1
|
Söderman A, Arvidsson-Lindvall M. Older persons making a life closure: experiences of loneliness in an academic nursing home - a phenomenological qualitative interview study. Int J Qual Stud Health Well-being 2024; 19:2398201. [PMID: 39217523 PMCID: PMC11382699 DOI: 10.1080/17482631.2024.2398201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Loneliness is a public health concern and more than half of the residents in nursing homes experience lonliness. Risk factors are age and loss of close relatives. PURPOSE This study aimed to describe experiences of loneliness among older people living in an academic nursing home. METHODS Qualitative semi-structured interviews were conducted with ten older people and data analysed with systematic text condensation inspired by a phenomenological approach. RESULTS Three themes were identified: "Relatives and health care professionals matter"; "Acceptance and meaningful existence alleviate loneliness"; and "Challenges affecting the experience of loneliness". The older persons described themselves as lonely, but their experience of loneliness differed. They managed loneliness by adapting to it or getting used to it; some also chose to be alone. To add meaningfulness to their daily life, talking about memories and their past were appriciated. Personality traits and variations in functional ability were identified as barriers to social interactions. CONCLUSIONS Health care professionals can reduce negative experiences of loneliness by listening to nursing home residents, creating a meaningful daily life with individualized activities, and by encouraging contacts with close relatives. This can be a way of maintaining older persons' dignity and coping with the longing for what has been.
Collapse
Affiliation(s)
- Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Mialinn Arvidsson-Lindvall
- Faculty of Medicine and Health, University Health Care Research Centre, Örebro, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| |
Collapse
|
2
|
Shimoda T, Tomida K, Nakajima C, Kawakami A, Shimada H. Combined effects of loneliness and diabetes mellitus on disability incidence among older Japanese adults. Arch Gerontol Geriatr 2024; 126:105544. [PMID: 38909439 DOI: 10.1016/j.archger.2024.105544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 06/10/2024] [Accepted: 06/18/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Developed countries worldwide face the challenge of aging populations in which loneliness is problematic, leading to mental and physical health issues. Diabetes mellitus (DM) can cause decreased physical activity, reduced functioning, and depressive symptoms. However, how interactions between loneliness and DM influence health outcomes remains unclear. We aimed to determine the effects of loneliness and DM-related complications on the incidence of disability among older individuals. METHODS We analyzed data from the Japanese National Center for Geriatrics and Gerontology Study of Geriatric Syndromes for community-dwelling adults aged ≥65 years without initial long-term care needs. Loneliness was assessed using the University of California Los Angeles Loneliness Scale, and DM status was determined based on medical history obtained through face-to-face interviews. Disability incidence was identified by monthly tracking of certifications under the Japanese long-term care insurance system. The combined effect of DM and loneliness on care needs was examined using Cox proportional hazard regression models. RESULTS Among 5,160 participants, 298 (5.8 %) developed incident disabilities within 24 months. Cox models adjusted for potential confounders revealed a significantly increased disability risk among persons with DM and loneliness. Having DM without loneliness and vice versa were not significant risk factors for disability incidence compared with having neither. CONCLUSIONS The combination of loneliness with DM was a risk factor for disability development among community-dwelling older adults. Loneliness and DM might be interrelated and associated with disability development, suggesting that support along with assessments of mental health and illness might help to avoid disability in this population.
Collapse
Affiliation(s)
- Takahiro Shimoda
- Department of Preventive Gerontology Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan.
| | - Kouki Tomida
- Department of Preventive Gerontology Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Chika Nakajima
- Department of Preventive Gerontology Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Ayuka Kawakami
- Department of Preventive Gerontology Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Aichi, Japan
| |
Collapse
|
3
|
Silva C, Ferreira R, Morgado B, Alves E, Fonseca C. Depression, Loneliness and Quality of Life in Institutionalised and Non-Institutionalised Older Adults in Portugal: A Cross-Sectional Study. NURSING REPORTS 2024; 14:2340-2354. [PMID: 39311182 PMCID: PMC11417865 DOI: 10.3390/nursrep14030174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 09/01/2024] [Accepted: 09/04/2024] [Indexed: 09/26/2024] Open
Abstract
Our study aims to estimate the prevalence of depressive symptomatology among older adults and to assess their association with loneliness and quality of life according to institutionalisation status in a Portuguese sample. BACKGROUND The World Health Organisation estimates that by 2050, the world's population over 60 will number two billion people, which poses complex challenges in terms of maintaining the mental health of older adults. The COVID-19 pandemic has increased the prevalence of depressive symptoms in this population, but the post-pandemic phase has not yet been studied much. METHODS A cross-sectional survey was carried out in 2023 among institutionalised and non-institutionalised older adults (total n = 525; institutionalised = 458; non-institutionalised = 67) who were selected by convenience sampling. The Patient Health Questionnaire (PHQ-9) was used to assess the presence of depressive symptoms, the WHOQOL-BREF to assess perceived quality of life and the Loneliness Scale (UCLA) to assess negative feelings of loneliness. Unconditional logistic regression models were fitted to compute crude adjusted odds ratios (ORs) and the respective 95% confidence intervals (95%CIs) for the association between sociodemographic, clinical and psychosocial characteristics and depressive symptomatology, according to institutionalisation status. The final model was adjusted for sex, age, QoL and feelings of loneliness. RESULTS Of the 525 participants, 74.6% of the non-institutionalised participants had no or minimal depressive symptoms, while 55.4% of the institutionalised participants fell into this category. Mild to moderately severe depressive symptoms were present in 25.4% of the non-institutionalised participants. 26.9% of the institutionalised participants had mild symptoms, 11.8% had moderate symptoms, 3.9% had moderately severe symptoms, and 2.0% had severe depressive symptoms. Overall, a higher quality of life was associated with lower levels of depressive symptoms. Participants describing feelings of loneliness were more likely also to present depressive symptoms (OR = 78.10; 95%CI 2.90-2106.08 and OR = 3.53; 95%CI 1.72-6.91 for non-institutionalised and institutionalised older adults, respectively), independently of institutionalisation status. CONCLUSIONS The prevalence of depressive symptoms is high in older adults, which means that it has not decreased after the increase seen due to the COVID-19 pandemic. A lower perception of quality of life and the presence of negative feelings of loneliness are associated with the presence of depressive symptoms. These conclusions suggest that plans should be developed to intervene in the dimensions of depressive symptoms, perceived quality of life and negative feelings of loneliness.
Collapse
Affiliation(s)
- Celso Silva
- Higher School of Health, Polytechnic Institute of Beja, 7800-295 Beja, Portugal
- Instituto de Investigação e Formação Avançada, University of Evora, 7000-811 Evora, Portugal
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
| | - Rogério Ferreira
- Higher School of Health, Polytechnic Institute of Beja, 7800-295 Beja, Portugal
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
| | - Bruno Morgado
- Escuela de Doctorado, Universitat Rovira y Virgili, 43005 Tarragona, Spain
| | - Elisabete Alves
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
- São João de Deus School of Nursing, University of Evora, 7000-811 Evora, Portugal
| | - César Fonseca
- Comprehensive Health Research Centre (CHRC), University of Evora, 7000-811 Evora, Portugal
- Nursing Department, University of Evora, 7000-811 Evora, Portugal
| |
Collapse
|
4
|
Gasull-Molinera V, Khan KS, Núñez Núñez M, Kouiti M. The impact of loneliness on mental and physical health outcomes: An umbrella review. Semergen 2024; 50:102261. [PMID: 38824784 DOI: 10.1016/j.semerg.2024.102261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/28/2024] [Indexed: 06/04/2024]
Abstract
Loneliness and related constructs associated with isolation are public health problems with increasing prevalence. The aim of this umbrella was to collate and grade evidence analyzing actual and subjective loneliness as a health risk factor. Following prospective registration, a systematic search was conducted in Pubmed, Embase, Scopus, Web of Sciences, psycoINFO and Cochrane Library until August 2023. Systematic reviews assessing the association between actual and subjective loneliness with adverse health outcomes were selected. Risk of bias was evaluated using AMSTAR-2 tool. Data were tabulated and synthesis was narrative. A total of 13 systematic reviews was selected (four included meta-analysis). The methodological quality was critically low in 10 reviews (76.92%) and low in 3 (23.08%). Results showed that loneliness was related to poor well-being and increase the risk of negative mental and physical health. The available data suggested but did not allow the confirmation of a causal association. Most constructs of loneliness seem to be related to mental and physical health conditions. A preventive strategy ought to be recommended, especially for vulnerable populations.
Collapse
Affiliation(s)
| | - K S Khan
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Consorcio Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M Núñez Núñez
- Consorcio Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain; Biosanitary Research Institute (Ibs. Granada), 18012 Granada, Spain
| | - M Kouiti
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Laboratory of Health Sciences and Technologies, Higher Institute of Health Sciences, Hassan First University of Settat, Settat 26000, Morocco.
| |
Collapse
|
5
|
O'Connor DB, Rogerson O. Loneliness, sleep and daily stress: Evidence of direct and indirect effects. Appl Psychol Health Well Being 2024. [PMID: 39219181 DOI: 10.1111/aphw.12586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024]
Abstract
This study investigated: i) the effects of loneliness on self-reported sleep outcomes and daily stress/hassles, ii) whether the effects of loneliness on sleep outcomes were mediated through prior-day stress/hassles and iii) if the effects of loneliness on daily stress/hassles were mediated through prior-night sleep measures. Using a 7-day diary design, this study aimed to investigate relationships between loneliness, daily sleep outcomes and daily stress/hassles. Participants (N = 174, Mage 19.95, 86.2% female) completed the UCLA Loneliness Scale once before a 7-day online diary twice per day. Measures of daily stress and hassles were completed before bed and sleep outcomes the following day. Multilevel modelling found higher levels of loneliness were associated with poorer sleep quality, greater pre-sleep arousal, morning tiredness, fewer total hours slept and higher levels of daily stress and hassles across the 7-day study. Loneliness was found also to have indirect effects on sleep quality, pre-sleep arousal and morning tiredness through prior-day daily stress and hassles. In addition, loneliness also had indirect effects on daily stress and hassles through prior night sleep measures. The current findings suggest that interventions aimed at mitigating the effects of loneliness should also incorporate components that target modifiable risk factors such as sleep and stress.
Collapse
|
6
|
Elovainio M, Airaksinen J, Nyberg ST, Pentti J, Pulkki-Råback L, Alonso LC, Suvisaari J, Jääskeläinen T, Koskinen S, Kivimäki M, Hakulinen C, Komulainen K. Estimating risk of loneliness in adulthood using survey-based prediction models: A cohort study. J Psychiatr Res 2024; 177:66-74. [PMID: 38981410 DOI: 10.1016/j.jpsychires.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/30/2024] [Accepted: 06/24/2024] [Indexed: 07/11/2024]
Abstract
It is widely accepted that loneliness is associated with health problems, but less is known about the predictors of loneliness. In this study, we constructed a model to predict individual risk of loneliness during adulthood. Data were from the prospective population-based FinHealth cohort study with 3444 participants (mean age 55.5 years, 53.4% women) who responded to a 81-item self-administered questionnaire and reported not to be lonely at baseline in 2017. The outcome was self-reported loneliness at follow-up in 2020. Predictive models were constructed using bootstrap enhanced LASSO regression (bolasso). The C-index from the final model including 11 predictors from the best bolasso -models varied between 0.65 (95% CI 0.61 to 0.70) and 0.71 (95% CI 0.67 to 0.75) the pooled C -index being 0.68 (95% CI 0.61 to 0.75). Although survey-based individualised prediction models for loneliness achieved a reasonable C-index, their predictive value was limited. High detection rates were associated with high false positive rates, while lower false positive rates were associated with low detection rates. These findings suggest that incident loneliness during adulthood. may be difficult to predict with standard survey data.
Collapse
Affiliation(s)
- Marko Elovainio
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland.
| | | | - Solja T Nyberg
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Jaana Pentti
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Pulkki-Råback
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Cachon Alonso
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | | | - Seppo Koskinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mika Kivimäki
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland; UCL Brain Sciences, University College London, London, UK
| | - Christian Hakulinen
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Kaisla Komulainen
- Department of Psychology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
7
|
Fenner M, Wilson T, Riley A, Culyba AJ. Exploring adolescent-adult connections, coping, and safety among minoritized youth in neighborhoods impacted by community violence. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:618-630. [PMID: 38477172 DOI: 10.1111/jora.12924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/16/2023] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
Dyadic interviews were conducted with 32 youth ages 13-21 and their self-identified key adult supports to illuminate how adult supports help protect youth in communities impacted by high levels of violence. Interview transcripts were analyzed using thematic content analysis. Youth described choosing social interactions carefully, avoiding high-violence areas, and keeping busy with activities. Many youths discussed the necessity of minimizing contact with peers to avoid violence, resulting in isolation from friends and increased engagement with family at home. Adult supports reflected upon an intergenerational transfer of violence avoidance, safety planning, and coping strategies through sharing their own lived experiences. Dyads highlighted the need for intergenerational programming to address social isolation and build supportive social networks.
Collapse
Affiliation(s)
- Maxine Fenner
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tyia Wilson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alexander Riley
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alison J Culyba
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Cheung MMY, Lewis S, Raja R, Willis K, Dubbin L, Rogers A, Moensted ML, Smith L. Disruption and Improvisation: Experiences of Loneliness for People With Chronic Illness. QUALITATIVE HEALTH RESEARCH 2024:10497323241265329. [PMID: 39186640 DOI: 10.1177/10497323241265329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2024]
Abstract
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.
Collapse
Affiliation(s)
- Melissa Mei Yin Cheung
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Sophie Lewis
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Revati Raja
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Karen Willis
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Leslie Dubbin
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Anne Rogers
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Maja Lindegaard Moensted
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
- Central Clinical School, Discipline of Addiction Medicine, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| |
Collapse
|
9
|
Klesiora M, Tsaras K, Papathanasiou IV, Malliarou M, Bakalis N, Kourkouta L, Melas C, Kleisiaris C. Frailty Assessment and Its Impact on Loneliness among Older Adults Receiving Home-Based Healthcare during the COVID-19 Pandemic. Healthcare (Basel) 2024; 12:1666. [PMID: 39201224 PMCID: PMC11353754 DOI: 10.3390/healthcare12161666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/31/2024] [Accepted: 08/19/2024] [Indexed: 09/02/2024] Open
Abstract
The purpose of this study was to identify the effect of frailty on loneliness among older adults receiving home care, in correlation to their socioeconomic and homebound statuses. This cross-sectional study recruited 218 individuals aged ≥65 years receiving home-based health services from the "Help at Home" program in the Region of Evrytania, Greece through an open invitation from the municipality authorities from March to June 2022. The Tilburg Frailty Indicator (TFI) was used for the evaluation of frailty, the UCLA Loneliness Scale version 3 was used for loneliness, and social isolation was accessed through five questions (living alone, frequency of interaction with children, relatives, friends, and participation in social organizations). The mean age of the participants was 81.48 ± 9.06, 61.9% were female, 54.1% experienced high levels of loneliness (UCLA-3 mean 45.76 ± 11.10 [range 20-68]), and 46.3% of the participants were found to be socially isolated. Also, 58.3% of the individuals were identified as frail (TFI mean 5.95 ± 3.07) [TFI range 0-13], with 57.3% experiencing physical frailty, 43.6% experiencing psychological frailty, and 27.1% experiencing social frailty. An analysis of covariance (ANCOVA) using UCLA-3 as the dependent variable revealed that loneliness across all domains of TFI was significantly higher in participants with frailty (total frailty [Yes] 49.27 vs. [No] 40,87 p < 0.001) (physical frailty [Yes] = 48.99 vs. [No] = 41.42, p < 0.001, psychological: 48.60 vs. 43.57 p < 0.001, and social: 53.38 vs. 42.94 p < 0.001), particularly compared to non-frail individuals, even after adjusting for potential confounding effects (covariates: gender, age, marital status, family status, living status, educational level, annual income, chronic diseases, homebound status, and social isolation). Our findings indicate that frail older adults experienced higher levels of loneliness, suggesting that frailty and loneliness are independently associated among older adults who receive home-based healthcare.
Collapse
Affiliation(s)
- Maria Klesiora
- Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece; (M.K.); (K.T.); (I.V.P.); (M.M.)
| | - Konstantinos Tsaras
- Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece; (M.K.); (K.T.); (I.V.P.); (M.M.)
| | - Ioanna V. Papathanasiou
- Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece; (M.K.); (K.T.); (I.V.P.); (M.M.)
| | - Maria Malliarou
- Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece; (M.K.); (K.T.); (I.V.P.); (M.M.)
| | - Nikolaos Bakalis
- Department of Nursing, University of Patras, 26334 Patras, Greece;
| | - Lambrini Kourkouta
- Department of Nursing, International Hellenic University, Sindos, 57400 Thessaloniki, Greece;
| | - Christos Melas
- Department of Nursing, Hellenic Mediterranean University, 71410 Heraklion, Greece
| | - Christos Kleisiaris
- Department of Nursing, University of Thessaly, Gaiopolis, 41500 Larissa, Greece; (M.K.); (K.T.); (I.V.P.); (M.M.)
| |
Collapse
|
10
|
Hornstein E, Lazar L, Eisenberger N. Loneliness and the persistence of fear: Perceived social isolation reduces evaluative fear extinction. PLoS One 2024; 19:e0303895. [PMID: 39159214 PMCID: PMC11333009 DOI: 10.1371/journal.pone.0303895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/02/2024] [Indexed: 08/21/2024] Open
Abstract
Loneliness has been linked to a host of harmful physical and mental health outcomes, detrimental effects that may stem from increases in threat-responding caused by altered fear learning in lonely individuals. In particular, the heightened threat-vigilance that is a hallmark of loneliness may augment the processes by which fear learning occurs, ultimately resulting in a greater number of perceived threatening cues in the environment. However, almost no research has examined how loneliness alters fear learning processes in humans. Here, we investigated the effect of loneliness on fear learning during an evaluative learning procedure in which participants (n = 782) were taught to associate fearful, positive, or neutral control stimuli with neutral images. Results showed that reduced extinction of evaluative fear associations occurred in high (vs. low) lonely individuals, but there was no difference in extinction of evaluative appetitive (also known as positive or reward) associations, suggesting this effect is specific to fear learning. In addition to shedding light on the link between loneliness and poor health, these results represent an important step forward in the growing understanding of the powerful impact of social bonds on fear learning processes.
Collapse
Affiliation(s)
- Erica Hornstein
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Lee Lazar
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, United States of America
| | - Naomi Eisenberger
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, United States of America
| |
Collapse
|
11
|
Tang VFY, Jiang D, Kwok JYY, Qian M, Yeung DYL, Chow EOW, Choi NG, Chou KL. Study protocol of a sequential, multiple assignment, randomised trial using an adaptive intervention to reduce loneliness among Chinese older adults in Hong Kong. BMJ Open 2024; 14:e087245. [PMID: 39153786 PMCID: PMC11331834 DOI: 10.1136/bmjopen-2024-087245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Loneliness is a prevalent and alarming issue among older adults that requires effective interventions. While randomised controlled trials have been commonly undertaken to explore reduction in loneliness, there is a growing recognition that a comprehensive treatment strategy involving multiple interventions may yield better outcomes. Therefore, this study aims to develop and identify a two-stage adaptive intervention that combines telephone-delivered behavioural activation (Tele-BA) and mindfulness techniques (Tele-MF) to reduce loneliness in older adults in Hong Kong. METHODS A Sequential, Multiple Assignment, Randomised Trial (SMART) design will be adopted. 244 lonely older adults will be recruited from the community and randomly assigned to either one of the 4-week two-stage, embedded adaptive interventions involving different sequences and dosages of Tele-BA and Tele-MF (eg, 4 weeks of Tele-BA followed by booster sessions for responders or 4 weeks of Tele-BA followed by 4 weeks of Tele-BA with motivational component or 4 weeks of Tele-MF for non-responders) based on a set of decision rules. The primary outcome will be loneliness measured by the Revised University of California Los Angeles (UCLA) Loneliness Scale. Secondary outcomes, such as De Jong Gierveld Loneliness Scale, perceived stress, sleep quality and depressive and anxiety symptoms, will be assessed. Adhering to the intention-to-treat principles, the data will be analysed using linear mixed models. The findings may have implications for the development of psychosocial adaptive interventions involving BA and MF to reduce loneliness and improve well-being among older adults in Hong Kong using the SMART design. ETHICS AND DISSEMINATION Ethical approval was obtained by the Human Research Ethics Committee at The Education University of Hong Kong (reference: 2022-2023-0117). The findings from this study will be presented in academic conferences and submitted for publication. TRIAL REGISTRATION NUMBER ChiCTR2300077472.
Collapse
Affiliation(s)
- Vivien Foong Yee Tang
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Da Jiang
- Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong, Hong Kong
| | - Jojo Yan Yan Kwok
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Min Qian
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Dannii Yuen-lan Yeung
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong, Hong Kong, Hong Kong
| | - Esther Oi Wah Chow
- Department of Social Work, Hong Kong Shue Yan University, Hong Kong, Hong Kong
| | - Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
| | - Kee Lee Chou
- Department of Social Sciences and Policy Studies, The Education University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
12
|
Hajek A, Sutin AR, Posi G, Stephan Y, Peltzer K, Terracciano A, Luchetti M, König HH. Chronic loneliness and chronic social isolation among older adults. A systematic review, meta-analysis and meta-regression. Aging Ment Health 2024:1-16. [PMID: 39126212 DOI: 10.1080/13607863.2024.2385448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to examine the prevalence and antecedents/consequences of chronic loneliness and social isolation (i.e. enduring or persistent experience that extends over a certain period of time) among older adults. Moreover, we conducted a meta-regression to explore sources of heterogeneity. METHOD A search was conducted in four electronic databases. We included observational studies that reported prevalence and, where available, antecedents/consequences of chronic loneliness or chronic social isolation amongst older adults. Key characteristics of the studies were extracted. RESULTS Across 17 studies included in the meta-analysis, the estimated prevalence of chronic loneliness was 20.8% (95% CI: 16.1-25.5%), including 21.7% among women (95% CI: 16.1-27.4%) and 16.3% among men (95% CI: 10.6-21.9%). One study reported chronic social isolation (13.4%) and found that chronic social isolation predicted higher depression scores. Meta-regressions indicated that loneliness was less prevalent when assessed with single-item measures. Regarding antecedents/consequences, spousal loss can contribute to chronic loneliness which in turn may contribute to adverse health-related outcomes. CONCLUSION About one in five older adults experiences chronic loneliness reflecting the need to address chronic loneliness. More longitudinal research is needed on chronic loneliness and social isolation, particularly from low and middle-income countries.
Collapse
Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Angelina R Sutin
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Giuliana Posi
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | | | - Karl Peltzer
- Department of Health Education and Behavioral Sciences, Faculty of Public Health, Mahidol University, Bangkok, Thailand
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | | | - Martina Luchetti
- College of Medicine, Florida State University, Tallahassee, FL, USA
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| |
Collapse
|
13
|
Raygani S, Martyn-Nemeth P, Park LG. Addressing the Epidemic of Loneliness and Social Isolation for Cardiovascular Health. J Cardiovasc Nurs 2024:00005082-990000000-00214. [PMID: 39116381 DOI: 10.1097/jcn.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
|
14
|
Grace K, Remington A, Davies J, Crane L. Evaluating measures to assess loneliness in autistic adults. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1959-1971. [PMID: 38143433 PMCID: PMC11301961 DOI: 10.1177/13623613231217056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
LAY ABSTRACT There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people.
Collapse
|
15
|
Imai A, Matsuoka T, Nakayama C, Hashimoto N, Sano M, Narumoto J. Effectiveness of a Virtual Reality Open-Air Bath Program in Reducing Loneliness and Improving Brain Function for Dementia Prevention in Older Adults: Protocol for a Prospective Randomized Crossover Study. JMIR Res Protoc 2024; 13:e57101. [PMID: 39088243 PMCID: PMC11327636 DOI: 10.2196/57101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/23/2024] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Older adults often face loneliness due to chronic illness or loss of close ones, a situation worsened by the COVID-19 pandemic. Increased loneliness heightens the risk of diseases, especially dementia, necessitating urgent action. OBJECTIVE This study aims to assess the impact of a virtual reality (VR)-based open-air bath program on depression and loneliness in older individuals with subjective cognitive decline/mild cognitive impairment attending the Dementia Medical Center in Kyoto, Japan. We further aim to evaluate the feasibility of the program (participant recruitment and adherence) and to measure program enjoyment and satisfaction. METHODS The study design is a crossover trial with a 1:1 ratio, wherein 12 participants will be randomly assigned to groups 1 and 2, with group 2 serving as a waitlist control and group 1 receiving the VR program from the onset for 6 months; the VR program will be conducted 6 times (monthly). Program completion for group 1 will be followed by an observation period from months 7 to 12. Group 2 will participate in the VR program from months 7 to 12, with an observation period from months 1 to 6. Cognitive tests, psychiatric assessments, and the University of California, Los Angeles Loneliness Scale will be conducted before the study, at 6 months, and at 12 months. Results will be analyzed using repeated-measures ANOVA. Head magnetic resonance imaging and single-photon emission computed tomography scans will be performed before and after the VR program to evaluate changes and effects on brain regions. RESULTS Recruitment began in September 2023 and data collection is expected to be completed by March 2025. Complete study results will be published by September 2025. CONCLUSIONS This study examines the preliminary effects of VR on loneliness in older adults with predementia through open-air bath simulations. VR experiences could benefit this population, particularly those with limited outdoor activities. Quantifying VR's impact will aid in determining the size for a larger clinical trial. Qualitative results will inform participation mechanisms and guide the implementation and design of future trials. TRIAL REGISTRATION University hospital Medical Information Network UMIN000052667; https://tinyurl.com/3yaccay5. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/57101.
Collapse
Affiliation(s)
- Ayu Imai
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Teruyuki Matsuoka
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Department of Psychiatry, National Hospital Organization Maizuru Medical Center, Maizuru, Japan
| | - Chikara Nakayama
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Nana Hashimoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mutsuo Sano
- Department of Information Science and Technology, Osaka Institute of Technology, Osaka, Japan
| | - Jin Narumoto
- Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| |
Collapse
|
16
|
Finch EF, Kealy D. Loneliness in narcissistic vulnerability: Examining domains of personality functioning. Personal Ment Health 2024; 18:259-268. [PMID: 38666522 DOI: 10.1002/pmh.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 04/17/2024] [Indexed: 08/13/2024]
Abstract
Research has indicated loneliness to be a detrimental correlate of narcissistic vulnerability. However, no research has examined if this relationship persists across time or why it occurs. The present study explores the link between narcissistic vulnerability and loneliness across time and examines which domains of personality dysfunction (i.e., identity, self-direction, empathy, and intimacy) may account for why narcissistic vulnerability is related to loneliness. Adult participants (N = 298) were recruited from Prolific and completed study questionnaires assessing narcissistic vulnerability, narcissistic grandiosity, loneliness, domains of self and interpersonal functioning, and neuroticism. Two months later, participants repeated the measure of loneliness. Correlations among all study variables were calculated, followed by linear regression analyses to investigate how personality functioning domains may mediate the longitudinal relationship between narcissistic vulnerability and loneliness. The effects of baseline loneliness, relationship status, and trait neuroticism were controlled for. Narcissistic vulnerability, but not narcissistic grandiosity, was associated with loneliness at baseline and 2 months later. Intimacy functioning, but not identity, self-direction, or empathy functioning, was a significant mediator of the relationship between narcissistic vulnerability and loneliness over time. These findings suggest that narcissistic vulnerability may contribute to the development or maintenance of loneliness across time, highlighting the role of impaired intimacy functioning in this relationship. The impact of these findings on our understanding of interpersonal functioning in narcissistic vulnerability, as well as clinical implications, is discussed.
Collapse
Affiliation(s)
- Ellen F Finch
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - David Kealy
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Millett G, Franco G, Fiocco AJ. A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care. Aging Ment Health 2024; 28:1169-1178. [PMID: 38709573 DOI: 10.1080/13607863.2024.2345776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 04/15/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVES In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months. METHOD Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months. RESULTS Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources). CONCLUSION Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.
Collapse
Affiliation(s)
- Geneva Millett
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Giselle Franco
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - Alexandra J Fiocco
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| |
Collapse
|
18
|
Mobach L, Wolters NE, Klein AM, Koelen JA, Vonk P, van der Heijde CM, Wuthrich VM, Rapee RM, Wiers RW. Temporal associations of emotional and social loneliness and psychosocial functioning in emerging adulthood. Scand J Psychol 2024. [PMID: 39036816 DOI: 10.1111/sjop.13056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 06/26/2024] [Accepted: 06/30/2024] [Indexed: 07/23/2024]
Abstract
Emerging adulthood is an important developmental phase often accompanied by peaks in loneliness, social anxiety, and depression. However, knowledge is lacking on how the relationships between emotional loneliness, social loneliness, social isolation, social anxiety and depression evolve over time. Gaining insight in these temporal relations is crucial for our understanding of how these problems arise and maintain each other across time. Young adults from a university sample (N = 1,357; M = 23.60 years, SD = 6.30) filled out questionnaires on emotional and social loneliness, social isolation, depressive and social anxiety symptoms at three time points within a 3-year period. Random intercept cross-lagged panel models were used to disentangle reciprocal and prospective associations of loneliness subtypes, social isolation, depressive and social anxiety symptoms across time. Results showed that on the within-person level, increases in emotional and social loneliness as well as social isolation predicted higher depression levels on later timepoints. Increases in depressive symptoms also predicted increases in subsequent social loneliness, but not in emotional loneliness. Finally, increases in depressive symptoms predicted increases in social isolation. There were no significant temporal relations between loneliness and social isolation on the one hand and social anxiety symptoms on the other hand. Social distancing imposed by COVID-19 related government restrictions may have impacted the current results. The findings suggest that emotional and social loneliness precede development of depressive symptoms, which in turn precedes development of social loneliness and social isolation, indicating a potential vicious cycle of social loneliness, social isolation and depressive symptoms in emerging adulthood. Social anxiety did not precede nor follow loneliness, depressive symptoms, or social isolation. The current study sheds more light on the temporal order of loneliness and psychopathological symptoms and hereby assists in identifying times where prevention and intervention efforts may be especially helpful to counter development of depression and loneliness.
Collapse
Affiliation(s)
- Lynn Mobach
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Institute for Integrated Mental Health Care Pro Persona, Nijmegen, the Netherlands
| | - Nine E Wolters
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
- General Practitioners Practice UvA-HvA, University of Amsterdam, Amsterdam, the Netherlands
| | - Anke M Klein
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Developmental and Educational Psychology, Leiden University, Leiden, the Netherlands
| | - Jurrijn A Koelen
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Psychology, Health & Technology, University of Twente, Twente, the Netherlands
| | - Peter Vonk
- General Practitioners Practice UvA-HvA, University of Amsterdam, Amsterdam, the Netherlands
| | | | | | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Reinout W Wiers
- Developmental Psychology, University of Amsterdam, Amsterdam, the Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, the Netherlands
| |
Collapse
|
19
|
Taylor HO, Chen YC, Tsuchiya K, Cudjoe TKM, Qin W, Nguyen AW, Roy A. Racial/Ethnic Differences in Loneliness Among Older Adults: The Role of Income and Education as Mediators. Innov Aging 2024; 8:igae068. [PMID: 39139381 PMCID: PMC11319872 DOI: 10.1093/geroni/igae068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Indexed: 08/15/2024] Open
Abstract
Background and Objectives Loneliness is a major public health concern; however, limited research has examined the mechanisms contributing to racial/ethnic inequities in loneliness. Race/ethnicity has been hypothesized to be a distal factor influencing loneliness, and racial/ethnic inequities in loneliness may be attributable to socioeconomic factors (e.g., income and education). Our study seeks to confirm these hypotheses by examining mechanisms that contribute to racial/ethnic inequities in loneliness. In other words, if racial/ethnic differences in loneliness among older adults are mediated by income and education. Research Design and Methods Data came from the Health and Retirement Study Leave-Behind Questionnaire, 2014-2016. Loneliness was measured by the UCLA 3-item loneliness scale. Race/ethnicity categories were White, Black, and Hispanic/Latino. The mediator variables were household income and education. Multivariable linear regression models were used to determine differences in loneliness by race/ethnicity. The Karlson-Holm-Breen (KHB) mediation method was used to determine if income and education mediated racial/ethnic differences in loneliness. Results In models examining income and education together, a complete mediation was found between White and Black older adults, in that income and education completely mediated differences in loneliness between these groups. A partial mediation was found between White and Hispanic, and Black and Hispanic older adults. When examining income and education separately, we found that income solely accounted for racial/ethnic differences in loneliness compared to education. Discussion and Implications Our study is the first to explicitly determine if socioeconomic factors mediate race/ethnicity differences in loneliness among a national sample of older adults. These findings illustrate that income may have greater proximate effects for loneliness among older adults in comparison to education. Additionally, these findings can inform evidence-based interventions to reduce loneliness among older adults. Interventions that enhance quality of life and provide opportunities for socialization for racialized low-income older adults may help decrease racial/ethnic inequities in loneliness.
Collapse
Affiliation(s)
- Harry Owen Taylor
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Yu-Chih Chen
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Kazumi Tsuchiya
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Thomas K M Cudjoe
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Weidi Qin
- Sandra Rosenbaum School of Social Work, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ann W Nguyen
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA
| | - Arka Roy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Patil U, Braun KL. Interventions for loneliness in older adults: a systematic review of reviews. Front Public Health 2024; 12:1427605. [PMID: 39091527 PMCID: PMC11291379 DOI: 10.3389/fpubh.2024.1427605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/05/2024] [Indexed: 08/04/2024] Open
Abstract
Loneliness in older persons is a major risk factor for adverse health outcomes. Before the COVID-19 pandemic led to unprecedented isolation and hampered programs aimed at preventing or reducing loneliness, many interventions were developed and evaluated. However, previous reviews provide limited or conflicting summaries of intervention effectiveness. This systematic review aimed to assess previous review quality and bias, as well as to summarize key findings into an overarching narrative on intervention efficacy. The authors searched nine electronic databases and indices to identify systematic reviews of interventions to reduce loneliness in older people prior to the COVID-19 pandemic; 6,925 records were found initially. Of these, 19 reviews met inclusion criteria; these encompassed 101 unique primary intervention studies that varied in research design, sample size, intervention setting, and measures of loneliness across 21 nations. While 42% of reviews had minimal risk of bias, only 8% of primary studies appraised similarly. Among the 101 unique articles reviewed, 63% of tested interventions were deemed by article author(s) as effective or partially effective. Generally, interventions that included animals, psychological therapies, and skill-building activities were more successful than interventions focused on social facilitation or health promotion. However, interventions that targeted multiple objectives aimed at reducing loneliness (e.g., improving social skills, enhancing social support, increasing social opportunities, and changing maladaptive social cognition) were more effective than single-objective interventions. Future programs should incorporate multiple approaches, and these interventions should be rigorously tested.
Collapse
Affiliation(s)
- Uday Patil
- Office of Public Health Studies, Thompson School of Social Work & Public Health, University of Hawaiʻi at Mānoa, Honolulu, HI, United States
| | | |
Collapse
|
21
|
Hansen T, Nes RB, Hynek K, Nilsen TS, Reneflot A, Stene-Larsen K, Tornes RA, Bidonde J. Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness. BMC Public Health 2024; 24:1917. [PMID: 39020331 PMCID: PMC11256365 DOI: 10.1186/s12889-024-19396-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 07/08/2024] [Indexed: 07/19/2024] Open
Abstract
BACKGROUND Social isolation and loneliness are urgent public health concerns associated with negative physical and mental health outcomes. Understanding effective remedies is crucial in addressing these problems. This umbrella review aimed to synthesize and critically appraise scientific evidence on the effectiveness of social isolation and loneliness interventions overall and across subgroups. We focused on systematic reviews (SRs) of randomized controlled trials (RCTs). METHODS We searched seven databases (June 2022 and updated June 2023) and supplemented the search with grey literature and reference screening to identify SRs published since 2017. Screening, data extraction, and quality assessment using the AMSTAR2 tool were conducted independently by author pairs, with disagreements resolved through discussion. RESULTS We included 29 SRs, 16 with meta-analysis and 13 with narrative synthesis. All SRs focused on loneliness, with 12 additionally examining social isolation. Four SRs focused on young people, 11 on all ages, and 14 on older adults. The most frequently examined intervention types were social (social contact, social support), psychological (therapy, psychoeducation, social skills training), and digital (e.g., computer use and online support). Meta-analyses indicated small-to-moderate beneficial effects, while narrative synthesis demonstrated mixed or no effect. Social interventions for social isolation and psychological interventions for loneliness were the most promising. However, caution is warranted due to the effects' small magnitude, significant heterogeneity, and the variable quality of SRs. Digital and other interventions showed mixed or no effect; however, caution is advised in interpreting these results due to the highly diverse nature of the interventions studied. CONCLUSIONS This overview of SRs shows small to moderate effectiveness of social interventions in reducing social isolation and psychological ones in tackling loneliness. Further rigorously conducted RCTs and SRs are needed to guide policy decisions regarding the implementation of efficacious and scalable interventions. Evaluation should focus on both preventive structural interventions and tailored mitigating strategies that address specific types and causes of loneliness.
Collapse
Affiliation(s)
- Thomas Hansen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway.
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway.
| | - Ragnhild Bang Nes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Kamila Hynek
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Thomas Sevenius Nilsen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
- Promenta Research Center, Department of Psychology, University of Oslo, Oslo, Norway
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Kim Stene-Larsen
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Ragnhild Agathe Tornes
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Julia Bidonde
- School of Rehabilitation Science, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
22
|
Zhu L, Yang J, Yuan J. The use of multilevel emotion regulation strategies in the context of critical public events: the more the better? Front Psychol 2024; 15:1403308. [PMID: 39077198 PMCID: PMC11285105 DOI: 10.3389/fpsyg.2024.1403308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/01/2024] [Indexed: 07/31/2024] Open
Abstract
Critical public events, like COVID-19, significantly impact individuals' emotional and mental health. People tend to use multi-level emotion regulation strategies (intrapersonal, interpersonal and hyper-personal) to cope with these events, resulting in various strategy profiles. However, few studies have examined ER strategies from a multilevel perspective. Therefore, this study examines the use of multi-level strategies during COVID-19, and evaluates the effectiveness of these strategies, with a particular interest in identifying strategy profiles promoting mental health. We conducted a two-wave study (an interval of 1 week) using online questionnaires during COVID-19, with an initial sample of 1,189 participants and 895 samples completing the surveys across the two waves. Cross-lagged analysis indicated that experiential avoidance was reciprocally positively related to negative emotions while perspective-taking and humorous-meme-saving were reciprocally positively related to life satisfaction or positive emotions over time. Cluster analysis suggested that there were 9 different profiles which scored differently on mental health indicators. Specifically, the use of multi-level strategies tended to be associated with greater positive emotions and life satisfaction while with lower negative emotions and loneliness. This study revealed that the use of multi-level strategies plays a protective role in mental health when facing critical public events. These findings expanded our understanding of how multilevel emotion regulation strategies impact mental health during critical public events and identify protective profiles for mental health.
Collapse
Affiliation(s)
- Leling Zhu
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jiemin Yang
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
| | - Jiajin Yuan
- Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, China
- Sichuan Key Laboratory of Psychology and Behavior of Discipline Inspection and Supervision, Sichuan Normal University, Chengdu, China
| |
Collapse
|
23
|
Bucaktepe PGE, Akgül F, Çelİk SB. Evaluation of the effects of pandemic-related fears on anxiety and depression: the mediating roles of traumatic stress and loneliness. BMC Psychol 2024; 12:388. [PMID: 38997784 PMCID: PMC11241983 DOI: 10.1186/s40359-024-01880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic. METHODS A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software. RESULTS Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively). CONCLUSIONS The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.
Collapse
Affiliation(s)
| | - Fethiye Akgül
- Department of Infectious Diseases and Clinical Microbiology, Batman Training and Research Hospital, Batman, Turkey
| | - Sercan Bulut Çelİk
- Batman GAP Family Health Center, Provincial Health Directorate, Batman, Turkey
| |
Collapse
|
24
|
Corbin IM, Dhand A. Unshared Minds, Decaying Worlds: Towards a Pathology of Chronic Loneliness. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2024; 49:354-366. [PMID: 38815253 PMCID: PMC11237889 DOI: 10.1093/jmp/jhae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
The moment when a person's actual relationships fall short of desired relationships is commonly identified as the etiological moment of chronic loneliness, which can lead to physical and psychological effects like depression, worse recovery from illness and increased mortality. But, this etiology fails to explain the nature and severe impact of loneliness. Here, we use philosophical analysis and neuroscience to show that human beings develop and maintain our world-picture (our sense of what is true, important, and good) through joint attention and action, motivated by friendship, in the Aristotelian sense of "other selves" who share a sense of the true and the good, and desire the good for each other as much as for themselves. The true etiological event of loneliness is the moment one's world-picture becomes unshared. The pathogenesis is a resultant decay of our world-picture, with brain and behavior changes following as sequelae.
Collapse
Affiliation(s)
| | - Amar Dhand
- Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
25
|
Wilson L, Rice C, Thompson S. Social Participation and Loneliness in Older Adults in a Rural Australian Context: Individual and Organizational Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:886. [PMID: 39063463 PMCID: PMC11276585 DOI: 10.3390/ijerph21070886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024]
Abstract
A rise in aging populations globally calls attention to factors that influence the well-being and health of older adults, including social participation. In Australia, rural older adults face cultural, social, and physical challenges that place them at risk for isolation. Thus, research surrounding social participation and healthy aging is increasingly relevant, especially in rural areas. This qualitative study in a remote town in Western Australia explores barriers and facilitators to older adults' social participation. To investigate multiple perspectives, 23 adults aged 50+ and 19 organizations from a rural town were interviewed. A stakeholder reference group was engaged to refine the research design and validate the findings. Feedback from early interviews was used to refine the data collection process, thus enhancing the validity of the findings. Thematic analysis showed that health and mobility issues, inadequate infrastructure, poor sustainability, and cultural tensions commonly impacted social participation. Themes of rural town culture, cultural power dynamics, and rural stoicism were identified as cultural aspects that inhibited participation. Based on results of this study and the supporting literature, recommendations for inclusive activities include supporting community-designed programs, utilizing culturally sensitive language and personnel, expanding services using existing community resources, and diversifying older adults' roles in existing groups.
Collapse
Affiliation(s)
- Leah Wilson
- Department of Global Health, Georgetown University, Washington, DC 20057, USA
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6009, Australia;
| | - Carrigan Rice
- Department of Global Health, Georgetown University, Washington, DC 20057, USA
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6009, Australia;
| | - Sandra Thompson
- Western Australian Centre for Rural Health, University of Western Australia, Geraldton, WA 6009, Australia;
| |
Collapse
|
26
|
Liu X, Yue J, Yang Y. Why So Lonely? The Direct and Indirect Associations between Developmental Trajectories of Fear of Negative Evaluation, Prosocial Behavior and Loneliness in Adolescence. J Youth Adolesc 2024; 53:1699-1710. [PMID: 38446286 DOI: 10.1007/s10964-024-01959-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024]
Abstract
Fear of negative evaluation and prosocial behavior have been identified as predictive factors influencing the development of loneliness in adolescence, representing typical factors in the cognitive and behavioral processes of re-affiliation. The elucidation of plausible direct and indirect pathways linking these pivotal factors to adolescents' loneliness need further exploration. This study aimed to investigate the direct and indirect relationships between the fear of negative evaluation, prosocial behavior, and adolescents' loneliness through the lens of developmental changes. A total of 533 adolescents (49.0% girls, Mage = 15.18 years, SD = 0.71) participated in this longitudinal study, assessed at three timepoints over a span of two years with 12-month intervals. Latent growth modeling uncovered direct associations between the developmental trajectories of both fear of negative evaluation and prosocial behavior with the developmental trajectory of adolescents' loneliness. The developmental trajectory of fear of negative evaluation exhibited an indirect association with the developmental trajectory of loneliness through the mediating role of prosocial behavior. These findings highlighted the roles of cognitive and behavioral re-affiliation processes, both independently and as mediators, in influencing adolescent loneliness, suggesting that interventions aimed at reducing fear of negative evaluation and promoting prosocial behavior could effectively mitigate adolescents' loneliness.
Collapse
Affiliation(s)
- Xinyi Liu
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China
| | - Jiaying Yue
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
| | - Ying Yang
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Shanghai, 200062, China.
| |
Collapse
|
27
|
Usama SM, Kothari YL, Karthikeyan A, Khan SA, Sarraf M, Nagaraja V. Social Isolation, Loneliness, and Cardiovascular Mortality: The Role of Health Care System Interventions. Curr Cardiol Rep 2024; 26:669-674. [PMID: 38713361 DOI: 10.1007/s11886-024-02066-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 05/08/2024]
Abstract
PURPOSE OF REVIEW The world is proliferating rapidly, with science and technology advancing at an incredible rate. These advances have, however, ushered in an age with a rise in social isolation (SI) and loneliness. SI is an objective term that refers to lacking social contact or support. On the other hand, loneliness is subjective and refers to feeling alone or isolated. These concepts are rapidly gaining prominence mainly due to their negative impact on the physical and psychological health of the population, mainly through behavioural modifications that encompass substance abuse, decreased physical activity and unhealthy food habits, and poor sleep hygiene. This review summarizes the pathophysiology, evaluates the evidence behind impact of SI on cardiovascular mortality, and interventions to overcome SI. RECENT FINDINGS Through proposed mechanisms, such as activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, both SI and loneliness have strong evidence linking them to cardiovascular morbidity and mortality. A systematic review and meta-analysis of 90 prospective cohort studies including 2,205,199 individuals reported that SI was independent predictor of cardiovascular mortality with a point estimate of 1.34 (95% confidence interval:1.25-1.44). The evidence so far is compelling and necessitates urgent action with the implementation of strict policies to tackle this issue. As healthcare professionals, it becomes even more critical to remain vigilant, recognize this insidious pandemic, and take appropriate action.
Collapse
Affiliation(s)
| | - Yash Lalit Kothari
- Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | | | - Syed Anjum Khan
- Department of Critical Care Medicine, Mayo Clinic Health System - Southwest Minnesota Region, Mankato, MN, USA
| | - Mohammad Sarraf
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Vinayak Nagaraja
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| |
Collapse
|
28
|
Wu D, Liu M, Li D, Yin H. The longitudinal relationship between loneliness and both social anxiety and mobile phone addiction among rural left-behind children: A cross-lagged panel analysis. J Adolesc 2024; 96:969-982. [PMID: 38375869 DOI: 10.1002/jad.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/14/2023] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
INTRODUCTION Left-behind children are a special group that needs urgent attention. Due to enduring separation from their parents, loneliness is considered the most common and prevalent developmental hurdle in the experiences of left-behind children. This longitudinal cross-lagged study examined the direction of the association between loneliness and both internalizing and externalizing symptoms, with considering gender and left-behind status differences. METHODS A total of 1175 rural Chinese children (48.3% boys, 39.9% left-behind children, Mage = 14.54 ± 1.18 at baseline) completed self-reported loneliness, social anxiety, and mobile phone addiction at two-time points with 6 months intervals. Descriptive statistics, cross-lagged panel analysis, and multiple group analysis were estimated in the present study. RESULTS Loneliness exacerbated social anxiety and mobile phone addiction, and vice versa. In addition, gender and left-behind status moderated these relationships, with boys more likely to be mobile phone addicted due to loneliness and girls more likely to be lonely due to mobile phone addiction. More importantly, left-behind children with loneliness are more prone to social anxiety and mobile phone addiction, and vice versa, compared with non-left-behind children. CONCLUSIONS The targeted interventions should be carried out for different genders and left-behind statuses. Particularly for left-behind children, neglecting to address both the symptoms of loneliness and both social anxiety and mobile phone addiction could significantly undermine the efficacy of intervention programs that solely target either one of these afflictions.
Collapse
Affiliation(s)
- Dehua Wu
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, Hunan, China
- Cognition and Human Behavior Key Laboratory of Hunan Province, School of Educational Science, Hunan Normal University, Changsha, China
- Center for Mind & Brain Science, School of Educational Science, Hunan Normal University, Changsha, China
| | - Menghua Liu
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, Hunan, China
- Cognition and Human Behavior Key Laboratory of Hunan Province, School of Educational Science, Hunan Normal University, Changsha, China
- Center for Mind & Brain Science, School of Educational Science, Hunan Normal University, Changsha, China
| | - Dan Li
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, Hunan, China
- Cognition and Human Behavior Key Laboratory of Hunan Province, School of Educational Science, Hunan Normal University, Changsha, China
- Center for Mind & Brain Science, School of Educational Science, Hunan Normal University, Changsha, China
| | - Huazhan Yin
- Department of Psychology, School of Education Science, Hunan Normal University, Changsha, Hunan, China
- Cognition and Human Behavior Key Laboratory of Hunan Province, School of Educational Science, Hunan Normal University, Changsha, China
- Center for Mind & Brain Science, School of Educational Science, Hunan Normal University, Changsha, China
| |
Collapse
|
29
|
Frangieh J, Hughes V, Edwards-Capello A, Humphrey KG, Lammey C, Lucas L. Fostering belonging and social connectedness in nursing: Evidence-based strategies: A discussion paper for nurse students, faculty, leaders, and clinical nurses. Nurs Outlook 2024; 72:102174. [PMID: 38761699 DOI: 10.1016/j.outlook.2024.102174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/14/2024] [Accepted: 04/20/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The phenomenon of loneliness among healthcare providers, particularly nurses, has garnered increasing attention due to its detrimental effects on individual well-being and professional retention. The isolation experienced by nurses has been linked to heightened turnover rates and intentions to leave the profession, posing significant challenges to healthcare systems globally. Recognizing loneliness as an epidemic in 2023, the U.S. Surgeon General highlighted the urgency of addressing this issue within the healthcare workforce. PURPOSE This paper explores evidence-based strategies to mitigate loneliness and promote social connectedness among nurses, drawing insights from various stakeholders. It aims to offer actionable recommendations to enhance the nursing experience and retain professionals in the field. DISCUSSION Strategies include peer support programs, mentorship initiatives, wellness activities, and fostering open communication. Leveraging technology for virtual connections is also highlighted, especially in remote work scenarios. CONCLUSION A holistic approach is vital, combining individual, interpersonal, and systemic interventions to combat nurse loneliness. Prioritizing social connectedness fosters a supportive work environment, benefiting both nurses and patient care quality.
Collapse
Affiliation(s)
| | | | | | | | | | - Laura Lucas
- Johns Hopkins School of Nursing, Baltimore, MD
| |
Collapse
|
30
|
Lucjan P, Bird T, Murray C, Lorimer A. Loneliness and psychotic-like experiences in middle-aged and older adults: the mediating role of selective attention to threat and external attribution biases. Aging Ment Health 2024:1-8. [PMID: 38938159 DOI: 10.1080/13607863.2024.2372072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/19/2024] [Indexed: 06/29/2024]
Abstract
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.
Collapse
Affiliation(s)
- Pawel Lucjan
- Department of Clinical Psychology, Older Adult Mental Health Service, NHS Grampian, Aberdeen, UK
| | - Timothy Bird
- School of Health and Social Sciences, University of Edinburgh, Edinburgh, UK
| | - Caroline Murray
- Department of Clinical Psychology, Older Adult Mental Health Service, NHS Grampian, Aberdeen, UK
| | - Angus Lorimer
- Department of Clinical Psychology, Older Adult Mental Health Service, NHS Grampian, Aberdeen, UK
| |
Collapse
|
31
|
McDonald B, Reiter AMF, Kanske P. Theater-based interventions as a means of reducing social isolation and loneliness, facilitating successful aging, and strengthening social cognition in older adults. Front Psychol 2024; 15:1364509. [PMID: 39006549 PMCID: PMC11240220 DOI: 10.3389/fpsyg.2024.1364509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 05/20/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Brennan McDonald
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Saxony, Germany
| | - Andrea M F Reiter
- German Center of Prevention Research on Mental Health, Würzburg, Bavaria, Germany
- Department of Psychology, Faculty of Medicine, University of Würzburg, Würzburg, Germany
- Clinic and Polyclinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Bavaria, Germany
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Saxony, Germany
| |
Collapse
|
32
|
Lange SK, Stig MH, Eghøj M, Petersen CB. Can We Steer Nursing Home Residents Away from Loneliness? A Qualitative Study of Cycling without Age. Geriatrics (Basel) 2024; 9:88. [PMID: 39051252 PMCID: PMC11270177 DOI: 10.3390/geriatrics9040088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Loneliness among nursing home residents is an increasing public health issue and consists of a combination of social, emotional, and existential loneliness. Cycling Without Age (CWA) involves taking nursing home residents on trishaw rides pedaled by trained volunteer 'pilots'. This study aims to explore nursing home residents' lived experiences of CWA and whether participation in CWA can mitigate experiences of loneliness. METHODS A qualitative phenomenological design was used. We conducted three observations and eight interviews: semi-structured interviews (n = 5) and informal interviews (n = 3) with passengers in CWA. Data were analyzed using reflexive thematic analysis. RESULTS Three themes were developed: 1. creating meaningful communities (related to the social mechanism connected to participating in CWA), 2. breaking the monotony of everyday life (related to how the passengers experience CWA as a meaningful activity), and 3. reconnecting to oneself (related to the meaningful experience the passengers have when they are connected to their local communities and reminiscence). CONCLUSION Taking part in CWA may mitigate loneliness, as passengers perceive it as being meaningful. These results strengthen the notion that participating in meaningful activities hold the potential to mitigate feelings of loneliness among nursing home residents.
Collapse
Affiliation(s)
- Sara Kruse Lange
- The Department of Sport Science and Clinical Biomechanics, University of Southern Denmark, 5230 Odense, Denmark
| | - Maiken Hauge Stig
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (M.H.S.); (M.E.)
| | - Martin Eghøj
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (M.H.S.); (M.E.)
| | - Christina Bjørk Petersen
- National Institute of Public Health, University of Southern Denmark, 1455 Copenhagen, Denmark; (M.H.S.); (M.E.)
| |
Collapse
|
33
|
Rotger N. Narrating Loneliness: Isolation, Disaffection, and the Contemporary Novel. THE JOURNAL OF MEDICAL HUMANITIES 2024:10.1007/s10912-024-09855-z. [PMID: 38907866 DOI: 10.1007/s10912-024-09855-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 06/24/2024]
Abstract
This article focuses on the ways in which narrative accounts of loneliness in literature problematize current definitions of this important and yet underexplored determinant of health. I argue that the prevailing conceptualization of loneliness in health research, with a general emphasis on social prescribing, obscures other dimensions of loneliness beyond social connectedness that also need to be accounted for in its definition. Drawing on narrative approaches to health and care and taking as a case study Santiago Lorenzo's Spanish novel Los asquerosos (2018), the article gestures toward a more political-rather than exclusively subjective and relational-reading of loneliness. It shows how the novel's exploration of loneliness as an ambivalent experience of tranquility and disaffection questions whether there is any direct causation between loneliness and aloneness or social isolation, presenting loneliness not so much as a problem or a social pain in need of curing, but as a symptom of a larger structural crisis. The article also reflects on the ability of literary narratives to illuminate, discuss, and ultimately challenge the underlying dynamics of loneliness, raising questions about how we understand these narratives and the type of agency we attribute to them.
Collapse
Affiliation(s)
- Neus Rotger
- Universitat Oberta de Catalunya (UOC), Barcelona, Spain.
| |
Collapse
|
34
|
An SJ, Seo YS. Exploring Loneliness among Korean Adults: A Concept Mapping Approach. Behav Sci (Basel) 2024; 14:492. [PMID: 38920824 PMCID: PMC11201173 DOI: 10.3390/bs14060492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/27/2024] Open
Abstract
In South Korea, the proportion of adults experiencing severe loneliness has been increasing rapidly. Accordingly, this study examines the elements of loneliness experienced by Korean adults and investigates their structural relevance using concept mapping. Korean adults (47) were recruited for individual in-depth interviews based on their scores on the UCLA Loneliness Scale. The interviews yielded 80 unique statements, which were then evaluated using multidimensional scaling and a hierarchical cluster analysis. A cluster map of loneliness was derived, with three clusters: (1) emotional distress due to the actual or anticipated absence of connection in relationships, (2) emotional distance from oneself or from others in a relationship, and (3) powerlessness and emptiness due to being directionless. Two dimensions distinguished these clusters: the lack of a sense of connection or self-assurance, and an inward or outward focus. These findings reveal that loneliness encompasses more than unmet relational needs; it also involves self-attentional focus, indicating a need to reconceptualize the notion of loneliness. The study's implications extend to counseling theory and practices by highlighting the importance of addressing both relational connections and self-perceptions in interventions for loneliness. By expanding the understanding of loneliness through empirical data, this research provides a more comprehensive framework for addressing loneliness.
Collapse
Affiliation(s)
- Soo-Jung An
- Department of Psychotherapy, Myongji University, Seoul 03674, Republic of Korea;
| | - Young-Seok Seo
- Faculty of Education, Yonsei University, Seoul 03722, Republic of Korea
| |
Collapse
|
35
|
Shorer S, Weinberg M, Koko Y, Marom D. "My Scar": Posttraumatic Loneliness as a Source of Pain and Resource for Coping. QUALITATIVE HEALTH RESEARCH 2024; 34:649-661. [PMID: 38243742 PMCID: PMC11103923 DOI: 10.1177/10497323241226599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
Contemporary understanding of combat trauma's psychological effects emphasizes the interpersonal ways survivors process their experiences. Yet cases of incongruence between survivors who want to share their traumatic experience and close others who are not ready to take part in this challenging task are common. Hence, many trauma survivors are compelled to cope with the posttraumatic consequences mostly alone. The present study followed the interpretive phenomenological approach to examine the experience of loneliness, as described by 15 male combat veterans dealing with posttraumatic stress. Participants completed semistructured qualitative interviews in which they shared their knowledge regarding postservice distress, loneliness, coping, and growth. Two main themes emerged: "The Loneliness Complex," highlighting this phenomenon's multifaceted, layered, and cyclical nature; and "Emotional Growth after Loneliness," presenting the positive potential of loneliness. These findings emphasize the importance of interpersonal relations in trauma survivors' recovery process. Participants described how experiences with peers can serve as a pivotal point for coping with postservice distress and how internalization of positive interpersonal interactions seems to be a crucial psychological resource for further rehabilitation and growth. Being a multilayered and cyclical condition, loneliness might serve trauma survivors in their search of safety, while also bearing the potential to motivate them to act upon their condition and promote emotional growth. Clinicians should acknowledge the risks trauma survivors take by leaving their lonely yet safe place, as they are encouraged to process their traumatic experiences and share their inner world with others.
Collapse
Affiliation(s)
- Shai Shorer
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
- B’Shvil, Or Yehuda, Israel
| | - Michael Weinberg
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
| | - Yael Koko
- School of Social Work, Faculty of Social Welfare and Health studies, University of Haifa, Haifa, Israel
| | | |
Collapse
|
36
|
Urbański PK, Tasiemski T, Schroeder K, Lewandowska M, Bojkowski Ł. Loneliness and Coping Styles Among Athletes With Disabilities During the COVID-19 Pandemic. Scand J Med Sci Sports 2024; 34:e14671. [PMID: 38850106 DOI: 10.1111/sms.14671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 04/18/2024] [Accepted: 05/19/2024] [Indexed: 06/09/2024]
Abstract
The study aimed to assess loneliness experiences among athletes with disabilities (AWD) during the different phases of the pandemic and to understand its relationship with coping styles. Ninety-one AWD participated in a longitudinal study spanning 10 months, covering three time points: April (A), June (Time B), and November (Time C) 2021. The study used the Coping Inventory for Stressful Situations and the revised University of California Los Angeles Loneliness Scale-Revised (UCLA-R) to measure coping mechanisms and feelings of loneliness, respectively. Loneliness levels peaked during the most intense phase of the pandemic, showing significant differences between consecutive time points (χ2 = 20.29, p < 0.001, d = 0.24). The most robust regression models were built in Time B, using the "intimate contacts" dimension of loneliness as the dependent variable and "emotion-oriented coping", "avoidance-oriented coping", and "impairment" as independent variables, explaining 44% of the variance (p < 0.001). Loneliness among Paralympic athletes fluctuated during various phases of the pandemic. The findings highlight the significant influence of coping styles, particularly emotional styles which heightened perceived loneliness, and task-oriented styles which reduced it, on athletes' experiences of loneliness. These results underscore the need for longitudinal studies to delve deeper into the relationship between loneliness and mental health. Moreover, they stress the importance of developing tailored interventions that promote effective coping mechanisms in AWD during challenging times amid to COIVID-19.
Collapse
Affiliation(s)
- Piotr Kazimierz Urbański
- Department of Adapted Physical Activity, Poznan University of Physical Education, Poznań, Poland
| | - Tomasz Tasiemski
- Department of Adapted Physical Activity, Poznan University of Physical Education, Poznań, Poland
| | - Kingsley Schroeder
- Department of Psychology, Springfield College, Springfield, Massachusetts, USA
| | | | - Łukasz Bojkowski
- Department of Psychology, Poznan University of Physical Education, Poznań, Poland
| |
Collapse
|
37
|
Magid K, Sagui-Henson SJ, Sweet CC, Smith BJ, Chamberlain CEW, Levens SM. The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study. Int J Behav Med 2024; 31:468-478. [PMID: 37488324 PMCID: PMC11106110 DOI: 10.1007/s12529-023-10204-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Loneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform. METHODS A purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care. RESULTS At baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04). CONCLUSIONS This study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.
Collapse
Affiliation(s)
- Kirby Magid
- University of North Carolina at Charlotte, NC, Charlotte, USA
- Modern Health, San Francisco, CA, USA
| | | | | | | | | | - Sara M Levens
- University of North Carolina at Charlotte, NC, Charlotte, USA
| |
Collapse
|
38
|
Huxhold O, Fiori KL. Understanding loneliness in late life. Curr Opin Psychol 2024; 57:101801. [PMID: 38428351 DOI: 10.1016/j.copsyc.2024.101801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/18/2023] [Accepted: 02/13/2024] [Indexed: 03/03/2024]
Abstract
Loneliness in late adulthood is a public health issue. Thus, understanding the etiology of loneliness is of critical importance. Here, we conceptualize the development of loneliness in late life as dynamic interactions between individual and contextual processes. Specifically, we suggest that loneliness arises if the existing social relationships are unable to meet a set of social expectations. These expectations are fulfilled by three different layers of the social structure: 1) close confidants; 2) broader social networks; and 3) involvement in the community. Although older adults experience losses in their broader network and engage less in the community, they may avoid loneliness by focusing on close confidants. However, these adaptations may make it more difficult for older adults to overcome loneliness.
Collapse
Affiliation(s)
- Oliver Huxhold
- German Centre of Gerontology, Manfred-von-Richthofen-Str 2, D-12101, Berlin, Germany.
| | | |
Collapse
|
39
|
Valdelamar A, de la Hoz F, Sánchez R. Loneliness as a predictor of mortality in cancer patients, a cohort study. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:119-138. [PMID: 39079136 PMCID: PMC11418832 DOI: 10.7705/biomedica.7150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 04/15/2024] [Indexed: 08/04/2024]
Abstract
Introduction. Some studies have indicated that loneliness may be associated with an increased risk of mortality in cancer patients, as it can weaken treatment response and the immune system, and promote harmful behaviors, worsening the prognosis and increasing the likelihood of death. Addressing loneliness in public health is essential to provide social support and improve outcomes in cancer patients. Objective. To obtain an estimator of the unwanted loneliness-mortality association. Materials and methods. We followed a prospective cohort of 400 patients for two years (exposure=loneliness levels; outcome=mortality; sociodemographic and clinical control variables were included). A parametric survival model (log normal) was used. Results. The cohort had a median survival of 20.2 months and a mortality rate of 3.2 deaths/100 patient-months (95% CI: 2.8 to 3.7). The survival model found the following time ratios (TR): moderate level/low level: TR=0.55; 95% CI: 0.39 to 0.77; moderately high level/low level: TR=0.62; 95% CI: 0.41 to 0.93; high level/low level: TR=1.17; 95% CI: 0.31 to 4.42. Conclusion. Compared to patients with low levels of loneliness, patients with moderate or moderately high levels reach death more quickly (statistically significant TRs, adjusted for the effect of other variables in the model); this highlights the need for interventions to mitigate loneliness and promote social support in patients having cancer.
Collapse
Affiliation(s)
- Adriana Valdelamar
- Grupo del Área de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología ESE, Bogotá, D.C., ColombiaInstituto Nacional de Cancerología ESEInstituto Nacional de Cancerología ESEBogotá, D.C.Colombia
- Grupo de Epidemiología y Evaluación en Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., ColombiaUniversidad Nacional de ColombiaUniversidad Nacional de ColombiaBogotá, D.C.Colombia
| | - Fernando de la Hoz
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., ColombiaUniversidad Nacional de ColombiaUniversidad Nacional de ColombiaBogotá, D.C.Colombia
| | - Ricardo Sánchez
- Grupo del Área de Investigación Clínica y Epidemiológica del Cáncer, Instituto Nacional de Cancerología ESE, Bogotá, D.C., ColombiaInstituto Nacional de Cancerología ESEInstituto Nacional de Cancerología ESEBogotá, D.C.Colombia
- Instituto de Investigaciones Clínicas, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., ColombiaUniversidad Nacional de ColombiaUniversidad Nacional de ColombiaBogotá, D.C.Colombia
| |
Collapse
|
40
|
Oken BS, Kaplan J, Klee D, Gallegos AM. Contributions of loneliness to cognitive impairment and dementia in older adults are independent of other risk factors and Alzheimer's pathology: a narrative review. Front Hum Neurosci 2024; 18:1380002. [PMID: 38873650 PMCID: PMC11169707 DOI: 10.3389/fnhum.2024.1380002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/20/2024] [Indexed: 06/15/2024] Open
Abstract
Loneliness significantly contributes to cognitive impairment and dementia in older adults. Loneliness is a distressing feeling resulting from a perceived lack of social connection (i.e., a discrepancy between desired and actual social relationships), while social isolation is a related term that can be defined by number and type of social relationships. Importantly, loneliness is distinct from social isolation in that it is associated with a distressing self-perception. The primary focus of this narrative review is the impact of chronic loneliness on cognitive impairment and dementia among older adults. Loneliness has a significant association with many factors that are related to worse cognition, and therefore we include discussion on health, mental health, as well as the physiological effects of loneliness, neuropathology, and potential treatments. Loneliness has been shown to be related to development of dementia with a hazard ratio (HR) risk comparable to having a single APOE4 gene. The relationship of dementia to loneliness appears to be at least partially independent of other known dementia risk factors that are possibly associated with loneliness, such as depression, educational status, social isolation, and physical activity. Episodic memory is not consistently impacted by loneliness, which would be more typically impaired if the mild cognitive impairment (MCI) or dementia was due to Alzheimer's disease (AD) pathology. In addition, the several longitudinal studies that included neuropathology showed no evidence for a relationship between loneliness and AD neuropathology. Loneliness may decrease resilience, or produce greater cognitive change associated with the same level of AD neuropathology. Intervention strategies to decrease loneliness in older adults have been developed but need to consider key treatment targets beyond social isolation. Loneliness needs to be assessed in all studies of cognitive decline in elders, since it significantly contributes to the variance of cognitive function. It will be useful to better define the underlying mechanism of loneliness effects on cognition to determine if it is similar to other psychological factors related to excessive stress reactivity, such as neuroticism or even depression, which are also associated with cognitive decline. It is important from a health perspective to develop better strategies to decrease loneliness in older adults.
Collapse
Affiliation(s)
- Barry S. Oken
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
- Department of Behavioral Neuroscience, Oregon Health and Science University, Portland, OR, United States
| | - Josh Kaplan
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Daniel Klee
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States
| | - Autumn M. Gallegos
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, United States
| |
Collapse
|
41
|
Bellucci G, Park SQ. Loneliness is associated with more trust but worse trustworthiness expectations. Br J Psychol 2024. [PMID: 38807533 DOI: 10.1111/bjop.12713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/07/2024] [Indexed: 05/30/2024]
Abstract
Subjective feelings of loneliness emerge due to unsatisfactory social relationships, representing a major risk for mental and physical well-being. Despite its social nature, evidence on how loneliness affects social behaviours and expectations is lacking. Using Bayesian analyses and economic games, we show in three different studies that lonelier individuals trusted their partners to a greater extent despite less favourable trustworthiness expectations, showing a greater discrepancy between their trusting behaviours and their expectations of others' trustworthiness. Such discrepancy was reversed in extravert individuals who also reported to be less lonely. These results provide evidence on two opposing effects of loneliness as a motivator for social connections and promoter of social withdrawal, and demonstrate the moderating role of personality traits. This work contributes to a better understanding of how loneliness impacts social behaviour and social expectations, with important downstream clinical implications for varying health conditions associated with heightened feelings of loneliness.
Collapse
Affiliation(s)
- Gabriele Bellucci
- Department of Psychology, Royal Holloway, University of London, Egham, UK
- Department of Psychology I, University of Lübeck, Lübeck, Germany
| | - Soyoung Q Park
- Department of Psychology I, University of Lübeck, Lübeck, Germany
- Department of Decision Neuroscience and Nutrition, German Institute of Human Nutrition (DIfE), Potsdam-Rehbruecke, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Neuroscience Research Center, Berlin, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| |
Collapse
|
42
|
Fanelli G, Robinson J, Fabbri C, Bralten J, Roth Mota N, Arenella M, Sprooten E, Franke B, Kas M, Andlauer TFM, Serretti A. Shared genetics linking sociability with the brain's default mode network. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307883. [PMID: 38826220 PMCID: PMC11142265 DOI: 10.1101/2024.05.24.24307883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
The brain's default mode network (DMN) plays a role in social cognition, with altered DMN function being associated with social impairments across various neuropsychiatric disorders. In the present study, we examined the genetic relationship between sociability and DMN-related resting-state functional magnetic resonance imaging (rs-fMRI) traits. To this end, we used genome-wide association summary statistics for sociability and 31 activity and 64 connectivity DMN-related rs-fMRI traits (N=34,691-342,461). First, we examined global and local genetic correlations between sociability and the rs-fMRI traits. Second, to assess putatively causal relationships between the traits, we conducted bi-directional Mendelian randomisation (MR) analyses. Finally, we prioritised genes influencing both sociability and rs-fMRI traits by combining three methods: gene-expression eQTL MR analyses, the CELLECT framework using single-nucleus RNA-seq data, and network propagation in the context of a protein-protein interaction network. Significant local genetic correlations were found between sociability and two rs-fMRI traits, one representing spontaneous activity within the temporal cortex, the other representing connectivity between the frontal/cingulate and angular/temporal cortices. Sociability affected 12 rs-fMRI traits when allowing for weakly correlated genetic instruments. Combing all three methods for gene prioritisation, we defined 17 highly prioritised genes, with DRD2 and LINGO1 showing the most robust evidence across all analyses. By integrating genetic and transcriptomics data, our gene prioritisation strategy may serve as a blueprint for future studies. The prioritised genes could be explored as potential biomarkers for social dysfunction in the context of neuropsychiatric disorders and as drug target genes.
Collapse
Affiliation(s)
- Giuseppe Fanelli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jamie Robinson
- Global Computational Biology and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
| | - Chiara Fabbri
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Janita Bralten
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nina Roth Mota
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martina Arenella
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - Emma Sprooten
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Barbara Franke
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martien Kas
- Groningen Institute for Evolutionary Life Sciences, University of Groningen, Groningen, The Netherlands
| | - Till FM Andlauer
- Global Computational Biology and Data Sciences, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riß, Germany
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
| |
Collapse
|
43
|
Zhou Y, Ferraro FV, Fan C. Artistic sports activities effectiveness for enhancing students' academic performance among left-behind children: mediating effects of loneliness. Front Psychol 2024; 15:1366501. [PMID: 38770248 PMCID: PMC11104499 DOI: 10.3389/fpsyg.2024.1366501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Numerous studies within the school and academic contexts have underscored the profound impact of psychometric variables such as academic self-efficacy, self-esteem, and loneliness on academic achievement among children. Although physical activities and dance practices are known to bolster academic self-efficacy and enhance academic outcomes, the effect of Artistic Sports Activities on these psychological determinants among left-behind children (LBC) in rural schools remains underexplored. Method This study was conducted from September 2020 to January 2022 among 405 LBCs aged 9 to 13 from six randomly selected primary schools in Hunan Province, China. Schools were chosen in collaboration with the Hunan Women and Children's Federation, ensuring informed consent through stakeholder informational sessions. The study employed rigorous sampling and data analysis methods, including the Shapiro-Wilk test for normal distribution and Cronbach's alpha for reliability, alongside Pearson correlation, independent and paired t-tests, and multiple linear regression analyses to investigate the effects of Artistic Sports Activities on psychometric variables and academic performance among LBCs. Data collection involved standardized questionnaires assessing academic self-efficacy, self-esteem, and loneliness before and after intervention. Results Findings indicate that Artistic Sports Activities significantly improved academic self-efficacy and self-esteem and reduced loneliness, leading to enhanced academic performance. Notably, loneliness was identified as mediating the relationship between academic self-efficacy and self-esteem among LBCs. Discussion The findings highlight the critical role of integrating Artistic Sports Activities in educational frameworks to bolster psychological and academic outcomes for LBCs. The study reveals the intricate interplay between loneliness, self-esteem, and academic self-efficacy, underscoring the necessity for targeted educational interventions.
Collapse
Affiliation(s)
- Yutao Zhou
- Physical Education Institute, Hunan University of Technology, Zhuzhou, China
- Hunan Research Centre for Excellence in Fitness, Health and Performance, Zhuzhou, China
| | - Francesco Vincenzo Ferraro
- Hunan Research Centre for Excellence in Fitness, Health and Performance, Zhuzhou, China
- School of Human Sciences, University of Derby, Derby, United Kingdom
| | - Chengwen Fan
- Physical Education Institute, Hunan University of Technology, Zhuzhou, China
- Hunan Research Centre for Excellence in Fitness, Health and Performance, Zhuzhou, China
| |
Collapse
|
44
|
Hunter SC, Seth R, Houghton S, Lawrence D, Zadow C, Rosenberg M, Wood L, Qualter P, Shilton T. Trajectories of Loneliness During Adolescence Predict Subsequent Symptoms of Depression and Positive Wellbeing. J Youth Adolesc 2024; 53:1078-1090. [PMID: 38129340 PMCID: PMC10980621 DOI: 10.1007/s10964-023-01925-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
There is a need to identify the outcomes of changes in loneliness during adolescence, and to consider this within a multidimensional framework of loneliness. This study considered the effects of different trajectories of change in Isolation Loneliness and in Friendship Loneliness upon both positive wellbeing and symptoms of depression. To achieve this, 1782 (43% female; 12.92 years old at the start of the study, SD = 1.60) young people took part in a longitudinal study with four data points across 2 years. Four Isolation Loneliness trajectories and five Friendship Loneliness trajectories were identified. Youth who experienced low levels of Isolation Loneliness that subsequently increased appear to be at particular risk for poor outcomes. Similarly, initially high levels of Friendship Loneliness that decreased rapidly, or which began at a low level and only increased marginally, seem to also be a risk. Loneliness is a multi-dimensional construct and its development during adolescence impacts upon young people's depressive symptomatology and positive mental wellbeing.
Collapse
Affiliation(s)
- Simon C Hunter
- Glasgow Caledonian University, Cowcaddens Road, Glasgow, G4 0BA, Scotland, UK.
- University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia.
| | - Rebecca Seth
- Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Stephen Houghton
- University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia
- University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XQ, Scotland, UK
| | - David Lawrence
- Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - Corinne Zadow
- University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia
| | - Michael Rosenberg
- University of Western Australia, 35 Stirling Highway, Crawley, 6009, WA, Australia
| | - Lisa Wood
- University of Notre Dame, 23 High Street, Fremantle, WA, Australia
| | - Pamela Qualter
- University of Manchester, Oxford Road, Manchester, M13 9PL, England, UK
| | - Trevor Shilton
- Curtin University, Kent Street, Perth, WA, 6102, Australia
| |
Collapse
|
45
|
Kim J, Lee J. Age-Specific Changes in the Effects of Social Connectedness and Loneliness on Depressive Symptoms: Evidence From the Korean Longitudinal Study of Ageing Before and During the COVID-19 Pandemic. Psychiatry Investig 2024; 21:475-486. [PMID: 38810996 PMCID: PMC11136577 DOI: 10.30773/pi.2023.0268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/15/2024] [Accepted: 02/04/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE This study investigates the longitudinal effects of changes in the associations between two distinct aspects of social connections-i.e., social connectedness and loneliness-on depressive symptoms among community-dwelling Korean adults. This study also examines whether these associations vary across three age groups (45-64, 65-74, and 75 or above). METHODS Using data from the Korean Longitudinal Study of Ageing collected between 2014 and 2020 (n=3,642 individuals), fixed effects models were used to examine the age-specific associations between the two distinct aspects of social connections and depressive symptoms (Center for Epidemiologic Studies-Depression Scale) while, accounting for time-invariant individual heterogeneity. Social connectedness is measured by asking the frequency of interactions with friends, relatives, or neighbors. RESULTS The findings indicate that the impact of loneliness on depressive symptoms outweighs that of social disconnectedness. Notably, this study unveils age-specific patterns concerning the impact of the coronavirus disease-2019 pandemic on depressive symptoms and changes in the association between loneliness and depressive symptoms. Specifically, middle-aged individuals reported higher levels of depressive symptoms and loneliness along with a heightened impact of loneliness on depressive symptoms, despite maintaining stable social connections. Conversely, the oldest adults experienced reductions in both depressive symptoms and loneliness, despite a significant decrease in socializing. CONCLUSION These findings shed light on the differential effects of loneliness on depressive symptoms within distinct age groups before and during the pandemic. The implications of these findings are discussed with a focus on informing the development of targeted policy interventions tailored to the specific needs of different age groups.
Collapse
Affiliation(s)
- Juyeon Kim
- Department of Urban Sociology, University of Seoul, Republic of Korea
| | - Jungtaek Lee
- Department of Economics, Dongguk University, Seoul, Republic of Korea
| |
Collapse
|
46
|
Shastri VG, Erney EJ. Psychosocial and Financial Issues Affecting LGBTQ+ Older Adults. Clin Geriatr Med 2024; 40:309-320. [PMID: 38521601 DOI: 10.1016/j.cger.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Isolation, financial insecurity, incomplete advance care planning, and lack of safe/affordable/inclusive long-term care are challenges magnified in gender and sexual minorities. LGBTQIA+ older adults are disproportionately more likely to live alone and experience financial poverty and social isolation. LGBTQIA+ adults suffering from cognitive impairment are an especially defenseless population due to their lack of social connection and potential lack of financial resources and advance care planning.
Collapse
Affiliation(s)
- Vinita Gidvani Shastri
- GRECC, VA Palo Alto Health Care System, Stanford School of Medicine, 3801 Miranda Avenue (182b), Palo Alto, CA 94304, USA.
| | - Erica Joy Erney
- The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, 710 Lawrence Expressway, Dept 440 (MOB), Santa Clara, CA 95051, USA
| |
Collapse
|
47
|
Ashrafioun L, Allan NP, Stecker TA. A randomized clinical trial to assess feasibility, acceptability and preliminary effects of telehealth-delivered cognitive-behavioral therapy for perceived social isolation among individuals with opioid use disorders. Drug Alcohol Depend 2024; 258:111268. [PMID: 38520791 PMCID: PMC11088495 DOI: 10.1016/j.drugalcdep.2024.111268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The purpose of this study was to report on feasibility, acceptability, and initial efficacy data cognitive-behavioral therapy for perceived isolation (CBT-PSI) compared to health education among individuals with opioid use disorders (OUD) reporting elevated loneliness. METHODS Participants (n = 125) with OUD reporting elevated loneliness were recruited using online advertising to participate in a telehealth-delivered randomized clinical trial. Participants received either a 6-session CBT-PSI (n = 63) or health education (n = 62). Measures assessing loneliness, quantity of social interactions, perceived social support, substance use, substance use consequences, and treatment engagement among others, were completed at baseline, post-intervention, and 1- and 2-months post-intervention. Participants also reported on treatment acceptability for both conditions. RESULTS Target enrollment was met with loneliness, social disconnectedness measures, and substance use reflecting a clinically severe sample. Retention was high (> 80%) for both conditions. Participants rated both Health Education and CBT-PSI as acceptable, helpful, and useful interventions to address loneliness and opioid use. Loneliness was reduced and quantity of social interactions and perceived social support were increased to the same extent for both conditions and across the follow-up assessments. Opioid use and overall substance use were reduced in both conditions; however, the reductions among participants received CBT-PSI were significantly greater compared to Health Education. CONCLUSIONS This study supports the feasibility and acceptability of CBT-PSI. CBT-PSI findings related to loneliness, substance use, and other social connectedness outcomes are encouraging. Additional testing of CBT-PSI in a fully-powered trial is warranted.
Collapse
Affiliation(s)
- Lisham Ashrafioun
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, 300 Crittenden Boulevard, Rochester, NY 14642, USA; VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA.
| | - Nicholas P Allan
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; Department of Psychiatry & Behavioral Health, Ohio State University, 370 W 9th Avenue, Columbus, OH 43210, USA
| | - Tracy A Stecker
- VA Center of Excellence for Suicide Prevention, VA Finger Lakes Healthcare System, 400 Fort Hill Avenue, Canandaigua, NY 14424, USA; School of Nursing, Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC 29425, USA
| |
Collapse
|
48
|
Moshtael R, Lynch ME, Duncan GE, Beam CR. A Genetically Informed Study of the Association Between Perceived Stress and Loneliness. Behav Genet 2024; 54:268-277. [PMID: 38341828 PMCID: PMC11032291 DOI: 10.1007/s10519-023-10176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/27/2023] [Indexed: 02/13/2024]
Abstract
Although research shows a strong positive association between perceived stress and loneliness, the genetic and environmental etiology underlying their association remains unknown. People with a genetic predisposition to perceived stress, for example, may be more prone to feeling lonely and vice versa. Conversely, unique factors in people's lives may explain differences in perceived stress levels that, in turn, affect feelings of loneliness. We tested whether genetic factors, environmental factors, or both account for the association between perceived stress and loneliness. Participants were 3,066 individual twins (nFemale = 2,154, 70.3%) from the Washington State Twin Registry who completed a survey during April-May, 2020. Structural equation modeling was used to analyze the item-level perceived stress and loneliness measures. The correlation between latent perceived stress and latent loneliness was .68. Genetic and nonshared environmental variance components underlying perceived stress accounted for 3.71% and 23.26% of the total variance in loneliness, respectively. The genetic correlation between loneliness and perceived stress was .45 and did not differ significantly between men and women. The nonshared environmental correlation was .54 and also did not differ between men and women. Findings suggest that holding constant the strong genetic association between perceived stress and loneliness, unique life experiences underlying people's perceived stress account for individual differences in loneliness.
Collapse
Affiliation(s)
- Ryan Moshtael
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, 3620 McClintock Ave., Seeley G. Mudd Room 501, Los Angeles, CA, 90063, USA.
| | - Morgan E Lynch
- Department of Psychology, University of Southern California, Los Angeles, USA
| | - Glen E Duncan
- Department of Nutrition and Exercise Physiology, Washington State University, Pullman, USA
| | - Christopher R Beam
- Department of Psychology, University of Southern California, Los Angeles, USA
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, USA
| |
Collapse
|
49
|
Shao L, Zhu X, Li DL, Wu L, Lu X, Fan Y, Qiao Z, Hou L, Pan CW, Ke C. Quantifying depressive symptoms on incidence of common chronic diseases and multimorbidity patterns in middle-aged and elderly Chinese adults. J Psychiatr Res 2024; 173:340-346. [PMID: 38579479 DOI: 10.1016/j.jpsychires.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified. METHODS For this cohort analysis, we included 9024-14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms. RESULTS Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05-1.26) to 1.64 (1.38-1.96) and 5% (0-10%) to 17% (6-28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11-1.42), 1.34 (1.07-1.69), 1.45 (1.29-1.63), and 2.01 (1.36-2.96), and respective PAFs (95% CIs) of 5% (0-10%), 8% (-4-21%), 12% (7-17%), and 20% (5-35%). CONCLUSION Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese.
Collapse
Affiliation(s)
- Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiaohong Zhu
- Suzhou Centers for Disease Control and Prevention, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xujia Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yulong Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zhengpeng Qiao
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Liying Hou
- School of Public Health, North China University of Science and Technology, Tangshan, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
| |
Collapse
|
50
|
Shakya S, Silva SG, McConnell ES, McLaughlin SJ, Cary MP. Psychosocial stressors associated with frailty in community-dwelling older adults in the United States. J Am Geriatr Soc 2024; 72:1088-1099. [PMID: 38391046 DOI: 10.1111/jgs.18821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/14/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Frailty is multifactorial; however, psychosocial stressors contributing to frailty are poorly understood. This study aimed to examine whether gender, race/ ethnicity, and education are associated with differential exposure to psychosocial stressors, determine psychosocial stressors contributing to frailty, and explore the mediating psychosocial stressors pathway. METHODS This cross-sectional study involved 7679 community-dwelling older adults (≥65) from the Health and Retirement Study (2006 and 2008 waves). Psychosocial stressors such as loneliness, low subjective social status, financial strain, poor neighborhood cohesion, everyday discrimination, and traumatic life events were measured. Frailty was defined by the Fried phenotype measure. Multivariable logistic regressions were used to examine the association of gender, race/ethnicity, and education with psychosocial stressors, psychosocial stressors associated with frailty, and the mediating psychosocial stressors pathway. RESULTS Females experienced greater financial strain but lower discrimination (both p < 0.05). Older adults who identified as Hispanic, Black, and racially or ethnically minoritized experienced low subjective social status, high financial strain, low neighborhood cohesion, and high discrimination than their White counterparts (all p < 0.05). Those with lower education experienced high loneliness, low subjective social status, high financial strain, low neighborhood cohesion but lower traumatic life events (all p < 0.05). Psychosocial stressors: High loneliness, low subjective social status, high financial strain, and low neighborhood cohesion (all p < 0.05) independently increased the odds of frailty. The mediating pathway of psychosocial stressors was not significant. CONCLUSION: Disparities exist in exposure to psychosocial stressors associated with frailty. Multilevel interventions are needed to reduce the influence of psychosocial stressors on frailty.
Collapse
Affiliation(s)
- Shamatree Shakya
- College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Susan G Silva
- School of Nursing, Duke University, Durham, North Carolina, USA
| | - Eleanor S McConnell
- Department of Veterans Affairs Medical Center, Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina, USA
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
| | - Michael P Cary
- School of Nursing, Duke University, Durham, North Carolina, USA
| |
Collapse
|