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

Overview of the prevalence of loneliness and associated risk factors among older adults across six continents: A meta-analysis

BACKGROUND

Globally, loneliness is a growing public health concern associated with poor mental and physical health among older adults. Therefore, we performed a meta-analysis to explore the prevalence of loneliness and associated risk factors among older adults across six continents.

METHODS

Web of Science, PubMed, Embase, CINAHL, Cochrane Library, and references lists were comprehensively searched until April 2024. Data analysis was performed using Logit Transformation model in R-Software for pooled prevalence and DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis for associated factors of loneliness. Heterogeneity was quantified by I2 and τ2 statistics. The funnel plot and Egger's regression test assessed publication bias.

RESULTS

A total of 70 studies with 462,083 older adults were included. The pooled prevalence of loneliness was 26 % (95 %CI, 23 %-30 %) with 38 % for North America, 34 % for Africa, 32 % for Asia and South America, 23 % for Europe, and 13 % for Oceania. Cognitive impairment (2.98; 95 %CI, 1.30-6.81), poor health (2.35; 95 %CI, 1.59-3.45), female (1.92; 95 %CI, 1.53-2.41), depression (1.74; 95 %CI, 1.40-2.16), widowed (1.67; 95 %CI, 1.13-2.48), single (1.51; 95 %CI, 1.06-2.17), institutionalization (2.95; 95 %CI, 1.48-5.88), rural residency (1.18; 95 %CI, 1.04-1.34) were associated with increased risk of loneliness. Being married (0.51; 95 %CI, 0.31-0.82), male (0.55; 95 %CI, 0.43-0.70), and non-institutionalization (0.34; 95 %CI, 0.17-0.68) were associated with lower risk of loneliness.

CONCLUSION

Approximately, three among ten older adults aged ≥ 60 years are lonely worldwide. Early detection, prevention, and management of loneliness among older adults should consider diverse needs using gender-specific approaches.

Association between loneliness and mild cognitive impairment in older adults: a meta-analysis of longitudinal studies

OBJECTIVES

Prior studies reporting the effects of loneliness on mild impairment cognitive (MCI) have generated inconsistent results. This meta-analysis aimed to investigate the longitudinal association between loneliness and risk of MCI among community-dwelling middle-aged and older adults.

METHOD

Five electronic databases were searched from inception to 9 May 2023. Eligible studies examined the longitudinal association between loneliness and cognitive outcomes, including incident MCI, cognitive impairment, and cognitive decline. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects meta-analysis. Sensitivity analysis and subgroup analysis were conducted. Publication bias was examined using Egger's and Begg tests.

RESULTS

Eight studies were included. Among the 45,032 participants, 10,570 were diagnosed with MCI/cognitive decline. Loneliness was positively associated with an increased risk of MCI (overall OR = 1.14; 95% CI = 1.05, 1.23), with moderate heterogeneity (I2 = 44.2%). Sensitivity analysis have minimal influence on the aforementioned pooled effect. Subgroup analyses indicated stronger associations in studies which employed incident MCI as cognitive outcome (OR = 2.55, 95%CI = 1.31, 1.83), were conducted in non-Asia countries (OR = 1.52, 95%CI = 0.95, 1.20), and reported no depression adjustment (OR = 1.51, 95%CI = 1.04, 1.25). The association between loneliness and MCI was stronger among males compare to females. The Egger test and Begg test showed no evidence of significant publication bias (p = .493; p = .474).

CONCLUSION

The findings indicated that loneliness was associated with an increased risk of MCI. Future longitudinal studies should evaluate potential cases of MCI through comprehensive clinical assessments by practitioners to draw robust findings on the association of loneliness with MCI.

A longitudinal study of the mediator role of physical activity in the bidirectional relationships of cognitive function and specific dimensions of depressive symptoms

BACKGROUND

The bidirectional relationship between cognitive function and depressive symptoms has been extensively reported. However, the potential mechanisms are still not clear. We aim to longitudinally investigate whether physical activity mediates the bidirectional relationships between cognitive function and specific dimensions of depressive symptoms.

METHODS

Data from 6,787 individuals aged ≥50 of 2014/15 (T1), 2016/17 (T2), and 2018/19 (T3) waves of the English Longitudinal Study of Ageing (ELSA). Cognitive function was assessed by domains of memory, orientation in time, and executive function. Physical activity was measured with the intensity and frequency of participation. Specific dimensions of depressive symptoms were assessed by the 8-item Center for Epidemiologic Studies Depression Scale, distinguishing between cognitive-affective and somatic symptoms. Cross-lagged panel models were used to investigate the mediating role of physical activity in the bidirectional relationships between cognitive function and two dimensions of depressive symptoms.

RESULTS

Poorer cognitive function was indirectly associated with worse cognitive-affective symptoms (indirect effect = -0.002, 95%CI: -0.004, -0.001) through lower physical activity levels. Poorer cognitive function was also indirectly associated with worse somatic symptoms (indirect effect = -0.003, 95%CI: -0.006, -0.002) through lower physical activity levels, and the reverse mediation was observed as well (indirect effect = -0.002, 95%CI: -0.004, -0.001).

LIMITATIONS

There is no distinction between potential within-person and between-person effects.

CONCLUSIONS

Collaborative interventions of physical activity are beneficial in protecting cognitive function and mental health in older adults.

Qualitative exploration of the lived experiences of loneliness in later life to inform technology development

PURPOSE

Loneliness is a negative emotional state which is common in later life. The accumulative effects of loneliness have a significant impact on the physical and mental health of older adults. We aim to qualitatively explore the experiences of loneliness in later life and identify relevant behaviours and indicators which will inform novel methods of loneliness detection and intervention.

METHODS

We conducted 60 semi-structured interviews with people aged 65 and over between September 2022 and August 2023. Data were analysed using a reflective thematic approach with early theme development on NVIVO software.

RESULTS

Three themes were identified from the experiences of loneliness in older adults. 1) Unique responses to loneliness, including crying, increased eating or drinking and sleep difficulties, 2) Age-related losses, such as networks, roles, and abilities to engage in activities reducing over time and 3) Individual differences in overcoming loneliness, where strategies such as keeping busy and adopting a positive mindset were impacted by motivation and mood of older adults.

CONCLUSION

Distinct signs and relevant factors to loneliness in later life have been identified which can be detected by future sensing technologies. Findings of this in-depth qualitative study highlight that loneliness is a subjective experience requiring a holistic and person-centred approach to detection and intervention.

Mediating effect of social support and resilience between loneliness and depression in older adults: A systematic review and meta-analytic structural equation modeling

BACKGROUND

Loneliness is a powerful stressor for depression in older adults, and resilience and social support may mediate this relationship, while the evidence is limited. Hence, our study aims to explore the mediating role of social support and resilience between loneliness and depression and to test possible moderators.

METHODS

We searched 12 databases without language and publish time restrictions and obtained the correlation coefficients. This review constructed two-stage meta-analytical structural equality modeling (MASEA) to test the mediating effect of social support and resilience. Additionally, use one-stage MASEA to test the moderator effect of women proportion, published year, and country of study.

RESULTS

This study included 53 studies and 40, 929 older adults. Loneliness directly affected depression (β = 0.28, 95 % CI: 0.20, 0.36). Social support (β = 0.06, 95 % CI: 0.02, 0.09) and resilience (β = 0.15, 95 % CI: 0.12, 0.18) mediated the relationship. The proportion of women in the sample was moderator (χ2(5) = 11.10, p = 0.05). When the proportion exceeded 60 %, the path coefficient of loneliness and social support (β = -0.45, SE = 0.055) was larger than that of the subgroup below 60 % (β = -0.32, SE = 0.041).

LIMITATIONS

It was indefinite whether the evidence would be supported in longitudinal designs. Influenced by the original research data, it is impossible to calculate the model parameters of gender discrepancy.

CONCLUSIONS

Health aging policy-makers adopting social support and resilience intervention will help strengthen the coping skills of older adults confronting loneliness and reduce the risk of depression.

Aging wisely: The impact of Internet use on older adults' mental health

This study aims to explore the impact of Internet use on the mental health of older adults and its pathway mechanisms and to provide a theoretical basis and practical guidance for improving the mental health of older adults and better realizing active aging. Using cross-sectional data from the 2020 China Health and Retirement Longitudinal Survey, 6722 older adults over 60 were finally included. We conducted descriptive and correlation analyses of the data; we analyzed the correlation of Internet use on the depression level and cognitive ability of older adults using seemingly unrelated regression; we further explored the mediating role of socialization frequency in the relationship between Internet use and the depression level and cognitive ability of older adults and its differences through mediation analysis. The results showed that the mean age of older adults in this study was (68.52 ± 5.97), the mean Internet use score was (1.12 ± 1.63), the mean depression score was (8.44 ± 6.31), and the mean cognitive score was (12.17 ± 3.27). Internet use had a positive impact on the mental health of older adults, including lowering depression (β = -0.275, P < 0.05) and improving cognition (β = 0.300, P < 0.05). Socialization frequency mediated the relationship between Internet use and depression/cognitive ability (95 % CI = -0.034 to -0.008, 95 % CI = 0.007-0.022). Therefore, it is essential to encourage older adults to use the Internet, actively integrate into the digital society, promote wise aging, share the fruits of technological development, and utilize the Internet to maintain the mental health of older adults.

Social Isolation, Loneliness, and Risk of Microvascular Complications Among Individuals With Type 2 Diabetes Mellitus

RATIONALE & OBJECTIVE

Social disconnection has been associated with poor cardiometabolic health. This study sought to investigate the associations of social isolation and loneliness with diabetic microvascular complications (DMCs) among individuals with type 2 diabetes mellitus (T2DM) and compare these associations versus those related to traditional risk factors.

STUDY DESIGN

Prospective cohort study.

SETTING & PARTICIPANTS

A total of 24,297 UK Biobank participants with T2DM and no DMCs at baseline.

EXPOSURE

Social isolation and loneliness were measured using self-reported questionnaires.

OUTCOME

The incidence of DMCs defined as a composite of diabetic kidney disease, diabetic retinopathy, or diabetic neuropathy.

ANALYTICAL APPROACH

Multivariable cause-specific hazards regression. To compare the relative importance of social disconnection with other established factors, the R2 values of the Cox models were calculated.

RESULTS

During a median follow-up of 12.6 years, 5,530 patients were documented to experience DMCs (3,458 with diabetic kidney disease, 2,255 with diabetic retinopathy, and 1,146 with diabetic neuropathy). The highest level of social isolation was associated with an increased risk of any DMC component (most vs least: HR, 1.13; 95% CI, 1.05-1.22), especially diabetic kidney disease (HR, 1.14; 95% CI, 1.04-1.25) and neuropathy (HR, 1.31; 95% CI, 1.11-1.53). Any level of loneliness was associated with an increased risk of any DMC component (HR, 1.12; 95% CI, 1.02-1.23) and diabetic kidney disease (HR, 1.16; 95% CI, 1.03-1.30). Social isolation and loneliness exhibited associations with DMCs comparable to those of other conventional risk factors, including smoking, blood pressure, and physical activity.

LIMITATIONS

Limited generalizability related to the composition of participants in the UK Biobank Study.

CONCLUSIONS

Social isolation and loneliness were independently associated with a higher risk of incident DMCs among individuals with T2DM, with comparable importance to other traditional risk factors. These findings underscore social isolation and loneliness as novel and potentially modifiable risk factors for DMCs.

PLAIN-LANGUAGE SUMMARY

Social isolation and loneliness are important social determinants that are associated with adverse cardiometabolic health. Individuals with diabetes are particularly vulnerable to social isolation and loneliness. However, the relationship of social isolation or loneliness with diabetic microvascular complications (DMCs) remains unclear. Our study used the UK Biobank study data to investigate the associations of social isolation and loneliness with the development of DMCs. We found that social isolation and loneliness were independently associated with a higher risk of incident DMCs. Remarkably, their association with DMCs was comparable to those of other lifestyle factors such as smoking, blood pressure, and physical activity. These findings collectively imply that social isolation and loneliness are 2 important potentially modifiable risk factors for DMCs among individuals with type 2 diabetes mellitus.

Controlling for polygenic genetic confounding in epidemiologic association studies

Epidemiologic associations estimated from observational data are often confounded by genetics due to pervasive pleiotropy among complex traits. Many studies either neglect genetic confounding altogether or rely on adjusting for polygenic scores (PGS) in regression analysis. In this study, we unveil that the commonly employed PGS approach is inadequate for removing genetic confounding due to measurement error and model misspecification. To tackle this challenge, we introduce PENGUIN, a principled framework for polygenic genetic confounding control based on variance component estimation. In addition, we present extensions of this approach that can estimate genetically unconfounded associations using GWAS summary statistics alone as input and between multiple generations of study samples. Through simulations, we demonstrate superior statistical properties of PENGUIN compared to the existing approaches. Applying our method to multiple population cohorts, we reveal and remove substantial genetic confounding in the associations of educational attainment with various complex traits and between parental and offspring education. Our results show that PENGUIN is an effective solution for genetic confounding control in observational data analysis with broad applications in future epidemiologic association studies.

The mediating role of perceived social support on loneliness and depression in community-dwelling Nepalese older adults

BACKGROUND

Loneliness has been identified as a significant independent predictor of depression among older adults. Social support has been reported to play a protective role against both loneliness and depression in older adults. However, few studies to date have investigated the three constructs concurrently and the mediating role of Perceived Social Support (PSS) on the relationship between loneliness and depression in this age group. The current study aimed to assess the relationship between loneliness and depression among community-dwelling Nepalese older adults based on the mediating role of PSS.

METHODS

This descriptive cross-sectional research study included 367 community-dwelling older adults from a randomly selected ward in Kathmandu, Nepal. The University of California, Los Angeles Loneliness Scale, Geriatric Depression Scale, and Multidimensional Scale of Perceived Social Support were used. Correlation analysis, regression analysis, and the PROCESS 4.1 macro developed by Hayes with a bootstrapping procedure were used to test the mediating effect of the PSS on the relationship between loneliness and depression.

RESULTS

Loneliness was negatively associated with the PSS (β = -0.405; 95% CI: -0.473, -0.337; P < 0.001), and the PSS was positively associated with depression (β = 0.057; 95% CI: 0.014, 0.099; P = 0.009). The direct effect of loneliness on depression was positive and significant (β = 0.151; 95% CI: 0.117, 0.184; P < 0.001), whereas the indirect effect of loneliness on depression through the PSS was negative (path c; β = -0.023, 95% CI: -0.041, -0.005). The results indicated that the PSS partially mediated the relationship between loneliness and depression.

CONCLUSION

These findings suggest that interventions focusing on reducing loneliness and fostering social support may be able to lessen depressive symptoms in older adults. By addressing these factors, healthcare providers and carers can promote the mental health of older adults.

Sociodemographic and Health Determinants of Loneliness in Older Immigrants in Canada: A Cross-Sectional Study

The COVID pandemic brought to light the pressing issues of social isolation and loneliness for older adults. Immigrant older adults' experience of loneliness is even more exacerbated by factors, such as, language barriers, and the loss of cultural community. Key determinants of loneliness in older immigrants are not clear in the literature. A cross-sectional study was conducted in nine cities across Canada to: describe the experience of emotional, social and overall loneliness; and examine the determinants of loneliness among Punjabi, Mandarin, and Arabic-speaking older immigrants. A total of 647 older immigrants participated in the study. Descriptive statistics were used to describe their experience of loneliness, and multiple regression analysis was performed to examine the determinants of loneliness. Most participants had a post-secondary education, were married, and had been in Canada for about 16 years. On average, the participants reported good physical and mental health, and moderate levels of emotional, social, and overall loneliness. Ethnocultural group, emotional wellbeing, and depression were associated with emotional loneliness. Social loneliness was associated with education, depression, psychological distress, age, and ethnocultural group. Determinants of overall loneliness were age, gender, ethnocultural group, self-rated mental health, emotional wellbeing, depression, and psychological distress. Community based interventions that target these key factors must be designed to address loneliness experienced by older immigrants.

The societal cost of 'unwanted' loneliness in Spain

Unwanted loneliness negatively affects people's health and quality of life, increasing morbidity and the risk of premature death; this situation can generate major social costs. The aim of this study is to estimate the social costs of loneliness in Spain for 2021: both tangible costs -monetary value of health costs and production losses- and intangible costs -Quality Adjusted Life Years (QALYs). To estimate costs not derived from mortality, information from a sample of 400 people with unwanted loneliness was compared with that derived from two samples of the general population obtained from the Spanish National Health Surveys. To estimate the costs associated with premature deaths, the population attributable fraction was calculated using the relative risks estimated in previous survival studies. In the baseline scenario, the tangible costs of unwanted loneliness are estimated to be around 14,129 million euros in 2021, representing 1.2% of Spain's GDP. Approximately 56.8% of the tangible costs correspond to production losses due to reduced working time, and 43.2% are due to healthcare costs related with increased consultation frequency in healthcare services and higher consumption of medicines related to loneliness. In addition, loneliness generates a reduction in quality of life equivalent to 1.04 million QALYs, which corresponds to 2.8% of the total stock of QALYs of the Spanish population over 15 years of age.

The association between microaggressions and mental health among UK trans people: a cross-sectional study

PURPOSE

Epidemiological studies investigating the mental health impacts of microaggressions in the trans population have tended to have methodological limitations, including a lack of validated measures, raising concerns about the validity of their findings. To address this evidence gap, we investigated the associations between microaggressions and poor mental health (depression; anxiety; non-suicidal self-harm [NSSH]; suicidal thoughts; suicide attempt) amongst trans people.

METHODS

We conducted a cross-sectional survey of 787 trans adults in the UK, measuring mental health and exposure to microaggressions using the Gender Identity Microaggressions Scale (GIMS). Using univariable and multivariable linear and logistic regression models we tested for an association of microaggressions with depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), lifetime NSSH, lifetime suicidal thoughts, and lifetime suicide attempt.

RESULTS

Of the 787 participants, 574 (73%) provided complete data. Microaggressions were a common experience, affecting 97.6% of participants over their lifetime. In adjusted analyses, using sociodemographic and clinical variables, increased microaggression scores were associated with increased depressive symptoms (adjusted coefficient: 1.86 (95%CI = 1.35 to 2.36)), anxiety symptoms (adjusted coefficient: 1.57 (95%CI = 1.09 -2.05)) and with increased odds of NSSH (Odds Ratio [OR]adj 1.83 (95%CI = 1.45 -2.30)), suicidal thoughts (ORadj 2.18, (95%CI = 1.52 -3.13)), and suicide attempt (ORadj, 1.59, (95%CI = 1.32 -1.92)). In exploratory analyses different GIMS subscales were associated with these various outcomes.

CONCLUSIONS

There was evidence of associations between microaggressions and adverse mental health outcomes, as well as to support specific microaggressions being associated with specific outcomes, emphasizing the importance of public health interventions that target microaggressions directed at trans adults. Longitudinal studies are needed to investigate the temporality of the associations between microaggressions and mental health outcomes.

Prevalence of Unwanted Loneliness and Associated Factors in People over 65 Years of Age in a Health Area of the Region of Murcia, Spain: HELPeN Project

Background/Objectives: Population aging poses many challenges to public health, highlighting loneliness and social isolation as severe problems that affect the physical and mental health of older adults. During the COVID-19 pandemic, these became aggravated. The objective of the present study was to assess the prevalence of loneliness and its relationship with social isolation, depression, cognitive deterioration, sleep quality, and the level of physical mobility and functioning of older adults in Health Area 3 of the Region of Murcia. Methods: A descriptive, observational, and cross-sectional study was performed. The inclusion criteria were age ≥ 65, living in Health Area 3 of the Region of Murcia, and not being institutionalized. The following variables were evaluated: sociodemographic variables, loneliness (UCLA scale), social isolation (DUFSS), depression (GDS), cognitive deterioration (Pfeiffer), sleep quality (PSQI), and mobility (Barthel index). A univariate and multivariate regression model was created to examine how the dependent variable was related to the independent variables. Results: A total of 102 older adults participated in the study. Of these, 31.4% perceived unwanted loneliness and 14.7% low social support. The multivariate regression analysis showed that social isolation, geriatric depression, and cognitive deterioration were significant predictors of loneliness. Conclusions: The findings highlight the importance of developing multifaceted interventions that address not only social isolation but also other interrelated factors such as depression, cognitive deterioration, and sleep quality. The strategies should be centered on community programs and support networks. It is fundamental to perform longitudinal studies to better understand the causal relationships between these variables.

Observational and genetic evidence disagree on the association between loneliness and risk of multiple diseases

Loneliness-the subjective experience of social disconnection-is now widely regarded as a health risk factor. However, whether the associations between loneliness and multiple diseases are consistent with causal effects remains largely unexplored. Here we combined behavioural, genetic and hospitalization data from the UK Biobank to examine the associations of loneliness with a wide range of non-overlapping diseases. During a median 12.2-year follow-up, loneliness was associated with greater risks in 13 of 14 disease categories and 30 of 56 individual diseases considered. Of the 30 diseases significantly associated with loneliness, 26 had genetic data available for Mendelian randomization (MR) analyses. After Benjamini‒Hochberg correction and multiple sensitivity analyses within the MR framework, non-causal associations were identified between genetic liability to loneliness and 20 out of the 26 specific diseases, including cardiovascular diseases, type 2 diabetes mellitus, obesity, chronic liver diseases, chronic kidney disease, most neurological diseases and the other common diseases. Genetic liability to loneliness was only potentially causally associated with the remaining six diseases. Socioeconomic factors, health behaviours, baseline depressive symptoms and comorbidities largely explained the associations between loneliness and diseases. Overall, our study revealed a dissociation between observational and genetic evidence regarding the associations of loneliness with multiple diseases. These findings suggest that loneliness may serve as a potential surrogate marker rather than a causal risk factor for most diseases tested here.

Embracing Connection: A Review of First-Ever Clinical Guidelines on Social Isolation and Loneliness in Older Adults

Social isolation and loneliness are major public health concerns and are associated with morbidity and mortality. As this is an increasing issue in older adults, guidance for healthcare providers is a priority. The Canadian Coalition for Senior's Mental Health (CCSMH) has developed the first Canadian social isolation and loneliness guidelines to help providers recognize, assess, and manage social isolation and loneliness among older adults. We review and summarize these guidelines to support healthcare and social service providers to apply best practices and evidence-based care for older adults experiencing social isolation and loneliness.

Eight-year total, cognitive-affective, and somatic depressive symptoms trajectories and risks of cardiac events

In this study, we analyzed pooled data from two prospective population-based cohorts-the Health Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA)-to explore the association between trajectories of depressive symptoms and the risk of cardiac events. Depressive symptoms were assessed using the 8-item CES-D scale and categorized into somatic and cognitive-affective subtypes. Trajectories were tracked for four surveys from baseline. Heart disease was identified based on self-reported physician-diagnosed conditions. Hazard ratios and 95% confidence intervals were calculated with Cox proportional risk models that adjusted for potential confounders. In total, 17,787 subjects (59.7% female, median age 63 years) were enrolled at baseline. During a 10-year follow-up, 2409 cases of heart disease were identified. Participants with fluctuating (HR = 1.13, 95% CI: 1.06-1.20), increasing (HR = 1.43, 95% CI: 1.25-1.64), and consistently high (HR = 1.64, 95% CI: 1.45-1.84) depressive symptom trajectories exhibited an increased risk of heart disease compared to those with consistently low depressive symptoms, while a decreasing (HR = 1.07, 95% CI: 0.96-1.19) depressive symptom trajectory did not significantly affect the risk of heart disease. Moreover, the association between heart disease and somatic depressive symptoms was found to be stronger than with cognitive-affective symptoms. These findings suggest a significant link between depressive symptom trajectories and heart disease, with particular emphasis on stronger associations with somatic symptoms. It is recommended that the identification and management of depressive symptoms be incorporated into heart disease prevention strategies.

Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan

BACKGROUND

Psychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied.

METHODS

We used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0-24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD.

RESULTS

Regression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0-47.3%), 13.7% (95% CI: 8.2-19.3%), and 10.5% (95% CI: 8.0-13.0%), respectively; consequently increasing PD between 50 and 75 years.

CONCLUSION

The results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

Research Agenda and Applications for Preliminarily Validated Measures of d/Deaf and Hard of Hearing Stigma

In this special supplement of Ear and Hearing, we have presented preliminarily validated measures for stigma related to being d/Deaf or hard of hearing (d/DHH) in the United States and Ghana. In this concluding article, we suggest avenues for the future refinement and use of these measures. First, the measures should be further validated. Second, they should be used to assess the current state of d/DHH stigma and the importance of different kinds of stigma in different populations, which should in turn drive the development of interventions to reduce d/DHH stigma. Third, these measures can assist in evaluating the effectiveness and cost-effectiveness of those interventions. The evidence from this work can then inform investment cases and cost-of-condition studies, which will support advocacy efforts and policy development for reducing stigma and improving the lives of people who are d/DHH.

Evaluation of Changes in Social Isolation and Loneliness with Incident Cardiovascular Events and Mortality

BACKGROUND

It remains unknown how the patterns of change of social isolation and loneliness are associated with the onset of cardiovascular disease (CVD) and mortality. We aimed to investigate the longitudinal association of changes in social isolation and loneliness with incident CVD, all-cause mortality, CVD mortality and subsequent cardiac function.

METHODS

This prospective cohort study included 18,258 participants aged 38-73 years who participated in visit 0 (2006-2010) and visit 1 (2012-2013) using UK Biobank (mean age 57.1, standard deviation [SD] 7.4; 48.7% males). Social isolation or loneliness was categorized into four patterns: never, transient, incident, and persistent. Incident CVD, all-cause and CVD mortality were ascertained through linkage data. Cardiac function was assessed by cardiovascular magnetic resonance imaging in a subsample (N = 5188; visit 2, since 2014).

RESULTS

Over a median follow-up of 8.3 (interquartile range [IQR] 8.1-8.6) years, compared with never social isolation, persistent social isolation was associated with the higher risk of incident CVD (hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.03-1.33), all-cause (1.42, 1.12-1.81) and CVD (1.53, 1.05-2.23) mortality. Likewise, persistent loneliness was strongly associated with the greater risk of incident CVD (1.13, 1.00-1.27), all-cause (1.28, 1.02-1.61) and CVD mortality (1.52, 1.06-2.18).

CONCLUSIONS

Persistent social isolation and loneliness posed a substantially higher risk for incident CVD, all-cause and CVD mortality, and cardiac dysfunction than other patterns. Persistent social isolation and loneliness, along with an increasing cumulative score, are associated with lower cardiac function.

The associations of socioeconomic status, social activities, and loneliness with depressive symptoms in adults aged 50 years and older across 24 countries: findings from five prospective cohort studies

BACKGROUND

Depression is the leading cause of mortality among mental health disorders. Evidence about the associations of socioeconomic status, social activities, and loneliness with depression is scarce. We aimed to identify whether social activities and loneliness mediate the association between socioeconomic status and depression, and the extent of interactive or joint relationships between social activities, loneliness, and socioeconomic status on depression.

METHODS

In this population-based, cross-national cohort study we used data from five nationally representative surveys across 24 countries between Feb 15, 2008, and Feb 27, 2019: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); the China Health and Retirement Longitudinal Study (CHARLS); and the Mexican Health and Ageing Study (MHAS). We included participants who were aged 50 years and older with reported information on socioeconomic status, social activities, and loneliness at baseline, and who had been assessed at least twice. We excluded participants with depressive symptoms at baseline; those with missing data on depressive symptoms and covariates; and those lost to follow-up. We defined socioeconomic status as high and low using latent class analysis based on family income, education, and employment status. Depression was assessed using the Center for Epidemiological Studies Depression Scale (CES-D) or EURO-D. We applied Cox proportional hazard models to estimate the association of socioeconomic status with depression. We used random-effects models to obtain pooled results. Joint and interactive effects of socioeconomic status, social activities, and loneliness on depression were explored, and the mediating roles of social activities and loneliness in the association between socioeconomic status and depression were explored using causal mediation analysis.

FINDINGS

A total of 69 160 participants were included in our study and, during a median follow-up of 5 years, a total of 20 237 participants developed depression with a pooled incidence of 7·2 (95% CI 4·4-10·0) per 100 person-years. Compared with participants with high socioeconomic status, those with low socioeconomic status had a higher risk of depression (pooled hazard ratio [HR] 1·34; 95% CI 1·23-1·44). The proportion of the associations between socioeconomic status and depression mediated by social activities and loneliness were 6·12% (1·14-28·45) and 5·54% (0·71-27·62), respectively. We only observed a significant multiplicative interaction of socioeconomic status and loneliness with depression (pooled HR 0·84; 0·79-0·90). Compared with participants with high socioeconomic status and who were socially active and not lonely, those with low socioeconomic status and who were socially inactive and lonely had a higher risk of depression (pooled HR 2·45; 2·08-2·82).

INTERPRETATION

Social inactivity and loneliness positively mediated a small proportion of the association between socioeconomic status and depression, indicating that other approaches in addition to interventions targeting social isolation and loneliness are required to mitigate the risk of depression in older adults. Additionally, the joint effects of socioeconomic status, social activities, and loneliness highlight the benefits of simultaneous and integrated interventions to reduce the global burden of depression.

FUNDING

National Natural Science Foundation of China.

Pandemic Loneliness in Healthcare Workers. Does It Predict Later Psychological Distress?

Increased loneliness associated with the COVID-19 pandemic has been widely reported, with healthcare workers at increased risk compared to the general population. Pre-pandemic research indicates that loneliness has long-term detrimental effects on mental well-being, but the effect of loneliness in the context of COVID-19 is not clear. We conducted an online survey of healthcare workers (HCWs) at a large teaching hospital in Sydney, Australia after the peak of the first wave of the pandemic in 2020. Over one-third experienced loneliness at the peak of the first wave. An observed association with high psychological distress in subsequent months was attenuated after adjusting for status of mental well-being during the peak and before the pandemic. Mental well-being during the peak of the pandemic and, to a lesser extent, mental well-being before the pandemic were the strongest predictors of later distress. Increased conflict at home was also predictive of later distress. The mental health of HCWs is an important consideration at any time and is especially so in the face of crises such as the current global pandemic. Strategies to enhance baseline mental well-being and bolster well-being during crisis situations should assist HCWs cope with unexpected stressors and reduce the associated detrimental psychological consequences.

Short-term dynamics of loneliness and depressive symptoms: Gender differences in older adults

BACKGROUND

Previous research examining the relationship between loneliness and depressive symptoms often treated these constructs as static traits rather than dynamic states. The current study focused on the short-term, prospective link between loneliness and depressive symptoms, while also analyzing potential gender differences.

METHODS

We modeled panel data from seven bi-weekly assessments gathered in the FRequent health Assessment In Later life (FRAIL70+) study. At baseline, the sample size amounted to N = 426 community-dwelling older adults aged 70 years or older in Austria. The relationship between loneliness and depressive symptoms was analyzed using a latent change score modeling framework.

RESULTS

As regards depressive symptoms, women showed higher initial levels and more change across the three months than men. Loneliness did not considerably change across time for both sexes. Moreover, greater levels of loneliness at a given point in time were associated with an accelerated increase in depressive symptoms two weeks later in women but not in men.

CONCLUSION

Loneliness appeared to be a potential determinant of future increases in depressive symptoms. The varying effects observed between men and women suggest potential gender differences in short-term fluctuations of depressive symptoms and their underlying mechanisms.

Protein signatures associated with loneliness and social isolation: plasma proteome analyses in the English Longitudinal Study of Ageing, with causal evidence from Mendelian randomization

The understanding of biological pathways related to loneliness and social isolation remains incomplete. Cutting-edge population-based proteomics offers opportunities to uncover novel biological pathways linked to social deficits. This study employed a proteome-wide and data-driven approach to estimate the cross-sectional associations between objective measures of social connections (i.e., social isolation) and subjective measures (i.e., loneliness) with protein abundance, using the English Longitudinal Study of Ageing. Greater social isolation was associated with higher levels of 11 proteins (TNFRSF10A, MMP12, TRAIL-R2, SKR3, TNFRSF11A, VSIG2, PRSS8, FGFR2, KIM1, REN, and NEFL) after minimal adjustments; and three proteins were significantly associated after full adjustments (TNFRSF10A, TNFRSF11A, and HAOX1). Findings from two-sample Mendelian randomization indicated that a lower frequency of in-person social contact with friends or family causally increased levels of TNFRSF10A, TRAIL-R2, TNFRSF11A, and KIM1, and decreased the level of NEFL. The study also highlighted several enriched biological pathways, including necrosis and cell death regulation, dimerization of procaspase-8, and inhibition of caspase-8 pathways, which have previously not been linked to social deficits. These findings could help explain the relationship between social deficits and disease, confirming the importance of continuing to explore novel biological pathways associated with social deficits.

Longitudinal cross-lagged analysis of depression, loneliness, and quality of life in 12 European countries

BACKGROUND

In the older population, depression, loneliness, and quality of life are closely related, significantly influencing health status. This paper aimed (1) to investigate autoregressive and cross-lagged associations over 2 years between depression, loneliness, and quality of life, and (2) to examine sex-related differences in the 2-year associations between depression, loneliness, and quality of life in a large sample of European citizens aged ≥ 50 years.

METHODS

This is a longitudinal analysis. We included 7.456 individuals (70.89 ± 7.64 years; (4.268 females) who responded to waves 7 (2017) and 8 (2019) of the SHARE project. The variables analyzed in both waves were depression, loneliness, and quality of life.

RESULTS

Comparatively, females indicated higher depression and loneliness scores than males and a lower perception of quality of life. Autoregressive associations pointed that past depression, loneliness, and quality of life predicted their future episodes 2 years later (p < 0.001). The cross-lagged analysis of males showed positive and significant bidirectional associations between depression and loneliness 2 years later. Females also showed a positive and significant association between depression and loneliness, but loneliness was not associated with depression 2 years later. In turn, previous high levels of quality of life had a protective role in late depression and loneliness up to 2 years.

CONCLUSIONS

This study highlighted the need to simultaneously assess and manage depression, loneliness, and quality of life in the older European population. It is suggested that sex-specific policies can be created, including social support, in order to reduce depression and loneliness, and promote quality of life.

The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: A prospective cohort study

BACKGROUND

This study aims to understand the mechanisms contributing to the elevated risk of depression among sexual minority older adults compared to heterosexuals. Specifically, the role of loneliness as a potential mediator is investigated to inform targeted interventions for preventing depression in sexual minority populations.

METHODS

Data from the English Longitudinal Study of Ageing, focusing on adults aged over 50, were analysed. Sexual orientation (sexual minority or heterosexual) and loneliness scores (UCLA scale) were assessed at wave six (2010-2011), while depressive symptoms (CESD) were assessed at wave seven (2013-14). Linear regression models and mediation analyses, using g-computation formula and adjusted for confounders, were conducted.

RESULTS

The sample included 6794 participants, with 478 (7.0 %) identifying as sexual minorities. After adjustments, sexual minorities scored higher on depressive symptoms at wave seven (mean difference): 0.23, 95 % CI 0.07 to 0.39) and loneliness at wave six (MD: 0.27, 95 % CI 0.08 to 0.46). Loneliness was positively associated with depressive symptoms (coefficient: 0.27, 95 % CI 0.26 to 0.29). In mediation analyses, loneliness explained 15 % of the association between sexual orientation and subsequent depressive symptoms.

LIMITATIONS

The dataset used sexual behaviour rather than desire and identity, potentially skewing representation of sexual minorities. Additionally, transgender older adults were not included due to limited gender diversity reported within the ELSA dataset.

CONCLUSIONS

Loneliness appears to be a significant modifiable mechanism contributing to the heightened risk of depressive symptoms in sexual minority older adults compared with their heterosexual counterparts.

A mediation analysis framework based on variance component to remove genetic confounding effect

Identification of pleiotropy at the single nucleotide polymorphism (SNP) level provides valuable insights into shared genetic signals among phenotypes. One approach to study these signals is through mediation analysis, which dissects the total effect of a SNP on the outcome into a direct effect and an indirect effect through a mediator. However, estimated effects from mediation analysis can be confounded by the genetic correlation between phenotypes, leading to inaccurate results. To address this confounding effect in the context of genetic mediation analysis, we propose a restricted-maximum-likelihood (REML)-based mediation analysis framework called REML-mediation, which can be applied to either individual-level or summary statistics data. Simulations demonstrated that REML-mediation provides unbiased estimates of the true cross-trait causal effect, assuming certain assumptions, albeit with a slightly inflated standard error compared to traditional linear regression. To validate the effectiveness of REML-mediation, we applied it to UK Biobank data and analyzed several mediator-outcome trait pairs along with their corresponding sets of pleiotropic SNPs. REML-mediation successfully identified and corrected for genetic confounding effects in these trait pairs, with correction magnitudes ranging from 7% to 39%. These findings highlight the presence of genetic confounding effects in cross-trait epidemiological studies and underscore the importance of accounting for them in data analysis.

Loneliness and risky behaviours among mobile fishers in Elmina, Ghana: a convergent parallel mixed-method study

BACKGROUND

Loneliness affects individuals of all age groups, and mobile fishers are susceptible to loneliness due to the nature of their occupation. However, there is no study examining loneliness and risky behaviours among fishers in Ghana. Therefore, the purpose of this study was to examine fishers' mobility history, prevalence of loneliness, predictors of loneliness, effects of loneliness on fishers, coping strategies to address loneliness, and prevalence of risky behaviour among fishers in Elmina, Ghana.

METHODS

This is a convergent parallel mixed-method study involving 385 fishers in Elmina. A questionnaire and interview guides were used to collect data from respondents. Descriptive statistics, Pearson's chi-square and Fisher exact tests, and binary logistic regression were used to analyse the quantitative data, while the qualitative data were analysed thematically.

RESULTS

From the quantitative findings, most fishers were mobile (54.5%) and travelled alone (45.7%). Approximately 83% of the fishers experienced loneliness. Male fishers (AOR = 0.049; 95% CI = 0.003-0.741; p-value = 0.030), fishers affiliated with the African Traditionalist religion (AOR = 0.043; 95% CI = 0.002-0.846; p-value = 0.038), and fishers who travelled with their working colleagues (AOR = 0.002; 95% CI = 0.000-0.023; p-value = ≤ 0.001), were less likely to be experience loneliness. Feeling bored, isolated and worried/anxious were the main perceived effects of loneliness. Alcohol consumption and finding a companion to spend time with were the main strategies fishers used to cope with their loneliness. Most male fishers consumed alcohol (92.5%; p-value = ≤ 0.001) and spent time with companions (73.5%; p-value = ≤ 0.001) to cope with their loneliness. The quantitative and qualitative findings showed that fishers engaged in risky behaviours (excessive alcohol consumption, casual sex, and smoking marijuana and tobacco). From the quantitative findings, more male fishers engaged in excessive alcohol consumption (97.6% vs. 74.5%; p-value = ≤ 0.001), casual sex (88.2% vs. 61.7%, p-value = ≤ 0.001), smoking marijuana (43.0% vs. 13.0%, p-value = ≤ 0.001) and tobacco (49.4% vs. 19.1%; p-value = 0.001) than female fishers.

CONCLUSIONS

Loneliness and risky behaviours were common among fishers. Therefore, there is an urgent need to design interventions to help reduce loneliness and risky behaviour among fishers.

Lower motor performance is linked with poor sleep quality, depressive symptoms, and grey matter volume alterations

Motor performance (MP) is essential for functional independence and well-being, particularly in later life. However, the relationship between behavioural aspects such as sleep quality and depressive symptoms, which contribute to MP, and the underlying structural brain substrates of their interplay remains unclear. This study used three population-based cohorts of younger and older adults (n=1,950) from the Human Connectome Project-Young Adult (HCP-YA), HCP-Aging (HCP-A), and enhanced Nathan Kline Institute-Rockland sample (eNKI-RS). Several canonical correlation analyses were computed within a machine learning framework to assess the associations between each of the three domains (sleep quality, depressive symptoms, grey matter volume (GMV)) and MP. The HCP-YA analyses showed progressively stronger associations between MP and each domain: depressive symptoms (unexpectedly positive, r=0.13, SD=0.06), sleep quality (r=0.17, SD=0.05), and GMV (r=0.19, SD=0.06). Combining sleep and depressive symptoms significantly improved the canonical correlations (r=0.25, SD=0.05), while the addition of GMV exhibited no further increase (r=0.23, SD=0.06). In young adults, better sleep quality, mild depressive symptoms, and GMV of several brain regions were associated with better MP. This was conceptually replicated in young adults from the eNKI-RS cohort. In HCP-Aging, better sleep quality, fewer depressive symptoms, and increased GMV were associated with MP. Robust multivariate associations were observed between sleep quality, depressive symptoms and GMV with MP, as well as age-related variations in these factors. Future studies should further explore these associations and consider interventions targeting sleep and mental health to test the potential effects on MP across the lifespan.

Bidirectional Associations of Depressive Symptoms and Cognitive Function Over Time

Importance

Cognitive decline and depressive symptoms often co-occur among older adults, and they share several mechanisms. Despite the fact that cognitive dysfunction has been linked to increased depressive symptoms, the directionality of this association remains unclear.

Objective

To examine whether there is a bidirectional association between depressive symptoms and cognitive function in English adults aged 50 years or older throughout a 16-year follow-up period.

Design, Setting, and Participants

This cohort study included a nationally representative sample of community-dwelling English adults aged 50 years or older. The current analysis included 8268 eligible participants with relevant data. These participants were examined every other year from 2002 and 2003 until 2018 and 2019, resulting in a follow-up period of up to 16 years. Data were analyzed from July to November 2023.

Main Outcomes and Measures

The bivariate dual change score models were used to estimate the multivariable associations between depressive symptoms and cognitive function, which were interchangeably used as exposures and outcomes. Cognitive measures include memory and verbal fluency tests, while the Center for Epidemiologic Studies Depression Scale evaluated depressive symptoms.

Results

The study population of 8268 participants had a mean (SD) age of 64 (10) years at the study baseline, and 4517 participants (55%) were female. Higher depressive symptoms were cross-sectionally associated with poorer memory (β intercept, -0.018; standard error [SE], 0.004; P < .001) and verbal fluency (β intercept, -0.009; SE, 0.004; P = .02) at study baseline. A steeper linear change in depressive symptoms was associated with an accelerated memory change (β intercept, -0.253; SE, 0.079; P = .001), and a linear change in memory was associated with an acceleration in depressive symptoms over time (β intercept, 0.016; SE, 0.006; P = .005). This bidirectional change was not observed with verbal fluency.

Conclusions and Relevance

In this study, greater depressive symptoms were associated with poorer memory at the study baseline and steeper memory change over time. A gradual linear change in depressive symptoms contributed to accelerated memory loss and vice versa, suggesting that psychological mood and memory performance are intrinsically associated.

Chronic exercise effects on overall depression severity and distinct depressive symptoms in older adults: A protocol of a systematic and meta-analytic review

INTRODUCTION

There is high evidence that chronic exercise benefits overall depression severity in older adults. However, late-life depression is characterized by considerable heterogeneity in clinical manifestation emphasizing the need for more individualized exercise intervention programs. Therefore, the objective of the proposed review is to investigate the effects of chronic exercise on overall depression severity and on different symptoms of depression in randomized controlled trials (RCTs) including older adults with a mean age of at least 60 years, and by considering the moderating effects of intervention characteristics and individual characteristics.

METHODS

This protocol is guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P). We will use the Population-Intervention-Comparator-Outcomes-Study design (PICOS) criteria for study inclusion and will search the following database sources for relevant RCTs: Web of Science, Academic Search Complete, CINAHL, APA Psycinfo, SPORTDiscuss, Cochrane. Two independent reviewers will conduct the study selection, data extraction, and quality assessment. Disagreement will be solved by a third reviewer. Primary outcome will be changes in overall depression severity and secondary outcomes will encompass changes in symptoms of depression as defined by the DSM-5, such as sleep quality, fatigue, anxiety, mood, apathy, changes in weight, information processing speed, and executive functions, from baseline until the end of the intervention and to any available intermediary measurement or follow up. Meta-analysis will be undertaken to synthesize the effects of chronic exercise on primary and secondary outcomes. Subgroup analysis will investigate the moderating effects of intervention characteristics (frequency, intensity, duration, type of exercise, cognitive demand, social interactions, exercise supervision, behavioral change techniques, compliance, study design, dropout-rate, type of control group) and individual characteristics (age, sex, education, functional capacity, global cognition, population) on primary and secondary outcomes. Additionally, we plan to assess quality of evidence and publication bias, and to carry out sensitivity analysis.

CONCLUSION

The results of the proposed review are anticipated to have a substantial impact on research and clinical practice. On the one hand, the review's conclusions could form the foundation for developing evidence-based recommendations for individualized exercise programs that alleviate depression in older adults. On the other hand, by revealing research gaps, the review results could encourage the formulation of research questions for further RCTs.

PROTOCOL REGISTRATION NUMBER

This protocol has been published in the Prospero repository (PROSPERO 2022 CRD42022361418, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022361418).

Evaluation of an exercise program incorporating an international cycling competition: a multimodal intervention model for physical, psychological, and social wellbeing in residential aged care

BACKGROUND

The transition into residential aged care is frequently associated with a reduction in physical activity, social engagement, and emotional wellbeing. Our aim was to evaluate the impact of a 26-day international cycling competition (Road Worlds Competition for Seniors), incorporating elements of exercise, audiovisual cycling footage, social engagement, and gamification, on the physical, psychological, and social well-being of aged care residents. We aimed to use findings to inform the development of a multi-modal intervention model to maximise wellbeing for older adults.

METHODS

Residents (N = 32) participated in a mixed-methods single-group intervention pilot study that compared pre-and post-competition measures for the following wellbeing domains; physical, psychological, and social. In addition, interviews were conducted with residents (n = 27) and staff (n = 6) to explore their experiences.

RESULTS

Measures identified significant improvements across multiple wellbeing domains, including functional fitness, depression, self-efficacy, and social network sizes. Findings from the interview data indicated that the multimodal components involved in the program delivery were valued by staff and residents who enjoyed the gamification, audiovisual cycling footage, social engagement, opportunities for reminiscence, and camaraderie between peers, staff, and volunteers.

CONCLUSIONS

Findings highlight a constellation of benefits across physical, psychological, and social domains of wellbeing and inform a model for innovative multidimensional programs in residential aged care. The benefits for residents with varying physical and cognitive abilities support the use of creative strategies that maximise inclusion and engagement for residents.

The relationship between the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes: The mediating role of loneliness

The current study aims to investigate the meaning of life, psychological well-being, self-care, and social capital, with depression and death anxiety in the elderly living in nursing homes through the mediating role of loneliness. The statistical population included all the elderly aged at least 60 years living in Tehran, Qazvin and Zanjan, Iran in 2020, among whom 489 (273 men and 216 women) were selected using convenience sampling method. Participants filled out Steger's Meaning of Life, Ryff and Singer's Psychological Well-Being Scale, Söderhamn et al.'s Self-Care Ability, Nahapiet and Ghoshal's Social capital, Beck's depression, Templer's Death Anxiety, Russell et al.'s Loneliness questionnaires. The results indicated that meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to depression. Furthermore, meaning of life, psychological well-being, self-care, and social capital are negatively associated with loneliness, which in turn, is positively associated to death anxiety. Moreover, the results of path analysis revealed that the hypothesized model of the current study has an excellent fit in the study sample. That is, meaning of life, psychological well-being, self-care, and social capital are related to depression and death anxiety through mediating role of loneliness.

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial

OBJECTIVE

To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients.

MEASUREMENT

The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period.

RESULTS

Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants.

CONCLUSIONS

The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation.

SUMMARY

This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis

Many studies focus on problematic peer functioning in attention deficit/hyperactivity disorder (ADHD) but loneliness has been studied less. This paper examined (1) The loneliness level differences between young people (below 25 years old) with ADHD and those without ADHD, and (2) The association between loneliness and mental health difficulties in young people with ADHD. Six electronic databases were searched and 20 studies were included. A random effects meta-analysis was carried out in RStudio using the metafor package for the first question, while a narrative synthesis summarized the findings for the second question. The meta-analysis (n = 15) found that young people with ADHD reported significantly higher loneliness than those without ADHD, with a small-to-medium weighted pool effect (Hedges' g = 0.41) and high heterogeneity (I2 = 75.1%). For the second question (n = 8), associations between loneliness and mental health difficulties in ADHD was found (r = 0.05-0.68). Targeted research and interventions on loneliness in young people with ADHD is needed.

Quantifying depressive symptoms on incidence of common chronic diseases and multimorbidity patterns in middle-aged and elderly Chinese adults

BACKGROUND

Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified.

METHODS

For this cohort analysis, we included 9024-14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms.

RESULTS

Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05-1.26) to 1.64 (1.38-1.96) and 5% (0-10%) to 17% (6-28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11-1.42), 1.34 (1.07-1.69), 1.45 (1.29-1.63), and 2.01 (1.36-2.96), and respective PAFs (95% CIs) of 5% (0-10%), 8% (-4-21%), 12% (7-17%), and 20% (5-35%).

CONCLUSION

Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese.

Chronically socially isolated mice exhibit depressive-like behavior regulated by the gut microbiota

Objectives

Chronic loneliness is a widespread issue, and the gut-brain axis is known to be crucial in facilitating communication between the gut and brain. However, the precise mechanism by which chronic loneliness affects the gut-brain axis remains uncertain.

Methods

Fourteen 55-week-old Balb/c mice were used in the experiment, with seven mice being randomly assigned to the chronic social isolation (CSI) group. The CSI group mice underwent 12 weeks of isolation to simulate the psychiatric state of a population in prolonged social isolation. The mental state of the CSI mice was assessed through animal behavior analysis, while plasma cytokines were measured using ELISA. Additionally, the composition of the gut microbiota was analyzed using 16S rRNA sequencing, and the metabolite composition of the intestinal contents was examined using nontargeted metabolomics. The Student-T test was used to determine significant mean differences.

Results

Mice that were exposed to the CSI exhibited increased immobility time lengths in forced swimming and hanging tail experiments, and decreased movement lengths and number of times traversing the intermediate region, compared to control mice. Additionally, CSI decreased the abundance of the probiotics Ruminococcaceae, Akkermansiaceae, and Christensenellaceae. Additionally, CSI reduced the production of the metabolites oleamide and tryptophan. Furthermore, IL-1β, IL-4, and IL-6 were significantly increased, while TNF-α was significantly decreased.

Conclusion

CSI induces a dysbiotic gut microbiota and the production of neurorelated metabolites, which in turn increase inflammatory responses and result in depressive behaviors in CSI mice. Therefore, these findings suggest that the gut microbiota may serve as a target for the treatment of long-term social isolation-induced mental disorders.

Psychosocial characteristics pattern correlated with suicidal ideation and non-suicidal self-injury among nurse staff: a latent profile analysis

BACKGROUND

Nurses frequently endure elevated levels of psychosocial stress, which often correlates with an increased suicide risk. This study aimed to investigate the impact of latent psychosocial characteristic patterns on suicidal ideation and non-suicidal self-injury among nursing staff.

METHOD

Participants were recruited from the Dehong districts of Yunnan province, China, between July 11th and July 26th, 2022. Subgroups were identified using variables linked to suicidal ideation and non-suicidal self-injury, including perceived cognitive deficits, anxiety symptoms, depressive symptoms, resilience, social support, childhood trauma, loneliness, and sleep quality. Measurement tools included the Perceived Deficit Questionnaire-5-item (PDQ-5), Generalized Anxiety Disorder-7 items (GAD-7), Patient Health Questionnaire (PHQ-9), Connor-Davidson Resilience Scale-10 items (CD-RISC10), Multidimensional Scale of Perceived Social Support (MSPSS), Childhood Trauma Questionnaire-Short Form (CTQ-SF), Three-Item Loneliness Scale, and a single-item sleep quality scale.

RESULTS

Latent profile analysis (LPA) revealed four distinct psychosocial characteristic patterns: "class 1," "class 2," "class 3," and "class 4." Compared to class 2, individuals in class 1 had a sixfold increased risk of suicidal ideation (OR = 6.59, 95%CI = 4.42-9.81) and a fivefold increased risk of non-suicidal self-injury (OR = 5.13, 95%CI = 3.38-7.78). Similarly, class 4 individuals had twice the risk of suicidal ideation (OR = 2.13, 95%CI = 1.25-3.62) and non-suicidal self-injury (OR = 2.13, 95%CI = 1.25-3.65) compared to class 2. Conversely, class 3 individuals had a lower risk of suicidal ideation (OR = 0.21, 95%CI = 0.11-0.42) and non-suicidal self-injury (OR = 0.15, 95%CI = 0.07-0.36) than class 2. Additionally, divorced/other marital status individuals had a higher risk of suicidal ideation (OR = 2.34, 95%CI = 1.02-5.35) and non-suicidal self-injury (OR = 2.58, 95%CI = 1.01-6.65) compared to married individuals, while unmarried individuals had a lower risk of suicidal ideation (OR = 0.58, 95%CI = 0.37-0.91).

CONCLUSIONS

The study identified eight important psychosocial factors divided into four latent pattern classes. Individuals in "class 1" and "class 4" were more likely to have a higher risk of suicidal ideation and non-suicidal self-injury, while those in "class 3" were more likely to have a lower risk of both outcomes. It is suggested that further research should focus on "class 1" and "class 4" for targeted intervention.

Perceived Loneliness, Social Isolation, and Social Support Resources of Frail Older People Ageing in Place Alone in Italy

This paper presents some findings from the IN-AGE ("Inclusive ageing in place") study, which the authors carried out in 2019 in Italy. It explores the available social support resources for frail older people with functional limitations ageing in place alone, and possible links between their social isolation and perceived loneliness. The authors conducted qualitative/semi-structured interviews involving 120 participants aged 65 years and over, and used a mixed-methods analysis (quantitative/qualitative). The main results show the family as the main help resource for daily activities, but also for intimate confidences against social isolation, especially when said relatives live close. Family confidants are less present when seniors are supported by friends/neighbours or/and public services. Moreover, the family is valuable for decreasing loneliness, although not always. However, some older people feel particularly alone when they are supported by public services. Such a complex context draws attention on the need of support for frail seniors living alone and could provide insights for policymakers on adequate policies for preventing and managing loneliness and social isolation in later life. This is especially relevant when family (and other) resources are not available or scarce, also considering the opportunities offered by technology, which can help seniors remain socially connected to relatives, friends and their overall community.

Decoding emotional resilience in aging: unveiling the interplay between daily functioning and emotional health

Background

EPs pose significant challenges to individual health and quality of life, attracting attention in public health as a risk factor for diminished quality of life and healthy life expectancy in middle-aged and older adult populations. Therefore, in the context of global aging, meticulous exploration of the factors behind emotional issues becomes paramount. Whether ADL can serve as a potential marker for EPs remains unclear. This study aims to provide new evidence for ADL as an early predictor of EPs through statistical analysis and validation using machine learning algorithms.

Methods

Data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) national baseline survey, comprising 9,766 samples aged 45 and above, were utilized. ADL was assessed using the BI, while the presence of EPs was evaluated based on the record of "Diagnosed with Emotional Problems by a Doctor" in CHARLS data. Statistical analyses including independent samples t-test, chi-square test, Pearson correlation analysis, and multiple linear regression were conducted using SPSS 25.0. Machine learning algorithms, including Support Vector Machine (SVM), Decision Tree (DT), and Logistic Regression (LR), were implemented using Python 3.10.2.

Results

Population demographic analysis revealed a significantly lower average BI score of 65.044 in the "Diagnosed with Emotional Problems by a Doctor" group compared to 85.128 in the "Not diagnosed with Emotional Problems by a Doctor" group. Pearson correlation analysis indicated a significant negative correlation between ADL and EPs (r = -0.165, p < 0.001). Iterative analysis using stratified multiple linear regression across three different models demonstrated the persistent statistical significance of the negative correlation between ADL and EPs (B = -0.002, β = -0.186, t = -16.476, 95% CI = -0.002, -0.001, p = 0.000), confirming its stability. Machine learning algorithms validated our findings from statistical analysis, confirming the predictive accuracy of ADL for EPs. The area under the curve (AUC) for the three models were SVM-AUC = 0.700, DT-AUC = 0.742, and LR-AUC = 0.711. In experiments using other covariates and other covariates + BI, the overall prediction level of machine learning algorithms improved after adding BI, emphasizing the positive effect of ADL on EPs prediction.

Conclusion

This study, employing various statistical methods, identified a negative correlation between ADL and EPs, with machine learning algorithms confirming this finding. Impaired ADL increases susceptibility to EPs.

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.

Social isolation and the risk of Parkinson disease in the UK biobank study

Parkinson disease (PD) has become one of the most rapidly growing causes of disability among the older population and social isolation is a major concern in the PD community. However, the relationship between social isolation and future risk of PD remains unclear. This study included 192,340 participants aged 60 or older who were free of dementia and PD at baseline from the UK Biobank study. Social isolation was measured using a composite score derived from three questions on number in household, frequency of friend/family visits, and leisure/social activities. Incident PD cases were identified through electronic health records. Multivariable-adjusted Cox regression models were used to compute the hazard ratio (HR) and 95% confidence interval (CI). Among the 192,340 participants (mean [standard deviation] age, 64.2 [2.9] years; 103,253 [53.7%] women), 89,075 (46.3%) participants were in the least isolated group and 26,161 (13.6%) were in the most isolated group. Over a median follow-up of 12.5 years, 2048 incident PD cases were documented. Compared to the least isolated group, the multivariable-adjusted HRs (95% CIs) for PD were 1.00 (0.91-1.10) for the moderately isolated group and 1.19 (1.05-1.36) for the most isolated group (P-trend = 0.04). The observed association was independent of the genetic susceptibility to PD and consistent in subgroup analyses. Social isolation was associated with a higher risk of PD regardless of genetic risk. Our findings highlighted the importance of developing screening and intervention strategies for social isolation among older adults to reduce the risk of PD.

Oregon Death with Dignity Act access: 25 year analysis

OBJECTIVES

Assisted dying has been legally available in Oregon in the USA for 25 years, since when official reports have been published each year detailing the number of people who have used this option as well as sociodemographic and information about the process. The aim of this study was to examine changes over time in these data.

METHODS

We collated and reviewed data on 2454 assisted deaths included in annual reports on assisted deaths published by the Oregon Health Authority from 1998 to 2022. Descriptive statistics were used to describe time trends.

RESULTS

The number of assisted deaths in Oregon increased from 16 in 1998 to 278 in 2022. Over this time, patients' health funding status changed from predominantly private (65%) to predominantly government support (79.5%), and there was an increase in patients feeling a burden and describing financial concerns as reasons for choosing an assisted death. There has been a reduction in the length of the physician-patient relationship from 18 weeks in 2010 to 5 weeks in 2022, and the proportion referred for psychiatric assessment remains low (1%). Data are frequently missing, particularly around complications.

CONCLUSIONS

The number and characteristics of people accessing assisted deaths, and the process, have changed since data collection started in 1998. Prospective studies are needed to examine the relationship between socioeconomic factors and the desire for an assisted death in Oregon.

Trajectories of depressive symptom and its association with air pollution: evidence from the Mr. OS and Ms. OS Hong Kong cohort study

BACKGROUND

Depression is a global health priority. Maintaining and delaying depressive symptoms in older adults is a key to healthy aging. This study aimed to identify depressive symptom trajectories, predictors and mortality, while also exploring the relationship between air quality and depressive symptoms in older adults in the Hong Kong community over 14 years.

METHODS

This study is a longitudinal study in Hong Kong. The target population was community-dwelling older adults over age 65. Depressive symptoms were measured by the Geriatric Depression Scale (GDS-15). Group-based trajectory model was used to identify heterogeneity in longitudinal changes over 14 years and examine the associations between baseline variables and trajectories for different cohort members using multinomial logistic regression. The Kaplan-Meier method was employed to conduct survival analysis and explore the variations in survival probabilities over time among different trajectory group. Linear mixed model was used to explore the relationship between air quality and depressive symptoms.

RESULTS

A total of 2828 older adults were included. Three different trajectories of depressive symptoms in older people were identified: relatively stable (15.4%), late increase (67.1%) and increase (17.5%). Female, more number of chronic diseases, poor cognitive function, and poor health-related quality of life (HRQOL) were significantly associated with other less favorable trajectories compared with participants with stable levels of depressive symptoms. The late increase group had a lower mortality rate than the relatively stable and increased groups. Lower baseline ambient air pollutant exposure to NO2 over 14 years was significantly associated with fewer depressive symptoms.

CONCLUSIONS

In this study, we found that a late increase in depressive symptoms was the predominant trend in older Chinese people in Hong Kong. Poorer HRQOL was predictive of less favorable trajectories of depressive symptoms. Ambient air pollution was associated with depressive symptoms. This novel observation strengthens the epidemiological evidence of longitudinal changes in depressive symptoms and associations with late-life exposure to air pollution.

Association between the COVID-19 pandemic and mental health in very old people in Sweden

BACKGROUND

During the COVID-19 pandemic, Sweden implemented social distancing measures to reduce infection rates. However, the recommendation meant to protect individuals particularly at risk may have had negative consequences. The aim of this study was to investigate the impact of the COVID-19 pandemic on very old Swedish peoples' mental health and factors associated with a decline in mental health.

METHODS

We conducted a cross-sectional study among previous participants of the SilverMONICA (MONItoring of Trends and Determinants of CArdiovascular disease) study. Of 394 eligible participants, 257 (65.2%) agreed to participate. Of these, 250 individuals reported mental health impact from COVID-19. Structured telephone interviews were carried out during the spring of 2021. Data were analysed using the χ2 test, t-test, and binary logistic regression.

RESULTS

Of 250 individuals (mean age: 85.5 ± 3.3 years, 54.0% women), 75 (30.0%) reported a negative impact on mental health, while 175 (70.0%) reported either a positive impact (n = 4) or no impact at all (n = 171). In the binary logistic regression model, factors associated with a decline in mental health included loneliness (odds ratio [95% confidence interval]) (3.87 [1.83-8.17]) and difficulty adhering to social distancing recommendations (5.10 [1.92-13.53]). High morale was associated with positive or no impact on mental health (0.37 [0.17-0.82]).

CONCLUSIONS

A high percentage of very old people reported a negative impact on mental health from the COVID-19 pandemic, primarily from loneliness and difficulty adhering to social distancing measures, while high morale seemed to be a protective factor.

Loneliness and suicide risks in the general population before and during first-year COVID-19 in Taiwan

PURPOSE

Loneliness is a critical issue affecting the general population. Current evidence from national surveys of loneliness is scarce. The study aimed to examine the impact of COVID-19 pandemic on the prevalence of loneliness and its associating suicide risks in Taiwan.

METHODS

Four annual telephone interview surveys were performed by the Taiwan Suicide Prevention Center in 2015-2017 and 2020 during COVID outbreak. Each year the sample was randomly selected by stratifying the general public in different geographical areas and fulfilled a questionnaire collecting information including loneliness, psychological distress, and suicide risk assessment. All the data were analyzed using SPSS25 analysis.

RESULTS

A total of 8460 participants were recruited. The average prevalence of loneliness was 12.6 %. Feelings of loneliness was significantly correlated with psychological distress and most risk factors relating to suicide. The odds of loneliness for lifetime suicidal ideation, lifetime suicide attempt, and future suicide intent were 4.9, 5.1, and 9.2, respectively. During the COVID-19 period, loneliness and suicidality demonstrated a noteworthy decline trend, whereas "no one trustworthy to talk to" was the only item that showed significant increase under the pandemic and also impacted on loneliness.

CONCLUSION

Nearly one in ten Taiwanese people felt lonely before and during COVID-19. Loneliness was closely linked with various suicide risk factors such as lifetime suicide ideation and attempt or future intention. Although psychological distress and suicide risk were not increased during COVID-19, maintaining trustful relationships to seek support appeared to be critical to prevent the risks of loneliness or suicide.

Sex-based trajectories of health system use in lonely and not lonely older people: A population-based cohort study

BACKGROUND

There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey.

METHODS

We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three-Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 -year observation period. Annual risks of moving from the community to inpatient, long-stay home care, long-term care settings-and death-were estimated across loneliness levels using sex-stratified multistate models.

RESULTS

Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long-term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2-year home care risk: 6.1% [95% CI 5.5-6.6], 8.4% [95% CI 7.4-9.5] and 9.4% [95% CI 8.2-10.9] in female respondents, and 3.5% [95% CI 3.1-3.9], 5.0% [95% CI 4.0-6.0], and 5.4% [95% CI 4.0-6.8] in male respondents; 5-year long-term care risk: 9.2% [95% CI 8.0-10.8], 11.1% [95% CI 9.3-13.6] and 12.2% [95% CI 9.9-15.3] [female], and 5.3% [95% CI 4.2-6.7], 9.1% [95% CI 6.8-12.5], and 10.9% [95% CI 7.9-16.3] [male]).

CONCLUSIONS

Lonely older female and male respondents were more likely to need home care and long-term care, with severely lonely female respondents having the highest probability of moving to these settings.

Alexithymia and negative emotions among nursing students: a moderated mediation model

Nursing students, who comprise a high percentage of China's college students, experience many psychological problems; however, few studies explored the mechanisms underlying these problems. This cross-sectional study explored the relationships and mechanisms of depression, anxiety, stress, and narrative disorders in senior nursing students. Questionnaires were administered to 380 senior nursing students in Hubei Province using the Sociodemographic Questionnaire, Toronto Alexithymia-20 Scale, Perceived Social Support Scale, 10-Item Connor-Davidson Resilience Scale, and Depression-Anxiety-Stress Scale. After controlling for sociodemographic variables, Hayes' PROCESS macros were used to test how psychological resilience moderates the relationships among narrative disorders, negative affect, and perceived social support. Bootstrap confidence intervals tested for indirect effects. Correlation analyses revealed that alexithymia was correlated significantly positively with depression-anxiety-stress (r = 0.57, 0.56, and 0.58, resp.) and significantly negatively with perceived social support (r = 0-0.46). Psychological resilience was correlated significantly negatively with alexithymia (r=-0.39) and depression-anxiety-stress (r=-0.31, -0.30, and-0.32, resp.) but significantly positively with perceived social support(r = 0.50). Perceived social support was correlated significantly negatively with depression-anxiety-stress (r=-0.33, -0.34, and - 0.42 resp.). Stress was correlated significantly positively with anxiety and depression (r = 0.81 and 0.77, resp.). Psychological resilience was a partial mediator between depression and dysphoria (β=-0.08, p < 0.05). Dysphoria directly predicted anxiety (β = 0.31) and stress (β = 0.37); moreover,alexithymia predicted depression not only directly but also through the mediating effect of psychological resilience. Therefore, educators and clinical administrators must promote and recognise negative emotions among nursing students to help ensure the nursing workforce's stability.

"Meaning in Life" Mediates the Relationship between Loneliness and Depressive Symptoms among Older Adults during the COVID-19 Pandemic

BACKGROUND

Loneliness was found to be a commonly experienced feeling among older adults during the COVID-19 pandemic and is considered to be a high-risk factor for depressive symptoms. Maintaining meaning in life has been found to be a protective resource for mental health among older adults. The purpose of this study was to examine the mediating effects of an individual's meaning in life in the relationship between loneliness and depressive symptoms among older Korean adults.

METHODS

The data were obtained from a sample of 213 community-dwelling older adults aged over 65. The instruments were the UCLA Loneliness Scale, the Center for Epidemiologic Studies Depression Scale, and the Meaning in Life Questionnaire.

RESULTS

Loneliness was positively associated with depressive symptoms and negatively associated with the presence of and search for meaning among older adults. The presence of meaning mediated the relationship between loneliness and depressive symptoms but the search for meaning did not. The search for meaning mediated the relationship between loneliness and depressive symptoms through the presence of meaning.

CONCLUSIONS

Our study findings suggest that efforts to reduce loneliness and improve meaning in life should be undertaken to prevent depressive symptoms among older adults.

Social isolation, loneliness, and the risk of incident type 2 diabetes mellitus by glycemic status

AIM

The modifying effect of prediabetic status on the association of social isolation and loneliness with the risk of type 2 diabetes mellitus (T2DM) remains uncertain. We aimed to explore whether prediabetic status modifies the association of social isolation and loneliness with incident T2DM.

METHODS

358,951 participants with random blood glucose < 11.1 mmol/l, hemoglobin A1c < 6.5 % and without diagnosis of diabetes from the UK Biobank were included. Prediabetes was defined by hemoglobin A1c level at 5.7-6.4 %. Social isolation and loneliness were assessed using self-reported questionnaires. The study outcome was incident T2DM.

RESULTS

During a median follow-up of 12.5 years, 13,213 (3.7 %) incident T2DM cases were documented. Social isolation and loneliness in subjects with normoglycemia (adjusted HR [95 %CI]: social isolation: 1.14 [1.07;1.23]; loneliness: 1.33 [1.20;1.47]) were more strongly associated with increased risk of T2DM than in those with prediabetes (adjusted HR [95 %CI]: social isolation: 0.97 [0.91;1.03]; loneliness: 1.04 [0.95;1.13]) (Both P for interaction < 0.001). Among individuals with prediabetes, alcoholic consumption (30.9 %), household income (23.3 %), healthy sleep (17.1 %), loneliness (14.9 %), and physical activity (12.6 %) mediated most of the variance in the association between social isolation and incident T2DM, while body mass index (17.9 %) and healthy sleep (17.6 %) mediated most of the variance in the association between loneliness and incident T2DM.

CONCLUSION

Social isolation and loneliness were independently associated with a higher risk of T2DM among individuals without prediabetes. Among those with prediabetes, the association of social isolation and loneliness with incident T2DM were mainly mediated by some socioeconomic and lifestyle factors.