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Lederman Z. Loneliness-a clinical primer. Br Med Bull 2023; 145:132-140. [PMID: 36752026 DOI: 10.1093/bmb/ldad003] [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: 09/19/2022] [Revised: 01/14/2023] [Accepted: 01/21/2023] [Indexed: 02/09/2023]
Abstract
INTRODUCTION loneliness is prevalent worldwide. It is also associated with an increased risk for depression, high blood pressure, cardiovascular disease, stroke and early death. As such, loneliness is a major public health issue. This paper summarizes the salient points clinicians should know and encourages clinicians to assume an active part in the identification, mitigation and prevention of loneliness. SOURCES OF DATA white papers, academic publications. AREAS OF AGREEMENT loneliness is a distressful subjective experience, which does not always correlate with social isolation. Both internal (personal) and external (contextual, societal) factors determine whether an individual would feel lonely in a given situation. AREAS OF CONTROVERSY identifying loneliness in the clinic may be time consuming and challenging. There is a scarce robust evidence to support interventions. GROWING POINTS due to increased individualization and incidence of infectious diseases, loneliness is likely to become even more prevalent. AREAS TIMELY FOR DEVELOPING RESEARCH more research is needed to further elucidate the health impacts of loneliness as well as to find evidence-based interventions to prevent and mitigate loneliness that could then be implemented by policy-makers and clinicians.
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Affiliation(s)
- Zohar Lederman
- Medical Ethics and Hum anities Unit, Hong Kong University, Hong Kong.,Centre for Medical Ethics and Law, Hong Kong University, Hong Kong.,International Center of Health, Law, and Ethics, University of Haifa, Israel
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Maes M, Qualter P, Lodder GMA, Mund M. How (Not) to Measure Loneliness: A Review of the Eight Most Commonly Used Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710816. [PMID: 36078540 PMCID: PMC9518421 DOI: 10.3390/ijerph191710816] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/19/2022] [Accepted: 08/21/2022] [Indexed: 05/27/2023]
Abstract
Loneliness affects well-being and has long-term negative impacts on physical and mental health, educational outcomes, and employability. Because of those current and long-term impacts, loneliness is a significant issue for which we need reliable and appropriate measurement scales. In the current paper, psychometric properties of the eight most commonly used loneliness scales are reviewed both descriptively and meta-analytically. Results suggest that for many of the scales, the psychometric properties are promising. However, for some psychometric features, especially test-retest reliability and measurement invariance, evidence is rather scarce. Most striking, however, is the fact that all of the scales included items that do not measure loneliness. Surprisingly, for many (sub)scales, this was even the case for about half of the items. Because our measures are the foundation of our research work, it is crucial to improve the way loneliness is being measured.
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Affiliation(s)
- Marlies Maes
- Interdisciplinary Social Science: Youth Studies, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Pamela Qualter
- Manchester Institute of Education, The University of Manchester, Manchester M13 9PL, UK
| | - Gerine M. A. Lodder
- Department of Developmental Psychology, Tilburg University, 5037 AB Tilburg, The Netherlands
| | - Marcus Mund
- Personality Psychology and Psychological Assessment, Klagenfurt University, 9020 Klagenfurt, Austria
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The acute and persisting impact of COVID-19 on trajectories of adolescent depression: Sex differences and social connectedness. J Affect Disord 2022; 299:246-255. [PMID: 34798146 PMCID: PMC8605896 DOI: 10.1016/j.jad.2021.11.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 10/13/2021] [Accepted: 11/13/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND The COVID-19 era is a time of unprecedented stress, and there is widespread concern regarding its short- and long-term mental health impact. Adolescence is a sensitive period for the emergence of latent psychopathology vulnerabilities, often activated by environmental stressors. The present study examined COVID-19's impact on adolescent depression and possible influences of different domains of social connectedness (loneliness, social media use, social video game time, degree of social activity participation). METHODS A community sample of 175 adolescents (51% boys, mean age = 16.01 years) completed questionnaires once before and twice during the COVID-19 pandemic. Piecewise growth modeling examined the acute (7 weeks) and persistent (8 months) effects of COVID-19 on depressive symptoms, and differences across sex and social connectedness. RESULTS Significant increases in depressive symptoms followed pandemic onset for boys and girls. However, this increase was earlier and more pronounced among girls than boys, whose depression only increased significantly during the persistent period and to a lesser degree. Trajectories of depression were influenced by loneliness and social connections. LIMITATIONS Most participants had economic stability and minimal exposure to the virus. Exacerbation of depressive symptoms may be more severe in higher risk populations. CONCLUSIONS Adolescent depression levels have increased during COVID-19, and are higher for girls and those who are lonely. Enhanced screening and management for adolescent depression and social connectedness could play a critical role in mitigating the negative mental health fallout of COVID-19 and future pandemics within this population.
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Gratitude and loneliness in daily life across the adult lifespan. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02488-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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A Systematic Review of the Development and Psychometric Properties of Loneliness Measures for Children and Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063285. [PMID: 33810076 PMCID: PMC8004998 DOI: 10.3390/ijerph18063285] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
This paper reviews the three most commonly used measures of loneliness for children and adolescents (children: Loneliness and Aloneness Scale for Children and Adolescents [LACA] and Children’s Loneliness and Social Dissatisfaction Scale [CLS]; adolescents: UCLA Loneliness Scale [UCLA] and LACA). Loneliness is a pertinent issue across populations and affects the mental health and academic achievement of children and adolescents. To date, there has been no thorough examination of the loneliness measures for this age group. We examine how each of the three measures was developed, and assess the psychometric properties of those measures, gaining insight into whether they are valid and reliable assessments of loneliness. Results suggest that the UCLA Loneliness Scale is the most popular measure of loneliness for use with adolescents, but it does not have robust psychometric properties for that group. For children, the CLS appears most suitable. Results of the review identify gaps in aspects of measure development, with no measure having been developed with children or adolescents. Implications for future loneliness measurement research are considered.
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Raes F, Bastin M, Pede T, Belmans E, Goossens L, Vanhalst J. Repetitive Negative Thinking outperforms loneliness and lack of social connectedness as a predictor of prospective depressive symptoms in adolescents. Scand J Child Adolesc Psychiatr Psychol 2021; 8:149-156. [PMID: 33564631 PMCID: PMC7863726 DOI: 10.21307/sjcapp-2020-015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Repetitive Negative Thinking (RNT) is a well-established predictor in adolescents of emotional problems, such as depression. Surprisingly little research, however, has looked at the relative importance of RNT vs. more interpersonally relevant variables in the context of depression, such as loneliness and lack of social connectedness. Objective: The present study, therefore, set out to examine whether RNT is a significant predictor when taking into account the contribution of loneliness and social connectedness. Methods: A sample of 135 typically developing adolescents (N = 135; 79.3% girls; Mage = 17.5; range 16-21) completed measures of depressive symptoms, RNT, loneliness and social connectedness at two time points with a 3-month interval. Results: Results showed that above and beyond baseline depressive symptoms, RNT was the only other significant predictor of prospective depressive symptoms. Conclusions: According to these results, RNT seems a relatively more important factor to consider in the context of adolescent depression than factors in the interpersonal or social context. Consequently, targeting RNT might be expected to yield more significant gains in reducing or preventing depressive symptoms in adolescents compared to focusing on feelings of loneliness or social connectedness – a hypothesis that remains to be tested.
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Affiliation(s)
- Filip Raes
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Margot Bastin
- Research Unit School Psychology and Development in Context, KU Leuven, Belgium
| | - Tina Pede
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Eline Belmans
- Research Unit Behaviour, Health and Psychopathology, KU Leuven, Belgium
| | - Luc Goossens
- Research Unit School Psychology and Development in Context, KU Leuven, Belgium
| | - Janne Vanhalst
- Department of Developmental, Personality and Social Psychology, Ghent University, Belgium
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Lippke S, Fischer MA, Ratz T. Physical Activity, Loneliness, and Meaning of Friendship in Young Individuals - A Mixed-Methods Investigation Prior to and During the COVID-19 Pandemic With Three Cross-Sectional Studies. Front Psychol 2021; 12:617267. [PMID: 33603702 PMCID: PMC7884761 DOI: 10.3389/fpsyg.2021.617267] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
Meaningful social interactions and regular physical activity are inversely associated with loneliness. Using a mixed-methods research design employing quantitative and qualitative research approaches, this research aimed to explore loneliness, physical activity, friendship, and experiences relating to the COVID-19 pandemic both prior to and during the pandemic. Quantitative data of (1) n = 363 first-year university students assessed in 2018/2019 and of (2) n = 175 individuals aged 18-29 years assessed in 2020 were gathered using independent self-administered online surveys. In addition, (3) n = 4 students were recruited for semi-structured, qualitative interviews in 2020 during the onset phase of the COVID-19 pandemic. Correlation and regression analyses as well as analyses of variance were conducted. Thematic analysis as a qualitative method was used to explore the role physical activity, friendship, and social interactions played in loneliness, particularly in times of social isolation and social distancing. Results revealed associations of varying strength between physical activity and loneliness in 2018/2019 (r = -0.09, p ≤ 0.05) and 2020 (r = -0.20, p < 0.01). In 2020, n = 73 (41.7%) participants felt that their loneliness had increased since the COVID-19 social and physical distancing guidelines were introduced, but this was not associated with a perceived change in physical activity (r = -0.05, p > 0.05). Analyses of qualitative data revealed three main themes: (1) the lack of deep friendships at university, (2) the positive perceived impact of team sports on feelings of loneliness, and (3) the need for real connection in times of crisis. Thus, with regard to feelings of loneliness during the pandemic, being physically active seems to be a small but potentially relevant factor among young individuals. The qualitative study suggests that first-year university students might buffer the lack of deep friendships and meaningful interactions by building social bonds in team sports. In times of physical distancing, young individuals vulnerable to loneliness may therefore require special support such as doing sports with physical distance and perceiving connected with their team for instance by digital devices and emotional coping.
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Affiliation(s)
- Sonia Lippke
- Department of Psychology & Methods, Jacobs University Bremen, Bremen, Germany
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Badcock JC, Adery LH, Park S. Loneliness in psychosis: A practical review and critique for clinicians. ACTA ACUST UNITED AC 2020. [DOI: 10.1111/cpsp.12345] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Elphinstone B. Identification of a Suitable Short‐form of the UCLA‐Loneliness Scale. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12285] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Brad Elphinstone
- Faculty of Health, Arts, and Design, Swinburne University of Technology,
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Sancho P, Pinazo‐hernandis S, Donio‐bellegarde M, Tomás JM. Validation of the University of California, Los Angeles Loneliness Scale (version 3) in Spanish older population: An application of exploratory structural equation modelling. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12428] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Patricia Sancho
- Department of Educational and Developmental Psychology, University of Valencia, Valencia, Spain,
| | | | | | - José M. Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain,
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Wongpakaran N, Wongpakaran T, Pinyopornpanish M, Simcharoen S, Suradom C, Varnado P, Kuntawong P. Development and validation of a 6-item Revised UCLA Loneliness Scale (RULS-6) using Rasch analysis. Br J Health Psychol 2020; 25:233-256. [PMID: 31999891 DOI: 10.1111/bjhp.12404] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 01/06/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The UCLA Loneliness Scale, containing 20 items, is one of the commonly used loneliness scales. Some shorter versions have been developed using factor analysis. The study aimed to shorten the UCLA Loneliness Scale using Rasch and factor analysis methods and test the psychometric properties of the new scale. METHODS The full sample of the study included 719 respondents, divided into three subsamples (205, 324, and 190 for samples 1-3, respectively). The original, 20-item Revised UCLA Loneliness Scale (R-ULS) was shortened using 205 students (sample 1); the shortened scale was then validated for construct and concurrent validity with 324 students (sample 2) and 190 clinical participants (sample 3). Confirmatory factor analysis and Rasch analysis were used for construct validity. Convergent, discriminant, and concurrent validity were assessed by exploring the correlation with other psychological measurements. RESULTS In sample 1, the R-ULS was shortened to a 6-item scale (RULS-6) that fits the Rasch model. The RULS-6 met the criteria of unidimensionality and local independence without differential item functioning due to age and sex, and good targeting the clinical sample. Person Separation Index (PSI) reflected that reliability from the Rasch perspective was acceptable. However, collapsing categories 2 (sometime) and 3 (rarely) may be required in a clinical sample. When tested in samples 2 and 3, the RULS-6 fits the Rasch measurement model. Convergent and discriminant validity were demonstrated with interpersonal problems and attachment scales. As expected, a positive correlation was found between RULS-6 and anxiety, depression subscale, interpersonal difficulties, and somatization subscales denoting concurrent validity. Cronbach's alpha of the RULS-6 was good (.83). CONCLUSION Using Rasch analysis, the proposed RULS-6 constituted a 70% reduction of the number of original items, yet preserved the psychometric properties in independent samples of students and psychiatric outpatients. Statement of contribution What is already known on this subject? The UCLA Loneliness Scale is a common instrument used to gauge loneliness levels. The 20-item revised scale (R-ULS) has acceptable psychometric properties but its construct varies. Due to the length of the questionnaire, administration of R-ULS is not always practical. Short versions vary in items and were developed with classic test theory (e.g., factor analysis). Rasch analysis - providing more accuracy based on measurement theory - could be used instead. What does this study add? Using a Rasch analysis approach, a 6-item scale of loneliness (RULS-6) was created. The RULS-6 was tested in student and clinical samples, meeting Rasch measurement model criteria. The RULS-6 showed promising psychometrics to be used in both non-clinical and clinical samples.
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Affiliation(s)
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | | | | | - Chawisa Suradom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | - Pairada Varnado
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
| | - Pimolpun Kuntawong
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Thailand
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Eccles AM, Qualter P, Madsen KR, Holstein BE. Loneliness in the lives of Danish adolescents: Associations with health and sleep. Scand J Public Health 2020; 48:877-887. [PMID: 31969070 PMCID: PMC7678339 DOI: 10.1177/1403494819865429] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims: We examined the relationship between loneliness and health among young adolescents. We also investigated the validity of a single-item measure of loneliness by comparing this to a composite score. Methods: The current data come from a nationally representative sample of 11- to 15-year-old adolescents (N=3305; F=52%) from Denmark collected in 2014 as part of the Health Behaviour in School-aged Children (HBSC) collaborative cross-national survey. Results: A series of binary logistic regressions showed that higher loneliness among adolescents, whether measured using the single- or multi-item measurement, was associated with poorer self-rated health, higher frequency of headache, stomach ache, backache, difficulties sleeping, greater sleep disturbance and more instances of feeling tired in the morning. Those associations were relatively consistent across sex and age groups. Conclusions:Loneliness is associated with poorer self-reported health and sleep problems among young adolescents. Those findings are similar across two measures of loneliness, suggesting robust findings. The development of interventions and health-education efforts to fight loneliness in adolescence is important.
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Affiliation(s)
- Alice M Eccles
- School of Psychology, University of Central Lancashire, UK.,Manchester Institute of Education, University of Manchester, UK
| | - Pamela Qualter
- Manchester Institute of Education, University of Manchester, UK
| | - Katrine R Madsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Bjørn E Holstein
- National Institute of Public Health, University of Southern Denmark, Denmark
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