Psychometric analysis of the short-form UCLA Loneliness Scale (ULS-6) in older adults

Quality of life in older adults with mood states associated with bipolar disorder: A secondary analysis of the English longitudinal study of ageing data

OBJECTIVES

To investigate: (i) whether mood states associated with bipolar disorder are associated with poorer quality of life in older adults, and (ii) what are some of the predictors of quality of life in older adults with mood states associated with bipolar disorder.

METHODS

The authors completed a cross-sectional multilevel analysis of panel data from seven waves of The English Longitudinal Study of Ageing dataset. The main analysis included 567 participants who reported experiencing mood states associated with bipolar disorder. Some participants reported this in more than one wave, resulting in 835 observations of mood states associated with bipolar disorder across the seven waves. Quality of life was assessed using the Control, Autonomy, Self-realization, and Pleasure-19 (CASP-19) measure.

RESULTS

The presence of mood states associated with bipolar disorder was significantly associated with poorer quality of life, even after controlling for multiple covariates (age, sex, social isolation, loneliness, alcohol use, education level, and economic status). Loneliness significantly predicted poorer quality of life in older adults with mood states associated with bipolar disorder. In contrast, higher educational attainment and being female predicted better quality of life in this group.

CONCLUSIONS

Older adults with mood states associated with bipolar disorder have potentially worse quality of life compared to the general population, which may be partly driven by loneliness. This has ramifications for the support offered to this population and suggests that treatments should focus on reducing loneliness to improve outcomes.

Depression and loneliness in a volunteer sample of adults at a suicide prevention and fund-raising walk: A feasibility study

BACKGROUND

Loneliness is recognized as a distinct psychological experience separate from depression. This feasibility study explored the prevalence and association of depression and loneliness among adults at a suicide prevention walk, a potentially high risk and vulnerable population for depression, loneliness and suicide.

METHODS

Adults completed anonymous loneliness, depression, and physical activity surveys. Based on Patient Health Questionnaire-2 (PHQ-2), adults were classified as screening positive (3 to 6) or negative (0 to 2) for depression. T-tests determined if the revised UCLA Loneliness Score (ULS) differed by depression screening status.

RESULTS

Of the 133 survey participants, 13% screened positive for depression. Positive screens were highest for males, aged 18-35, living alone with a less active lifestyle. Participants averaged 36.8 ± 10.4 on the ULS; 11 %(n = 13) and 5%(n=6) were classified as experiencing moderate and very high levels of loneliness, respectively. Loneliness was significantly greater for those who screened positive for depression (49±9) compared to those who screened negative (35 ± 9)(p < 0.001). ULS and PHQ-2 were positively correlated (r=0.70, p < 0.01). Active participants reported less loneliness than less active participants(p < 0.01).

LIMITATIONS

The findings may be biased due to the volunteer sample composed primarily of female Caucasians.

CONCLUSION

In a sample that may be at higher risk for depression due to suicide attempts or being suicide loss survivors, 13 % screened positive for depression. Loneliness scores were not elevated in this population compared to national estimates. Suicide awareness events may be an efficient and cost-effective public health measure for the screening and appropriate follow-up of physical activity, depression and loneliness.

Quantifying Social Connectedness in Parkinson's Disease: Reliability and Validity of a Clinical Assessment Toolkit

BACKGROUND

Loneliness and isolation impact health detrimentally but are understudied in Parkinson's disease (PD). Outcome measurement properties for social connection remain unexplored in PD.

OBJECTIVE

To evaluate the measurement properties of six social connection outcomes in PD.

METHODS

We evaluated internal consistency, structural validity, and construct validity for measures of loneliness (brief UCLA Loneliness Scale [ULS3], short and long de Jong Gierveld Loneliness Scale [dJGLS], social isolation [Cohen Social Network Index-SNI total people, SNI high contact networks], and social support brief Perceived Social Support Scale [PSS]).

RESULTS

We administered measures to 178 PD participants (Mage = 67.9; 81.5% at Hoehn & Yahr stage 2). There was strong internal consistency, content validity across outcomes, and a 1-factor structure (PSS, ULS3) and a 2-factor structure (dJGLS) for two measures each.

CONCLUSIONS

We provide a toolbox for clinicians and researchers studying social connection in PD.

Protective and stress factors for psychological distress: a comparative analysis of LGB and non-LGB older adults

OBJECTIVES

Population ageing raises major public health and psychosocial challenges. Particularly, lesbian, gay, and bisexual (LGB) older people may face increased vulnerabilities and marginalization when compared to their non-LGB (heterosexual) counterparts, which may entail more risks for their mental health. The aim of this study was to comparatively evaluate the levels of protective - social support, spirituality, and resilience and stress factors - loneliness and ageism - among LGB and non-LGB older adults, and their impact on psychological distress (PD).

METHOD

A sample of 647 people aged 60 years or older (M = 66.01; SD = 4.93) was collected, 368 non-LGB and 279 LGB. Participation was carried out through an online survey in Portugal.

RESULTS

LGB older adults had lower scores on all protective factors, except on social support from friends, and higher levels on all stress factors, except on hostile ageism, compared to non-LGB older adults. Further, resilience and loneliness were the main predictors of PD regardless of the sexual orientation. Stress factors explained the levels of PD over and above the effects of protective factors, both among LGB and non-LGB older adults.

CONCLUSION

Psychological distress in aging presents different protective and stressful factors according to the sexual orientation of older adults. More comparative studies are suggested in the intersection between ageing and sexual orientation.

Relating mental health, health-related quality of life and well-being in the aftermath of the COVID-19 pandemic: A cross-sectional comparison in 14 European countries in early 2023

OBJECTIVES

To understand country-level differences in the population's health and well-being in Europe in the aftermath of the COVID-19 pandemic, while also investigating the internal relationships among health and well-being outcomes.

STUDY DESIGN

Cross-sectional study.

METHODS

We collected representative panel-based samples of 1000 adult respondents per country across 14 Western European countries in early 2023. The survey used standardised instruments to assess health and well-being, including EQ-5D-5L, GHQ-12, PHQ-9, general satisfaction, the Brief Resilience Scale and the ULS-6 (Loneliness) Scale. Summary statistics of the aggregate scores for each country were calculated and ranked. Multidimensional unfolding was used to visualize the rank relationships across countries and the indices, whereby a closer distance between a country and an index indicated a higher/better rank. Additionally, two key objective country-level indices (GDP growth rate and excess mortality rates) were integrated into the analysis.

RESULTS

Austria was found to report better status on most of the indices, while Sweden and the UK ranked consistently worse than the other countries. The loneliness, EQ-VAS and satisfaction scores were plotted further from the mental well-being scores and EQ-5D utility scores. Countries that did well in controlling excess mortality and maintaining economic growth tended to exhibit lower performance in self-reported well-being.

CONCLUSION

This study presents the variability in health and well-being across 14 West-European countries. Discrepancies between countries in self-reported outcomes reveal the complex interrelationship among different aspects of well-being. The study also highlights the complexities and challenges in optimising policies to maximize the overall well-being of society.

Risky behaviors in Ethiopian university students and its relationship with loneliness and coping self-efficacy

Research shows that risky behavior peaks in young adulthood, endangering young adult's mental health and making it difficult for them to grow up to be responsible members of society. As a result, this study aimed to adapt the Risk Behavior Scale into Amharic and examine the relationships between risky behaviors, loneliness, and coping self-efficacy. A cross-sectional research design was used and convenience sampling was employed to gather data from a total of 242 Ethiopian university students. Confirmatory Factor Analysis (CFA) was carried out to test the factor structures of the Risky Behaviors Scale. The CFA results validated the scale's four-factor structures (χ2 = 435, df = 183, (p < .001), CFI = 0.94, TLI = 0.91, RMSEA = 0.08, and SRMR =0.05). This would make it possible for mental health experts to research the psychological impacts of risky behaviors (alcohol use, suicidality, drug use, and khat use) in Ethiopian young adults. The findings of hierarchical regression analysis revealed that male gender and loneliness were predictors of risky behavior. This research holds significant implications for interventions that attempt to reduce loneliness in young adults to alter their vulnerabilities to risky behaviors.

A web step-based digital solution's impact on physical, cognitive and psychosocial functioning of community-dwelling older adults: A mixed methods randomized and controlled trial

Background

As the population ages, innovative responses are urgently needed to promote physical activity at scale. Thus, this study investigated whether a step-based activity mediated by a digital solution impacts the physical functioning of community-dwelling older adults. The secondary aims were to assess whether the same activity impacts cognitive and psychosocial functioning and explore participants' views towards the activity.

Methods

A mixed method, randomized, and controlled study with one group performing a step-based activity using DanceMove (recommended dosage: twice a week for 20 to 30 min for eight weeks) and the other their usual activities. DanceMove was used at the individuals' homes without any direct supervision. Clinical tests and questionnaires administered in person were used to assess participants at baseline, post-intervention, and three-month follow-up. The primary outcome of interest was gait velocity. Secondary outcomes were balance, pain intensity, cognitive functioning, self-efficacy, social support, loneliness, and quality of life. Also, at the end of the intervention, a semi-structured individual interview was conducted with participants in the experimental group.

Results

Seventy participants were randomized to the control (n = 37) and experimental (n = 33) groups. Of the 33 participants in the experimental group, four did not use the DanceMove at all and two used it for only 3 min. The remaining 26 participants used it for a total time over the eight weeks that varied between 15 and 991 min (mean ± SD = 306.55 ± 258.83 min). The step-based activity was not more effective than usual activities for any of the variables assessed (P > .05). Difficulties, positive and negative aspects regarding the digital solution, and reasons for not using it were identified in the interviews.

Conclusions

Eight weeks of a step-based activity mediated by a digital solution did not impact the physical, cognitive, and psychosocial functioning of community-dwelling healthy older adults. However, the activity was enjoyable and safe to be performed at home without direct supervision. Further studies are needed to explore aspects that could modulate the impact of this type of technology-mediated activity.

Trial registration

The study was registered at clinialtrials.gov (NCT05460039) before the enrolment of the first participant.

A blended group intervention to promote social connectedness and wellbeing among international university students: an exploratory study

Introduction

Loneliness is a prevalent issue among international university students, often exacerbated by cultural and linguistic barriers. This pilot study aims to assess the feasibility, acceptability and impact of a blended intervention to promote international students' social connectedness and well-being.

Methods

A sample of 49 international students from the University of Padua (Italy) was recruited. The study followed the methodology of a non-randomized controlled trial comparing a blended intervention (comprising group activities and online self-help materials) with two other active conditions (self-help only and peer-to-peer interventions) and a control condition at two times (baseline and at 8 weeks). Participants completed a survey to assess their satisfaction with the interventions, changes in their interactions and wellbeing. They also filled in some questionnaires to measure anxiety, depression, perceived social support, loneliness and satisfaction with life. A mixed-method analysis was conducted.

Results

Results showed that interventions involving in-person activities had significant advantages over self-help intervention in terms of interaction improvement and a higher number of relationships. Participants perceived self-help materials as more relevant, satisfactory, and functional within the blended group compared to the self-help group. Contrary to the control group, the blended and peer-to-peer groups reported lower scores on the standardized measures of loneliness, anxiety, and depression, and higher scores on satisfaction with life, collected pre- and post-intervention. The thematic analysis of the answers to the open-ended questions showed that in-person group activities provided the opportunity to compare themselves with peers and have a direct experience of new social connections.

Discussion

The findings highlight the importance of translating insights from self-help materials into active and direct social experiences, to reduce loneliness through the emergence of new perspectives and shared meaning making.

The Association Between Social Isolation and Medication Adherence Among Chinese Older Adults With Chronic Diseases: Serial Mediation of Social Support and Loneliness

BACKGROUND

Medication adherence is essential for chronic disease management among older adults. Previous studies have shown significant links among social isolation, social support, loneliness, and medication adherence, yet most were based on cross-sectional designs.

PURPOSE

We conducted a longitudinal cohort study among Chinese older adults with chronic diseases to explore the mediating effects of social support and loneliness in the association between social isolation and medication adherence.

METHODS

This study followed a cohort of 797 older adults with chronic diseases in China from 2022 to 2023. The serial mediation model was examined via bootstrapping techniques to evaluate the mediating effect of social support and loneliness in the association between social isolation and medication adherence.

RESULTS

From baseline to follow-up, there were significant decreases in social support (from 26.6 ± 6.2 to 23.5 ± 6.7) and medication adherence (from 6.7 ± 1.2 to 6.0 ± 1.5) and significant increases in social isolation (from 1.8 ± 1.3 to 2.5 ± 1.4) and loneliness (13.2 ± 4.1 to 23.5 ± 6.7), all with p < .001. A serial mediation model was confirmed, where social support and loneliness serially and partially mediated the association between social isolation and medication adherence (total effect c = -0.216, 95% CI = -0.296 to -0.136; direct effect c' = -0.094, 95% CI = -0.171 to -0.017; total indirect effect ab = -0.122, 95% CI = -0.179 to -0.070).

CONCLUSIONS

Our findings yield critical insights into the relationship between social isolation and medication adherence through various mediating mechanisms. These findings hold significant implications for devising psychosocial interventions to enhance medication adherence among older adults with chronic diseases, underscoring the pivotal role of bolstering social support and alleviating loneliness.

Development and validation of a nomogram for predicting anorexia of aging in older people

BACKGROUND

Anorexia of aging (AA) is a common geriatric syndrome that seriously endangers the health of older adults. Early identification of populations at risk of AAand the implementation of appropriate intervention measures hold significant public health importance. This study aimed to develop a nomogram for predicting the risk of AA among older people.

METHODS

We conducted a cross-sectional study involving 2144 community-dwelling older adults to evaluate the AA using the Simplified Nutritional Appetite Questionnaire. We utilized the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression analysis to select variables and develop a nomogram prediction model. The predictive performance of the nomogram was evaluated using the Receiver Operating Characteristic (ROC) curves, calibration curves, Decision Curve Analysis (DCA), and internal validation.

RESULTS

The prevalence of AA among Chinese older adults was 21.7% (95%CI: 20.0%-23.5%). Age, sex, family economic level, smoking status, dysphagia, loneliness, depressive symptoms, living alone, health literacy, life satisfaction, and body mass index have been identified as predictive factors for AA among older people. The nomogram constructed based on these predictive factors showed an area under the curve (AUC) of 0.766 (95%CI: 0.742-0.791), indicating good calibration and discrimination ability. Additionally, the results obtained from the 10-fold cross-validation process confirmed the nomogram's good predictive capabilities. Furthermore, the DCA results showed that the nomogram has clinical utility.

CONCLUSION

The nomogram constructed in this study serves as an effective tool for predicting anorexia of aging among community-dwelling older adults. Its implementation can help community healthcare workers evaluate the risk of AA in this population and identify high-risk groups.

Mask wearing and self-harming thoughts among international students in the United States during COVID-19: The moderating role of discrimination

Objective: This study examined associations among discrimination, mask-wearing behavior, and self-harming thoughts among international students in the United States during COVID-19. Participants: Undergraduate and graduate international students enrolled in universities during the 2020 summer semester participated in the online survey (N = 103). Methods: Perceived discrimination, mask-wearing behavior, and self-harming thoughts during COVID-19 were assessed by self-reports. Multivariable logistic regressions examined the association among discrimination, mask-wearing behavior, and self-harming thoughts and explored the potential moderation effect of discrimination on the association between mask-wearing and self-harming thoughts. Results: 18.6% of participants reported self-harming thoughts. Increased discrimination was significantly associated with increased odds of self-harming thoughts. Discrimination significantly moderated the association between mask wearing and self-harming thoughts. Conclusions: The findings highlight the importance of increased availability of culturally appropriate mental health services for international students and the need for increased advocacy to decrease discrimination against international students in the current societal context.

Coping with COVID-19: a prospective cohort study on young Australians' anxiety and depression symptoms from 2020-2021

BACKGROUND

Studies have shown that the coronavirus (COVID-19) pandemic negatively impacted the mental health of young Australians. However, there is limited longitudinal research exploring how individual factors and COVID-19 related public-health restrictions influenced mental health in young people over the acute phase of the COVID-19 pandemic. This study aimed to identify risk and protective factors associated with changes in individual symptoms of anxiety and depression among young Australians during the COVID-19 pandemic.

METHODS

This prospective cohort study collected data on anxiety and depression symptoms of young Australians aged 15-29 years old using the Depression, Anxiety and Stress Scale short form (DASS-21). We delivered four online questionnaires from April 2020 to August 2021 at intervals of 3, 6, and 12 months after the initial survey. We implemented linear mixed-effects regression models to determine the association among demographic, socioeconomic, lifestyle and COVID-19 public health restrictions related factors and the severity of anxiety and depression symptoms over time.

RESULTS

Analyses included 1936 young Australians eligible at baseline. There was a slight increase in DASS-21 anxiety mean scores from timepoint 3 to timepoint 4. DASS-21 depression scores showed slight fluctuations across timepoints with the highest mean score observed in timepoint 2. Factors associated with increases in anxiety and depression severity symptoms included LGBTQIA + identity, financial insecurity both before and during the pandemic, higher levels of loneliness, withdrawal or deferral of studies, spending more time on social media, and difficulties to sleep. Risk factors for only depression symptoms include unemployment during COVID-19 pandemic and being in lockdown. Living with someone was a protective factor for both anxiety and depression symptoms, pre-COVID-19 unemployment for depression symptoms, and older age and unemployment during the pandemic for anxiety symptoms.

CONCLUSION

These findings indicate that during the first year of the pandemic in Australia, there were significant changes in young people's mental health which were associated with multiple demographic, socioeconomic, lifestyle, and lockdown factors. Hence, in future public health crises, we suggest more inclusive guidelines that involve young people in their development and implementation ensuring that their unique perspectives and needs are adequately considered.

Digital music and movement intervention to improve health and wellbeing in older adults in care homes: a pilot mixed methods study

BACKGROUND

Low physical activity among older adults is related to adverse health outcomes such as depression and loneliness, poor physical function and increased risk of falls. This study was designed to increase physical activity through a digital, group-based, physical activity and music intervention and to examine its effectiveness on social, mental and physical health outcomes.

METHODS

Participants were 34 older adults (65 years +) recruited across four care homes in Scotland to a pilot study. Surveys were administered at baseline and post-intervention, comprising measures of fear of falling, depression and anxiety, loneliness, sleep satisfaction and quality of life. A battery of physical function tests and saliva sampling for cortisol and dehydroepiandrosterone hormone analysis were also conducted at each time point. Additionally, process evaluation measures (recruitment, intervention fidelity, attendance, retention rates and safety) were monitored. The intervention comprised 12 weeks of three prescribed digital sessions per week: movement and music (n = 2) and music-only (n = 1), delivered by an activity coordinator in the care home. Post-intervention interviews with staff and participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

An average of 88% of prescribed sessions were delivered. Pre- to post-intervention intention-to-treat analysis across all participants revealed significant improvements in anxiety, salivary DHEA, fear of falling and loneliness. There were no significant improvements in health-related quality of life, perceived stress, sleep satisfaction or physical function tests, including handgrip strength. Qualitative analysis highlighted benefits of and barriers to the programme.

CONCLUSIONS

The digital movement and music intervention was deemed acceptable and delivered with moderate fidelity, justifying progression to a full-scale trial. Although a proper control group would have yielded more confident causal relationships, preliminary psychosocial and biological effects were evident from this trial. To show significant improvements in physical function, it is likely that a bigger sample size providing sufficient power to detect significant changes, greater adherence, longer intervention and/or higher exercise volume may be necessary.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov, number NCT05601102 on 01/11/2022.

Understanding the Effect of Loneliness on Quality of Life in Older Adults from Longitudinal Approaches

Aim: To study the longitudinal relationship between loneliness and quality of life (QoL) in adults to identify key mechanisms to better design future psychosocial interventions. Method: 13,222 participants from three consecutive waves of the Survey of Health, Ageing, and Retirement in Europe (SHARE), aged 65 or older, 56.3% women. They were analyzed using cross-lagged panel model (CLPM), random intercept cross-lagged panel model (RI-CLPM), and multi-group models disaggregated by gender. Results: The RI-CLPM provided a better fit than the CLPM. Both models showed the stability of QoL and loneliness. All autoregressive paths were significant, and a negative association between concurrent QoL and loneliness was observed across all waves. The CLPM supported a reciprocal relationship, while the RI-CLPM only confirmed the effects of loneliness on QoL. Women reported higher levels of loneliness and poorer QoL, but no gender differences were identified in the longitudinal association. Conclusions: Addressing loneliness in early stages could be a better preventive measure to promote quality of life in both genders.

The positive solitude scale (PS): psychometric properties among Chinese older

BACKGROUND

Positive solitude, taken as a meaningful activity, contributes to the improvement of health, well-being, and quality of life of older adults. The purpose of this study was to examine the reliability and validity of the Positive Solitude Scale (PS) among Chinese older to provide a reference for related research.

METHODS

A convenience sample of 608 older people from 10 provinces in China was used to conduct the survey.

RESULTS

The Chinese version of the PS consisted of 9 items with a unidimensional structure, which could explain 60.91% of the variance. The factor loadings of each item ranged from 0.67 to 0.82, and the communality ranged from 0.44 to 0.68. The confirmatory factor analysis showed good model fit (χ2/df = 2.771, RMSEA = 0.076, CFI = 0.972, IFI = 0.972, TLI = 0.959, PNFI = 0.665, PCFI = 0.675). It was found from the criterion-related validity test that PS scores were significantly and positively correlated with Satisfaction With Life Scale (SWLS), Autonomy, Competence, and Relatedness scores (r = 0.45 to 0.44); PS scores were significantly and negatively correlated with Short-Form UCLA Loneliness Scale (ULS-6), Kessler Psychological Distress Scale (K10), Ego Depletion Scale (EDS), and Acceptance and Action Questionnaire-2nd Edition (AAQ-II) (r = -0.27 to -0.36). The Cronbach's α coefficient value for the scale was 0.917; the split-half reliability coefficient value was 0.928. In addition, the PS showed cross-gender consistency.

CONCLUSIONS

The PS presented favorable psychometric characteristics in older people, which can be used as a valid tool for assessing older people's positive solitude.

A mixed methods feasibility study of a virtual group-based social support program for older adults in residential care

OBJECTIVES

In response to calls for inventive ways to mitigate risks of physical distancing due to the COVID-19 pandemic for older adults living in residential care, the JAVA Music Club-Digital (JMC-D) was developed. The current feasibility study investigated benefits, usability, and implementation of weekly JMC-D sessions over 6 months.

METHOD

Employing a pre-post mixed methods study, depressive symptoms, loneliness, social isolation, and quality of life were measured at baseline, 3 and 6 months. Qualitative interviews were conducted at 3 months.

RESULTS

Twenty-one residents were recruited. Across the three time points there was a large effect for depressive symptoms, social isolation, and quality of life, though not statistically significant. There was a significant immediate increase in happiness following engagement in the JMC-D sessions. Thematic analysis of semi-structured interviews generated two overarching themes: Experiencing the JMC-D (subthemes: Benefits, Navigating the virtual platform, Feedback) and Considerations for Implementation (subthemes: Perceived purpose, Characteristics that impact the experience, and Infrastructure and resources).

CONCLUSION

Findings are encouraging and suggest that the JMC-D may support emotional and other psychosocial indices of wellness in residential care during times of physical distancing. Appropriate staffing, resources, and internet accessibility are important for implementation and uptake.

Interventions for loneliness in older adults: a systematic review of reviews

Loneliness in older persons is a major risk factor for adverse health outcomes. Before the COVID-19 pandemic led to unprecedented isolation and hampered programs aimed at preventing or reducing loneliness, many interventions were developed and evaluated. However, previous reviews provide limited or conflicting summaries of intervention effectiveness. This systematic review aimed to assess previous review quality and bias, as well as to summarize key findings into an overarching narrative on intervention efficacy. The authors searched nine electronic databases and indices to identify systematic reviews of interventions to reduce loneliness in older people prior to the COVID-19 pandemic; 6,925 records were found initially. Of these, 19 reviews met inclusion criteria; these encompassed 101 unique primary intervention studies that varied in research design, sample size, intervention setting, and measures of loneliness across 21 nations. While 42% of reviews had minimal risk of bias, only 8% of primary studies appraised similarly. Among the 101 unique articles reviewed, 63% of tested interventions were deemed by article author(s) as effective or partially effective. Generally, interventions that included animals, psychological therapies, and skill-building activities were more successful than interventions focused on social facilitation or health promotion. However, interventions that targeted multiple objectives aimed at reducing loneliness (e.g., improving social skills, enhancing social support, increasing social opportunities, and changing maladaptive social cognition) were more effective than single-objective interventions. Future programs should incorporate multiple approaches, and these interventions should be rigorously tested.

The design and implementation of a multi-center, pragmatic, individual-level randomized controlled trial to evaluate Baby2Home, an mHealth intervention to support new parents

BACKGROUND

Becoming a parent is a transformative experience requiring multiple transitions, including the need to navigate several components of health care, manage any mental health issues, and develop and sustain an approach to infant feeding. Baby2Home (B2H) is a digital intervention built on the collaborative care model (CCM) designed to support families during these transitions to parenthood.

OBJECTIVES

We aim to investigate the effects of B2H on preventive healthcare utilization for the family unit and patient-reported outcomes (PROs) trajectories with a focus on mental health. We also aim to evaluate heterogeneity in treatment effects across social determinants of health including self-reported race and ethnicity and household income. We hypothesize that B2H will lead to optimized healthcare utilization, improved PROs trajectories, and reduced racial, ethnic, and income-based disparities in these outcomes as compared to usual care.

METHODS

B2H is a multi-center, pragmatic, individual-level randomized controlled trial. We will enroll 640 families who will be randomized to: [1] B2H + usual care, or [2] usual care alone. Preventive healthcare utilization is self-reported and confirmed from medical records and includes attendance at the postpartum visit, contraception use, depression screening, vaccine uptake, well-baby visit attendance, and breastfeeding at 6 months. PROs trajectories will be analyzed after collection at 1 month, 2 months, 4 months, 6 months and 12 months. PROs include assessments of stress, depression, anxiety, self-efficacy and relationship health.

IMPLICATIONS

If B2H proves effective, it would provide a scalable digital intervention to improve care for families throughout the transition to new parenthood.

The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: A prospective cohort study

BACKGROUND

This study aims to understand the mechanisms contributing to the elevated risk of depression among sexual minority older adults compared to heterosexuals. Specifically, the role of loneliness as a potential mediator is investigated to inform targeted interventions for preventing depression in sexual minority populations.

METHODS

Data from the English Longitudinal Study of Ageing, focusing on adults aged over 50, were analysed. Sexual orientation (sexual minority or heterosexual) and loneliness scores (UCLA scale) were assessed at wave six (2010-2011), while depressive symptoms (CESD) were assessed at wave seven (2013-14). Linear regression models and mediation analyses, using g-computation formula and adjusted for confounders, were conducted.

RESULTS

The sample included 6794 participants, with 478 (7.0 %) identifying as sexual minorities. After adjustments, sexual minorities scored higher on depressive symptoms at wave seven (mean difference): 0.23, 95 % CI 0.07 to 0.39) and loneliness at wave six (MD: 0.27, 95 % CI 0.08 to 0.46). Loneliness was positively associated with depressive symptoms (coefficient: 0.27, 95 % CI 0.26 to 0.29). In mediation analyses, loneliness explained 15 % of the association between sexual orientation and subsequent depressive symptoms.

LIMITATIONS

The dataset used sexual behaviour rather than desire and identity, potentially skewing representation of sexual minorities. Additionally, transgender older adults were not included due to limited gender diversity reported within the ELSA dataset.

CONCLUSIONS

Loneliness appears to be a significant modifiable mechanism contributing to the heightened risk of depressive symptoms in sexual minority older adults compared with their heterosexual counterparts.

Experiences of Loneliness: COVID-19 Versus Incarceration

As the world comes to terms with the realities surrounding COVID-19, media sources have likened quarantine experiences to that of incarceration. Individuals who have experienced incarceration and individuals who have experienced the incarceration of loved ones (LO), have already experienced periods of time apart. We are exploring the experiences of individuals who have some experience with incarceration; whether they were personally incarcerated, or they experienced the incarceration of a LO. Utilizing snowball sampling, a mixed methods survey was circulated on social media. Survey items included demographic information, questions about incarceration, issues related to COVID-19 quarantines, and the UCLA Loneliness Scale. Results follow similar patterns to previous studies. However, this unique population argues that COVID-19 quarantines are not the same as periods of incarceration. Similarly, future research and community agencies need to examine the unique needs of those who have experienced the incarceration of a loved one.

Addressing loneliness and social isolation through the involvement of primary and secondary informal caregivers in nursing homes: a scoping review

OBJECTIVES

To clarify the mechanisms of interventions addressing loneliness and social isolation in older adults living in nursing homes through the involvement of primary and secondary informal caregivers.

METHODS

This scoping review was performed by two independent reviewers, covering the period between 2011 and 2022 and the databases MEDLINE, CINAHL, PsycINFO and Scopus. It included terms related to (A) informal caregivers, (B) nursing homes, (C) psychosocial interventions, (D) involvement and (E) social isolation or loneliness.

RESULTS

Thirty-three studies met the inclusion criteria. Although there were various definitions and assessment tools related to social isolation and loneliness, the studies referred to three dimensions of these concepts in nursing home residents: the quantity of social interactions, the perception of these encounters and biographical changes in social relationships. Most studies did not explicate the mechanisms of these interventions. The review uncovered the following aspects of intervention mechanisms: increasing opportunities for social contact, creating meaningful encounters, maintaining existing relationships with primary informal caregivers and establishing new ones with secondary informal caregivers.

CONCLUSION

Studies reporting on interventions addressing loneliness and social isolation in nursing home residents need to clarify and detail their intervention mechanisms in order to foster more targeted interventions. In addition, there is a need for further research on large-scale programs or care philosophies in this field and the development of intervention designs, which allow for tailored intervention formats in order to respond to the individual perception of social relationships.

Moderators of Loneliness Trajectories in People with Systemic Sclerosis During the COVID-19 Pandemic: A SPIN COVID-19 Cohort Longitudinal Study

BACKGROUND

Many individuals with systemic sclerosis (SSc) are at heightened risk for COVID-19 related morbidity and isolation due to interstitial lung disease, frailty, and immunosuppressant use. Minimal research has explored loneliness predictors in individuals with chronic illnesses during COVID-19. This study evaluated moderators of loneliness trajectories in individuals with SSc during COVID-19.

METHODS

Longitudinal data were analyzed across 30 timepoints from April 2020 to May 2022 from 775 adults in the Scleroderma Patient-centered Intervention Network (SPIN) COVID-19 Cohort. Hierarchical linear modeling evaluated cross-level moderators of loneliness trajectories, including marital status, baseline number of household members, number of virtual or telephone one-on-one or virtual group conversations, number of hours spent enjoying in-person household conversations or activities, and satisfaction with quality of in-person household conversations (all in the past week). Level-1 moderation analyses assessed effects of conversation, activity, and satisfaction means and slopes over time.

RESULTS

Baseline values were not statistically significant moderators of loneliness trajectories. Higher mean (averaged over time) virtual or telephone one-on-one and in-person household conversations, in-person household activity, and in-person household conversation satisfaction were associated with lower loneliness trajectories (ps < .05). The relationship between in-person household conversation satisfaction and loneliness trajectory was statistically significantly but minimally attenuated over time (p < .001).

CONCLUSIONS

For people with SSc, higher mean conversation, activity, and satisfaction variables were associated with lower levels of loneliness during the pandemic, but changes in these social variables were generally not predictive of changes in loneliness.

Rural-urban differences in older adults' life satisfaction and its determining factors

Although determinants of life satisfaction in older adults have been well documented, research has to date failed to fully address the experience of older adults living in places with different levels of urbanization. Furthermore, there are conflictive findings regarding the type of residence environment that offers the greatest benefits for the wellbeing of older adults. Our study proposes an integrative research model to determine the nature of the relationships between loneliness, self-esteem and life satisfaction, with a particular focus on the living environment (rural-urban) of the older adults. Using a cross-sectional survey design volunteers (aged 60+) from rural (n = 198) and urban (n = 198) in Galicia (Spain) completed a questionnaire. Structural Equation Modelling (SEM) was used to test the relationships between loneliness, self-esteem and life satisfaction and multigroup analysis was performed to analyse the existence of differences in the relationships based on the area of residence of older adults. We found that higher levels of loneliness were a significant predictor of reduced life satisfaction and reduced self-esteem. Self-esteem not only increases life satisfaction, but also reduces the negative impact loneliness may have on it. Where the older adults lived had a significant effect on the relationships between loneliness, self-esteem and life satisfaction. The relationships were stronger for older adults living in urban areas. Differentiated policy initiatives should be considered, depending on the area of residence in order to increase the life satisfaction of older adults.

The relationship between fear of old age, loneliness and death anxiety in adults

BACKGROUND

The increase in the number of elderly people in the world, individuals' perspectives on older adults, and false beliefs and ideas about old age negatively affect adults in terms of ageing. This study was conducted to determine the relationship between fear of old age, loneliness and death anxiety in adults.

METHOD

This study, which was designed in a correlational cross-sectional descriptive model, was conducted with 1074 adult individuals living in one province in eastern Turkey. Data were collected using Personal Information Form, Fear of Old Age Scale, UCLA Loneliness Scale and Turkish Death Anxiety Scale. Data were analyzed using SPSS 25.0, AMOS 24.0, G*Power 3.1 statistical package programs.

RESULTS

In our study, it was determined that the model created in line with the hypotheses was compatible and the model fit indices were within the desired limits as χ2/df = 4.737, root mean square error of approximation = 0.05, comparative fit index = 0.93, goodness-of-fit index = 0.92, adjusted goodness-of-fit index = 0.90, IFI = 0.93. There is a significant relationship between loneliness and death anxiety (P < 0.05). There is a significant relationship between loneliness and fear of old age (P < 0.05). There is a significant relationship between death anxiety and fear of old age (P < 0.05). It was determined that death anxiety has a mediating role in the effect of loneliness on fear of old age (95% confidence interval: 0.112-0.226; P < 0.05).

CONCLUSION

As the level of loneliness increases, the level of death anxiety and fear of old age increases. Fear of old age also increases in the mediating role of death anxiety. It is recommended to conduct intervention studies to reduce fear of old age. Longitudinal study on fear of old age is recommended.

Loneliness and Subjective Wellbeing During the Covid-19 Pandemic: A Systematic Review

To prevent the transmission of COVID-19, unprecedented measures were implemented, such as community lockdowns. With limited social interactions, the problem of loneliness might have worsened. As loneliness is thought to have a detrimental effect on subjective wellbeing (SWB), the present systematic review aims to better investigate and summarize the existing evidence about the association of loneliness and SWB during the COVID-19 pandemic. A total of 18 articles were included. In all studies, independently of the component of wellbeing assessed or of the instrument used, a negative association between loneliness and SWB was found. The results show an increase in loneliness during times of restrictions on social contacts, with a subsequent association with lower SWB, and underscore the need for developing specific interventions to tackle loneliness and for promoting alternative forms of social interaction if further physical distancing measures are needed. However, the literature had several limitations, since most of the studies followed cross-sectional and descriptive methodologies.

The Migrant-Local Difference in the Relationship Between Social Support, Sleep Disturbance, and Loneliness Among Older Adults in China: Cross-Sectional Study

BACKGROUND

Driven by the accelerated aging of the population of China, the number of older adults has increased rapidly in the country. Meanwhile, following children, migrant older adults (MOA) have emerged as a vulnerable group in the process of fast urbanization. Existed studies have illustrated the association between social support and loneliness and the relationship between sleep disturbance and loneliness; however, the underlying mechanisms and the migrant-local difference in the association between social support, sleep disturbance, and loneliness have not been identified.

OBJECTIVE

This study aimed to clarify the migrant-local difference in the relationship between social support, sleep disturbance, and loneliness in older adults in China.

METHODS

Multistage cluster random sampling was used to select participants: 1205 older adults (n=613, 50.9%, MOA and n=592, 49.1%, local older adults [LOA]) were selected in Weifang City, China, in August 2021. Loneliness was assessed with the 6-item short-form University of California, Los Angeles Loneliness Scale, social support was evaluated with the Social Support Rating Scale, and sleep disturbance was measured with the Pittsburgh Sleep Quality Index. The chi-square test, t test, and structural equation modeling (SEM) were adopted to explore the migrant-local difference between social support, sleep disturbance, and loneliness among the MOA and LOA.

RESULTS

The mean score of loneliness was 8.58 (SD 3.03) for the MOA and 8.00 (SD 2.79) for the LOA. SEM analysis showed that social support exerts a direct negative effect on both sleep disturbance (standardized coefficient=-0.24 in the MOA and -0.20 in the LOA) and loneliness (standardized coefficient=-0.44 in the MOA and -0.40 in the LOA), while sleep disturbance generates a direct positive effect on loneliness (standardized coefficient=0.13 in the MOA and 0.22 in the LOA).

CONCLUSIONS

Both MOA and LOA have a low level of loneliness, but the MOA show higher loneliness than the LOA. There is a negative correlation between social support and loneliness as well as between social support and sleep disturbance among the MOA and LOA (MOA>LOA), while loneliness is positively associated with sleep disturbance in both populations (MOA Collapse

Key Words

• loneliness
• migrant-local difference
• older adults
• sleep disturbance
• social support
• structural equation modeling

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MESH Headings

• Child
• Humans
• Aged
• Cross-Sectional Studies
• Loneliness
• Transients and Migrants
• China/epidemiology
• Sleep Wake Disorders/epidemiology
• Social Support
• Sleep

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Grants Collapse

Affiliation(s)

Mingli Pang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Jieru Wang Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Mingyue Zhao Human Resource Department, The Second Hospital of Shandong University, Jinan, China
Rui Chen Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Hui Liu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Xixing Xu Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Shixue Li Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China
Fanlei Kong Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China Institute of Health and Elderly Care, Shandong University, Jinan, China

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Mindfulness and loneliness in retired older adults in China: mediation effects of positive and negative affect

Objectives: Drawing from the mindfulness framework and the broaden-and-build theory, this study investigates the extent to which mindfulness influences loneliness and whether the relation is mediated by positive and negative affect.Method: Data were collected from 748 retired older adults aged 60 and above in Chengdu, China in 2022. Loneliness and mindfulness were measured by the UCLA loneliness scale and by the short-form version of the Five Facet Mindfulness Questionnaire, while the positive and negative affect was assessed by the International Positive and Negative Affect Schedule.Results: The results of this study show that mindfulness was positively associated with positive affect (β = 0.37, p<.001), negatively related to negative affect (β=-0.21, p<.001) and loneliness (β=-0.13, p<.001), and had an indirect effect on loneliness via positive and negative affect (β=-0.20, p<.001).Conclusion: The findings suggest that mindfulness could be a positive resource for improving mental health and reducing loneliness among retired older adults in China.

A Short-Form Measure of Loneliness to Predict Depression Symptoms Among Adolescents

The purpose of this study was to produce a short-form measure of loneliness and assesses its prediction of depressive symptoms relative to a comprehensive measure. Western Australian adolescents completed the Friendship Related Loneliness and Isolation subscales of the Perth Aloneness Scale (PALs) three times over 18 months (T 1 n = 1538; T 2, n = 1683; T 3, n = 1406). Items were reduced while preserving predictability. Follow-up confirmatory factor analyses and predictive models with the reduced and full PALs were then tested. A reduced six-item scale (PALs-6) preserved the two-factor structure of the PALs and showed strong prediction of very elevated depressive symptoms (Sensitivity = 0.70, Specificity = 0.78, AUC = 0.81); it was less successful in predicting future symptoms (Sensitivity = 0.67, Specificity = 0.64, AUC = 0.74). The PALs-6 provides a brief measure of adolescent loneliness for clinicians and researchers that also predicts very elevated levels of depression.

The positive and negative emotion functions related to loneliness: a systematic review of behavioural and neuroimaging studies

Loneliness is associated with high prevalences of major psychiatric illnesses such as major depression. However, the underlying emotional mechanisms of loneliness remained unclear. We hypothesized that loneliness originates from both decreases in positive emotional processing and increases in negative emotion processing. To test this, we conducted a systematic review of 29 previous studies (total participants n = 19 560, mean age = 37.16 years, female proportion = 59.7%), including 18 studies that included questionnaire measures of emotions only, and 11 studies that examined the brain correlates of emotions. The main findings were that loneliness was negatively correlated with general positive emotions and positively correlated with general negative emotions. Furthermore, limited evidence indicates loneliness exhibited negative and positive correlations with the brain positive (e.g. the striatum) and negative (e.g. insula) emotion systems, respectively, but the sign of correlation was not entirely consistent. Additionally, loneliness was associated with the structure and function of the brain emotion regulation systems, particularly the prefrontal cortex, but the direction of this relationship remained ambiguous. We concluded that the existing evidence supported a bivalence model of loneliness, but several critical gaps existed that could be addressed by future studies that include adolescent and middle-aged samples, use both questionnaire and task measures of emotions, distinguish between general emotion and social emotion as well as between positive and negative emotion regulation, and adopt a longitudinal design that allows us to ascertain the causal relationships between loneliness and emotion dysfunction. Our findings provide new insights into the underlying emotion mechanisms of loneliness that can inform interventions for lonely individuals.

The moderating role of neighborhood social cohesion in the mediation effects of the loneliness between acculturation stress and post-traumatic growth among female North Korean defectors

Loneliness negatively predicts post-traumatic growth (PTG) among North Korean defectors (NKD), one of the representative groups of refugees. Additionally, evidence also suggests that females, who account for 70% of NKDs entering South Korea, are vulnerable not only to past trauma but also to the current acculturation stress and loneliness affected by neighborhood social cohesion. This study explores whether the mediating effect of loneliness on the relationship between acculturation stress and PTG was moderated by the neighborhood social cohesion among female NKDs. In this study, the data of 166 female NKDs who completed an online survey regarding acculturation stress, PTG, loneliness, and neighborhood social cohesion were used. Moderated mediation analysis was conducted using SPSS PROCESS macro program. Loneliness was associated with PTG (B = - 1.896, p < 0.001), and mediated the association between acculturation stress and PTG (indirect effect = - 0.278, 95% LLCI - 0.403, 95% ULCI - 0.166). Neighborhood social cohesion moderated the mediation effect of loneliness on the association between acculturation stress and PTG (B = - 0.016, 95% LLCI 0.001, 95% ULCI 0.035). The indirect effect of acculturation stress on PTG through loneliness was notably high for those with low neighborhood social cohesion. Therefore, increasing neighborhood social cohesion would reduce loneliness caused by acculturation stress and support the positive growth among female NKDs. This represents the most effective approach to aiding female NKDs in achieving growth, even after suffering trauma.

Well-Being Implications of Digital Social Multitasking in Adolescent Friendship: A Latent Profile Analysis

Adolescents' phone use during face-to-face interactions (i.e., digital social multitasking [DSMT]) has gained increasing attention because of its prevalence as well as implications for well-being. However, most studies have focused on only one dimension of the behavior and relied on variable-centered approaches. Informed by the DSMT framework, we adopted a person-centered approach to identify different groups of adolescents based on their levels, perceptions, and motives of phone use during face-to-face interactions with friends. We also examined how these groups differed in five well-being variables (loneliness, depressive symptoms, digital stress, friendship quality, and satisfaction of basic psychological needs). A total of 517 adolescents (Mage = 14.83, standard deviation [SD] = 1.93; 50 percent female) completed an online survey. Three profiles were identified: the Intentional (low levels, quite positive perceptions, motivated for clear goals), the Embracers (high levels, highly positive perceptions, strong motives), and the Unimpressed (low levels, low positive perceptions, low motives). The Embracers scored the highest on both positive and negative indicators of well-being, whereas the Unimpressed scored the lowest on all well-being scales. The Intentional appeared to be the most adaptive group. Implications are discussed.

Evaluation of Measurement Properties and Differential Item Functioning in the English and French Versions of the University of California, Los Angeles, Loneliness Scale-6: A Scleroderma Patient-Centered Intervention Network (SPIN) Study

OBJECTIVE

Loneliness has been associated with poorer health-related quality of life but has not been studied in patients with systemic sclerosis (SSc). The current study was undertaken to examine and compare the psychometric properties of the English and French versions of the University of California, Los Angeles, Loneliness Scale-6 (ULS-6) in patients with SSc during the COVID-19 pandemic.

METHODS

This study used baseline cross-sectional data from 775 adults enrolled in the Scleroderma Patient-Centered Intervention Network (SPIN) COVID-19 Cohort. Reliability and validity of ULS-6 scores overall and between languages were evaluated using confirmatory factor analysis (CFA), differential item functioning (DIF) through the multiple-indicator multiple-cause (MIMIC) model, omega/alpha calculation, and correlations of hypothesized convergent relationships.

RESULTS

CFA for the total sample supported the single-factor structure (comparative fit index [CFI] 0.96, standardized root mean residual [SRMR] 0.03), and all standardized factor loadings for items were large (0.60-0.86). The overall MIMIC model with language as a covariate fit well (CFI 0.94, SRMR 0.04, root mean square error of approximation 0.11). Statistically significant DIF was found for 3 items across language (βitem2  = 0.14, P < 0.001; βitem4  = -0.07, P = 0.01; βitem6  = 0.13, P < 0.001), but these small differences were without practical measurement implications. Analyses demonstrated high internal consistency with no language-based convergent validity differences.

CONCLUSION

Analyses demonstrated evidence of acceptable reliability and validity of ULS-6 scores in English- and French-speaking adults with SSc. DIF analysis supported use of the ULS-6 to examine comparative experiences of loneliness without adjusting for language.

Promoting Connection in the Faith Community Through Letter Writing

ABSTRACT

Faith community nurses can reduce loneliness and provide connection for homebound members of faith communities through promotion of letter writing. Undergraduate nursing students who were matched with members of their own faith community wrote letters to older adults for 10 weeks as a community service-learning project. Data from the UCLA Loneliness Scale pre- and post-intervention showed reduced loneliness and greater connection among recipients of the letters.

Can digital health researchers make a difference during the pandemic? Results of the single-arm, chatbot-led Elena+: Care for COVID-19 interventional study

Background

The current paper details findings from Elena+: Care for COVID-19, an app developed to tackle the collateral damage of lockdowns and social distancing, by offering pandemic lifestyle coaching across seven health areas: anxiety, loneliness, mental resources, sleep, diet and nutrition, physical activity, and COVID-19 information.

Methods

The Elena+ app functions as a single-arm interventional study, with participants recruited predominantly via social media. We used paired samples T-tests and within subjects ANOVA to examine changes in health outcome assessments and user experience evaluations over time. To investigate the mediating role of behavioral activation (i.e., users setting behavioral intentions and reporting actual behaviors) we use mixed-effect regression models. Free-text entries were analyzed qualitatively.

Results

Results show strong demand for publicly available lifestyle coaching during the pandemic, with total downloads (N = 7'135) and 55.8% of downloaders opening the app (n = 3,928) with 9.8% completing at least one subtopic (n = 698). Greatest areas of health vulnerability as assessed with screening measures were physical activity with 62% (n = 1,000) and anxiety with 46.5% (n = 760). The app was effective in the treatment of mental health; with a significant decrease in depression between first (14 days), second (28 days), and third (42 days) assessments: F2,38 = 7.01, p = 0.003, with a large effect size (η2G = 0.14), and anxiety between first and second assessments: t54 = 3.7, p = <0.001 with a medium effect size (Cohen d = 0.499). Those that followed the coaching program increased in net promoter score between the first and second assessment: t36 = 2.08, p = 0.045 with a small to medium effect size (Cohen d = 0.342). Mediation analyses showed that while increasing number of subtopics completed increased behavioral activation (i.e., match between behavioral intentions and self-reported actual behaviors), behavioral activation did not mediate the relationship to improvements in health outcome assessments.

Conclusions

Findings show that: (i) there is public demand for chatbot led digital coaching, (ii) such tools can be effective in delivering treatment success, and (iii) they are highly valued by their long-term user base. As the current intervention was developed at rapid speed to meet the emergency pandemic context, the future looks bright for other public health focused chatbot-led digital health interventions.

Prevalence and associated factors of alexithymia among people living with HIV/AIDS in China: a cross-sectional study

BACKGROUND

Alexithymia is common and causes serious harm to people living with HIV/AIDS. Therefore, this study aimed to examine its prevalence and associated factors among people living with HIV/AIDS in China.

METHODS

A cross-sectional study was conducted in two designated AIDS medical institutions in Harbin, China between January and December 2019. In total, 767 participants completed the 20-item Toronto Alexithymia Scale, the University of California Los Angeles Loneliness short-form, the Patient Health Questionnaire-9, the HIV Treatment Regimen Fatigue Scale, and the Alcohol Use Disorders Identification Test-Consumption. The participants responded to several questions regarding their demographic characteristics, life satisfaction, disease-related economic burden, and their antiretroviral therapy (ART) side effects. Multivariate logistic regression assessed the relationship between alexithymia and associated factors. Odds ratios (OR) and 95% confidence intervals (CI) for OR were calculated.

RESULTS

Approximately 36.1% of the participants were classified as having alexithymia. After adjusted age and education, the logistic regression model indicated that disease-related economic burden (OR = 1.477, 95% CI = 1.155-1.888), ART side effects (OR = 1.249, 95% CI = 1.001-1.559), loneliness (OR = 1.166, 95% CI = 1.101-1.236), and HIV treatment regimen fatigue (OR = 1.028, 95% CI = 1.017-1.039) were positively associated with alexithymia.

CONCLUSIONS

The mental health problems of people living with HIV/AIDS are essential to understand and deserve attention. Disease-related economic burdens are major associated factors. Multiple actors should provide better services and guarantees for patients.

Instruments for Assessing Loneliness in Older People in Portugal: A Scoping Review: Instrumentos de avaliação da solidão em adultos mais velhos em Portugal: uma scoping review

Background

Loneliness is a public health problem that affects many older adults. The subjective nature of loneliness challenges its assessment. Thus, assessing loneliness with valid and reliable instruments is crucial to characterizing the phenomenon and planning adequate interventions.

Summary

This study mapped the instruments validated for the Portuguese older population that assess loneliness. A scoping review was performed. The search for studies was carried out in SciELO, PsycInfo, Scopus, MEDLINE, MedicLatina, Nursing & Allied Health Collection: Comprehensive, CINAHL, and Open Access Scientific Repositories of Portugal. The findings showed three instruments validated for the Portuguese older population: ULS-16, ULS-6, and SELSA-S.

Key Messages

Future testing of those instruments is required to update and accumulate psychometric evidence. In addition, it is important to translate and validate other instruments to the Portuguese older adults population, namely de Jong Gierveld and UCLA-R (most used internationally), as well as the ALONE scale (new and brief).

Measuring loneliness: Psychometric properties of the three-item loneliness scale among community-dwelling adults

Loneliness is a prevalent set of negative feelings associated with unsatisfactory and reduced social interactions, inadequate social support, poor satisfaction with life and health, negative emotions, and economic burden. Thus, its measurement is of foremost importance. Therefore, this study aimed (i) to devise the Portuguese version of the three-Item Loneliness Scale (T-ILS), which is ideal for epidemiological studies, and (ii) to evaluate its psychometric properties. Three hundred forty-five community-dwelling Portuguese adults with a mean age of 54.6 ± 19.5 years, 61.7% women, recruited door-to-door, were assessed with the Portuguese versions of T-ILS, Satisfaction With Life Scale-SWLS, Lubben Social Network Scale 6-items-LSNS-6, a question regarding Happiness/Unhappiness, and a sociodemographic questionnaire. The T-ILS showed good psychometric properties and correlated moderately with SWLS and LSNS-6, and happiness, and weakly with the number of people in the household. The Portuguese version of the T-ILS proved to be a valid and reliable instrument, easy and quick to administer. It proved to be a valuable tool in screening loneliness in Portugal, being potentially useful to the identification of lonelier people in need of intervention.

A systematic review evaluating loneliness assessment instruments in older adults

Introduction and objectives

The experiences and changes that come along with old age may lead to a feeling of loneliness, usually followed by negative physical and mental manifestations. In this systematic review, we evaluated the existing tools to assess loneliness in older adults.

Methods

We performed a literature search in the Web of Science, Medline, and PsycINFO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After, we examined the psychometric properties of the instruments with a focus on reliability, validity, and main conclusions.

Results

We included 27 articles published between 1996 and 2021.

Conclusion

To date, there are few instruments to assess loneliness in older adults. In general, they present adequate psychometric properties, although it is true that some scales show somewhat low levels of reliability and validity.

Capturing the Dynamics of the Social Environment Through Experience Sampling Methods, Passive Sensing, and Egocentric Networks: Scoping Review

BACKGROUND

Social interactions are important for well-being, and therefore, researchers are increasingly attempting to capture people's social environment. Many different disciplines have developed tools to measure the social environment, which can be highly variable over time. The experience sampling method (ESM) is often used in psychology to study the dynamics within a person and the social environment. In addition, passive sensing is often used to capture social behavior via sensors from smartphones or other wearable devices. Furthermore, sociologists use egocentric networks to track how social relationships are changing. Each of these methods is likely to tap into different but important parts of people's social environment. Thus far, the development and implementation of these methods have occurred mostly separately from each other.

OBJECTIVE

Our aim was to synthesize the literature on how these methods are currently used to capture the changing social environment in relation to well-being and assess how to best combine these methods to study well-being.

METHODS

We conducted a scoping review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

RESULTS

We included 275 studies. In total, 3 important points follow from our review. First, each method captures a different but important part of the social environment at a different temporal resolution. Second, measures are rarely validated (>70% of ESM studies and 50% of passive sensing studies were not validated), which undermines the robustness of the conclusions drawn. Third, a combination of methods is currently lacking (only 15/275, 5.5% of the studies combined ESM and passive sensing, and no studies combined all 3 methods) but is essential in understanding well-being.

CONCLUSIONS

We highlight that the practice of using poorly validated measures hampers progress in understanding the relationship between the changing social environment and well-being. We conclude that different methods should be combined more often to reduce the participants' burden and form a holistic perspective on the social environment.

A realist evaluation of the feasibility of a randomised controlled trial of a digital music and movement intervention for older people living in care homes

BACKGROUND

Low physical activity in care home residents brings about negative mental health consequences, such as higher levels of depression and loneliness. With advancements in communication technology, particularly during the COVID-19 pandemic, the feasibility and effectiveness of a randomised controlled trial (RCT) of a digital Physical Activity (PA) resource in care homes deserve more research attention. A realist evaluation was used to uncover influencing factors of a feasibility study implementation to inform how a digital music and movement programme would work and under what circumstances this would be most effective.

METHODS

Participants were 49 older adults (aged 65 years +) recruited across ten care homes in Scotland. Surveys were administered at baseline and post-intervention comprising psychometric questionnaires on multidimensional health markers validated in older adults with possible cognitive impairment. The intervention comprised 12 weeks of four prescribed digitally delivered movement (n = 3) and music-only (n = 1) sessions per week. An activity coordinator delivered these online resources in the care home. Post-intervention focus groups with staff and interviews with a sub-sample of participants were conducted to gain qualitative data on the acceptability of the intervention.

RESULTS

Thirty three care home residents started the intervention, but only 18 residents (84% female) completed both pre- and post-intervention assessments. Activity coordinators (AC) offered 57% of the prescribed sessions, with an average residents' adherence of 60%. Delivery of the intervention did not go as planned due to Covid restrictions in care homes and delivery challenges, including (1) motivation and engagement, (2) changes in cognitive impairment and disabilities of the participants, (3) death or hospitalisation of the participants and (4) limited staffing and technology resources to deliver the programme as intended. Despite this, group participation and encouragement of residents supported the delivery and acceptance of the intervention, with ACs and residents reporting improved mood, physical health, job satisfaction and social support. Improvements with large effect sizes were found for anxiety, depression, loneliness, perceived stress and sleep satisfaction, but no changes in fear of falling, domains of general health or appetite.

CONCLUSION

This realist evaluation suggested that this digitally delivered movement and music intervention is feasible. From the findings, the initial programme theory was refined for future implementation of an RCT in other care homes but future research exploring how to tailor the intervention to those with cognitive impairment and/or lacking capacity to consent is needed.

TRIAL REGISTRATION

Retrospectively registered at ClinicalTrials.gov NCT05559203.

Attachment, loneliness, and social connection as prospective predictors of suicidal ideation during the COVID-19 pandemic: A relational diathesis-stress experience sampling study

INTRODUCTION

Concerns about the impact of the COVID-19 pandemic on mental health have led to efforts to understand how pandemic-specific factors, such as decreased social contact during periods of social distancing, may relate to suicide risk. The present study evaluated personality-based risk factors and frequency of social contact as prospective predictors of suicidal ideation (SI) during the pandemic.

METHODS

We tested a relational diathesis-stress model of suicide focusing on insecure attachment, trait loneliness, and social contact as predictors of SI, using twice-weekly survey data collected via smartphone from a community sample (n = 184) over 8 weeks.

RESULTS

Multilevel modeling showed that both trait loneliness and anxious attachment predicted the prospective development of SI during the study period. Reduced in-person contact, but not remote contact, was proximally associated with increased SI. Participants with high attachment avoidance were more likely to develop SI in the context of reduced daily in-person contact compared to participants without these traits.

CONCLUSION

Findings support a relational diathesis-stress model of suicide risk during the pandemic, showing that dispositional traits related to emotional connection with others predicted the relative salience of reduced social contact as a proximal risk factor for SI.

Loneliness, ageism, and mental health: The buffering role of resilience in seniors

Introduction

Ageism and loneliness are two relevant public health phenomena because of their negative impact on the senior's mental health. With the increase in average life expectancy, these tend to co-occur, which may increase the psychological distress (PD) of seniors. Resilience has been shown to be an important protective factor of seniors mental health, although its potential buffering role of public health risk factors with cumulative impact on mental health, such as loneliness and ageism, needs to be more studied.

Aim

To assess the potential mediator role of resilience between the effects of ageism and loneliness on PD in seniors.

Methods

A sample of 349 Portuguese seniors aged 60 years and over was collected through an online survey and during the COVID-19 pandemic period. Seniors completed the Kessler Psychological Distress Scale (K6), the Short-Form of UCLA Loneliness Scale (USL-6), the Ambivalent Ageism Scale (AAS) and the Connor-Davidson Resilience Scale (CD-RISC-10). A mediation analysis model was developed with resilience as a mediating variable.

Results

There were moderate to high levels of PD and moderate levels of ageism, loneliness and resilience. Resilience fully mediated the effect of ageism on PD and partially mediated the effect of loneliness on PD.

Conclusions

Resilience was an important protective factor of mental health against the effects of ageism, and partially protected mental health from the effects of loneliness among seniors. It is suggested that resilience be considered as a factor to be integrated in future intervention programs for mental health. The practical applicability of this study is discussed.

Autonomy and loneliness - longitudinal within- and between-person associations among Swedish older adults

OBJECTIVES

Loneliness is an important risk factor for mental and physical health over the life span. Little is known about psychosocial predictors and consequences of loneliness apart from social network characteristics. One important factor that may both prevent from, but also be affected by loneliness, is perceived autonomy.

METHOD

In the present study, we investigated the longitudinal association of loneliness and autonomy over four years among participants of the Swedish Health, Aging and Retirement Transitions in Sweden (HEARTS) study (n = 5718, age 60-66 at baseline). We used a latent curve model with structured residuals, which distinguishes within- and between-person associations and includes cross-lagged parameters.

RESULTS

Higher levels of autonomy at baseline were associated with lower levels of loneliness, and increases in autonomy were associated with decreases in loneliness. When individuals felt more autonomous than usual, they also reported less loneliness. However, the cross-lagged paths were not significant, which means that autonomy did not predict loneliness over time on the within-person level, and loneliness did not predict autonomy over time.

CONCLUSION

Our findings show that higher autonomy was related to lower loneliness on different analytical levels, but the direction of effects is unclear. More research is needed to understand the development of this association over the life span.

The effect of letter writing on a long-term care resident with loneliness

Older adults living in long term care (LTC) facilities may experience increased isolation and loneliness. This was compounded with the Coronavirus Disease 2019 (COVID-19) pandemic. Loneliness and isolation increase the risk for physical, psychological, and social decline. This case report discusses the effect of a letter writing initiative on feelings of loneliness and connection in a long-term care resident. Personalized care is the standard in the long-term care setting and letter writing between two people can contribute to personalized meaningful care as evidenced by the example provided. Further research is needed to explore social connection and loneliness and methods to combat these issues with a personalized approach for different populations within LTC facilities.

Social isolation due to COVID-19: impact on loneliness, sedentary behavior, and falls in older adults

OBJECTIVES

The World Health Organization has recommended social isolation to prevent the transmission of COVID-19. Thus, feelings of loneliness, sedentary behavior, and predisposition to falls have been reported more often due to the adoption of social isolation, especially for older adults. The objective of this study was to compare older adults' loneliness, sedentary behavior, and occurrence of falls before and during social isolation due to the pandemic as well as to analyze the association of loneliness with sedentary lifestyle and falls in older adults.

METHOD

Retrospective analytical study conducted through an online survey with older adults from Brazilian states in social isolation, approved by the Research Ethics Committee (number 32168920.0.0000.0068).

RESULTS

There was a significant increase in loneliness and sedentary behavior during social isolation (p-value < 0.05 for both), but no increase was observed for falls (p-value = 0.615). There was no correlation between the outcomes, nor was there a correlation between the outcomes and the number of days in social isolation.

CONCLUSION

The results of this research show that adoption of social isolation due to the COVID-19 pandemic brought an increase in sedentary behavior and loneliness for older adults but had no effect on the number of falls.

Mattering and Depressive Symptoms in Portuguese Postpartum Women: The Indirect Effect of Loneliness

BACKGROUND

Postpartum depression is described as the most prevalent clinical condition in the postpartum period, with several negative consequences. The current study aimed to understand the relationship between mattering, loneliness and depressive symptoms in Portuguese postpartum women and to examine the potential mediating role of loneliness in the relationship between mattering and depressive symptomatology among postpartum women.

METHODS

This cross-sectional study included a sample collected online composed of 530 Portuguese women in the postpartum period, who answered self-report questionnaires to assess depressive symptoms, mattering, and loneliness.

RESULTS

It was found that the relationships between mattering, loneliness, and depressive symptoms were significant, p < 0.001: (a) higher levels of mattering were associated with lower levels of loneliness and depressive symptomatology and (b) higher levels of loneliness were associated with higher levels of depressive symptomatology. The relationship between mattering and postpartum depressive symptoms occurred directly and indirectly through loneliness, 95% CI = [-0.75, -0.46].

CONCLUSIONS

These results highlight the importance of studying loneliness as a possible risk factor for postpartum depression and alert to the pertinence of considering mattering and loneliness in the assessment and intervention with women in the perinatal period.

"… Exercise opportunities became very important": Scottish older adults' changes in physical activity during Covid19'

BACKGROUND

The purpose of this study was to explore perceived changes in physical activity (PA) due to Covid19 stay-at-home and social distancing guidance among older adults.

METHODS

Participants (n = 1429, 77% female, 84% ≥60 years) living in Scotland completed an online survey in Summer 2020 measuring PA and wellbeing (indexed through loneliness, and health-related quality of life). The survey included open- and closed-ended questions about how these variables changed in response to Covid19 social distancing and 'shielding' guidelines.

RESULTS

From the International Physical Activity Questionnaire (IPAQ), the majority reported high volumes of PA, indicative of being 'moderately' or 'highly' active. When asked specifically about strength training, 12% reported engagement on ≥2d/wk. Most participants reported that PA had changed during this time, citing reduced use of exercise facilities, increased active travel, and online PA classes; although only 16% reported engaging in PA online.

CONCLUSIONS

Higher levels of PA were found to be associated with better health-related quality of life. Additional efforts should be made to support PA engagement in older adults, including strength training and other tailored approaches to support individual needs.

Stop talking about it already! Co-ruminating and social media focused on COVID-19 was associated with heightened state anxiety, depressive symptoms, and perceived changes in health anxiety during Spring 2020

BACKGROUND

Social distancing presents a significant obstacle for relationships and threatens mental health. Identifying maladaptive, voluntary coping strategies may inform how to maintain interpersonal relationships and mental health during quarantine. Co-ruminating with peers on negative events, moods and fears has adjustment trade-offs of increasing depression and anxiety risk while also enhancing friendship quality. Similarly, social media use is associated with social benefits and risk to mental health. We extend prior research by examining whether co-ruminating on COVID-19, social media use, and social media use focused on COVID-19 during social isolation was associated with heightened depression and anxiety symptoms but also lower loneliness and higher social support during initial lockdown measures in the USA.

METHODS

Adults were recruited through social media (n = 345) to complete self-report surveys on co-rumination, social media use, social distancing, social support from March-May 2020. During this cross-sectional assessment, in addition to completing surveys on current depressive symptoms and state and health anxiety, participants also provided retrospective report of their perceived health anxiety levels six months prior.

RESULTS

Co-ruminating on COVID-19 with peers and greater time on social media focused on COVID-19 predicted perceived increases in health anxiety and were also associated with higher depressive symptoms and state anxiety, even after controlling for significant demographic predictors. Further, in the context of social distancing, both interaction strategies failed to confer social benefits.

CONCLUSIONS

Results have direct implications for maintaining psychosocial health during social distancing restrictions. Adults may modify how they engage with peers by limiting COVID-19 content on social media and COVID-19 discussion.