The relationship between loneliness, interpersonal competence, and immunologic status in hiv-infected men

Loneliness, Methamphetamine Use, and Cardiovascular Risk Factors Among Sexual Minority Men in the COVID-19 Era

BACKGROUND

Important gaps exist in our understanding of loneliness and biobehavioral outcomes among sexual minority men (SMM), such as faster HIV disease progression. At the same time, SMM who use methamphetamine are approximately one-third more likely than non-users to develop cardiovascular disease. This study examined associations of loneliness, stimulant use, and cardiovascular risk in SMM with and without HIV.

METHOD

Participants were enrolled from August 2020 to February 2022 in a 6-month prospective cohort study. The study leveraged self-report baseline data from 103 SMM, with a subset of 56 SMM that provided a blood sample to measure markers of cardiovascular risk.

RESULTS

Loneliness showed negative bivariate associations with total cholesterol and LDL cholesterol in the cardiometabolic subsample (n = 56). SMM with methamphetamine use (t(101) = 2.03, p < .05; d = .42) and those that screened positive for a stimulant use disorder (t(101) = 2.07, p < .05; d = .46) had significantly higher mean loneliness scores. In linear regression analyses, negative associations of loneliness with LDL and total cholesterol were observed only among SMM who used methamphetamine.

CONCLUSION

We observed lower cholesterol in SMM reporting loneliness and methamphetamine use. Thus, in addition to the observed associations of loneliness with cholesterol, there are important medical consequences of methamphetamine use including cardiovascular risk, higher HIV acquisition risk and progression, as well as stimulant overdose death. This cross-sectional study underscores the need for clinical research to develop and test interventions targeting loneliness among SMM with stimulant use disorders.

The relationship between parental emotional abuse and interpersonal competence and digital game addiction: A path analysis

BACKGROUND

Digital game addiction is a negative effect of the technological developments that have taken place and has been reported in literature as a serious mental health problem for children and adolescents in the developmental period.

AIM

This study investigates the relationship between perceived emotional abuse from parents and interpersonal competence and game addiction by using a model.

METHODS AND MATERIAL

The study group comprised 360 adolescents, with 197 (54.7%) being female and 163 (45.8%) male. The adolescents' ages varied between 13 and 18 and their average age was 15.55. The data were collected using Psychological Maltreatment Questionnaire, Interpersonal Competence Scale, and Game Addiction Scale. The relationship between variables was tested using structural equation modeling.

RESULTS

The emotional abuse perceived from the mother significantly influences interpersonal competence and game addiction. Emotional abuse perceived from the father significantly influences game addiction. Interpersonal competence negatively influences game addiction at a significant level. Interpersonal competence mediates the relationship between maternal emotional abuse and digital game addiction.

CONCLUSIONS

Maternal emotional abuse has been effective in decreasing interpersonal competence levels in adolescents. Parental emotional abuse is effective in game addiction in adolescents. Low level of interpersonal competence among adolescents affects game addiction. Emotional abuse perceived from the mother affects digital game addiction through interpersonal competence. Accordingly, educators, researchers, and clinicians dealing with digital game addiction in adolescents should consider the effect of perceived parental emotional abuse and interpersonal competence.

Loneliness, Risky Beliefs and Intentions about Practicing Safer Sex among Methamphetamine Dependent Individuals

BACKGROUND

Methamphetamine use is a known predictor of riskier sexual behaviors, which can have important public health implications (e.g., HIV-transmission risk). Loneliness also is associated with riskier sexual behaviors, though the relationship between loneliness and beliefs and/or intentions to practice safer sex has not been examined among people dependent on methamphetamine.

MATERIALS AND METHODS

Individuals who met DSM-IV criteria for lifetime methamphetamine dependence and current (≤ 18-months) methamphetamine abuse or dependence (METH+ n = 56) were compared to those without severity and recency of methamphetamine use (METH- n = 59). These groups did not differ on social network size or proportion of people with HIV (∼58% HIV+). Participants completed the NIH Toolbox Loneliness Scale and the Sexual Risks Scale's "Norms" and "Intentions" subscales.

RESULTS

METH+ individuals were significantly lonelier than METH- controls (t(113) = 2.45, p = .02). Methamphetamine dependence remained significantly associated with greater loneliness, after controlling for HIV status and other relevant covariates (e.g., neurocognitive impairment, history of mood disorder, social network size; F = 3.70, Adjusted R2 = 0.18, p = .0009). Loneliness, above and beyond the aforementioned covariates, was significantly associated with riskier beliefs and intentions to practice safer sex among METH+, but not METH-, individuals (β = 2.92, p = .02).

CONCLUSIONS

Loneliness is prevalent among individuals dependent on methamphetamine, and is uniquely associated with riskier beliefs and intentions regarding practicing safer sex. Findings may aid in identifying individuals at-risk of engaging in riskier sexual behaviors and guide risk prevention strategies.

Loneliness in monkeys: Neuroimmune mechanisms

Loneliness, or perceived social isolation, may be evident in any group-living species, although its assessment in nonhumans provides some measurement challenges. It is well-known that loneliness in humans confers significant risk for morbidity and mortality, although mechanisms remain unclear. The authors describe a naturally-occurring model of loneliness in adult male rhesus monkeys that shows many parallels with the phenomenon in humans. Lonely monkeys (those that display high frequencies of social initiations but low frequencies of complex interaction) show elevated sympathetic nervous system activity and down regulated Type I interferon responses. Analysis of data from simian immunodeficiency virus-infected monkeys indicates that these physiological changes have functional consequences. Use of this animal model can help identify mechanisms by which loneliness impacts health.

Genome-Wide Association Study of Loneliness Demonstrates a Role for Common Variation

Loneliness is a complex biological trait that has been associated with numerous negative health outcomes. The measurement and environmental determinants of loneliness are well understood, but its genetic basis is not. Previous studies have estimated the heritability of loneliness between 37 and 55% using twins and family-based approaches, and have explored the role of specific candidate genes. We used genotypic and phenotypic data from 10 760 individuals aged ⩾50 years that were collected by the Health and Retirement Study (HRS) to perform the first genome-wide association study of loneliness. No associations reached genome-wide significance (p>5 × 10^-8). Furthermore, none of the previously published associations between variants within candidate genes (BDNF, OXTR, RORA, GRM8, CHRNA4, IL-1A, CRHR1, MTHFR, DRD2, APOE) and loneliness were replicated (p>0.05), despite our much larger sample size. We estimated the chip heritability of loneliness and examined coheritability between loneliness and several personality and psychiatric traits. Our estimates of chip heritability (14-27%) support a role for common genetic variation. We identified strong genetic correlations between loneliness, neuroticism, and a scale of 'depressive symptoms.' We also identified weaker evidence for coheritability with extraversion, schizophrenia, bipolar disorder, and major depressive disorder. We conclude that loneliness, as defined in this study, is a modestly heritable trait that has a highly polygenic genetic architecture. The coheritability between loneliness and neuroticism may reflect the role of negative affectivity that is common to both traits. Our results also reflect the value of studies that probe the common genetic basis of salutary social bonds and clinically defined psychiatric disorders.

Using Gene Expression Analysis to Examine Changes in Loneliness, Depression and Systemic Inflammation in Lonely Chronically Ill Older Adults

Purpose

The purpose of this study was to evaluate the effectiveness of LISTEN (Loneliness Intervention) on loneliness, depression, physical health, systemic inflammation, and genomic expression in a sample of lonely, chronically ill, older adults.

Methods

This was a prospective, longitudinal randomized trial of LISTEN, a novel intervention based on theories of narrative and cognitive restructuring to target specific aspects of loneliness. Twenty-three older, lonely, chronically ill adults were recruited from a family medicine clinic in West Virginia. Participants were randomized to two groups, 13 in LISTEN group (Loneliness Intervention) and 10 in attention control (healthy aging education). Participants attended an enrollment session where they completed consent, survey data (including sociodemographics and chronic illness diagnoses), baseline physical measures, and blood sampling for gene expression analysis. After completing the 5 weekly sessions, all participants attended a 12 week post data collection meeting (17 weeks post-baseline) for survey completion, physical measures and blood sampling.

Results

The results of this study show that the LISTEN intervention improves measures of physical and psychosocial health. Specifically, subjects enrolled in LISTEN showed reductions in systolic blood pressure, as well as decreased feelings of loneliness and depression. These changes may be due, in part, to a reduction in systemic inflammation, as measured by interleukin-2.

Conclusion

This study provides support for the use of LISTEN in reducing loneliness in chronically ill, older adults. Further, while some of our results are inconclusive, it provides rationale to expand our study population to evaluate the relationship between loneliness and systemic inflammation. In the future, enhancing knowledge about the relationships among loneliness, chronic illness, systemic inflammation, and gene expression of these particular targets, and how these relationships may change over time with intervention will inform translation of findings to clinical settings.

Loneliness and substance use: the influence of gender among HIV+ Black/African American adults 50+

Estimates suggest 30% of adults report the highest levels of loneliness. Though men are more likely than women to use illicit substances and engage in heavy drinking, the prevalence of substance use in women is growing and their escalation toward dependence occurs more rapidly. Loneliness and substance use have greater relevance within the HIV+ population, with higher rates of substance misuse than the general population. However, the association between loneliness and substance use within HIV+ individuals remains understudied. The purpose of the present study was to test the hypothesis that there would be an association between loneliness and substance moderated by gender in HIV+ older adults. A cross-sectional study was conducted between October 2013 and January 2014. Study participants included 96 HIV-positive Black/African American men and women recruited through the University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) in Jacksonville, Florida. Participants completed an interviewer-administered assessment examining mental and behavioral health. Pearson correlations examined associations between loneliness and substance use. Binary logistic regression analyses stratified by gender examined the association between loneliness and substance use while controlling for covariates. Among women, loneliness was associated with illicit drug use, AOR = 3.37, 95% CI: 1.23-9.21, p = .018 and heavy drinking, AOR = 2.47, 95% CI: 1.07-5.71, p = .033. No significant associations were found between loneliness and illicit drug use, and heavy drinking in men. Substance use among women in this population may be linked to loneliness. Interventions should be gender specific. Further research into this association is necessary as it will likely have important clinical implications for this population.

Brief Form of the Interpersonal Competence Questionnaire (ICQ-15)

Abstract. The Interpersonal Competence Questionnaire (ICQ) developed by Buhrmester and colleagues ( 1988 ) in the US assesses the multidimensional construct of social competence via five distinct, but related subscales. Two versions comprising 40 and 30 items, respectively, are available in German. The purpose of the current study is to develop and validate a brief version of the ICQ among a large adult sample that is representative of the German general population. Data were collected from 2,009 participants. Three confirmatory factor analyses (CFA) were conducted in order to develop and validate the ICQ-15. Cronbach’s alpha coefficients were computed for the ICQ-15. An initial CFA with the ICQ-30 formed the basis for the selection of the items to be included in the ICQ-15. Two subsequent CFA’s with the ICQ-15 revealed an excellent fit of the hypothesized five-factor model to the observed data. Internal consistency coefficients were in the adequate range. This preliminary evaluation shows that the ICQ-15 is a structurally valid measure of interpersonal competence recommended for research contexts with limited assessment time and for psychotherapy progress tracking in clinical settings.

Social Relationships and Health: The Toxic Effects of Perceived Social Isolation

Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum - the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.

A Cross-Cultural Exploration of Masculinity and Relationships in Men From Turkey, Norway, and the United States

Masculinity ideology is the endorsement of a set of culturally based male role norms that influences gender-related attitudes, beliefs, and behaviors. However, masculinity research has been criticized for not being inclusive enough of different cultures. This study explored the cultural and relational components of masculinity by comparing 564 Turkish, Norwegian, and U.S. men’s endorsement of masculinity ideology and examining the associations between masculinity ideology and interpersonal attitudes and behavioral competencies with romantic partners and work colleagues separately for the three groups of men. Norwegian men had significantly lower scores on a measure of masculinity ideology than both Turkish and U.S. men. Canonical correlation analyses revealed that all three groups of men had significant associations between male role norms and interpersonal relationship variables, but the patterns of association differed by country. Generally, endorsement of traditional male role norms was associated with poorer interpersonal competencies for men in all three countries, although the associations were much stronger for the Norwegian sample. Implications, limitations, and directions for future research are discussed.

Thoughts, attitudes, and feelings of HIV-positive MSM associated with high transmission-risk sex

This study presents survey data collected from a sample of HIV-positive men (N = 182) who had high transmission-risk sex, defined as unprotected anal intercourse with a man whose HIV-status was negative or unknown, in the previous 6 months. Despite the tremendous changes in HIV treatment and their impact on people living with HIV, little recent research has examined current trends in their thoughts toward unprotected anal intercourse. Here, the authors describe the self-justifications reported by HIV-positive men who have sex with men (MSM) in their current study conducted between 2006 and 2009 and explore key differences between the those of the HIV-positive MSM and those collected from a previous cohort of HIV-negative men (n = 124), who previously reported engaging in high transmission-risk sex. Whereas HIV-negative men focused on themes related to the impulsivity of and gratification from unprotected intercourse, HIV-positive men focused on themes regarding the deferral of responsibility/assumption the partner is positive (i.e., "If he's doing X, he must be positive . . ."), or the role of condomless sex fulfilling emotional needs. The findings highlight unique aspects of how HIV-positive men approach decision making regarding the use of condoms, as well as how they perceive issues of responsibility for initiating safer sex practices.

Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV in the rural south

We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering--the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole.

Loneliness matters: a theoretical and empirical review of consequences and mechanisms

As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.

Disclosure of HIV status and psychological well-being among Latino gay and bisexual men

This study examined disclosure of HIV-positive serostatus by 301 Latino gay and bisexual men to members of their social networks and the mental health consequences of such disclosure. The sample was recruited from clinics, hospitals, and community agencies in New York City, Washington, DC, and Boston. Proportions disclosing differed depending on the target, with 85% having disclosed to closest friend, 78% to male main partner, 37% to mother, and 23% to father. Although there were differences depending on the target, disclosure was related to greater quality of social support, greater self-esteem, and lower levels of depression. Moreover, findings indicated that social support mediated the relationship between disclosure of serostatus and both self-esteem and depression. Thus, disclosure resulted in greater social support, which in turn had positive effects on psychological well-being. Findings demonstrate that generally Latino gay men are selective in choosing people to whom they disclose their serostatus and that disclosure tends to be associated with positive outcomes.

Self-concealment, social self-efficacy, acculturative stress, and depression in African, Asian, and Latin American international college students

The primary purpose of this exploratory investigation was to examine self-concealment behaviors and social self-efficacy skills as potential mediators in the relationship between acculturative stress and depression in a sample of 320 African, Asian, and Latin American international college students. The authors found several differences by demography with regard to the study's variables. After controlling for regional group membership, sex, and English language fluency, they found that self-concealment and social self-efficacy did not serve as mediators in the relationship between African, Asian, and Latin American international students' acculturative stress experiences and depressive symptomatology. Implications of the findings are discussed.

The Existential Loneliness Questionnaire: background, development, and preliminary findings

We described the background and the development of a new measure of existential loneliness, the Existential Loneliness Questionnaire (ELQ). Specifically, we analyzed the items of the preliminary version of the ELQ (ELQ-P) using methods based on item response theory (the Rasch model) and examined the convergent and discriminative validity of the ELQ in a sample of 47 HIV-infected women. Item analysis produced an ELQ version consisting of 22 items that were internally consistent and performed well in measuring an underlying construct conceptualized as existential loneliness. In addition, the ELQ discriminated well between symptomatic and asymptomatic HIV-infected women. The ELQ correlated strongly with measures of depression, loneliness not identified as existential and purpose-in-life and moderately strongly with a measure of hopelessness. Holding constant depression scores, the correlation between the ELQ and loneliness not identified as existential was significantly attenuated. Limitations of the study include the small sample size, which precluded an analysis of the dimensional structure of the ELQ.

The effects of depression, stressful life events, social support, and coping on the progression of HIV infection

This article reviews recent findings concerning the role of psychosocial factors on the progression of HIV. Specifically, we examine the role of depression, stressful life events, social support, and coping on changes in CD4 T-lymphocytes and other indicators of HIV disease progression. Studies have yielded important evidence that depression, stressful life events, low social support, and denial coping may have a detrimental impact on HIV disease course. Delineating the role of psychosocial factors on HIV disease progression may aid in the development of new interventions for this devastating disease.

To tell or not to tell: patterns of disclosure among men with prostate cancer

This paper draws on the results of a longitudinal, qualitative study of men with prostate cancer (treated with prostatectomy) and their spouses. Interviews were conducted separately and simultaneously with men and their spouses, at three points in time (pre-surgery, 8-10 weeks post-surgery and 11-13 months post-surgery). The primary focus in the paper is on men's responses to questions about their decisions to share information (or not) with others about their diagnosis and ongoing medical situation. Most men with prostate cancer avoided disclosure about their illness where possible, and placed great importance on sustaining a normal life. Factors related to limiting disclosure included men's low perceived need for support, fear of stigmatization, the need to minimize the threat of illness to aid coping, practical necessities in the workplace, and the desire to avoid burdening others. This study contributes to an understanding of disclosure issues related to prostate cancer, and raises issues about how best to be helpful to men, given their tendency to minimize the impact of illness, and the need for support.

Social relationships and the progression of human immunodeficiency virus infection: a review of evidence and possible underlying mechanisms

We review studies examining the quality and quantity of social relationships as potential risk factors for differential progression of human immunodeficiency virus (HIV) infection. Several well-conducted prospective studies suggest that the health effects associated with the presence of supportive social relationships vary according to disease stage and mode of transmission. For gay or bisexual males in the early stages of infection, the presence of supportive social relationships appears to be a risk factor for accelerated disease progression. For individuals in the later stages of infection and those who acquire HIV via intravenous drug use or transfusion, supportive social relationships appear to be associated with health protective effects similar to those observed in other disease settings. We consider a variety of potential explanations for accelerated disease progression in gay men with extensive networks of personal relationships.

Psychosocial differences between urban and rural people living with HIV/AIDS

During the past decade, many investigations have examined the life circumstances of people living with HIV disease. Most of these studies, however, have focused on HIV-infected people in large metropolitan areas. This study compares the psychosocial profiles of rural and urban people living with HIV disease. Anonymous, self-administered surveys were completed by 276 people with HIV/AIDS in a Midwestern state. The assessment instrument measured respondents' quality of life, perceptions of loneliness, social support, experiences with AIDS-related discrimination, access to services, and illness-related coping strategies. Compared with their urban counterparts, rural people with HIV reported a significantly lower satisfaction with life, lower perceptions of social support from family members and friends, reduced access to medical and mental health care, elevated levels of loneliness, more community stigma, heightened personal fear that their HIV serostatus would be learned by others, and more maladaptive coping strategies. Programs that are designed to improve the life circumstances of people with HIV disease in rural areas--particularly those that facilitate access to adequate health care, increase perceptions of social support, and improve illness-related coping--are urgently needed.

Social relationships and immune processes in HIV seropositive gay and bisexual men

This three-year longitudinal study assessed the association between social relationships and human immunodeficiency virus (HIV) progression in individuals at risk for morbidity and mortality due to acquired immune deficiency syndrome (AIDS). Two-hundred five HIV seropositive men without AIDS completed measures of social integration and loneliness at baseline. Blood samples used to assess CD4 T-lymphocyte levels were collected at baseline and at six-month intervals for a three-year follow-up period. Contrary to expectation, lower levels of baseline loneliness predicted more rapid declines in CD4 levels over the follow-up period. This association was independent of baseline CD4 values, negative affect, and health practices. A series of mediational analyses revealed that sexual behavior, medication use, bereavement, coping, and a number of other variables were not mechanisms through which loneliness affected the immune system. Loneliness was not associated with time to AIDS diagnosis or time to AIDS-related mortality. These findings are consistent with the emerging view that social relationships can have deleterious, as well as protective, influences on health outcomes.