[Loneliness during the first wave of the SARS-CoV-2 pandemic-results of the German National Cohort (NAKO)]

The Impact of Loneliness on Late-Life Depression and Anxiety During the COVID-19 Pandemic

OBJECTIVE

This study investigates the association of loneliness during the COVID-19 pandemic and the course of depressive, anxiety and sleep symptoms after psychological treatment in older adults.

METHODS

During the first wave of the pandemic in 2020, we assessed additional, original data of 132 participants aged ≥60 years who had completed psychological treatment for late-life depression (LLD) in the context of a multicenter, randomized controlled trial (CBT-late). We measured loneliness using the UCLA Loneliness Scale. Depression, anxiety and sleep symptoms were assessed using the Geriatric Depression Scale (GDS), Geriatric Anxiety Inventory (GAI), and Insomnia Severity Index (ISI).

RESULTS

Participants with higher loneliness scores (n = 44) experienced a significant worsening of depressive and anxiety symptoms during the pandemic (estimated marginal mean difference (emmd) of change in GDS between post-treatment and COVID-19 visit: GDSemmd= -4.61, [95% CI: -6.97 to -2.26], GAIemmd= -2.21, [95% CI: -3.76 to -0.65]), while those with low to moderate loneliness (n = 72) maintained stable mild symptoms (GDSemmd= -1.39, [95% CI: -3.00 to 0.22], GAIemmd= -0.49, [95% CI: -1.69 to 0.72]). All patients reported increased sleep disturbances during the pandemic regardless of loneliness, while remaining in the range for sub-threshold insomnia.

CONCLUSIONS

Our results suggest an association of significant loneliness during the COVID-19 pandemic and a clinically relevant worsening of depressive and anxiety symptoms in older adults. Loneliness assessments and interventions may be incorporated into treatments for LLD, particularly during pandemics or other crises.

[Rapid Assessment of Future Pandemic Effects in Individuals with Severe Mental Illness: Can Ongoing Population-Representative Cohorts Contribute?]

To provide an overview of ongoing cohorts including severely mentally ill patients to study collateral effects of pandemics.Systematic literature search.None of the ongoing German health cohorts includes people with severe mental illness (SMI). Four cohorts include individuals with severe depressive and anxiety symptoms.German population-representative cohorts do not make a significant contribution to the rapid detection of future pandemic effects in individuals with SMI. Care-based patient cohorts seem better suitable for generating insights into the protection of this vulnerable group under pandemic conditions.

Anxiety and depression in cancer patients and survivors in the context of restrictions in contact and oncological care during the COVID-19 pandemic

Treatment modifications and contact restrictions were common during the COVID-19 pandemic and can be stressors for mental health. There is a lack of studies assessing pandemic-related risk factors for anxiety and depression of cancer patients and survivors systematically in multifactorial models. A total of 2391 participants, mean age 65.5 years, ≤5 years post-diagnosis of either lung, prostate, breast, colorectal cancer, or leukemia/lymphoma, were recruited in 2021 via the Baden-Württemberg Cancer Registry, Germany. Sociodemographic information, pandemic-related treatment modifications, contact restrictions, and anxiety/depression (Hospital Anxiety and Depression Scale, HADS) were assessed via self-administered questionnaire. Clinical information (diagnosis, stage, and treatment information) was obtained from the cancer registry. Overall, 22% of participants reported oncological care modifications due to COVID-19, mostly in follow-up care and rehabilitation. Modifications of active cancer treatment were reported by 5.8%. Among those, 50.5% had subclinical anxiety and 55.4% subclinical depression (vs. 37.4% and 45.4%, respectively, for unchanged active treatment). Age <60 years, female sex, lung cancer, low income, and contact restrictions to peer support groups or physicians were identified as independent risk factors for anxiety. Risk factors for depression were lung cancer (both sexes), leukemia/lymphoma (females), recurrence or palliative treatment, living alone, low income, and contact restrictions to relatives, physicians, or caregivers. The study demonstrates that changes in active cancer treatment and contact restrictions are associated with impaired mental well-being. The psychological consequences of treatment changes and the importance for cancer patients to maintain regular contact with their physicians should be considered in future responses to threats to public health.

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

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

Mood, Quality of Life, and Immune Fitness During the COVID-19 Pandemic of Young Adults in Germany

Background: The COVID-19 pandemic has profoundly affected young adults' lives globally, including those in Germany. This study investigated mental health and quality of life during the pandemic, with a particular focus on mood. Immune fitness, the body's capacity to respond to health challenges (such as infections) by activating an appropriate immune response, was assessed as a physical health indicator. Methods: Data were collected from 317 participants, aged 18 to 35, via an online survey conducted between November 2021 and March 2022. Participants included 103 men (32.5%) and 214 women (67.5%), with a mean age of 25.5 years (SD = 4.1). Results: Compared to pre-pandemic levels, significant declines in mood, quality of life, immune fitness, and sleep quality were observed during the lockdown periods of the COVID-19 pandemic (p < 0.0125). The most pronounced effects were observed during the second lockdown, with declines extending into the second no-lockdown period for fatigue, depression, happiness, optimism, and immune fitness (p < 0.0125). Significant sex differences were found for the magnitude of mood effects (anxiety, depression, stress). No significant differences were found according to age or occupational status (student vs. work). Conclusions: The COVID-19 pandemic and associated lockdown periods had a significant negative effect on the mood, immune fitness, and well-being of young adults living in Germany.

[Loneliness in Bavaria before and during the COVID-19 pandemic]

BACKGROUND

Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes.

METHODS

Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources.

RESULTS

According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups.

DISCUSSION AND CONCLUSIONS

During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted.

Mental health of individuals with pre-existing mental illnesses at the beginning of the COVID-19 pandemic: results of the German National Cohort (NAKO)

Background

The COVID-19 pandemic prompted a range of studies on mental health, with mixed results. While numerous studies reported worsened conditions in individuals with pre-existing mental disorders, others showed resilience and stability in mental health. However, longitudinal data focusing on the German population are sparse, especially regarding effects of age and pre-existing mental disorders during the early stages of the pandemic.

Objectives

To assess the interplay between psychiatric history, age, and the timing of the pandemic, with a focus on understanding how these factors relate to the severity of depression and anxiety symptoms.

Methods

Exploratory analyses were based on 135,445 individuals aged 20-72 years from the German National Cohort (NAKO). Depressive and anxiety symptoms were assessed before and after the first wave of the pandemic. Inferential statistical analyses and negative binomial regression models were calculated.

Results

Persons with a self-reported psychiatric history exhibited comparable levels of depression and anxiety symptom severity after the first wave of the pandemic compared to the time before. In contrast, individuals without a psychiatric history, particularly those in their 20s to 40s, experienced an increase in mental health symptom severity during the first wave of the pandemic.

Limitations

Analyses focuses on the first wave of the pandemic, leaving the long-term mental health effects unexplored.

Conclusion

Future research should consider age-specific and mental-health-related factors when addressing global health crises. Additionally, it is important to explore factors influencing resilience and adaptation, aiming to develop targeted interventions and informed policies for effective mental health management during pandemics.

Music-Making and Depression and Anxiety Before and During the COVID-19 Pandemic-Results From the NAKO Cohort Study in Germany

Objectives

To investigate the association of musical activity with mental health during the COVID-19 pandemic.

Methods

A total of 3,666 participants reported their musical activity before and mental health indicators before and during the pandemic. Depression was assessed with the Patient Health Questionnaire, anxiety with the Generalized Anxiety Disorder scale. The association between mental health scores and musical activities was investigated using linear regression.

Results

Within the last 12 months, 22.1% of the participants reported musical activity (15.1% singing, 14.5% playing an instrument). Individuals with frequent singing as their main musical activity had higher scores before the pandemic than non-musicians and the worsening during the pandemic was more pronounced compared to non-musicians. Instrumentalists tended to have slightly lower scores than non-musicians indicating a possible beneficial effect of playing an instrument on mental health.

Conclusion

The pandemic led to a worsening of mental health, with singers being particularly affected. Singers showed poorer mental health before the pandemic. The tendency for instrumentalists to report lower depression scores compared to non-musicians may support the hypothesis that music-making has a beneficial effect on health.

Social isolation in the oldest-old: determinants and the differential role of family and friends

PURPOSE

To examine the association of sociodemographic and health-related determinants with social isolation in relation to family and friends in the oldest-old.

METHODS

Database was the multi-center prospective AgeCoDe/AgeQualiDe cohort study assessed at follow-up wave 5 (N = 1148; mean age 86.6 years (SD 3.0); 67% female). Social isolation was assessed using the short form of the Lubben Social Network Scale (LSNS-6). The LSNS-6 contains two sets of items establishing psychometrically separable subscales for isolation from family and friends (ranges 0-15 points), with lower scores indicating higher isolation. Cross-sectional linear (OLS) regression analyses were used to examine multivariate associations of sociodemographic and health-related determinants with social isolation from family and friends.

RESULTS

Overall, n = 395 participants (34.6%) were considered socially isolated. On average, isolation was higher from friends (mean 6.0, SD 3.8) than from family (mean 8.0, SD 3.5). Regression results revealed that in relation to family, males were more socially isolated than females (β = - 0.68, 95% CI - 1.08, - 0.28). Concerning friends, increased age led to more isolation (β = - 0.12, 95% CI - 0.19, - 0.05) and functional activities of daily living to less isolation (β = 0.36, 95% CI 0.09, 0.64). Independent of the social context, depression severity was associated with more social isolation, whereas cognitive functioning was associated with less social isolation.

CONCLUSIONS

Different determinants unequally affect social isolation in relation to family and friends. The context of the social network should be incorporated more strongly regarding the detection and prevention of social isolation to sustain mental and physical health.

Reducing Loneliness through the Power of Practicing Together: A Randomized Controlled Trial of Online Dyadic Socio-Emotional vs. Mindfulness-Based Training

Loneliness has become a pressing topic, especially among young adults and during the COVID-19 pandemic. In a randomized controlled trial with 253 healthy adults, we evaluated the differential efficacy of two 10-week app-delivered mental training programs: one based on classic mindfulness and one on an innovative partner-based socio-emotional practice (Affect Dyad). We show that the partner-based training resulted in greater reductions in loneliness than the mindfulness-based training. This effect was shown on three measures of loneliness: general loneliness assessed with the 20-item UCLA Loneliness Scale, state loneliness queried over an 8-day ecological momentary assessment in participants' daily lives, and loneliness ratings required before and after daily practice. Our study provides evidence for the higher efficacy of a mental training approach based on a 12 min practice conducted with a partner in reducing loneliness and provides a novel, scalable online approach to reduce the increasing problem of loneliness in society.

[Developments in the digitalization of public health since 2020 : Examples from the Leibniz ScienceCampus Digital Public Health Bremen]

Digital public health has received a significant boost in recent years, especially due to the demands associated with the COVID-19 pandemic. In this report, we provide an overview of the developments in digitalization in the field of public health in Germany since 2020 and illustrate these with examples from the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH).The following topics are central: How do digital survey methods as well as digital biomarkers and artificial intelligence methods shape modern epidemiology and prevention research? What is the status of digitalization in public health offices? Which approaches to health economics evaluation of digital public health interventions have been utilized so far? What is the status of training and further education in digital public health?The first years of the Leibniz ScienceCampus Digital Public Health Bremen (LSC DiPH) were also strongly influenced by the COVID-19 pandemic. Repeated population-based digital surveys of the LSC indicated an increase in use of health apps in the population, for example, in applications to support physical activity. The COVID-19-pandemic has also shown that the digitalization of public health enhances the risk of misinformation and disinformation.

Changes in physical activity and sedentary behavior during the first COVID-19 pandemic- restrictions in Germany: a nationwide survey : Running head: physical activity during the COVID-19 restrictions

BACKGROUND

The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups.

METHODS

Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions.

RESULTS

Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines.

CONCLUSIONS

Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.

Loneliness during the Covid-19 pandemic in Germany: Impact of social factors and polygenic risk scores on interpersonal differences in loneliness and mental health

OBJECTIVES

The outbreak of Covid-19 negatively affected mental health and increased loneliness. The subjective feeling of loneliness is influenced by genetic and social factors and has a negative impact on mental health.

METHODS

From March 2020 to June 2021 loneliness was investigated in N = 517 individuals using monthly acquired questionnaire data and Latent Growth Curve Analysis. Associations of social factors and polygenic risk scores (PRSs, n = 361) with class membership were investigated.

RESULTS

Three classes ("average", 40%; "not lonely", 38%; "elevated loneliness", 22%) were identified, that differ significantly regarding loneliness, mental dysfunction, and response to the lockdown phases. Individuals with a high PRS for neuroticism are more likely to belong to the "elevated loneliness" class, living with another person is a protective factor.

CONCLUSION

As the "elevated loneliness" class was at the highest risk of mental dysfunction, our findings underscore the importance of identifying those individuals to implement counteractive measures.

Impact of the COVID-19 pandemic on well-being and quality of life of patients with alpha-1-antitrypsin deficiency

BACKGROUND

Alpha-1-antitrypsin deficiency (AATD) is a genetic disorder characterized by mutations in the SERPINA1 gene, primarily affecting the lungs and liver. The COVID-19 pandemic has raised questions about the susceptibility of individuals with AATD to COVID-19 and whether patients with rare lung disease might experience increased stress-related symptoms and mental health challenges. This study aims to investigate the impact of the COVID-19 pandemic on the quality of life of individuals living with AATD.

METHODS

The study enrolled participants from the German registry for individuals with AATD. Questionnaires were sent to the 1250 participants, and a total of 358 patients were included in the analysis. The primary objective was to examine the influence of sociodemographic and disease-related factors on the occurrence of stress-related symptoms. This was accomplished through correlation and regression analyses. We also investigated the role of baseline quality of life (QoL), as measured by the St. George's Respiratory Questionnaire (SGRQ), as a mediator of this relationship.

RESULTS

Stress-related symptoms were predicted by young age, female gender, psychological disorders, and a history of exacerbations of lung disease, as determined by multiple regression analysis. QoL as measured by the SGRQ mediated the relationship between poor lung function, stress, and a decline in overall well-being.

CONCLUSION

The presented data demonstrate that the COVID-19 pandemic significantly affects the psychological well-being of patients with rare diseases, leading to increased levels of anxiety and stress. Disease-related factors can exacerbate stress manifestations, especially when compounded by sociodemographic and contextual factors. Thus, our study emphasizes the crucial role of taking these factors into account when managing individuals with AATD in pandemic situations.

Temporal dynamics in mental health symptoms and loneliness during the COVID-19 pandemic in a longitudinal probability sample: a network analysis

Figuring out which symptoms are central for symptom escalation during the COVID-19 pandemic is important for targeting prevention and intervention. Previous studies have contributed to the understanding of the course of psychological distress during the pandemic, but less is known about key symptoms of psychological distress over time. Going beyond a pathogenetic pathway perspective, we applied the network approach to psychopathology to examine how psychological distress unfolds in a period of maximum stress (pre-pandemic to pandemic onset) and a period of repeated stress (pandemic peak to pandemic peak). We conducted secondary data analyses with the Understanding Society data (N = 17,761), a longitudinal probability study in the UK with data before (2019), at the onset of (April 2020), and during the COVID-19 pandemic (November 2020 & January 2021). Using the General Health Questionnaire and one loneliness item, we computed three temporal cross-lagged panel network models to analyze psychological distress over time. Specifically, we computed (1) a pre-COVID to first incidence peak network, (2) a first incidence peak to second incidence peak network, and (3) a second incidence peak to third incidence peak network. All networks were highly consistent over time. Loneliness and thinking of self as worthless displayed a high influence on other symptoms. Feeling depressed and not overcoming difficulties had many incoming connections, thus constituting an end-product of symptom cascades. Our findings highlight the importance of loneliness and self-worth for psychological distress during COVID-19, which may have important implications in therapy and prevention. Prevention and intervention measures are discussed, as single session interventions are available that specifically target loneliness and worthlessness to alleviate mental health problems.

"Of course, drones delivering urgent medicines are necessary. But I would not use them until…" Insights from a qualitative study on users' needs and requirements regarding the use of medical drones

BACKGROUND

The current COVID-19 pandemic, demographic trends, and the increasing shortage of skilled workers pose major challenges for the care of people with and without care needs. The potential of drones as unmanned aerial vehicles in health care is being discussed as an effective innovative way of delivering much-needed medicines, especially in rural areas. Although the advantages are well known, the needs of the users have not yet been taken into account.

METHODS

Online-based focus groups (via WebEx) were conducted with participants from different disciplines: nursing, pharmacy, physicians. Focus groups with COVID-19 patients were conducted face-to-face. The focus was primarily on potential problems and requirements of the users regarding the use of drones. Structured and contrastive snowball sampling has been deployed. The focus groups were audio recorded, transcribed by a transcription-company, and coded with the help of the program "f4analyse 2" for content (Elo et al. 2008).

RESULTS

Especially during the pandemic situation, delays, and restrictions in the delivery of medicines have been noticed. All interview partners (patients, pharmacists, physicians, and nurses; n = 36 participants) see drones as useful in cases of limited mobility, time-critical medicines (rapid availability), emergencies, and disasters (e.g., floods), but also for the delivery of regular medicines in rural areas (e.g., for the treatment of chronic diseases). Moreover, only 16.7% of the participants have experiences with drones.

DISCUSSION

Drone deliveries do not play a role in the health system yet despite their great importance, which is perceived as particularly evident in the pandemic situation. The results lead to the conclusion that this is mainly due to knowledge and application deficits, so that educational and advisory work is absolutely necessary. There is also a need for further studies that go beyond the scope of acceptance research to describing and evaluating concrete scenarios of drone delivery on the basis of a user-centered approach.

Mental health-related communication in a virtual community: text mining analysis of a digital exchange platform during the Covid-19 pandemic

BACKGROUND

Virtual communities played an important role in mental health and well-being during the Covid-19 pandemic by providing access to others and thereby preventing loneliness. The pandemic has accelerated the urge for digital solutions for people with pre-existing mental health problems. So far, it remains unclear how the people concerned communicate with each other and benefit from peer-to-peer support on a moderated digital platform.

OBJECTIVE

The aim of the project was to identify and describe the communication patterns and verbal expression of users on the inCLOUsiv platform during the first lockdown in 2020.

METHODS

Discussions in forums and live chats on inCLOUsiv were analysed using text mining, which included frequency, correlation, n-gram and sentiment analyses.

RESULTS

The communication behaviour of users on inCLOUsiv was benevolent and supportive; and 72% of the identified sentiments were positive. Users addressed the topics of 'corona', 'anxiety' and 'crisis' and shared coping strategies.

CONCLUSIONS

The benevolent interaction between users on inCLOUsiv is in line with other virtual communities for Covid-19 and the potential for peer-to-peer support. Users can benefit from each other's experiences and support each other. Virtual communities can be used as an adjuvant to existing therapy, particularly in times of reduced access to local health services.

Smartphone-Based Ecological Momentary Assessment of Coping with Loneliness amid COVID-19 in Germany

The COVID-19 pandemic may have caused people to feel isolated, left out, and in need of companionship. Effective strategies to cope with such unrelenting feelings of loneliness are needed. In times of COVID-19, we conducted a smartphone-based ecological momentary assessment (EMA) study with 280 lonely participants in Germany over 7 months, where a long and hard second national lockdown was in place. Each participant reported their daily loneliness and coping strategies for loneliness once in the evening for 7 consecutive days. We found that managing emotions and social relationships were associated with decreased feelings of loneliness, while using a problem-focused coping strategy was associated with increased feelings of loneliness amid COVID-19. Interestingly, managing emotions was particularly effective for easing loneliness during the second lockdown. Females tend to use more emotion-focused coping strategies to overcome their loneliness compared to males. Our study highlights the importance of managing emotions against loneliness throughout the COVID-19 pandemic in Germany. Designing technology that provides emotional support to people may be one of the keys to easing loneliness and promoting well-being.

The Lonely Brain - Associations Between Social Isolation and (Cerebro-) Vascular Disease From the Perspective of Social Neuroscience

The current COVID-19 pandemic led to a considerable reduction in in-person social contacts all over the world. In most individuals, reduced social contacts lead to the perception of social isolation causing feelings of loneliness, which are experienced as stressful. Experiencing social distress due to actual or perceived social isolation has been associated with negative health outcomes such as depression, (cerebro-) vascular disease and mortality. Concrete mechanisms behind this association are still a matter of debate. A group of researchers around Hugo Critchley with special contributions of Sarah Garfinkel and Lisa Quadt proposes a framework for the underlying brain-body interactions including elements from models of social homeostasis and interoceptive predictive processing that provides important insights and testable pathways. While in a previous publication, we reviewed literature on the observed association between social isolation and stroke and coronary heart disease, we now extent this review by presenting a comprehensive model to explain underlying pathomechanisms from the perspective of social neuroscience. Further, we discuss how neurodivergent people, e.g. autistic individuals or persons with attention deficit disorders, might differ in these pathomechanisms and why they are especially vulnerable to social isolation. Finally, we discuss clinical implications for the prevention and therapy of (cerebro-) vascular diseases.

Positive and negative experiences with the COVID-19 pandemic among lonely and non-lonely populations in Germany

The COVID-19 pandemic is causing an epidemic of loneliness. Previous studies have shown the differences in positive and negative experiences of lonely and non-lonely people in a non-pandemic setting. However, it is unclear how the drastic alteration of the COVID-19 pandemic may influence peoples' reactions and beliefs, especially among those who feel lonely. Our study aims to examine the positive and negative experiences among lonely and non-lonely people. We undertook a cross-sectional online survey of the general population in Germany (N = 1,758) from May 2020 to May 2022. We assessed their feelings of loneliness with the short eight-item UCLA Loneliness Scale (ULS-8), their positive and negative experience of living in the COVID-19 pandemic as well as their psychological distress regarding the pandemic with the COVID-19 Peritraumatic Distress Index (CPDI). We found lonely individuals (ULS-8 score ≥ 16) reported fewer positive experiences of living in the COVID-19 pandemic, for example, less time with loved ones [z _{(1, 756)} = -2.5, p = 0.012] and less sense of togetherness [z _{(1, 756)} = -2.39, p = 0.017] as compared to non-lonely individuals. Meanwhile, they experienced more negative experiences, for example, worry and fear [z _{(1, 756)} = 6.31, p < 0.001] compared with non-lonely individuals. Interestingly, lonely people were less likely to view the pandemic as a conspiracy than non-lonely people were [z _{(1, 756)} = -3.35, p < 0.001]. Our results may give insight into attribution bias and the negative affect of lonely people during the COVID-19 pandemic as well as highlight the experience of non-lonely people and raise the question of differences in conspiracy beliefs. For pandemic preparedness and response, decision-makers may focus on interventions to foster social cohesion, empower people, build resilience, and most importantly provide timely social care.

[Epidemiological approaches to address key research questions on COVID-19-an overview]

Epidemiology as a scientific discipline is predestined to address key problems in the COVID-19 pandemic. In order to do so, classic and new methods are used, and new challenges are emerging.This paper addresses the various phases of the population-based progression of SARS-CoV‑2 infection and COVID-19. Based on a selective literature search, sample questions from studies conducted in Germany and internationally are presented, their respective epidemiological approaches discussed, and research gaps described.Scientific questions to be answered with epidemiological data and research approaches arise in every phase of infection and disease. Descriptive data are often generated via (repeated) cross-sectional studies. For analytical questions, such as the identification of risk groups, case-control studies could have provided valuable results, especially in the early phase of the pandemic, but were rarely conducted. Data from health insurance companies have an important function in the analysis of the course of disease; however, the potential of this data source with regard to questions on vaccination can probably hardly be used. Improved coordination of the various studies and a more "open data" oriented research infrastructure can further strengthen the contribution of epidemiology to the control of the current and future pandemics.