Loneliness as a predictor of outcomes in mental disorders among people who have experienced a mental health crisis: a 4-month prospective study

Cultural Dimensions Moderate the Association between Loneliness and Mental Health during Adolescence and Younger Adulthood: A Systematic Review and Meta-Analysis

Cultural factors, such as country or continent, influence the relationship between loneliness and mental health. However, less is known about how cultural dimensions moderate this relationship during adolescence and younger adulthood, even if these dimensions manifest as country or continent differences. This study aims to examine the potential influence of Hofstede's cultural dimensions on this relationship using a three-level meta-analysis approach. A total of 292 studies with 291,946 participants aged 10 to 24 were included in this study. The results indicate that cultural dimensions, such as individualism vs. collectivism, indulgence vs. restraint, power distance, and long-term vs. short-term orientation, moderated the associations between loneliness and social anxiety, stress, Internet overuse, and negative affect. The association between loneliness and mental health was not moderated by cultural dimensions, such as masculinity and uncertainty avoidance. These findings suggest that culture's influence on the association between loneliness and mental health is based on a domain-specific mechanism.

An exploration of loneliness experienced by people living with mental illness and the impact on their recovery journey: An integrative review

WHAT IS KNOWN ON THE SUBJECT?: There is evidence that social isolation and loneliness is more prevalent in people living with mental illness than in the general population. People living with mental illness frequently experience stigma, discrimination, rejection, repeated psychiatric admissions, low self-esteem, low self-efficacy, and increased symptoms of paranoia, depression, and anxiety. There is evidence of common interventions that can be used to improve loneliness and social isolation such as psychosocial skills training and cognitive group therapy. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper offers a comprehensive assessment of the evidence between mental illness, loneliness, and recovery. The results suggest that people living with mental illness experience elevated levels of social isolation and loneliness leading to poor recovery and quality of life. Social deprivation, social integration and romantic loneliness are related to loneliness, poor recovery, and reduced quality of life. A sense of belonging, ability to trust and hope are important aspects of improved loneliness, quality of life and recovery. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The existing culture in mental health nursing practice needs to be examined to address loneliness in people living with mental illness and its impact on recovery. Existing tools to research loneliness do not consider dimensions in loneliness experience as reflected in the literature. Practice needs to demonstrate an integrated approach to recovery, optimal service delivery and augmentation of evidence-based clinical practice to improve individual's loneliness, social circumstances, and relationships. Practice needs to demonstrate nursing knowledge in caring for people living with mental illness experiencing loneliness. Further longitudinal research is required to clearly understand the relationship between loneliness, mental illness, and recovery.

ABSTRACT

INTRODUCTION: To our knowledge, there are no previous reviews on the impact of loneliness experienced by people aged 18-65, who are living with mental illness and their recovery experience.

AIM/QUESTION

To explore the experience and impact of loneliness in people living with mental illness during recovery.

METHOD

An integrative review.

RESULTS

A total of 17 papers met the inclusion criteria. The search was conducted using four electronic databases: MEDLINE, CINAHL, Scopus and PsycINFO. Across these 17 papers, participants were most commonly, diagnosed with schizophrenia or psychotic disorders and recruited from community mental health services.

DISCUSSION

The review revealed loneliness to be substantial in people living with mental illness and that loneliness affected their recovery, and their quality of life. The review identified many factors that contribute to loneliness including unemployment, financial strain, social deprivation, group housing, internalized stigma and mental illness symptoms. Individual factors such as social/community integration and social network size as well as an inability to trust, a sense of not belonging, hopelessness and lack of romance were also evident. Interventions targeting social functioning skills and social connectedness were found to improve social isolation and loneliness.

IMPLICATIONS FOR PRACTICE

It is vital for mental health nursing practice to employ an approach integrating physical health as well as social recovery needs, optimal service delivery and augmentation of evidence-based clinical practice to improve loneliness, recovery, and quality of life.

Understanding the relationship between loneliness, substance use traits and psychiatric disorders: A genetically informed approach

Loneliness is a common, yet distressing experience associated with adverse outcomes including substance use problems and psychiatric disorders. To what extent these associations reflect genetic correlations and causal relationships is currently unclear. We applied Genomic Structural Equation Modelling (GSEM) to dissect the genetic architecture between loneliness and psychiatric-behavioural traits. Included were summary statistics from 12 genome-wide association analyses, including loneliness and 11 psychiatric phenotypes (range N: 9,537 - 807,553). We first modelled latent genetic factors amongst the psychiatric traits to then investigate potential causal effects between loneliness and the identified latent factors, using multivariate genome-wide association analyses and bidirectional Mendelian randomization. We identified three latent genetic factors, encompassing neurodevelopmental/mood conditions, substance use traits and disorders with psychotic features. GSEM provided evidence of a unique association between loneliness and the neurodevelopmental/mood conditions latent factor. Mendelian randomization results were suggestive of bidirectional causal effects between loneliness and the neurodevelopmental/mood conditions factor. These results imply that a genetic predisposition to loneliness may elevate the risk of neurodevelopmental/mood conditions, and vice versa. However, results may reflect the difficulty of distiguishing between loneliness and neurodevelopmental/mood conditions, which present in similar ways. We suggest, overall, the importance of addressing loneliness in mental health prevention and policy.

Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study

OBJECTIVES

To investigate the longitudinal associations between loneliness, social isolation, depression and anxiety in the elderly.

METHODS

A longitudinal cohort study was conducted among 634 older adults from three districts of Shanghai. Data were collected at baseline and 6-month follow-up. Loneliness and social isolation were measured using the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale respectively. Depressive and anxiety symptoms were assessed using the subscales of Depression Anxiety Stress Scales. Logistic regression and negative binomial regression models were used to examine the associations.

RESULTS

We found that moderate to severe loneliness at baseline predicted higher depression scores 6 months later (incidence rate ratio (IRR)=1.99, 95% confidence interval (CI) [1.12, 3.53], p=0.019), while higher depression scores at baseline predicted social isolation at follow-up (odds ratio (OR)=1.14, 95% CI [1.03, 1.27], p=0.012). We also observed that higher anxiety scores predicted lower risk of social isolation (OR=0.87, 95% CI [0.77, 0.98], p=0.021). Additionally, persistent loneliness at both timepoints was significantly associated with higher depression scores at follow-up, and persistent social isolation was associated with a greater likelihood of having moderate to severe loneliness and higher depression scores at follow-up.

CONCLUSIONS

Loneliness was found to be a robust predictor of changes in depressive symptoms. Both persistent loneliness and social isolation were closely associated with depression. We should develop effective and feasible interventions for older adults who have depressive symptoms or who are at risk of long-term social relationship problems to avoid the vicious circle among depression, social isolation and loneliness.

Pre- and post-COVID-19: The impact of the pandemic and stock market psychology on the growth and sustainability of consumer goods industries

The objective of this study is to investigate the impact of the COVID-19 pandemic and stock market psychology on investor investment decisions in different business units operating in the Shandong stock market. The sample size of the study consists of 5,000 individuals from six different business units. The study used the event study statistical technique to analyze the market reaction to newly released information from the stock market perspective to assess whether the number of COVID-19 positive cases impacted it. With a Z score value of 40.345 and a P-value of 0.000, the Wilcoxon test indicated that stock prices before and after the pandemic were quite different. The test showed a positive relationship between the pandemic and the stock market. Further, the results indicated that COVID-19 and stock market psychology had a significant positive impact on investor investment decisions in cosmetic and beauty, consumer household, textiles and apparel, and consumer electronics industries; however, in the sporting and consumer appliance industries, it had an insignificant negative impact. This study serves to guide investors to make suitable changes in their stock market trading practices to counter these challenges to increase their required rate of return from their specific stock market investment. The findings have important insights for various stakeholders including governments, regulatory bodies, practitioners, academia, industry, and researchers.

A scoping review of studies into crisis resolution teams in community mental health services

BACKGROUND AND PURPOSE OF ARTICLE

Crisis Resolution Teams (CRT) for rapid assessment and short-term treatment of mental health problems have increasingly been implemented internationally over the last decades. Among the Nordic countries, the CRT model has been particularly influential in Norway, where 'Ambulante akutteam (AAT)' is a widespread psychiatric emergency service for adult patients. However, the clinical practice of these teams varies significantly. To aid further development of the service and guide future research efforts, we carried out a scoping review to provide an up-to-date overview of research available in primary studies focusing on phenomena related to CRTs in English and Scandinavian literature.

METHODS

A systematic literature search was conducted in the bibliometric databases MEDLINE, Embase, PsychINFO, Scopus, and SveMed+. Included studies were thematically analyzed using a qualitative method.

RESULTS

The search identified 1516 unique references, of which 129 were included in the overview. Thematic analysis showed that the studies could be assigned to: (1) Characteristics of CRTs (k = 45), which described key principles or specific interventions; (2) Implementation of CRTs (k = 54), which were descriptive about implementation in different teams, or normative about what clinical practice should include; and (3) Effect of CRTs (k = 38).

CONCLUSIONS

The international research literature on CRTs or equivalent teams is extensive. Many sub-themes have been studied with various research methodologies. Recent studies provide a better evidence base for how to organize services and to select therapeutic interventions, but there is still a need for more controlled studies in the field.

Assessment of Unmet Health-Related Social Needs Among Patients With Mental Illness Enrolled in Medicare Advantage

Importance

A large body of literature has found associations between unmet health-related social needs (HRSNs) and adverse mental health outcomes. A comparative analysis of the risks associated with HRSNs among patients with varying severity of mental illness and an assessment of how these risks compare with those of individuals without mental illness are needed.

Objective

To examine the prevalence and risks of HRSNs among patients with serious and persistent mental illness (SPMI), patients with mental health diagnoses but no serious and persistent mental illness (non-SPMI), and patients with both SPMI and non-SPMI compared with individuals without mental illness.

Design, Setting, and Participants

This retrospective cohort study used data from the Accountable Health Communities HRSN Screening Tool surveys, which target a nationally representative sample of Medicare Advantage members of a large payer (Humana Inc). The surveys were conducted between October 16, 2019, and February 29, 2020. Of the initial 329 008 eligible Medicare Advantage enrollees, 70 273 responded to the survey (21.4% response rate). Of those, 56 081 respondents (79.8%) had complete survey responses and were included in the final analytic sample.

Main Outcomes and Measures

Outcomes of interest included 7 HRSNs (financial strain, food insecurity, housing instability, housing quality, severe loneliness, transportation problems, and utility affordability) based on responses to the survey. The major independent variable was the presence of mental illness up to 12 months preceding the date of survey completion. Codes indicating mental illness listed as the primary, principal, or secondary diagnoses of a patient's inpatient or outpatient medical claims data were identified, and participants were grouped into 4 cohorts: SPMI, non-SPMI, SPMI plus non-SPMI, and no mental illness.

Results

Among 56 081 older adults, the mean (SD) age was 71.31 (8.59) years; 32 717 participants (58.3%) were female, and 43 498 (77.6%) were White. A total of 21 644 participants (38.6%) had at least 1 mental illness diagnosis in the past year, 30 262 (54.0%) had an HRSN, and 14 163 (25.3%) had both mental illness and an HRSN. Across all specific HRSNs, the odds of experiencing the respective HRSN was most substantial for those with SPMI plus non-SPMI vs those with only non-SPMI or SPMI. The HRSN with the largest risk differences among the study cohorts was severe loneliness; compared with the cohort without mental illness, the non-SPMI cohort had 2.07 times higher odds (95% CI, 1.84-2.32; P < .001), the SPMI cohort had 3.35 times higher odds (95% CI, 3.03-3.71; P < .001), and the SPMI plus non-SPMI cohort had 5.13 times higher odds (95% CI, 4.68-5.61; P < .001) of severe loneliness.

Conclusions and Relevance

In this study, the increased risk of having HRSNs associated with SPMI, alone or in combination with non-SPMI, emphasizes the need for more targeted interventions to address social needs in this vulnerable population.

Enhanced supported living for people with severe and persistent mental health problems: A qualitative investigation

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi-structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on-site activities; and (3) the experience of supported living as a stepping-stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer-relations, autonomy and fostering hope in empowering individuals in their ongoing recovery.

The unseen epidemic: trauma and loneliness in urban midlife women

Background

Connectedness and attachment are vital parts of humanity. Loneliness, a state of distress in reaction to perceived detachment and isolation, is reported by over one-third of U.S. adults and is associated with numerous physical and mental health consequences. What contributes to loneliness, especially in women and minority populations, is poorly understood, but this population is also at greater risk for abuse and trauma. Our study aimed to further understand loneliness in urban midlife women and to explore the relationship that may exist with trauma(s).

Methods

To identify primacies for mental health care, female midlife participants (N=50) of a long-standing urban community-based cohort focused on health improvement completed a one-time audiotaped interview with both quantitative assessments and a qualitative interview. Loneliness was assessed by the UCLA 3-item Loneliness Scale. Using semi-structured interviews, open-ended questions facilitated a discussion regarding mental health needs and experiences. Interview transcripts were coded and analyzed following a grounded theory methodology. Themes around loneliness and trauma emerged. The transcripts were coded using the same methodology and coders as the individual interviews. Twenty women participated in two optional focus groups.

Results

Participants had a mean age of 50, with the majority identifying as Black/African American (N=37) and unemployed (N=33). Three themes emerged regarding perceived causes of loneliness: trauma, the burden of responsibilities for others, and secondary to unhealthy relationships. Loneliness associated with trauma will be explored here; other themes are beyond the scope of this paper and will be discussed in subsequent analyses. Quantitative results suggest that physical abuse (loneliness scores 5.4 vs. 4.0, p=0.003), as well as emotional abuse and neglect (loneliness scores 5.6 vs. 4.4, p=0.01), were associated with greater loneliness.

Conclusion

In urban midlife low-income women, lifetime physical abuse and emotional abuse/neglect are associated with increased feelings of loneliness. Qualitative data provide insight into how participants viewed their traumatic histories, ways in which the trauma has ongoing influence, and how they experience loneliness. Though further investigation is needed, trauma-informed approaches should be considered in both primary care and mental health settings with a focus on mitigating loneliness and providing appropriate support and trauma treatment.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40695-022-00080-z.

Examining Differences, Relationships, and Predictors for Loneliness in an Adult Population: The Roles of Personal Characteristics, Place of Residence, Leisure Activities, Mental Health, and Social Outcomes

Loneliness is associated with poor mental and social outcomes globally. The literature suggests an association between loneliness and personal characteristics, place of residence, and leisure activities. However, the current literature has produced inconsistent findings and has focused largely on older adults. This study is one of the first to examine the differences, relationships, and predictors of loneliness in an adult population, and the roles of personal characteristics, place of residence, leisure activities, mental health, and social outcomes. A cross-sectional online survey was undertaken. A sample of 155 adults responded, with a mean age of 34.5 years (SD = 13.2), and with 54.1% identifying as female. An analysis revealed experiences of loneliness across the sample. In addition, age was moderately associated with loneliness, while psychological distress, depressive symptoms, and social networks were significantly associated with loneliness. Depressive symptoms were a positive predictor for loneliness, and social networks were a negative predictor for loneliness. This study has confirmed findings from previous research and provided new information on loneliness, which can guide future research and interventions to prevent or support people who suffer from loneliness.

Decreased self-reported receiving of social touch and social support predict loneliness in healthy adults

Loneliness has emerged as a public health concern. Previous research has reported its deleterious effects on physical and mental health; however, some specific psychophysiological mechanisms in healthy adults remain to be elucidated. The aim of the current study is to investigate whether self-reported social support and social touch (giving and receiving social touch), as well as resting heart rate variability (HRV), are significant negative predictors of loneliness in healthy adults. The study sample consists of 120 healthy students (50% female) with a mean age of 21.85 years old (DP= 2.21). The students were asked to complete a psychiatric screening questionnaire utilizing loneliness, social support, and social touch scales. HRV was derived from an electrocardiographic signal recorded for 15 min, with the participant relaxed in a supine position. Linear regression analyses were conducted to evaluate loneliness as a function of social support, social touch (giving or receiving touch), and resting HRV. The results show that social support (p< 0.001) and social touch, specifically receiving touch (p< 0.002), accounted for a significant proportion of the variance in loneliness. However, neither giving touch nor resting HRV was a significant predictor of loneliness. The current study highlights specific psychosocial factors in healthy adults that should be considered as promising pathways in order to reduce or work toward preventing loneliness, thus promoting better health and well-being.

Distress, loneliness, and mental health during the COVID-19 pandemic: Test of the extension of the Evolutionary Theory of Loneliness

COVID-19 restrictions such as lockdowns or quarantines may increase the risk for social isolation and perceived loneliness. The mechanisms can be modeled by Cacioppo's Evolutionary Theory of Loneliness (ETL), which predicts that a lack of perceived social connectedness may lead, in the long-term, to mental and physical health consequences. However, the association between COVID-19 pandemic distress, mental health, and loneliness is not sufficiently understood. The present longitudinal study examined the relationship between distress and depression, and the mediating effects of anxiety and loneliness in a German rehabilitation sample (N = 403) at two timepoints (≤6 weeks pre-rehabilitation; ≥12 weeks post-rehabilitation; mean time between T1 and T2 was  52 days). Change scores between T1 and T2 were examined for the variables COVID-19 Peritraumatic Distress Index (CPDI), anxiety, loneliness, and depression. The results of the serial mediation analysis indicated that anxiety and loneliness were able to explain the relationship between distress and depression with 42% of variance in depression accounted for. Findings extend research on the relationship between COVID-19 and mental health by considering anxiety and loneliness as sustaining factors of depressive symptoms, thus, successfully applying the ETL. Results stress the necessity to consider anxiety and loneliness in the treatment or prevention of depression.

Using a Loneliness Measure to Screen for Risk of Mental Health Problems: A Replication in Two Nationally Representative Cohorts

Background: Loneliness co-occurs alongside many mental health problems and is associated with poorer treatment outcomes. It could therefore be a phenomenon of interest to clinicians as an indicator of generalised risk for psychopathology. The present study tested whether a short measure of loneliness can accurately classify individuals who are at increased risk of common mental health problems. Methods: Data were drawn from two nationally representative cohorts: the age-18 wave of the UK-based Environmental Risk (E-Risk) Longitudinal Twin Study and the age-38 wave of the New Zealand-based Dunedin Multidisciplinary Health and Development Study. In both cohorts, loneliness was assessed using the three-item UCLA Loneliness Scale, plus two stand-alone items about feeling alone and feeling lonely. Outcome measures consisted of diagnoses of depression and anxiety and self-reports of self-harm/suicide attempts, assessed via a structured interview. Results: ROC curve analysis showed that the Loneliness Scale had fair accuracy in classifying individuals meeting criteria for all three outcomes, with a cut-off score of 5 (on a scale from 3 to 9) having the strongest empirical support. Both of the stand-alone items showed modest sensitivity and specificity but were more limited in their flexibility. The findings were replicated across the two cohorts, indicating that they are applicable both to younger and older adults. In addition, the accuracy of the loneliness scale in detecting mental health problems was comparable to a measure of poor sleep quality, a phenomenon which is often included in screening tools for depression and anxiety. Conclusions: These findings indicate that a loneliness measure could have utility in mental health screening contexts, as well as in research.

Participating in Longitudinal Observational Research on Psychiatric Rehabilitation: Quantitative Results From a Patient Perspective Study

BACKGROUND

Longitudinal observational studies play on an important role for evidence-based research on health services and psychiatric rehabilitation. However, information is missing about the reasons, why patients participate in such studies, and how they evaluate their participation experience.

METHODS

Subsequently to their final assessment in a 2-year follow-up study on supported housing for persons with severe mental illness, n = 182 patients answered a short questionnaire on their study participation experience (prior experiences, participation reasons, burden due to study assessments, intention to participate in studies again). Basic respondent characteristics as well as symptom severity (SCL-K9) were also included in the descriptive and analytical statistics.

RESULTS

To help other people and curiosity were cited as the main initial reasons for study participation (>85%). Further motives were significantly associated with demographic and/or clinical variables. For instance, "relieve from boredom" was more frequently reported by men and patients with substance use disorders (compared to mood disorders), and participants 'motive" to talk about illness" was associated with higher symptom severity at study entry. Furthermore, only a small proportion of respondents indicated significant burdens by study participation and about 87% would also participate in future studies.

CONCLUSIONS

The respondents gave an overall positive evaluation regarding their participation experience in an observational study on psychiatric rehabilitation. The results additionally suggest that health and social care professionals should be responsive to the expectations and needs of patients with mental illness regarding participation in research.

Trajectories of loneliness and objective social isolation and associations between persistent loneliness and self-reported personal recovery in a cohort of secondary mental health service users in the UK

BACKGROUND

Loneliness is a frequent and distressing experience among people with mental health problems. However, few longitudinal studies have so far investigated the trajectories of loneliness and objective social isolation, and the extent to which both issues may impact mental health outcomes among mental health service users. Therefore, this study aims to describe the trajectories of loneliness and objective social isolation and their associations with self-rated personal recovery among people leaving crisis resolution teams (CRTs).

METHODS

A total of 224 participants receiving care from CRTs (recruited for a large multi-site randomised controlled trial) were included in this longitudinal cohort study. They completed the eight-item University of California at Los Angeles Loneliness Scale (ULS-8), Lubben-Social Network Scale (LNSN-6), and the Questionnaire about the Process of Recovery (QPR) (primary outcome) at baseline, 4- and 18-month follow-up, as well as baseline sociodemographic and clinical variables.

RESULTS

We compared groups who were persistently lonely (at all time points), intermittently lonely (at one or two time points) and never lonely. After adjusting for all potential confounders and baseline predictive variables, persistent severe loneliness was associated with worse personal recovery at 18-month follow-up compared with the never lonely (reference group) (coef. = - 12.8, 95% CI -11.8, - 3.8, p < .001), as was being intermittently lonely (coef. = - 7.8, 95% CI -18.8, - 6.8, p < .001). The persistently objectively social isolated group (coef. = - 9.8, 95% CI -15.7, - 3.8, p = .001) also had poorer self-rated recovery at 18-month follow-up than those who were not socially isolated at any timepoint (i.e., reference category).

CONCLUSION

Results suggest that both persistent loneliness and objective social isolation are associated with poorer self-rated recovery following a crisis, compatible with a causal relationship. These findings suggest a potential role for interventions aimed at alleviating loneliness and objective social isolation in improving recovery outcomes for people with mental health symptoms. Increased awareness of both issues among health practitioners is also warranted.

The Relationship Between Loneliness and Psychological Adjustment: Validation of the Italian Version of the Interpersonal Acceptance-Rejection Loneliness Scale

In recent literature, many researchers have highlighted that the feeling of loneliness can be considered a sign of relevant distress with short- and long-term consequences on the health of people who needs to be appropriately monitored and treated. In this view, the Interpersonal Acceptance-Rejection Loneliness Scale (IPARLS) has been developed to evaluate the subjective feelings and distress related to interpersonal loneliness and to overcome the limits of the previous scales; however, its psychometric characteristics have not yet been fully investigated. Starting from these considerations, two studies have been conducted. The first study, involving 688 adults (19-69 years; 51% females), assessed dimensionality, reliability, and validity of and tested the measurement invariance (MI) of the Italian version of the IPARLS. The second study, involving 205 adults (20-69 years; 51% females), investigated the relationship between loneliness and psychological adjustment. Results confirmed the unidimensionality of the scale and showed that it is reliable, valid, and fully invariant as a function of age and gender. Moreover, data showed a strong association between perceived loneliness and psychological adjustment. The IPARLS is confirmed to be a valid and reliable measure to investigate loneliness in the life cycle from clinical and research perspectives.

Personal Growth and Well-Being in the Time of COVID: An Exploratory Mixed-Methods Analysis

The physical distancing measures necessitated by COVID-19 have resulted in a severe withdrawal from the patterns of daily life, necessitating significantly reduced contact with other people. To many, such withdrawal can be a major cause of distress. But, to some, this sort of withdrawal is an integral part of growth, a pathway to a more enriching life. The present study uses a sequential explanatory QUAN-qual design to investigate whether people who felt that their lives had changed for the better after being forced to engage in physical distancing, what factors predicted such well-being, and how they spent their time to generate this sense of well-being. We invited 614 participants who reported closely following physical distancing recommendations to complete a survey exploring this topic. Our analyses, after controlling for all other variables in the regression model, found a greater positive association between presence of meaning in life, coping style, and self-transcendent wisdom and residualized current well-being accounting for retrospective assessments of well-being prior to physical distancing. An extreme-case content analysis of participants' personal projects found that participants with low self-transcendent wisdom reported more survival-oriented projects (e.g., acquiring groceries or engaging in distracting entertainments), while participants reporting high self-transcendent wisdom reported more projects involving deepening interactions with other people, especially family. Our findings suggest a more nuanced pathway from adversity to a deeper sense of well-being by showing the importance of not merely coping with adversity, but truly transcending it.

Acute day units for mental health crises: a qualitative study of service user and staff views and experiences

BACKGROUND

Acute Day Units (ADUs) provide intensive, non-residential, short-term treatment for adults in mental health crisis. They currently exist in approximately 30% of health localities in England, but there is little research into their functioning or effectiveness, and how this form of crisis care is experienced by service users. This qualitative study explores the views and experiences of stakeholders who use and work in ADUs.

METHODS

We conducted 36 semi-structured interviews with service users, staff and carers at four ADUs in England. Data were analysed using thematic analysis. Peer researchers collected data and contributed to analysis, and a Lived Experience Advisory Panel (LEAP) provided perspectives across the whole project.

RESULTS

Both service users and staff provided generally positive accounts of using or working in ADUs. Valued features were structured programmes that provide routine, meaningful group activities, and opportunities for peer contact and emotional, practical and peer support, within an environment that felt safe. Aspects of ADU care were often described as enabling personal and social connections that contribute to shifting from crisis to recovery. ADUs were compared favourably to other forms of home- and hospital-based acute care, particularly in providing more therapeutic input and social contact. Some service users and staff thought ADU lengths of stay should be extended slightly, and staff described some ADUs being under-utilised or poorly-understood by referrers in local acute care systems.

CONCLUSIONS

Multi-site qualitative data suggests that ADUs provide a distinctive and valued contribution to acute care systems, and can avoid known problems associated with other forms of acute care, such as low user satisfaction, stressful ward environments, and little therapeutic input or positive peer contact. Findings suggest there may be grounds for recommending further development and more widespread implementation of ADUs to increase choice and effective support within local acute care systems.

Psychosocial impact of the COVID-19 pandemic: a cross-sectional study of online help-seeking Canadian men

Purpose: The COVID-19 pandemic has had a profound impact on the lives of men. The present study investigated psychosocial impacts of the COVID-19 pandemic on a help-seeking sample of Canadian men, focusing on diverse aspects of their psychosocial well-being.Methods: A cross-sectional, open survey study design was used. Canadian adult men who were visiting an eHealth depression resource (HeadsUpGuys.org) were recruited to complete an online survey. Descriptive statistics, including means and standard deviations for continuous variables and frequency and percentages for categorical variables, were used to summarize survey responses. Regression analysis was utilized to identify factors associated with various mental health indicators (anxiety, depression, fear of COVID-19, suicidality). The Patient Health Questionnaire-4, Fear of COVID-19 Scale, and item 9 (suicidality item) from the Patient Health Questionnaire-9 were used to assess the mental health indicators.Results: A total of 434 men completed the study. Most respondents (79.3%; N = 344) indicated that their mental health was negatively affected by COVID-19, and two-thirds (65.5%; N = 284) conveyed that government-imposed physical distancing measures had negatively affected their mental health. Half the sample (51.2%; N = 222) reported at least moderate financial stress due to COVID-19. Nearly a third of respondents (31.1%; N = 135) reported that their current living situation has had a considerable or severe negative impact on their mental health since COVID-19. About two-fifths (37.7%; N = 94) of men felt that COVID-19 has had a negative impact on their relationship with their intimate partner. Nearly a third of respondents who were in a relationship (30.9%; N = 77) reported that they engaged in some type of abuse (primarily verbal abuse, 22.9%; N = 57) toward their intimate partner during COVID-19, and more than a quarter (27.3%; N = 68) reported being abused by their intimate partner (also primarily verbal abuse, 22.5%; N = 56). Just under half (42.2%; N = 183) of the respondents indicated experiencing suicidal ideation.Conclusion: These findings can help inform providers of health services to Canadian men, as well as policies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.

Association between social capital and loneliness among older adults: a cross-sectional study in Anhui Province, China

BACKGROUND

We aimed to examine the association between social capital and loneliness in Anhui Province, China.

METHODS

Data were collected from a cross-sectional study using a multi-stage stratified cluster sampling strategy. Data on demographic characteristics, socioeconomic factors, social capital, and loneliness in 1810 older adults (aged 60 years and older) were used for analysis. Binary logistic regression models and a classification and regression tree model were performed to assess the association of social capital and loneliness.

RESULTS

Our results indicated that social capital in terms of lower level of social participation (AOR = 1.38; 95% CI: 1.10-1.74), social connection (AOR = 1.51; 95% CI: 1.18-1.93), and reciprocity (AOR = 1.47; 95% CI: 1.13-1.90) were associated with higher odds of developing loneliness. We noted the interactive effect of different social capital dimensions on loneliness, suggesting that the risk for suffering loneliness was greatest in older people limited in functional ability, with less trust, less social connection, and less social participation.

CONCLUSIONS

Our findings show that social capital is associated with loneliness in older adults. This implies that social capital, especially in terms of trust, social connection, and social participation may be significant for alleviating loneliness in later life.