A meta-analysis of interventions to reduce loneliness

Mapping vulnerability factors of chronic emotional and social loneliness: A network analysis

BACKGROUND

Chronic loneliness adversely impacts both mental and physical health. As current interventions are only moderately effective, examining vulnerability factors reflected in interpersonal behavior and their relationships with specific chronic loneliness subtypes may provide insights. The present study explored the associations between loneliness vulnerability factors and two subtypes of chronic loneliness: chronic emotional loneliness (a longing for intimate connections) and chronic social loneliness (dissatisfaction with the quantity and quality of one's social network).

METHODS

The sample consisted of 294 university students who had recently started at a new university. Participants completed surveys across three time points, separated by three-month intervals, including questionnaires on emotional and social loneliness, adult attachment styles, interpersonal behavioral styles, and features of emotional disorders. To explore relationships, we used network analysis by estimating a Mixed Graphical Model (MGM), in which chronic emotional loneliness and chronic social loneliness were dichotomized as binary variables (absence versus presence), while vulnerability factors were treated as continuous variables.

RESULTS

The network analysis demonstrated that chronic loneliness subtypes were differentially linked to vulnerability factors. Chronic emotional loneliness was predominantly linked to features of emotional disorders, whereas chronic social loneliness demonstrated a negative conditional association with secure attachment style.

LIMITATIONS

The assessment of chronic loneliness was based on three time points, which does not capture potential fluctuations between assessments.

CONCLUSIONS

These findings highlight the importance of differentiating between chronic loneliness subtypes when examining vulnerability factors. By distinguishing these subtypes, tailored interventions for loneliness can be developed to enhance prevention.

Disruption and Improvisation: Experiences of Loneliness for People With Chronic Illness

Chronic illness can disrupt many aspects of life, including identity, social relationships, and anticipated life trajectories. Despite significant scholarship on chronic illness, we know less about the ways in which chronic illness impacts feelings of loneliness and how people with chronic illness deal with loneliness. Drawing on concepts of biographical disruption and liminality and data from walking and photo-elicitation interviews with 14 people, we aimed to explore how people with chronic illness experience loneliness in their everyday lives. Tracing how past and present illness experiences are implicated in the lived experience of loneliness and the strategies people use to manage loneliness, our findings illustrated that being caught in a liminal state where participants struggled to maintain and adapt to a new normality in life with chronic illness was a central thread woven throughout their experience of loneliness. Although participants drew on their personal agency and adopted strategies to account for, manage, and limit disruptions from chronic illness and loneliness, they found that their strategies were not completely effective or satisfactory. Chronic illness and loneliness continue to be largely considered as an individual's problem, limiting opportunities for people with chronic illness who experience loneliness to seek support and social connection. Our research highlighted that chronic illness and loneliness need to be acknowledged as both a personal and collective problem, with multi-level responses that involve individuals, communities, and society.

The Moderated Mediating Effects of Social Media Identity and Loneliness on the Relationship Between Problematic Internet Use and Mental Health in China: Nationwide Cross-Sectional Questionnaire Study

BACKGROUND

Mental health disorders are a major public health challenge, and problematic internet use (PIU) may play an important role in this issue. However, the underlying mechanisms of PIU and its effects on mental health have not yet been elucidated.

OBJECTIVE

This study examines the mediating effect of loneliness on the relationship between PIU and mental health, as well as the moderating effect of social media identity on the relationships among PIU, loneliness, and mental health.

METHODS

A cross-sectional questionnaire survey was conducted on 21,292 participants recruited using a multistage stratified sampling strategy from 31 provinces/regions in mainland China from June 20 to August 31, 2022. This study assesses PIU (PIU questionnaire-short form-6), depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), loneliness (3-item loneliness scale), and social media identity (identity bubble reinforcement scale). Additionally, we collected the sociodemographic characteristics of the participants. Participants whose total score of PHQ-9≥15 or total score of GAD-7≥10 were considered to have moderate or severe symptoms of depression or anxiety, respectively. A moderated mediation model was established to examine the mediating effect of loneliness on the association between PIU and mental health outcomes (depression and anxiety), moderated by social media identity.

RESULTS

Approximately 22.80% (4854/21,292) and 14.20% (3023/21,292) of the respondents reported moderate or severe symptoms of depression and anxiety, respectively. Loneliness significantly mediated the association between PIU and mental health outcomes, explaining 42.53% and 45.48% of the total effect of PIU on depression and anxiety, respectively. Social media identity significantly moderated the associations between PIU and depression (β=0.002, 95% CI 0.001-0.002), PIU and anxiety (β=0.001, 95% CI 0.000-0.002), loneliness and depression (β=0.010, 95% CI 0.007-0.013), and loneliness and anxiety (β=0.007, 95% CI 0.004-0.010), but not between PIU and loneliness (β=0.000, 95% CI -0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness (β=-0.018, 95% CI -0.020 to -0.016).

CONCLUSIONS

Addressing loneliness may serve as a valuable approach to mitigate the impact of PIU on mental health outcomes. However, social media identity poses a significant challenge in addressing health issues linked to PIU.

Loneliness: A Scoping Review of Reviews From 2001 to 2023

The growing number of primary studies and reviews on loneliness, and the multidisciplinary efforts to comprehend this complex phenomenon from various perspectives, underscore the heightened recognition of its impact on individual and societal well-being and health. To comprehensively assess the size and scope of this research field, we conducted a scoping review of 35 English-language reviews of primary studies on loneliness, published between 2001 and 2023. Focusing specifically on psychological research, these reviews covered a total of N = 1,089 studies, which were conducted between 1986 and 2022. In addition to providing a broad overview of the structure of the field, the present scoping review aimed to explore the methodological landscape of loneliness research, including data collection, sample demographics, and measures, and to present key topics and evidence in the field. By deepening the understanding of loneliness and identifying data gaps and methodological challenges, our analyses provide critical insights for future research endeavors, thereby fostering advances in the field.

Loneliness trajectories and predictors in Spain: Results from the Spanish longitudinal study on aging and health (Edad con Salud)

BACKGROUND

In recent years, loneliness has been recognized as a public health problem, exacerbated by the COVID-19 pandemic. This study aims to identify groups of people with different trajectories of loneliness, and to explore potential determinants (sociodemographic, social, psychological, and health-related) associated with these trajectories.

METHODS

In this 12-year longitudinal study, we analyzed data on 4537 Spanish adults from a nationwide representative survey. A growth mixture modeling approach was used to identify different loneliness trajectories and logistic regressions to explore the determinants of these trajectories.

RESULTS

Two trajectory classes were identified: low-stable (87.86 %) and high-fluctuating (12.14 %). Marital status, living status, migration, social isolation, depression, suicidal ideation, and cognitive complaints were identified as significant determinants of belonging to the high-fluctuating trajectory. Conversely, social support, social trust, and life satisfaction were protective factors for this trajectory.

CONCLUSION

This study revealed the presence of diverse courses of loneliness (each showing some distinctive characteristics from the other), outlining some relevant implications for the assessment, prevention, and management of loneliness.

The role of cultural isolation in the relationship between racial discrimination and substance use

Immigrant young adults from predominantly people of color countries (IYPOC) encounter structural stressors that potentially exacerbate health outcomes such as substance use amidst ongoing societal challenges. The association may be further compounded by cultural isolation and the dual task of identity negotiation. The current study explored cultural isolation as a mediator of the association between racial discrimination and substance use among IYPOC. A cross-sectional online survey was conducted to collect data from IYPOC residing in the United States. The analytic sample was composed of 262 individuals aged 18 to 29, and the largest racial group was Black or African American. The current study performed regressions and PROCESS Macro Model 4 with bootstrapping. Racial discrimination and cultural isolation were statistically significantly associated with substance use. The indirect effect of racial discrimination on substance use through cultural isolation was statistically significant. The results underscore the need for tailored support and interventions that address the complex interplay of racial discrimination, cultural isolation, and health outcomes among IYPOC.

Assessing the Effectiveness of Digital Health Behavior Strategies on Type 2 Diabetes Management: Systematic Review and Network Meta-Analysis

BACKGROUND

Various mobile technologies and digital health interventions (DHIs) have been developed for type 2 diabetes mellitus (T2DM) management. Strategies are crucial for ensuring the effectiveness of DHIs. However, there is currently a lack of categorization and summarization of the strategies used in DHIs for T2DM.

OBJECTIVE

This study aims to (1) identify and categorize the strategies used in DHIs for T2DM management; (2) assess the effectiveness of these DHI strategies; and (3) compare and rank the efficacy of different strategy combinations on glycated hemoglobin A1c (HbA1c) levels, fasting blood glucose (FBG) levels, BMI, and weight loss.

METHODS

Relevant randomized controlled trials (RCTs) were extracted from PubMed, Web of Science, and Scopus databases. Three rounds of screening and selection were conducted. The strategies were identified and categorized based on the principles of behavior change techniques and behavior strategies. The synthesis framework for the assessment of health IT was used to structure the evaluation of the DHI strategies qualitatively. A network meta-analysis was performed to compare the efficacy of different strategy combinations. The data quality was assessed using the Cochrane Risk of Bias tool.

RESULTS

A total of 52 RCTs were included, identifying 63 strategies categorized into 19 strategy themes. The most commonly used strategies were guide, monitor, management, and engagement. Most studies reported positive or mixed outcomes for most indicators based on the synthesis framework for the assessment of health IT. Research involving a medium or high number of strategies was found to be more effective than research involving a low number of strategies. Of 52 RCTs, 27 (52%) were included in the network meta-analysis. The strategy combination of communication, engagement, guide, and management was most effective in reducing HbA1c levels (mean difference [MD] -1.04, 95% CI -1.55 to -0.54), while the strategy combination of guide, management, and monitor was effective in reducing FBG levels (MD -0.96, 95% CI -1.86 to -0.06). The strategy combination of communication, engagement, goal setting, management, and support was most effective for BMI (MD -2.30, 95% CI -3.16 to -1.44) and weight management (MD -6.50, 95% CI -8.82 to -4.18).

CONCLUSIONS

Several DHI strategy combinations were effective in reducing HbA1c levels, FBG levels, BMI, and weight in T2DM management. Health care professionals should be encouraged to apply these promising strategy combinations in DHIs during clinical care. Future research should further explore and optimize the design and implementation of strategies.

TRIAL REGISTRATION

PROSPERO CRD42024544629; https://tinyurl.com/3zp2znxt.

How people think about being alone shapes their experience of loneliness

Loneliness is a widespread issue routinely targeted by the media and public health campaigns. We propose that these efforts, though well-intentioned, may exacerbate this problem by negatively influencing a potential driver of loneliness: people's beliefs about being alone. Supporting this thesis, we show that contemporary U.S. news articles are 10 times more likely to describe being alone as harmful than beneficial (Study 1, N = 144 articles) and that exposure to such articles causally impacts people's beliefs about being alone (Study 2, N = 456). Further, a 2-week experience-sampling study (Study 3, N = 161) demonstrates that people with negative beliefs about being alone experience a steep increase in loneliness after spending time alone in daily life, whereas those with positive beliefs feel less lonely after spending time alone. Finally, multi-national studies demonstrate the generalizability of these results across nine countries spanning six continents (Studies 4 and 5, N = 2930). Together, these findings reveal the critical role of beliefs about being alone in shaping loneliness.

Content Specificity of Interpretation Bias Related to Social and Emotional Loneliness in Emerging Adulthood

According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB. Sample 1 included an unselected university sample (N = 138, 81.9% female, M = 20.8 years, SD = 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels (N = 315, 69.5% female, M = 23.8 years, SD = 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB. The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness. Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

Guidelines for evaluating and reporting social isolation and loneliness interventions

Given the unpleasant nature of social isolation and loneliness (SIL) and their negative effects on health and wellbeing, interventions are needed. However, persistent issues in the design, evaluation, and reporting of SIL interventions preclude conclusive evidence and commentary on the effectiveness of SIL interventions. Here, we propose guidelines for evaluating SIL interventions, firstly by operationalising them into two categories: (1) interventions aiming to reduce SIL as a primary outcome and (2) interventions aiming to improve non-SIL outcomes in the lives of individuals experiencing SIL. Secondly, we evaluate instruments for measuring SIL and research designs for studying intervention effectiveness. Thirdly, guidelines for reporting information about the intervention, study design, results, and discussion in SIL intervention studies are presented. These guidelines will help researchers to better and more consistently report on SIL interventions and improve comparability of SIL interventions, ultimately contributing to the improvement of interventions and to the mitigation of SIL.

Multiple social factors are associated with wellbeing when accounting for shared genetic and environmental confounding

PURPOSE

Social factors are associated with mental health and wellbeing. However, few studies have examined genetic and environmental influences on social factors themselves, limiting current understanding of influences on aspects of the social environment. Most studies which have identified links between social factors and mental health are also limited by the possible influence of unmeasured genetic and environmental confounding. In this study, we investigated the genetic and environmental underpinnings of multiple social factors (relationship satisfaction, loneliness, attachment, trust, relationship disruptions), and their associations with life satisfaction measured concurrently and six years later, after accounting for shared genetic and environmental confounding.

METHODS

Data from a population-based sample of adult twins (N = 1987) and two measurement timepoints were used for the primary analyses. We used multivariate Cholesky models to estimate genetic and environmental influences across five social factors. Subsequently, we conducted co-twin control analyses to examine associations between social factors and wellbeing after controlling for shared genetic and environmental confounding.

RESULTS

Heritability estimates for the social factors ranged from 24 to 42%. Genetic correlations across social factors were substantial, indicative of considerable genetic overlap. Associations between wellbeing and relationship satisfaction, loneliness, anxious and avoidant attachment, trust, and disruptions in relationships in the past year were attenuated in co-twin control analyses but remained statistically significant. Relationship satisfaction, loneliness, and attachment avoidance were also associated with wellbeing measured six years later in estimates which controlled for shared genetic and environmental confounding.

CONCLUSION

Our findings provide evidence that multiple social factors are associated with wellbeing after accounting for potential confounding by shared genetic and/or environmental factors. These findings highlight the importance of multiple aspects of the social environment for wellbeing in older adulthood. Future studies should examine the directionality in associations between social factors and mental health and assess these relationships beyond older adulthood.

The feasibility of using photovoice as a loneliness intervention with older Myanmar migrants

Loneliness has detrimental physical and mental health outcomes. To date, there are few studies on loneliness interventions in lower-resource settings. Based on participatory action research methods that are theoretically informed by the social relationship expectations framework, we developed a loneliness intervention called amanane using the photovoice method with older Myanmar migrants in northern Thailand. The aim of our study was to test the feasibility and preliminary effectiveness of photovoice as an intervention for lonely older adults. Over 6 weeks, we coproduced 5 weekly workshops, individual interviews, and a photo exhibition with an older Myanmar migrant cofacilitator and nine participants (57-82 years old). The workshops focused on older people's care provisions. The qualitative evaluation entailed group discussions, interviews, and videos. Results indicated a perfect completion rate and high acceptability. Participants reported a reduction in loneliness due to opening up to each other through photography, feeling united despite cultural differences, and feeling valued by visitors attending the photo exhibition. Overall, photovoice may be a promising intervention for lonely older adults and has the potential to be tested in larger trials across diverse settings.

"I'd Rather Be Alone." Examining the Interactive Effects of Social Proximity and Social Preference on Suicidal Thinking

INTRODUCTION

Emerging and young adulthood is associated with heightened risk for suicide, with interpersonal factors potentially exerting disproportionate effects during this critical life stage. Research examining the interplay of subjective and objective interpersonal factors for suicide ideation (SI) in daily life is limited.

METHODS

Dynamic structural equation models were used to analyze ecological momentary assessment data (21 days; 7 semi-random daily surveys) in a sample of at-risk young adults (N = 140) to test within-person main and interactive effects of objective social proximity (alone vs. not alone) and subjective social preference (desire to be alone or with others) on SI severity concurrently and prospectively over 2-h intervals in daily life.

RESULTS

Preferring to be alone (while alone or with others) was associated with intraindividual near-term increases in SI severity, whereas preferring to be with others (while alone or with others) was associated with near-term decreases in SI severity.

CONCLUSIONS

Being with others can be either a risk or protective factor for near-term SI severity depending on whether the present company is desired. Considering multiple interpersonal factors combined may be necessary to understand and treat SI as these factors may either buffer or confer greater near-term risk depending on other factors.

Recorded Loneliness and Adverse Outcomes in Older Acute Care Inpatients Receiving Psychiatric Assessment

OBJECTIVES

We investigated the prevalence of loneliness recorded during assessment of general hospital inpatients by older adult liaison psychiatry services and its associations with level of subsequent hospitalisation, emergency presentation and mortality.

METHODS

Data were drawn from a large south London mental healthcare provider of older adult liaison psychiatry services to four acute general hospitals. The sample comprised all patients receiving assessments from these services from 2007-2017. Recorded loneliness was ascertained from text fields via a bespoke natural language processing algorithm and, via a linkage with national hospitalisation data, was investigated as a risk factor for repeat emergency department (ED) attendance, inpatient days in the subsequent 12 months, and mortality.

RESULTS

In 11,631 patients assessed, loneliness was recorded in 11.2%. After adjustment for a range of demographic and health covariates, recorded loneliness was associated with an increased risk of ED attendance, but with lower mortality and, in survivors, with fewer hospitalisation days over a 12-month follow-up.

CONCLUSIONS

Loneliness is recorded in over 10% of inpatients assessed by older adult liaison services and is likely to be present in substantially more. Lack of recording in more severe illness and/or cognitive disorders may explain associations with lower mortality and hospitalisation days. Its association with higher likelihood of repeat ED attendance suggests that loneliness should be considered more routinely in clinical assessments, possibly with formal screening.

Interventions for subjective and objective social isolation among people living with HIV: A scoping review

Subjective and objective social isolation has been a globally significant public health issue for people living with HIV, yet little is known about the characteristics, effectiveness, and acceptability of available interventions. The purpose of this scoping review was to systematically identify and map the available evidence on interventions for subjective and objective social isolation among people living with HIV. We searched PubMed, Cochrane Library, Embase, Scopus, Social Sciences Citation Index, PsycArticles, CINAHL, ProQuest Dissertation & Theses Global, OpenGrey, Google Scholar, international trial registers, and websites for eligible studies from their inception to June 1, 2024. We included any studies that identified subjective or objective social isolation as a primary goal or outcome of an intervention for people living with HIV (≥18 years old). Two researchers independently conducted study selection, data extraction, and data analysis. A 'basic qualitative content analysis' approach was used to analyze the findings of the included studies. Of the 12762 records identified, 19 full-text studies involving 961 participants were included in this scoping review. Overall, we identified seven interventions for subjective and objective social isolation among people living with HIV, as well as their characteristics, including psychological therapy, support group intervention, online support community, peer mentorship, navigation-type intervention, activity intervention, and knowledge/skills development intervention. However, there was limited, mixed evidence on the effectiveness and acceptability of different interventions for subjective and objective social isolation among people living with HIV. More rigorously designed and large-scale randomized control trials are needed to support and enrich existing evidence further.

A randomised feasibility trial comparing group and individual format GROUPS FOR HEALTH interventions for loneliness in people who experience psychosis

OBJECTIVES

Loneliness in people who experience psychosis is common and associated with poor mental health. In this randomised trial, we tested the feasibility and acceptability of an adapted Groups for Health (G4H) intervention for loneliness, delivered in group or individual format.

DESIGN

Mixed methods, two-arm feasibility randomised controlled trial.

METHODS

Forty individuals who self-identified as having psychosis were recruited from UK mental health care services, recovery colleges and charities. G4H was modified for people with psychosis, with participants randomised to receive the intervention delivered via group (N = 20) or individual (N = 20) format. The primary outcomes related to trial acceptability and feasibility. Exploratory repeated measures ANOVAs and t-tests evaluated differences between formats over time in loneliness, wellbeing and possible mechanisms of change including social identification, identity integration and perceived in-group and out-group empathy. Measures were completed at baseline, end of treatment and 1- and 6-month follow-up.

RESULTS

Recruitment, retention and trial acceptability ratings for both group and individual formats of G4H were acceptable to good. No participants reported experiencing a serious adverse event. Exploratory ANOVAs indicated no differences related to format but positive change in key variables of loneliness, wellbeing, social identification and identity integration over time. T-tests for loneliness indicated that this change was step-wise from baseline, through end of treatment to 1-month follow-up.

CONCLUSIONS

G4H is a feasible intervention for people with psychosis who identify as lonely and it can be delivered in either group or individual formats. This feasibility trial provides support for a future full randomised controlled trial.

Examining the relationships between self-stigma, loneliness, depressive symptoms, and suicidal ideation among people with bipolar disorder

People diagnosed with bipolar disorder (BD) commonly experience self-stigma, which negatively affects various health outcomes. The aim of the present study was to elucidate the mechanisms through which self-stigma may contribute to suicidality among bipolar patients by investigating the mediating roles of loneliness and depressive symptoms. A total of 140 patients with BD were cross-sectionally assessed with self-report scales measuring self-stigma, loneliness, depressive symptoms and suicidal ideation, and with a clinician-rated scale evaluating overall psychopathology. Path analysis was used to analyze the data. Self-stigma was directly related to more severe loneliness, depressive symptoms and suicidal thoughts. There were also significant direct effects of loneliness on depressive symptoms and depressive symptoms on suicidal ideation. The direct effect of loneliness on suicidality was non-significant. The following indirect effects on suicidal ideation were found: from self-stigma via depressive symptoms, from loneliness via depressive symptoms and a sequential effect from self-stigma through loneliness and depressive symptoms. Our findings clearly indicate that interventions aiming to reduce the risk of suicide among people with BD should be comprehensive and take into account not only psychiatric symptoms, but also social context and the psychological aspects of living with this diagnosis.

Recommendations to Advance Social Connectedness in End Stage Kidney Disease Care in a Post-COVID-19 Era

Social connectedness, defined as a sense of belonging and inclusion among individuals and groups, is crucial for the well-being of end-stage kidney disease (ESKD) patients. This perspective employs a hypothetical case study to highlight the risks of social isolation and loneliness faced by ESKD patients. It offers guidance on how the ESKD community can effectively address these challenges. Although in-center hemodialysis provides an inherent environment for fostering social connections, the COVID-19 pandemic has intensified the risk of social disconnection. This paper delineates five key recommendations to mitigate this risk: 1) improve detection of loneliness and social isolation; 2) implement evidence-based social support interventions; 3) revitalize the in-center experience; 4) engage family caregivers; and 5) leverage technology for social connectedness. Neglecting opportunities to bolster social connections among ESKD patients would represent a significant interdisciplinary lapse. The proposed recommendations are feasible due to the integral role of interdisciplinary care within dialysis centers.

Wisdom and socio-cognitive mindfulness as predictors of loneliness in late adulthood: the mediating role of meaning in life

OBJECTIVES

This research aimed to examine whether (1) socio-cognitive mindfulness, defined as actively noticing novel distinctions in events and situations, negatively predicted loneliness in older adults and whether (2) meaning in life mediated the relationships between wisdom and loneliness and between socio-cognitive mindfulness and loneliness.

METHOD

Two cross-sectional studies were conducted. In Study 1 (N = 76), participants aged 60 to 85 years completed questionnaires measuring wisdom, loneliness, meaning in life, and self-rated health. In Study 2 (N = 117), care home residents aged 60 to 87 years completed measures of socio-cognitive mindfulness, loneliness, meaning in life, and self-rated health.

RESULTS

Study 1 found a negative relationship between wisdom and loneliness, even after accounting for socio-demographic factors and meaning in life. Study 2 revealed a negative relationship between socio-cognitive mindfulness and loneliness. The relationships of both wisdom and socio-cognitive mindfulness to loneliness were mediated by meaning in life.

CONCLUSION

The two studies indicate that attributes associated with wisdom and socio-cognitive mindfulness, such as perceiving events from multiple perspectives and maintaining a compassionate attitude, contribute to an increase in meaning in life, which in turn reduces loneliness in late adulthood.

"Telephone Angels" Against Loneliness: Experimental Evaluation of the Effectiveness of Telephone Partnerships with Older Adults

Loneliness affects many older adults. As part of the "Telephone Angel" project, telephone partnerships between volunteers and older adults affected by loneliness were designed to counteract experiencing loneliness. Volunteers (100 ≤ N ≤ 114) and older adults who are (22 ≤ N ≤ 45) and who are not (25 ≤ N ≤ 71) part of the project were surveyed twice. Concerning loneliness, telephone partnerships increased the sense of community (d = .38). Older adults' life satisfaction increased (d = .46) as well. Stigmatization increased between the survey periods for those inside and outside the project (.21 ≤ d ≤ .35).

Mapping the Landscape of Digital Health Intervention Strategies: 25-Year Synthesis

BACKGROUND

Digital health interventions have emerged as promising tools to promote health behavior change and improve health outcomes. However, a comprehensive synthesis of strategies contributing to these interventions is lacking.

OBJECTIVE

This study aims to (1) identify and categorize the strategies used in digital health interventions over the past 25 years; (2) explore the differences and changes in these strategies across time periods, countries, populations, delivery methods, and senders; and (3) serve as a valuable reference for future researchers and practitioners to improve the effectiveness of digital health interventions.

METHODS

This study followed a systematic review approach, complemented by close reading and text coding. A comprehensive search for published English academic papers from PubMed, Web of Science, and Scopus was conducted. The search employed a combination of digital health and intervention-related terms, along with database-specific subject headings and filters. The time span covered 25 years, from January 1, 1999, to March 10, 2024. Sample papers were selected based on study design, intervention details, and strategies. The strategies were identified and categorized based on the principles of Behavior Change Techniques and Behavior Strategies.

RESULTS

A total of 885 papers involving 954,847 participants met the eligibility criteria. We identified 173 unique strategies used in digital health interventions, categorized into 19 themes. The 3 most frequently used strategies in the sample papers were "guide" (n=492, 55.6%), "monitor" (n=490, 55.4%), and "communication" (n=392, 44.3%). The number of strategies employed in each paper ranged from 1 to 32. Most interventions targeted clients (n=844, 95.4%) and were carried out in hospitals (n=268, 30.3%). High-income countries demonstrated a substantially higher number and diversity of identified strategies than low- and middle-income countries, and the number of studies targeting the public (n=647, 73.1%) far exceeded those focusing on vulnerable groups (n=238, 26.9%).

CONCLUSIONS

Digital health interventions and strategies have undergone considerable development over the past 25 years. They have evolved from simple approaches to sophisticated, personalized techniques and are trending toward multifaceted interventions, leveraging advanced technologies for real-time monitoring and feedback. Future studies should focus on rigorous evaluations, long-term effectiveness, and tailored approaches for diverse populations, and more attention should be given to vulnerable groups.

A lack of sexual autonomy is associated with increased loneliness in young mothers

BACKGROUND

Loneliness is a significant risk factor for both mental and physical health issues, including depression and increased mortality. Loneliness is reported at higher levels during life transitions, such as the transition to motherhood. Loneliness in mothers has far-reaching detrimental impacts on both mother and child, such as an increased risk of maternal depression and child abuse. Understanding the impact of different risk factors for loneliness, specifically in young mothers, may inform potential interventions for this at-risk group. The aim of this study was to determine whether mothers were lonelier than childfree women, and whether there are different risk factors for loneliness in mothers relative to childfree women, both for gender-associated and established risk factors for loneliness.

METHODS

This cross-sectional study included partnered mothers and partnered childfree women between the ages of 20 and 29 from the 2020 Generations and Gender Survey (GGS) in the Republic of Moldova. The De Jong Gierveld Loneliness Scale was used to assess overall, emotional, and social loneliness. A total of 11 potential risk factors were considered, across gender, well-being, relationships, and household status. Depending on the nature of the variables and their distributions, Wilcoxon rank-sum tests or Spearman correlation coefficients were used to assess loneliness risk factors for partnered mothers and childfree women.

RESULTS

Data from 396 mothers and 113 childfree women in the Republic of Moldova were analysed in this study. There was no significant difference between the mean overall, emotional, or social loneliness scores in partnered mothers and childfree women. A lack of sexual autonomy was a risk factor associated with social loneliness in young mothers, but not in childfree women. This was the only gendered risk factor that differed between populations. Other gendered risk factors were not significant for any types of loneliness in either population. There were differences between mothers and childfree women in several established risk factors for loneliness.

CONCLUSION

Mothers were not lonelier than childfree women in this study, but a lack of sexual autonomy was a risk factor associated with loneliness only in mothers.

Prolonged Grief Symptoms Predict Social and Emotional Loneliness and Depression Symptoms

A minority of bereaved individuals develops severe, persistent, and disabling grief, termed "prolonged grief." The International Classification of Diseases, eleventh edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR) include such grief reactions as prolonged grief disorder (PGD). Loneliness is often experienced by bereaved persons and can have severe health consequences. Preliminary research suggests that loneliness may perpetuate grief, but prolonged grief may also aggravate loneliness. Since existing empirical research provides limited information on temporal relationships between both constructs, we aimed to fill this gap in knowledge. Bereaved adults (88% female, mean age 54 years) filled in questionnaires assessing general, social, and emotional loneliness and prolonged grief and depression symptoms across two time points, 6 months apart. Cross-lagged panel model analyses showed that prolonged grief symptoms predicted more severe general, social, and emotional loneliness, as well as more depression symptoms. Loneliness did not predict prolonged grief symptoms and depression symptoms. Depression symptoms did not predict prolonged grief symptoms and loneliness. Additionally, latent change score analyses demonstrated that within person changes in prolonged grief symptoms and loneliness were related. Findings are inconsistent with the notion that loneliness causes prolonged grief and depression. Possibly, severe grief could lead to stigmatization, reduced social support, and feeling socially disconnected, perpetuating loneliness and depression symptoms.

Extracting social support and social isolation information from clinical psychiatry notes: comparing a rule-based natural language processing system and a large language model

OBJECTIVES

Social support (SS) and social isolation (SI) are social determinants of health (SDOH) associated with psychiatric outcomes. In electronic health records (EHRs), individual-level SS/SI is typically documented in narrative clinical notes rather than as structured coded data. Natural language processing (NLP) algorithms can automate the otherwise labor-intensive process of extraction of such information.

MATERIALS AND METHODS

Psychiatric encounter notes from Mount Sinai Health System (MSHS, n = 300) and Weill Cornell Medicine (WCM, n = 225) were annotated to create a gold-standard corpus. A rule-based system (RBS) involving lexicons and a large language model (LLM) using FLAN-T5-XL were developed to identify mentions of SS and SI and their subcategories (eg, social network, instrumental support, and loneliness).

RESULTS

For extracting SS/SI, the RBS obtained higher macroaveraged F1-scores than the LLM at both MSHS (0.89 versus 0.65) and WCM (0.85 versus 0.82). For extracting the subcategories, the RBS also outperformed the LLM at both MSHS (0.90 versus 0.62) and WCM (0.82 versus 0.81).

DISCUSSION AND CONCLUSION

Unexpectedly, the RBS outperformed the LLMs across all metrics. An intensive review demonstrates that this finding is due to the divergent approach taken by the RBS and LLM. The RBS was designed and refined to follow the same specific rules as the gold-standard annotations. Conversely, the LLM was more inclusive with categorization and conformed to common English-language understanding. Both approaches offer advantages, although additional replication studies are warranted.

Exploring the Experience of Loneliness among People Living with Schizophrenia: A Qualitative Study

BACKGROUND

People living with schizophrenia or schizoaffective disorder are at heightened risk for experiencing loneliness, which is associated with negative health, quality of life, and symptom-specific outcomes.

AIMS

This study aimed to better understand the experience of loneliness among adults living with schizophrenia or schizoaffective disorder.

METHODS

Using a semi-structured interview guide, researchers interviewed twelve participants living with schizophrenia or schizoaffective disorder. Interview topics included the contexts of loneliness, hopes related to living a life less impacted by loneliness, and coping strategies. Researchers used conventional content analysis to analyze interview data and generate themes.

RESULTS

The research team identified four themes from the interview data: emotional disconnection, social anxiety leading to loneliness, unmet needs within social networks, and lacking companionship. Participants had a variety of hopes for the future, including increasing the quality of their relationships and improving their sense of self-efficacy. Participants described a variety of coping strategies, ranging from individual (e.g. leveraging technology, using cognitive reframing techniques) to systems-level (e.g. local clubhouses and walkable neighborhoods).

CONCLUSIONS

Participants have identified several priorities and coping strategies to reduce loneliness that can be integrated with current models of loneliness to develop interventions that are meaningful and effective for this population.

Prevalence and associations of problematic smartphone use with smartphone activities, psychological well-being, and sleep quality in a household survey of Singapore adults

INTRODUCTION

Despite the many benefits of smartphones, researchers have raised concerns over problematic smartphone use (PSU) and its negative effects on physical and psychological well-being. Studies examining PSU and its impact among adults remain limited. Hence, we aim to examine the prevalence of PSU among adults in Singapore, and explore its associations with smartphone activities, sleep quality, and psychological well-being, as well as age and gender-related differences in these associations.

METHODS

A household survey (n = 1200) was conducted among multi-ethnic Singapore adults aged 21 to 60. The survey employed a proportionate stratified random sampling approach. The Smartphone Addiction Scale-Short Version was used to determine risk of PSU. Adjusted multivariable logistic regressions, age-stratified (21-30, and above 30) analyses and sensitivity analyses were performed.

RESULTS

The survey response rate was 45.7%. PSU prevalence rate was estimated to be 34.0%. Adults at risk were younger (OR = 3.72, p < 0.001), had poor sleep quality (OR = 2.94), reported depressive (OR = 2.84, p = 0.001) or anxiety symptoms (OR = 2.44, p < 0.001), tend to use smartphones for social media (OR = 2.81, p = 0.002) or entertainment (OR = 2.72, p < 0.001). Protective factors include higher levels of social support (OR = 0.76, p = 0.007), using smartphones for calling family (OR = 0.39, p = 0.003) and friends (OR = 0.53, p = 0.030), and spending four hours or less of smartphone usage duration (OR = 0.40, p < 0.001). Sensitivity analyses confirmed these findings. Associations between PSU and poor sleep quality (OR = 3.72, p < 0.001), depressive (OR = 3.83, p < 0.001), and anxiety symptoms (OR = 2.59, p = 0.004) and social media usage (OR = 3.46, p < 0.001) were more pronounced in adults over 30. PSU was more prevalent among females in those aged 21-30 (OR = 2.60, p = 0.022). Social support appears to be a protective factor for adults over 30 (OR = 0.64, p < 0.001) but was not observed in those aged 21-30. Among males, younger age (21-30 years), poor sleep quality, depressive symptoms, and anxiety symptoms, and using social media and entertainment apps were significantly associated with PSU. Females showed similar associations. Social support appears to be a protective factor for females (OR = 0.70, p = 0.018), but this association was not observed for males. Shorter smartphone usage times were inversely associated with PSU in both genders.

CONCLUSION

A substantial proportion of adults exhibited PSU. Findings highlight the differential associations between PSU and psychological well-being, social support, interactions with technology, and sleep quality. These associations are influenced by age which has implications for preventive efforts.

The impact of family climate on problematic internet use: Findings from one nationwide study in China

BACKGROUND

With the growing attention paid to problematic internet use (PIU), this study aims to i) explore the prevalence of PIU based on a nationally representative sample and ii) propose and validate the theoretical model that correlates family climate with PIU.

METHODS

One national cross-sectional study was conducted with probability sampling and stratified sampling. Overall, 21,854 sample were included and analyzed. Validated measures of family climate, loneliness, and PIU was distributed and collected from June 2022 to August 2022.

RESULTS

The overall prevalence of PIU in the sample population is approximately 30.86 %. The model findings showed that family communication and family health had indirect effects of -0.12 and - 0.05 on PIU by the mediating effects of loneliness. The indirect effect explained 80.0 % of the total effect of family communication on PIU and 38.5 % of family health on PIU, highlighting the dominance effects of path family communication and PIU via loneliness. Extended family type (-0.047, p = 0.050), low family income (income≤3000 group, -0.127, p < 0.001) were identified as protective factors against PIU, while not living with family members (0.034, p = 0.021) was identified as risk factors of PIU.

LIMITATIONS

The nature of cross-sectional data have the limitation of preventing examining the casual relationships of PIU and the loneliness and family climate, in which future longitudinal study design is needed.

CONCLUSIONS

The high prevalence of PIU should be given adequate attention. Optimizing the family climate or family atmosphere by improving positive communication skills, providing family support and family health external resources can be served as effective strategies for controlling PIU.

Feasibility and Acceptability of a Remote Group Intervention for Depression, Social Isolation, and Loneliness in Older Adults

OBJECTIVES

This mixed-methods study examines the acceptability, feasibility, and preliminary effect of a novel, remotely delivered group intervention (Empower@Home: Connected) targeting depression, social isolation, and loneliness in older adults (≥ 60).

METHODS

Acceptability was assessed via participant satisfaction, and feasibility was measured by attrition rates and session attendance. Participants completed pre- and posttest measures of depression, social isolation, and loneliness, with depression also assessed biweekly. Post-intervention, participants completed semi-structured qualitative interviews about their experiences.

RESULTS

31 participants completed the intervention. The intervention had high acceptability and feasibility. Depressive symptoms significantly decreased. Reductions in loneliness and social isolation were observed but not statistically significance. Linear mixed modeling revealed a significant reduction in depressive symptoms during the intervention. Qualitative interviews highlighted participants' beliefs in the intervention's impact. They appreciated the convenience of remote delivery and valued shared experiences and emotional support from group interactions.

CONCLUSIONS

This uncontrolled pilot intervention was acceptable, feasible, and reduced depressive symptomatology. Future research should refine social isolation and loneliness components and explore the intervention's long-term impact.

CLINICAL IMPLICATIONS

This pilot remote group-based interventions to address depression, social isolation, and loneliness in older adults was acceptable and feasible, making it a potentially valuable option for improving mental health care.

Reducing loneliness and depressive symptoms in older adults during the COVID-19 pandemic: A pre-post evaluation of a psychosocial online intervention

BACKGROUND

Loneliness is related to worse mental health, particularly in people with poor social support. The COVID-19 pandemic altered our lives and ways of social interaction, especially among vulnerable populations such as older adults.

METHODS

We designed a group-based psychosocial online intervention for older adults (≥ 65 years) facilitated by gerontologists addressing loneliness consisting of: (i) sharing experiences and promoting peer support to overcome feelings of loneliness and (ii) increasing the chances of establishing successful social relationships. This was a feasibility non-controlled prospective pilot study carried out during the COVID-19 pandemic with a pre-post evaluation. Interviews before and after the intervention assessed loneliness (emotional and social), social support, depressive and anxiety symptoms, quality of life, and perceived health. Groups of 6-8 participants and 2 facilitators met once a week for 8 weeks through videoconferencing. The intervention effectiveness was assessed with multilevel models for repeated measures.

RESULTS

The study sample (N = 27) was mainly composed of females (74%) and the mean age was 74.26 years. 21 participants completed the intervention (22% drop-out rate). Statistically significant (p<0.01) decreases in emotional loneliness and depressive symptoms were observed following the intervention. Qualitatively, participants positively evaluated the intervention and found in the group a space for personal growth where they could meet new people and express themselves with confidence and security.

CONCLUSIONS

Interventions overcoming social distancing restrictions through online tools and targeting vulnerable population sectors (e.g., older adults) can become essential to lessen the collateral consequences of the COVID-19 pandemic on social behaviour and mental health.

The Role of World Beliefs in Loneliness: Implications for Daily Social Interaction and Persistence of Loneliness Over Time

INTRODUCTION

Lonely people often crave social connection, but their social interactions fall short of fulfilling their needs. Although loneliness has been associated with negative views of the world, it is not clear whether these world beliefs contribute to the unfulfilling social interaction patterns that sustain loneliness. This research examined the role of world beliefs in explaining the effects of loneliness on daily frequency and quality of interaction, and the implications for sustained loneliness over time.

METHODS

Both members of romantic couples (N = 472) completed measures of loneliness, world beliefs, and daily social interactions with weak and strong ties over 2 weeks (daily N = 6411) and completed a follow-up assessment of loneliness a year later.

RESULTS

Relative to those who felt connected, lonely people believed the world was worse, dangerous, dull, and did not need them. Loneliness also indirectly predicted reduced quality and quantity of social interaction via negative, dull, and not needed world beliefs. In turn, the quality of interactions with strong ties predicted maintained loneliness a year later. However, dangerous world beliefs predicted better interactions with close relationship partners.

CONCLUSION

Findings suggest that the negative subjective worlds inhabited by lonely people may partially explain why lonely people have unfulfilling social interactions that tend to sustain their loneliness.

The Long-Lasting Effect of Multidisciplinary Interventions for Emotional and Social Loneliness in Older Community-Dwelling Individuals: A Systematic Review

BACKGROUND

Loneliness can occur at any age, but it is more prevalent among older adults due to the associated risk factors. Various interventions exist to improve this situation, but little is known about their long-term effects. Our aims were to determine if these interventions have long-lasting effects and for how long they can be sustained. Additionally, we aimed to analyze if the interventions carried out by volunteers affected the outcomes regarding loneliness and psychological impact.

METHODS

A systematic review was performed by searching the literature in the MEDLINE PubMed, SCOPUS, Web of Science, PsycINFO, and Web of Science databases for interventions focused on the lonely population. The inclusion criteria for this review were the assessment of loneliness using a validated tool, and loneliness being the primary or secondary outcome. The CASPe checklist was used to assess the risk of bias in the selected studies, and the PRISMA-ScR recommendations were followed to present and synthesize the results.

RESULTS

Thirty articles were included. The interventions identified were classified into five categories: psychosocial, technological, health promotion, physical exercise, and multicomponent interventions. Loneliness improved in 24 studies during the post-intervention analysis. Social connectivity and depressive symptoms also improved in most interventions. Long-term follow-ups were conducted with positive results in a total of 16 interventions. Depressive symptoms and social connectivity were also improved. Eight of the interventions were carried out by volunteers and showed good results regarding loneliness.

CONCLUSIONS

The results obtained in this work suggested that multidisciplinary interventions can reduce loneliness, but more controlled clinical studies are needed.

Loneliness and psychotic-like experiences in middle-aged and older adults: the mediating role of selective attention to threat and external attribution biases

OBJECTIVES

Loneliness has been associated with psychotic-like experiences (PLEs) in the general population, but the mechanisms underlying this association are poorly understood. Theoretical models, corroborated by empirical findings, signify the key role of biased cognition in both loneliness and psychosis. This study tested whether two cognitive biases - Selective Attention to Threat (ATB) and External Attribution Bias (EAB) - account for the association between loneliness and PLEs.

METHOD

A convenience sample (n = 357) of middle-aged and older adults (aged 40+) was recruited online from the UK population. The parallel mediation model with two the aforementioned cognitive biases as mediators was tested.

RESULTS

A mediation effect between loneliness and PLEs via ATB (ab1 = 0.441, 95% CI = [0.264, 0.646]) and EAB (ab2 = 0.354, 95% CI [0.124, 0.627] was established. This model remained significant after controlling for the current symptoms of anxiety and depression.

CONCLUSION

Greater loneliness was associated with a higher rate of PLEs in the sample of middle-aged and older adults. This association was fully explained by ATB and EAB, independent of the current symptoms of anxiety and depression.

Investing in Custodial Grandparents: Cost Analysis of the Social Intelligence Program

Rising child welfare costs and a desire to keep kids out of the system have encouraged the use of kinship care-of which custodial grandparents make up the majority of caregivers. Unfortunately, custodial grandparents report greater needs for social and emotional support to successfully care for their grandchildren. Yet, the resources required to provide preventive social-emotional support to these families are unknown. In the wake of the Family First Act and other policy actions to expand preventive services, we undertake a cost analysis of the social intelligence training (SIT) within a randomized controlled trial spanning 48 states of the United States of America. Estimated implementation costs were $90,638 (CI $45,254-186,998) which equated to $255 (CI $127-526) per participant. This dual-generation online approach offers key lessons into not only how to resource social-emotional learning (SEL) prevention for custodial grandparents-but also sheds light on how we might provide universal supports to this population. Child welfare system costs have risen to over $33 billion dollars a year-with nearly half of all spending being the result of out-of-home placement (Rosinsky et al., 2021) Child Welfare Financing SFY 2018: A survey of federal, state, and local expenditures. https://www.childtrends.org/wp-content/uploads/2021/05/ChildWelfareFinancing_ChildTrends_March2021.pdf ). Practitioners, policymakers, and child advocates are seeking solutions for how to both better protect children and manage these growing public costs (Ringel et al., 2018). Improving child welfare outcomes: Balancing investments in prevention and treatment. Rand health quarterly, 7(4)). Further, many extended families seek ways to keep children out of the "system" when parents are unable to care for their offspring (Lin, Children and Youth Services Review 93:203-216, 2018). A strategy used by all of these groups is the use of kinship care arrangements where extended family provides formal or informal care of children. Several important benefits are recognized from kinship care, including providing connections to family members, communities, and culture. Yet, little is known about how social-emotional supports could enhance kinship arrangements, and to date, no studies have systematically evaluated the costs of such supports. In this context, we conduct a cost analysis of such a program-known as social intelligence training.

Interventions in ambulatory healthcare settings to reduce social isolation among adults aged 18-64: a systematic review

BACKGROUND

Social isolation is associated with increased all-cause and premature mortality, poor chronic disease management, and mental health concerns. Limited research exists on interventions addressing social isolation among individuals under 65 despite its increasing prevalence among young and middle-aged adults.

AIM

To identify interventions from the extant literature that address social isolation and loneliness in ambulatory healthcare settings in adults aged 18-64 and to identify elements of successful studies for future intervention design.

DESIGN & SETTING

Systematic review of interventions targeting social isolation in community-dwelling adults aged 18-64 within ambulatory healthcare settings.

METHOD

A search strategy was developed to identify relevant articles in the following databases: Ovid MEDLINE, Embase, EBM Reviews, Scopus, CINAHL, and PsychInfo. Data were extracted on study design and setting, intervention type, outcome related to social isolation/loneliness, and scale of measure used.

RESULTS

25 078 citations were identified and underwent title and abstract screening. 75 articles met our inclusion criteria and were synthesised, including an assessment of bias. Effective interventions were delivered in community health settings, incorporated a group component, and used digital technologies. They also addressed the association between mental health and social isolation using cognitive-behavioural therapy (CBT) approaches and enhanced self-management and coping strategies for chronic conditions through psycho-educational interventions.

CONCLUSION

Future research should prioritise adults living in low-income and middle-income countries, racialised individuals, as well as those with fewer educational opportunities. There is also a need to advance research in primary care settings, where longitudinal patient-provider relationships would facilitate the success of interventions.

Understanding the Meaning of Loneliness and Social Engagement for the Workings of a Social Network Intervention Connecting People to Resources and Valued Activities

BACKGROUND

Addressing loneliness, which is associated with poor mental and physical health, implicates the need for connectivity to a broad set of situated relationships and activities in the contexts of people's everyday lives. Social engagement has been identified as a relevant psychosocial mechanism mediating health and wellness and is central to addressing loneliness. The aim here is to explore the way in which people identified as lonely conceptualise their experiences of loneliness and social engagement for the purposes of incorporating these into the design and workings of an intervention that allows people to map their social networks and connect them to community-based valued activities.

METHODS

Semi-structured qualitative interviews were undertaken with 20 participants, aged 21-82 years old (mean age 59.7) nested within a pragmatic, community-based randomised controlled trial in the north and south of England. Participants had wide-ranging social network sizes (from 1 to 10 individuals) and reported variable impact of loneliness on their lives.

RESULTS

Loneliness consisted as an absence of intimacy in the face of being surrounded by others, a sense of entrapment and boredom, lacking access to meaningful activities and difficulties in relating to others. The analysis highlighted the role that important relationships have in mediating loneliness. Individual readiness, skills and confidence in forming new connections and engaging with new activities are important barriers that exist in overcoming loneliness. For many, wider socio-political factors, such as transport provision, availability of resources and costs associated with social engagement are also important barriers which are difficult to overcome.

IMPLICATIONS

Exploring the link between feelings, experiences and meaning of loneliness and the way in which a network intervention can be incorporated offers a focus for mediating the richness and opportunities that arise from locality-based connections and collective activities in the broader social environment. However, any intervention seeking to address loneliness requires a further focus on both individual and relational factors which might contribute to addressing loneliness and increasing a sense of wellness.

PATIENT OR PUBLIC CONTRIBUTION

The study team worked closely with community partner organisations in all aspects of this research, including, the submission of the funding proposal, development of the study protocol and procedures, recruitment, intervention deployment and assessment of implementation. PPI representatives provided advice on participant materials and interview schedules, and project management throughout and contributed to management and steering committee meetings.

Qualitative exploration of the lived experiences of loneliness in later life to inform technology development

PURPOSE

Loneliness is a negative emotional state which is common in later life. The accumulative effects of loneliness have a significant impact on the physical and mental health of older adults. We aim to qualitatively explore the experiences of loneliness in later life and identify relevant behaviours and indicators which will inform novel methods of loneliness detection and intervention.

METHODS

We conducted 60 semi-structured interviews with people aged 65 and over between September 2022 and August 2023. Data were analysed using a reflective thematic approach with early theme development on NVIVO software.

RESULTS

Three themes were identified from the experiences of loneliness in older adults. 1) Unique responses to loneliness, including crying, increased eating or drinking and sleep difficulties, 2) Age-related losses, such as networks, roles, and abilities to engage in activities reducing over time and 3) Individual differences in overcoming loneliness, where strategies such as keeping busy and adopting a positive mindset were impacted by motivation and mood of older adults.

CONCLUSION

Distinct signs and relevant factors to loneliness in later life have been identified which can be detected by future sensing technologies. Findings of this in-depth qualitative study highlight that loneliness is a subjective experience requiring a holistic and person-centred approach to detection and intervention.

A blended group intervention to promote social connectedness and wellbeing among international university students: an exploratory study

Introduction

Loneliness is a prevalent issue among international university students, often exacerbated by cultural and linguistic barriers. This pilot study aims to assess the feasibility, acceptability and impact of a blended intervention to promote international students' social connectedness and well-being.

Methods

A sample of 49 international students from the University of Padua (Italy) was recruited. The study followed the methodology of a non-randomized controlled trial comparing a blended intervention (comprising group activities and online self-help materials) with two other active conditions (self-help only and peer-to-peer interventions) and a control condition at two times (baseline and at 8 weeks). Participants completed a survey to assess their satisfaction with the interventions, changes in their interactions and wellbeing. They also filled in some questionnaires to measure anxiety, depression, perceived social support, loneliness and satisfaction with life. A mixed-method analysis was conducted.

Results

Results showed that interventions involving in-person activities had significant advantages over self-help intervention in terms of interaction improvement and a higher number of relationships. Participants perceived self-help materials as more relevant, satisfactory, and functional within the blended group compared to the self-help group. Contrary to the control group, the blended and peer-to-peer groups reported lower scores on the standardized measures of loneliness, anxiety, and depression, and higher scores on satisfaction with life, collected pre- and post-intervention. The thematic analysis of the answers to the open-ended questions showed that in-person group activities provided the opportunity to compare themselves with peers and have a direct experience of new social connections.

Discussion

The findings highlight the importance of translating insights from self-help materials into active and direct social experiences, to reduce loneliness through the emergence of new perspectives and shared meaning making.

A Longitudinal Study of Loneliness Before the End of the COVID-19 Pandemic: Trajectories, Predictors, and Impact on Chinese Adolescent Mental Health

Background

COVID-19 threatened global health, however little is known about the long-term courses of loneliness and their effect on mental health in adolescents. This study aimed to explore the trajectories of loneliness among adolescents in Taizhou, Zhejiang Province, China, during the last phase of the pandemic. We also aimed to identify risk factors in each loneliness course and the impact of loneliness on emotional problems, peer problems, hyperactivity and conduct problems.

Methods

The study employed multistage cluster sampling to collect four waves of data from 2347 Chinese adolescents (average baseline age of 14.7 years) covering a period of 20 months (October 2021 - May 2023). The UCLA 3-Item Loneliness Scale and the Strengths and Difficulties Questionnaire were utilized to assess loneliness and mental health problems, respectively. Growth mixture modelling was employed to identify latent classes of loneliness trajectories. Associated risk factors were investigated using multinomial logistic regression model. Mixed-effects logistic regression models were constructed to examine the long-term impact of loneliness classes on mental health outcomes.

Results

The overall percentage of loneliness increased from 22.9% at baseline to 32.2% at the fourth wave in our sample. Three classes of loneliness were identified: Decreasing Low Loneliness (58.71%), Increasing Medium Loneliness (36.52%), and Increasing High Loneliness (4.77%). Risk factors for poorer loneliness trajectories included lack of physical exercise habits, poorer mental health literacy, medium or low perceived social support, having study difficulties, being female, higher grades, and lower economic status. Loneliness classes were associated with the severity and variability of emotional problems, peer problems, hyperactivity and conduct problems (ORs for the highest loneliness class: 10.24, 4.21, 3.87, 2.68, respectively). Individuals in the higher loneliness classes experienced a significant increase in these mental health problems over time (p < 0.05 for interactions between loneliness classes and time).

Conclusion

During the last phase of the pandemic, a large proportion of adolescents in our study endured medium to high levels of loneliness with no signs of improvement. Both unfavorable loneliness trajectories adversely affected internalizing and externalizing problems and displayed an upward trend in these difficulties. Results highlight the importance of tackling loneliness and improving mental health in adolescents.

Developmental Trajectories of Loneliness Among Chinese Early Adolescents: The Roles of Early Peer Preference and Social Withdrawal

This study aimed to examine distinct loneliness trajectories and to explore the roles of group-level peer preference and individual-level social withdrawal (i.e., unsociability and shyness) as predictors of these trajectories. Participants were 1134 Chinese elementary school students (Mage = 10.44 years; 565 boys). Data were collected from self-reports and peer nominations. Latent class growth analysis (LCGA) was employed to identify distinct trajectories of loneliness, and multinomial logistic regression was subsequently used to examine the relationships between these trajectories and their predictors. Results showed that three loneliness trajectories were identified: high increasing, moderate decreasing, and low decreasing. Participants at baseline with higher peer preference were more likely to belong to the low decreasing trajectory subgroup rather than the other two subgroups. Furthermore, those at Time 1 with higher unsociability had lower odds of being classified into the moderate or low decreasing trajectory subgroup compared to the high increasing trajectory subgroup. Additionally, participants at baseline with higher shyness had reduced likelihoods of following the low decreasing trajectory subgroup as opposed to the other two subgroups. These results have implications for how we understand both the different subgroups of loneliness trajectories and the predictions of peer preference and social withdrawal on these trajectories in Chinese early adolescents.

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

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

Depression and loneliness among Sub-Saharan immigrants living in the greater Paris area: results from the MAKASI empowerment stepped wedge cluster randomised controlled trial

PURPOSE

The MAKASI intervention aimed to empower Sub-Saharan African immigrants living in precarious situations in the Paris metropolitan area. Because there are factors specifically related to immigration that may increase the risk for common mental disorders, the present study aimed to examine participants' levels of depression and loneliness and analyze the effect of the intervention on depression and loneliness.

METHODS

The MAKASI study was designed as a stepped wedge cluster randomized trial. Study participants were recruited through an outreach program led by a nongovernmental organization and randomly assigned to two clusters, with an intervention delay of 3 months between them. Participants were assessed for 6 months after inclusion and the effect of the intervention on depression and loneliness was assessed using generalized linear mixed models. The study was conducted from 2018 to 2021 and took in consideration whether being interviewed during one of the Covid-19 confinement had an effect on the results.

RESULTS

Between 2018 and 2021 a total of 821 subjects participated in the Makasi study. High levels of depression and loneliness were found in the study population. We found no effect of the intervention on depression [95% CI 0.77 to 2.40]. Similarly, no effect of the intervention was found on loneliness [95% CI 0.87 to 2.54].

CONCLUSIONS

The intervention tested did not appear to improve the level of depression and loneliness among participants. However, the high prevalence of mental and emotional problems in the study population suggests a public health crisis among immigrants in the greater Paris area.

CLINICAL TRIAL REGISTRATION NUMBER

 Trial registration Clinicaltrials.gov, NCT04468724 (July 13, 2020).

The effects of sleep quality on loneliness among older adults: cohort analysis from the life course perspective

BACKGROUND

Using cohort analysis to examine the effects of sleep quality on loneliness among older adults from the life course perspective.

METHODS

The hierarchical age-period-cohort growth curve model was used to analyze the data from the 2005-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS).

RESULTS

(1) Loneliness has a 'U' curve relationship with age, but with the rate of increase gradually slowing down. (2) There were significant differences in loneliness across birth cohorts, with younger cohorts having higher predicted loneliness than older cohorts at the same age. (3) The influence of different sleep quality on loneliness showed a trend of increasing with age. (4) There were no significant differences in the impact of sleep quality on loneliness in different cohorts.

CONCLUSIONS

This study has identified heterogeneity in loneliness, emphasising the need for a diversified intervention approach. Sleep quality has a protective effect on loneliness and is easy to assess, making it an important intervention tool. In addition, it is imperative to account for the influences of age and cohort effects when formulating intervention strategies.

A Technology-Supported Psychoeducational Intervention for Older Adults and Their Families to Improve Social Isolation, Loneliness, and Intergenerational Connectedness-A Randomized Controlled Study

Information and communication technologies (ICT) provide digital tools to support and facilitate social engagement. However, the extent to which new ICTs, such as instant messaging, and training on its use, enhance intergenerational family interactions and reduce social isolation and loneliness needs further exploration. In the present study, we developed a brief psychoeducational intervention to promote older adults and their family members (N = 64) to use new technologies to increase communication with each other. With a randomized controlled trial design, we evaluated the effectiveness of the intervention in changing primarily participants' intergenerational interactions, perceived social isolation, and loneliness. Through repeated-measures analysis of variance, an overall condition by time effect was found in younger family members such that contact frequency improved in the intervention condition compared with the waitlist control condition. Using a dyadic framework, we further investigated the role of the intervention in fostering interactions among family members. Dyadic analyses showed a partner effect with contact frequency in younger adults at pre-assessment predicting contact frequency of older adults at post-assessment. This suggests that support and encouragement from younger family members could increase intergenerational interactions and technology adoption among older adults. Moreover, online phone calls served as a promising tool to enhance intergenerational communication; higher user satisfaction was associated with increased ICT use, perceived usefulness, and fewer barriers to technology. This study provides preliminary findings on the effectiveness of ICT-based interventions for engaging older adults and their family members in the use of newer technologies to promote intergenerational interactions and reduce social isolation.

Prevalence and burden of loneliness in COPD: A systematic review and meta-analysis

BACKGROUND

Loneliness poses significant public health concerns on a global scale. Being alone and lacking social connections have been proven to impact prognosis and response to treatment in different diseases, including COPD. Yet, the prevalence and burden of loneliness on COPD outcomes remain unclear.

METHODS

Various relevant databases were systematically searched in March 2024. The quality of the studies included was assessed using a modified Newcastle-Ottawa Scale. The random effect model was used to compute the pooled prevalence and associated 95 % confidence intervals (95%CI) of loneliness and living alone in COPD patients.

RESULTS

After reviewing 256 studies, 11 studies, including 4644 COPD patients, met the inclusion criteria and were included in the systematic review. Of the included studies, 5/11 (45.5%) reported the prevalence of loneliness or lone living among COPD patients and were included in the meta-analysis. The prevalence of loneliness and lone living among COPD patients was 32% (95% CI = 16%-48%) and 29% (95% CI = 16%-41%), respectively. The Three-item UCLA loneliness scale was the most often used loneliness assessment tool (5/11, 45.5%). Loneliness and lone living were associated with poor outcomes, including emergency department visits, readmissions, depression, and reduced pulmonary rehabilitation response.

CONCLUSION

Despite one-third of COPD patients experiencing loneliness, researchers have not consistently documented its impact on COPD outcomes. More studies are needed to assess the impact of loneliness on COPD and how to mitigate the negative effects on patients' outcomes.

Social connection and self-neglect: A case for broader exploration

OBJECTIVE

Self-neglect (SN) is the most common report to Adult Protective Services (APS) and is associated with significant morbidity and mortality risks for older adults. Lack of instrumental support is a well-evidenced etiologic factor in the development and continuation of SN, but little is known about other modifiable social connection characteristics. The social connection framework provides evidence-based characteristics across structure, function, and quality missing from SN studies that could be identified if explored. These factors could provide prevention and intervention targets related to poor health.

METHODS

A narrative case study is presented using quantitative and qualitative data to explore social connection across structure, function, and quality in the context of SN.

RESULTS

The findings highlight the complexity of social connection that may be observed in SN cases reported to APS. Strategic utilization of direct and indirect social interventions to support social connection in this case are presented.

CONCLUSION

The results from this case give rise to considerations that may be generalizable to other SN cases. Recommendations for future research on social connection in this population are provided.

The associations between daily reports of loneliness and psychotic experiences in the early risk stages for psychosis

AIM

Bi-directional associations between loneliness and psychotic experiences (PEs) have been reported, but the mechanisms underlying these associations are unknown. This study aims to explore associations between daily reports of loneliness and PEs, and test differences in this association across young adult individuals at different levels of risk for psychosis.

METHODS

We analysed 90-day diary data on loneliness and PEs from N = 96 participants (mean age 24.7, range 18-35, 77% female) divided into 4 subgroups, each indexing increased levels of risk for psychosis according to the clinical staging model: 'psychometric' (n = 25), 'low' (n = 27), 'mild' (n = 24), and 'ultra-high'(n = 20) risk. Multilevel vector autoregressive models examined within-day (contemporaneous) and between-day (temporal) associations between loneliness and PEs for the total sample. Next, these associations were compared across subgroups.

RESULTS

Loneliness and PEs were significantly associated contemporaneously (partial correlation B = 0.14) but not temporally. Subgroup membership moderated both contemporaneous and temporal associations. The contemporaneous association between loneliness and PEs was stronger in the low-risk subgroup compared to the mild-risk (B = -0.35, p < .01) and ultra-high-risk (B = -0.36, p < .01) subgroups. The temporal association between loneliness on the previous day and PEs on the current day was stronger in mild-risk subgroup compared to the ultra-high-risk subgroup (B = -0.03, p = .03). After adjusting for multiple testing, only the contemporaneous-but not the temporal-associations remained statistically significant.

CONCLUSIONS

Loneliness is associated with PEs in individuals at risk for psychosis, particularly in those with low to mild symptoms. Our findings tentatively suggest that especially individuals with low expressions of PEs may be more sensitive to social context, but future studies are needed to replicate and further unravel the potentially stage-specific interplay between social context and PEs.

Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study

BACKGROUND

Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users' autonomy, competence, and relatedness.

OBJECTIVE

This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism.

METHODS

Participants were each prompted with a single question: "What's your struggle?" Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts.

RESULTS

Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively.

CONCLUSIONS

Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options.

Loneliness and Problematic Internet Use in Adolescents: The Mediating Role of Dissociation

BACKGROUND/OBJECTIVES

Problematic Internet uUse (PIU) is a multifaceted syndrome characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding Internet use leading to significant impairments in daily life and mental health. Previous research has separately related PIU to loneliness and dissociation, both in adults and adolescents. The aim of the present study is to analyze the mutual relationship between PIU, loneliness, and dissociation in an adolescent sample, in particular evaluating the indirect effect of dissociation on the relationship between loneliness and PIU.

METHODS

A cross-sectional design was used with 243 Italian high school students (69.1% females), from year 9 to 13 (age: M = 17.1, SD = 1.4 years), who participated in the study from January to June 2020. They completed measures of PIU (Generalized Problematic Internet Use Scale-2), loneliness (UCLA Loneliness Scale), and dissociation (Adolescent Dissociative Experiences Scale). Socio-demographic and contextual variables were also collected (i.e., age, gender, type of school, school year, sport practice, hobby engagement, assessment before/during the COVID-19 pandemic). Data were analyzed using regression, Pearson's correlation, and mediation analysis.

RESULTS

Severe PIU was observed in 8.6% of the sample. None of the socio-demographic and contextual variables had a significant effect on PIU. Positive medium-sized correlations were observed between PIU, loneliness, and dissociation. Mediation analyses showed an indirect effect of loneliness on PIU through dissociation.

CONCLUSIONS

Feelings of loneliness may significantly exacerbate adolescents' PIU by increasing their dissociative tendency. Understanding this dynamic is crucial for developing targeted interventions to address both loneliness and dissociation in efforts to mitigate PIU among adolescents.

United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study

BACKGROUND

People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology.

OBJECTIVE

While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV.

METHODS

In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13).

RESULTS

The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording.

CONCLUSIONS

Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.