mental health diagnoses or psychiatric symptom severity, in clinical or general population samples. We also included reviews of general population studies investigating the relationship between loneliness and risk of onset of mental health problems.

RESULTS

We identified 53 relevant systematic reviews, including them in a narrative synthesis. We found evidence regarding associations between (i) loneliness, social isolation, social support, social network size and composition, and individual-level social capital and (ii) diagnoses of mental health conditions and severity of various mental health symptoms. Depression (including post-natal) and psychosis were most often reported on, with few systematic reviews on eating disorders or post-traumatic stress disorder (PTSD), and only four related to anxiety. Social support was the most commonly included social construct. Our findings were limited by low quality of reviews and their inclusion of mainly cross-sectional evidence.

CONCLUSION

Good quality evidence is needed on a wider range of social constructs, on conditions other than depression, and on longitudinal relationships between social constructs and mental health symptoms and conditions.

An umbrella review of candidate predictors of response, remission, recovery, and relapse across mental disorders

We aimed to identify diagnosis-specific/transdiagnostic/transoutcome multivariable candidate predictors (MCPs) of key outcomes in mental disorders. We conducted an umbrella review (protocol  link ), searching MEDLINE/Embase (19/07/2022), including systematic reviews of studies reporting on MCPs of response, remission, recovery, or relapse, in DSM/ICD-defined mental disorders. From published predictors, we filtered MCPs, validating MCP criteria. AMSTAR2/PROBAST measured quality/risk of bias of systematic reviews/individual studies. We included 117 systematic reviews, 403 studies, 299,888 individuals with mental disorders, testing 796 prediction models. Only 4.3%/1.2% of the systematic reviews/individual studies were at low risk of bias. The most frequently targeted outcome was remission (36.9%), the least frequent was recovery (2.5%). Studies mainly focused on depressive (39.4%), substance-use (17.9%), and schizophrenia-spectrum (11.9%) disorders. We identified numerous MCPs within disorders for response, remission and relapse, but none for recovery. Transdiagnostic MCPs of remission included lower disease-specific symptoms (disorders = 5), female sex/higher education (disorders = 3), and quality of life/functioning (disorders = 2). Transdiagnostic MCPs of relapse included higher disease-specific symptoms (disorders = 5), higher depressive symptoms (disorders = 3), and younger age/higher anxiety symptoms/global illness severity/ number of previous episodes/negative life events (disorders = 2). Finally, positive trans-outcome MCPs for depression included less negative life events/depressive symptoms (response, remission, less relapse), female sex (response, remission) and better functioning (response, less relapse); for schizophrenia, less positive symptoms/higher depressive symptoms (remission, less relapse); for substance use disorder, marital status/higher education (remission, less relapse). Male sex, younger age, more clinical symptoms and comorbid mental/physical symptoms/disorders were poor prognostic factors, while positive factors included social contacts and employment, absent negative life events, higher education, early access/intervention, lower disease-specific and comorbid mental and physical symptoms/conditions, across mental disorders. Current data limitations include high risk of bias of studies and extraction of single predictors from multivariable models. Identified MCPs can inform future development, validation or refinement of prediction models of key outcomes in mental disorders.

Clinical guidelines for the use of lifestyle-based mental health care in major depressive disorder: World Federation of Societies for Biological Psychiatry (WFSBP) and Australasian Society of Lifestyle Medicine (ASLM) taskforce

OBJECTIVES

The primary objectives of these international guidelines were to provide a global audience of clinicians with (a) a series of evidence-based recommendations for the provision of lifestyle-based mental health care in clinical practice for adults with Major Depressive Disorder (MDD) and (b) a series of implementation considerations that may be applicable across a range of settings.

METHODS

Recommendations and associated evidence-based gradings were based on a series of systematic literature searches of published research as well as the clinical expertise of taskforce members. The focus of the guidelines was eight lifestyle domains: physical activity and exercise, smoking cessation, work-directed interventions, mindfulness-based and stress management therapies, diet, sleep, loneliness and social support, and green space interaction. The following electronic bibliographic databases were searched for articles published prior to June 2020: PubMed, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register), CINAHL, PsycINFO. Evidence grading was based on the level of evidence specific to MDD and risk of bias, in accordance with the World Federation of Societies for Biological Psychiatry criteria.

RESULTS

Nine recommendations were formed. The recommendations with the highest ratings to improve MDD were the use of physical activity and exercise, relaxation techniques, work-directed interventions, sleep, and mindfulness-based therapies (Grade 2). Interventions related to diet and green space were recommended, but with a lower strength of evidence (Grade 3). Recommendations regarding smoking cessation and loneliness and social support were based on expert opinion. Key implementation considerations included the need for input from allied health professionals and support networks to implement this type of approach, the importance of partnering such recommendations with behaviour change support, and the need to deliver interventions using a biopsychosocial-cultural framework.

CONCLUSIONS

Lifestyle-based interventions are recommended as a foundational component of mental health care in clinical practice for adults with Major Depressive Disorder, where other evidence-based therapies can be added or used in combination. The findings and recommendations of these guidelines support the need for further research to address existing gaps in efficacy and implementation research, especially for emerging lifestyle-based approaches (e.g. green space, loneliness and social support interventions) where data are limited. Further work is also needed to develop innovative approaches for delivery and models of care, and to support the training of health professionals regarding lifestyle-based mental health care.

Prevalence and associated factors of incident and persistent loneliness among middle-aged and older adults in Thailand

BACKGROUND

The aim of the study was to assess the prevalence and associated factors of incident and persistent loneliness in a prospective cohort study among middle-aged and older adults (≥ 45 years) in Thailand.

METHODS

Longitudinal data from the Health, Aging, and Retirement in Thailand (HART) study in 2015 and 2017 were analysed. Loneliness was assessed with one item from the Center for Epidemiological Studies Depression scale. Logistic regression was used to calculate predictors of incident and persistent loneliness.

RESULTS

In total, at baseline 21.7% had loneliness, 633 of 3696 participants without loneliness in 2015 had incident loneliness in 2017 (22.2%), and 239 of 790 adults had persistent loneliness (in both 2015 and 2017) (30.3%). In adjusted logistic regression analysis, low income (aOR: 1.27, 95% CI: 1.03 to 1.57), poor self-rated physical health status (aOR: 1.64, 95% CI: 1.27 to 2.12), hypertension (aOR: 1.34, 95% CI: 1.09 to 1.65), depressive symptoms (aOR: 1.97, 95% CI: 1.11 to 3.49), and having three or chronic conditions (aOR: 1.76, 95% CI: 1.19 to 2.60) were positively associated and a higher education (aOR: 0.74, 95% CI: 0.55 to 0.98) and living in the southern region of Thailand (aOR: 0.43, 95% CI: 0.30 to 0.61) were inversely associated with incident loneliness. Poor self-rated physical health status (aOR: 1.91, 95% CI: 1.26 to 2.88), and having three or more chronic diseases (aOR: 1.78, 95% CI: 1.07 to 2.98), were positively associated, and living in the southern region (aOR: 0.40, 95% CI: 0.25 to 0.65) was inversely associated with persistent loneliness.

CONCLUSION

More than one in five ageing adults had incident loneliness in 2 years of follow-up. The prevalence of incident and/or persistent loneliness was higher in people with a lower socioeconomic status, residing in the central region, poor self-rated physical health status, depressive symptoms, hypertension, and a higher number of chronic diseases.

Psychological correlates of perceived loneliness in college students before and during the COVID-19 stay-at-home period: a longitudinal study

BACKGROUND

Loneliness is increasingly acknowledged as a serious public health issue. This longitudinal study aimed to assess the extent to which psychological distress and alexithymia can predict loneliness among Italian college students before and one year after the COVID-19 outbreak.

METHODS

A convenience sample of 177 psychology college students were recruited. Loneliness (UCLA), alexithymia (TAS-20), anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), and somatic symptoms (PHQ-15) were assessed before the COVID-19 outbreak and one year after the spread of COVID-19 worldwide.

RESULTS

After controlling for baseline loneliness, students with high levels of loneliness during lockdown showed worsening psychological distress and alexithymic traits over time. Suffering from depressive symptoms before COVID-19 and the aggravation of alexithymic traits independently predicted 41% of perceived loneliness during the COVID-19 outbreak.

CONCLUSIONS

College students with higher levels of depression and alexithymic traits both before and one year after the lockdown were more at risk of suffering from perceived loneliness and may constitute the target sample for psychological support and intervention.

The mediating role of depressive symptoms and subjective cognitive dysfunction in the relationship between stressful life events and functional disability in adult community volunteers

BACKGROUND

Stressful life events (SLE) impact psychosocial functioning. However, the psychological mechanism underlying the association between SLE and functional disability (FD) has not been fully elucidated. This study focused on whether depressive symptoms (DS) and subjective cognitive dysfunction (SCD) mediated the influence of SLE, comprising negative SLE (NSLE) and positive SLE (PSLE), on FD.

METHODS

A total of 514 adults from Tokyo, Japan, completed the self-administered questionnaires to evaluate DS, SCD, SLE, and FD. We investigated the relationships among the variables using path analysis.

RESULTS

Path analyses showed that NSLE positively affected FD directly (β = 0.253, p < .001), and indirectly via DS and SCD (β = 0.192, p < .001). PSLE negatively affected FD indirectly via DS and SCD (β = -0.068, p = .010), although PSLE did not affect FD directly (β = -0.049, p = .163).

LIMITATIONS

Causal relationships could not be determined owing to the cross-sectional design. All participants were recruited in Japan, which limits the generalization of findings to other countries.

CONCLUSIONS

DS and SCD, in this order, may partially mediate the positive effect of NSLE on FD. DS and SCD may fully mediate the negative effect of PSLE on FD. When considering the impact of SLE on FD, evaluating the mediating role of DS and SCD could be useful. Our findings may elucidate how perceived life stress affects daily functioning via depressive and cognitive symptoms. In the future, it is desirable to conduct a longitudinal study based on our results.

metaumbrella: the first comprehensive suite to perform data analysis in umbrella reviews with stratification of the evidence

OBJECTIVE

Umbrella reviews are a new form of literature review that summarises the strength and/or quality of the evidence from all systematic reviews and meta-analyses conducted on a broad topic. This type of review thus provides an exhaustive examination of a vast body of information, providing the highest synthesis of knowledge. A critical strength of umbrella reviews is recalculating the meta-analytic estimates within a uniform framework to allow a consistent evidence stratification. To our best knowledge, there is no comprehensive package or software to conduct umbrella reviews.

METHODS

The R package metaumbrella accomplishes this aim by building on three core functions that (1) automatically perform all required calculations in an umbrella review (including but not limited to pairwise meta-analyses), (2) stratify evidence according to various classification criteria and (3) generate a visual representation of the results. In addition, this package allows flexible inputs for each review or meta-analysis analysed (eg, means plus SD, or effect size estimate and CI) and customisation (eg, stratification criteria following Ioannidis, algorithmic GRADE or personalised classification).

RESULTS

The R package metaumbrella thus provides the first comprehensive range of facilities to perform umbrella reviews with stratification of the evidence.

CONCLUSION

To facilitate the use of this package, even for researchers unfamiliar with R, we also provide a JAMOVI module and an open-access, browser-based graphical interface that allow use of the core functions of the package with a few mouse clicks.

Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland

So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.

Loneliness as a mediation from social support leading to a decrease of health-related quality of life among PLWHIV

This study focused on the mental health of people living with HIV(PLWHIV) and explored their relationship between loneliness and perceived social support, health related quality of life (HRQoL) with a method of structural equation model. We collected clinical and psychological data from consecutively enrolled PLWHIV. A total of 201 PLWHIVs were enrolled and measured with self-reporting survey instruments of UCLA Loneliness Scale, Self-Rating Depression Scale, Self-Rating Anxiety Scale, Social Support Ratio Scale and Short Form Health Survey-36. The levels of loneliness, depression, anxiety, perceived social support and HRQoL were assessed. PLWHIV enrolled were divided into two groups of loneliness and non-loneliness based on their UCLA Loneliness Scale scores. Multivariable analysis indicated that being married is a protective factor associated with loneliness (OR = 0.226; P = 0.032). We further found the loneliness group had a higher level of depression (P < 0.001) and anxiety (P < 0.001), but lower level of HRQoL (P < 0.001) than the non-loneliness group. We found there was a positive linear correlation between social support and HRQoL among the enrolled PLWHIVs (r2 = 0.0592; P = 0.0005). A structural equation model (SEM) was established to evaluate whether the loneliness played as a mediation role between social support and HRQoL. The model showed loneliness as a mediation from social support leading to a decrease of HRQoL. Our findings showed a potential psychological pathway from social support to HRQoL, suggesting the need for interventions focusing on social support may improve poor HRQoL lead by loneliness.

Melancholic features and typical neurovegetative symptoms of major depressive disorder show specific polygenic patterns

BACKGROUND

Major depressive disorder (MDD) is a highly prevalent psychiatric condition characterised by a heterogeneous clinical presentation and an estimated twin-based heritability of ~40-50 %. Different clinical MDD subtypes might partly reflect distinctive underlying genetics. This study aims to investigate if polygenic risk scores (PRSs) for different psychiatric disorders, personality traits, and substance use-related traits may be associated with different clinical subtypes of MDD (i.e., MDD with melancholic or psychotic features), higher symptom severity, or different clusters of depressive symptoms (i.e., sadness symptoms, typical neurovegetative symptoms, detachment symptoms, and negative thoughts).

METHODS

The target sample included 1149 patients with MDD, recruited by the European Group for the Study of Resistant Depression. PRSs for 25 psychiatric disorders and traits were computed based on the most recent publicly available summary statistics of the largest genome-wide association studies. PRSs were then used as predictors in regression models, adjusting for age, sex, population stratification, and recruitment sites.

RESULTS

Patients with MDD having higher PRS for MDD and loneliness were more likely to exhibit melancholic features of MDD (p = 0.0009 and p = 0.005, respectively). Moreover, patients with higher PRS for alcohol intake and post-traumatic stress disorder were more likely to experience greater typical neurovegetative symptoms (p = 0.0012 and p = 0.0045, respectively).

LIMITATIONS

The proportion of phenotypic variance explained by the PRSs was limited.

CONCLUSIONS

This study suggests that melancholic features and typical neurovegetative symptoms of MDD may show distinctive underlying genetics. Our findings provide a new contribution to the understanding of the genetic heterogeneity of MDD.

The "loneliness epidemic", intersecting risk factors and relations to mental health help-seeking: A population-based study during COVID-19 lockdown in Canada

BACKGROUND

Pandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada.

METHODS

A population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7).

RESULTS

The estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26-1.85), those who were younger (OR's range 1.42-3.00), women without college degree (OR = 1.44, 99 % CI: 1.01-2.04), those living alone (OR = 1.56, 99 % CI: 1.09-2.23), immigrant men (OR = 1.79, 99 % CI: 1.23-2.60), those with small network (OR's range: 1.73-3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04-4.28), past-month binge drinkers (OR's range: 1.39-1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12-1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness. Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21-2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17-1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29-2.49).

LIMITATIONS

Cross-sectional data prohibits causal inferences.

CONCLUSION

The COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.

The severe impact of the COVID-19 pandemic on bullying victimization, mental health indicators and quality of life

Children and adolescents have been severely affected by the COVID-19 pandemic. The aim of this study was to explore the prevalence of traditional and digital bullying and mental health problems a year into the pandemic. Further, how anxiety level, loneliness, and self-perceived school functioning have influenced the quality of life. A comprehensive questionnaire was administered (N = 1239) in the city of Tromsø and compared to a similar data collection (N = 972) conducted in the same schools in 2017. The main findings were increased prevalence in bullying, more mental health problems and significantly reduced quality of life compared to before the pandemic. Implications and the importance of implementing anti-bullying and psychosocial measures after the pandemic are discussed.

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.

The Central Role of Schools in Promoting Death Education Interventions

Avoidance of discussion about death is common in contemporary Western societies. Plenty of literature substantiates that (at the beginning of the sentence), the actual tendency toward death denial can produce many negative effects such as the suppression of death-related thoughts and emotions. Death Education aims to strengthen the psychological anchors that allow us to recognize the profiles of anguish, prevent the decompensating factors of pathological mourning and process the experiences of loss at all ages. The article aims to support the usefulness and use of Death Education interventions in schools and their central role in promoting these interventions.

A man-made divide: Investigating the effect of urban–rural household registration and subjective social status on mental health mediated by loneliness among a large sample of university students in China

Introduction

The urban–rural household registration system in China has been documented with profound social consequences in almost all areas of people’s life. This study aims to investigate the underlying mechanism of the rural and urban discrepancies on mental health conditions among a large sample of college students in China.

Methods

A survey was distributed among college students in China. A total of 96,218 college students from 63 colleges completed the survey, answering questions on their urban–rural household registration, disposable household income, subjective social status, feelings of loneliness, and anxiety and depression symptoms. Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) analyses were conducted, testing the effect of urban–rural registration on one’s mental health, mediated by subjective social status, and loneliness.

Results

Structural Equation Modelling (SEM) results revealed that the urban–rural household registration showed a direct effect on anxiety (B = −0.03, 95% CI [−0.038, −0.022], β = −0.03, p &lt; 0.001) and depression (B = −0.03, 95% CI [−0.035, −0.023], β = −0.03, p &lt; 0.001), indicating that rural household registration had a negative association with anxiety and depression symptoms, albeit the standardised estimate being very small. The indirect path from the urban–rural registration mediated through subjective social status and loneliness to anxiety and depression was both significant, with B = 0.01, 95% CI [0.010, 0.010], β = 0.01, p &lt; 0.001, and B = 0.01, 95% CI [0.0090, 0.0090], β = 0.01, p &lt; 0.001, respectively. The results of the indirect paths demonstrated that students of the rural household registration reported higher anxiety and depression symptoms through a lower subjective social status and higher level of loneliness.

Conclusion

This study indicated that decreasing the disparity of social status and tackling loneliness is the key to improve the overall mental health of college students. The urban–rural household registration system may have a very small direct effect on the college students’ mental health; but students of urban registration enjoyed higher subjective social status, which had a clear protective effect against anxiety and depression symptoms.

Feelings of loneliness, COVID-19-specific-health anxiety and depressive symptoms during the first COVID-19 wave in Swiss persons with multiple sclerosis

The aim of our study was to investigate whether self-reported feeling of loneliness (FoL) and COVID-19-specific health anxiety were associated with the presence of depressive symptoms during the first coronavirus disease 2019 (COVID-19) wave. Questionnaires of 603 persons of the Swiss Multiple Sclerosis Registry (SMSR) were cross-sectionally analyzed using descriptive and multivariable regression methods. The survey response rate was 63.9%. Depressive symptoms were assessed by the Beck Depression Inventory-Fast Screen (BDI-FS). COVID-19-specific health anxiety and FoL were measured using two 5-item Likert scaled pertinent questions. High scoring FoL (2.52, 95% confidence interval (CI) (2.06-2.98)) and/or COVID-19 specific health anxiety (1.36, 95% CI (0.87-1.85)) were significantly associated with depressive symptoms. Further stratification analysis showed that the impact of FoL on depressive symptoms affected all age groups. However, it was more pronounced in younger PwMS, whereas an impact of COVID-19 specific health anxiety on depressive symptoms was particularly observed in middle-aged PwMS. FoL and COVID-19-specific health anxiety were age-dependently associated with depressive symptoms during the first COVID-19 wave in Switzerland. Our findings could guide physicians, health authorities, and self-help groups to better accompany PwMS in times of public health crises.

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.

Loneliness Status and Related Factors among the Hakka Elderly in Fujian, China: Based on the Health Ecological Model

There are few studies estimating the loneliness of the Hakka elderly in China. This study aims to examine the loneliness status and related factors among the Hakka elderly in Fujian, China. The short-form UCLA Loneliness Scale (ULS-8) was used to assess the loneliness of the Hakka elderly. Factors associated with loneliness were classified as individual indicators, behavioral indicators, interpersonal indicators, and social indicators according to the health ecological model (HEM). Hierarchical linear regression models were established to identify the main factors that were most predictive of loneliness. A sample of 1,262 Hakka elderly people was included in this study. Females (β = 0.631, P=0.012), those with ≥2 chronic diseases (β = 1.340, P < 0.001), those who were currently living in rural areas (β = 4.863, P < 0.001) or suburban areas (β = 2.027, P < 0.001), those with parents both died (β = 0.886, P=0.001), and those with the Urban Employees Basic Medical Insurance (UEBMI; β = 0.852, P=0.030) obtained a higher score of ULS-8. Those exercised regularly (β = −2.494, P < 0.001), those had leisure activities (β = −1.937, P < 0.001), those ate healthy (β = −1.270, P < 0.001), and those with better self-rated financial status and higher education level received a lower score of ULS-8. There are differences in loneliness among different Hakka elderly population subgroups, and healthy behaviors and lifestyles may reduce the loneliness of the Hakka elderly. Relevant interventions should be implemented in a targeted manner, focusing on susceptible populations. This is most evident among those who were female, living in rural areas, with parents both died, with lower education, and with multiple chronic diseases.

A network analysis on the relationship between loneliness and schizotypy

BACKGROUND

Schizotypy is a multidimensional personality trait related to the heightened risk for the development of schizophrenia spectrum disorders. While it has been suggested that loneliness may be associated with schizotypy in general, whether it relates to the specific schizotypal traits differentially remains unknown. Besides, as loneliness often co-occurs with depression and anxiety, it is important to delineate its relationship with schizotypy in consideration of these co-occurring emotional disturbances.

METHODS

A demographically diverse sample of young people was obtained from multiple sources. The validated sample consisted of 2089 participants (68.4% female, age range: 18-30). The structural relationship between loneliness and schizotypy was modelled using a network analytic approach. The Gaussian graphical model with loneliness and nine schizotypal traits as nodes was first estimated without, and then with adjustment for the levels of depressive and anxiety symptoms. Edges were estimated as unique associations between nodes.

RESULTS

'Suspiciousness', 'odd beliefs or magical thinking', 'no close friends', 'constricted affect' and 'excessive social anxiety' were linked to loneliness directly. Loneliness was found to be more strongly associated with 'suspiciousness' and 'no close friends' than other schizotypal traits. After adjustment for the levels of depressive and anxiety symptoms, the above direct edges remained robust.

LIMITATIONS

The use of cross-sectional data indicated only undirected associations between variables.

CONCLUSIONS

Loneliness was more strongly linked to some schizotypal traits than others, with the relationships maintaining above and beyond the effects of anxiety and depression. These findings warrant further investigation of the specific relationships between loneliness and individual schizotypal traits.

Methodological approaches for assessing certainty of the evidence in umbrella reviews: A scoping review

Introduction

The number of umbrella reviews (URs) that compiled systematic reviews and meta-analysis (SR-MAs) has increased dramatically over recent years. No formal guidance for assessing the certainty of evidence in URs of meta-analyses exists nowadays. URs of non-interventional studies help establish evidence linking exposure to certain health outcomes in a population. This study aims to identify and describe the methodological approaches for assessing the certainty of the evidence in published URs of non-interventions.

Methods

We searched from 3 databases including PubMed, Embase, and The Cochrane Library from May 2010 to September 2021. We included URs that included SR-MAs of studies with non-interventions. Two independent reviewers screened and extracted data. We compared URs characteristics stratified by publication year, journal ranking, journal impact factor using Chi-square test.

Results

Ninety-nine URs have been included. Most were SR-MAs of observational studies evaluating association of non-modifiable risk factors with some outcomes. Only half (56.6%) of the included URs assessed the certainty of the evidence. The most frequently used criteria is credibility assessment (80.4%), followed by GRADE approach (14.3%). URs published in journals with higher journal impact factor assessed certainty of evidence than URs published in lower impact group (77.1 versus 37.2% respectively, p < 0.05). However, criteria for credibility assessment used in four of the seven URs that were published in top ranking journals were slightly varied.

Conclusions

Half of URs of MAs of non-interventional studies have assessed the certainty of the evidence, in which criteria for credibility assessment was the commonly used method. Guidance and standards are required to ensure the methodological rigor and consistency of certainty of evidence assessment for URs.

Depression and loneliness may predict work inefficiency among professionally active adults

Purpose

Both depression and loneliness have been recognized as major public health issues, yet investigation into their role among young and middle-aged, professionally active persons is still required. The aim of the present study was to evaluate whether depression and loneliness may independently predict inefficiency at work among professionally active adults.

Methods

This is a cross-sectional study on a representative, nationwide sample. 1795 questionnaires were gathered from among professionally active adults from Poland from 1 to 31 July 2018 with a direct pen-and-paper interview. The sample was chosen by means of the stratified random method. The survey included a Patient Health Questionnaire (PHQ-9) to measure depression and questions, devised by the authors, relating to loneliness and inefficiency at work. Regression models were constructed with depression and loneliness as predictors of inefficiency at work, unadjusted and adjusted for selected sociodemographic, health- and work-related factors.

Results

In the unadjusted models, both depression and loneliness were independently associated with an increase of work inefficiency and absence from work, with effect sizes being higher for loneliness than for depression. After accounting for the control variables (i.e., sociodemographic, work- and health-related factors), the PHQ-9 score, but not the loneliness score, was associated with an increased probability of frequent thoughts about changing or leaving a job.

Conclusion

Depression and loneliness independently predicted occupational functioning and differentially affect its various aspects. Counteracting depression and loneliness among employees should be regarded as a public health priority.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-022-01869-1.

A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems

Given the links between the built environment and loneliness, there is interest in using place-based approaches (addressing built environment characteristics and related socio-spatial factors) in local communities to tackle loneliness and mental health problems. However, few studies have described the effectiveness, acceptability, or potential harms of such interventions. This review aimed to synthesize the literature describing local community-based interventions that target place-based factors to address loneliness and mental health problems, informing the development of future public health approaches. We searched PsycINFO, Medline, and Embase using a structured search strategy to identify English-language studies evaluating the effectiveness, acceptability, and potential harms of place-based community interventions in addressing loneliness and mental health problems, both in general and clinical populations. Seven studies met the inclusion criteria, classified as evaluating provision of community facilities (such as clubhouses), active engagement in local green spaces, and housing regeneration. None were randomised trials. Quantitative and qualitative findings suggested promising effects and/or acceptability of six interventions, with minimal potential harms. There is a clear need for randomised trials or quasi-experimental studies of place-based interventions to describe their effectiveness in addressing loneliness and mental health problems, as well as complementary qualitative work investigating acceptability. This will inform future policy development.

A social exclusion perspective on loneliness in older adults in the Nordic countries

Several factors associated with loneliness are also considered indicators of social exclusion. While loneliness has been proposed as an outcome of social exclusion, there is limited empirical evidence of a link. This study examines the associations between social exclusion indicators and loneliness in older adults (60+ years) in four Nordic countries. Data from four waves of the European Social Survey were pooled, providing a total of 7755 respondents (Denmark n = 1647; Finland n = 2501, Norway n = 1540; Sweden n = 2067). Measures of loneliness, demographic characteristics, health, and eight indicators of social exclusion were selected from the survey for analysis. Country-specific and total sample hierarchical logistic regression models of loneliness were developed. Significant model improvement occurred for all models after social exclusion indicators were added to models containing only demographic and health variables. Country models explained between 15.1 (Finland) and 21.5% (Sweden) of the variance in loneliness. Lower frequency of social contacts and living alone compared to in a two-person household was associated with a higher probability of loneliness in all countries, while other indicators were associated with loneliness in specific countries: lower neighbourhood safety (Sweden and Denmark); income concern (Sweden and Finland); and no emotional support (Denmark, Finland, and Sweden). A robust relationship was apparent between indicators of social exclusion and loneliness with the direction of associations being highly consistent across countries, even if their strength and statistical significance varied. Social exclusion has considerable potential for understanding and addressing risk factors for loneliness.

Behavioral Epidemic of Loneliness in Older U.S. Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study

OBJECTIVE

This study aimed to characterize the current prevalence of loneliness, and the relation between loneliness severity and mental and physical health conditions, suicidality, and functional measures in a predominantly older sample of U.S. military veterans.

METHODS

This cross-sectional study used data from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. veterans (N = 4,069; mean age = 62) from November 2019 through March 2020. Veterans were classified into one of 3 groups based on their current level of loneliness (hardly ever, sometimes, often) on an adapted version of the Revised UCLA Loneliness Scale. A comprehensive range of mental and physical health, and functioning variables were assessed using valid and reliable self-report assessments.

RESULTS

A total of 56.9% of veterans endorsed feeling lonely sometimes (37.2%) or often (19.7%). Loneliness severity was independently associated with a range of mental health (odds ratios [ORs] = 1.21-33.30), physical health (ORs = 1.21-6.80), and functional difficulties (d's = 0.09-0.59). Relative to hardly ever feeling lonely, feeling lonely often or sometimes was associated with a more than 12- and three-fold greater likelihood of current suicidal ideation (29.0% versus 7.3% versus 1.5%), even after adjustment for sociodemographic, military, and psychiatric risk factors.

CONCLUSIONS

Loneliness is highly prevalent in U.S. military veterans, with more than half endorsing feeling lonely sometimes or often, and 1-of-5 reporting feeling lonely often. Loneliness severity was independently associated with a broad range of mental and physical health and functional measures, ias well as suicidal ideation. Results underscore the importance of loneliness as a transdiagnostic prevention and intervention target in the U.S. veteran population.