Loneliness in the United States: A 2018 National Panel Survey of Demographic, Structural, Cognitive, and Behavioral Characteristics

Experiences of Loneliness: COVID-19 Versus Incarceration

As the world comes to terms with the realities surrounding COVID-19, media sources have likened quarantine experiences to that of incarceration. Individuals who have experienced incarceration and individuals who have experienced the incarceration of loved ones (LO), have already experienced periods of time apart. We are exploring the experiences of individuals who have some experience with incarceration; whether they were personally incarcerated, or they experienced the incarceration of a LO. Utilizing snowball sampling, a mixed methods survey was circulated on social media. Survey items included demographic information, questions about incarceration, issues related to COVID-19 quarantines, and the UCLA Loneliness Scale. Results follow similar patterns to previous studies. However, this unique population argues that COVID-19 quarantines are not the same as periods of incarceration. Similarly, future research and community agencies need to examine the unique needs of those who have experienced the incarceration of a loved one.

Associations Among Family Caregivers' Perceptions of Loneliness, Choice, and Purpose: a Comparative Analysis Between Non-Hispanic Black Caregivers and Non-Hispanic White Caregivers in a Population-Based Sample

BACKGROUND

Loneliness is a frequent experience among family members engaging in caregiving responsibilities and may vary across racial and ethnic groups. This study aimed to examine (a) the difference in loneliness between non-Hispanic Black and non-Hispanic White caregivers, (b) the associations between loneliness and perceptions of choice and purpose in caregiving, and (c) whether those associations with loneliness differ by caregivers' race.

METHOD

Descriptive statistics and ordinal logistic regression were conducted in a population-based sample of 1000 caregivers (Black caregivers, n = 199; White caregivers, n = 801) from the 2020 Caregiving in the U.S.

STUDY

The survey design was properly addressed. Key variables included loneliness (level of feeling alone about being a caregiver), choice (whether or not reporting a choice in taking on the caregiver responsibility), sense of purpose (level of purpose/meaning in life from caregiving), and race (Black/White). Models adjusted for caregiving characteristics (e.g., hour of caregiving) and sociodemographic characteristics (e.g., age and education).

RESULTS

Black caregivers had lower odds of reporting a higher level vs. a lower level of loneliness than White caregivers (aOR = 0.67, 95%CI = 0.47, 0.96). Reporting having no choice was associated with higher odds of a higher level of loneliness (aOR, 0.77, 95%CI = 0.67, 0.88). Higher sense of purpose scores were associated with lower odds of a higher level of loneliness (aOR = 0.81, 95%CI = 0.71, 0.93). No significant moderation effects of race were found.

CONCLUSION

Black caregivers reported lower loneliness scores than White caregivers. Reporting no choice and lower sense of purpose were associated with higher loneliness in both racial groups.

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study

BACKGROUND

Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform.

METHODS

A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care.

RESULTS

At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04).

CONCLUSIONS

This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

Factors Influencing Social Isolation among Cancer Patients: A Systematic Review

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation.

Online Video-Mediated Compassion Training Program for Mental Health and Well-Being of University Students

College students experiencing psychological distress have significantly greater negative emotions than students who practice compassionate thinking. We have developed Eight Steps to Great Compassion (ESGC), an innovative brief and no-cost online video training program about how to increase compassion among busy and young adult university students. To examine the effectiveness and benefits of the ESGC, a single-group pre-test-post-test quantitative design with undergraduate university students (N = 92; Mage = 20.39) evaluated its effects. The results from the post-test showed that the ESGC had a significant positive impact on increased feelings of compassion towards oneself, compassion for others, and the sense of personal well-being from the pre-test. The analysis of the PERMA-Profiler subscales also reflected a statistically significant increase in overall well-being and health and a decrease in negative emotions and loneliness. From the Post-Survey Lesson Feedback, 88% of the participants reported significant positive changes in themselves and the way that they live due to the program. These findings appear to show important implications for improving healthy minds and reducing negative emotions among university students.

Mitigating the affective and cognitive consequences of social exclusion: an integrative data analysis of seven social disconnection interventions

BACKGROUND

Being socially excluded has detrimental effects, with prolonged exclusion linked to loneliness and social isolation. Social disconnection interventions that do not require direct support actions (e.g., "how can I help?") offer promise in mitigating the affective and cognitive consequences of social exclusion. We examine how various social disconnection interventions involving friends and unknown peers might mitigate social exclusion by buffering (intervening before) and by promoting recovery (intervening after).

METHODS

We present an integrative data analysis (IDA) of five studies (N = 664) that systematically exposed participants to exclusion (vs. inclusion) social dynamics. Using a well-validated paradigm, participants had a virtual interaction with two other people. Unbeknownst to participants, the other people's behavior was programmed to either behave inclusively toward the participant or for one to behave exclusively. Critically, our social disconnection interventions experimentally manipulated whether a friend was present (vs. an unknown peer vs. being alone), the nature of interpersonal engagement (having a face-to-face conversation vs. a reminder of an upcoming interaction vs. mere presence), and the timing of the intervention in relation to the social dynamic (before vs. during vs. after). We then assessed participants' in-the-moment affective and cognitive responses, which included mood, feelings of belonging, sense of control, and social comfort.

RESULTS

Experiencing exclusion (vs. inclusion) led to negative affective and cognitive consequences. However, engaging in a face-to-face conversation with a friend before the exclusion lessened its impact (p < .001). Moreover, a face-to-face conversation with a friend after exclusion, and even a reminder of an upcoming interaction with a friend, sped-up recovery (ps < .001). There was less conclusive evidence that a face-to-face conversation with an unknown peer, or that the mere presence of a friend or unknown peer, conferred protective benefits.

CONCLUSIONS

The findings provide support for the effectiveness of social disconnection interventions that involve actual (i.e., face-to-face) or symbolic (i.e., reminders) interactions with friends. These interventions target momentary vulnerabilities that arise from social exclusion by addressing negative affect and cognitions before or after they emerge. As such, they offer a promising approach to primary prevention prior to the onset of loneliness and social isolation.

Loneliness predicts decreased physical activity in widowed but not married or unmarried individuals

Background

Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month).

Methods

We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size.

Results

Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely (p = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals.

Discussion

Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging.

Social anxiety and loneliness among older adults: a moderated mediation model

BACKGROUND

Few studies have clarified the mechanisms linking social anxiety and loneliness in older populations. The study aimed to explore how social network mediate the relationship between social anxiety and loneliness in older adults, with perceived social support playing a moderating role.

METHODS

A total of 454 older patients completed the Social Avoidance and Distress Scale, Lubben Social Network Scale-6, Chinese version of the Short Loneliness Scale and Perceived Social Support Scale. Bootstrap and simple slope methods were used to test the moderated mediation model.

RESULTS

Social anxiety had a significant positive predictive effect on loneliness and social network partially mediated this relationship. The relationship between social anxiety and social network, as well as the relationship between social network and loneliness, was moderated by perceived social support. Specifically, perceived social support buffered the effects of social anxiety on social network, but the buffering effect diminished with increasing levels of social anxiety. On the social network and loneliness pathway, the social network of older persons with higher perceived social support has a stronger prediction of loneliness.

CONCLUSIONS

The study found that social anxiety can contribute to loneliness by narrowing older adults' social network. High perceived social support can buffer this process, but do not overstate its protective effects. Thus, interventions to reduce social anxiety and improve social network and social support may help prevent and alleviate loneliness in older adults.

Loneliness and firearm acquisition among low-income U.S. veterans: Findings from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study

RATIONALE

There are theoretical reasons to expect loneliness related to firearm purchasing. For instance, loneliness might amplify social isolation and feelings of insecurity, anxiety, perceived danger, and need for self-reliance. Purchasing a firearm might be seen as a way to bolster one's security and gain a sense of control when faced with potential threats, yet there is a lack of research assessing this possibility.

OBJECTIVE

This study aimed to examine the relationship between loneliness and purchasing a firearm among a sample of low-income U.S. military veterans.

METHODS

Data are from a national survey of 1,004 low-income U.S. veterans collected in December 2022 and January 2023. Firth logistic regression-a rare event logistic regression model to address small-sample bias stemming from rare outcomes through a penalized likelihood approach-was used to estimate the adjusted association between loneliness and purchasing a firearm in the past year.

RESULTS

Approximately 5.4% reported the purchase of a new firearm in the past year, and respondents reported an average loneliness score of 1.82 (standard deviation = 1.96; range = 0-6). Results of Firth Logit regression analyses found that net of control variables for demographic, socioeconomic, and household characteristics, loneliness was positively associated with purchasing a firearm in the past year (OR = 1.167, 95% CI = 1.006, 1.352).

CONCLUSION

The findings indicate that loneliness among U.S. military veterans is associated with firearm purchasing. Considering the risks posed by both loneliness and firearm ownership for veteran suicide, the findings suggest the need for greater focus and synergistic strategies to address loneliness and safe firearm practices among U.S. veterans.

The clustering of lifestyle behaviors in U.S. college students: a network approach

Objective: College student mental health has been decreasing and lifestyle factors may be an important factor in improving mental health. These behaviors may cluster together in complex ways, which could impact the success of lifestyle interventions. Participants: Two samples of U.S. undergraduate college students were drawn from the American College Health Association's National College Health Assessment (NCHA). The data were collected in Fall of 2019 (N = 30,075) and Spring of 2021 (N = 70,059). Methods: Students responded to various health and well-being related questions. Network models were used to examine how lifestyle behaviors cluster together and additional models contained both lifestyle behaviors and health and well-being outcomes. Results: Lifestyle clustering was found, and some similar patterns were seen across time periods and across levels of psychological distress. Conclusions: Individual lifestyle behaviors exist within a complex lifestyle network, which may need to be accounted for in lifestyle interventions.

Negotiating Experiences of Belonging Alongside Age-Related Life Transitions

Belonging is a pervasive human need that is vital to our well-being as we age. Ageist attitudes, stereotyping, and life transitions tend to jeopardise older adults' experiences of belonging. Although community involvement can lead to the development of social relationships that support belonging in older adulthood, little is known about how belonging is perceived and experienced by older adults. The purpose of this article is to share findings from research conducted with members of a community centre for people 50 years of age and older who shared their perceptions and experiences of belonging. Findings highlight the ways that age-related life transitions affect experiences of belonging. Findings also reveal that features of a belonging experience include feeling worthwhile, being welcomed and accepted, having opportunities for connection, and seeking to belong. We draw from these findings to suggest ways to enhance belonging for older adults.

Prevalence and Associated Factors of Depression among Adults Suffering from Migraine in Spain

Considering the significance of migraine and the limited amount of research conducted on its association with depression in population-based studies in Spain, this study aimed to determine the prevalence and change of depression from 2017 to 2020 among adults with migraine in Spain and to analyze the sociodemographic and health-related variables linked to depression in migraine sufferers. A cross-sectional study on 5329 adults with migraine from the Spanish National Health Survey 2017 and the European Health Survey in Spain 2020 was performed. Binary logistic regression was used to examine the factors related to depression. A total of 26.32% of people with migraine suffered from depression. No significant changes in that prevalence between 2017 and 2020 were observed. The risk factors associated with depression included being between the ages of 25 and 44 (p = 0.018), being separated or divorced (p = 0.033), being unemployed (p < 0.001), not engaging in recreational physical activity (p = 0.016), perceiving one's health as average, poor, or very poor (p < 0.001), experiencing moderate to severe pain in daily activities (p = 0.011, p = 0.004, p < 0.001, respectively), and having 1-2 or ≥3 chronic conditions (p = 0.003, p < 0.001, respectively). Conversely, being married (p = 0.001) and alcohol consumption (p = 0.007) were identified as protective factors.

Feasibility of recruiting adolescents into a prospective cohort study of the effects of social isolation during COVID-19

BACKGROUND

Social connection and loneliness in adolescence are increasingly understood as critical influences on adult mental and physical health. The unique impact of the social isolation imposed by the COVID-19 lockdown on emerging adults is therefore expected to be especially profound. We sought to investigate the feasibility of using ecological momentary assessment (EMA) and wearable accelerometers to characterize the effects of social isolation and/or loneliness experienced by adolescents during the COVID-19 pandemic.

METHODS

We recruited 19 participants aged 13-18 from an Adolescent Medicine practice in Atlanta, GA. Participants completed surveys at baseline and throughout a 2-week study period using EMA regarding their degree of social isolation, loneliness, family functioning, school climate, social media use, and COVID-19 experiences surrounding their physical, mental, and social domains. Six participants agreed to wear an activity tracker and heart rate measurement device for 14 days to monitor their emotional state and physical health. Participant feedback was collected via open-ended exit interviews. Feasibility of recruitment/retention, adherence, and outcome measures were investigated. Implementation was also assessed by evaluating the barriers and facilitators to study delivery. Associations between the social isolation and loneliness variables and all other variables were performed with univariate linear regression analysis with significance set at p < 0.05. The progression criteria were a recruitment rate of > 30% and a retention rate of > 80%.

RESULTS

Progression criteria were met for recruitment (76%) of participants, but not retention (38%). Adherence to EMA survey completion was highly variable with only 54% completing ≥ 1 survey a day, and accelerometry use was not feasible. Social isolation was significantly correlated with lower school climate, higher COVID-19 experiences, higher depression scores, and lower sleep quality. Loneliness also showed a significant correlation with all these factors except COVID-19 experiences.

CONCLUSIONS

EMA and wearable accelerometer use was not feasible in this longitudinal study of adolescents during the COVID-19 pandemic. Future research should further investigate barriers to conducting long-term research with adolescents and the potential effects of the pandemic on subject recruitment and retention.

Longitudinal Impact of the Pandemic on Social Disruption and Loneliness in Autistic and Non-Autistic Youth

OBJECTIVE

The coronavirus pandemic drastically increased social isolation. Autistic youth already experience elevated social isolation and loneliness, making them highly vulnerable to the impact of the pandemic. We examined trajectories of social disruption and loneliness in autistic and non-autistic youth during a six-month period of the pandemic (June 2020 until November 2020).

METHOD

Participants were 76 youth, ages 8 through 17, (Mage = 12.82, Nautistic = 51) with an IQ ≥ 70. Youth completed a biweekly measure of loneliness (Revised UCLA Loneliness Scale) and their parent completed a measure of pandemic-related family social disruption (Epidemic Pandemic Impacts Inventory).

RESULTS

There were no time trends in loneliness across all youth, however, social disruption displayed linear, quadratic, and cubic trends. Non-autistic youth reported relatively greater declines in social disruption compared to autistic youth. Additionally, autistic youth reported relatively greater declines in loneliness relative to non-autistic youth. Greater social disruption was associated with higher loneliness, however, autistic youth demonstrated a relatively stronger relationship between social disruption and loneliness compared to non-autistic youth.

CONCLUSIONS

The current study was one of the first to investigate social disruption and loneliness in autistic youth during the COVID-19 pandemic. Results indicated that autistic youth experienced relative decreases in loneliness during this time, perhaps due to reductions in social demands. Nonetheless, when autistic youth did experience social disruption, they reported relatively higher levels of loneliness. This work contributes to our understanding of risk factors for loneliness and highlights the need to understand the benefits, as well as the challenges, to remote schooling and social interactions.

Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis

BACKGROUND

Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated.

OBJECTIVE

We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness.

METHODS

Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention.

RESULTS

In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use.

CONCLUSIONS

Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources.

Social Media Use Early in the Pandemic Predicted Later Social Well-Being and Mental Health in a National Online Sample of Adults in the United States

Social media use increased early in the Covid-19 pandemic, but little information is available about its impact. The present study examined associations of frequency of use of different social media and the motives for use with subsequent social well-being and mental health. Data were gathered on a nationwide sample of 843 Americans during the first wave of lockdowns and infections in mid-April 2020, and again five weeks later. Participants were adults ages 20 to 88 years old (M = 39.3 years old) recruited from Amazon Mechanical Turk (MTurk). Controlling for age and gender, greater frequency of Facebook and video chat app use predicted higher levels social support but also higher levels of cumulative Covid-19-related stress appraisals and posttraumatic stress symptoms. Greater use of video chat apps also predicted less loneliness. Greater use of both Instagram and Snapchat predicted more anxiety and cumulative Covid-19-related stress appraisals. Greater use of Instagram also predicted higher levels of posttraumatic stress symptoms. Motives for use (e.g., connect with others, waste time/avoid responsibility, online video gaming with others) also differentially predicted social well-being and mental health. Results indicate that greater social media use early in the pandemic was often associated with more distress and lower levels of social well-being but, effects varied depending on types, frequency, and motivations for use. Overall, the study revealed that social media use related to social well-being and mental health in complex ways.

Neuroanatomical and neurochemical effects of prolonged social isolation in adult mice

Introduction

As social animals, our health depends in part on interactions with other human beings. Yet millions suffer from chronic social isolation, including those in nursing/assisted living facilities, people experiencing chronic loneliness as well as those in enforced isolation within our criminal justice system. While many historical studies have examined the effects of early isolation on the brain, few have examined its effects when this condition begins in adulthood. Here, we developed a model of adult isolation using mice (C57BL/6J) born and raised in an enriched environment.

Methods

From birth until 4 months of age C57BL/6J mice were raised in an enriched environment and then maintained in that environment or moved to social isolation for 1 or 3 months. We then examined neuronal structure and catecholamine and brain derived neurotrophic factor (BDNF) levels from different regions of the brain, comparing animals from social isolation to enriched environment controls.

Results

We found significant changes in neuronal volume, dendritic length, neuronal complexity, and spine density that were dependent on brain region, sex, and duration of the isolation. Isolation also altered dopamine in the striatum and serotonin levels in the forebrain in a sex-dependent manner, and also reduced levels of BDNF in the motor cortex and hippocampus of male but not female mice.

Conclusion

These studies show that isolation that begins in adulthood imparts a significant change on the homeostasis of brain structure and chemistry.

Cumulative Pandemic Stressors, Psychosocial Resources, and Psychological Distress: Toward a More Comprehensive Test of a Pandemic Stress Process

Although the mental health consequences of individual COVID-19 stressors (e.g., bereavement, job loss, or financial strain) have been well-documented, little is known about the cumulative toll of multiple pandemic stressors. Using national data from the Crime, Health, and Politics Survey (May–June 2021), we test whether the accumulation of pandemic stressors is associated with greater psychological distress. We also consider whether this association is moderated by psychosocial resources (i.e., mastery, self-esteem, and social support). Our findings suggest that individuals who report three or more pandemic stressors tend to exhibit greater psychological distress than those who report fewer pandemic stressors or no pandemic stressors. While mastery offsets the impact of pandemic stressors at higher levels of stress exposure (i.e., two or more COVID-19 stressors), social support and self-esteem played a stress-buffering role to a point, but became ineffective at the highest levels of pandemic stress. The current study provides new insights into the pandemic stress process by conceptualizing and operationalizing the cumulative impact of COVID-19 stressors. We also confirm the continued significance of traditional coping resources in the context of novel pandemic stressors.

Psychological, Socio-Demographic, and Logistical Factors Associated With Changes in Sex Life After Over a Year Into the COVID-19 Pandemic

This study examined changes in sex life about a year into the COVID-19 pandemic for both partnered and non-partnered individuals and identified the determinants of these changes. The results of an online survey (N = 675) reflect a significant decrease in the frequency of intimate and sexual behaviors and declines in sexual desire, quality, intimacy, diversity, and satisfaction. This study also showed that socio-demographic characteristics, psychological factors, and the logistical impacts of the pandemic explain trends in people's sex lives during the pandemic. This study contributes to understanding the long(er)-term nature, scope, and determinants of changes in sex life during the pandemic.

Online acceptance and commitment therapy as treatment for loneliness among older adults: Report of a pilot study

BACKGROUND

Loneliness has been linked to cognitive decline, cardiovascular risk, and risk of mortality among older adults. Creative approaches are needed to increase access for older adults to evidence-based intervention programs. One possible approach is acceptance and commitment therapy (ACT). The aim of this study was to pilot test a novel ACT-based online intervention to decrease loneliness in older adults living in the community.

METHODS

A self-paced online ACT program consisting of eight interactive modules designed to teach participants skills to address common contributors to loneliness was evaluated. It was delivered to a sample of 529 men and women, aged 65 or over, who were assessed pre-intervention, postintervention, and at a one-month follow-up, with a short 10-item version of the UCLA Loneliness Scale.

RESULTS

For participants who completed all eight modules of the intervention, average levels of loneliness significantly decreased from pre- to posttreatment, b = -0.013, t (385) = -4.69, p < 0.001 (Cohen's d = 0.30). The improvement in loneliness was maintained at the one-month follow-up assessment. These improvements were particularly robust for individuals who were lonely at outset (Cohen's d = 0.73). The change in loneliness among these individuals was significantly greater than that observed in members of a "hold-out" group of lonely individuals that did not participate in the intervention (Cohen's d = 0.24).

CONCLUSIONS

This pilot investigation suggests the feasibility of this program for decreasing loneliness in older adults. Future controlled investigations with long-term follow-up assessments are needed to confirm the effectiveness and sustained benefits of the program.

An exploration of factors related to service utilization in emerging adults: Loneliness and psychosocial supports

Objective: To examine the relationships between loneliness and psychosocial supports, emerging adult service utilization, and barriers to utilization. Participants: 18 to 29-year-old students enrolled in a large Midwestern University (n = 292). Methods: Online surveys were administered to all participants involving information on loneliness, social supports, basic need satisfactions, community/university service utilization, and barriers to service use. Logistic and linear regressions, analysis of variance were conducted. Results: Emerging adults were found to have a greater likelihood of service utilization when higher in social support from friends and less likely to utilize services when high in relatedness and competence need satisfaction, specifically in regard to community services. Group differences in greater barriers to service utilization were found among the highest levels of loneliness and the lowest levels of need satisfaction. Conclusion: Overall, this study indicates psychosocial supports and loneliness are related to service utilization in a nuanced manner.

The Impact of Household Context on Self-Perceived Changes in Solo and Partnered Sexual Behaviors During the COVID-19 Pandemic: Findings from a U.S. Probability Survey

To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18-94 years; 62% response rate) from April 10-20, 2020. We used weighted descriptive statistics with Wilcoxon rank sign tests to understand the population prevalence and significance of self-reported changes (five-point scale: much less to much more) in 10 solo and partnered sexual behaviors. Ordinal regression was used to assess the impact of household predictor variables-including number of children at home, number of adults in home, partnership status (unpartnered, partnered and not living together, partnered and living together) and employment status (not working, employed not as essential worker, employed as essential worker). All models were adjusted for gender, age, sexual orientation, race/ethnicity, and residence location (urban, suburban, rural).All solo and partnered sexual behaviors showed some amount of significant change-increased activity for some and decreased for others-for U.S. adults during the pandemic. Not living with a partner was broadly associated with decreased affectionate partnered sexual behaviors; unpartnered adults reported increased sexting. Individuals not employed reported increased oral sex and increased consumption of sexually explicit materials as compared to non-essential workers. Number of children at home and household size were not significantly linked to self-reported behavior change. Ongoing sexual health-focused research should continue to focus on understanding how adults manage opportunities and constraints to their sexual lives in the context of a still-going pandemic. While many aspects of social life look more "normal" (e.g., many people have returned to their in-person offices and children are largely back in school), new and more-infectious strains of COVID-19 have proven that the pandemic may still yet impact daily living. Lessons learned from COVID need to include sexual health planning both for any future strains of COVID, as well as for future public health emergencies.

Patient perspectives and use of copayment assistance during the COVID-19 pandemic

BACKGROUND: Copay assistance programs provide financial assistance for patients to access medicines and may be one solution to addressing patient affordability, especially because of additional financial hardships due to the COVID-19 pandemic. These programs have been scrutinized by payers and policymakers, but there is little information on the patient perspective to inform these policy discussions. OBJECTIVE: To understand patients' perspectives and use of copay assistance during the COVID-19 pandemic. METHODS: A nationwide cross-sectional online descriptive patient survey was administered to collect data from adult recent medication users and caregivers. Data on demographics, skipping/stopping medications, current/past/future use of copay assistance, perceptions of copay assistance, and alternative actions taken if copay assistance was unavailable were collected. Descriptive analysis was conducted across the total sample, with subgroup analysis between those using and not using specialty pharmacies conducted on select measures. Analyses were conducted using STATA version 14.2. RESULTS: The final sample consisted of 1,001 adults aged 18 years or older. Twenty-eight percent of respondents reported currently or previously using copay assistance, with use higher among specialty pharmacy users vs non-specialty pharmacy users (46% vs 15%, P < 0.01). Copay assistance programs were viewed positively by most respondents (> 70%), with the proportion who viewed them "somewhat or more positively" during the COVID-19 pandemic growing significantly more among specialty pharmacy users than among non-specialty pharmacy users (53% vs 24%, P < 0.01). Respondents using copay assistance programs indicated they would take on more debt and cut back in other areas as alternatives to copay assistance, if unavailable. The alternative actions differed by specialty pharmacy use, with specialty pharmacy users reporting being more likely to use savings/retirement funds to help cover the cost (44% vs 22%, P < 0.01) or switch insurance plans (36% vs 22%, P = 0.03). CONCLUSIONS: Patients' positive perceptions of copay assistance programs have grown during the COVID-19 pandemic, and removing access to these programs may result in further debt and/or loss of savings for patients, especially for those using specialty medicines. Future patient-centric research is warranted and should be central to informing future policy discussions on the regulation of copay assistance programs. DISCLOSURES: W Wong and K Jinnett are employees of Genentech, Inc, and have stock in Roche (outside the submitted work). Research reported in this publication was supported by Genentech, Inc. Editorial services were provided by Esther Tazartes, MS, of Global Outcomes Group. These services were funded by Genentech, Inc.

The Twenty Five Most Important Studies in Health Promotion

Which are the studies, special reports and commentaries that have been most influential in shaping the health promotion profession? This editorial poses that question to many of America's most accomplished researchers. Each was asked to name one or two 'must read' studies from other scholars as well as to feature one of their own research projects that has had the greatest reach. This review of seminal studies focuses on community health, patient education and behavior change research and a future editorial will focus on workplace based health promotion research. Readers are challenged to review the four decades of research represented by this list and consider whether trends can be identified with respect to the relative attention researchers are giving to individual, interpersonal, community and societal factors influencing health behavior. How clear is the evidence that the choices we make are determined by the choices we have?

Risk and resilience in couple's adjustment to the COVID-19 pandemic

The COVID-19 pandemic's global scope and resulting social distancing measures have caused unprecedented economic, lifestyle, and social impacts to personal and relationship well-being. While lockdowns have prompted individuals to increase reliance on intimate partners for support, stressful external contexts can also interfere with partners' capacity to request and provide support, resulting in relationship dissatisfaction and even dissolution. Guided by a risk and resilience framework, this study examined the impact of perceived stress, social contextual factors, and dyadic coping on self-reported relationship satisfaction changes during the initial United States COVID-19 lockdown period. Participants were adults in romantic relationships who completed an online survey between April 13 and June 8, 2020. Overall, survey respondents (N = 1106) reported higher perceived stress levels than established population norms, and small but significant decrements in relationship satisfaction. Multivariable models revealed that higher perceived stress levels were associated with lower relationship satisfaction levels. Additionally, dyadic coping was found to moderate the impact of perceived stress on relationship satisfaction (B = .05, 95% CI = .02- .07), suggesting that engaging in dyadic coping buffered individuals from adverse effects of perceived stress on their relationships. Findings emphasize heightened stress experienced by individuals during the pandemic, potential detrimental effects of stress on couple relationships, and suggest dyadic coping may help buffer couples from adverse effects of the pandemic on their relationships. As such, dyadic coping may be an important target for future interventions designed to assist couples during the ongoing pandemic and future pandemics/natural disasters.

Key Elements and Mechanisms of a Peer-Support Intervention to Reduce Loneliness and Isolation among Low-Income Older Adults: A Qualitative Implementation Science Study

This paper describes the evaluation of a longitudinal peer-support program developed to address loneliness and isolation among low-income, urban community-dwelling older adults in San Francisco. Our objective was to determine barriers, challenges, and successful strategies in implementation of the program. In-depth qualitative interviews with clients (n = 15) and peers (n = 6) were conducted and analyzed thematically by program component. We identified barriers and challenges to engagement and outlined strategies used to identify clients, match them with peers, and provide support to both peers and clients. We found that peers played a flexible, non-clinical role and were perceived as friends. Connections to community resources helped when clients needed additional support. We also documented creative strategies used to maintain inter-personal connections during the COVID-19 pandemic. This study fills a gap in understanding how a peer-support program can be designed to address loneliness and social isolation, particularly in low-income, urban settings.

Assessing the Effectiveness of Intergenerational Virtual Service-Learning Intervention on Loneliness and Ageism: A Pre-Post Study

BACKGROUND

Service-learning is an effective intervention to solve social issues. The purpose of this study is to assess the effectiveness of intergenerational virtual service-learning on loneliness and ageism.

METHOD

This study used a pre-post design. A group of undergraduate students were randomly assigned to a "service-learning" project (n = 18). They were paired with seniors (n = 22) to have at least a 30-min weekly virtual interaction for six weeks. The following scales were used: the Aging Semantic Differential (ASD) Scale, the UCLA Loneliness Scale, a one-item researcher generated Likert-rating of loneliness, and two-item researcher generated Likert-rating of student competence.

RESULTS

Among college students, the service-learning group showed lower ASD and ageism scores at the post-test compared to the non-service-learning group, t (1, 40) = -2.027, p = 0.049; t (1, 40) = -2.102, p = 0.042, respectively. Among seniors, loneliness scores on the UCLA Scale and the one-item scale of loneliness dropped significantly from pre- to post-interactions with students, t (1, 19) = 2.301, p = 0.033, and t (1, 22) = 2.412, p = 0.009, respectively.

CONCLUSION

Virtual service-learning is an effective way to solve social issues such as loneliness and ageism.

How the home features in young adults' representations of loneliness: The impact of COVID-19

Loneliness is a rapidly growing problem globally and has attracted a great deal of attention in light of the COVID-19 pandemic. Young adults, and in particular, those residing in deprived areas are currently the loneliest group in the United Kingdom. Utilizing a novel-free association technique, young adults' experiences of loneliness were explored both prior to (n = 48) and during (n = 35) the COVID-19 pandemic. Drawing on social representations theory, a thematic analysis revealed that many young adults associated the experience of loneliness with their homes. Therefore, this comparative study aims to investigate how the home features in young adults' representations of loneliness, prior to and during the COVID-19 pandemic using a systematic qualitative methodology. Three salient themes emerged from the data in both periods: 'The Lonely Home,' 'The Socially Connected Home' and 'The Safe, Peaceful, Authentic Home'. 'The Lonely Home' and 'The Socially Connected Home' emerged as a dialogical antimony. Representations of home were similar across the two periods; however, there were some notable differences. In particular, the themes 'The Socially Connected Home' and 'The Safe, Peaceful, Authentic Home' were less frequently mentioned by the during-COVID-19 sample where the 'The Lonely Home' was more frequently mentioned by the during-COVID-19 sample. Overall, discussion of the home was more negatively valenced in the during-COVID-19 sample compared to the pre-COVID-19 sample. This comparative, exploratory study alerts us to the nature of the role that home plays in exacerbating or ameliorating loneliness both prior to and during the COVID-19 pandemic.

Loneliness influences avoidable absenteeism and turnover intention reported by adult workers in the United States

Purpose

Loneliness is known to adversely impact employee health, performance and affective commitment. This study involves a quantitative cross-sectional analysis of online survey data reported by adults employed in the United States (n = 5,927) to explore how loneliness and other related factors may influence avoidable absenteeism and turnover intention.

Design/methodology/approach

Worker loneliness was assessed using the UCLA Loneliness Scale (Version 3). Composite variables were constructed as proxy measures of worker job and personal resources. Structural equation modeling (SEM) was used to examine independent variable effects on dependent outcomes of (a) work days missed in the last month due to stress (stress-related absenteeism) and (b) likelihood to quit within the next year (turnover intention).

Findings

The job resources of social companionship, work-life balance and satisfaction with communication had significant negative relationships to loneliness in the SEM, as did the personal resources of resilience and less perceived alienation. Results further show lonely workers have significantly greater stress-related absenteeism (p = 0.000) and higher turnover intention ratings (p = 0.000) compared to workers who are not lonely. Respondent demographics (age, race and gender) and other occupational characteristics also produced significant outcomes.

Practical implications

Study findings underscore the importance of proactively addressing loneliness among workers and facilitating job and personal resource development as an employee engagement and retention strategy.

Originality/value

Loneliness substantially contributes to worker job withdrawal and has negative implications for organizational effectiveness and costs.

Social Interactivity in Live Video Experiences Reduces Loneliness

Background

Loneliness, especially when chronic, can substantially reduce one's quality of life. However, positive social experiences might help to break cycles of loneliness by promoting more prosocial cognitions and behaviors. Internet-mediated live video communication platforms (eg Zoom and Twitch) may offer an engaging and accessible medium to deliver such social experiences to people at scale. Despite these platforms' widespread use, there is a lack of research into how their socially interactive elements affect users' feelings of loneliness and connection.

Objective

We aimed to experimentally evaluate whether socially interactivity in live video experience improves loneliness-related outcomes.

Materials and Methods

We recruited participants from an online survey recruitment platform and assigned half to participate in a socially interactive live video experience with 6–12 strangers and the other half to a non-interactive control experience that was designed to be identical in every way but not socially interactive. Participants completed several baseline self-report measures of psychosocial wellbeing, participated in the hour-long video experience (an entertaining astronomy lesson), and then completed some baseline measures again. Four weeks later, we followed up with participants to evaluate their change in trait loneliness since baseline. We Pre-registered our hypotheses and analysis plan and provide our data, analysis code, and study materials online.

Results

Two hundred and forty-nine participants completed the initial study and met inclusion criteria, 199 of whom also completed the 4-week follow-up. Consistent with our predictions, we found that directly after the more socially interactive experience, participants' feelings of connectedness increased more (p < 0.001), positive affect increased more (p = 0.002), feelings of loneliness decreased more (p < 0.001), social threat decreased more (p = 0.006), and negative affect decreased more (p = 0.003) than they did after the less interactive experience. However, change in trait loneliness between baseline and 4 weeks later did not differ between conditions (p = 0.953).

Conclusions

Including socially interactive components in live video experiences can improve loneliness-related psychosocial outcomes for a short time. Future work should explore leveraging these benefits toward longer-term prosociality. Future work can also identify if the effects we observed generalize across different populations and kinds of online experiences.

Emotional Justice as an antidote to loneliness: children's books, listening and connection

Loneliness is intimately related to the ongoing epidemics of systemic forms of oppression, including white supremacy, capitalism, heteropatriarchy and settler colonialism. The epidemic of loneliness has only intensified and grown during the isolation engendered by the COVID-19 pandemic. In this article, we aim to think about how children's picturebooks wrestle with explaining loneliness and its antidotes (connection, community) and how these picturebooks are themselves manifestations of ongoing conversations related to Emotional Justice. We conclude by reviewing a number of children's books in order to think about how the picturebook might itself be an artifact that helps to fight feelings of loneliness as well as teaching children and adults alike about the importance of connection.

Efeitos de um programa de exercícios remoto em ambiente domiciliar na capacidade funcional e a percepção da solidão em idosos socialmente isolados durante a covid-19

Resumo Objetivo Determinar os efeitos de um programa de exercício físico remoto realizado em ambiente domiciliar na capacidade funcional e percepção de solidão de idosos socialmente isolados, devido a pandemia da covid-19. Método Vinte e nove (29) idosos foram divididos aleatoriamente em dois grupos: (1) grupo controle (GC) e grupo de exercício em ambiente domiciliar (GEAD). A força muscular dos membros inferiores, a capacidade funcional e a percepção de solidão foram avaliadas no início (pré-teste), 4 semanas e 8 semanas (pós-teste). As avaliações consistiram no teste de sentar e levantar da cadeira (TSL), teste de velocidade de marcha (TVM), Timed Up and Go (TUG) e teste de percepção de solidão (TPS). Resultados O número de repetições durante o TSL foi estatisticamente diferente entre os grupos (GC vs. GEAD, p=0,006 e entre os momentos (Pré vs. 4S vs. 8S, p=0,043.). No teste de TUG, dentro do GC, o momento pré foi estatisticamente menor em relação ao momento de 8 semanas (p<0,021), indicando maior tempo para completar o TUG (pré 12,0±5,9 s vs. 8W 12,7±6,5 s). Essa mesma comparação não foi estatisticamente diferente dentro do GEAD. Não houve diferenças estatísticas no TVM e TPS entre os grupos e entre os momentos. Conclusão O programa de exercício domiciliar melhorou a capacidade funcional após 8 semanas de treinamento, mas a percepção de solidão e o teste de velocidade de marcha não foram afetados pelo programa de exercícios físico remoto em idosos isolados devido à pandemia de covid-19.

Effects of remote home-based exercise program on functional capacity and perceived loneliness in older adults during COVID-19 lockdown

Abstract Objective to determine the effects of a simple home-based exercise program on functional capacity and perceived loneliness of older adults in lockdown due to the COVID-19 pandemic. Method Twenty-nine volunteers were randomly divided into two groups: (1) control group (CG); and (2) home-based exercise group (HBEG). Lower limb muscle strength, functional capacity, and perceived loneliness were assessed at baseline (pre-test), 4 weeks, and 8 weeks (post-test) using the Chair Standing Test (CST), Gait Speed Test (GST), Timed Up and Go test (TUG), and Perceived Loneliness Scale (PLS). Results The number of repetitions on the CST differed statistically between the groups (CG vs. HBEP, p=0.006) and among timepoints (Pre vs. 4W vs. 8W, p=0.043.). In the CG group, TUG test completion time was statistically lower at baseline than at 8 weeks (p=0.021) (pre 12.0±5.9 s vs. 8W 12.7±6.5 s). There was no statistical difference in TUG time in the HBEG. No statistical differences were found on the GST and PSL between groups or among timepoints. Conclusion The home-based exercise program improved general functional capacity after 8 weeks of training, but perceived loneliness and gait speed were unchanged in the older adults experiencing lockdown due to the COVID-19 pandemic.

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

BACKGROUND

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Comparing mortality from covid-19 to mortality due to overdose: A micromort analysis

OBJECTIVE

To compare the mortality risk due to covid-19 with death due to overdose in British Columbia, Canada. The opioid epidemic was declared a public health emergency in 2016.

METHODS

Mortality risk was calculated in micromorts with covid-19 data for January-October 2020, derived from the BC center for Disease Control, and illicit drug toxicity deaths for January 2010-September 2020, derived from the BC Coroners Service. Age-stratified covid-19 incidence and deaths per 100,000 population and age-stratified illicit drug toxicity death rates per 100,000 population were calculated. A micromort is a unit of risk equivalent to a one-in-a-million chance of death.

RESULTS

During the covid-19 pandemic, illicit drug toxicity deaths reached 1.0 micromorts per day, representing an increase of 0.5 micromorts per day relative to 2019 rates. In comparison, covid-19 mortality risk was 0.05 micromorts per day among individuals from the general population living in British Columbia and 21.1 micromorts per day among those infected with covid-19. Covid-related mortality risk was significantly lower among individuals aged <60 years, relative to older adults, whereas drug toxicity-related mortality was highest for individuals aged 30-59 years.

CONCLUSIONS

The mortality associated with covid-19 is apparent and distributed unevenly across subpopulations. The mortality due to overdose has increased during covid-19 and exceeds mortality due to covid-19. Our results instantiate the triple threat caused by covid-19 (i.e., public health crisis, economic crisis and mental health crisis) and quantitatively highlight the externality of increased mortality due to deaths of despair in response to public health efforts to reduce covid-related mortality.

Adapting to Uncertainty: A Mixed-Method Study on the Effects of the COVID-19 Pandemic on Expectant and Postpartum Women and Men

Detrimental biopsychosocial effects of the COVID-19 pandemic on populations have been established worldwide. Despite research indicating that the transition to parenthood is a vulnerable period for maternal and paternal health, an in-depth examination of the specific challenges the pandemic poses for new mothers and fathers is still lacking. Using a mixed-method design, we investigated individual and relational well-being of women and men who were expecting their first child during the first months of the COVID-19 pandemic in Portugal and its associations with contextual, individual, and relational factors. Adults older than 18 (n = 316, 198 women) from early pregnancy to 6-months postpartum completed a cross-sectional online survey assessing sociodemographic, individual (depression, anxiety, perceived stress), and relational (dyadic adjustment, perceived social support) self-report measures. From those, 99 participants (64 women) responded to an open-ended question and reported perceived changes in their couple's relationship due to the pandemic. Men responding during strict lockdown measures reported significantly higher levels of perceived stress relative to those men who were not under lockdown. Overall, women reported higher levels of depression and greater social support than men. Qualitative analyses resulted in two main themes: Individual Changes and Relational Changes. These themes aggregate personal concerns and experiences (e.g., worsening of mental health, uncertainty about the future, lack of freedom) interrelated with relational issues (e.g., increased togetherness, avoidance of physical contact, and increased availability for parenthood during lockdown). The prevalence of negative effects (58.6%) exceeded the described positive effects (28.3%), and 13.1% described both positive and negative effects of the pandemic. Current findings offer grounds for important evidence-based strategies to mitigate the potential adverse effects of the current pandemic on new mothers' and fathers' individual and relational well-being.

Therapist-Guided Internet-Based Treatments for Loneliness: A Randomized Controlled Three-Arm Trial Comparing Cognitive Behavioral Therapy and Interpersonal Psychotherapy

INTRODUCTION

Chronic loneliness has been linked to many adverse outcomes, including mental health problems. Psychological treatment of loneliness can be effective, but the evidence base is limited.

OBJECTIVE

To investigate the efficacy of 2 internet-based interventions based on cognitive behavioral therapy (ICBT) and interpersonal psychotherapy (IIPT) relative to a wait-list control group and each other.

METHODS

A total of 170 participants were recruited and randomized to either 9 weeks of ICBT (n = 68), IIPT (n = 68), or a wait-list condition (n = 34). The primary outcome was loneliness, measured using the UCLA Loneliness Scale before, during, and after treatment. Secondary measures of psychiatric disorders and quality of life were administered before and after treatment. Follow-up was conducted 4 months after the treatment had ended. Primary outcome data were analyzed using growth curve modeling. Secondary outcomes were analyzed using robust regression models. The trial was preregistered (ClinicalTrials.gov ID: NCT03807154).

RESULTS

The ICBT condition had a significantly greater impact on loneliness compared to the wait-list and IIPT conditions. Effect sizes were moderate to large (Cohen d = 0.71) compared to the wait-list and moderate (d = 0.53) compared to IIPT. The IIPT condition did not differ significantly from the wait-list. Both active treatments led to significant increases in quality of life. Only the ICBT group had significantly lower symptoms of depression and generalized anxiety compared to the wait-list group. Treatment gains were maintained but not improved at follow-up.

CONCLUSIONS

ICBT can be an efficacious option for alleviating loneliness. The IIPT intervention was not as effective.

Reaching people with disabilities to learn about their experiences of social connection and loneliness

BACKGROUND

People with disabilities experience higher rates of social isolation and loneliness than people without disabilities, but there is limited information about how these conditions are manifested in people with specific types of disabilities.

OBJECTIVES

Using data collected as part of the second administration of the National Survey on Health and Disability (n = 2,132), our objectives were to determine if disability type and recruitment method added explanatory power to observed levels of social connectedness, after controlling for socio-demographic and environmental indicators.

METHODS

We used hierarchical regression to evaluate how socio-demographic, disability, environmental, and recruitment type explained four outcome variables for different dimensions of social connectedness, including satisfaction with social activity, quantity of social connections, quality of social connections, and loneliness.

RESULTS

Across all models, employment status (not employed), having mental illness/psychiatric disability, lack of transportation for social needs, and recruitment type (MTurk) significantly predicted lower levels of social connectedness.

CONCLUSIONS

The study provides evidence that using alternative methods, such as MTurk, to complement conventional recruitment strategies can improve understanding of social isolation and feelings of loneliness among people with disabilities, particularly those with mental illnesses and/or psychiatric disorders who are less likely to be accessed through group affiliations, but who are at greater risk for experiencing social isolation and feelings of loneliness.

Exploring Latent Profiles of Psychopathology in a Sample of Lonely People Seeking Treatment

Loneliness is a common experience in populations experiencing mental health problems. Associations with symptoms of psychopathology are prevalent, but little is known about the diversity of symptom profiles in people suffering from prolonged and distressing loneliness. The current study sought to investigate the existence of subgroups of loneliness and common forms of psychopathology in a sample of adults (n = 332) seeking treatment for their loneliness. Using latent profile analysis, five profiles were identified and differences in demographic factors were investigated. The profiles differed mainly in the severity of symptoms of depression, worry, and social anxiety, with the largest profile exhibiting minimal-to-mild symptoms (n = 109) across these indicators. The second largest group was characterized primarily by high ratings of social anxiety (n = 90). Overall, three of the five profiles, encompassing roughly half of the sample, scored at a clinical level on mental health symptom measures. Age was inversely related to symptom severity among the profiles, indicating that the older subgroups of the sample exhibited milder symptoms, particularly on social anxiety. The results provide insight into the heterogeneity of the clinical symptoms of people suffering from loneliness and add important knowledge that could help inform how to best intervene to help this population.

Does unemployment lead to greater levels of loneliness? A systematic review

There is evidence that loneliness and unemployment each have a negative impact on public health. Both are experienced across the life course and are of increasing concern in light of the COVID-19 pandemic. This review seeks to examine the strength and direction of the relationship between loneliness and unemployment in working age individuals, and in particular the potential for a self-reinforcing cycle with combined healthcare outcomes. A systematic search was undertaken in Medline, PubMed, PsycINFO, Embase and EconLit from inception to December 2020. PRISMA reporting guidelines were followed throughout this review, study quality was assessed using the Joanna Briggs Institute checklist and results were summarised in a narrative synthesis. English language studies evaluating the relationship between loneliness and unemployment in higher income western countries were included. Thirty-seven studies were identified; 30 cross-sectional and 7 longitudinal. Loneliness was measured by a direct question or loneliness scale while unemployment was self-reported or retrieved from a national register. A positive association between unemployment and increased loneliness was observed across all studies. Thus, across the life-course a clear yet complex relationship exists between unemployment and greater experience of loneliness. The magnitude of this relationship increases with the severity of loneliness and appears to peak at age 30–34 and 50–59. Logistic regression provided the greatest consistency at statistical significance revealing at least a 40% increase in the likelihood of reporting loneliness when unemployed. Recent longitudinal studies identified in this review found higher levels of loneliness following job loss, but also that loneliness was predictive of unemployment suggesting potential bi-directionality in the relationship. This bi-directionality may create a multiplier effect between loneliness and unemployment to form a self-reinforcing relationship and greater health concerns for those most at risk. Thus, review findings suggest the need for cross-sector awareness and intervention to tackle both loneliness and unemployment.

•

Unemployment is related to feeling lonely.

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Stronger association of unemployment with severe experience of loneliness.

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Greatest connection between loneliness and unemployment at age 30–34 and 50-59.

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Potential for a bi-directional relationship between loneliness and unemployment.

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Greater understanding is needed in the face of COVID-19 recovery.

Advancing Human-Animal Interaction to Counter Social Isolation and Loneliness in the Time of COVID-19: A Model for an Interdisciplinary Public Health Consortium

The mental and physical human costs of social isolation and loneliness-and their possible amelioration through human-animal interaction (HAI)-have both received intense attention since the onset of the COVID-19 pandemic, and its lockdowns, quarantines, and related mitigation measures. Concern about society's "loneliness epidemic", however, predates the pandemic, as does serious inquiry into HAI as a positive intervention. Recognizing the potential of companion animals to make a difference on an important public health issue, the Consortium on Social Isolation and Companion Animals-a novel partnership of the Human Animal Bond Research Institute (HABRI) and Mars Petcare-launched a joint initiative in 2019 to advance HAI research, address barriers to HAI, and support best practices in bringing together animals and people to ease loneliness. Beginning with a first-ever summit of multidisciplinary thought leaders, this collaboration has already yielded actionable insights and research projects. As a novel partnership initiative in the HAI field, it offers a promising model for future cross-disciplinary forward thinking to elevate HAI for the mutual benefit of companion animals and their welfare, as well as vulnerable human populations.

Social Disconnection in Late Life Suicide: An NIMH Workshop on State of the Research in Identifying Mechanisms, Treatment Targets, and Interventions

Both social disconnection and suicide are significant public health concerns among older adults, and social disconnection is associated with greater risk for suicide-related thoughts and behaviors in late life. We present a synthesis of research discussed during a workshop hosted by the National Institute of Mental Health on social disconnection and late-life suicide. Social disconnection is related to suicide risk in late life via a variety of mechanisms, including biological, behavioral, and psychological correlates. Researchers in several scientific fields have begun to establish these connections and identify targets for interventions to reduce risk in late life. While research has demonstrated that social connection is amenable to change, there is little research to date on the most evidence-based interventions to mitigate social disconnection or the related risks. However, there are several promising biological, behavioral, and psychological interventions that may target various mechanisms, as well as social disconnection itself. With a relative paucity of research in this area, these lines of study are ripe for innovative investigation. In order to most effectively advance the field, we must establish more consistent definitions of social connection and disconnection; more accurately measure and assess older adults' social needs; examine the most effective approaches and modalities for assessment and intervention; take into account important contextual factors; and apply a translational, convergent scientific approach.

Factors associated with social isolation and loneliness in community-dwelling older adults during pandemic times: a cross-sectional study

INTRODUCTION

Psychosocial aspects need to be discussed in the context of the Covid-19 pandemic. Currently, no studies have investigated the factors associated with social isolation and loneliness among community-dwelling older adults. Therefore, this study analyzed the association of social isolation and loneliness with socioeconomic, clinical, and health characteristics, and Covid-19-related variables, among community-dwelling older adults during the pandemic.

METHODS

A cross-sectional study was conducted via a telephone survey of community-dwelling older adults aged ≥60 years in Macapa, Amapa, Brazil. A structured form was used to collect data. Descriptive and inferential analyses were performed using Pearson's correlation test and a linear regression model.

RESULTS

Participants comprised 86 community-dwelling older adults with a mean age of 71.78+6.98 years. Among them, 9.3% were diagnosed with Covid-19, of whom 3.5% were hospitalized. Most participants reported no difficulty obtaining food, medicines, or attending routine medical appointments during the pandemic. Furthermore, 23.3% (n=20) were socially isolated, and 20.9% (n=18) reported feelings of loneliness. The mean values for fear, anxiety, and obsession were 19.01±7.25, 1.01±1.90, and 2.84±3.28, respectively. A moderate positive correlation was identified between loneliness and the number of diseases, and a weak positive correlation between loneliness and the number of medications and depressive symptoms and risk for sarcopenia. The linear regression model indicated that higher loneliness scores were associated with a greater number of diseases (β=0.288; p=0.007).

CONCLUSIONS

The findings suggest a probable resilience of the older population to Covid-19, despite the association of loneliness with many diseases in times of a pandemic.

Factors associated with social isolation and loneliness in community-dwelling older adults during pandemic times: a cross-sectional study

INTRODUCTION:

Psychosocial aspects need to be discussed in the context of the Covid-19 pandemic. Currently, no studies have investigated the factors associated with social isolation and loneliness among community-dwelling older adults. Therefore, this study analyzed the association of social isolation and loneliness with socioeconomic, clinical, and health characteristics, and Covid-19-related variables, among community-dwelling older adults during the pandemic.

METHODS:

A cross-sectional study was conducted via a telephone survey of community-dwelling older adults aged ≥60 years in Macapa, Amapa, Brazil. A structured form was used to collect data. Descriptive and inferential analyses were performed using Pearson's correlation test and a linear regression model.

RESULTS:

Participants comprised 86 community-dwelling older adults with a mean age of 71.78+6.98 years. Among them, 9.3% were diagnosed with Covid-19, of whom 3.5% were hospitalized. Most participants reported no difficulty obtaining food, medicines, or attending routine medical appointments during the pandemic. Furthermore, 23.3% (n=20) were socially isolated, and 20.9% (n=18) reported feelings of loneliness. The mean values for fear, anxiety, and obsession were 19.01±7.25, 1.01±1.90, and 2.84±3.28, respectively. A moderate positive correlation was identified between loneliness and the number of diseases, and a weak positive correlation between loneliness and the number of medications and depressive symptoms and risk for sarcopenia. The linear regression model indicated that higher loneliness scores were associated with a greater number of diseases (β=0.288; p=0.007).

CONCLUSIONS:

The findings suggest a probable resilience of the older population to Covid-19, despite the association of loneliness with many diseases in times of a pandemic.

Depression and loneliness during April 2020 COVID-19 restrictions in the United States, and their associations with frequency of social and sexual connections

PURPOSE

To estimate the prevalence of depression and loneliness during the US COVID-19 response, and examine their associations with frequency of social and sexual connections.

METHODS

We conducted an online cross-sectional survey of a nationally representative sample of American adults (n = 1010), aged 18-94, running from April 10-20, 2020. We assessed depressive symptoms (CES-D-10 scale), loneliness (UCLA 3-Item Loneliness scale), and frequency of in-person and remote social connections (4 items, e.g., hugging family member, video chats) and sexual connections (4 items, e.g., partnered sexual activity, dating app use).

RESULTS

One-third of participants (32%) reported depressive symptoms, and loneliness was high [mean (SD): 4.4 (1.7)]. Those with depressive symptoms were more likely to be women, aged 20-29, unmarried, and low-income. Very frequent in-person connections were generally associated with lower depression and loneliness; frequent remote connections were not.

CONCLUSIONS

Depression and loneliness were elevated during the early US COVID-19 response. Those who maintained very frequent in-person, but not remote, social and sexual connections had better mental health outcomes. While COVID-19 social restrictions remain necessary, it will be critical to expand mental health services to serve those most at-risk and identify effective ways of maintaining social and sexual connections from a distance.

Differential Patterns of Social Media Use Associated with Loneliness and Health Outcomes in Selected Socioeconomic Groups

Loneliness has emerged as a chronic and persistent problem for a considerable fraction of the general population in the developed world. Concurrently, use of online social media by the same societies has steadily increased over the past two decades. The present study analyzed a recent large country-wide loneliness survey of 20,096 adults in the US using an unsupervised approach for systematic identification of clusters of respondents in terms of their social media use and representation among different socioeconomic subgroups. We studied the underlying population heterogeneity with a computational pipeline that was developed to gain insights into cluster- or group-specific patterns of loneliness. In particular, distributions of high loneliness were observed in groups of female users of Facebook and YouTube of certain age, race, marital, and socioeconomic status. For instance, among the group of predominantly YouTube users, we noted that non-Hispanic white female respondents of age 25-44 years who have high school or less education level and are single or never married have more significant high loneliness distribution. In fact, their high loneliness scores also seem to be associated with self-reported poorer physical and mental health outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41347-021-00208-4.

Positive and Negative Impacts of the COVID-19 Pandemic on Relationship Satisfaction in Male Couples

Little is known about the impact of the coronavirus pandemic and control measures on gay, bisexual, and other men who have sex with men (GBMSM) couples. The goal of this study was to investigate individual-level relationship satisfaction during the COVID-19 pandemic in a sample of 209 coupled GBMSM in the United States. We analyzed reported happiness and feelings about a relationship's future and assessed the odds of changing relationship happiness and investment associated with pandemic-related life changes (pandemic-related employment change; COVID-19 illness; high-risk of severe illness), using logistic and multinomial logit models. Fifty-five percent of participants (N = 114) reported that their relationship happiness had not changed during the pandemic, but 30% (N = 62) reported increased relationship happiness. 25% (N = 53) reported they had become more invested in their relationship's future during the pandemic, and only one participant reported decreased investment. The odds of increased relationship investment was significantly associated with pandemic-related employment change (adjusted odds ratio (aOR), 95% confidence interval (CI): 2.19 [1.04, 4.61]) and increased sex during the pandemic (aOR: 4.38 [1.55, 12.41]). Those with a pandemic-related employment change also had significantly higher odds of increased relationship happiness than those without a change (aOR: 2.10 [1.01, 4.35]). COVID-19 cases that reported being at higher risk of serious COVID-19 disease had higher odds of decreased relationship happiness than high-risk non-cases (aOR: 6.58 [1.10, 39.39]). Additional research in this area is warranted to minimize the long-term impacts of the pandemic on coupled GBMSM.