The physical and mental health consequences of social isolation and loneliness in the context of COVID-19

Balance and Health-Related Quality of Life After 1 Year of COVID-19 Social Restriction Measures: A Cross-Sectional Study in Two Samples from Spain

BACKGROUND

The COVID-19 pandemic significantly impacted the well-being of the general population. However, more information is needed regarding the relationship between participation-related outcomes. This study aimed to analyze the impact of the pandemic on occupational balance (OB) and health-related quality of life (HRQoL) before and after social restrictions and to explore their relationship with COVID-19 diagnosis.

METHODS

We conducted a study among individuals diagnosed with COVID-19, assigning a healthy control group with the same sociodemographic characteristics using the EQ-5D-5L and the Occupational Balance Questionnaire (OBQ).

RESULTS

The final sample size consisted of 61 participants in the COVID-19 diagnosis group (50.8% male; mean age 34.6 ± 14.17 years) and 57 healthy participants (50.8% male; mean age 33.7 ± 13.77 years). There were no differences in the sociodemographic variables between the groups. Significant differences were found between groups both before the pandemic and 1 year after confinement measures in HRQoL and OBQ (p < 0.005). The regression model indicated significant associations (p < 0.001) between HRQoL and both current OB and COVID-19 diagnosis. However, the OBQ scores from before the pandemic did not show a significant association with HRQoL (p = 0.336).

CONCLUSIONS

In conclusion, social restrictions from the COVID-19 pandemic negatively impacted HRQoL in our sample even 1 year after confinement, with COVID-19 diagnosis and occupational imbalance predicting worse outcomes, highlighting the need for targeted interventions not only for the current situation but also for possible future public health crises.

Assessing mental health treatment receipt among Asian adults with limited English proficiency using an intersectional approach

US Asian adults and people with limited English proficiency (LEP) confront mental health treatment receipt disparities. At the intersection of racial and language injustice, Asian adults with LEP may face even greater disparity, but studies have not assessed this through explicitly intersectional approaches. Using 2019 and 2020 National Survey of Drug Use and Health data, we computed disparities in mental health treatment among those with mental illness comparing: non-Hispanic (NH) Asian adults with LEP to NH White adults without LEP (joint disparity), NH Asian adults without LEP to NH White adults without LEP (referent race disparity), NH Asian adults with LEP to those without LEP (referent LEP disparity), and the joint disparity versus the sum of referent disparities (excess intersectional disparity). In age- and gender-adjusted analyses, excess intersectional disparity was 26.8% (95% CI, -29.8 to 83.4) of the joint disparity in 2019 and 63.0% (95% CI, 29.1-96.8) in 2020. The 2019 joint disparity was 1.37 (95% CI, 0.31-2.42) times that if the race-related disparity did not vary by LEP, and if LEP-related disparity did not vary by race; this figure was 2.70 (95% CI, 0.23-5.17) in 2020. These findings highlight the necessity of considering the intersection of race and LEP in addressing mental health treatment disparities. This article is part of a Special Collection on Mental Health.

How Can the Roma Deal with the Health and Social Crisis Generated by the COVID-19 Pandemic? Inequalities, Challenges, and Successful Actions in Catalonia (Spain)

The Roma is the most excluded non-migrant ethnic minority in Europe, facing prejudice, intolerance, discrimination, and social exclusion in their daily lives. This has led to a huge gap in several social domains between the Roma and non-Roma created for centuries. The COVID-19 pandemic has only increased the social and health inequalities that the Roma faced. In this context, it is important to identify actions that have been successful in mitigating the effects that the COVID-19 has had in increasing such inequalities. This paper presents the findings of a mixed-method study carried out in Catalonia (Spain) with the participation of more than 500 Roma, who reported their experience. The study results confirm the significant vulnerability and the negative impact of the COVID-19 pandemic on the Roma communities. Our research also highlights several successful actions developed by the Integrated Plan for the Roma of the Catalan Government, such as health literacy and adult education, as having a positive impact on the quality of life of many Roma during the health and social crisis generated by the COVID-19 pandemic. This paper suggests that the lessons learned from Catalonia could be transferred to other contexts across Europe and guide decision makers to promote the social inclusion and quality of life of the Roma, protecting Roma communities during current and future pandemics.

Lifestyle Medicine Approach to Wound Management

Chronic wounds impact 4.5% of the US population, necessitating a comprehensive understanding of their types and underlying mechanisms. Diabetic foot ulcers (DFUs), prevalent in 25% of individuals with diabetes, contribute significantly to lower limb amputations. The pathophysiology involves neuropathy, peripheral arterial disease, impaired immunity, glycemic control, and mechanical stress. Lifestyle medicine emerges as a pivotal aspect of care, offering both prevention and treatment by integrating plant-predominant nutrition, physical activity, stress management, avoidance of harmful substances, restful sleep, and social connectedness. These interventions impact gene interactions, immune function, and tissue regeneration, playing a crucial role in chronic wound management. The standard of care involves a multidisciplinary approach, emphasizing infection and vascular management, pressure offloading, conducive wound healing environments, and lifestyle adjustments. As diabetes prevalence rises, a proactive integration of lifestyle interventions is crucial, offering a promising avenue to alleviate the growing healthcare burden associated with chronic wounds.

Societal costs of untreated perinatal mood and anxiety disorders in Vermont

PURPOSE

To estimate the societal costs of untreated perinatal mood and anxiety disorders (PMADs) in Vermont for the 2018-2020 average annual birth cohort from conception through five years postpartum.

METHODS

We developed a cost analysis model to calculate the excess cases of outcomes attributed to PMADs in the state of Vermont. Then, we modeled the associated costs of each outcome incurred by birthing parents and their children, projected five years for birthing parents who do not achieve remission by the end of the first year postpartum.

RESULTS

We estimated that the total societal cost of untreated PMADs in Vermont could reach $48 million for an annual birth cohort from conception to five years postpartum, amounting to $35,910 in excess societal costs per birthing parent with an untreated PMAD and their child.

CONCLUSION

Our model provides evidence of the high costs of untreated PMADs for birthing parents and their children in Vermont. Our estimates for Vermont are slightly higher but comparable to national estimates, which are $35,500 per birthing parent-child pair, adjusted to 2021 US dollars. Investing in perinatal mental health prevention and treatment could improve health outcomes and reduce economic burden of PMADs on individuals, families, employers, and the state.

The impact of social isolation and loneliness on cardiovascular disease risk factors: a systematic review, meta-analysis, and bibliometric investigation

Data on the association between social isolation, loneliness, and risk of incident coronary heart disease (CVD) are conflicting. The objective of this study is to determine the relationship between social isolation and loneliness, and the risk of developing cardiovascular disease (CVD) in middle age and elderly using meta-analysis. The purpose of the bibliometric analysis is to systematically evaluate the existing literature on the relationship between social isolation, loneliness, and the risk of developing cardiovascular disease (CVD) in middle-aged and elderly individuals. A comprehensive search through four electronic databases (MEDLINE, Google Scholar, Scopus, and Web of Science) was conducted for published articles that determined the association between social isolation and/or loneliness and the risk of developing coronary heart disease from June 2015 to May 2023. Two independent reviewers reviewed the titles and abstracts of the records. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline to conduct the systematic review and meta-analysis. Data for the bibliometric analysis was obtained from the Scopus database and analyzed using VOSviewer and Bibliometrix applications. Six studies involving 104,511 patients were included in the final qualitative review and meta-analysis after screening the records. The prevalence of loneliness ranged from 5 to 65.3%, and social isolation ranged from 2 to 56.5%. A total of 5073 cardiovascular events were recorded after follow-up, ranging between 4 and 13 years. Poor social relationships were associated with a 16% increase in the risk of incident CVD (Hazard Ratio of new CVD when comparing high versus low loneliness or social isolation was 1.16 (95% Confidence Interval (CI) 1.10-1.22). The bibliometric analysis shows a rapidly growing field (9.77% annual growth) with common collaboration (6.37 co-authors/document, 26.53% international). The US leads research output, followed by the UK and Australia. Top institutions include University College London, Inserm, and the University of Glasgow. Research focuses on "elderly," "cardiovascular disease," and "psychosocial stress," with recent trends in "mental health," "social determinants," and "COVID-19". Social isolation and loneliness increase the risk of and worsen outcomes in incident cardiovascular diseases. However, the observed effect estimate is small, and this may be attributable to residual confounding from incomplete measurement of potentially confounding or mediating factors. The results of the bibliometric analysis highlight the multidimensional nature of CVD research, covering factors such as social, psychological, and environmental determinants, as well as their interplay with various demographic and health-related variables.

Unveiling Coronasomnia: Pandemic Stress and Sleep Problems During the COVID-19 Outbreak

The COVID-19 pandemic posed an unprecedented challenge to public well-being, necessitating an examination of its health impact. This review discusses the relationship between pandemic-induced stressors and individual sleep patterns and quality. The pandemic stressors include lockdown or physical distancing measures, direct virus exposure, and the dissemination of misinformation and disinformation. The pandemic led to delayed sleep-wake cycles, except for healthcare professionals, and worsened sleep quality. The prevalence of insomnia was higher for women due to pre-existing conditions and susceptibility stressors such as lockdown stress and family responsibilities. Healthcare professionals, who experienced worsened work conditions during the pandemic, reported higher rates of insomnia and sleep difficulties due to infection anxiety and post-traumatic stress from direct virus exposure. For the general population, stress stemmed from social isolation under lockdown and overwhelming false information available online, resulting in sleep problems. Taken together, the findings highlight the importance of promoting social interactions, providing psychological support services, and caution in navigating health information. In summary, this review underscores the need for individual- and group-centered approaches in ongoing research and interventions to address pandemic-related stress and sleep issues during COVID-19.

Addressing loneliness and social isolation in 52 countries: a scoping review of National policies

BACKGROUND

Even prior to the advent of the COVID-19 pandemic, there was ample evidence that loneliness and social isolation negatively impacted physical and mental health, employability, and are a financial burden on the state. In response, there has been significant policy-level attention on tackling loneliness. The objective of this scoping review was to conduct a loneliness policy landscape analysis across 52 countries of the UN European country groups. Our policy analysis sought to highlight commonalities and differences between the different national approaches to manage loneliness, with the goal to provide actionable recommendations for the consideration of policymakers wishing to develop, expand or review existing loneliness policies.

METHODS

We searched governmental websites using the Google search engine for publicly available documents related to loneliness and social isolation. Seventy-eight documents were identified in total, from which 23 documents were retained. Exclusion of documents was based on predetermined criteria. A structured content analysis approach was used to capture key information from the policy documents. Contextual data were captured in a configuration matrix to highlight common and unique themes.

RESULTS

We could show that most policies describe loneliness as a phenomenon that was addressed to varying degrees in different domains such as social, health, geographical, economic and political. Limited evidence was found regarding funding for suggested interventions. We synthesised actionable recommendations for the consideration of policy makers focusing on the use of language, prioritisation of interventions, revisiting previous campaigns, sharing best practice across borders, setting out a vision, evaluating interventions, and the need for the rapid and sustainable scalability of interventions.

CONCLUSIONS

Our study provides the first overview of the national loneliness policy landscape, highlighting the increasing prioritisation of loneliness and social isolation as a major public health and societal issue. Our findings suggest that policymakers can sustain this momentum and strengthen their strategies by incorporating rigorous, evidence-based intervention evaluations and fostering international collaborations for knowledge sharing. We believe that policymakers can more effectively address loneliness by directing funds to develop and implement interventions that impact the individual, the community and society.

Influences of Indoor Air Temperatures on Empathy and Positive Affect

The consequences of climate change are already visible, and yet, its effect on psychosocial factors, including the expression of empathy, affect, and social disconnection, is widely unknown. Outdoor conditions are expected to influence indoor conditions. Therefore, the aim of this study was to investigate the effect of indoor air temperature during work hours on empathy, positive and negative affect, and social disconnection. Participants (N = 31) were exposed, in a cross-over design, to two thermal conditions in a simulated office environment. Questions on empathy and social disconnection were administered before and after the exposure to each condition, while affect was measured throughout the day. Subjective thermal sensation and objective measures of mean skin temperature were considered. The results indicated a significant difference in empathy (F(1, 24) = 5.37, p = 0.03, with an η2 = 0.126) between conditions. Participants reported increases in empathy after exposure to the warm condition compared to the cool condition, in which reductions in empathy were reported. Although the same pattern was observed for positive affect, the difference was smaller and the results were not significant. Thermal sensation had a significant effect on changes in empathy too (F(1, 54) = 7.015, p = 0.01, with an R2 = 0.115), while mean skin temperature had no effect on empathy (F(1, 6) = 0.53, p = 0.89, with an R2 = 0.81). No effects were observed for positive and negative affect and social disconnection. Longitudinal studies are needed to support these findings.

COVID-19 pandemic stress and cancer symptom burden

OBJECTIVES

In a sample of patients with cancer (n=1145) who were assessed during the height of the COVID-19 pandemic, latent profile analysis was used to identify subgroups of patients with distinct stress profiles and to evaluate for differences in demographic and clinical characteristics and symptom severity scores among these subgroups.

METHODS

Patients completed measures of cancer-specific and COVID-19 stress, global stress, social isolation, loneliness, depression, state and trait anxiety, morning and evening fatigue, morning and evening energy, sleep disturbance, cognitive function, and pain. Latent profile analysis was used to identify subgroups of patients with distinct stress profiles. Differences among the subgroups in study measures were evaluated using parametric and non-parametric tests.

RESULTS

Using clinically meaningful cut-off scores for the stress measures, four distinct stress profiles were identified (ie, none class (51.3%); low stress and moderate loneliness class (24.4%), high stress and moderate loneliness class (14.0%), and very high stress and moderately high loneliness class (high, 10.3%)). Risk factors associated with membership in the high class included: younger age, lower annual household income, lower functional status and higher comorbidity burden. The two worst stress profiles reported clinically meaningful levels of all of the common symptoms associated with cancer and its treatments.

CONCLUSION

Findings from this study, obtained prior to the availability of COVID-19 vaccines and anti-viral medications, provide important 'benchmark data' to evaluate for changes in stress and symptom burden in patients with cancer in the postvaccine era and in patients with long COVID-19.

COVID-19 risk, course and outcome in people with mental disorders: a systematic review and meta-analyses

AIMS

It has been suggested that people with mental disorders have an elevated risk to acquire severe acute respiratory syndrome coronavirus 2 and to be disproportionally affected by coronavirus disease 19 (COVID-19) once infected. We aimed to analyse the COVID-19 infection rate, course and outcome, including mortality and long COVID, in people with anxiety, depressive, neurodevelopmental, schizophrenia spectrum and substance use disorders relative to control subjects without these disorders.

METHODS

This study constitutes a preregistered systematic review and random-effects frequentist and Bayesian meta-analyses. Major databases were searched up until 27 June 2023.

RESULTS

Eighty-one original articles were included reporting 304 cross-sectional and prospective effect size estimates (median n per effect-size = 114837) regarding associations of interest. Infection risk was not significantly increased for any mental disorder that we investigated relative to samples of people without these disorders. The course of COVID-19, however, is relatively severe, and long COVID and COVID-19-related hospitalization are more likely in all patient samples that we investigated. The odds of dying from COVID-19 were high in people with most types of mental disorders, except for those with anxiety and neurodevelopmental disorders relative to non-patient samples (pooled ORs range, 1.26-2.57). Bayesian analyses confirmed the findings from the frequentist approach and complemented them with estimates of the strength of evidence.

CONCLUSIONS

Once infected, people with pre-existing mental disorders are at an elevated risk for a severe COVID-19 course and outcome, including long COVID and mortality, relative to people without pre-existing mental disorders, despite an infection risk not significantly increased.

Social avoidance and altered hypothalamic-pituitary-adrenal axis in a mouse model of anxious depression: The role of LPA1 receptor

Anxious depression is a prevalent disease with devastating consequences. Despite the lack of knowledge about the neurobiological basis of this subtype of depression, recently our group has identified a relationship between the LPA1 receptor, one of the six characterized G protein-coupled receptors (LPA1-6) for lysophosphatidic acid, with a mixed depressive-anxiety phenotype. Dysfunctional social behaviors, which have been related to increased activation of the hypothalamus-pituitary-adrenal (HPA) axis, are key symptoms of depression and are even more prominent in patients with comorbid anxiety and depressive disorders. Social behavior and HPA functioning were assessed in animals lacking the LPA1 receptor. For these purposes, we first examined social behaviors in wild-type and LPA1 receptor-null mice. In addition, a dexamethasone (DEX) suppression test was carried out. maLPA1-null mice exhibited social avoidance, a blunted response to DEX administration and an impaired circadian rhythm of corticosterone levels, which are features that are consistently dysregulated in many mental illnesses including anxious depression. Here, we have strengthened the previous experimental evidence for maLPA1-null mice to represent a good animal model of anxious depression, providing an opportunity to explore new therapeutic targets for the treatment of mood disorders, particularly this subtype of depression.

Effective interventions to reduce loneliness in big cities

PURPOSE OF REVIEW

Loneliness is a state of distress or discomfort between the desired and experienced level of connectedness to others. These feelings may be particular salient in urban environments that seemingly offer more opportunities for social contact, highlighting the discrepancy. The topic of loneliness has received increased attention because of its negative impact on mental and physical health combined with concerns of increased loneliness due to lockdowns and social distancing regulations during the coronavirus disease 2019 pandemic. We provide a bibliometric and random-effects meta-analysis of clinical trials published since 2020 and available via PubMed.

RECENT FINDINGS

Loneliness interventions have predominantly focused on elderly in the community. Adolescents and young adults as a second group at risk have received much less attention. On average across 44 effect sizes studied in 38 trials, interventions show moderate levels of effectiveness but are characterized by high heterogeneity and trials are often underpowered and use low quality designs. Multidimensional interventions show promise for alleviating loneliness, but the intervention context needs greater attention.

SUMMARY

Scalable and effective interventions for the general population and at-risk groups of loneliness are still scarce. Some promising interventions have been trialled and merit further attention.

Self-criticism and romantic relationship satisfaction as serial mediators of links between childhood psychological maltreatment and loneliness

BACKGROUND

Psychological maltreatment may be one of the causes of adults' loneliness despite having a partner. There are some links between psychological maltreatment, self-criticism, relationship satisfaction, and loneliness in the literature. But the nature of these links requires further explanation.

OBJECTIVE

The present study examined the serial mediation role of self-criticism and romantic relationship satisfaction on the pathway from childhood psychological maltreatment to loneliness, in a Turkish sample.

PARTICIPANTS AND SETTINGS

In total 403 individuals (Female = 294, Male = 109) participated from 53 different cities in Türkiye. Participants were either dating (65.8 %), had a fiancée (4 %), or were married (30.3 %).

METHOD

The data was collected using Psychological Maltreatment Questionnaire, UCLA Loneliness Scale, Self-criticism Rumination Scale, and the Relationship Assessment Scale.

RESULTS

Structural equation modeling results indicated that self-criticism and romantic relationship satisfaction fully mediated the impact of psychological maltreatment on loneliness. The model was a good fit [χ² (29, N = 403) = 63.846, p < .001; χ²/df = 2.20; SRMR = 0.061; RMSEA = 0.055; GFI = 0.969; CFI = 0.979; NFI = 0.963; IFI = 0.979].

CONCLUSIONS

Childhood experiences of psychological maltreatment can continue to haunt individuals, even as adults. Although being in a relationship can help individuals with their loneliness, psychologically maltreated adults may feel lonely in their relationships due to self-criticism and dissatisfaction. Interventions focused on childhood psychological maltreatment and self-criticism may help lonely adults. Along with this focus, relationship satisfaction can be addressed in family/couple counseling.

Links between COVID-19 and Parkinson's disease/Alzheimer's disease: reciprocal impacts, medical care strategies and underlying mechanisms

The impact of coronavirus disease 2019 (COVID-19) pandemic on patients with neurodegenerative diseases and the specific neurological manifestations of COVID-19 have aroused great interest. However, there are still many issues of concern to be clarified. Therefore, we review the current literature on the complex relationship between COVID-19 and neurodegenerative diseases with an emphasis on Parkinson's disease (PD) and Alzheimer's disease (AD). We summarize the impact of COVID-19 infection on symptom severity, disease progression, and mortality rate of PD and AD, and discuss whether COVID-19 infection could trigger PD and AD. In addition, the susceptibility to and the prognosis of COVID-19 in PD patients and AD patients are also included. In order to achieve better management of PD and AD patients, modifications of care strategies, specific drug therapies, and vaccines during the pandemic are also listed. At last, mechanisms underlying the link of COVID-19 with PD and AD are reviewed.

Social isolation and subclinical vascular pathways to cerebrovascular disease

Social isolation and lack of social support are risk factors for cardiovascular and cerebrovascular disease (CVD). This study explored the relationship between measures of social support and subclinical measures of CVD risk. 58 healthy adults ages 18 to 85 years participated in this study. The Berkman-Syme Social Network Inventory (SNI) was used to assess social isolation, with higher scores signifying less isolation. Social support was defined using the 12-Item Interpersonal Support Evaluation List (ISEL-12) with a higher score signifying higher social support. Subclinical CVD measures included carotid-femoral pulse wave velocity (cfPWV), carotid beta-stiffness index, and middle cerebral artery (MCA) pulsatility index. Path analysis models for both the SNI and ISEL appraisal domain predicting cfPWV and cerebrovascular pulsatility fit the data well. Path analyses showed significant direct paths from the SNI (β = -.363, t = -2.91) and ISEL appraisal domain (β = -.264, t = -2.05) to cfPWV. From cfPWV, both models revealed significant direct paths to carotid stiffness (β = .488, t = 4.18) to carotid pulse pressure (β = .311, t = 2.45) to MCA pulsatility (β = .527, t = 4.64). Social isolation and appraisal of social support are related to unfavorably higher aortic stiffness, with subsequent detrimental effects on cerebrovascular hemodynamic pulsatility.

Pexidartinib (PLX3397) through restoring hippocampal synaptic plasticity ameliorates social isolation-induced mood disorders

Social behavior is essential for the well-being and survival of individuals. However, social isolation is a serious public health issue, especially during the COVID-19 pandemic, affecting a significant number of people worldwide, and can lead to serious psychological crises. Microglia, innate immune cells in the brain, are strongly implicated in the development of psychiatry. Although many microglial inhibitors have been used to treat depression, there is no literature report on pexidartinib (PLX3397) and social isolation. Herein, we adopted PLX3397 to investigate the role of microglia in the modulation of social isolation. Our results found that social isolation during adolescence caused depressive-like, but not anxiety-like behavior in mice in adulthood, with enhanced expression of the microglial marker Iba1 in the hippocampus. In addition, treatment with PLX3397 reduced the expression of the microglial marker Iba1, decreased the mRNA expression of IL-1β, increased the mRNA expression of Arg1, elevated the protein levels of DCX and GluR1 and restored the dendritic spine branches and density, ultimately mitigating depressive-like behavior in mice. These findings suggest that inhibition of microglia in the hippocampus could ameliorate mood disorders in mice, providing a new perspective for the treatment of psychiatric disorders such as depression.