Social and emotional loneliness: an examination of Weiss's typology of loneliness

Women with knee osteoarthritis have more pain and poorer function than men, but similar physical activity prior to total knee replacement

Background

Osteoarthritis of the knee is a major clinical problem affecting a greater proportion of women than men. Women generally report higher pain intensity at rest and greater perceived functional deficits than men. Women also perform worse than men on function measures such as the 6-minute walk and timed up and go tests. Differences in pain sensitivity, pain during function, psychosocial variables, and physical activity levels are unclear. Further the ability of various biopsychosocial variables to explain physical activity, function and pain is unknown.

Methods

This study examined differences in pain, pain sensitivity, function, psychosocial variables, and physical activity between women and men with knee osteoarthritis (N = 208) immediately prior to total knee arthroplasty. We assessed: (1) pain using self-report measures and a numerical rating scale at rest and during functional tasks, (2) pain sensitivity using quantitative sensory measures, (3) function with self-report measures and specific function tasks (timed walk, maximal active flexion and extension), (4) psychosocial measures (depression, anxiety, catastrophizing, and social support), and (5) physical activity using accelerometry. The ability of these mixed variables to explain physical activity, function and pain was assessed using regression analysis.

Results

Our findings showed significant differences on pain intensity, pain sensitivity, and function tasks, but not on psychosocial measures or physical activity. Women had significantly worse pain and more impaired function than men. Their levels of depression, anxiety, pain catastrophizing, social support, and physical activity, however, did not differ significantly. Factors explaining differences in (1) pain during movement (during gait speed test) were pain at rest, knee extension, state anxiety, and pressure pain threshold; (2) function (gait speed test) were sex, age, knee extension, knee flexion opioid medications, pain duration, pain catastrophizing, body mass index (BMI), and heat pain threshold; and (3) physical activity (average metabolic equivalent tasks (METS)/day) were BMI, age, Short-Form 36 (SF-36) Physical Function, Kellgren-Lawrence osteoarthritis grade, depression, and Knee Injury and Osteoarthritis Outcome Score (KOOS) pain subscale.

Conclusions

Women continue to be as physically active as men prior to total knee replacement even though they have significantly more pain, greater pain sensitivity, poorer perceived function, and more impairment on specific functional tasks.

Health related quality of life and psychosocial correlates among HIV-infected adolescent and young adult women in the US

In this study HIV health-related quality of life (HIV-HRQOL) is examined among 179 behaviorally infected adolescent and young adult women. Modifiable psychosocial variables including depression, stigma, social support, and illness acceptance, and the biological end-points of CD4 cell count and viral load were explored in relation to HIV-HRQOL. The three factors of the HIV-HRQOL measure include current life satisfaction, illness related anxiety and illness burden. Bivariate linear regression analysis demonstrated statistically significant associations for all psychosocial variables and HIV HRQOL factors (p < .01), but not for biological end-points. In multivariate linear regression analysis significant associations remained between: depression (p = .006), illness acceptance (p < .001), social support (p = .001), and current life satisfaction, and depression (p = .012), illness acceptance (p = .015), and illness burden. A trend in association was noted for HIV stigma, with current life satisfaction and illness related anxiety but did not reach statistical significance (p = .097 and p = .109 respectively). Interventions that effectively decrease stigma and depression and increase social support and illness acceptance will likely improve the well-being and quality of life of HIV-infected adolescent women.

A marginal structural model analysis for loneliness: implications for intervention trials and clinical practice

OBJECTIVE

Clinical scientists, policymakers, and individuals must make decisions concerning effective interventions that address health-related issues. We use longitudinal data on loneliness and depressive symptoms and a new class of causal models to illustrate how empirical evidence can be used to inform intervention trial design and clinical practice.

METHOD

Data were obtained from a population-based study of non-Hispanic Caucasians, African Americans, and Latino Americans (N = 229) born between 1935 and 1952. Loneliness and depressive symptoms were measured with the UCLA Loneliness Scale-Revised and Center for Epidemiologic Studies Depression Scale, respectively. Marginal structural causal models were employed to evaluate the extent to which depressive symptoms depend not only on loneliness measured at a single point in time (as in prior studies of the effect of loneliness) but also on an individual's entire loneliness history.

RESULTS

Our results indicate that if interventions to reduce loneliness by 1 standard deviation were made 1 and 2 years prior to assessing depressive symptoms, both would have an effect; together, they would result in an average reduction in depressive symptoms of 0.33 standard deviations, 95% CI [0.21, 0.44], p < .0001.

CONCLUSIONS

The magnitude and persistence of these effects suggest that greater effort should be devoted to developing practical interventions on alleviating loneliness and that doing so could be useful in the treatment and prevention of depressive symptoms. In light of the persistence of the effects of loneliness, our results also suggest that, in the evaluation of interventions on loneliness, it may be important to allow for a considerable follow-up period in assessing outcomes.

Amygdala volume and social network size in humans

We found that amygdala volume correlates with the size and complexity of social networks in adult humans. An exploratory analysis of subcortical structures did not find strong evidence for similar relationships with any other structure, but there were associations between social network variables and cortical thickness in three cortical areas, two of them with amygdala connectivity. These findings indicate that the amygdala is important in social behavior.

Social isolation is associated with elevated tumor norepinephrine in ovarian carcinoma patients

Noradrenergic pathways have been implicated in growth and progression of ovarian cancer. Intratumoral norepinephrine (NE) has been shown to increase with stress in an animal cancer model, but little is known regarding how tumor NE varies with disease stage and with biobehavioral factors in ovarian cancer patients. This study examined relationships between pre-surgical measures of social support, depressed mood, perceived stress, anxiety, tumor histology and tumor catecholamine (NE and epinephrine [E]) levels among 68 ovarian cancer patients. We also examined whether associations observed between biobehavioral measures and tumor catecholamines extended to other compartments. Higher NE levels were found in advanced stage (p=0.006) and higher grade (p=0.001) tumors. Adjusting for stage, grade, and peri-surgical beta blockers, patients with a perceived lack of social support had significantly higher tumor NE (β=-0.29, p=0.012). A similar trend was seen for social support and ascites NE (adjusting for stage, peri-surgical beta blockers and caffeine: β=-0.50, p=0.075), but not for plasma NE. Other biobehavioral factors were not related to tumor, ascites, or plasma NE (p values >0.21). Tumor E was undetectable in the majority of tumors and thus E was not further analyzed. In summary, these results suggest that tumor NE provides distinct information from circulating plasma concentrations. Tumor NE levels were elevated in relationship to tumor grade and stage. Low subjective social support was associated with elevated intratumoral NE. As beta-adrenergic signaling is related to key biological pathways involved in tumor growth, these findings may have implications for patient outcomes in ovarian cancer.

The Relation Between Trust Beliefs and Loneliness During Early Childhood, Middle Childhood, and Adulthood

Four studies examined the relation between trust and loneliness. Studies 1, 2, and 3 showed that trust beliefs negatively predicted changes in loneliness during early childhood (5—7 years), middle childhood (9—11 years), and young adulthood (18—21 years). Structural equation modeling yielded support for the hypothesis that the relation between trust beliefs and loneliness was mediated, in part, by social disengagement, which varied by age and gender. Study 4 showed that when young adults were primed for distrust rather than for trust cognitions, they showed greater withdrawal (loneliness) affect, lower willingness to disclose, and less perceived success in achieving rapport. The findings yielded support for the hypotheses that (a) low trust beliefs promote loneliness from childhood to adulthood and (b) social disengagement and cognitive schema mechanisms account for the relation.

Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study

We present evidence from a 5-year longitudinal study for the prospective associations between loneliness and depressive symptoms in a population-based, ethnically diverse sample of 229 men and women who were 50-68 years old at study onset. Cross-lagged panel models were used in which the criterion variables were loneliness and depressive symptoms, considered simultaneously. We used variations on this model to evaluate the possible effects of gender, ethnicity, education, physical functioning, medications, social network size, neuroticism, stressful life events, perceived stress, and social support on the observed associations between loneliness and depressive symptoms. Cross-lagged analyses indicated that loneliness predicted subsequent changes in depressive symptomatology, but not vice versa, and that this temporal association was not attributable to demographic variables, objective social isolation, dispositional negativity, stress, or social support. The importance of distinguishing between loneliness and depressive symptoms and the implications for loneliness and depressive symptomatology in older adults are discussed.

The older, the lonelier? Risk factors for social loneliness in old age

Loneliness is often associated with old age, but many studies have shown that the relationship is not straightforward. This paper seeks a better understanding of the impact of social isolation on feelings of loneliness among older people, by building on the theoretical and actual distinction between social and emotional loneliness. Social loneliness refers to a lack of feelings of social integration; emotional loneliness emerges in the absence of an attachment figure. This paper focuses on social loneliness and has two aims, first to disentangle the direct and intermediate effects of both the number and the quality of social relationships on social loneliness in old age, and second to detect the groups at risk of social loneliness by identifying which personal features correspond with which relational deficits and therefore indirectly increase the risk on social loneliness. Data are analysed for a sample of 1,414 respondents aged 55 or more years drawn from the Panel Study of Belgian Households conducted in 2000. The results confirm that improved understanding is gained by decomposing the interrelation between age and other background features, on the one hand, and the social relational features, on the other, as indirect and direct predictors of social loneliness. Generally, this approach promotes a correct identification of the groups at risk of social loneliness in old age.

An empirical test of ecodevelopmental theory in predicting HIV risk behaviors among Hispanic youth

Ecodevelopmental theory is a theoretical framework used to explain the interplay among risk and protective processes associated with HIV risk behaviors among adolescents. Although ecodevelopmentally based interventions have been found to be efficacious in preventing HIV risk behaviors among Hispanic youth, this theory has not yet been directly empirically tested through a basic research study in this population. The purpose of this cross-sectional study was to empirically evaluate an ecodevelopmentally based model using structural equation modeling, with substance use and early sex initiation as the two outcomes of the ecodevelopmental chain of relationships. The sample consisted of 586 Hispanic youth (M age = 13.6; SD = 0.75) and their primary caregivers living in Miami, Florida. Adolescent, parent, and teacher reports were used. The results provided strong support for the theoretical model. More specifically, the parent-adolescent acculturation gap is indirectly related both to early sex initiation and to adolescent substance use through family functioning, academic functioning, perceived peer sexual behavior, and perceived peer substance use. Additionally, parent's U.S. orientation is associated with adolescent substance use and adolescent sex initiation through social support for parents, parental stressors, family functioning, academic functioning, and perceived peer sexual behavior and substance use. These findings suggest that HIV risk behaviors may best be understood as associated with multiple and interrelated ecological determinants.

Mediators of HIV-related stigma and risk behavior in HIV infected young women

Stigma in HIV positive persons has been associated with numerous negative sequelae, including decreased social support, depressive symptoms, and engagement in risk behaviors. Few studies examined the interrelationships of these factors to facilitate understanding of the mechanisms by which HIV stigma influences risk behavior, thus the current study focuses on identifying pathways between HIV-related stigma and risk behavior in 147 young HIV positive women. Depression and social support were hypothesized to mediate between HIV-related stigma and risk behavior. Structural equation modeling was used to test these hypothesized pathways, results suggested that depression was a significant mediator between HIV-related stigma and risk behavior. Implications for interventions with young HIV positive women who report high levels of HIV-related stigma include a focus on depression as a method of reducing engagement in risk behavior and improving mental health and health behaviors in persons living with HIV.

Perceptions of Family of Origin Among Lonely Adult Filipino Males With Schizophrenia: A Qualitative Analysis

This study explored the perceived family life experiences in the family of origin among 35 hospitalized lonely adult (range 27 to 44 years) Filipino males with schizophrenia during a period of remission of their overt psychotic features. Open-ended interview, checklists, and projective techniques were used to collect data. Together with an in-depth analysis of narratives, the responses of the lonely and the loneliest participants were compared by Mann—Whitney U nonparametric test of comparison. It was predicted in this study that individuals with schizophrenia with higher level of loneliness would be more likely to perceive their family life experiences negatively than the less lonely individuals with schizophrenia. Results showed that the degree of negative family experiences among the loneliest participants was significantly higher than the lonely participants. Moreover, a few participants regardless of the degree of loneliness positively viewed their family as united and close, interactive, affectionate and loving, kind and good, trustworthy, religious, morally good, complete, and supportive.

Loneliness and the health of older people

BACKGROUND

The intense focus on major psychiatric disorders in both contemporary psychiatric research and clinical practice has resulted in the relative neglect of less definable constructs such as loneliness and how such entities might impact on health outcomes. The purpose of this review is to raise awareness among physicians and psychiatrists of the medical impact and biological effects of loneliness as well as making the argument that loneliness should be a legitimate therapeutic target.

METHODS

Using Pubmed we searched the literature for research and review papers looking at loneliness as a construct, how it is measured and its health effects. We reviewed the relevant papers and have summarized their main findings.

RESULTS

Loneliness has strong associations with depression and may in fact be an independent risk factor for depression. Furthermore loneliness appears to have a significant impact on physical health being linked detrimentally to higher blood pressure, worse sleep, immune stress responses and worse cognition over time in the elderly. There is a relative deficiency in adequate evidence based treatments for loneliness.

CONCLUSION

Loneliness is common in older people an is associated with adverse health consequences both from a mental and physical health point of view. There needs to be an increased focus on initiating intervention strategies targeting loneliness to determine if decreasing loneliness can improve quality of life and functioning in the elderly.

Biobehavioral influences on matrix metalloproteinase expression in ovarian carcinoma

PURPOSE

Stromal cells in the tumor microenvironment, such as macrophages, play an active role in tumor growth and angiogenesis. However, little is known about relationships of biobehavioral factors with angiogenic cytokines and matrix metalloproteinases (MMP) produced by stromal cells. This study examined distress, MMPs, and angiogenic cytokines in ovarian cancer patients and in vitro.

EXPERIMENTAL DESIGN

Patients suspected of ovarian cancer completed preoperative questionnaires. At surgery, 56 were confirmed to have epithelial ovarian cancer. Tumor samples were analyzed for macrophage (CD68(+)) and tumor cell levels of MMP-2, MMP-9, and vascular endothelial growth factor. In vitro stimulation of isolated macrophage cells by the stress hormones norepinephrine and cortisol was done to assess effects on MMP-9.

RESULTS

Depressed patients showed significant elevations of MMP-9 in CD68(+) cells, adjusting for stage (P<0.0001). Patients with higher levels of current stress (P=0.01), life stress over the last 6 months (P=0.004), and general negative affect (P=0.007) also showed significantly greater MMP-9 in CD68(+) cells. In contrast, higher social support was associated with lower levels of MMP-9 (P=0.023) and vascular endothelial growth factor (P=0.036) in tumor cells. In vitro analyses showed that macrophage MMP-9 production could be directly enhanced (up to a 2-fold increase) by the stress hormones norepinephrine and cortisol.

CONCLUSIONS

Ovarian cancer patients with elevated depressive symptoms, chronic stress, and low social support showed elevations in MMP-9 in tumor-associated macrophages. Direct in vitro enhancement of stromal MMP-9 production by stress hormones was also shown. These findings may have implications for patient outcomes in ovarian cancer.

Depression predicts mortality in the young old, but not in the oldest old: results from the Berlin Aging Study

OBJECTIVE

There is evidence that depression in old age is associated with an increased mortality risk, but studies have also yielded inconclusive results. Possible moderators of the depression-mortality association in old age discussed in the literature are differences in cardiovascular morbidity, effects of multimorbidity, and increasing effects of subthreshold depression symptoms, such as minor depression and loneliness, on mortality. This study is concerned with the depression-mortality association in old and very old age.

METHOD

Information about mortality status and dates of death for 497 participants of the Berlin, Germany, Aging Study (mean age: 85.16 years; range: 70-103 years), a population based, age-stratified, longitudinal study, were obtained from the Berlin, Germany, City Registry for up to 15 years. The authors calculated proportional hazard regression models to examine associations between clinical diagnosis of depression at baseline assessment and subsequent mortality for young-old (70-84 years; N = 243; 68% deceased) and oldest-old participants (85+ years; N = 254; 98% deceased). In an additional step, the authors examined whether depression-mortality associations remained after statistically controlling for the effects of other mortality predictors including age, gender, education, dementia, cardiovascular risk factors, and other somatic diseases.

RESULTS

Our analyses revealed strong predictive effects of depression diagnoses for mortality among the young old (Relative Risk = 1.60, 95% Confidence Interval = 1.13-2.26) that were not due to the effects of other mortality predictors (Relative Risk = 1.56, 95% Confidence Interval = 1.09-2.22). Among the oldest old, no depression-mortality associations were found.

CONCLUSION

Depression is a significant risk factor for all-cause mortality in old age, yet the risk conveyed by depression does not hold in very old age. Possible underlying mechanisms in the very old are discussed.

Stress and depression among older residents in religious monasteries: do friends and God matter?

The purpose of this investigation was to explore how friendship and attach-0 ment to God provide protective benefits against stress and depression. Participants included 235 men and women, age 64 and older, residing in religious monasteries affiliated with the Order of St. Benedict. Hierarchical multiple regression analyses were completed to assess main and moderating effects of friendship and attachment to God relative to the influence of stress on depressive symptomology. Lower degree of friendship closeness (beta = -.12, p < .10) and greater insecurity with God (beta = -.15, p < .01) were directly associated with greater depressive symptoms. A significant three-way interaction (Stress x Friendship x Attachment to God) also existed relative to depressive symptoms (beta = .14, p < .05). Three "stress-buffering" mechanisms emerged relative to the influence of stress on depressive symptomology. First, a greater degree of friendship closeness in combination with less secure attachment to God represented a greater risk for depressive symptoms. Second, greater friendship closeness in combination with greater secure attachment to God reduced the risk for depressive symptoms. Third, lower degree of friendship closeness combined with less secure attachment to God diminished the noxious effects of stress on depressive symptoms. This has implications relative to how social and spiritual resources can be used to reduce stress and improve quality of life for older adults residing in religious communities.

The impact of social support and sense of coherence on health-related quality of life among nursing home residents--a questionnaire survey in Bergen, Norway

BACKGROUND AND OBJECTIVES

Few studies have examined the association between social support and health-related quality of life (HRQOL) among nursing home residents and whether the sense of coherence (SOC) modifies the effect of social support on health-related quality of life. The main aims of this study were to determine the relationship between social support and HRQOL and to investigate whether the SOC modifies the effect of social support on HRQOL.

DESIGN

A cross-sectional, descriptive, correlational design.

SETTINGS

All 30 nursing homes in Bergen in western Norway.

PARTICIPANTS

Two hundred and twenty-seven mentally intact long-term nursing home residents 65 years and older.

METHODS

Data were obtained through face-to-face interviews using the SF-36 Health Survey, Social Provisions Scale and Sense of Coherence Scale. Possible relationships between the Social Provisions Scale and the eight SF-36 subdimensions were analysed using multiple linear regression while controlling for age, sex, marital status, education and comorbid illness. Interactions between the Sense of Coherence Scale and Social Provisions Scale were investigated.

RESULTS

Attachment affected the mental health subdimension (p=0.001), opportunity for nurturance affected social functioning (p=0.003) and reassurance of worth affected vitality (p=0.001) after adjustment for demographic variables and comorbid illness. After the analysis included the sense of coherence, nurturance still significantly affected social functioning and reassurance of worth still significantly affected vitality. No interaction with sense of coherence was found, and sense of coherence significantly affected all SF-36 subdimensions.

CONCLUSIONS

The opportunity to provide nurturance for others appears to be important for social functioning, and sense of competence and sense of self-esteem appear to be important for vitality. Further, the residents' relationships with significant others comprise an important component of mental health. Finally, independent of the level of sense of coherence, social support is an important resource for better health-related quality of life. Clinical nurses should recognize that social support is associated with health-related quality of life and pay attention to the importance of social support for the residents in daily practice.

The contribution of loneliness and posttraumatic stress disorder to marital adjustment following war captivity: a longitudinal study

This prospective study examined the relative contribution of loneliness and posttraumatic stress disorder (PTSD) to marital adjustment among Israeli veterans of the 1973 Yom Kippur war. Specifically, we examined the mediating role of loneliness as measured in 1991 in the association between PTSD as measured in 1991 and marital adjustment as measured in 2003. Our sample consisted of 225 participants divided into 2 groups: ex-prisoners of war (ex-POWs) (N = 122) and a comparison group comprised of veterans who fought in the same war but who had not experienced captivity (N = 103). The findings demonstrate that ex-POWs display lower levels of marital adjustment and higher levels of PTSD than controls. Loneliness was found to mediate the relationship between PTSD as measured in 1991 and marital adjustment as measured in 2003 for both ex-POWs and controls. Further, for ex-POWs, loneliness contributes to marital adjustment above and beyond the contribution of PTSD as measured in 2003. The theoretical implications of loneliness for the marital relationships of traumatized ex-POWs are discussed.

Perceived social isolation in a community sample: its prevalence and correlates with aspects of peoples' lives

Although there are many studies reporting perceived social isolation or loneliness and their correlates in specific groups, there are few modern prevalence studies. This study reports on the prevalence of perceived social isolation in an Australian community sample. Randomly sampled Australian adults (n = 3,015) were interviewed using a standard questionnaire. In addition to perceived social isolation assessed by the Friendship Scale, data were collected on socio-demographic variables and chronic health conditions. The findings suggest that while most participants were socially connected, 9% reported some social isolation and 7% were isolated or very isolated. Perceived social isolation varied by gender and age group, region of birth, relationship, labourforce, and income status. A key finding was that younger adults had higher probabilities of being classified as being socially isolated than did older participants. Depression was very strongly associated with perceived social isolation. Other health conditions or life experiences associated with it were hearing, incontinence and lifetime trauma exposure. The demographic characteristics and chronic health conditions associated with perceived social isolation are structural circumstances of peoples' lives. Given there are poor long-term health outcomes, including early death and suicide, there are clear public health implications for those trapped by these life circumstances.

Bullying and social and emotional loneliness in a sample of adult male prisoners

The present study explored social and emotional loneliness, and victimisation among a sample of adult male prisoners. 241 prisoners took part, completing a behavioural measure of behaviours indicative of bullying (DIPC-R: Direct and Indirect Prisoner behaviour Checklist, Ireland, J.L. 2003. The Direct and Indirect Prisoner behaviour Checklist -- Revised. Psychology Department, University of Central Lancashire). and a measure of social and emotional loneliness (SELSA: Social and Emotional Loneliness Scale for Adults, DiTommaso, E. & Spinner, B. (1993). The development and initial validation of the social and emotional loneliness scale for adults (SELSA). Personality and Individual Differences, 14, 127-134.). Differences between the groups involved in bullying (i.e. pure bullies, pure victims, bully/victims and those not involved) were noted, with victim groups (pure victims and bully/victims) presenting with higher levels of social loneliness than those not-involved. Emotional loneliness was not a distinguishing characteristic for membership to the pure victim or bully/victim group, and instead was found to be associated with the type and amount of victimisation reported: victims who reported multiple types of victimisation presented with higher levels of emotional (family) loneliness than victims reporting just one type of victimisation. Increased victimisation was also associated with increased levels of social and emotional loneliness, most notably with regards to indirect victimisation. The results are discussed with reference to the environment in which the victimisation is taking place, and we outline a potential application of life events and added stress models in understanding social maladjustment (loneliness) among prisoners.

Positive psychosocial factors and NKT cells in ovarian cancer patients

Psychosocial factors are known to be associated with properties of both NK cells and T cells in cancer patients. Less is known about the relationship between psychosocial factors and NKT cells, a rare group of lymphocytes that have known relevance for tumor control. We examined four psychosocial factors and percentage and number of CD3+CD56+ NKT cells, CD3-CD56+ NK cells, and CD3+CD56- T cells in peripheral blood lymphocytes (PBL), ascites, and tumor of 35 ovarian cancer patients and 28 patients with benign pelvic masses. Patients awaiting surgery for a suspected cancerous mass completed questionnaires and gave a pre-surgical blood sample. Ascites and tumor were taken during surgery. After lymphocyte isolation, subpopulations were analyzed by flow cytometry. Benign and cancer patients did not differ on PBL subpopulations. Among cancer patients, NKT cell percentage was significantly higher in tumor and ascites than in PBL; T cell percentage was significantly higher in PBL than tumor. NKT, NK, and T cell number were significantly higher in peripheral blood than in ascites. Positive reframing was related to significantly higher NKT cell percentage and number in PBL. Social support was related to significantly higher NKT cell percentage in tumor. Vigor was related to significantly higher NKT cell percentage in PBL. Total mood disturbance was not related to NKT cell percentage or number. No significant relationships were found between psychosocial factors and NK cell percentage and number and T cell percentage and number. Given the anti-tumor activity of CD3+CD56+ cells, these relationships may have relevance for cancer control.

Prevalence and predictors of post-traumatic stress disorder (PTSD) in physically injured victims of non-domestic violence. A longitudinal study

BACKGROUND

Victims of violent assault experience diverse post-event emotional problems such as post-traumatic stress disorder (PTSD), and they may have multiple emotional problems. The aim of the present study was to evaluate the prevalence and predictors of PTSD in a longitudinal design.

METHODS

The levels of physical injury, perceived life threat, prior experience of violence, peritraumatic dissociation (PD), acute PTSD, perceived self-efficacy and perceived social support are considered possible predictors. This study had a single group (N = 70), longitudinal design with three repeated measures over a period of 12 months. Questionnaires used were: Impact of Event Scale-15 and 22 (IES-15 and 22), Post-Traumatic Symptom Scale-10 (PTSS-10), Peritraumatic Dissociation (PD) 7-item self-report measure, Social Provisions Scale (SPS) and Generalized Self-Efficacy scale (GSE).

RESULTS

Results showed a high prevalence and severity of PTSD on all outcomes, for instance 31% scored as probable PTSD-cases and 14% as risk level cases by IES-15 at T3. Either injury severity or prior experience of being a victim of violence predicted PTSD in this study. Early PTSD predicted subsequent PTSD, and perceived life threat was a predictor of PD. Furthermore, lack of perceived social support was a predictor of PTSD symptoms at T3. In addition, low perceived self-efficacy was a predictor of PTSD and influenced perceived social support at T1.

CONCLUSIONS

Our results showed that experience of non-domestic violence may cause serious chronic emotional problems, and therefore it is important to be aware of early symptoms indicating needs for special follow-ups.

Correlates of Minimal Dating

Researchers have associated minimal dating with numerous factors. The present author tested shyness, introversion, physical attractiveness, performance evaluation, anxiety, social skill, social self-esteem, and loneliness to determine the nature of their relationships with 2 measures of self-reported minimal dating in a sample of 175 college students. For women, shyness, introversion, physical attractiveness, self-rated anxiety, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. For men, physical attractiveness, observer-rated social skill, social self-esteem, and loneliness correlated with 1 or both measures of minimal dating. The patterns of relationships were not identical for the 2 indicators of minimal dating, indicating the possibility that minimal dating is not a single construct as researchers previously believed. The present author discussed implications and suggestions for future researchers.

Primary caregivers of cancer patients in the palliative phase: a path analysis of variables influencing their burden

Research has shown that several variables influence the burden of primary caregivers of cancer patients staying at home in the palliative phase, but the associations between these variables have hardly been explored. The aim of this study was to examine the associations of theory-driven variables with the caregivers' burden by means of path analysis. The sample consisted of 96 caregivers of cancer patients in the palliative phase staying at home recruited from a hospital trust in Norway. The dimensions of burden from the Caregiver Reaction Assessment, namely self esteem, lack of family support, impact on finances, and impact on daily schedule, were used as the dependent variable. The following independent variables were tested in the models: the patients' levels of pain, fatigue, and nausea; and the caregivers' physical quality of life, anxiety and depression, and social support. The Partial Least Squares approach to structural equation modelling was used for the path analysis. Model 1 shows the direct associations between the independent variables and the dependent variable, explaining 16% of the variance in caregiver burden. Model 1 supports the finding that only caregivers' depression has a direct significant association with caregiver burden, and shows further that the effects of the other independent variables on burden are mediated through depression. In Model 2, anxiety and depression are mediating factors between three other independent variables and caregiver burden, and 12% of the variance is explained. Model 2 supports none of the independent variables as antecedents of burden. Testing of the models suggested that caregivers' depression was the main factor associated with caregiver burden, but also an important mediator of indirect associations of indirect associations of caregivers' anxiety and physical health.

The clinical significance of loneliness: a literature review

Satisfying social relationships are vital for good mental and physical health. Accordingly, we recommend that the alleviation and prevention of social relationship deficits be a key focus of clinicians. In this review, we focus on loneliness as a crucial marker of social relationship deficits and contend that loneliness should command clinicians' attention in its own right--not just as an adjunct to the treatment of other problems such as depression. With a particular focus on the adolescent developmental period, this review is organized into five sections: Drawing on developmental and evolutionary psychology theories, the nature of social relationships and the function they serve is first discussed. In the second section, loneliness is introduced as an exemplar of social relationship deficits. Here a definition of loneliness is provided, as well as an explanation of why it may pose a situation of concern. This is followed by a review of the prototypic features of loneliness through examination of its affective, cognitive, and behavioral correlates. The fourth section includes a review of theories related to the antecedent and maintenance factors involved in loneliness. Finally, methodological and theoretical considerations are addressed, and conclusions and proposals for future research directions are put forth.

Perceived social support and mortality in older people

OBJECTIVES

This study examines the effect of perceived social support on all-cause mortality at a 10-year follow-up as well as the plausible mediating factors in this association.

METHODS

We measured perceived social support in 206 Finnish men and women aged 80 years old by using the Social Provision Scale, which consists of six dimensions: attachment, social integration, opportunity for nurturance, reassurance of worth, reliable alliance, and guidance.

RESULTS

By using a theoretical framework that divided perceived social support into assistance-related and non-assistance-related support, we found that the risk of death was almost 2.5 times higher in women in the lowest tertile of non-assistance-related social support (comprising infrequent experiences of reassurance of worth, emotional closeness, sense of belonging and opportunity for nurturance) than in women in the highest tertile. The risk remained strong even when we controlled for the indicators of baseline sociodemographics and psychological and physiological health and functioning. Among men, none of the perceived social support dimensions showed a significant association with mortality.

DISCUSSION

The results of this study present a challenge for society to find and develop new social innovations and interventions in order to promote a sense of emotional social support in older people, thereby contributing to their health and welfare.

Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses

The extent to which loneliness is a unique risk factor for depressive symptoms was determined in 2 population-based studies of middle-aged to older adults, and the possible causal influences between loneliness and depressive symptoms were examined longitudinally in the 2nd study. In Study 1, a nationally representative sample of persons aged 54 and older completed a telephone interview as part of a study of health and aging. Higher levels of loneliness were associated with more depressive symptoms, net of the effects of age, gender, ethnicity, education, income, marital status, social support, and perceived stress. In Study 2, detailed measures of loneliness, social support, perceived stress, hostility, and demographic characteristics were collected over a 3-year period from a population-based sample of adults ages 50-67 years from Cook County, Illinois. Loneliness was again associated with more depressive symptoms, net of demographic covariates, marital status, social support, hostility, and perceived stress. Latent variable growth models revealed reciprocal influences over time between loneliness and depressive symptomatology. These data suggest that loneliness and depressive symptomatology can act in a synergistic effect to diminish well-being in middle-aged and older adults.

Social support, psychological distress, and natural killer cell activity in ovarian cancer

PURPOSE

Psychosocial stress has been related to impaired immunity in cancer patients. However, the extent to which these relationships exist in immune cells in the tumor microenvironment in humans has not been explored. We examined relationships among distress, social support, and natural killer (NK) cell activity in ovarian cancer patients in peripheral-blood mononuclear cells (PBMC), ascitic fluid, and tumor-infiltrating lymphocytes (TIL).

PATIENTS AND METHODS

Patients awaiting surgery for a pelvic mass suspected of being ovarian cancer completed psychological questionnaires and gave a presurgical sample of peripheral blood. Samples of tumor and ascites were taken during surgery, lymphocytes were then isolated, and NK cytotoxicity and percentage were determined. The final sample, which was confirmed by surgical diagnosis, included 42 patients with epithelial ovarian cancer and 23 patients with benign masses.

RESULTS

Peripheral NK cell activity was significantly lower among ovarian cancer patients than in patients with benign masses. Among ovarian cancer patients, NK cytotoxicity in TIL was significantly lower than in PBMC or ascitic fluid. Social support was related to higher NK cytotoxicity in PBMC and TIL, adjusting for stage. Distress was related to lower NK cytotoxicity in TIL. A multivariate model indicated independent associations of both distress and social support with NK cell activity in TIL.

CONCLUSION

Psychosocial factors, such as social support and distress, are associated with changes in the cellular immune response, not only in peripheral blood, but also at the tumor level. These relationships were more robust in TIL. These findings support the presence of stress influences in the tumor microenvironment.

Associations between loneliness, depressive symptoms and perceived togetherness in older people

This study explores the associations of loneliness with depressive symptoms in a five-year follow-up and describes how the six dimensions of perceived togetherness explain loneliness and depressive symptoms at baseline. The data were collected on 207 residents of Jyväskylä, central Finland, who at baseline in 1990 were aged 80; and 133 residents who at follow-up in 1995 were aged 85. Loneliness was assessed using a questionnaire item with four preset response options, perceived togetherness using the Social Provisions Scale, and depressive symptoms using the CES-D scale. A recursive structural equation model showed that in women but not in men, depressive symptoms predicted more experiences of loneliness. Those who were lonely were more depressed (CES-D score 16 or over) and experienced less togetherness than those who were not. Loneliness was explained by reliable alliance, social integration and attachment; and depressive symptoms were explained by guidance, reassurance of worth, reliable alliance and attachment. A common feature in both loneliness and depressive symptoms was a lower level of perceived emotional togetherness in social interaction.

The importance of spirituality among gay and lesbian individuals

Religion is a conduit for expressing spirituality. Since most mainstream religions condemn any form of homosexuality one would expect that gay men and lesbians would have little to do with spirituality. Experts, however, believe that gay and lesbian individuals would especially benefit from spiritual nourishment because of the oppression they face. Using an instrument that measures spiritual well-being, this study investigated the spirituality of 93 gay and lesbian individuals. The findings revealed that respondents espoused high levels of spiritual well-being: how one relates to God (religious well-being) and how one feels about life (existential well-being). Those who identified with a formal religion and who attended religious services frequently espoused higher religious well-being. Respondents with a diagnosis of depression, on the other hand, espoused lower existential well-being. Multiple regression analyses revealed that existential well-being was a significant predictor of adjustment: having high self-esteem, accepting one's homosexual orientation, and feeling less alienated. In contrast, religious well-being was not a significant predictor of any measure of adjustment. These findings point to the importance of the existential aspect of spirituality among gay and lesbian individuals in determining adjustment. They also suggest that being well-adjusted does not entail being reconciled with a traditional religion or with a theistic belief.

Are normal narcissists psychologically healthy?: self-esteem matters

Five studies established that normal narcissism is correlated with good psychological health. Specifically, narcissism is (a) inversely related to daily sadness and dispositional depression, (b) inversely related to daily and dispositional loneliness, (c) positively related to daily and dispositional subjective well-being as well as couple well-being, (d) inversely related to daily anxiety, and (e) inversely related to dispositional neuroticism. More important, self-esteem fully accounted for the relation between narcissism and psychological health. Thus, narcissism is beneficial for psychological health only insofar as it is associated with high self-esteem. Explanations of the main and mediational findings in terms of response or social desirability biases (e.g., defensiveness, repression, impression management) were ruled out. Supplementary analysis showed that the links among narcissism, self-esteem, and psychological health were preponderantly linear.

Factor structure in the Camberwell Assessment of Need

BACKGROUND

In order to define needs for care of people with severe mental illness, the Camberwell Assessment of Need (CAN) is focused on measuring personal and social functioning. However, previous studies of the CAN have given inconsistent results in terms of what variables are actually being measured.

AIMS

To investigate the factor structure of the CAN.

METHOD

Assessments of 741 out-patients (mean age 45.5 years, 50% females) with severe mental illness (68% schizophrenia or other psychotic disorder) were used in an exploratory maximum likelihood factor analysis.

RESULTS

Support was found for a three-factor model, comprising 13 of the 22 variables in the CAN, with the factors corresponding to functional disability (7 variables), social loneliness (3 variables) and emotional loneliness (3 variables). The remaining variables did not load on any factor.

CONCLUSIONS

Exploratory factor analysis revealed three homogeneous dimensions in the CAN that may represent functional disability and two aspects of social health.

Loneliness and depression in independent living retirement communities: risk and resilience factors

Socio-emotional selectivity theory posits that as individuals age, they desire less social stimulation and novelty, and tend to select close, reliable relationships to meet their emotional needs. Residence in congregate facilities affords social exposure, yet does not guarantee access to close relationships, so that loneliness may be a result. Further, the gerontology literature has suggested that loneliness in late life may be a risk factor for serious mental health concerns such as depression. This article examined data on loneliness and depressive symptoms from older adults aged 60-98, residing in two age-segregated independent living facilities. Overlap between those scoring in the depressed range on the Geriatric Depression Scale and those scoring more than one standard deviation above the mean on the UCLA Loneliness Scale was less than 50%, although zero-order correlation of the two continuous scores was moderately high. Potential risk and resilience factors were regressed on the continuous scores of the two scales in separate hierarchical multiple regression analyses. Depression was predicted by being older, number of chronic health conditions, grieving a recent loss, fewer neighbor visitors, less participation in organized social activities and less church attendance. Grieving a recent loss, receiving fewer visits from friends, and having a less extensive social network predicted loneliness. In addition, loneliness scores explained about 8% of the unique variance in depression scores, suggesting it is an independent risk factor for depressive symptoms. Loneliness scores were seen to be more widely dispersed in these respondents, with less variance explained by the available predictors. Suggestions are made for addressing loneliness in older adults as a means of preventing more serious mental health consequences.

Self-pity: exploring the links to personality, control beliefs, and anger

Self-pity is a frequent response to stressful events. So far, however, empirical research has paid only scant attention to this subject. The present article aims at exploring personality characteristics associated with individual differences in feeling sorry for oneself. Two studies with N = 141 and N = 161 university students were conducted, employing multidimensional measures of personality, control beliefs, anger, loneliness, and adult attachment. With respect to personality, results showed strong associations of self-pity with neuroticism, particularly with the depression facet. With respect to control beliefs, individuals high in self-pity showed generalized externality beliefs, seeing themselves as controlled by both chance and powerful others. With respect to anger expression, self-pity was primarily related to anger-in. Strong connections with anger rumination were also found. Furthermore, individuals high in self-pity reported emotional loneliness and ambivalent-worrisome attachments. Finally, in both studies, a strong correlation with gender was found, with women reporting more self-pity reactions to stress than men. Findings are discussed with respect to how they support, extend, and qualify the previous literature on self-pity, and directions for future empirical research are pointed out.

Loneliness, lack of emotional support, lack of companionship, and the likelihood of having a heart condition in an elderly sample

Social isolation has been linked to a variety of adverse health outcomes, including cardiovascular disease. Researchers have attributed this association to the feelings of loneliness that accompany social isolation, but they have rarely assessed loneliness directly. In a sample of 180 older adults, feelings of loneliness and two kinds of social deficits that underlie loneliness--limited emotional support and limited companionship--were examined in relation to the likelihood of having a coronary condition. Potential physiological, behavioral, and affective mediators were examined as well. Greater loneliness was found to be associated with an increased probability of having a coronary condition, as were low levels of both emotional support and companionship. Mediators of these links were not identified, however, in this sample. These results underscore the value of examining the specific social deficits that underlie loneliness in investigations of the relation between loneliness and cardiovascular health in later life.

Results of a pilot intervention trial to improve antiretroviral adherence among HIV-positive patients

A small pilot trial of a multicomponent (behavioral strategies, simplified patient information, and social support) and multidisciplinary (cognitive-behavioral therapy and nursing) medication adherence intervention was conducted for HIV-infected adults prescribed antiretrovirals. Patients (N = 33) were randomly assigned to the intervention condition or standard care. Compared to the control group, patients in the intervention condition had significantly higher self-efficacy to communicate with clinic staff (p = .04) and to continue treatment (p = .04), were significantly more likely to be using behavioral and cognitive strategies (p = .01 and p = .04), reported significantly higher life satisfaction (p = .03), reported significantly increased feelings of social support (p = .04), and showed a trend toward an increase in taking their medications on schedule (p = .06). The intervention, however, did not appear to affect health-related anxiety or to significantly improve adherence to dose. Implications for future intervention planning are discussed.