Differential impact of transient and chronic loneliness on health status. A longitudinal study

Loneliness Trajectories and Chronic Loneliness Around the World

OBJECTIVES

We examine cross-national variation in (a) loneliness trajectories and (b) the association between common social risk factors and chronic loneliness in middle and older adulthood.

METHODS

Using longitudinal data, we assess the country-level prevalence of loneliness trajectories (chronic, transitory, and no loneliness) and the extent of common social risk factors for loneliness (living alone, widowhood, divorce, no grandchildren, having chronic conditions, and never working) among adults 50 and older in 20 countries covering 47% of the global population in this age bracket. Additionally, we compare how the associations between social risk factors and chronic loneliness vary across countries.

RESULTS

We find considerable variation in the prevalence of chronic loneliness cross-nationally, ranging between 4% (Denmark) and 15% (Greece) of adults 50 and older. Living arrangements have the most consistent association with the likelihood of chronic loneliness across countries, with those ever living alone having an 8% higher likelihood of chronic loneliness on average across countries, with a range of 2%-25%. Additionally, those who never report working and those with chronic conditions have a higher likelihood of chronic loneliness across more than a third of the countries.

DISCUSSION

These results suggest that policies and interventions targeted to middle age and older adults living alone and with limited work histories or with chronic conditions are critical in reducing the public health challenges of chronic loneliness.

The Emotional Burden of Loneliness and its Association with Mental Health Outcomes

BACKGROUND

The present study examined, for the first time, the emotional burden of loneliness on dimensions of emotional valence and arousal, and its association with mental health outcomes.

METHOD

A cross-sectional design was used, and data were collected from 503 adults across the UK with an online survey. Measures included socio-demographic characteristics, self-reported measures of loneliness and social isolation, affective ratings (i.e., valence and arousal) of loneliness experiences, and symptoms of depression and anxiety as mental health outcomes.

RESULTS

The emotional burden of loneliness differed significantly across groups with differing loneliness experiences, and females scored significantly higher in the emotional burden of loneliness than males. The emotional burden of loneliness was associated with both depression and anxiety symptoms, and respectively added 4.7% and 6.2% of the variance, on top of measures of loneliness frequency and social isolation.

CONCLUSIONS

Measuring the valence and arousal dimensions of loneliness experiences advances our understanding of loneliness experiences and its association with mental health outcomes. The theoretical, methodological, and practical implications of our study are discussed.

Early-life circumstances and late life loneliness trajectories among Finnish older adults

BACKGROUND

Later life loneliness has become a significant public health concern worldwide. Research has focused on the prevalence, risk factors and consequences of loneliness in different age groups. This study aimed to advance the understanding of the impact of early-life circumstances on later life loneliness by examining the associations between adversities in childhood and youth and loneliness trajectories in Finnish older adults.

METHODS

The data were derived from the 10-year follow-up survey study Good Aging in the Lahti Region (n = 1552, mean age 64.89 years). The baseline study was conducted in 2002 with a regionally and locally stratified random sample of older persons living in the Lahti Region located in southern Finland. The follow-up surveys were carried out in 2005, 2008 and 2012. Loneliness was measured using a single question at the three follow-ups. Childhood conditions were retrospectively assessed at baseline with questions regarding the death of parents, household affection, relocation, and fear of a family member. Latent class growth analysis with time invariant covariates was used to identify loneliness trajectories and to examine the associations between loneliness trajectories and adverse circumstances in childhood and youth.

RESULTS

The results identified three distinct loneliness trajectories: low, moderate, and severe, including 36%, 50% and 14%, respectively, of the study population. The non-significant slopes of the three trajectories indicate that trajectories were stable during the seven years of follow-up. Being afraid of a family member, having a cold childhood, and death of a father or mother in childhood or youth significantly increased the odds of having a severe loneliness trajectory as compared to low loneliness trajectory. None of the early-life circumstances differentiated between severe and moderate levels of loneliness.

CONCLUSIONS

The findings suggest that some adverse early-life circumstances increase the odds of an unfavorable loneliness trajectory in later life. The results highlight the need to recognize the role of diverse life-course adversities in loneliness research and interventions. The study also underscores the importance of identifying individuals who are at risk of long-term and severe loneliness and providing them with appropriate support to decrease and/or prevent the negative health consequences of loneliness in old age.

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Chronic loneliness and chronic social isolation among older adults: a study protocol for a systematic review, meta-analysis and meta-regression

INTRODUCTION

There are around 20 studies identifying the prevalence of chronic loneliness and chronic social isolation in older adults. However, there is an absence of a systematic review, meta-analysis and meta-regression that consolidates the available observational studies. Therefore, our objective was to address this knowledge gap. Here, we present the study protocol for this upcoming work. Such knowledge can help in addressing older individuals at risk for chronic loneliness and chronic social isolation.

METHODS AND ANALYSIS

Established electronic databases will be searched. Observational studies reporting the prevalence of chronic loneliness and chronic social isolation among individuals aged 60 years and over will be included. Disease-specific samples will be excluded. The focus of data extraction will be on methods, sample characteristics and key findings. The Joanna Briggs Institute (JBI) standardised critical appraisal instrument for prevalence studies will be used for assessing the quality of the studies. Two reviewers will be responsible for carrying out the study selection, data extraction and assessment of study quality. The results will be presented through the use of figures, tables, narrative summaries and a meta-analysis and meta-regression.

ETHICS AND DISSEMINATION

No primary data will be collected. Thus, there is no need for approval from an ethics committee. We intend to share our results through publication in a peer-reviewed journal.

Chronic and Transient Loneliness in Western Countries: Risk Factors and Association With Depression. A 2-Year Follow-Up Study

INTRODUCTION

Our aim was to test risk factors for chronic and transient loneliness as well as cross-sectional and longitudinal associations of courses of loneliness with depression.

METHODS

Responses from participants in Wave 5 (T1, 2013) and Wave 6 (T2, 2015) of The Survey of Health, Ageing and Retirement in Europe (SHARE) (N = 45,490) were analyzed. The existence of clinically significant symptoms of depression was defined as reporting a value greater than or equal to 4 on the Euro-D scale. Loneliness was measured through the 3-item UCLA loneliness scale and a single question. Both measures were tested in separate regression models to identify risk factors for transient (loneliness at T1) and chronic (loneliness at T1 and T2) loneliness as well as their associations with depression.

RESULTS

Chronic loneliness was observed in 47%-40% of the cases of loneliness, according to the UCLA scale and the single question, respectively. Risk factors for chronic loneliness in both models were being female, not being married, having a low educational level, having poor mental and physical health, being limited in activities, having a poor social network, and living in a culturally individualistic country. Risk factors for transient loneliness were less robust and no significant effects were found for variables such as sex and physical health in both models, education level in the UCLA measure model, and social network size in the single question model. Chronic loneliness also showed a strong association with depression in the cross-sectional model and a marked one in the longitudinal model.

CONCLUSION

The courses of loneliness are relevant in the study of its risk factors and association with depression.

Older men and loneliness: a cross-sectional study of sex differences in the English Longitudinal Study of Ageing

BACKGROUND

Research into men and masculinities suggests men may be more reluctant than women to state they are lonely, more reliant on partners/spouses and/or alcohol to tackle it, and that this may be a result of poorer social relationships. Ageing is often associated with loneliness, and research has indicated gendered results in older people, but existing evidence lacks generalisability and cultural context. This study tests hypotheses on sex differences in loneliness in older England-based men and women.

METHODS

We conducted a cross-sectional study using a sample of 6936 respondents aged 50 + from the English Longitudinal Study of Ageing (wave 8). Multiple imputation with chained equations was conducted to handle missing data. Multivariate regression was used to investigate the impact of sex on a direct question on loneliness whilst controlling for the University of California loneliness (UCLA) scale. Multivariate regression with interaction terms were used to examine sex differences in loneliness and alcohol consumption, partner status, and social relationships.

RESULTS

Older men were less likely than older women to state they are lonely even when controlling for UCLA score. Older men showed a greater association between loneliness and alcohol consumption, but only when measuring the number of units consumed in the last week, and not using a less precise measure of the past year. Older men who cohabited with a partner were less lonely than cohabiting older women, whereas previously married but not cohabiting older men were lonelier than their female counterparts. However, never married older men were less lonely than never married older women. Evidence was found to suggests older men's worse friendships mediated this association, but social isolation and number of close relationships did not. Severe isolation predicted greater loneliness in older women, but not older men.

CONCLUSIONS

Cultural ideals of masculinity and older men's poorer quality friendships may explain their reluctance to directly state loneliness, greater dependency on partners/spouses, and use of alcohol. Severely isolated older men may under-report loneliness on the UCLA scale as well as a direct question.

Disentangling the Longitudinal Relationship between Loneliness and Depressive Symptoms in U.S. Adults Over 50

OBJECTIVES

A seminal study on loneliness and depression suggested that loneliness influences depression more than the reverse. However, the study's analytic method has since been criticized for failing to account for the trait-like nature of variables. This study aimed to examine the longitudinal relationship between loneliness and depressive symptoms while accounting for the trait-like nature of both variables.

METHODS

Data (n = 16,478) came from the Health and Retirement Study (2006-2016). Measures included the Hughes Loneliness Scale and a modified Center for Epidemiologic Studies Depression scale (loneliness item omitted). Analyses consisted of random intercepts cross-lagged panel models (three time-points evenly spaced across eight years).

RESULTS

There was evidence that loneliness and depressive symptoms are trait-like and these trait-like components are strongly associated. There was not evidence of cross-lagged effects between loneliness and depressive symptoms.

CONCLUSIONS

A tendency toward loneliness corresponded with a tendency toward depressive symptoms. However, deviations in one's typical level of loneliness did not predict deviations in one's typical level of depressive symptoms or vice-versa. These findings do not support past assertions that loneliness shapes subsequent depression more than the reverse.

CLINICAL IMPLICATIONS

By middle to late adulthood, loneliness and depressive symptoms are trait-like phenomena that are strongly associated.

The robust reciprocal relationship between loneliness and depressive symptoms among the general population: Evidence from a quantitative analysis of 37 studies

BACKGROUND

Loneliness has long been associated with depressive symptoms, but there is no evidence on the question of "which comes first". To help us to answer this question, this study conducted a meta-analysis using a cross-lagged formula to examine the reciprocal relations between loneliness and depressive symptoms, as well as potential moderators.

METHODS

The meta-analytic dataset consisted of 37 studies with sample sizes ranging from 52 to 5991. Effect sizes (including autoregressive effects and lagged coefficients) were included. We computed weighted mean effect sizes for the correlation effect and cross-lagged effect between loneliness and depressive symptoms. We also performed a meta-regression to investigate potential moderators.

RESULTS

The results showed that loneliness and depressive symptoms reciprocally predicted each other over time with similar effect sizes. There was no moderation of our overall effect size in either direction by time interval between measurements, the proportion of female participants, mean age of the sample, or type of measurement.

LIMITATIONS

Caution should be taken in drawing final conclusions about the relative strength of reciprocal effects between loneliness and depressive symptoms due to the potential influence of varied research focus in the included studies, which could affect the effect size.

CONCLUSIONS

These findings advance the study of the relationship between loneliness and depressive symptoms by providing evidence that the link between them is symmetrically reciprocal and robust, which may help clinicians to develop effective intervention methods.

The prevalence of chronic and episodic loneliness and social isolation from a longitudinal survey

Loneliness and social isolation, experienced more long-term, has been shown to increase mortality and lead to poorer health outcomes in specific cohorts. However, it is unclear what the prevalence of chronic loneliness and social isolation is, and which demographic groups are most at risk of reporting more chronic forms. A psychometrically validated classification system was used to identify people who met criteria for episodic and chronic loneliness and social isolation using the Household Income and Labour Dynamics in Australia (HILDA) survey waves 14-18. The prevalence of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded that of social isolation (overall 17%; 13% episodic, 4% chronic). There was consistency in the demographic characteristics (from age, sex, household type, income) of those who experienced loneliness and social isolation. However, people with a long-term health condition had an elevated risk of episodic loneliness (AOR 1.24, 95% CI 1.11-1.39) and a markedly higher risk of chronic loneliness (AOR 2.01, 95% CI 1.76-2.29), compared with those without a long-term health condition. Loneliness, both episodic and chronic subtypes, is more prevalent than social isolation. However, both chronic loneliness and social isolation remains neglected and poorly targeted within current practice and policy.

Predictors of loneliness onset and maintenance in European older adults during the COVID-19 pandemic

Objectives

Loneliness is a major public health concern. Duration of loneliness is associated with severity of health outcomes, and further research is needed to direct interventions and social policy. This study aimed to identify predictors of the onset vs. the maintenance of loneliness in older adults before and during the pandemic using longitudinal data from the Survey of Health, Age, and Retirement in Europe (SHARE).

Methods

Groupings of persistent, situational, and no loneliness were based on self-reports from an ordinary pre-pandemic SHARE wave and a peri-pandemic telephone interview. Predictors were identified and compared in three hierarchical binary regression analyses, with independent variables added in blocks of geographic region, demographics, pre-pandemic social network, pre-pandemic health, pandemic-related individual, and country level variables.

Results

Self-reported loneliness levels for the persistent, situational, and no loneliness groups were stable and distinct through 7 years preceding the pre-pandemic baseline measure. Shared predictors were chronic diseases, female sex, depression, and no cohabitant partner. Persistent loneliness was uniquely predicted by low network satisfaction (OR: 2.04), functional limitations (OR: 1.40), and a longer country-level isolation period for older adults (OR: 1.24).

Conclusion

Interventions may target persons with depression, functional limitations, chronic health issues, and no cohabitant partner. The added burden of the length of isolation on those who are already lonely should be taken into account when employing social policies that target older adults. Further research should distinguish between situational and persistent loneliness, and seek to identify predictors of chronic loneliness onset.

Utilizing variable auto encoder-based TDO optimization algorithm for predicting loneliness from electrocardiogram signals

Several seniors and a substantial part of the general population are living in social isolation. This frequently occurs in vulnerability, isolation, and depression, which then have a poor impact on other health-related factors. A number of health problems, including a higher risk of cardio problems, are brought on by social isolation and loneliness. Electrocardiogram (ECG) usage for mental condition recognition enables accurate determination of a person's internal representation. The electrocardiogram (ECG) signals can be thoroughly analyzed to uncover hidden data that may be helpful for the precise identification of cardiac problems. ECG time-series information typically have great dimensions and complicated componentry. Using relevant information to guide training is among the main achievements of this type of learning. An ECG signal plays a significant part in the individual body's ability to manage behavior. Furthermore, loneliness identification is crucial since it has the worse effect on the circumstances that afflict persons. This study suggested an approach for detecting loneliness from an ECG signal to use a variable auto encoder-based optimization algorithm for ESN technique. The suggested approach consists of three phases for identifying a person's loneliness. Firstly, undecimated discrete wavelet transform is used to preprocess the acquired ECG data. Next, further characteristics are extracted from the precompiled signals using a variable auto encoder. For the precise categorization of loneliness in the ECG signal, a metaheuristic optimized ESN is, therefore, presented. The outcomes of the tests demonstrate that the suggested system with suitable ECG representations produces improved accuracy as well as performance.

The developmental course of loneliness in adolescence: Implications for mental health, educational attainment, and psychosocial functioning

The present study examined patterns of stability and change in loneliness across adolescence. Data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a UK population-representative cohort of 2,232 individuals born in 1994 and 1995. Loneliness was assessed when participants were aged 12 and 18. Loneliness showed modest stability across these ages (r = .25). Behavioral genetic modeling indicated that stability in loneliness was explained largely by genetic influences (66%), while change was explained by nonshared environmental effects (58%). Individuals who reported loneliness at both ages were broadly similar to individuals who only reported it at age 18, with both groups at elevated risk of mental health problems, physical health risk behaviors, and education and employment difficulties. Individuals who were lonely only at age 12 generally fared better; however, they were still more likely to finish school with lower qualifications. Positive family influences in childhood predicted reduced risk of loneliness at age 12, while negative peer experiences increased the risk. Together, the findings show that while early adolescent loneliness does not appear to exert a cumulative burden when it persists, it is nonetheless a risk for a range of concomitant impairments, some of which can endure.

Loneliness During the School Years: How It Affects Learning and How Schools Can Help. THE JOURNAL OF SCHOOL HEALTH 2023;93:428-435. [PMID: 36861756 DOI: 10.1111/josh.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Substantial evidence links loneliness to poor academic outcomes and poor employment prospects. Schools have been shown to be places that mitigate or aggravate loneliness, suggesting a need to consider how schools can better support youth experiencing loneliness.

METHODS

We conducted a narrative review on loneliness in childhood and adolescence to examine the literature on how loneliness changes over the school years and how it influences learning. We also examined whether there were increases in loneliness because of the COVID-19 pandemic and associated school closures, and whether schools can be places for loneliness interventions/prevention.

FINDINGS

Studies describe how loneliness becomes more prevalent during the adolescent years and why that is the case. Loneliness is associated with poor academic outcomes and poor health behaviors that impact learning or turn students away from education. Research shows that loneliness increased during the COVID-19 pandemic. Evidence suggests that creating positive social classroom environments, where teacher and classmate support are available, is crucial in combatting youth loneliness.

CONCLUSIONS

Adaptations to the school climate can be made to meet the needs of all students, reducing loneliness. Investigation of the impacts of school-based loneliness prevention/intervention is crucial.

Longitudinal Associations Between Loneliness and Self-Rated Health Among Black and White Older Adults

OBJECTIVES

This study examined the longitudinal association between loneliness and self-rated health (SRH), and whether there were race differences between non-Hispanic Black and White adults in these associations.

METHOD

A total of 1,407 participants were drawn Social Relations Study, a regional study of social relations across the life span with 3 waves of data collection in 1992, 2005, and 2015 (Wave 1, W1: Mage = 50.28, 28% Black, 59% women). Cross-lagged structural equation models examined the association between loneliness and SRH over 3 waves. We adjusted for baseline age, gender, social network size, and depressive symptoms.

RESULTS

There were no race differences in loneliness at any wave. Loneliness W1 was associated with Loneliness W2; Loneliness W2 was associated with Loneliness W3. We had similar findings for associations among SRH. However, only one of the cross-lagged paths was significant. Worse SRH W2 was associated with more Loneliness W3. The only path that varied across race was in the association between SRH W2 and Loneliness W3, and this path was significant only in Whites.

DISCUSSION

Findings indicate that worse SRH at later midlife may increase risk for loneliness in later life, particularly for Whites. As a valid indicator of health, SRH can be used in the body of research on health correlates of loneliness as adults age. Use of the current sample of Black and White adults provides nuanced understanding in the ways in which racially diverse adults experience loneliness and should be useful in refining and developing culturally competent interventions for older adults.

Associations between transient and chronic loneliness, and depression, in the understanding society study

OBJECTIVES

Loneliness has a long-established link with depression; however, patterns of loneliness, specifically transient (short-term) and chronic loneliness (longer-term), have seldom been researched in terms of their associations with depression and psychiatric distress. We investigated whether chronic loneliness could predict higher levels of psychiatric distress and higher chance of depression diagnosis (via self-report) than transient and no loneliness.

METHODS

We used data from 18,999 participants in Waves 9 and 10 of the Understanding Society survey: a nationally representative study of adults in the United Kingdom. The study used a between-subjects, cross-sectional, design, where participants' scores on loneliness measures across two time points were combined to form patterns of loneliness, and participants were compared on their levels of psychiatric distress and depression diagnoses across the three loneliness groups: chronic loneliness (lonely at both time points), transient loneliness (lonely at one time point) and no loneliness.

RESULTS

Regression analyses revealed that patterns of loneliness predicted both the likelihood of participants reporting a history of depression diagnosis and participants' levels of psychiatric distress. The chronic loneliness group had the highest likelihood of self-reported depression diagnosis and had the highest levels of psychiatric distress, compared to both the transient and no loneliness groups. Transient loneliness, in turn, predicted higher likelihood of reporting a history of depression diagnosis and higher levels of psychiatric distress than the no loneliness group.

CONCLUSIONS

The study replicates and extends prior findings, suggesting that prolonged loneliness even over the course of one year is a risk factor for poorer mental health.

Psychological impact of COVID-19: A cross-lagged network analysis from the English Longitudinal Study of Aging COVID-19 database

Background

The COVID-19 pandemic and its subsequent health restrictions had an unprecedented impact on mental health, contributing to the emergence and reinforcement of various psychopathological symptoms. This complex interaction needs to be examined especially in a vulnerable population such as older adults.

Objective

In the present study we analyzed network structures of depressive symptoms, anxiety, and loneliness from the English Longitudinal Study of Aging COVID-19 Substudy over two waves (Months of June-July and November-December 2020).

Methods

For this purpose, we use measures of centrality (expected and bridge-expected influence) in addition to the Clique Percolation method to identify overlapping symptoms between communities. We also use directed networks to identify direct effects between variables at the longitudinal level.

Results

UK adults aged >50 participated, Wave 1: 5,797 (54% female) and Wave 2: 6,512 (56% female). Cross-sectional findings indicated that difficulty relaxing, anxious mood, and excessive worry symptoms were the strongest and similar measures of centrality (Expected Influence) in both waves, while depressive mood was the one that allowed interconnection between all networks (bridge expected influence). On the other hand, sadness and difficulty sleeping were symptoms that reflected the highest comorbidity among all variables during the first and second waves, respectively. Finally, at the longitudinal level, we found a clear predictive effect in the direction of the nervousness symptom, which was reinforced by depressive symptoms (difficulties in enjoying life) and loneliness (feeling of being excluded or cut off from others).

Conclusion

Our findings suggest that depressive, anxious, and loneliness symptoms were dynamically reinforced as a function of pandemic context in older adults in the UK.

Social and Emotional Loneliness in Older Community Dwelling-Individuals: The Role of Socio-Demographics

BACKGROUND

Social determinants have a major influence on individuals' health, and among them, loneliness has an important impact on the health of the elderly.

OBJECTIVES

The aims were to determine loneliness and its social and emotional components in a sample of elderly people and to assess its prevalence and associations with sociodemographic variables.

METHODS

Analytical, cross-sectional, observational research was carried out based on a population over 60 years of age in Valencia (Spain). Loneliness was assessed with the De Jong-Gierveld Loneliness Scale.

RESULTS

Five-hundred and thirty community-dwelling individuals participated. The mean age of the sample was 72.7 years (84.2% women); 36.2% suffered from moderate loneliness and 6.6% suffered from extreme loneliness. The sociodemographic variables most significantly related to loneliness were being single, separated, or divorced (p < 0.01). Among widowers, loneliness was inversely associated with years of widowhood (p < 0.01). Having sons/daughters was a significant protective factor (p < 0.05), while having grandchildren or siblings did not have a significant influence. The ability to walk and smartphone and video call use were not associated with loneliness.

CONCLUSIONS

There is a high prevalence of unwanted loneliness in community-dwelling individuals, and some social factors play an important role. Interventions against loneliness among older people are a priority for welfare and public health.

Persistent loneliness due to COVID-19 over 18 months of the pandemic: A prospective cohort study

BACKGROUND

Loneliness was common early in the COVID-19 pandemic due to physical distancing measures, but little is known about how loneliness persisted into later stages of the pandemic. We therefore examined longitudinal trajectories of loneliness over 18 months of the pandemic and subgroups at risk for persistent loneliness.

METHODS

We used data from the COVID-19 & Chronic Conditions study collected between March 27, 2020 to December 10, 2021, including 641 predominantly older adults with ≥1 chronic condition who completed six interviews at approximately 3 month intervals. Participants reported loneliness (defined as some, most, or all of the time) during the past week due to COVID-19. We used trajectory mixture models to identify clusters of individuals following similar trajectories of loneliness, then determined subgroups likely to be classified in different loneliness trajectories using multivariable regression models adjusted for sociodemographic and clinical covariates.

RESULTS

Participants were on average 63 years old, 61% female, 30% Black, 20% Latinx, and 29% were living below the poverty level. There was an overall reduction in loneliness over time (March to April/2020: 51% to September to December/2021: 31%, p = 0.01). Four distinct trajectory groups emerged: (1) "Persistent Loneliness" (n = 101, 16%); (2) "Adapted" (n = 141, 22%), individuals who were initially lonely, with feelings of loneliness decreasing over time; (3) "Occasional loneliness" (n = 189, 29%); and (4) "Never lonely" (n = 211, 33%). Subgroups at highest risk of the "Persistently Lonely" trajectory included those identifying as Latinx (aOR 2.5, 95% CI: 1.2, 5.2), or living in poverty (aOR 2.5; 95% CI: 1.4, 4.6).

CONCLUSIONS

Although loneliness declined for a majority of older adults during the pandemic in our sample, persistent loneliness attributed to the COVID-19 pandemic was common (1 in 6 adults), particularly among individuals identifying as Hispanic/Latinx or living in poverty. Interventions addressing loneliness can ease pandemic-related suffering, and may mitigate long-term mental and physical health consequences.

Social isolation and the brain in the pandemic era

Intense sociality has been a catalyst for human culture and civilization, and our social relationships at a personal level play a pivotal role in our health and well-being. These relationships are, however, sensitive to the time we invest in them. To understand how and why this should be, we first outline the evolutionary background in primate sociality from which our human social world has emerged. We then review defining features of that human sociality, putting forward a framework within which one can understand the consequences of mass social isolation during the COVID-19 pandemic, including mental health deterioration, stress, sleep disturbance and substance misuse. We outline recent research on the neural basis of prolonged social isolation, highlighting especially higher-order neural circuits such as the default mode network. Our survey of studies covers the negative effects of prolonged social deprivation and the multifaceted drivers of day-to-day pandemic experiences.

Benefits of a psychosocial intervention programme using volunteers for the prevention of loneliness among older women living alone in Spain

This study aims to analyse the effectiveness of a psychosocial intervention programme in preventing loneliness and increasing self-efficacy and social participation among older women living alone in Spain. A sequential, nested experimental design was used, with a primary quantitative quasi-experimental pre-post study with a control group (CG) and a secondary qualitative study. A total of 48 women participated, and 34 of them (the experimental group, EG) received a 25-hour psychosocial support intervention delivered by volunteers who focused on three aspects: conversation, attribution retraining and behavioural activation. The other women remained on the waiting list (CG = 14). The women (EG and CG) were all interviewed before and after the intervention and a follow-up of the EG was performed at 6 months (N = 25). Semi-structured interviews were used to collect sociodemographic and health-related data, as well as data on satisfaction with the programme and its benefits. Validated instruments were used to collect data on the dependent variables (self-efficacy in ageing, subjective social participation and loneliness). Quantitative and qualitative methods were used for data analysis. Compared to the pre-test results, women in the EG improved their self-efficacy in ageing (t-test: -2.246; p: 0.031; d: 0.30), and, more specifically, their self-efficacy in managing socio-emotional problems such as loneliness (t-test: -1.995; p: 0.054; d: 0.25) and in managing their health (t-test: -2.450; p: 0.020; d: 0.47). No significant differences were observed between the follow-up and the post-test results, meaning that the changes identified after the intervention remained stable. Four additional categories of benefits were identified in the participants' discourses. In conclusion, the intervention appears to be beneficial and effective in improving self-efficacy, which is a well-established predictor of loneliness in old age, in a group of vulnerable individuals. Further studies on this type of community intervention are necessary to prevent loneliness among older people.

Loneliness, internalizing symptoms, and inflammatory markers in adolescent COVID-19 survivors

BACKGROUND

Concerns about the psychiatric sequelae after COVID-19 infection have increased as the pandemic spreads worldwide. The increase in self-isolation during this pandemic period has also revealed the importance of feelings of loneliness. This study aimed to examine the relationship between baseline inflammation levels, internalizing symptoms, and feelings of loneliness in adolescent COVID-19 survivors in the long term.

METHODS

A total of 74 adolescents (41 girls, 55.4%, mean age 14.88) and their parents were included in the study. This cross-sectional study assessed internalizing symptoms via Revised Children's Anxiety and Depression Scale (RCADS) and feelings of loneliness using the UCLA-loneliness scale. Baseline inflammatory markers at COVID-19 diagnosis were collected. Logistic regression analysis was used to determine predictors for depression in adolescents.

RESULTS

The most common disorder was Major Depressive Disorder (MDD) (25.7%), and 33.8% of the adolescents were in the clinical range in at least one internalizing domain. Baseline C-Reactive Protein (CRP) levels correlated weakly with MDD scores. Loneliness scores correlated with all internalizing symptoms, strong association with MDD scores. Loneliness, anxiety, and parental anxiety were associated with an increased likelihood of MDD. Baseline CRP positivity did not predict MDD in adolescent COVID-19 survivors.

CONCLUSIONS

This study indicates that anxiety, loneliness, and parental anxiety play an important role in adolescents' experience of depressive symptoms after COVID-19 infection. Thus, screening parental psychopathology and loneliness in COVID-19 survivors seems to be preventive for adolescent mental health problems.

Impact of transient and chronic loneliness on progression and reversion of frailty in community-dwelling older adults: four-year follow-up

Background

Frailty is a common condition in older adults that is characterized by transitions between frailty states in both directions (progression and reversion) over time. Loneliness has been reported to be associated with the incidence of frailty, but few studies have explored the impact of persistent loneliness over time on frailty. In this study, we aimed to whether and how two different types of loneliness, transient and chronic, were associated with changes in frailty status in older adults.

Methods

The analytic sample contained 2961 adults aged ≥ 60 years who completed interviews for both the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study. The logistic regression model was used to examine the relationship between transient and chronic loneliness and progression and reversion of frailty. Demographics (age, sex, education level, marital status, urban–rural residence), living alone, chronic conditions, physical function, and depressive symptoms from the 2011 wave were adjusted.

Results

After four years, 21% of the studied sample reported progression, 20% reported reversion in frailty, 31% reported transient loneliness, and 14% reported chronic loneliness. There was no significant difference in participants who reported transient loneliness (OR = 1.10, 95% CI [0.89,1.37]), or chronic loneliness (OR = 1.14, 95% CI [0.84,1.57]) on the progression of frailty, compared with no report of loneliness. Participants reporting chronic loneliness (OR = 0.68, 95% CI [0.50,0.93]) were less likely to report reversion in their level of frailty compared to participants who did not report loneliness but not transient loneliness (OR = 0.87, 95% CI [0.70,1.08]).

Conclusions

Roughly the same percentage, a fifth, of older Chinese adults progressed or reversed in frailty status without active intervention. Chronic loneliness was related to a lower probability of reversion in the frail group than in the no loneliness group, but not in the transient loneliness group. More attention should be given to older adults with chronic loneliness.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03283-1.

Loneliness in Autism and Its Association with Anxiety and Depression: A Systematic Review with Meta-Analyses

Objectives

This systematic review aimed to quantify differences in loneliness levels between autistic and neurotypical samples and investigate the association between loneliness and mental health in autistic individuals.

Methods

Three meta-analyses were conducted. Studies were methodologically appraised using established tools.

Results

Overall, 39 studies were included. The majority of these achieved moderate methodological quality ratings. The primary meta-analysis (N = 23) found autistic samples reported higher loneliness compared with neurotypical samples (Hedges’ g = .89). The meta-analyses on the associations between loneliness and anxiety (N = 14) and depression (N = 11) in autistic samples found significant pooled correlations (r = .29 and r = .48, respectively).

Conclusions

This review highlights numerous limitations within current autism and loneliness research. Nevertheless, loneliness in autism merits targeted clinical and research attention.

Perceived stress, trust, safety and severity of SARS-CoV-2 infection among patients discharged from hospital during the COVID-19 pandemic's first wave: a PREMs survey

AIM

To investigate experiences of stress, feelings of safety, trust in healthcare staff and perceptions of the severity of a SARS-CoV-2 infection among inpatients discharged from Valais Hospital, Switzerland, during the COVID-19 pandemic's first wave.

METHODS

Discharged patients aged 18 years or more (n=4665), hospitalised between 28 February and 11 May 2020, whether they had been infected by SARS-CoV-2 or not, were asked to complete a self-reporting questionnaire, as were their informal caregivers, if available (n=866). Participants answered questions from Cohen's Perceived Stress Scale (PSS) (0=no stress, 40=severe stress), Krajewska-Kułak et al's Trust in Nurses Scale and Anderson and Dedrick's Trust in Physician Scale (10=no trust, 50=complete trust), the severity of a SARS-CoV-2 infection (1=not serious, 5=very serious), as well as questions on their perceived feelings of safety (0=not safe, 10=extremely safe).

RESULTS

Of our 1341 respondents, 141 had been infected with SARS-CoV-2. Median PSS score was 24 (IQR1-3=19-29), median trust in healthcare staff was 33 (IQR1-3=31-36), median perceived severity of a SARS-CoV-2 infection was 4 (IQR1-3=3-4) and the median feelings of safety score was 8 (IQR1-3=8-10). Significant differences were found between males and females for PSS scores (p<0.001) and trust scores (p<0.001). No significant differences were found between males and females for the perceived severity of SARS-CoV-2 infection scores (p=0.552) and the feelings of safety (p=0.751). Associations were found between age and trust scores (Rs=0.201), age and perceived SARS-CoV-2 severity scores (Rs=0.134), sex (female) and perceived stress (Rs=0.114), and sex (female) and trust scores (Rs=0.137). Associations were found between SARS-CoV-2 infected participants and the perceived SARS-CoV-2 severity score (Rs=-0.087), between trust scores and feelings of safety (Rs=0.147), and perceived severity of a SARS-CoV-2 infection (Rs=0.123).

DISCUSSION

The results indicated that inpatients experienced significant feelings of stress regarding perceived symptoms of the illness, yet this did not affect their feelings of safety, trust in healthcare staff or perception of the severity of SARS-CoV-2 infection. Future patient-reported experience measures research is needed to give a voice to healthcare users and facilitate comparison measures internationally.

Collaboration between general practitioners and social workers: a scoping review

OBJECTIVES

Aim of the study is to present an overview of collaboration structures and processes between general practitioners and social workers, the target groups addressed as well the quality of available scientific literature.

DESIGN

A scoping review following the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews).

INCLUDED SOURCES AND ARTICLES

According to a pre-published protocol, three databases (PubMed, Web of Science, DZI SoLit) were searched using the participant-concept-context framework. The searches were performed on 21 January 2021 and on 10 August 2021. Literature written in English and German since the year 2000 was included. Two independent researchers screened all abstracts for collaboration between general practitioners and social workers. Articles selected were analysed regarding structures, processes, outcomes, effectiveness and patient target groups.

RESULTS

A total of 72 articles from 17 countries were identified. Collaborative structures and their routine differ markedly between healthcare systems: 36 publications present collaboration structures and 33 articles allow an insight into the processual routines. For all quantitative studies, a level of evidence was assigned. Various measurements are used to determine the effectiveness of collaborations, for example, hospital admissions and professionals' job satisfaction. Case management as person-centred care for defined patient groups is a central aspect of all identified collaborations between general practitioners and social workers.

CONCLUSION

This scoping review showed evidence for benefits on behalf of patients, professionals and healthcare systems by collaborations between general practitioners and social workers, yet more rigorous research is needed to better understand the impact of these collaborations.

TRIAL REGISTRATION NUMBER

www.osf.io/w673q.

Loneliness and not living alone is what impacted on the healthcare professional's mental health during the COVID-19 outbreak in Spain

The present study is aimed at exploring the role of loneliness in the healthcare professionals' mental health during the COVID-19 outbreak in Spain. A total of 1,421 healthcare professionals who were in contact with at least one positive COVID-19 patient participated in a cross-sectional online survey from April to June 2020. Mental health was measured with the General Health Questionnaire-12, and loneliness was assessed with the 3-item UCLA Loneliness Scale. More than 80% of participants showed a certain prone to experience mental health problems, and 90% felt that they had not enough workplace protective measures to manage COVID-19 patients. Presence of loneliness was positively related to higher mental health problems after controlling for other covariates. Other factors related to higher mental health problems were a higher COVID-19 risk perception, being in quarantine, checking COVID-19-related news several times a day and having a lower training on managing infectious diseases. Neither living alone, nor supervisor social support, were related to healthcare professionals' mental health. Results suggest that the impact of COVID-19 in terms of mental health in the healthcare professionals could be more related to subjective appraisals of social isolation rather than to be physically alone. There were also a variety of cognitive, behavioural and training-related factors that were associated with the healthcare professionals' mental health, and that should be potentially managed in the mental healthcare interventions.

Pre-pandemic Psychobiological Features Predict Impact of COVID-19 Confinement on Loneliness

The coronavirus disease 2019 (COVID-19) pandemic led to various government-imposed limitations on social interaction and strict home confinement. Such involuntary social-distancing policies can exacerbate feelings of loneliness and alter emotional well-being. Dysregulation of the hypothalamic-pituitary-adrenocortical (HPA) axis is a potential mechanism for loneliness' deleterious health effects. In this study, we explored whether pre-pandemic diurnal cortisol output (AUC G ), a measure of HPA axis function, may predict the propensity to changes in loneliness during long-term COVID-19 home confinement and if extraversion would moderate this relationship. This association has been explored by analysing the impact of COVID-19 pandemic and strict home confinement on social and emotional loneliness in 45 Spanish young adults. Diurnal cortisol levels were measured from five saliva samples obtained across a day just before the pandemic, and data about participants' perceived loneliness, empathic state, extraversion, and prospective volunteering were obtained both before and during the confinement. Participants' social and family loneliness increased during long-term strict home confinement, while prospective volunteering tendencies and extraversion decreased. Importantly, after adjusting for relevant confounders, moderation analyses revealed that in young adults with high pre-pandemic extraversion, a higher AUC G predicted a larger increase in social loneliness during confinement, while in individuals with low extraversion, AUC G was negatively related to change in loneliness. Our findings highlight the utility of pre-pandemic diurnal cortisol output in predicting the social impact of COVID-19 home confinement, presenting this hormone as a potential biomarker for a priori identification of at-risk groups during public health crises.

Loneliness and Social Isolation Detection Using Passive Sensing Techniques: Scoping Review

BACKGROUND

Loneliness and social isolation are associated with multiple health problems, including depression, functional impairment, and death. Mobile sensing using smartphones and wearable devices, such as fitness trackers or smartwatches, as well as ambient sensors, can be used to acquire data remotely on individuals and their daily routines and behaviors in real time. This has opened new possibilities for the early detection of health and social problems, including loneliness and social isolation.

OBJECTIVE

This scoping review aimed to identify and synthesize recent scientific studies that used passive sensing techniques, such as the use of in-home ambient sensors, smartphones, and wearable device sensors, to collect data on device users' daily routines and behaviors to detect loneliness or social isolation. This review also aimed to examine various aspects of these studies, especially target populations, privacy, and validation issues.

METHODS

A scoping review was undertaken, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Studies on the topic under investigation were identified through 6 databases (IEEE Xplore, Scopus, ACM, PubMed, Web of Science, and Embase). The identified studies were screened for the type of passive sensing detection methods for loneliness and social isolation, targeted population, reliability of the detection systems, challenges, and limitations of these detection systems.

RESULTS

After conducting the initial search, a total of 40,071 papers were identified. After screening for inclusion and exclusion criteria, 29 (0.07%) studies were included in this scoping review. Most studies (20/29, 69%) used smartphone and wearable technology to detect loneliness or social isolation, and 72% (21/29) of the studies used a validated reference standard to assess the accuracy of passively collected data for detecting loneliness or social isolation.

CONCLUSIONS

Despite the growing use of passive sensing technologies for detecting loneliness and social isolation, some substantial gaps still remain in this domain. A population heterogeneity issue exists among several studies, indicating that different demographic characteristics, such as age and differences in participants' behaviors, can affect loneliness and social isolation. In addition, despite extensive personal data collection, relatively few studies have addressed privacy and ethical issues. This review provides uncertain evidence regarding the use of passive sensing to detect loneliness and social isolation. Future research is needed using robust study designs, measures, and examinations of privacy and ethical concerns.

Loneliness Among US Adults Aged ≥55 Early in the COVID-19 Pandemic : Findings From the COVID-19 Coping Study

OBJECTIVES

Loneliness is associated with increased risks of adverse health outcomes among middle-aged and older adults. We estimated the prevalence of loneliness and identified key sociodemographic, employment, living, and health-related risk factors for loneliness among adults aged ≥55 during the early phase of the COVID-19 pandemic in the United States, when much of the country was under shelter-in-place orders.

METHODS

We collected data from online questionnaires in the COVID-19 Coping Study, a national study of 6938 US adults aged ≥55 from April 2 through May 31, 2020. We estimated the population-weighted prevalence of loneliness (scores ≥6 of 9 on the 3-item UCLA Loneliness Scale), overall and by sociodemographic, employment, living, and health-related factors. We used population-weighted modified Poisson regression models to estimate prevalence ratios (PRs) and 95% CIs for the associations between these factors and loneliness, adjusting for age, sex, race, ethnicity, and education level.

RESULTS

Overall, we estimated that 29.5% (95% CI, 27.9%31.3%) of US adults aged ≥55 were considered high in loneliness in April and May 2020. In population-weighted adjusted models, loneliness was the most prevalent among those who reported depression, who were not married or in a relationship, who lived alone, and who were unemployed at the onset of the pandemic.

CONCLUSIONS

We identified subpopulations of middle-aged and older adults who were vulnerable to loneliness during a period when COVID-19 shelter-in-place orders were in place across most of the country. These insights may inform the allocation of resources to mitigate an unintended health consequence during times of restricted activity.

Protocol for a patient-reported experience measures (PREMs) survey of patients discharged during the COVID-19 pandemic and their family caregivers

INTRODUCTION

In the Swiss canton of Valais, the first cases of SARS-CoV-2 were detected on 28 February 2020. Discharged patients' and their family caregivers' experiences in relation to safety, quality of care, trust and communication during the COVID-19 hospitalisation period remain unexplored. The study aims to collect the patient-reported experience measures (PREMs) survey of patients discharged during the COVID-19 pandemic and their family caregivers.

METHODS AND ANALYSIS

Patients aged ≥18 years, hospitalised between 28 February and 11 May 2020 and then discharged home, plus their family caregivers will be invited to complete a self-administrated questionnaire made up of 14 closed questions and 1 open-ended question. The questionnaire will include items on the patient's hospital trajectory and assess the interpersonal trust placed in nurses and physicians based on Krajewska-Kułak et al's Trust in Nurse Scale and Anderson et al's Trust in Physician Scale. Participants' perceived stress will be assessed using Cohen et al's Perceived Stress Scale. Feelings of safety will be examined based on Dryhurst et al's questionnaire on Risk Perception During Pandemics. After ethical clearance, data will be collected using a postal paper questionnaire and via an online web link. Descriptive and inferential statistics will be computed, and the open question will undergo a qualitative thematic analysis. We will analyse perceptions of the different hospital trajectories experienced by patients undergoing surgery with and without a SARS-CoV-2 infection.

ETHICS AND DISSEMINATION

The Human Research Ethics Committee of Vaud (2020-02025) authorised this study. Gathering experiences and learning about the impact of the COVID-19 pandemic on the social determinants of health among discharged patients and families fit in well with the Triple Aim framework and the PREMs survey. The study will formulate recommendations to support interventions in the face of the second wave of COVID-19 pandemic and their effects on patients' and their family caregivers' experiences.

Social Isolation and Mortality Among People Living with HIV in British Columbia, Canada

Social isolation, a risk factor for poor health within the general population, may be exacerbated by unique challenges faced by people living with HIV (PLHIV). This analysis examines the association between social isolation and all-cause mortality among a cohort of PLHIV experiencing multiple social vulnerabilities. The analytical sample included 936 PLHIV ≥ 19 years, living in British Columbia, Canada, and enrolled in the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study (2007–2010). Participants were classified as Socially Connected (SC), Minimally Isolated (MI) or Socially Isolated (SI) via latent class analysis. Cross-sectional survey data was linked to longitudinal clinical data from a provincial HIV treatment database. Mortality was assessed longitudinally up to and including December 31st, 2017. Through multivariable logistic regression, an association between SI and all-cause mortality was found (adjusted OR: 1.48; 95% CI 1.08, 2.01). These findings emphasize the need to mitigate effects of social isolation among PLHIV.

The trajectory of loneliness in response to COVID-19

Social distancing and "stay-at-home" orders are essential to contain the coronavirus outbreak (COVID-19), but there is concern that these measures will increase feelings of loneliness, particularly in vulnerable groups. The present study examined change in loneliness in response to the social restriction measures taken to control the coronavirus spread. A nationwide sample of American adults (N = 1,545; 45% women; ages 18 to 98, M = 53.68, SD = 15.63) was assessed on three occasions: in late January/early February 2020 (before the outbreak), in late March (during the President's initial "15 Days to Slow the Spread" campaign), and in late April (during the "stay-at-home" policies of most states). Contrary to expectations, there were no significant mean-level changes in loneliness across the three assessments (d = .04, p > .05). In fact, respondents perceived increased support from others over the follow-up period (d = .19, p < .01). Older adults reported less loneliness overall compared to younger age groups but had an increase in loneliness during the acute phase of the outbreak (d = .14, p < .05). Their loneliness, however, leveled off after the issuance of stay-at-home orders. Individuals living alone and those with at least one chronic condition reported feeling lonelier at baseline but did not increase in loneliness during the implementation of social distancing measures. Despite some detrimental impact on vulnerable individuals, in the present sample, there was no large increase in loneliness but remarkable resilience in response to COVID-19. (PsycInfo Database Record (c) 2020 APA, all rights reserved).