Women, loneliness, and incident coronary heart disease

Changes in loneliness prevalence in Denmark in the 21st century: Age-period-cohort analysis

AIM

The aim of this study was to investigate changes in the prevalence of loneliness in Denmark from 2000 to 2021 by conducting age-period-cohort analysis.

METHODS

Our study was based on a sample (N=83,437; age: ⩾16 years) of the Danish Health and Morbidity Surveys conducted in Denmark in 2000, 2005, 2010, 2013, 2017 and 2021. We used logistic regression models by gender to estimate the age-period-cohort effects, with loneliness as the dependent variable and age, survey year and birth cohort as independent variables, mutually adjusted.

RESULTS

The prevalence of adult loneliness increased by each survey year over the entire period (from 13.2% in 2000 to 27.4% in 2021 among men and from 18.8% to 33.7% among women). Overall, a U-shaped curve, for the prevalence of loneliness among different age groups, was observed, which was most pronounced among women. The greatest increase in the prevalence of loneliness from 2000 to 2021 was observed among the youngest age group (16-24 years), with 28.4 and 30.7 percentage points for men and women. No significant cohort effect was observed.

CONCLUSIONS

The observed increase in loneliness prevalence from 2000 to 2021 was driven by period and age effects rather than cohort effects. It should be noted that data from 2021 were collected during a national lockdown due to an outbreak of COVID-19, which could explain part of the large increase in loneliness from 2017 to 2021.

A brief but comprehensive three-item social connectedness screener for use in social risk assessment tools

BACKGROUND

The 2014 IOM report "Capturing Social and Behavioral Domains and Measures in Electronic Health Records" described three subdomains of social relationships that affect patient health and well-being. However, most social risk screeners currently assess only one subdomain, frequency of social connections. We are proposing a three-item Brief Social Connectedness (SC) screener that additionally assesses risks in social/emotional support and loneliness/social isolation subdomains.

METHODS

For this cross-sectional study, we used data from a 2021 Kaiser Permanente Northern California (KPNC) social risk survey for 2244 members ages 35-85 years. The survey included three validated questions that covered the SC subdomains (frequencies of social contacts with people they care about, feeling lonely/socially isolated, and getting enough social/emotional support). Variables representing moderate/high versus low risk were created for each subdomain. We used weighted data for bivariate analyses and modified log-Poisson regression models that adjusted for age, sex, race, and ethnicity to examine cross-sectional associations among the three subdomain risks, as well as with two structural SC risks, living alone and not being in a committed relationship. We then used modified log-Poisson regression models to study cross-sectional associations of these five SC variables with three single-item self-report measures of emotional health.

RESULTS

In regression models that included all five SC variables, loneliness/social isolation and social/emotional support risks were significantly associated with all three emotional health measures, while frequency of social contacts, living alone, and no committed relationship were not. However, low frequency of social contacts and no committed relationship significantly increased risk of often feeling lonely/socially isolated and lacking in social/emotional support.

CONCLUSIONS

A three-item social connectedness screener that assessed risks of loneliness/social isolation, inadequate social/emotional support, and low frequency of social contacts provided more comprehensive information about emotional health risks than social connection frequency alone.

Interpersonal Loneliness Predicts the Frequency and Intensity of Nightmares: An Examination of Theoretic Mechanisms

The evolutionary theory of loneliness (ETL) argues that human belongingness is essential to survival and failing to meet belongingness needs constitutes a threat to viability. In two separate studies (total N = 1,609), links between loneliness and nightmares were examined as a test of ETL postulates. As hypothesized, loneliness predicted nightmare frequency (both studies) and nightmare intensity (Study Two only). Although stress mediated the relationship between loneliness and nightmare frequency in Study One, stress was not a significant mediator of this relationship in Study Two. As predicted, in Study Two both hyperarousal and rumination mediated the relationships between loneliness and nightmare frequency and between loneliness and nightmare intensity. Theoretical implications include support for both the aversive signaling and implicit vigilance postulates of ETL.

Associations of state and chronic loneliness with interpretation bias: The role of internalizing symptoms

Loneliness is common and, while generally transient, persists in up to 22% of the population. The rising prevalence and adverse impacts of chronic loneliness highlight the need to understand its underlying mechanisms. Evolutionary models of loneliness suggest that chronically lonely individuals demonstrate negative interpretation biases towards social information. It may also be that such biases are exacerbated by momentary increases in state loneliness, or elevated anxiety or depression. Yet, little research has tested these possibilities. The current study aimed to advance understandings of loneliness by examining associations of chronic loneliness with individual differences in negative interpretation bias for social (relative to non-social) stimuli, and testing whether these associations change in the context of increased state loneliness and current levels of anxiety and depressive symptoms. These aims were explored in 591 participants who completed an interpretation bias task before and after undergoing a state loneliness induction. Participants also self-reported chronic loneliness, anxiety, and depression. Linear mixed models indicated that only state (but not chronic) loneliness was associated with more positive interpretations of non-social stimuli, with greater anxiety and depressive symptoms predicting more negative interpretations. Implications of these findings for present theoretical models of loneliness are discussed.

Music-Making and Depression and Anxiety Before and During the COVID-19 Pandemic-Results From the NAKO Cohort Study in Germany

Objectives

To investigate the association of musical activity with mental health during the COVID-19 pandemic.

Methods

A total of 3,666 participants reported their musical activity before and mental health indicators before and during the pandemic. Depression was assessed with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder scale. The association between mental health scores and musical activities was investigated using linear regression.

Results

Within the last 12 months, 22.1% of the participants reported musical activity (15.1% singing, 14.5% playing an instrument). Individuals with frequent singing as their main musical activity had higher scores before the pandemic than non-musicians and the worsening during the pandemic was more pronounced compared to non-musicians. Instrumentalists tended to have slightly lower scores than non-musicians indicating a possible beneficial effect of playing an instrument on mental health.

Conclusion

The pandemic led to a worsening of mental health, with singers being particularly affected. Singers showed poorer mental health before the pandemic. The tendency for instrumentalists to report lower depression scores compared to non-musicians may support the hypothesis that music-making has a beneficial effect on health.

Investigating the relationship between early cardiovascular disease markers and loneliness in young adults

Loneliness is recognised as a risk factor for cardiovascular disease development. However, it is unclear whether loneliness itself or other closely related mental health symptoms, such as depression and social anxiety, are associated with the development of cardiovascular disease. In the present study, we examined the relationship between loneliness and several early cardiovascular disease markers in young adults, after controlling for depression and social anxiety. Sixty-six young adults (18-35 years old, Mage = 22.70; 75.8% females) completed psychological questionnaires and took part in several physiological tests assessing cardiovascular health (e.g., vascular function). Results revealed higher loneliness was significantly associated with shorter pulse transit time (β = - 0.70, p = 0.002; shorter pulse transit time is a subclinical marker for arterial stiffness). Additionally, results show that while loneliness and depression were both related to vascular dysfunction in young adults, the underlining physiological mechanisms through which they affect vascular function may be different. Specifically, higher loneliness was associated with increased arterial stiffness, whereas depression was associated with increased endothelial dysfunction (β = - 0.43, p = 0.04). Our findings indicate that presence of loneliness and depression in young adults may be accompanied by early indicators of poor cardiovascular health, such as arterial stiffness and endothelial dysfunction. Results from the study further support the link between loneliness and cardiovascular disease development.

The mediating role of loneliness in the effect of physical activity barriers on quality of life

BACKGROUND

This study aims to examine the mediating role of loneliness in the effect of physical activity barriers on quality of life.

METHODS

The sample of the study consisted of 374 people over the age of 65 who applied to a hospital. The data collection tools used in the study are 'Personal Information Form', 'Physical Activity Barriers Questionnaire' 'World Health Organization Quality of Life Instrument-Older Adults Module' and 'Loneliness Scale for the Elderly'. The mediating effect analysis was conducted through the 'Process Macro' developed by Hayes.

RESULTS

According to the obtained results, loneliness mediates the relationship between physical activity barriers and quality of life. Individuals with high levels of loneliness and physical activity barriers have lower levels of quality of life. When the results of the regression analysis indicating the mediating effect were analyzed, it was determined that the effect of physical activity barriers on quality of life were negative and significant. As the level of physical activity barriers increases, the level of quality of life decreases.

CONCLUSION

In conclusion, it was determined that loneliness plays a mediating role in the relationship between physical activity barriers and the level of quality of life. The study results suggest that adopting a physically active lifestyle is important to reduce adverse health outcomes in the elderly.

Loneliness, social isolation, and cardiovascular disease among nonveteran and veteran women

We examined the prospective associations of social isolation and loneliness with incident cardiovascular disease (CVD) among aging nonveteran and veteran women, and effect modification by veteran status. Participants with no history of myocardial infarction (MI), stroke, coronary heart disease (CHD), or coronary heart failure from the Women's Health Initiative Extension Study II self-reported social isolation, loneliness, health behaviors, health status, and veteran status. CVD and CVD subevents were physician adjudicated. Hazard ratios (HR) and 95% confidence intervals (CI) for the Interquartile Range (IQR) in social isolation (IQR = 1) and loneliness (IQR=.33) were calculated using Cox proportional hazard models adjusting for sociodemographic, health behavior, and health status characteristics. Veteran status was tested as an effect modifier. Among 52,442 women (Mean age = 79 ± 6.1; veterans n = 1023; 89.2% non-Hispanic White), 3579 major CVD events occurred over an average 5.8 follow-up years. Compared to nonveterans, veteran women reported higher levels of social isolation (p < .01) and loneliness (p < .01). The CVD HR was 1.07 (95% CI, 1.04-1.10) for the IQR in social isolation and 1.03 (95% CI, 1.10-1.06) for the IQR in loneliness. The HR for the IQR in both social isolation and loneliness was 1.10 (95% CI, 1.05-1.15). Social isolation was associated with CHD (HR = 1.12; 95% CI, 1.03-1.21). The CHD HR for the IQR in social isolation was 1.12 (95% CI, 1.03-1.21). Associations did not differ by veteran status (all p-interactions > 0.08). Findings suggest that the adverse associations of social isolation and loneliness with CVD are similar among veteran and nonveteran women.

Digital loneliness-changes of social recognition through AI companions

Inherent to the experience of loneliness is a significant change of meaningful relatedness that (usually negatively) affects a person's relationship to self and others. This paper goes beyond a purely subjective-phenomenological description of individual suffering by emphasizing loneliness as a symptomatic expression of distortions of social recognition relations. Where there is loneliness, a recognition relation has changed. Most societies face an increase in loneliness among all groups of their population, and this sheds light on the reproduction conditions of social integration and inclusion. These functions are essential lifeworldly components of social cohesion and wellbeing. This study asks whether "social" AI promotes these societal success goals of social integration of lonely people. The increasing tendency to regard AI Companions (AICs) as reproducers of adequate recognition is critically discussed with this review. My skepticism requires further justification, especially as a large portion of sociopolitical prevention efforts aim to fight an increase of loneliness primarily with digital strategies. I will argue that AICs rather reproduce than sustainably reduce the pathodynamics of loneliness: loneliness gets simply "digitized."

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.

Loneliness and risk for cardiovascular disease in the United States and Japan: The effects of nationality, collectivism, and gender

RATIONALE

Loneliness is a global concern associated with adverse effects on cardiovascular disease (CVD) that may differ by nationality, collectivism, and gender.

OBJECTIVE

This study examined whether associations between loneliness and CVD indicators (e.g., metabolic dysregulation [MetD], inflammation, sleep dysfunction) would vary by nationality, collectivism, and gender. We predicted that loneliness would be associated with poorer CVD values in (1) Japan than the United States (U.S.), (2) in individuals higher rather than lower in collectivism, and (3) our exploratory hypotheses about gender were that loneliness would interact with gender to be associated with differential CVD indicators in the U.S. versus Japan.

METHODS

Participants (aged 36 to 78) from the MIDUS Refresher Biomarker (n = 644) and the MIDJA 2 Biomarker studies (n = 293) completed questionnaires, bloodwork, and a physical exam. U.S. participants were from multiple cities, and Japanese participants were from Tokyo. Loneliness was measured via responses to the question, "How often in the past week did you feel lonely?" Logistic regression and path analyses using structural equation modeling determined individual differences in loneliness, whether loneliness predicted CVD indicators, and whether nationality, collectivism, and gender moderated these associations.

RESULTS

Loneliness was prevalent in the U.S. (25.39%) and Japan (20.82%). Unexpectedly, Japanese adults reported less collectivism than U.S. adults. We found significant interactions of (1) nationality and gender on MetD and inflammation, (2) gender and loneliness on sleep dysfunction, and (3) nationality and loneliness on MetD. Loneliness was associated with greater MetD in the U.S. but not in Japan.

CONCLUSIONS

Cultural influences on loneliness contradicted expectations and suggested caution when equating nationality with cultural values. Our Japanese sample was from Tokyo, which may have lower collectivism than rural Japanese regions. We recommend future studies consider geographic location when examining associations between loneliness, collectivism, and CVD.

An Examination of Positive and Negative Outcomes During the COVID-19 Pandemic Among Persons With Multiple Sclerosis

IMPORTANCE

This study provides information to clinicians about how persons with MS coped in both positive and negative ways during a potentially traumatic experience (the coronavirus disease 2019 [COVID-19] pandemic), which will help clinicians to provide better services to this population in the face of stressful events.

OBJECTIVE

To describe both positive and negative outcomes among persons with multiple sclerosis (MS) and to examine whether resilience and social support were related to positive and negative outcomes during the peak of the pandemic.

DESIGN

An online survey administered during the COVID-19 pandemic.

PARTICIPANTS

Participants were 74 individuals with MS and 104 healthy controls (HCs) recruited through social media and community support groups.

OUTCOMES AND MEASURES

The survey included questionnaires that assessed both positive and negative responses to the pandemic, including benefit finding, loneliness, and distress. Resilience and social support were also assessed.

RESULTS

Differences were noted between persons with MS and HCs on negative but not positive outcomes. Better social support and resilience were related to positive outcomes.

CONCLUSIONS AND RELEVANCE

Both persons with MS and HCs were similar in benefit finding and stress management. However, negative outcomes were worse in the MS group. Our findings shed light on the importance of individuals with MS adopting a positive outlook to help during times of adversity. What This Article Adds: Among persons with disabilities such as multiple sclerosis, finding benefits during stressful times can be a potential coping mechanism. Furthermore, resilience and social support should be taken into account to moderate the effects of adverse events.

Social networks as a protective factor for worsened self-perceived health status related to self-perceived changes in loneliness and health conditions in adults aged 50+ during the COVID-19 outbreak

The coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading millions of people to change their lifestyles, especially older individuals who are the most at-risk population. Social isolation, the main preventive action to slow the pandemic's spread, reduced and drastically limited social connections, increasing older individuals' loneliness and stress, and worsening their health. We examined the connection between self-perceived changes in loneliness, the existence and type of social contact (face-to-face/electronic), and health conditions on self-perceived changes in health status during the outbreak, analyzing 51,778 individuals aged 50 plus from the Survey of Health, Ageing and Retirement in Europe (SHARE) database Wave 8 beta (June-August 2020). We found that the odds for worsened self-perceived health status were 249% higher among individuals who reported increased loneliness compared to the non-increase group and were lower in individuals with face-to-face contact (31%) or electronic contact (54%) during the outbreak. In addition, the odds for worsened self-perceived health status were higher for individuals with hypertension (17%), cancer (19%), chronic lung disease (25%), heart problems (27%), and other illnesses (32%). Based on the results obtained, electronic contact has shown a stronger connection as a protective factor for worsened self-perceived health since the outbreak compared to face-to-face interactions. Thus, adopting a policy that encourages the usage of electronic communications could reduce the burden on the healthcare system, particularly during pandemics, while improving patient health outcomes and minimizing pandemic-related health risks. This approach is especially important for older individuals, for whom any departure from home can cause an additional risk of exposure to the virus.

Impact of Social Support on Cardiovascular Risk Prediction Models: A Systematic Review

Cardiovascular diseases (CVD) stand as the primary causes of both mortality and morbidity on a global scale. Social factors such as low social support can increase the risk of developing heart diseases and have shown poor prognosis in cardiac patients. Resources such as PubMed and Google Scholar were searched using a boolean algorithm for articles published between 2003 and 2023. Eligible articles showed an association between social support and cardiovascular risks. A systematic review was conducted using the guidance published in the Cochrane Prognosis Method Group and the PRISMA checklist, for reviews of selected articles. A total of five studies were included in our final analysis. Overall, we found that participants with low social support developed cardiovascular events, and providing a good support system can decrease the risk of readmission in patients with a history of CVD. We also found that integrating social determinants in the cardiovascular risk prediction model showed improvement in accessing the risk. Population with good social support showed low mortality and decreased rate of readmission. There are various prediction models, but the social determinants are not primarily included while calculating the algorithms. Although it has been proven in multiple studies that including the social determinants of health (SDOH) improves the accuracy of cardiovascular risk prediction models. Hence, the inclusion of SDOH should be highly encouraged.

Helps you, helps me? Provision of instrumental and personal care and loneliness among adults aged 50 years and older during the COVID-19 pandemic

PURPOSE

To examine the association between provision of instrumental and personal care, and loneliness in adults aged 50 years and older during the COVID-19 pandemic. Instrumental care referred to the provision of assistance with obtaining necessary or essential products and/or services, whereas personal care referred to the assistance with daily life activities or the provision of emotional support. Social capital and caregiver stress theories served as the study's theoretical framework.

MATERIALS AND METHODS

The data were obtained from the two COVID-19 waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE) conducted in 2020 and 2021. The data were analyzed using logistic regression models. The analytical sample consisted of 48,722 adults in the abovementioned age bracket residing in Europe and Israel.

RESULTS

Providing instrumental care negatively related to loneliness. Providing instrumental care to a single category of people negatively related to loneliness, whereas providing personal care to multiple categories of people positively related to loneliness. Providing personal care to children positively related to loneliness.

CONCLUSIONS

The results suggest that different types of care provision correspond differently to the experience of loneliness while partially supporting both theoretical frameworks. Moreover, care indicators correspond differently to loneliness. The results imply that for a better understanding of the link between care provision and loneliness in later life, various parameters as well as various types of care provision should be examined.

Heart Rate During Sleep in PTSD Patients: Moderation by Contact with a Service Dog

There is growing interest in the potential health benefits of dog ownership in both the lay and scientific communities. Large reductions in risk for cardiovascular disease and all-cause mortality in dog owners relative to non-owners have been observed in epidemiological samples. Persons diagnosed with posttraumatic stress disorder exhibit elevated risk for cardiovascular disease. The current study tested a sample of 45 U.S. military veterans with deployment-related posttraumatic stress disorder employing an intensive, longitudinal, within-subjects design contrasting sleep heart rate on nights with and without a service dog. As participants were engaged in residential psychiatric treatment, sleep opportunities, waking activities, meals, and medications, were consistently scheduled. The primary recording methodology, mattress actigraphy, enabled passive quantification of heart rate over a total sample of 1097 nights. Service dog contact was associated with reduced sleep heart rate especially in participants with more severe PTSD. Longer-term longitudinal studies will be needed to assess the durability and asymptotic magnitude of this effect. An unexpected effect of nights in study was associated with increased heart rate consistent with hospitalization-associated deconditioning.

Loneliness - Cancer of the Mind

World is greying as the proportion of the ageing population increases and the demography is changing both in the developing and developed world. Contact between people is the central part of everyone's life and the glue that holds communities and society together. Lack of social relations is considered to cause loneliness and isolation for the individual and, simultaneously, on a societal level, leads to marginalisation, social disintegration and diminishing trust between people. This has come to sharp focus during the corona pandemic. Meaningful social connections are central to the physical and mental health of human beings. Off late, the deleterious health implication of social isolation and loneliness has increasingly been noticed, with a higher risk of premature death and accelerated risks of coronary heart disease, stroke, depression, and dementia. Worldwide, there is an increasing awareness regarding the alarming consequences of loneliness, especially among older adults. In response, 2018 saw the launch of a UK loneliness strategy and the first minister for loneliness in the world appointed.

Short- and Medium-Term Effects of Ageism on Loneliness Experienced During the COVID-19 Pandemic

Loneliness, common in old age, may be partially attributed to ageism. The present study explored the short- and medium-term effect of ageism on loneliness experienced during the COVID-19 pandemic using prospective data derived from the Israeli sample of the Survey of Health, Aging and Retirement in Europe (SHARE) (N = 553). Ageism was measured before the COVID-19 outbreak and loneliness in the summer of 2020 and 2021 using a direct single question. We also tested for age differences in this association. In both the 2020 and 2021 models, ageism was related to increased loneliness. This association remained significant after adjusting for a host of demographic, health, and social variables. In the 2020 model, we also found that the positive association between ageism and loneliness was significant only in people aged 70+. We discussed the results with reference to the COVID-19 pandemic, which drew attention to two global social phenomena: loneliness and ageism.

Loneliness-a clinical primer

INTRODUCTION

loneliness is prevalent worldwide. It is also associated with an increased risk for depression, high blood pressure, cardiovascular disease, stroke and early death. As such, loneliness is a major public health issue. This paper summarizes the salient points clinicians should know and encourages clinicians to assume an active part in the identification, mitigation and prevention of loneliness.

SOURCES OF DATA

white papers, academic publications.

AREAS OF AGREEMENT

loneliness is a distressful subjective experience, which does not always correlate with social isolation. Both internal (personal) and external (contextual, societal) factors determine whether an individual would feel lonely in a given situation.

AREAS OF CONTROVERSY

identifying loneliness in the clinic may be time consuming and challenging. There is a scarce robust evidence to support interventions.

GROWING POINTS

due to increased individualization and incidence of infectious diseases, loneliness is likely to become even more prevalent.

AREAS TIMELY FOR DEVELOPING RESEARCH

more research is needed to further elucidate the health impacts of loneliness as well as to find evidence-based interventions to prevent and mitigate loneliness that could then be implemented by policy-makers and clinicians.

Association between Social Isolation and Loneliness with Estimated Atherosclerotic Cardiovascular Disease Risk in a UK Biobank Population-Based Study

OBJECTIVE

The association of cardiovascular (CV) risk with social isolation and loneliness remains poorly studied. The purpose of this cross-sectional study was to investigate the associations between social isolation and loneliness with estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

METHODS

Among 302,553 volunteers of the UK Biobank population, social isolation and loneliness were assessed with a questionnaire. Associations between social isolation and loneliness with ASCVD risk were estimated using multiple gender regressions.

RESULTS

Men presented a higher estimated 10-year ASCVD risk (8.63% vs. 2.65%, p < 0.001) and higher proportions of social isolation (9.13% vs. 8.45%, p < 0.001) and loneliness (6.16% vs. 5.57%, p < 0.001) than women. In all covariate-adjusted models, social isolation was associated with an increased ASCVD risk in men (B = 0.21 (0.16; 0.26), p < 0.001) and women (B = 0.12 (0.10; 0.14), p < 0.001). Loneliness was associated with an increased ASCVD risk in men (B = 0.08 (0.03; 0.14), p = 0.001) but not in women (p = 0.217). A significant interaction was observed between social isolation and loneliness with ASCVD risk in men (p = 0.009) and women (p = 0.016). After adjustment for all covariates, both social isolation and loneliness were significantly associated with ASCVD risk in men (B = 0.44 (0.28; 0.61), p < 0.001) and women (B = 0.20 (0.12; 0.29), p < 0.001).

CONCLUSION

Social isolation was associated with a higher estimated 10-year ASCVD risk in both genders but only loneliness among men. Social isolation and loneliness can be considered potential added risk factors for CV risk. Health policies should address these notions in prevention campaigns, in addition to traditional risk factors.

Evaluating the impact of loneliness and social isolation on health literacy and health-related factors in young adults

Objectives

In current study, we aim to extend previous research by investigating the unique impact of loneliness on health literacy and health-related factors of young adults, after controlling for social isolation, depressive symptomology, and social anxiety, as well as evaluate how social isolation and loneliness differ in their impact on health literacy, and health-related factors among young adults, after accounting for abovementioned concomitant variables.

Methods

Using a cross-sectional study design, 521 young adults completed an online survey in 2020, where they self-reported their loneliness, social isolation, health-related factors, and health literacy data.

Results

Increased loneliness was associated with decrease in several health literacy domains (e.g., poorer social support for health, lower appraisal of health information, among others) and increase in some health-related factors (e.g., higher perceived stress, higher negative affect), among young adults, even after controlling for social anxiety, depressive symptomology, and social isolation. Contrastingly, increase in social isolation was associated with changes in some health-related factors - more somatic health complaints, higher alcohol use, poorer cognitive and physical functioning, and lower scores for only one health literacy domain (i.e., social support for health) among young adults, after adjusting for the influence of social anxiety, depressive symptomology, and loneliness.

Conclusion

Even after accounting for the influence of several co-occurring social and mental health symptoms, higher loneliness was associated poorer health literacy and health-related factors in young adults. We also found loneliness and social isolation may differ in the mechanisms through which they impact health literacy and health-related factors in young adults.

How Migration Status Shapes Susceptibility of Individuals' Loneliness to Social Isolation

Objectives: Our research provides competing hypotheses and empirical evidence how associations between objectively social isolation and subjective loneliness differ between host populations, migrants, and refugees. Methods: The analysis uses data of 25,171 participants from a random sample of the German population (SOEP v.35). We estimate regression models for the host population, migrants, and refugees and test five hypotheses on the association between social isolation and loneliness using a Bayesian approach in a multiverse framework. Results: We find the strongest relative support for an increased need for social inclusion among refugees, indicated by a higher Bayes factor compared to the hosts and migrants. However, all theoretically developed hypotheses perform poorly in explaining the major pattern in our data: The association of social isolation and loneliness is persistently lower for migrants (0.15 SD-0.29 SD), with similar sizes of associations for refugees and the host population (0.38 SD-0.67 SD). Conclusion: The migration history must be actively considered in health service provision and support programs to better cater to the needs of the different groups.

Loneliness, social isolation, and social support in older adults with active cancer during the COVID-19 pandemic

Introduction

The COVID-19 pandemic has had a considerable impact on mental health. The social distancing and stay-at-home orders have likely also impacted loneliness, social isolation, and social support. Older adults, particularly those with comorbidities such as cancer, have a greater potential to be impacted. Here we assessed loneliness, social isolation, and social support in older adults undergoing active cancer treatment during the pandemic.

Materials and methods

A mixed methods study in which quantitative data and qualitative response items were collected in parallel was conducted in 100 older adults with cancer. Participants completed a survey by telephone with a series of validated questionnaires to assess the domains of loneliness, social isolation, and social support as well as several open-ended questions. Baseline demographics and geriatric assessments were summarized using descriptive statistics. Bivariate associations between social isolation and loneliness and social support and loneliness were described using Spearman correlation coefficients. Conventional content analysis was performed on the open-ended questions.

Results

In a population of older adults with cancer, 3% were noted to be severely lonely, although 27% percent screened positive as having at least one indicator of loneliness by the University of California, Los Angeles (UCLA) Three Item Loneliness Scale. There was a significant positive correlation between loneliness and social isolation (r = +0.52, p < 0.05) as well as significant negative correlation between loneliness and social support (r = −0.49, p < 0.05). There was also a significant negative correlation between loneliness and emotional support (r = −0.43, p < 0.05). There was no significant association between loneliness and markers of geriatric impairments, including comorbidities, G8 score or cognition.

Discussion

Reassuringly, in this cohort we found relatively low rates of loneliness and social isolation and high rates of social support. Consistent with prior studies, loneliness, social isolation, and social support were found to be interrelated domains; however, they were not significantly associated with markers of geriatric impairments. Future studies are needed to study if cancer diagnosis and treatment may mediate changes in loneliness, social isolation, and social support in the context of the pandemic as well as beyond.

The importance of executive functioning for social skills in college students: a relative weights analysis

STATEMENT OF RELEVANCE

Social interaction is one of the most important things that humans do on a day-to-day basis, impacting both mental and physical wellness. College is a particularly important period where social interaction becomes increasingly important as well as complex. While there is no currently agreed upon cognitive basis of social interaction, the executive function (EF) system is believed to play a central role. The current study provides further evidence of the role of the EF system across different social skills in addition to highlighting the complexity of these relationships.

Prevalence of loneliness and social isolation among older adults during the COVID-19 pandemic: A systematic review and meta-analysis

OBJECTIVES

Pandemics and their public health control measures have generally substantially increased the level of loneliness and social isolation in the general population. Because of the circumstances of aging, older adults are more likely to experience social isolation and loneliness during pandemics. However, no systematic review has been conducted or published on the prevalence of loneliness and/or social isolation among the older population. This systematic review and meta-analysis aims to provide up-to-date pooled estimates of the prevalence of social isolation and loneliness among older adults during the COVID-19 pandemic and other pandemics in the last two decades.

DESIGN

EMBASE, PsychoINFO, Medline, and Web of Science were searched for relevant studies from January 1, 2000 to November 31, 2021 published in a variety of languages. Only studies conducted during the COVID-19 pandemic were selected in the review.

RESULTS

A total of 30 studies including 28,050 participants met the inclusion criteria. Overall, the pooled period prevalence of loneliness among older adults was 28.6% (95% CI: 22.9-35.0%) and 31.2% for social isolation (95% CI: 20.2-44.9%). Prevalence estimates were significantly higher for those studies conducted post 3-month from the start of the COVID-19 pandemic compared to those conducted within the first 3 months of the pandemic.

CONCLUSIONS

This review identifies the need for good quality longitudinal studies to examine the long-term impact of pandemics on loneliness and social isolation among older populations. Health policymaking and healthcare systems should proactively address the rising demand for appropriate psychological services among older adults.

Maternal Pragmatic Language Difficulties in the FMR1 Premutation and the Broad Autism Phenotype: Associations with Individual and Family Outcomes

Broader phenotypes associated with genetic liability, including mild difficulties with pragmatic language skills, have been documented in mothers of children with autism spectrum disorder (ASD) and mothers of children with fragile X syndrome (FXS). This study investigated the relationship between pragmatic difficulties and indicators of maternal well-being and family functioning. Pragmatic difficulty was associated with loneliness in mothers of children with ASD or FXS, and with depression, decreased life satisfaction, and poorer family relationship quality in mothers of children with FXS only. Results inform subtle maternal pragmatic language difficulties as a risk factor that that may contribute to reduced health and well-being, informing tailored support services to better meet the unique needs of families of children with ASD or FXS.

Evaluation of Social Isolation, Loneliness, and Cardiovascular Disease Among Older Women in the US

IMPORTANCE

Social isolation and loneliness are increasing public health concerns and have been associated with increased risk of cardiovascular disease (CVD) among older adults.

OBJECTIVE

To examine the associations of social isolation and loneliness with incident CVD in a large cohort of postmenopausal women and whether social support moderated these associations.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cohort study, conducted from March 2011 through March 2019, included community-living US women aged 65 to 99 years from the Women's Health Initiative Extension Study II who had no history of myocardial infarction, stroke, or coronary heart disease.

EXPOSURES

Social isolation and loneliness were ascertained using validated questionnaires.

MAIN OUTCOMES AND MEASURES

The main outcome was major CVD, which was physician adjudicated using medical records and included coronary heart disease, stroke, and death from CVD. Continuous scores of social isolation and loneliness were analyzed. Hazard ratios (HRs) and 95% CIs for CVD were calculated for women with high social isolation and loneliness scores (midpoint of the upper half of the distribution) vs those with low scores (midpoint of the lower half of the distribution) using multivariable Cox proportional hazards regression models adjusting for age, race and ethnicity, educational level, and depression and then adding relevant health behavior and health status variables. Questionnaire-assessed social support was tested as a potential effect modifier.

RESULTS

Among 57 825 women (mean [SD] age, 79.0 [6.1] years; 89.1% White), 1599 major CVD events occurred over 186 762 person-years. The HR for the association of high vs low social isolation scores with CVD was 1.18 (95% CI, 1.13-1.23), and the HR for the association of high vs low loneliness scores with CVD was 1.14 (95% CI, 1.10-1.18). The HRs after additional adjustment for health behaviors and health status were 1.08 (95% CI, 1.03-1.12; 8.0% higher risk) for social isolation and 1.05 (95% CI, 1.01-1.09; 5.0% higher risk) for loneliness. Women with both high social isolation and high loneliness scores had a 13.0% to 27.0% higher risk of incident CVD than did women with low social isolation and low loneliness scores. Social support was not a significant effect modifier of the associations (social isolation × social support: r, -0.18; P = .86; loneliness × social support: r, 0.78; P = .48).

CONCLUSIONS AND RELEVANCE

In this cohort study, social isolation and loneliness were independently associated with modestly higher risk of CVD among postmenopausal women in the US, and women with both social isolation and loneliness had greater CVD risk than did those with either exposure alone. The findings suggest that these prevalent psychosocial processes merit increased attention for prevention of CVD in older women, particularly in the era of COVID-19.

Low-Density Lipoprotein Cholesterol Is a Possible Blood Biomarker of Schizoid Personality Traits among Females

Lower serum levels of low-density lipoprotein cholesterol (LDL-C) have been suggested to indicate higher suicide risk and various psychiatric symptoms. Previously, we reported that lower serum LDL-C levels are associated with loneliness, social phobia, isolated life with little social support, and lower trust in others among young non-clinical females. Thus, we hypothesize that schizoid personality traits may be associated with lower serum LDL-C. We here verified this hypothesis using non-clinical data and clinical data with schizophrenia. Using the database from the Midlife in Japan (MIDJA), a cohort of residents living in Tokyo, we analyzed whether schizoid-related interpersonal characteristics were associated with LDL-C. In addition, we assessed the association between blood biomarkers including LDL-C and schizoid personality traits in 101 adult non-clinical volunteers. Finally, we evaluated the interaction between LDL-C and social decision making of patients with schizophrenia. In female non-clinical volunteers, serum LDL-C level was a predictive factor and negatively correlated with schizoid personality traits. Female patients with schizophrenia, whose serum LDL-C levels were lower, tended not to trust other females. The present findings suggest that LDL-C may influence schizoid personality traits in females, which provide a basis for further investigation into the biological aspects of schizoid personality disorder.

The Association Between Loneliness and Inflammation: Findings From an Older Adult Sample

Loneliness has been linked to poor mental and physical health outcomes. Past research suggests that inflammation is a potential pathway linking loneliness and health, but little is known about how loneliness assessed in daily life links with inflammation, or about linkages between loneliness and inflammation among older adults specifically. As part of a larger investigation, we examined the cross-sectional associations between loneliness and a panel of both basal and LPS-stimulated inflammatory markers. Participants were 222 socioeconomically and racially diverse older adults (aged 70-90 years; 38% Black; 13% Hispanic) systematically recruited from the Bronx, NY. Loneliness was measured in two ways, with a retrospective trait measure (the UCLA Three Item Loneliness Scale) and an aggregated momentary measure assessed via ecological momentary assessment (EMA) across 14 days. Inflammatory markers included both basal levels of C-reactive protein (CRP) and cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α) and LPS-stimulated levels of the same cytokines. Multiple regression analyses controlled for age, body-mass index, race, and depressive symptoms. Moderation by gender and race were also explored. Both higher trait loneliness and aggregated momentary measures of loneliness were associated with higher levels of CRP (β = 0.16, p = 0.02; β = 0.15, p = 0.03, respectively). There were no significant associations between loneliness and basal or stimulated cytokines and neither gender nor race were significant moderators. Results extend prior research linking loneliness with systemic inflammation in several ways, including by examining this connection among a sample of older adults and using a measure of aggregated momentary loneliness.

Differences in Loneliness Across the Rural-Urban Continuum Among Adults Living in Washington State

PURPOSE

Rural residents may be at higher risk for loneliness than urban residents due to factors such as social isolation, poorer health, and socioeconomic disadvantage. To date, there have been few studies examining rural-urban differences in loneliness among adults in the United States. We examined differences in loneliness across the rural-urban continuum among adult residents living in Washington State.

METHODS

Stratified random sampling was used to select 2,575 adults from small rural, large rural, suburban, and urban areas who were invited to complete a survey on factors affecting health. Data were obtained from 616 adults (278 from small rural, 100 from large rural, 98 from suburban, and 140 from urban areas) from June 2018 through October 2019. Loneliness was measured using the UCLA Loneliness Scale (3rd version). Multivariable linear and logistic regressions were used to examine geographic differences in loneliness (measured continuously and dichotomously).

FINDINGS

Mean unadjusted loneliness scores were lower in suburban compared to urban areas (35.06 vs 38.57, P = .03). The prevalence of loneliness was 50.7%, 59.0%, 40.8%, and 54.3% in small rural, large rural, suburban, and urban areas, respectively. Suburban living was associated with lower odds for being lonely compared to urban living (unadjusted OR = 0.58; 95% CI = 0.34-0.98), but this association was not statistically significant in the adjusted model (OR = 0.63; 95% CI = 0.33-1.19).

CONCLUSION

Loneliness is a prevalent health issue across the rural-urban continuum among Washington State adults.

Loneliness and Social Isolation: Determinants of Cardiovascular Outcomes

One in three Americans report experiencing loneliness in everyday life, a number that has grown exponentially over the last few decades. As we respond to the SARS-COV2 pandemic with quarantine and social distancing, social isolation and feelings of loneliness are increasing among people of all ages. This presents as an opportune time to recognize the public health impact of these important psychosocial determinants. Loneliness and social isolation are associated with a higher incidence of CVD, higher healthcare utilization and worse outcomes even after controlling for conventional risk factors of CVD. In this review, we discuss loneliness and social isolation as determinants of cardiovascular outcomes, the pathophysiology of this association, and its implications in clinical practice. We discuss some of the shortcomings in the assessment of loneliness and social isolation while identifying the most commonly used rating scales for the same. Finally, we suggest modifications to interventions for loneliness and social isolation during the COVID-19 pandemic.

Social isolation, social support and loneliness as predictors of cardiovascular disease incidence and mortality

BACKGROUND

Poor social health is associated with increased risk of cardiovascular disease (CVD). Recent research suggests that different social health domains should be considered separately as the implications for health and possible interventions may differ.

AIM

To assess social isolation, low social support and loneliness as predictors of CVD.

METHODS

Secondary analysis of 11,486 community-dwelling, Australians, aged 70 years and over, free of CVD, dementia, or significant physical disability, from the ASPirin in Reducing Events in the Elderly (ASPREE) trial. Social isolation, social support (Revised Lubben Social Network Scale), and loneliness were assessed as predictors of CVD using Cox proportional-hazard regression. CVD events included fatal CVD, heart failure hospitalization, myocardial infarction and stroke. Analyses were adjusted for established CVD risk factors.

RESULTS

Individuals with poor social health were 42 % more likely to develop CVD (p = 0.01) and twice as likely to die from CVD (p = 0.02) over a median 4.5 years follow-up. Interaction effects indicated that poorer social health more strongly predicted CVD in smokers (HR 4.83, p = 0.001, p-interaction = 0.01), major city dwellers (HR 1.94, p < 0.001, p-interaction=0.03), and younger older adults (70-75 years; HR 2.12, p < 0.001, p-interaction = 0.01). Social isolation (HR 1.66, p = 0.04) and low social support (HR 2.05, p = 0.002), but not loneliness (HR 1.4, p = 0.1), predicted incident CVD. All measures of poor social health predicted ischemic stroke (HR 1.73 to 3.16).

CONCLUSIONS

Among healthy older adults, social isolation and low social support may be more important than loneliness as cardiovascular risk factors. Social health domains should be considered in future CVD risk prediction models.

Loneliness, social isolation, and all-cause mortality in the United States

Social isolation and loneliness are both established risk factors for mortality, but it remains unclear how these two conditions interact with each other. We used data from 3975 adults aged 25-74 years who completed self-administered questionnaires (SAQs) for the Midlife in the United States (MIDUS) National Study Wave 2 (2004-2006). Loneliness was measured by asking participants how often they felt lonely. A shortened version of the Berkman-Syme Social Network Index that captured partnerships, friends/family, religious participation, and other forms of social connection was used to assess social isolation. Follow-up for all-cause mortality was censored at the end of 2016. We used progressively adjusted Cox proportional hazard models to examine the mortality risks of loneliness, social isolation, the components of social isolation, and combinations of loneliness and isolation. We adjusted for sociodemographic characteristics in our first models and then added health behaviors and physical and mental health conditions in subsequent models. In the minimally adjusted model, loneliness was associated with higher mortality risk (HR, 1.34; 95% CI, 1.22-1.47), but the association was not significant in the fully adjusted model. Social isolation was significantly associated with mortality in the minimally adjusted model (HR, 1.24; 95% CI, 1.15-1.34) and the fully adjusted model (HR, 1.13; 95% CI, 1.04-1.23). Having infrequent contact with family or friends was the component of isolation that had the strongest association with mortality. Contrary to prior literature, which has found either no interaction or a synergistic interaction between isolation and loneliness, we identified a significant, negative interaction between the two measures, indicating that loneliness and social isolation may partially substitute for one another as risk factors for mortality. Both are associated with a similar increased risk of mortality relative to those who express neither; we find no evidence that the combined effect is worse than experiencing either by itself.

Community and Social Context: An Important Social Determinant of Cardiovascular Disease

Disease prevention frameworks and clinical practice guidelines in the United States (US) have traditionally ignored upstream social determinants of health (SDOH), which are critical for reducing disparities in cardiovascular disease (CVD)-the leading cause of death in the US. Existing evidence demonstrates a protective effect of social support, social cohesion, and community engagement on overall health and wellbeing. Increasing community and social support is a major objective of the Healthy People 2030 initiative, with special provisions for vulnerable populations. However, to date, existing evidence of the association between community and social context (CSC)-an integral SDOH domain-and CVD has not been reviewed extensively. In particular, the individual and cumulative impact of CSC on CVD risk and the pathways linking CSC to cardiovascular outcomes are not well understood. In this review, we critically appraise current knowledge of the association between CSC and CVD, describe potential pathways linking CSC to CVD, and identify opportunities for evidence-based policy and practice interventions to improve CVD outcomes.

Study of loneliness and wisdom in 482 middle-aged and oldest-old adults: a comparison between people in Cilento, Italy and San Diego, USA

OBJECTIVES

There has been growing research interest in loneliness and wisdom in recent decades, but no cross-cultural comparisons of these constructs using standardized rating measures in older adults, especially the oldest-old. This was a cross-sectional study of loneliness and wisdom comparing middle-aged and oldest-old adults in Cilento, Italy and San Diego, United States.

METHOD

We examined loneliness and wisdom, using the UCLA Loneliness Scale Version 3 (UCLA-3) and San Diego Wisdom Scale (SD-WISE), respectively, in four subject groups: adults aged 50-65 and those ≥90 years from Cilento, Italy (N = 212 and 47, respectively) and San Diego, California, USA (N = 138 and 85, respectively).

RESULTS

After controlling for education, there were no significant group differences in levels of loneliness, while on SD-WISE the Cilento ≥90 group had lower scores compared to the other three groups. There was a strong inverse correlation between loneliness and wisdom in each of the four subject groups. Loneliness was negatively associated while wisdom was positively associated with general health, sleep quality, and happiness in most groups, with varying levels of significance.

CONCLUSION

These results largely support cross-cultural validity of the constructs of loneliness and wisdom, and extend previous findings of strong inverse correlations between these two entities. Loneliness has become a growing public health problem, and the results of our study suggest that wisdom could be a protective factor against loneliness, although alternative explanations are also possible. Research on interventions to reduce loneliness by enhancing wisdom in older adults is needed.

Social Isolation and Loneliness During the COVID-19 Pandemic: Impact on Weight

PURPOSE OF REVIEW

Social isolation and loneliness have long been identified as risk factors for poorer physical and mental health and increased mortality. These factors have also been shown to impact dietary behavior and physical activity which play a role in precipitating and maintaining obesity. Less is known about the impact of social isolation resulting from the COVID-19 pandemic in which social distancing is a major component of public health initiatives. This narrative review will examine the existing literature on the relationships between social isolation, loneliness, mental health, and weight as they relate to the COVID-19 pandemic.

RECENT FINDINGS

Individuals with obesity are at very high risk for worsening course of COVID-19, hospitalization, and death. This population may also be more significantly impacted by the dietary and physical activity consequences resulting from lockdown, social distancing, and isolation. The pandemic has led to significant lifestyle disruptions. However, early studies have largely relied upon cross-sectional studies or convenience samples. Future research will need to study the impact more rigorously, particularly among populations at greatest risk.

[Loneliness during the first wave of the SARS-CoV-2 pandemic-results of the German National Cohort (NAKO)]

Hintergrund

Mit Beginn der SARS-CoV-2-Pandemie und der nachfolgenden Maßnahmen zu ihrer Eindämmung im Frühjahr 2020 ist rasch die Frage nach Auswirkungen der Beschränkung sozialer Kontakte auf die psychische Gesundheit der Bevölkerung aufgekommen. Einsamkeit beschreibt eine wahrgenommene Qualität der eigenen Kontakte und Beziehungen zu anderen Menschen. Zahlreiche Studien haben einen Zusammenhang von Einsamkeit mit somatischen und psychischen Erkrankungen aufgezeigt.

Ziel

Auswertung der Häufigkeit von Einsamkeit und ihrer Beziehung zu Angst- und Depressionssymptomen in der ersten Welle der Pandemie im Mai 2020.

Methoden

Zwischen 2014 und 2019 hat die NAKO-Gesundheitsstudie 205.000 Personen im Alter zwischen 20 und 69 Jahren in 18 Studienzentren in Deutschland rekrutiert und untersucht. Die nachfolgende Zweituntersuchung musste aufgrund der Pandemie im Frühjahr 2020 unterbrochen werden. In dieser Zeit wurde ein COVID-19-bezogener Fragebogen entwickelt und an alle Teilnehmenden verschickt. Ausgewertet wurden die 113.928 Fragebögen, die innerhalb der ersten 30 Tage zurückgeschickt wurden. Einsamkeit wurde mit der 3‑Item UCLA Loneliness Scale, Angst und Depression mit den PHQ-9- und GAD-7-Skalen des Patient Health Questionnaire erhoben.

Ergebnisse

Im Mai 2020 nahmen sich 31,7 % der NAKO-Teilnehmenden als einsam wahr. Frauen und junge Menschen waren häufiger als Männer und ältere Personen betroffen. Mit steigender Wahrnehmung von Einsamkeit nahm der Schweregrad von Depressions- und Angstsymptomen stetig zu. Einsame Personen während der Pandemie hatten bereits zur NAKO-Basisuntersuchung mehr depressive und Angstsymptome angegeben als NAKO-Teilnehmende, die sich in der Pandemie nicht einsam fühlten.

Schlussfolgerung

In der NAKO-Gesundheitsstudie zeigte sich während der ersten Phase der Pandemie eine Zunahme von Einsamkeit und ihr deutlicher Zusammenhang mit schlechterer, psychischer Gesundheit.

Management of social isolation and loneliness in community-dwelling older adults: protocol for a network meta-analysis of randomised controlled trials

INTRODUCTION

Social isolation and loneliness in older adults are significant public health issues. Various interventions such as exercise programmes or social activities are used in the management of social isolation and loneliness in older adults. Network meta-analysis (NMA) provides effect estimates for all comparisons by considering the relative efficacy of multiple intervention alternatives. Therefore, this study will determine the comparative efficacy of intervention to alleviate social isolation and loneliness of older adults in community dwelling by comparing direct and indirect interventions through systematic review and NMA.

METHODS AND ANALYSIS

We will include all relevant randomised controlled trials for interventions of social isolation and loneliness in older adults written in English without any limitation of publication date through electronic databases: MEDLINE via OVID, EMBASE, Cochrane Central Registry of Controlled Trials (CENTRAL), PsycINFO and CINAHL. Independent teams of reviewers will screen trial eligibility, collect data, identify duplication and assess risk of bias, by using the Cochrane revised risk of bias tool. The interventions for the management of social isolation and loneliness will be included. The primary outcome is social isolation. The secondary outcomes are loneliness and health-related quality of life. We will conduct an NMA through a Bayesian hierarchical model, by testing assumption (ie, transitivity) for NMA. We will also estimate the ranking probabilities for all interventions at each possible rank for each intervention. For estimation of each intervention efficacy, we will assess the certainty and credibility using the Grading of Recommendations Assessment, Development and Evaluation approach.

ETHICS AND DISSEMINATION

Ethics approval will not be obtained for this systematic review as it will be conducted with published papers. The review results will be presented at a field-specific conference and published in a relevant peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42020155789.

Chinese only children and loneliness: Stereotypes and realities

Popular media has aroused concern that Chinese only children are growing up lonely owing to their lack of sibling interaction Mu et al. (2007). However, little research has been directed at determining whether Chinese adults believe in the only-child-as-lonely stereotype and whether Chinese only children actually suffer more loneliness than their peers with siblings. Three studies were conducted to examine belief in the only-child-as-lonely stereotype and determine whether only children report greater loneliness than children with siblings. With the first study, the prevalence of the only-child-as-lonely stereotype among young adults from six cities (Study 1, N = 588) was examined. The results showed that belief in this stereotypical perception was common among young Chinese adults, particularly those who had siblings. We then examined the validity of this stereotype by analyzing data from three samples, consisting of Chinese emerging adults (Study 2, N = 699) and late adolescents (Studies 3.1 and 3.2, N = 345 and 210, respectively). Results from Studies 2 and 3 consistently showed that, contrary to the stereotype, Chinese only children reported lower levels of loneliness than their counterparts with siblings. Additionally, open-ended responses from the adolescent participants in Study 3 provided hints about the situations that provoke their loneliness. The results are explained in terms of the two theoretical approaches to loneliness. In sum, our research suggests that belief in the loneliness of only children is widespread in Chinese society, but the evidence indicates that reports of loneliness are greater for those who grew up with siblings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Loneliness and mental health during the COVID-19 pandemic in older breast cancer survivors and noncancer controls

Background

The coronavirus disease 2019 (COVID‐19) pandemic has had wide‐ranging health effects and increased isolation. Older with cancer patients might be especially vulnerable to loneliness and poor mental health during the pandemic.

Methods

The authors included active participants enrolled in the longitudinal Thinking and Living With Cancer study of nonmetastatic breast cancer survivors aged 60 to 89 years (n = 262) and matched controls (n = 165) from 5 US regions. Participants completed questionnaires at parent study enrollment and then annually, including a web‐based or telephone COVID‐19 survey, between May 27 and September 11, 2020. Mixed‐effects models were used to examine changes in loneliness (a single item on the Center for Epidemiologic Studies–Depression [CES‐D] scale) from before to during the pandemic in survivors versus controls and to test survivor‐control differences in the associations between changes in loneliness and changes in mental health, including depression (CES‐D, excluding the loneliness item), anxiety (the State‐Trait Anxiety Inventory), and perceived stress (the Perceived Stress Scale). Models were adjusted for age, race, county COVID‐19 death rates, and time between assessments.

Results

Loneliness increased from before to during the pandemic (0.211; P = .001), with no survivor‐control differences. Increased loneliness was associated with worsening depression (3.958; P < .001) and anxiety (3.242; P < .001) symptoms and higher stress (1.172; P < .001) during the pandemic, also with no survivor‐control differences.

Conclusions

Cancer survivors reported changes in loneliness and mental health similar to those reported by women without cancer. However, both groups reported increased loneliness from before to during the pandemic that was related to worsening mental health, suggesting that screening for loneliness during medical care interactions will be important for identifying all older women at risk for adverse mental health effects of the pandemic.

Older breast cancer survivors and matched noncancer controls experienced similar increases in loneliness from before to during the COVID‐19 pandemic. Women who reported increased loneliness also experienced worsening depression and anxiety symptoms and higher stress during the pandemic.

An examination of reciprocal effects between cardiovascular morbidity, depressive symptoms and loneliness over time in a longitudinal cohort of Dutch older adults

BACKGROUND

Unidirectional studies suggest that the effects between cardiovascular disease, depressive symptoms and loneliness are reciprocal, but this has not been tested empirically. The aim was to study how cardiovascular morbidity, depressive symptoms and loneliness influence each other longitudinally.

METHODS

Data from 2979 older adults from the Longitudinal Aging Study Amsterdam were analysed. Depressive symptoms (≥16 points on the Center for Epidemiologic Studies Depression Scale), loneliness (≥3 points on the De Jong Gierveld Loneliness Scale) and cardiovascular morbidity were measured five times during 13-year follow-up. With structural equation modelling, a full cross-lagged panel model was compared to nine nested models reflecting different sets of temporal effects.

RESULTS

The best-fitting cross-lagged panel model showed reciprocal risk increasing effects between depressive symptoms and loneliness and a risk increasing effect of cardiovascular morbidity on depressive symptoms.

LIMITATIONS

A cross-lagged panel model has technical limitations, such as that the chosen time lag may not be appropriate for each effect. In addition, differential loss to follow-up and collider bias may have led to an underestimation of the effects.

CONCLUSIONS

Reciprocal effects tend to occur only between depressive symptoms and loneliness. Their interplay with cardiovascular morbidity seems more complex and mostly indirect, highlighting the potential of interventions to reduce depressive symptoms, loneliness and cardiovascular morbidity in concert to improve health at old age.

Potential impact of COVID-19 related unemployment on increased cardiovascular disease in a high-income country: Modeling health loss, cost and equity

BACKGROUND

Cardiovascular disease (CVD) is a leading cause of health loss and health sector economic burdens in high-income countries. Unemployment is associated with increased risk of CVD, and so there is concern that the economic downturn associated with the COVID-19 pandemic will increase the CVD burden.

AIMS

This modeling study aimed to quantify potential health loss, health cost burden and health inequities among people with CVD due to additional unemployment caused by COVID-19 pandemic-related economic disruption in one high-income country: New Zealand (NZ).

METHODS

We adapted an established and validated multi-state life-table model for CVD in the national NZ population. We modeled indirect effects (ie, higher CVD incidence due to high unemployment rates) for various scenarios of pandemic-related unemployment projections from the NZ Treasury.

RESULTS

We estimated the potential CVD-related heath loss in NZ to range from 23,300 to 36,900 health-adjusted life years (HALYs) for the different unemployment scenarios. Health inequities would be increased with the per capita health loss for Māori (Indigenous population) estimated to be 3.7 times greater than for non-Māori (49.9 vs 13.5 HALYs lost per 1000 people). The estimated additional health system costs ranged between (NZ$303 million [m] to 503m in 2019 values; or US$209m to 346m).

CONCLUSIONS AND POLICY IMPLICATIONS

Unemployment due to the COVID-19 pandemic could cause significant health loss, increase health inequities from CVD, and impose additional health system costs in this high-income country. Prevention measures should be considered by governments to reduce this risk, including additional job creation programs and measures directed towards the primary prevention of CVD.

Coping With COVID-19: The Benefits of Anticipating Future Positive Events and Maintaining Optimism

In early 2020, the COVID-19 pandemic forced a large portion of the world into quarantine, leading to an extensive period of stress making it necessary to explore regulatory techniques that are effective at stimulating long-lasting positive emotion. Previous research has demonstrated that anticipating positive events produces increases in positive emotion during discrete stressors. We hypothesized that state and trait positive anticipation during the COVID-19 pandemic would be associated with increased positive emotions. We assessed how often participants thought about a future positive/negative/neutral event, activity, or goal through a daily reconstruction method that represented a "day in the life" of people in the United States during the early stages of the COVID-19 pandemic. The results of multi-level modeling and mediational analyses demonstrated that higher optimism, one form of trait positive anticipation, was related to higher state positive anticipation, which was in turn related to higher positive emotions during the current episode, which persisted to the next episode. In addition, both optimism and state positive anticipation were related to adaptive responses to the pandemic. These findings suggest that anticipation of future emotional experiences and hopefulness for the future can be a powerful predictor of positive emotions during global pandemics and perhaps other similar chronic stressors.

Hearing impairment and loneliness in older adults in Shandong, China: the modifying effect of living arrangement

BACKGROUND

Hearing impairment is a highly prevalent condition and potential risk factor of loneliness in older adults. There is little evidence on whether living arrangement modifies the effects of hearing impairment on loneliness in older adults.

AIMS

(1) Explore the relationship between hearing impairment and loneliness in old adults; (2) investigate the modifying effect of living arrangement on the association between hearing impairment and loneliness.

METHODS

A cross-sectional analysis was conducted of 7070 participants (aged 60-101) in Shandong province of China. Hearing impairment was measured by a single self-reported question. Variables about social demography and physical functioning were assessed using self-administered questionnaires, and loneliness using short-form UCLA Loneliness Scale. Linear regression models were performed to evaluate the association between hearing impairment and loneliness and possible effect modified by living arrangement.

RESULTS

After controlling variables, older adults with hearing impairment reported significantly higher levels of loneliness than those with normal hearing (β = 0.024; P < 0.001). Living arrangement has a significant modifying effect on association between hearing impairment and loneliness.

CONCLUSIONS

Our results underscored the potential impact of hearing impairment on loneliness in older adults, and also suggested that having adult children in the same village/community may play a protective role in reducing the loneliness of older adults with hearing impairment.

The Relationship Between Surgeon Gender and Stress During the Covid-19 Pandemic

OBJECTIVE

To investigate the relationship between surgeon gender and stress during the Covid-19 pandemic.

BACKGROUND

Although female surgeons face difficulties integrating work and home in the best of times, the Covid-19 pandemic has presented new challenges. The implications for the female surgical workforce are unknown.

METHODS

This cross-sectional, multi-center telephone survey study of surgeons was conducted across 5 academic institutions (May 15-June 5, 2020). The primary outcome was maximum stress level, measured using the validated Stress Numerical Rating Scale-11. Mixed-effects generalized linear models were used to estimate the relationship between surgeon stress level and gender.

RESULTS

Of 529 surgeons contacted, 337 surgeons responded and 335 surveys were complete (response rate 63.7%). The majority of female respondents were housestaff (58.1%), and the majority of male respondents were faculty (56.8%) (P = 0.008). A greater proportion of male surgeons (50.3%) than female surgeons (36.8%) had children ≤18 years (P = 0.015). The mean maximum stress level for female surgeons was 7.51 (SD 1.49) and for male surgeons was 6.71 (SD 2.15) (P < 0.001). After adjusting for the presence of children and training status, female gender was associated with a significantly higher maximum stress level (P < 0.001).

CONCLUSIONS

Our findings that women experienced more stress than men during the Covid-19 pandemic, regardless of parental status, suggest that there is more to the gendered differences in the stress experience of the pandemic than the added demands of childcare. Deliberate interventions are needed to promote and support the female surgical workforce during the pandemic.

Older working adults in the HEAF study are more likely to report loneliness after two years of follow-up if they have negative perceptions of their work quality

BACKGROUND

Loneliness is an important public health issue associated with mortality and morbidity. Often researched amongst older people, less is known about risk factors for loneliness among adults aged 50-64 years who are in work. We investigated (a) if exit from the workforce increases the odds of loneliness; (b) whether adverse psychosocial work factors are associated with increased odds of loneliness over 2 years of follow-up; and (c) whether the association is stronger among subjects still working compared with those who have exited the workforce.

METHODS

Data came from the Health and Employment After Fifty (HEAF) study, a large population cohort who provided questionnaire information about work and health at baseline and 2 annual follow-ups. Logistic regression was used to explore the association between psychosocial risk factors and loneliness at follow-up 2, with adjustment for loneliness at baseline, sex, age, self-rated health, living alone, and mental health diagnosis.

RESULTS

Of the initial 8134 participants, 4521 were working at baseline and provided data for this analysis. Of those, 507 (11.2%) were defined as lonely at 2 years' follow-up. Exiting the workforce was not significantly associated with loneliness (OR = 1.1, 95%CI: 0.7-1.7). However, negative psychosocial work factors predicted loneliness at follow-up. After mutual adjustment, lack of choice at work (OR: 1.5, 95%CI: 1.1-1.9), often lying awake worrying about work (OR: 1.4, 95%CI: 1.0-1.9) and perceived not coping with physical demands of the job (OR: 1.3, 95%CI: 1.0-1.7) were independent predictors, with associations robust to adjustment for demographic factors and health. Associations were only slightly altered when we restricted the sample to those who remained in work until the end of follow-up.

CONCLUSIONS

Loneliness amongst middle-aged working adults is not predicted by permanent work exit but is predicted by individuals' perceptions about their work. Provision of good-quality work, matched to the capacity of the older worker, could prevent loneliness.

Sleep Disturbance Mediates the Association Between Loneliness and Health in Older Americans

BACKGROUND

As the research documenting loneliness as a risk factor for morbidity and mortality continues to grow, it becomes increasingly critical to understand the mechanics of this relationship. This study assessed whether sleep disturbance mediates the relationship between loneliness and health.

METHOD

Data came from the 2006, 2010, and 2014 waves of the Health and Retirement Study, a longitudinal study of older Americans; participants ≥ 65 who completed the Psychosocial and Lifestyle Questionnaire in 2006 were included (n = 5067). Measures include the Hughes loneliness scales, a modified version of the Jenkins sleep scale, and self-reported health. Cross-lagged mediation models (i.e., path analysis) were used to model the relationships between loneliness, sleep disturbance, and self-reported health over the 8-year span.

RESULTS

Loneliness predicted subsequent sleep disturbance, which in turn predicted subsequent self-reported health. Moreover, there was evidence of both direct and indirect effects (via sleep disturbance) of loneliness on self-reported health. These effects remained after controlling for demographics, isolation, and depression.

CONCLUSION

Sleep disturbance partially mediates the relationship between loneliness and self-reported health over 8 years. These findings are not attributable to isolation or depression. Further research is necessary to develop and assess a more comprehensive model of how loneliness shapes health. This study indicates that targeting sleep disturbance may mitigate the health risks of loneliness in older Americans.

The Contribution of Stressful Marital Interactions to Loneliness and Health across Mid-life and Later Adulthood

Although past research has noted longitudinal, and sometimes bi-directional, associations between marital interactions, loneliness, and physical health, previous work has not identified long-term associations and differential associations over life-course stages (i.e., mid-life and later adulthood). Utilizing a life-course stress process perspective and a sample of 250 couples in enduring marriages over 17 years (2001-2017), a structural equation model within a dyadic framework assessed the unique influences of stressful marital interactions on loneliness and physical health and the variation in bi-directional influences of loneliness and physical health over time. Marital interactions were relatively stable across life stages, yet marital interactions appear to influence loneliness and physical health. Notable distinctions were evident across life stages (from mid-life to later adulthood and then within later adulthood). Findings are discussed with an emphasis on the implications for health promotion and prevention programs targeting couples' quality of life in later years.