Pain, depression, and fatigue: loneliness as a longitudinal risk factor

Meeting the WHO Physical Activity Guidelines is Associated With Lower Odds of Depression in Older Adults: Potential Psychosomatic Mechanisms

OBJECTIVES

Limited data exist on the association between physical activity (PA) and depression in older adults from low- and middle-income countries (LMICs). In this study, we examine the association between meeting the World Health Organization (WHO) PA guidelines and depression in adults aged ≥50 years in Ghana and investigate the psychosomatic factors explaining this association.

METHODS

Cross-sectional data from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study in Ghana (2016-18) were analyzed. Depression was assessed with the Center for Epidemiological Studies Depression Scale (CES-D-10). PA was assessed using the International Physical Activity Questionnaire Short Form (IPAQ-SF). Multivariable logistic regression and Hayes PROCESS macro with bootstrapping mediation analyses were performed to evaluate the hypothesized associations.

RESULTS

The study included 1201 individuals (mean [SD] age 66.1 [11.9] years; 63.3% women). The prevalence of meeting PA guidelines and depression was 36.7% and 29.5%, respectively. Meeting the WHO-recommended PA guidelines was associated with a 16% lower rate of developing depression even after adjusting for potential confounders (OR = 0.84, p <0.001). This association was much stronger among men and those aged 50-64 years. Loneliness, social isolation, sleep problems, functional limitations, and pain characteristics largely mediated the association of PA with depression.

CONCLUSIONS

PA was negatively associated with depression among older adults in Ghana, and psychosocial and physical factors partially explained the association. The promotion of PA in old age may aid in the prevention of depression, especially in men and those aged 50-64 years. Longitudinal data may confirm our findings.

Interpersonal relationships, PNI, and health: Seeds in the 1980s, fruiting trees today

In this contribution to the Special Issue, I highlight how Janice Kiecolt-Glaser's research in the 1980s planted the seeds for two areas of social relationships and health research: loneliness and intimate/marital relationships. I review the foundational "seed" studies from the mid-to late-1980s, the research "saplings" that sprouted and grew during the subsequent twenty years, and the "mature trees" that have gone on to fruit and grow their respective areas of inquiry over the past twenty years. In addition to highlighting the mature trees that have borne rich empirical fruit, my other goal for this contribution is to draw attention to ideas and concepts from Kiecolt-Glaser's work and writing that merit further conceptual and empirical examination in the next generation of research on social relationships, psychoneuroendocrinology, psychoneuroimmunology, and health.

Loneliness and sleep in everyday life: Using ecological momentary assessment to characterize the shape of daily loneliness experience

BACKGROUND

Loneliness has been linked to an increased risk of sleep problems. Past research has largely relied on trait loneliness or daily recall loneliness when evaluating associations with sleep.

OBJECTIVE

The present study extended this work by evaluating the patterns of loneliness throughout the day, including a daily average of all reports, a maximum value, and daily variation. These loneliness patterns predicted daily subjective and objective sleep measures to evaluate whether they provide unique insight to this relationship.

METHODS

Undergraduate students (n = 71; 77% female; age 18-28) completed 2weeks of electronic surveys 4 times a day to assess loneliness. Each morning participants completed a diary of their prior night's sleep quality, as well as wore actigraphy devices to objectively assess sleep parameters. A total of 778 momentary surveys and 565days of actigraphy-assessed sleep data were collected. Multilevel models tested whether within-person daily aggregates of loneliness were associated with within-person daily sleep outcome variables.

RESULTS

Subjective sleep duration, quality, and fatigue were significantly predicted by daily average loneliness. Subjective sleep latency, quality, and fatigue were significantly predicted by daily max loneliness. Only fatigue was significantly predicted by daily loneliness variability. No objective sleep measures were significantly predicted by daily loneliness measures.

CONCLUSIONS

Patterns of daily loneliness focusing on central tendency (average) or intensity (max) were more consistently associated with subjective (but not objective) assessments of sleep than variability.

Understanding the biopsychosocial knee osteoarthritis pain experience: an ecological momentary assessment

Introduction

Psychological, social, and lifestyle factors contribute to the knee osteoarthritis (OA) pain experience. These factors could be measured more accurately using smartphone ecological momentary assessment (EMA).

Objectives

The objective of this study was to characterise the pain experiences of those with knee OA by a smartphone EMA survey and explain how momentary psychological and social states influence knee OA pain experiences.

Methods

A smartphone EMA survey was designed and piloted. Eligible participants completed smartphone EMA assessing the knee OA pain experience 3 times daily for 2 weeks. Descriptive statistics were used to characterise factors involved in knee OA pain followed by the development of mixed-effects location scale models to explore heterogeneity and relationships between symptoms involved in the knee OA pain experience.

Results

Eighty-six community-dwelling volunteers with knee OA were recruited. Pain, psychosocial, and lifestyle factors involved in knee OA pain experience were heterogeneous and variable. Those with greater variability in pain, fatigue, negative affect, and stress had worse levels of these symptoms overall. In addition, fatigue, negative affect, stress, anxiety, loneliness, and joint stiffness demonstrated within-person relationships with knee OA pain outcomes.

Conclusions

Knee OA pain is a heterogeneous biopsychosocial condition. Momentary experiences of psychological, social, fatigue, and joint stiffness explain individual and between-individual differences in momentary knee OA pain experiences. Addressing these momentary factors could improve pain and functional outcomes in those with knee OA. Validation studies, including individuals with more severe knee OA presentations, are required to support findings and guide clinical interventions to improve outcomes for those with knee OA.

Moving toward affective immunology: Legacy and future directions

The term "affective immunology" has recently been used to denote a field focused on the interplay between affective processes (including mood states, specific emotions, and regulatory processes) and various aspects of immune function. The overarching goals of this commentary are a) to provide historical underpinnings of this field with a focus on the profound impact of the work of Janice Kiecolt-Glaser, who is further honored in this special issue, b) to review important off-shoots of her legacy work in this domain, and c) to highlight important future directions for the field. Kiecolt-Glaser's work laid much of the foundation for affective immunology, with groundbreaking research related to depression, hostility and dyadic interactions, loneliness, and other affective patterns, often in the context of holistic models, novel experimental designs, and interventions. Her former mentees (and many of their mentees) have carried on her legacy in these domains, in ways that continue to advance appreciation of how affective processes relate to immune function. There are numerous remaining questions for the field to pursue, including better understanding of the role of emotion regulation, emotional reactivity and recovery, restorative processes, affective variability, and developmental and dynamic social processes. Such work will require greater use of longitudinal and within-person approaches and/or examination of processes in daily life, as well as models that account for interactive and reciprocal processes and which integrate behavior, social context, sociocultural factors, individual differences, and other aspects of health. As more work in these domains continues, building on Kiecolt-Glaser's rich legacy, we move toward the emergence of affective immunology as an important subfield in the domain of psychoneuroimmunology, one which will offer more nuanced understanding of the role of affective processes in immune health.

Attachment and negative affect on mental health and pain experience patients with Multiple Sclerosis: Mediated by coping strategies and loneliness

BACKGROUND

Multiple sclerosis and its related stressors significantly affect the mental health of people with MS. Considering the progressive and relapsing-remitting nature of the disease and somatic complaint, the Pain experience for MS patients is challenging. We examined the direct effects of Attachment and the negative affect on mental health and pain experience and the indirect effects of Attachment, negative affect, loneliness, and coping strategies on the mental health and pain experience of people with multiple sclerosis.

METHODS

Three hundred forty-five patients with MS were selected through the Iranian MS Association. Measures included the negative affect (PANAS), Adult Attachment Inventory (AAI), General Health Questionnaire (GHQ28), short-form McGill pain questionnaire (SF-mpq-2), Social and emotional loneliness scale for adults (SELSA-S), Coping Inventory for Stressful Situations(CISS-21). The present study has employed the Structural Equation Model (SEM) to investigate the direct and indirect effects of coping strategies, attachment, loneliness, and negative affect on mental health and pain experienced by individuals with MS. The fit of the model to the data was examined using the Discrepancy Function Divided by Degrees of Freedom (CMIN/DF), Normed Fit Index (NFI), TuckerLewis Index (TLI), Comparative Fit Index (CFI), and Root Mean Square Error of Approximation (RMSEA).

RESULTS

The fit indices results showed that the model's fit was good. Furthermore, findings indicate that 13 % (R2=13) of the pain experience Changes and 47 % (R2=47) of the mental health Changes are explained via study predictors. Negative affect directly affects mental health and pain experience, and Attachment directly affects mental health. Negative affect indirectly affects coping strategies. Attachment and Negative affect indirectly affect loneliness. Loneliness and coping strategies indirectly affect mental health and pain experience.

CONCLUSION

Study findings contribute to our understanding of the crucial structures that play a role in the mental health and pain experience of individuals with MS. Loneliness and coping strategies as mediating variables play essential roles in these people's mental health and pain experience. In the times ahead, it would be beneficial to prioritize addressing negative affect, attachment, coping strategies, and loneliness in the patients with MS' medical and psychological intervention.

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona's Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5-7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34-0.73 and 0.29-0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01-1.06). Holding all covariates constant, individuals reporting loneliness for 5-7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06-1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03-0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02-0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1-2, and 5-7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.

Association of Social Isolation and Loneliness With Chronic Low Back Pain Among Older Adults: A Cross-sectional Study From Japan Gerontological Evaluation Study (JAGES)

BACKGROUND

Per the biopsychosocial model, pain, especially chronic low back pain, which often presents with nonspecific pain, requires a comprehensive approach involving social factors. However, the association of social factors, including social isolation and loneliness, with this condition remains unclear. This study examined the cross-sectional association of social isolation and loneliness with chronic low back pain among older adults.

METHODS

We recruited functionally independent older adults through a mail survey in 2019 from the Japan Gerontological Evaluation Study (JAGES). Chronic low back pain was defined as low back pain lasting more than 3 months. Social isolation was identified based on face-to-face and non-face-to-face interactions ("not isolated," "isolated tendency," and "isolated"). Loneliness was assessed using the University of California, Los Angeles Loneliness Scale ("not lonely," "lonely tendency," and "lonely").

RESULTS

Consequently, 21,463 participants were analyzed (mean age: 74.4 years; 51.5% females); 12.6% reported chronic low back pain. Multivariable Poisson regression analysis revealed that loneliness was significantly associated with the likelihood of chronic low back pain; compared with "not lonely", the prevalence ratio (PR) was 1.14 (95% confidence interval [CI], 1.05-1.25) for "lonely tendency" and 1.40 (95% CI, 1.27-1.54) for "lonely." Social isolation was not associated; compared with "not isolated," the PR was 0.96 (95% CI, 0.88-1.05) for "isolated tendency" and 0.99 (95% CI, 0.89-1.10) for "isolated." A positive multiplicative interaction between social isolation and loneliness for chronic low back pain was found.

CONCLUSION

Lonelier individuals were more likely to experience chronic low back pain, and those with loneliness and social isolation were synergistically more likely for this condition.

Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms

BACKGROUND

Hematopoietic stem cell transplantation (hereafter "HCT") is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients' reports of pre-transplant social isolation, social constraints, and psychological distress.

METHOD

We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms.

RESULTS

Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms.

CONCLUSION

For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients' psychological health and sense of social connectedness.

The Assessment of Social Isolation and Loneliness in Cancer Patients and Survivors in the Pre-COVID-19 Period: A Systematic Review

BACKGROUND

In the context of cancer research, identifying social isolation and loneliness is a priority given how both exacerbate poor outcomes and lead to increased mortality in oncological populations. The purpose of this systematic review is to identify all quantitative instruments that have been used to assess either social isolation or loneliness in patients previously or currently diagnosed with cancer in the pre-COVID-19 period.

METHOD

PubMed (Web), Scopus, CINAHL, and PsycINFO were searched on August 22, 2019. All databases were searched from inception with no filters applied. The search strategies included terms that captured the following concepts: instruments/tools, social isolation or loneliness, and cancer.

RESULTS

A total of 289 titles/abstracts were returned. Upon review, 114 titles/abstracts were deemed to be potentially eligible and the full text was retrieved. Of the 114 full texts, 69 articles met inclusion criteria and comprised the final sample. Publications span years 1980 through 2019, with the majority (71%) occurring in the last decade prior to this review, between 2009 and 2019. Average age of the study samples, with few exceptions, was often over 50 years old. Many studies used all-female samples, while only one study used an all-male sample. The most common cancer diagnosis of participants was breast cancer. The most common measure was the UCLA Loneliness Scale, used in 22 studies. Most measures we identified were used only once, and 11 measures were used 2-3 times. When the information was given, response ranges were always Likert-type scales most often ranging from 1-4 or 1-5, and sometimes from 1-10 possible response options. In terms of psychometrics, test-retest reliability and validity were rarely reported; by contrast, internal consistency (Cronbach's alpha) was reported more than half of the time (60.9%).

CONCLUSION

When selecting a measure to assess loneliness in cancer populations, the UCLA Loneliness Scale is both psychometrically strong and versatile across patients with different cancers, ages, and racial backgrounds. When selecting a measure to assess social isolation in cancer populations, both the PROMIS-SF V 2.0 social isolation and the Berkman-Syme Network Index are brief and have been used in patients with non-White racial backgrounds.

Effects of Lockdown Restrictions and Impact of Anxiety and Depression Symptoms in People With Chronic Pain During the Covid-19 Pandemic: A 13-Wave Longitudinal Study

In early 2020, countries across the world imposed lockdown restrictions to curb the spread of the Covid-19 coronavirus. Lockdown conditions, including social and physical distancing measures and recommended self-isolation for clinically vulnerable groups, were proposed to disproportionately affect those living with chronic pain, who already report reduced access to social support and increased isolation. Yet, empirical evidence from longitudinal studies tracking the effects of prolonged and fluctuating lockdown conditions, and potential psychological factors mediating the effects of such restrictions on outcomes in chronic pain populations, is lacking. Accordingly, in the present 13-wave longitudinal study, we surveyed pain intensity, pain interference, and tiredness in people with chronic pain over the course of 11 months of the Covid-19 pandemic (April 2020-March 2021). Of N = 431 participants at baseline, average completion rate was ∼50% of time points, and all available data points were included in linear mixed models. We examined the impact of varying levels of lockdown restrictions on these outcomes and investigated whether psychological distress levels mediated effects. We found that a full national lockdown was related to greater pain intensity, and these effects were partially mediated by depressive symptoms. No effects of lockdown level were found for pain interference and tiredness, which were instead predicted by higher levels of depression, anxiety, pain catastrophising, and reduced exercise. Our findings are relevant for improving patient care in current and future crises. Offering remote management options for low mood could be particularly beneficial for this vulnerable population in the event of future implementation of lockdown restrictions. PERSPECTIVE: This longitudinal study demonstrates the impact of Covid-19 lockdown restrictions on people with chronic pain. Findings suggest a complex interaction of psychosocial factors that impacted various aspects of pain experience in patients, which offer the potential to inform clinical strategies for remote medicine and future crises.

Loneliness and social isolation among informal carers of individuals with dementia: A systematic review and meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to determine the prevalence of loneliness and social isolation among informal carers of individuals with dementia and to identify potential influencing factors.

METHODS

We conducted a comprehensive search across 10 electronic databases, including PubMed, Cochrane, Embase, Web of Science, PsycINFO, CINAHL, Scopus, Chinese Biomedical, China National Knowledge Internet, and WANFANG. Our search strategy covered the inception of the databases up to September 16, 2023, with an updated search conducted on March 8, 2024. Prevalence estimates of loneliness and social isolation, presented with 95% confidence intervals, were synthesized through meta-analysis. Subgroup analyses and meta-regression were employed to explore potential moderating variables and heterogeneity.

RESULTS

The study encompassed 27 research papers involving 11,134 informal carers from 17 different countries. The pooled prevalence of loneliness among informal carers of individuals with dementia was 50.8% (95% CI: 41.8%-59.8%), while the pooled prevalence of social isolation was 37.1% (95% CI: 26.7%-47.6%). Subgroup analyses and meta-regression indicated that various factors significantly influenced the prevalence of loneliness and social isolation. These factors included the caregiving setting, study design, the intensity of loneliness, geographical location (continent), data collection time, and the choice of assessment tools.

CONCLUSIONS

This study underscores the substantial prevalence of loneliness and social isolation among informal carers of individuals with dementia. It suggests that policymakers and healthcare providers should prioritize the development of targeted interventions and support systems to alleviate loneliness and social isolation within this vulnerable population.

Racial/Ethnic Disparities: Discrimination's Impact on Health-Related Quality of Life-An All of Us Cancer Survivors' Cross-sectional Study

BACKGROUND

Discrimination is associated with worse mental and physical health outcomes. However, the associations among cancer survivors are limited.

OBJECTIVE

We examined whether discrimination is associated with HRQoL and whether adjusting for it reduces racial/ethnic disparities in HRQoL among cancer survivors.

METHODS

Cross-sectional data from adult cancer survivors who completed surveys on discrimination in the medical settings (DMS), everyday perceived discrimination (PD), and HRQoL in the "All of Us" Program from 2018 to 2022 were assessed. We created a binary indicator for fair-to-poor vs. good-to-excellent physical health and mental health. PD and DMS scores were a continuous measure with higher scores reflecting more discrimination. Multivariable logistic regression models tested whether DMS and PD are associated with HRQoL and whether they differently affect the association between race/ethnicity and HRQoL.

RESULTS

The sample (N = 16,664) of cancer survivors was predominantly White (86%) and female (59%), with a median age of 69. Every 5-unit increase in DMS and PD scores was associated with greater odds of fair-to-poor physical health (DMS: OR [95%CI] = 1.66 [1.55, 1.77], PD: 1.33 [1.27, 1.40]) and mental health (DMS: 1.57 [1.47, 1.69], PD: 1.33 [1.27, 1.39]). After adjusting for DMS or PD, Black and Hispanic survivors had a decreased likelihood of fair-to-poor physical health and mental health (decrease estimate range: - 6 to - 30%) compared to White survivors. This effect was greater for Black survivors when adjusting for PD, as the odds of fair-to-poor mental health compared to White survivors were no longer statistically significant (1.78 [1.32, 2.34] vs 1.22 [0.90, 1.64]).

CONCLUSION

Experiences of discrimination are associated with lower HRQoL and reducing it may mitigate racial/ethnic disparities in HRQoL.

Social health in young women with chronic pain

Introduction

Chronic pain may negatively affect social functioning, but no study to date has examined the specific social impact of different chronic pain conditions in young women, and whether living with multiple chronic overlapping pain conditions (COPCs) differently influences social domains.

Objectives

This study aimed to assess social functioning (social isolation, hostility, informational support satisfaction, social roles, emotional support, friendships, and family relationships) among young women with chronic pain compared with pain-free controls and to test whether the number of COPCs influenced the extent of social burden.

Methods

Participants aged 18 to 30 years with a physician-confirmed diagnoses of migraine, fibromyalgia, or temporomandibular disorder (TMD) and pain-free controls were invited to participate from across the United States. After confirming eligibility, participants completed a 1-hour REDCap online questionnaire assessing social functioning.

Results

One hundred four participants (mean age 24.54 ± 3.35 years) were included (n = 26 with TMD, n = 25 with fibromyalgia, n = 25 with migraine, and n = 28 controls). All 3 chronic pain groups combined reported worse functioning than controls on friendship (P = 0.038), social isolation (P = 0.002), and social roles (P < 0.001). There were no differences on social variables between the 3 chronic pain groups (all P's > 0.05). Compared with those with 3 COPCs, participants with 1 condition reported better family relationships (P = 0.024).

Conclusions

Experience of chronic pain-regardless of the specific pain condition-may negatively affect some areas of social functioning in young women.

Bidirectional Longitudinal Association between Back Pain and Loneliness in Later Life: Evidence from English Longitudinal Study of Ageing

BACKGROUND

This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain.

METHODS

Data from 7,730 participants in waves 6 (2012-2013), 7 (2014-2015), and 8 (2016-2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0-10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness.

RESULTS

No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61-0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50-0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57-0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35-0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34-0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7.

CONCLUSION

Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.

Technology Use, Barriers, and Future Needs Among Community-Dwelling Older Adults

PURPOSE

Social isolation and loneliness are social determinants of health (SDOH) that can negatively affect the well-being of older adults. Using technology has the potential to reduce social isolation; thus, increasing safe use of technology among older adults can positively impact their health and promote aging in place.

METHOD

Older adults (N = 730) were surveyed regarding their use of, access and barriers to, satisfaction with, and anticipated future needs related to technology.

RESULTS

Survey respondents found technology was a significant resource for staying connected; however, low levels of satisfaction with devices and fear of scams indicate the need for additional training on the best and safest use of technology.

CONCLUSION/IMPLICATIONS

By screening older adults for SDOH, identifying their current and anticipated needs, and advocating for changes in health care and communities to meet these needs, nurses can help facilitate safe and healthy aging in place for their patients. [Journal of Gerontological Nursing, 50(2), 26-31.].

Understanding the impact of socioeconomic and health factors on geriatric depression: A comparative study in rural and urban Bangladesh

Background and Aims

The prevalence of depression among the elderly is a growing concern, and this study examines the differences between urban and rural areas in terms of geriatric depression.

Methods

Using a two-stage random sampling approach in urban areas and a multistage random sampling approach in rural areas, the study surveyed 944 elderly individuals of both sexes.

Results

The results indicate that the prevalence of depression was high, with 52.5% of the elderly population experiencing mild to severe depression. The study found that increasing age, female gender, nuclear family structure, and involvement of housewives or others were significant factors affecting depression in urban areas, while increasing age and elderly people without spouses were significant factors in rural areas. Additionally, the study identified hearing impairment, asthma, and arthritis as risk factors for depression in rural areas, and bronchitis, heart disease, and thyroid illness as significant factors in urban areas.

Conclusion

These findings highlight the need for policymakers to focus on addressing the mental health needs of older people, particularly women and those without spouses.

Loneliness, immunological recovery patterns, and health-related quality of life (HRQOL) outcomes in patients receiving hematopoietic stem cell transplantation

PURPOSE

Loneliness may compromise health-related quality of life (HRQOL) outcomes and the immunological impacts of loneliness via neuroendocrinological mechanisms likely have consequences for patients who have undergone a hematopoietic stem cell transplantation (HSCT).

RESEARCH APPROACH AND MEASURES

Loneliness (pre-transplant), immunological recovery (Day 30, Day 100, 1-year post-transplant), and HRQOL (Day 100, 1 year) were measured in a sample of 205 patients completing a HSCT (127 autologous, 78 allogenic).

RESULTS

Greater levels of pre-transplant loneliness predicted poorer HRQOL at Day 100 and 1-year follow-up. Loneliness also was associated with higher absolute neutrophil to absolute lymphocyte (ANC/ALC) ratios in the entire sample at Day 30, which in turn was associated with Day 100 HRQOL.

CONCLUSIONS

Findings demonstrate that pretransplant loneliness predicts HRQOL outcomes and associates with inflammatory immunological recovery patterns in HSCT patients. The balance of innate neutrophils to adaptive lymphocytes at Day 30 present a distinct profile in lonely individuals, with this immunity recovery profile predicting reduced HRQOL 100 days after the transplant. Addressing perceptions of loneliness before HSCT may be an important factor in improving immunological recovery and HRQOL outcomes.

The association between loneliness, social isolation, and sleep disturbances in older adults: A follow-up study from the Swedish good aging in Skåne project

Objectives

The aim of this follow-up study was to investigate whether loneliness and social isolation in a sample of older adults, mean age of 67.4 years at baseline examination, were associated with sleep disturbances at re-examination at a mean age of 76.4 years.

Methods

The study sample consisted of 2897 participants. Data on loneliness, social isolation, and sleep disturbances were collected through questionnaires and medical examinations. Logistic regression models were constructed to identify associations between levels of loneliness and social isolation at baseline and sleep disturbances at follow-up. Sociodemographic and health-related confounding factors were controlled for in the models.

Results

Sleep disturbances were reported by 25.6% (95% CI: 24.0%-27.2%) at baseline and 23.7% (95% CI: 22.1%-25.3%) at re-examination. Odds ratios for sleep disturbances at re-examination in relation to not being lonely or socially isolated were as follows: single occasions of loneliness (OR: 1.37, 95% CI: 1.05-1.78), recurring periods/constant loneliness (OR: 1.92, 95% CI: 1.01-1.99), less severe social isolation (OR: 1.18, 95% CI: 0.78-1.79), and severe social isolation (OR: 1.88, 95% CI: 1.01-3.49).

Discussion

Sleep disturbances are common among older adults and are associated with loneliness and social isolation. Healthcare professionals should be aware of the potential effects of loneliness and social isolation when investigating sleep disturbances in older adults.

Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

INTRODUCTION

The COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness has increased from 40% to 70% during COVID-19. Previous research indicates loneliness is strongly associated with increased mortality. Thus, strategies to mitigate the unintended consequences of social isolation and loneliness are urgently needed. Following the Obesity-Related Behavioural Intervention Trials model for complex behavioural interventions, we describe a protocol for a three-arm randomised clinical trial to reduce social isolation and loneliness.

METHODS AND ANALYSIS

A multicentre, outcome assessor blinded, three-arm randomised controlled trial comparing 12 weeks of: (1) the HOspitals WoRking in Unity ('HOW R U?') weekly volunteer-peer support telephone intervention; (2) 'HOW R U?' deliver using a video-conferencing solution and (3) a standard care group. The study will follow Consolidated Standard of Reporting Trials guidelines.We will recruit 24-26 volunteers who will receive a previously tested half day lay-training session that emphasises a strength-based approach and safety procedures. We will recruit 141 participants ≥70 years of age discharged from two participating emergency departments or referred from hospital family medicine, geriatric or geriatric psychiatry clinics. Eligible participants will have probable baseline loneliness (score ≥2 on the de Jong six-item loneliness scale). We will measure change in loneliness, social isolation (Lubben social network scale), mood (Geriatric Depression Score) and quality of life (EQ-5D-5L) at 12-14 weeks postintervention initiation and again at 24-26 weeks.

ETHICS AND DISSEMINATION

Approval has been granted by the participating research ethics boards. Participants randomised to standard care will be offered their choice of telephone or video-conferencing interventions after 12 weeks. Results will be disseminated through journal publications, conference presentations, social media and through the International Federation of Emergency Medicine.

TRIAL REGISTRATION NUMBER

NCT05228782.

Fatigue during the COVID-19 pandemic - prevalence and predictors: findings from a prospective cohort study

The COVID-19 pandemic and consequent lockdowns had a substantial impact on mental health. Distress and fatigue are highly correlated. However, little is known about the determinants of fatigue in the general population during the pandemic. This study aimed to examine the prevalence and predictors of fatigue during the COVID-19 pandemic in the UK population. Online surveys were completed by a UK community cohort in April 2020 (wave 1), July-September 2020 (wave 2) and November-December 2020 (wave 3). In total, 3097 participants completed the wave 1 survey, and 1385 and 1087 participants (85.4% women) completed wave 2 and 3 surveys respectively. Fatigue was assessed using the Chalder Fatigue Scale at waves 2 and 3. Hair samples were provided by 827 participants (90.6% women) at wave 1 and wave 2, which were analyzed to indicate HairE (stress hormone). The mean total fatigue score during wave 2 was 14.7 (SD = 4.7), significantly higher than pre-pandemic levels observed in the community (mean difference 0.50, p = .003). At wave 2, 614 (44.3%) participants met the case definition for fatigue, only 15.6% of whom indicated that fatigue lasted for more than 6 months (suggesting it had started prior to the pandemic). Predictors of fatigue at wave 3 included being in a risk group, depression and belief in having COVID-19, which explained 23.8% of the variability in fatigue scores. Depression at wave 1 was the only significant predictor of remaining a fatigue case at wave 3. Fatigue was highly prevalent in the UK community during the COVID-19 pandemic and limited people's daily function. Depression and sociodemographic variables were significant predictors of fatigue.

Chronic pain patients low in social connectedness report higher pain and need deeper pressure for pain relief

The experience of rejection and disconnection reliably amplifies pain. Yet, little is known about the impact of enduring feelings of closeness, or social connectedness, on experiences of chronic pain. The current secondary analysis tested the hypothesis that greater social connectedness would predict lower chronic pain ratings, mediated by lower depression and anxiety. In addition, based on the social-affective effects of deeper pressure, and our previous finding that deeper pressure from a weighted blanket reduced chronic pain ratings, we examined whether deeper pressure from a weighted blanket would induce greater pain relief in socially disconnected chronic pain patients. We assessed social connectedness, anxiety, and depression at baseline and pain levels before and after a remote, 7-day randomized-controlled trial of a heavy or light (control) weighted blanket in a predominately White (86%) and female (80%) sample of 95 chronic pain patients. Results revealed that lower social connectedness was associated with higher chronic pain ratings, which was mediated by anxiety, but not depression. Pressure level (light vs. deep) moderated associations between social connectedness and pain reductions, such that deeper pressure was necessary for pain relief in the most socially disconnected participants. Our findings suggest a close relationship between social connectedness and chronic pain through a mechanistic pathway of anxiety. Furthermore, our findings demonstrate that sensory-affective interventions such as a weighted blanket may be a beneficial tool for chronic pain sufferers who are prone to social disconnection, potentially by activating embodied representations of safety and social support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The relationship between loneliness, psychological resilience, quality of life and taste change in cancer patients receiving chemotherapy

PURPOSE

This study aimed to determine the correlation between taste change, nutritional intake and quality of life in cancer patients receiving chemotherapy. A total of 610 (F = 314, M = 296) volunteers aged 19 and 65 who received outpatient chemotherapy treatment participated in the study.

METHODS

Individuals' general information was obtained, anthropometric measurements were carried out, malnutrition status (Patient-Generated Subjective Global Assessment PG-SGA), loneliness (Cancer Loneliness Scale), psychological resilience (Psychological Resilience Scale), quality of life (Quality of Life Scale (EORT QLQ-C30) and taste changes were scrutinized [Chemotherapy-Induced Taste Alteration Scale (CiTAS)].

RESULTS

There was a negative correlation between the Cancer Loneliness Scale and PG-SGA and General Health Status (r = -0.494, p = 0.000; r = -0.406, p = 0.000) and a positive correlation with Symptom Scales (r = 0.484, p = 0.000; r = 0.506, p = 0.000) (p < 0.05). There was a positive correlation between the Psychological Resilience Scale and General Health Status (r = 0.393, P = 0.000), Functional Scales (r = 0.349, P = 0.000), and a negative correlation between Symptom Scales (r = -0.302, p = 0.000) (p < 0.05). 70.9% of men and 70.7% of women had severe malnutrition. General Taste Changes, General Health and Symptom Scale values were significant predictors of severe malnutrition status (p < 0.05).

CONCLUSION

The symptoms that develop during the treatment process cause many psychological problems. Before starting treatment, patients should be evaluated comprehensively, depression anxiety levels and quality of life levels should be determined, and precautions should be taken accordingly.

The influence of climate change on mental health in populations of the western Pacific region: An umbrella scoping review

The Western Pacific Region (WPR) is on the front line of climate change challenges. Understanding how these challenges affect the WPR populations' mental health is essential to design effective prevention and care policies. Thus, the present study conducted an umbrella scoping review that examined the influence of climate change on mental health in the WPR, using review articles as a source of information. Ten review articles were selected according to eligibility criteria, and the findings were synthesized according to the socio-economic status of the countries identified: Australia, the Republic of Korea, the Philippines, Vietnam, the Pacific Islands (broadly), and China. The findings revealed that each country and sub-region has its own unique profile of climate change-related challenges and vulnerable populations, highlighting the need for specific approaches to mental health care. Specifically, the influence of climate-related challenges differed according to populations' region (e.g., rural populations), demographic characteristics (e.g., age and gender), culture (e.g., traditional tights to land), and employment (e.g., farmers and fishers). The most frequently reported mental health outcomes in response to climate change-related challenges such as droughts, floods, storms, tornadoes, typhoons, and climate-related migration were the decline in mental well-being and the increase in post-traumatic stress disorder symptoms. In addition, using the GRADE framework for assessing the certainty of the findings, we identified that the number of articles discussing associations between a given climate change challenge and a mental health outcome was overall limited. Based on our findings and findings on a global scale, we identified several key research gaps in WPR and provided recommendations for future research and policy strategies.

Work-family conflicts and pain interference among midlife adults: a longitudinal serial mediation via family strain and loneliness

OBJECTIVE

Work-family conflict has been shown to adversely affect individuals' health and function, particularly among individuals with chronic pain. The current study's longitudinal serial mediation model examined whether work-to-family conflict predicted greater pain interference through higher levels of family strain and loneliness among midlife adults with chronic pain.

METHODS AND MEASURES

The study consisted of 303 participants from two waves of the national longitudinal study of Midlife in the United States (MIDUS) at wave II from 2004 to 2006 (Mage = 57, SD = 11) and wave 3 from 2013 to 2014 (Mage = 66, SD = 11). Participants were employed at time 1 and had chronic pain at both time points, and 54.5% of participants identified as female.

RESULTS

Family strain at time 1 (T1) and loneliness at time 2 (T2), respectively, significantly mediated the association of work-to-family conflict (T1) on pain interference at T2. Participants with greater work-to-family conflict perceived more family strain, felt lonelier, and, in turn, reported experiencing higher interference from chronic pain.

CONCLUSION

Results suggest that unmanaged work-to-family conflict could be a risk factor that exacerbates chronic pain symptoms through worsening family relationships and loneliness among midlife adults with chronic pain.

Applications of identity-based theories to understand the impact of stigma and camouflaging on mental health outcomes for autistic people

Autistic people have long been conceptualized from a deficit-based model of disability, but recent self-advocates and scholars have asserted the importance of recognizing autism as both a disability and an important part of a person's social identity. The autistic identity is subject to specific stigma and stressors beyond everyday discrimination and prejudice, which can have many downstream implications on mental health and well-being. Prior research on camouflaging has explained both quantitatively and qualitatively how autistic people conform to norms and mask their autistic traits to better fit in with non-autistic societal standards. Given this paradigm shift in understanding autistic peoples' lived experiences, researchers must also begin to reshape the theories guiding their work in order to improve diagnosis, intervention, and supports. This review examines the extant research on identity-related stigma and camouflaging and their subsequent impacts on mental health outcomes in autism. A model is proposed integrating identity-based theories-specifically the social model of disability, social identity theory, and minority stress model-to explain relationships across research areas and better explain the experiences of autistic people. We discuss how identity-based theories can be applied in autism research to better understand the impacts of stigma and camouflaging on autistic peoples' lived experiences and reduce disparities in their mental health outcomes.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Experiences and Perceptions of Using Smartphone Ecological Momentary Assessment for Reporting Knee Osteoarthritis Pain and Symptoms

BACKGROUND

Knee osteoarthritis (OA) is a prevalent, painful, and disabling musculoskeletal condition. One method that could more accurately monitor the pain associated with knee OA is ecological momentary assessment (EMA) using a smartphone.

OBJECTIVES

The aim of this study was to explore participant experiences and perceptions of using smartphone EMA as a way of communicating knee OA pain and symptoms following participating in a 2-week smartphone EMA study.

MATERIALS AND METHODS

Using a maximum variation sampling method, participants were invited to share their thoughts and opinions in semistructured focus group interviews. Interviews were recorded and transcribed verbatim before thematic analysis using the general inductive approach.

RESULTS

A total of 20 participants participated in 6 focus groups. Three themes and 7 subthemes were identified from the data. Identified themes included: user experience of smartphone EMA, data quality of smartphone EMA, and practical aspects of smartphone EMA.

DISCUSSION

Overall, smartphone EMA was deemed as being an acceptable method for monitoring pain and symptoms associated with knee OA. These findings will assist researchers in designing future EMA studies alongside clinicians implementing smartphone EMA into practice.

PERSPECTIVE

This study highlights that smartphone EMA is an acceptable method for capturing pain-related symptoms and experiences of those expereiencing knee OA. Future EMA studies should ensure design features are considered that reduce missing data and limit the responder burden to improve data quality.

Predictors of postoperative pain six months after breast surgery

Breast cancer, with a high prevalence and survival rate, leads to long-term complications. A major sequel is acute or chronic postoperative pain, and we investigated the possible relationship with clinical and psychological variables. Patients undergoing breast surgery filled out the loneliness (ULS-8) and depression (HADS) questionnaires. Patients rated their pain intensity with the Numerical Rating Scale (0-10, NRS) two days, seven days, and six months after surgery. Of 124 patients, the mean age was 45.86 years old, and the pain scores on the second and seventh postoperative days were 5.33 and 3.57, respectively. Sixth-month pain was significantly correlated with the acute scores with a mean of 3.27; and in the multivariate analysis, it was significantly associated with preoperative pain (p-value = 0.007), self-reported loneliness (p-value = 0.010), and adjuvant radiotherapy (p-value = 0.004). In conclusion, loneliness may be a risk factor for postoperative pain in breast surgery.

Neurophysiological and Psychosocial Mechanisms of Fibromyalgia: A Comprehensive Review and Call for An Integrative Model

Research into the neurobiological and psychosocial mechanisms involved in fibromyalgia has progressed remarkably in recent years. Despite this, current accounts of fibromyalgia fail to capture the complex, dynamic, and mutual crosstalk between neurophysiological and psychosocial domains. We conducted a comprehensive review of the existing literature in order to: a) synthesize current knowledge on fibromyalgia; b) explore and highlight multi-level links and pathways between different systems; and c) build bridges connecting disparate perspectives. An extensive panel of international experts in neurophysiological and psychosocial aspects of fibromyalgia discussed the collected evidence and progressively refined and conceptualized its interpretation. This work constitutes an essential step towards the development of a model capable of integrating the main factors implicated in fibromyalgia into a single, unified construct which appears indispensable to foster the understanding, assessment, and intervention for fibromyalgia.

The association between the interaction of migration background and physical activity with loneliness in middle-aged and older adults living in Germany

BACKGROUND

Reduced physical activity and having a migration background are both associated with higher loneliness; however, the moderating role of migration background in the association between loneliness and physical activity remains largely unknown.

METHODS

We used cross-sectional data from the sixth wave (year 2017) of the German Ageing Survey (DEAS). Loneliness was measured using the De Jong Gierveld tool and physical activity was dichotomised into either of the following (i.e., at least 150 min of moderate physical activity per week) or not following physical activity recommendations of the World Health Organization (WHO). For evaluation of the associations we applied adjusted linear regression models with robust standard errors.

RESULTS

We included 6257 (average age = 67 years, 50% female) and 285 (average age = 63 years, 51% female) participants without and with migration background, respectively. In multiple linear regressions both migration background (ß = 0.13, P = 0.001), as well as not following the WHO physical activity recommendations (ß = 0.06, P < 0.001) were associated with increased loneliness. Moreover, the respective interaction term reached statistical significance (ß = -0.27, P = 0.013). Participants with migration background have a more pronounced association between following the WHO physical activity recommendations and reduced loneliness compared to participants without migration background.

CONCLUSION

Among middle-aged and older individuals, those with migration background benefit to a larger extent from following physical activity recommendations than the population without migration background regarding loneliness. Thus, motivating individuals with migration background to follow the WHO physical activity guidelines could particularly assist in reducing loneliness.

Loneliness in patients with somatic symptom disorder

OBJECTIVES

Patients with somatoform disorders often experience loneliness. They feel misunderstood and socially rejected. Whereas loneliness is related to several medical conditions, social support can minimize loneliness. In the current study, differences in loneliness and the evaluation of social support between patients with Somatic Symptom Disorder (SSD) and healthy controls were investigated using standardized questionnaires. In addition, the relation between loneliness and somatic symptoms was investigated.

METHODS

In a cross-sectional study design, a group of patients with SSD (n=75) was compared to a healthy control group (n=112). It was hypothesized that [1] patients with SSD experience more loneliness and evaluate their social support more negatively than healthy controls and [2] loneliness will correlate positively with experienced somatic symptoms.

RESULTS

In comparison to healthy controls, patients with SSD experienced more loneliness and their evaluation of social support was more negative. In addition, loneliness correlated positively with the degree of experienced somatic symptoms.

CONCLUSIONS

Patients with SSD experienced lower social support, more loneliness, and across the two groups loneliness was positively associated with somatic symptoms. Effect sizes were all large. Therefore, these results may have implications for the treatment of SSD.

Predictors of psychoneurological symptoms in cancer caregivers over time: Role of caregiving burden, stress, and patient symptoms

PURPOSE

In cancer patients, stress is associated with a psychoneurologic (PN) symptom cluster of depressed mood, anxiety, pain, fatigue, and sleep disturbance. The stress of caregiving may trigger similar symptoms among caregivers and warrants investigation. The purpose of this analysis was to characterize correlates of PN symptom burden in cancer caregivers.

METHODS

Cancer patient-caregiver dyads (n = 29) provided eight weekly symptom reports using a web-based survey. Primary and secondary stressors of caregiving were also assessed. Mixed models accounting for repeated measurement were used to assess the between- and within-dyad predictors of caregiver PN symptom burden. The interaction of patient PN symptom burden and stress was tested. Exploratory cross-lagged Actor-Partner Interdependence Models were used to assess the week-to-week interdependence between patient and caregiver symptoms.

RESULTS

Caregivers most frequently reported feeling anxious (44% on average across timepoints), sleep problems (31%), fatigue (25%), and depressed mood (24%). Mixed models indicated that within dyads, greater hours of care and more patient symptoms were associated with greater caregiver PN symptom burden. Greater baseline perceived stress was also associated with higher caregiver PN symptom burden and moderated the association between patient and caregiver PN symptom burden. Cross-lagged Actor-Partner Interdependence Models indicated longitudinal interdependence among survivor and caregiver symptom burden.

CONCLUSIONS

The findings provide preliminary evidence of the interrelationship of PN symptom burden in caregivers and patients and the potential for stress to amplify this interrelationship, with implications for symptom management and supportive care practice.

Prosocial behaviour helps to ease physical pain: Longitudinal evidence from Britain

OBJECTIVE

Prior studies suggest that prosocial behaviour can lead to better mental and physical health. Yet little is known about whether engaging in prosocial behaviour contributes to reducing physical pain. The objective of this study is to investigate longitudinal associations of two prosocial behaviours, donating money to charity and/or volunteering time to an organisation, with pain.

METHODS

Data are from the United Kingdom Household Longitudinal Survey (UKHLS, approximate N = 48,000 individuals). Both prosocial behaviours were assessed in 2011 and pain was assessed annually through 2020, according to the extent to which it interfered with respondents' ability to do work. Using a prospective longitudinal study design, linear mixed models examined associations of each prosocial behaviour separately and both combined on pain interference across 10 years of follow-up adjusting for a broad range of covariates including demographics, initial health status, and depression.

RESULTS

People who did versus did not donate or volunteer reported lower pain interference over 10 years of follow-up (donating b = -0.059, p < 0.001; volunteering b = -0.086, p < 0.001). Individuals who donated more versus less money reported lower pain interference although volunteering more hours was not associated with lower pain interference. Finally, findings suggested that engaging in both donating and volunteering versus neither was associated with lower pain interference over follow-up.

CONCLUSION

There is a longitudinal association between donating money to charity and/or volunteering time to an organisation with pain interference with work. Understanding factors that help to reduce pain is relevant for the design of public health policies.

Emotional, behavioral, and physical health consequences of loneliness in young adult survivors of childhood cancer: Results from the Childhood Cancer Survivor Study

BACKGROUND

Young adults in the general population are at risk of experiencing loneliness, which has been associated with physical and mental health morbidities. The prevalence and consequences of loneliness in young adult survivors of childhood cancer remain unknown.

METHODS

A total of 9664 young adult survivors of childhood cancer (median age at diagnosis 10.5 years [interquartile range (IQR), 5-15], 27.1 years at baseline [IQR, 23-32]) and 2221 siblings enrolled in the Childhood Cancer Survivor Study completed a self-reported survey question assessing loneliness on the Brief Symptom Inventory-18 at baseline and follow-up (median follow-up, 6.6 years). Multivariable models evaluated the prevalence of loneliness at baseline only, follow-up only, and baseline + follow-up, and its associations with emotional distress, health behaviors, and chronic conditions at follow-up.

RESULTS

Survivors were more likely than siblings to report loneliness at baseline + follow-up (prevalence ratio [PR] 2.2; 95% confidence interval [CI], 1.7-3.0) and at follow-up only (PR, 1.4; 95% CI, 1.1-1.7). Loneliness at baseline + follow-up was associated with elevated risk of anxiety (relative risk [RR], 9.8; 95% CI, 7.5-12.7), depression (RR, 17.9; 95% CI, 14.1-22.7), and current smoking (odds ratio [OR], 1.7; 95% CI, 1.3-2.3) at follow-up. Loneliness at follow-up only was associated with suicidal ideation (RR, 1.5; 95% CI, 1.1-2.1), heavy/risky alcohol consumption (RR, 1.3; 95% CI, 1.1-1.5), and new-onset grade 2-4 chronic conditions (RR, 1.3; 95% CI, 1.0-1.7).

CONCLUSIONS

Young adult survivors of childhood cancer have elevated risk of experiencing loneliness, which is associated with future emotional distress, risky health behaviors, and new-onset chronic conditions.

Mitochondrial oxygen respiration is associated with loneliness in a sample of community-dwelling adults

Loneliness, a distressing perception of insufficient social support, is associated with physical illness and premature mortality that may be explained by reduced mitochondrial efficiency. In this human study (n = 50), loneliness was associated with less efficient mitochondrial functioning, indicated by the bioenergetic health index (BHI; r = -.39, p = .009), coupling efficiency (r = -.34, p = .021), and phosphorylating respiration (r = .39, p = .009). These findings remained significant when controlling for age, sex, and body mass index. The association between loneliness and mitochondrial functioning is important, given that both have been associated with age-related diseases.

Feasibility and preliminary efficacy of a virtual reality intervention targeting distress and anxiety in primary brain tumor patients at the time of clinical evaluation: Study protocol for a phase 2 clinical trial

BACKGROUND

Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms.

METHODS

PBT patients (N = 120) with upcoming MRI scans and clinical appointments who meet eligibility will be recruited to participate in a single arm trial conducted remotely through the NIH. Following completion of baseline assessments, participants will complete a 5-min VR intervention via telehealth using a head-mounted immersive device while under supervision of the research team. Following the intervention, over the course of 1 month patients can use VR at their discretion with follow-up assessments done immediately post-VR intervention, as well as 1 week and 4 weeks later. Additionally, a qualitative phone interview will be conducted to assess patient satisfaction with the intervention.

DISCUSSION

Use of immersive VR is an innovative interventional approach to target distress and scanxiety symptoms in PBT patients who are at high risk for experiencing these symptoms leading into their clinical appointments. Findings from this study may inform design of a future multicenter randomized VR trial for PBT patients and may aid in development of similar interventions for other oncology populations.

TRIAL REGISTRATION

Clinicaltrials.gov (NCT04301089), registered 9 March 2020.

Feasibility of a virtual reality intervention targeting distress and anxiety symptoms in patients with primary brain tumors: Interim analysis of a phase 2 clinical trial

PURPOSE

Cancer patients experience distress and anxiety when undergoing imaging studies to monitor disease status, yet these symptoms are not always appropriately identified or well-managed. This interim analysis of a phase 2 clinical trial explored feasibility and acceptability of a virtual reality relaxation (VR) intervention for primary brain tumor (PBT) patients at the time of clinical evaluation.

METHODS

English speaking, adult PBT patients with previous reports of distress and upcoming neuroimaging were recruited between March of 2021 and March 2022. A brief VR session was done within 2 weeks prior to neuroimaging with patient-reported outcomes (PROs) collected before and immediately post-intervention. Self-directed VR use over the next 1 month was encouraged with additional PROs assessments at 1 and 4 weeks. Feasibility metrics included enrollment, eligibility, attrition, and device-related adverse effects with satisfaction measured with qualitative phone interviews.

RESULTS

Fifty-five patients were approached via email, 40 (73%) responded and 20 (50%) enrolled (9 declines, 11 screen fails). 65% of participants were ≤ 50 years, 50% were male, 90% were White/non-Hispanic, 85% had good KPS (≥ 90), and most were on active treatment. All patients completed the VR intervention, PROs questionnaires, weekly check-ins, and qualitative interview. Most (90%) reported frequent VR use and high satisfaction and only 7 mild AEs were recorded (headache, dizziness, nausea, neck pain).

CONCLUSION

This interim analysis supports feasibility and acceptability of a novel VR intervention to target psychological symptoms for PBT patients. Trial enrollment will continue to assess for intervention efficacy.

TRIAL REGISTRATION

NCT04301089 registered on 3/9/2020.

Predictors of loneliness during the Covid-19 pandemic in people with dementia and their carers in England: findings from the DETERMIND-C19 study

OBJECTIVES

To identify factors that predict the risk of loneliness for people with dementia and carers during a pandemic.

METHODS

People with dementia and their carers completed assessments before (July 2019-March 2020; 206 dyads) and after (July-October 2020) the first Covid-19 'lockdown' in England. At follow-up, the analytic sample comprised 67 people with dementia and 108 carers. We built a longitudinal path model with loneliness as an observed outcome. Carer type and social contacts at both measurements were considered. Other social resources (quality of relationship, formal day activities), wellbeing (anxiety, psychological wellbeing) and cognitive impairment were measured with initial level and change using latent growth curves. We adjusted for socio-demographic factors and health at baseline.

RESULTS

In carers, higher levels of loneliness were directly associated with non-spouse coresident carer type, level and increase of anxiety in carer, more formal day activities, and higher cognitive impairment in the person with dementia. In people with dementia, non-spouse coresident carer type, and higher initial levels of social resources, wellbeing, and cognitive impairment predicted the changes in these factors; this produced indirect effects on social contacts and loneliness.

CONCLUSION

Loneliness in the Covid-19 pandemic appears to be shaped by different mechanisms for people with dementia and their carers. The results suggest that carers of those with dementia may prioritize providing care that protects the person with dementia from loneliness at the cost of experiencing loneliness themselves. Directions for the promotion of adaptive social care during the Covid-19 pandemic and beyond are discussed.

Feasibility and preliminary efficacy of a virtual reality intervention targeting distress and anxiety in primary brain tumor patients at the time of clinical evaluation: Study protocol for a phase 2 clinical trial

Background: Primary brain tumor (PBT) patients experience higher levels of distress and anxiety than other solid tumor patients, particularly at the time of clinical evaluation when uncertainty about disease status is high ("scanxiety"). There is promising evidence supporting use of virtual reality (VR) to target psychological symptoms in other solid tumor patients, though PBT patients have not been studied extensively in this context. The primary aim of this phase 2 clinical trial is to establish the feasibility of a remote VR-based relaxation intervention for a PBT population, with secondary aims designed to determine preliminary efficacy of improving distress and anxiety symptoms. Methods: PBT patients (N=120) with upcoming MRI scans and clinical appointments who meet eligibility will be recruited to participate in a single arm trial conducted remotely through the NIH. Following completion of baseline assessments, participants will complete a 5-minute VR intervention via telehealth using a head-mounted immersive device while under supervision of the research team. Following the intervention, over the course of 1 month patients can use VR at their discretion with follow-up assessments done immediately post-VR intervention, as well as 1 week and 4 weeks later. Additionally, a qualitative phone interview will be conducted to assess patient satisfaction with the intervention. Discussion: Use of immersive VR is an innovative interventional approach to target distress and scanxiety symptoms in PBT patients who are at high risk for experiencing these symptoms leading into their clinical appointments. Findings from this study may inform design of a future multicenter randomized VR trial for PBT patients and may aid in development of similar interventions for other oncology populations. Trial Registration: clinicaltrials.gov (NCT04301089), registered 9 March 2020.

Factors Associated with Fatigued Driving among Australian Truck Drivers: A Cross-Sectional Study

BACKGROUND

Fatigued driving is one of the leading factors contributing to road crashes in the trucking industry. The nature of trucking, prolonged working time, and irregular sleep patterns can negatively impact drivers' health and wellbeing. However, there is limited research in Australia investigating the impact of demographic, occupational, or lifestyle factors on fatigue among truck drivers.

OBJECTIVE

This cross-sectional study examines the role of demographic, occupational, lifestyle, and other health risk factors associated with fatigue among Australian truck drivers.

METHOD

This study was part of a larger study that used a short online survey with a follow-up telephone survey to capture in-depth information on a wide range of determinants related to truck drivers' physical and mental health outcomes. Fatigue was measured by three questions, including the frequency of fatigue, fatigue management training, and strategies used to combat fatigue. Multivariate regression analysis was used to determine the specific impact of demographics, occupational factors, lifestyle factors, and other health risk factors on fatigue.

RESULTS

In total, 332 drivers completed both the online and telephone surveys; 97% were male, representing drivers from broad age groups and professional experience. The odds of being in the high-risk fatigue group were nearly three times higher in drivers who worked 40-60 h compared to those who worked < 40 h. Poor sleep increased the odds of high-risk fatigue by seventimes (95% CI: 2.26-21.67, p = 0.001). Drivers who reported experiencing loneliness also had double the odds of being at high risk of fatigued driving.

CONCLUSIONS

The increased risk of fatigue in truck drivers is associated with prolonged working hours, poor sleep, and social aspects such as loneliness. Further interventions seeking to reduce driver fatigue should consider the impact of work schedules, the availability of quality sleeping spaces, and the level of social connections.

A Multi-Dimensional Model of Fatigue in Old Age: Implications for Brain Aging

As the most reported symptom in old age, fatigue is understudied in terms of both mechanisms and measures. Population heterogeneity and methodological inconsistency makes understanding the relationship between fatigue and brain aging challenging. The present article comprehensively reviews existing conceptual and operational frameworks of fatigue, as well as mechanistic heterogeneities of fatigue that exist in the aging literature. Then, I propose a Multi-Dimensional Model of fatigue to provide theoretical cohesion to the study of fatigue in old age, along with a "fatigue circuit" addressing brain profiles across dimensions of fatigue. The potential relationships between fatigue dimensions, the fatigue circuit, and brain aging are discussed to inform the direction of future research.

Loneliness is Associated With Lower Coping Self-Efficacy Among Older Adults

To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, sex, body mass index, chronic disease composite score, social support, coping self-efficacy, and depression symptoms. Loneliness was reported in 32.1% of participants and negatively associated with coping self-efficacy (OR = 0.68, 95% CI: 0.50-0.93) while controlling for age, race, sex, chronic disease composite score, and body mass index. Our findings suggest that coping self-efficacy may be a target for intervention involving loneliness in future research; however, the causal relationship between coping self-efficacy and loneliness should be explored further.

How has the COVID-19 pandemic affected patients' experience of pain management therapy?

Objectives

The current service evaluation aimed to explore the impact of COVID-19 on patients' experiences of pain management therapy. The study examined the barriers and benefits of the move from face-to-face to eHealth methods of delivery.

Design

A service evaluation was conducted in an outpatient pain clinic in an NHS Trust in the East of England. A qualitative approach was taken using semi-structured interviews.

Methods

Participants were recruited through a health psychology service operating as part of a multidisciplinary pain management clinic. Six patients, aged 39-67, were interviewed one-to-one using the online platform Zoom^TM. During COVID-19, participants had individual or group pain management therapy via telephone or video conferencing. All interviews were transcribed using Otter.ai^TM and thematic analysis was performed. The study was approved by internal clinical governance for service evaluations and the authors adhered to the BPS Code of Human Research Ethics.

Results

Three key themes emerged from the analysis; Benefits Aside From Pain Relief, Limited Their Experience, and COVID- 19: A D ouble-Edged Sword.

Conclusion

Findings suggested patients were able to benefit from pain management therapy despite the impact of COVID-19 on daily routines and pain experience. Adopting eHealth methods during the pandemic was an effective means of accessing pain management therapy. These methods allowed patients to continue to benefit from peer support and learn about skills and resources regarding self-management, whilst also improving accessibility for those with chronic pain. Yet, these methods are not without their limitations. Technical issues and difficulties creating therapeutic connections with psychologists limited patients' experience of pain management therapy.

Symptom Clusters in Family Caregivers of Hematopoietic Stem Cell Transplantation Recipients: Loneliness as a Risk Factor

A symptom cluster is a group of 2 or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplantation (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. The purpose of this analysis was to determine (1) whether clusters of 5 highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) which caregiver and patient characteristics influence membership in the identified symptom cluster groups. Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included the Caregiver Reaction Assessment (CRA), Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and Patient-Reported Outcomes Measurement Information System (PROMIS). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were performed to identify factors that contribute to symptom clusters. The average age of caregivers (n = 44) was 45.20 ± 15.05 years; primarily white (52.3%) and female (88.6%) and often the spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n = 24; 54.5%) and high symptom burden (n = 20; 45.5%). Caregivers with higher levels of loneliness (odds ratio, 1.12; 95% confidence interval, 1.04 to 1.22; P = .004) were more likely to be in the high symptom burden group. This study provides evidence that 5 symptoms commonly found in family caregivers-fatigue, sleep disturbance, depression, anxiety, and cognitive impairment-tend to occur in clusters. Therefore, clinicians should be aware that caregivers with 1 or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions also might include components that decrease loneliness. © 2022 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.

Serum metabolomics reveals the effects of accompanying treatment on fatigue in patients with multiple myeloma

PURPOSE

The renewal and iteration of chemotherapy drugs have resulted in more frequent long-term remissions for patients with multiple myeloma (MM). MM has transformed into a chronic illness for many patients, but the cancer-related fatigue (CRF) of many MM convalescent patients experience is frequently overlooked. We investigated whether the accompanying treatment of family members would affect MM patients' CRF and explore their serum metabolomics, so as to provide clinicians with new ideas for identifying and treating CRF of MM patients.

METHODS

This was a single-center study, and a total of 30 MM patients were included in the study. Patients were divided into two groups based on whether they have close family members accompanying them through the whole hospitalization treatment. These patients received regular chemotherapy by hematology specialists, and long-term follow-up was done by general practitioners. Patients' CRF assessment for several factors used the Chinese version of the Brief Fatigue Inventory (BFI-C). Face-to-face questionnaires were administered at a time jointly determined by the patient and the investigator. All questionnaires were conducted by a general practitioner. The LC-MS-based metabolomics analysis determined whether the patients' serum metabolites were related to their fatigue severity. A correlation analysis investigated the relationship between serum metabolites and clinical laboratory indicators.

RESULTS

The fatigue severity of MM patients whose family members participated in the treatment process (group A) was significantly lower than patients whose family members did not participate in the treatment process (group B). There was a statistically significant difference (fatigue severity composite score: t =  - 2.729, p = 0.011; fatigue interference composite score: t =  - 3.595, p = 0.001). There were no differences between the two groups of patients' gender, age, regarding clinical staging, tumor burden, blood routine, biochemical, or coagulation indexes. There were 11 metabolites, including guanidine acetic acid (GAA), 1-(Methylthio)-1-hexanethiol, isoeucyl-asparagine, L-agaritine, tryptophyl-tyrosine, and betaine, which significantly distinguished the two groups of MM patients. GAA had the strongest correlation with patient fatigue, and the difference was statistically significant (fatigue severity composite score: r = 0.505, p = 0.0044; fatigue interference composite score: r = 0.576, p = 0.0009). The results showed that GAA negatively correlated with albumin (r =  - 0.4151, p = 0.0226) and GGT (r =  - 0.3766, p = 0.0402). Meanwhile, GAA positively correlated with PT (r = 0.385, p = 0.0473), and the difference was statistically significant.

CONCLUSION

The study is the first to report that family presence throughout the whole hospitalization may alleviate CRF in MM patients. Moreover, the study evaluated serum metabolites linked to CRF in MM patients and found that CRF has a significant positive correlation with GAA. GAA may be a more sensitive biomarker than liver enzymes, PT, and serum albumin in predicting patient fatigue. While our sample may not represent all MM patients, it proposes a new entry point to help clinicians better identify and treat CRF in MM patients.

A cross-sectional study on the mental health of patients with COVID-19 1 year after discharge in Huanggang, China

OBJECTIVE

This study is aimed to investigate the mental health status of COVID-19 survivors 1 year after discharge from hospital and reveal the related risk factors.

METHODS

From April 11 to May 11, 2021, 566 COVID-19 survivors in Huanggang city were recruited through their primary doctors. A total of 535 participants (94.5%) admitted to participate in the survey and completed the questionnaires. Five scales were applied including 7-Items Generalized Anxiety Disorder Scale, Patient Health Questionnaire-9, Impact of Event Scale-Revised, Pittsburgh Sleep Quality Index, and Fatigue Scale-14. The chi-square and the Fisher's exact test were used to evaluate the classification data, multivariate logistic regression was used to explore the related factors of sleep quality, fatigue, anxiety, depression, and post-traumatic stress disorder (PTSD).

RESULTS

One year after being discharged, of the 535 COVID-19 survivors, 252 (47.1%) had poor sleep quality; 157 (29.3%) had the symptoms of fatigue; 84 (15.7%),112 (20.9%), and 130 (24.3%) suffered from symptoms of anxiety, depression, and PTSD, respectively. The logistic regression analysis showed that history of chronic disease was risk factor for poor sleep quality (OR 2.501; 95% CI, 1.618-3.866), fatigue (OR 3.284; 95% CI 2.143-5.033), PTSD (OR 2.323; 95% CI 1.431-3.773) and depression (OR 1.950; 95% CI 1.106-3.436) in COVID-19 survivors. Smoking contributed to the poor sleep quality (OR 2.005; 95% CI 1.044-3.850), anxiety (OR 4.491; 95% CI 2.276-8.861) and depression (OR 5.459; 95% CI 2.651-11.239) in survivors. Drinking influenced fatigue (OR 2.783; 95% CI 1.331-5.819) and PTSD (OR 4.419; 95% CI 1.990-9.814) in survivors. Compared with college-educated survivors, survivors with high school education were at higher risk for poor sleep quality (OR 1.828; 95% CI 1.050-3.181) and PTSD (OR 2.521; 95% CI 1.316-4.830), and survivors with junior high school education were at higher risk for PTSD (OR 2.078; 95% CI 1.039-4.155). Compared with overweight survivors (BMI ≥ 23.0), survivors with normal BMI (18.5-22.9) (OR 0.600; 95% CI 0.405-0.889) were at lower risk for fatigue. While being housewife (OR 0.390; 95% CI 0.189-0.803) was protective factor for fatigue and having more family members was protective factor for PTSD (OR 0.404 95% CI 0.250-0.653) in survivors.

CONCLUSIONS

One year after infection, poor sleep quality, fatigue, anxiety, depression, and PTSD, still existed in a relatively high proportion of COVID-19 survivors. Chronic disease history was an independent risk factor for poor sleep quality, fatigue, depression, and PTSD. Participants with low education levels were more likely to have mental problems than the others. We should focus on the long-term psychological impact of COVID-19 on survivors, and the government should apply appropriate mental health services to offer psychiatric support.