Review: Interventions addressing loneliness amongst university students: a systematic review

Loneliness in the college student population: Prevalence and associations with substance use outcomes

Objectives: We assessed the prevalence of loneliness by gender and gender-specific associations between loneliness and substance use in university students. Participants: Participants were students enrolled in colleges and universities throughout the United States (n = 84,481). Methods: Gender was self-reported and categorized as male, female, and transgender/nonbinary. Descriptive analyses were conducted, and logistic regression was used to measure associations between loneliness and substance use by gender and substance. Results: Loneliness prevalence was 58% in the sample, and loneliness was most prevalent among transgender/nonbinary students (79%). Loneliness was associated with reduced odds of alcohol use and increased odds of benzodiazepine use in all genders, and increased odds of marijuana, stimulant, and opioid misuse in females and males. Conclusions: Loneliness is prevalent in college students, especially in transgender/nonbinary students, and it is associated with increased odds of substance use. College administrators should consider implementing interventions to reduce loneliness in this population.

A qualitative exploration of migraine in students attending Irish Universities

INTRODUCTION

The complex neurological disorder of migraine is prevalent (19%) and burdensome in university students. Qualitative research exploring the lived experience of migraine in students has yet to be conducted.

METHODS

Students clinically diagnosed with migraine were recruited (purposive sampling) from a sample of Irish third-level institutions for a one-time anonymized Zoom focus group or individual interview. Focus group questions were sent to participants in advance. Interviews were iterative. Participants were also invited to submit a drawing. The interviews were audio-recorded, transcribed, and sent to participants for triangulation. Reflexive thematic content analysis was undertaken, data was imported to Microsoft Excel, initial codes were generated, and themes and sub-themes were derived from the codes. The Standards for Reporting Qualitative Studies Checklist (S1 File) ensured study rigour.

RESULTS

Twenty students from three Irish universities participated (mean age 23.8 years). The four key themes identified were (i) Migraine Characteristics, (ii) Migraine Self-Management, (iii) Migraine Clinical Management, and (iii) Migraine Impacts. Migraine was described as not just a headache but a debilitating sensory experience. A notable high level of self-management satisfaction indicated hopeful coping strategies. However, many participants said medications were ineffective and had side effects, and clinical management could be improved. Additionally, there was a marked academic and social impact of migraine, psychological issues abounded, and several participants worried about finances.

CONCLUSIONS

Migraine is impactful in a cohort of students attending Irish third-level institutions, with students carrying a wide range of debilitating migraine burdens. Students demonstrate an attitude of resilience and determination despite these challenges. Migraine awareness and education campaigns on university campuses are warranted.

Acceptability, engagement, and preliminary efficacy of a college human physiology course with integrated mindfulness practice to support student wellbeing

Objective

To evaluate the acceptability of and engagement with an undergraduate human physiology course embedded with mindfulness practice. To assess its preliminary efficacy on student mindfulness and wellbeing.

Methods

Students (N = 36, 17% freshman, 33% sophomore, 22% junior, and 28% senior) answered online surveys at course completion. Primary outcomes were course ratings, assignment and assessment completion rates, minutes, types of mindfulness practice, changes in trait mindfulness (Mindful Attention Awareness Scale, MAAS), and self-reported wellbeing outcomes. We ran Chi-square goodness of fit tests and paired Wilcoxon signed-rank tests to decide if the outcomes differed significantly post-class. We tested the dose-response relation between mindfulness practice time and trait mindfulness and whether the out-of-class practice time was consistent across the weeks with generalized linear mixed-effect models.

Results

All participants reported finding the course enjoyable and that they would recommend it to their friends. They practiced for an average of 66 (SD = 27) min per week in the class and 112 (SD = 59) min on their own. The most common out-of-class practices were mindful movements, sitting meditation, and breathing. Per self-reports, the course increased student understanding of specific mindfulness practices and appreciation for their body. It improved wellbeing and trait mindfulness (MAAS mean within-person change = 1.2, SD = 0.8, p < 0.00001). We found no does-response relation between practice time and trait mindfulness.

Conclusions

This pilot study supports that incorporating mindfulness practice into college-level courses may promote student wellbeing and such approaches warrant further investigation.

Growth mindset and well-being in social interactions: countering individual loneliness

Introduction

Loneliness is a prevalent negative emotion experienced by college students. This study explores the relationship between a growth mindset and loneliness among college students.

Methods

A total of 560 college students completed the Growth Mindset Scale (GMS), UCLA Loneliness Scale (UCLA), Interpersonal Relationships Assessment Scale (IRS), and two measures assessing distinct facets of well-being the Satisfaction with Life Scale (SWLS) and the revised Positive Affect and Negative Affect Scale (PANAS).

Results and discussion

The results found a significant negative correlation between a growth mindset and loneliness. A growth mindset negatively predicted loneliness through the chain-mediated effects of interpersonal distress and well-being. These findings underscore the important role of a growth mindset in influencing loneliness, providing teachers and practitioners a new perspective to understand and intervene college students' psychological challenges.

Effectiveness of physical activity interventions on undergraduate students' mental health: systematic review and meta-analysis

This systematic review and meta-analysis assessed the effectiveness of physical activity interventions on undergraduate students' mental health. Seven databases were searched and a total of 59 studies were included. Studies with a comparable control group were meta-analysed, and remaining studies were narratively synthesized. The included studies scored very low GRADE and had a high risk of bias. Meta-analyses indicated physical activity interventions are effective in reducing symptoms of anxiety (n = 20, standardized mean difference (SMD) = -0.88, 95% CI [-1.23, -0.52]), depression (n = 14, SMD = -0.73, 95% CI [-1.00, -0.47]) and stress (n = 10, SMD = -0.61, 95% CI [-0.94, -0.28]); however, there was considerable heterogeneity (anxiety, I2 = 90.29%; depression I2 = 49.66%; stress I2 = 86.97%). The narrative synthesis had mixed findings. Only five studies reported being informed by a behavioural change theory and only 30 reported intervention fidelity. Our review provides evidence supporting the potential of physical activity interventions in enhancing the mental health of undergraduate students. More robust intervention design and implementation are required to better understand the effectiveness of PA interventions on mental health outcomes.

Association between loneliness and cigarette smoking attitudes among university students in Iran: a cross-sectional study

OBJECTIVES

During the last two decades, cigarette smoking witnessed a global increase in use, especially among youth. Loneliness is one of the possible psychosocial determinants of smoking. This study examined the association between loneliness and attitudes towards cigarette smoking among university students of Iran.

DESIGN

Cross-sectional study.

SETTING AND PARTICIPANTS

This study was conducted among 538 university students, who were recruited using the cluster random sampling method. Loneliness and smoking attitudes of the samples were assessed using the revised version of the University of California Los Angeles Loneliness Scale and the Scale of Cigarette Smoking Attitude (CSA). Descriptive statistics, Pearson's correlation coefficient and multivariable regression analysis were used to analyse the data.

RESULTS

From a total of 538 participants, 301 (59.9%) students were young women. The mean age of the students was 22.2±2.9 years. Only 56 (10.4%) of the students were married and 370 (87.9%) of them were lived with their families. 131 (24.3%) students experienced cigarette smoking. In terms of university-related characteristics, 205 (38.1%) of the students studied in the faculty of medicine. Also, 30% of the students had a positive or indifferent attitude towards smoking, while 26.4% of the students reported feeling lonely. The mean scores for loneliness and CSA were 41.42±11.29 and 48.64±11.2, respectively. Statistically, a significant positive correlation was found between loneliness and CSA (r=0.289; p<0.001). After controlling for potential confounders by regression analysis, loneliness scores were also positively associated with CSA scores (B: 0.14; 95% CI 0.097 to 0.18).

CONCLUSIONS

According to the positive association between loneliness and students' CSA, paying more attention to the state of loneliness in college students, examining situations and reasons that increase it and identifying the interventions that might reduce it are necessary. Reducing loneliness among college students can correct their attitudes towards smoking.

Analysis of initial sandplay characteristics among university students with different levels of loneliness

BACKGROUND AND OBJECTIVE

Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. The mental health of college students is a hot topic at present. Despite numerous studies exploring interventions for loneliness among university students. However, little research has explored early psychological manifestations of university students with different levels of loneliness. Despite numerous studies exploring interventions for loneliness among university students, little research has explored early psychological manifestations of university students with different levels of loneliness. Initial sandplay is a good tool to reveal psychological activity. Therefore, our study aims to explore the characteristics of initial sandplay application among university students with different levels of loneliness.

METHODS

We recruited 60 volunteers from a university to perform a sandplay experiment from January to April 2021. The UCLA Loneliness Scale measured the levels of loneliness. These 60 participants were divided into the experimental group (n = 30) and control group (n = 30) according to their levels of loneliness. The experimental group included participants with a scale score of more than 44. Other participants with a scale score of less than 44 belong to the control group. We recorded their sandplay artwork and statistically analyzed it by the Sandplay Process Record Form. Group comparisons were performed using the t-test or Wilcoxon rank-sum test for continuous variables, and the chi-square test or Fisher's exact test for categorical variables. The logistic regression analysis by forward stepwise method was conducted to analyze the sandplay theme features for loneliness.

RESULTS

Regarding the sandplay tools, the experimental group used fewer transportation tools (t=-3.608, p < 0.01) and more natural elements (t = 2.176, p < 0.05) than the control group. Moreover, the experimental group created more natural scenes (χ2 = 4.310, p < 0.05) and used less of the lower left (χ2 = 4.593, p < 0.05) and lower right (χ2 = 5.934, p < 0.05) spaces. With regards to sand changes, the experimental group was less likely than the control group to make substantial changes (χ2 = 5.711, p < 0.05) and more likely to make almost no changes (χ2 = 4.022, p < 0.05). In terms of the themes, the experimental group was more likely to exhibit sandplay artwork themes of emptiness (χ2 = 8.864, p < 0.05) and neglect (χ2 = 6.667, p < 0.05), and less likely to show themes of energy (χ2 = 5.079, p < 0.05). In the logistic regression analysis of the sandplay themes, emptiness (OR = 5.714, 95%CI: 1.724-18.944, p = 0.003) and neglect (OR = 7.000, 95%CI: 1.381-35.479, p = 0.010) were demonstrated a nominal association with high levels of loneliness among both groups (F = 16.091, p < 0.01, ΔR2 = 0.193), but failed to pass the Bonferroni testing correction (p threshold < 0.0025).

CONCLUSION

University students with higher degree of loneliness do not like to drastic changes and prefer to use natural elements in element selection, while the control group likes to drastic changes and prefers to use transportation tools in element selection. Regression analysis of sandplay theme features revealed emptines and neglect may as significant associated factors for loneliness. We propose sandplay characteristics can help identify university students with different levels of loneliness during psychological evaluations. Therefore, it is important that the school and healthcare systems assist college students in identifying the loneliness through initial sandplay and carrying on the necessary psychological counseling to the lonely student population.

Prevalence and factors associated with smartphone addiction among nursing postgraduates during the COVID-19 pandemic: a multilevel study from China's mainland

BACKGROUND

Smartphone addiction is prevalent among college students, and there is a concern that the COVID-19 pandemic may bring an increased prevalence of smartphone addiction due to constant online classes and repeat quarantine policies. This study aims to assess the prevalence and influencing factors of smartphone addiction among Chinese nursing postgraduates during the pandemic by examining variables, including loneliness, perceived stress, resilience, and sense of security.

METHODS

This online cross-sectional survey recruited 224 nursing postgraduates in four cities in 2022, using Smartphone Addiction Scale for College Students, the Chinese version of Perceived Stress Scale, UCLA Loneliness Scale Version 3, Chinese version of the 10-item Connor-Davidson Resilience Scale, and the Security Questionnaire. Hierarchical regression analysis and logistic regression analysis were performed to explore the associated factors and predictors of smartphone addiction.

RESULTS

During the COVID-19 pandemic, the prevalence of smartphone addiction was 10.41%. There was a positive correlation between smartphone addiction and loneliness, perceived stress (P < 0.001), and a negative relationship with resilience and sense of security (P < 0.001). The logistic regression analysis identified five risk factors that contribute to smartphone addiction, including daily duration of using a smartphone (3-5 h) (OR = 11.085, 95%CI = 1.21-101.79), numbers of smartphone (OR = 3.704, 95%CI = 1.33-10.30), perceived stress (OR = 1.163, 95%CI = 1.06-1.28), loneliness (OR = 1.071, 95%CI = 1.01-1.13), age of using a smartphone first time (OR = 0.754, 95%CI = 0.60-0.95). Two protective factors, resilience (OR = 1.098, 95%CI = 1.01-1.20) and sense of security (OR = 0.950, 95%CI = 0.90-1.00), were identified.

CONCLUSIONS

Collectively, our study found that during the COVID-19 pandemic, smartphone addiction was prevalent among nursing postgraduates, and loneliness and perceived stress are important risk factors for smartphone addiction. Therefore, administrators should adopt targeted interventions to reduce smartphone addiction and the negative impacts on the psychological well-being of nursing postgraduates during a sudden outbreak of a national epidemic crisis.

Mental Health, Loneliness, and Social Support Among Undergraduate Students: A Multinational Study in Asia

In this study, we aimed to investigate the prevalence of poor mental health and its association with loneliness and social support among 3531 undergraduate students in nine Asian countries. Mental health was assessed using the Self-Reporting Questionnaire, which was developed by the World Health Organization. Across the entire sample, we detected that nearly half of the students reported poor mental health according to the Self-Reporting Questionnaire and nearly one out of seven students felt lonely. While feeling lonely increased the odds of experiencing poor mental health (odds ratio [OR]), moderate (OR: 0.35) and strong social support (OR: 0.18) decreases the odds of experiencing poor mental health. The high prevalence of poor mental health calls for further in-depth investigations and implementation of mental health support interventions.

The Association of Depression, Loneliness, and Internet Addiction Levels in Male Bachelor of Medicine, Bachelor of Surgery (MBBS) Students With Androgenetic Alopecia Male Pattern Baldness in a Medical College in Kolar, India

Introduction The genetically determined progressive process that causes a gradual conversion of terminal hair into vellus hair is known as androgenetic alopecia (AGA). AGA male pattern baldness is very common among male medical students whose self-image is severely deteriorated by AGA and this affects the quality of their professional career. Hence, the assessment of the association of depression, loneliness, and internet addiction levels of male Bachelor of Medicine, Bachelor of Surgery (MBBS) students with AGA male pattern baldness is essential to improving academic and professional performance. Aims and objectives The aim of this study is to evaluate the effects of AGA male pattern baldness and its severity on depression, loneliness, and internet addiction levels of male medical students in Kolar. Materials and methods This questionnaire-based cross-sectional study was conducted among 100 male MBBS students from Sri Devaraj Urs Medical College in Kolar with AGA male pattern baldness of varying grades. The participants were selected through simple random sampling from July 2022 to November 2022 with their prior informed consent. Students' AGA severity was evaluated clinically using the Norwood-Hamilton Classification. Their levels of depression, loneliness, and internet addiction were assessed using the standardized Beck Depression Inventory (BDI) scale, University of Carolina Los Angeles - Loneliness Scale (UCLA-LS), and Young Internet Addiction Test - Short Form (YIAT-SF), respectively, and one-way analysis of variance (ANOVA) was used to ascertain the statistical significance between the means of BDI, UCLA-LS, and YIAT-SF with the severity of AGA. Chi-square/Fisher Exact test was used to find the significance of study parameters on a categorical scale between two or more groups. Significance was assessed at a 5% level of significance. Results The mean of BDI (17.38, 25.11, 34.62, 41.25, 51.00), UCLA-LS (18.72,27.51,36.69,43.5,49.00), and YIAT-SF (20.51, 31.77, 50.31, 60.25, 72.00) scores in each of the AGA grades from Grade I to Grade V in our study showed that these scores increase along with an increase in the severity of AGA and are statistically significant. The frequency distribution of male medical students with varied degrees of AGA and the level of depression, loneliness, and internet addiction levels assessed by the BDI, UCLA-LS, and YIAT-SF showed a robust and statistically significant association between the severity of AGA and the severity of depression, loneliness, and internet addiction levels. Conclusion The current study showed that there is a statistically significant association of depression, loneliness, and internet addiction levels in male MBBS students with AGA male pattern baldness.