Loneliness, Social Anxiety Symptoms, and Depressive Symptoms in Adolescence: Longitudinal Distinctiveness and Correlated Change

Revisiting the cognitive and behavioral aspects of loneliness: Insights from different measurement approaches

Loneliness is increasingly recognized as a critical public health issue that profoundly affects psychological well-being and social functioning. This study evaluates cognitive and behavioral differences associated with different facets of loneliness. We classified 790 German-speaking adults (MAge = 31.86 (12.48), 81% female) as lonely or not lonely based on three dimensions - loneliness frequency, distress, and chronicity - and tested for group differences regarding cognitive and behavioral aspects, as proposed by the cognitive model of loneliness, while controlling for depressive and social anxiety symptoms. The results indicate fair to substantial agreement between the three classification methods. Further, we found significant group differences regarding all components, such as interpretation bias, social avoidance, and self-esteem, with each loneliness classification method. Our findings highlight the multifaceted nature of loneliness and underscore the importance of applying diverse methods to fully capture its complexity. This study contributes to a more nuanced understanding of loneliness and its implications, suggesting that interventions should consider the specific dimensions of loneliness to effectively address its cognitive and behavioral ramifications.

Examining the Latent Dimensions of Social Anxiety Disorder

While the body of literature has investigated the latent dimensions of Social Anxiety Disorder (SAD), only few have directly anchored in the DSM-5 SAD symptoms. Similarly, a continuing issue on measuring mental health disorders pertains to whether a symptom's frequency, intensity, or both, are appropriate and sufficient indicators of severity. To address this gap, the present study developed and validated a DSM-5-based measurement tool, the Social Anxiety Symptom Severity Inventory (SASSI), which assesses both the intensity (intensity of disturbance) and frequency (frequency of occurrence) of SAD symptoms. In study 1 (n = 6458, college students), the results revealed a two-factor structure using exploratory structural equation modeling. In study 2 (n = 425, left-behind emerging adults), confirmatory factor analysis, measurement invariance testing, and latent class analysis were used. Findings demonstrated the importance of using both frequency and intensity of symptoms in assessing SAD severity. Moreover, a five-class solution best fitted the sample. Studies 1 and 2 demonstrated the good psychometric properties of SASSI and filled an important gap among available measures in assessing SAD severity through symptom frequency and intensity.

Exploring the interconnections of loneliness, anxiety, and depression among nursing students: a network analysis approach

Objective

Nursing students experience higher rates of anxiety and depression than students in other disciplines due to the demanding academic requirements and clinical training challenges. Loneliness and symptoms of anxiety and depression occur simultaneously; however, the specific interrelationships between these states remain inadequately investigated. This study aimed to utilize network analysis to examine the item-level reciprocal action between loneliness, anxiety, and depression among nursing students.

Methods

A total of 888 nursing students were assessed using the short-form UCLA Loneliness Scale (ULS-6), the Generalized Anxiety Disorder 7-item Questionnaire (GAD-7), and the Patient Health Questionnaire-9 (PHQ-9) on loneliness, anxiety, and depression, respectively. Descriptive analyses were conducted using SPSS 26.0, whereas other statistical analytical procedures were performed using R software. The Gaussian graphical model was used to estimate network, and the Network Comparison Test was applied to compare differences in networks across gender and grades.

Results

The results indicated that 58.6% of nursing students exhibited varying degrees of loneliness. Network analysis revealed that loneliness formed a separate cluster with limited connections to anxiety and depression communities. The edges between PHQ3-PHQ4 (insomnia or hypersomnia and fatigue), GAD1-GAD2 (feeling anxious and excessive worrying), ULS1-ULS2 (lonely and no one) showed the strongest positive edges within their communities, respectively. And the strongest inter-community edges were observed between GAD5-PHQ8 (fidgety-retardation), ULS6-PHQ4 (isolation-fatigue), and ULS1-GAD1 (lonely-feeling anxious). The centrality analysis identified GAD2 (excessive worrying), ULS6 (isolation), PHQ4 (fatigue), and PHQ2 (feeling down) as the most central node, indicating their significant influence on the overall network structure. Additionally, PHQ8 (retardation), PHQ2 (feeling down), GAD5 (fidgety), and GAD1(feeling anxious) played a crucial role as bridging symptoms that linked the three communities. In addition, there is no statistically significant difference in the network structure except strength of GAD3 (generalized anxiety) and GAD6 (irritable) between sexes.

Conclusions

This study highlights the high prevalence of loneliness among nursing students and its distinct yet limited connection to anxiety and depression, emphasizing its unique role as a standalone psychological construct. The central symptoms in the network and important bridge symptoms across different psychological communities highlight the complexity of mental health symptom networks. This underscores the importance of targeting central symptoms for domain-specific interventions and addressing bridge symptoms to mitigate comorbidities across psychological conditions among nursing students.

Content Specificity of Interpretation Bias Related to Social and Emotional Loneliness in Emerging Adulthood

According to cognitive theories, loneliness is associated with biased cognitive processes. However, studies investigating interpretation bias (IB) related to feelings of loneliness are scarce. The current study aimed to investigate (a) whether emotional loneliness (perceived absence of intimacy) and social loneliness (perceived absence of satisfying connections) are associated with a negative IB while controlling for related psychosocial symptoms, and (b) whether these two types of loneliness show content-specific IB. Sample 1 included an unselected university sample (N = 138, 81.9% female, M = 20.8 years, SD = 4.4), and Sample 2 utilized a preselected university sample with elevated anxiety/depression levels (N = 315, 69.5% female, M = 23.8 years, SD = 4.3). Participants completed questionnaires on emotional and social loneliness, social isolation, social anxiety, depression, hostility, and an ambiguous scenarios task measuring IB. The results showed that emotional and social loneliness were uniquely associated with a negative IB related to the unavailability of social network. Social loneliness was additionally positively related to an IB for rejection and negatively to an IB for hostility in Sample 2. These results provide evidence for a content-specific negative IB in both types of loneliness. Future studies are needed to replicate these findings as it could aid in developing an effective treatment program for loneliness targeting underlying cognitions in young adults.

Loneliness and social anxiety in the general population over time - results of a cross-lagged panel analysis

BACKGROUND

Loneliness has become a major public health issue of the recent decades due to its severe impact on health and mortality. Little is known about the relation between loneliness and social anxiety. This study aimed (1) to explore levels of loneliness and social anxiety in the general population, and (2) to assess whether and how loneliness affects symptoms of social anxiety and vice versa over a period of five years.

METHODS

The study combined data from the baseline assessment and the five-year follow-up of the population-based Gutenberg Health Study. Data of N = 15 010 participants at baseline (Mage = 55.01, s.d.age = 11.10) were analyzed. Multiple regression analyses with loneliness and symptoms of social anxiety at follow-up including sociodemographic, physical illnesses, and mental health indicators at baseline were used to test relevant covariates. Effects of loneliness on symptoms of social anxiety over five years and vice versa were analyzed by autoregressive cross-lagged structural equation models.

RESULTS

At baseline, 1076 participants (7.41%) showed symptoms of social anxiety and 1537 (10.48%) participants reported feelings of loneliness. Controlling for relevant covariates, symptoms of social anxiety had a small significant effect on loneliness five years later (standardized estimate of 0.164, p < 0.001). Vice versa, there was no significant effect of loneliness on symptoms of social anxiety taking relevant covariates into account.

CONCLUSIONS

Findings provided evidence that symptoms of social anxiety are predictive for loneliness. Thus, prevention and intervention efforts for loneliness need to address symptoms of social anxiety.

A systematic review of longitudinal risk and protective factors for loneliness in youth

To effectively tackle loneliness in youth, prevention and intervention strategies should be based on solid evidence regarding risk and protective factors in this age group. This systematic literature review identifies and narratively synthesizes longitudinal studies of risk and protective factors for loneliness in children and adolescents aged below 25 years. A systematic literature search was conducted in October 2023 using PsycINFO and MEDLINE, resulting in n = 398 articles, with n = 105 articles meeting the inclusion criteria. The examined factors included demographic (e.g., gender), socioeconomic (e.g., income sufficiency), social (e.g., peer acceptance), mental health (e.g., depression), physical health (e.g., disabilities), health behavior (e.g., sport participation), and psychological factors (e.g., shyness). Additionally, adverse childhood experiences (e.g., child maltreatment) and environmental factors (e.g., neighborhood characteristics) were investigated. Despite the wide range of potential risk and protective factors examined, relatively few studies provided strong evidence for a prospective association with loneliness. Risk factors that were consistently identified across multiple longitudinal studies included low peer acceptance and peer victimization, depression, social anxiety, internalizing symptoms, low self-esteem, shyness, and neuroticism. Additional replication is required to evaluate factors that have shown significant associations with loneliness in only a limited number of longitudinal studies (e.g., aggression).

Effects of Empathy on Loneliness Among Rural Left-Behind Children in China: The Chain-Mediated Roles of Social Anxiety and Psychological Resilience

Objective

Loneliness is a prevalent issue among rural left-behind children in China, adversely affecting their physical and mental well-being, as well as social stability. However, the influencing factors and potential mechanisms of loneliness have not yet been fully clarified. This study aims to validate the mediating roles of social anxiety and psychological resilience by examining the association between affective/cognitive empathy and loneliness among Chinese rural left-behind children.

Methods

This cross-sectional survey employed a convenience sampling approach among Chinese left-behind children. A total of 540 participants aged 6 to 11 years old (Average age = 8.54, SD = 1.682) from 3 primary schools in Hunan Province completed the Children's Loneliness Scale, Social Anxiety Scale for Children, The Chinese version of Connor-Davidson Resilience Scale, and Basic Empathy Scale. Data analysis was conducted using SPSS 27.0, Origin 2020, and Mplus 8.3.

Results

Pearson correlation analyses suggested strong significant correlations among affective/cognitive empathy, loneliness, social anxiety, and psychological resilience. Path analyses indicated that the chain mediation effect size of social anxiety and psychological resilience was 0.016 between affective empathy and loneliness, while the chain mediation effect size between cognitive empathy and loneliness was -0.011.

Conclusion

Affective empathy positively correlates with loneliness among Chinese left-behind children through social anxiety and resilience, while cognitive empathy negatively correlates with loneliness. These findings suggest that left-behind children should enhance their cognitive empathy and psychological resilience to reduce their social anxiety, thereby mitigating their loneliness.

Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study

BACKGROUND

Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved.

OBJECTIVE

This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems.

METHODS

An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: "Have you ever considered committing suicide in the past 12 months?" Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling.

RESULTS

Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant.

CONCLUSIONS

IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study.

Risk factors associated with loneliness among mexican-origin adults in southern Arizona

This study examines factors associated with symptoms of loneliness among a sample (n = 213) of mostly Mexican-origin adults at risk of chronic diseases in Southern Arizona's Pima, Yuma, and Santa Cruz counties. It uses baseline data from a community-based participatory research partnership and multinominal logistic regression models. Controlling for chronic diseases and sociodemographic characteristics, perceived social support and hope exhibit negative main effects on loneliness when comparing individuals who experienced loneliness for 5-7 days in the preceding week with those who did not encounter such feelings during the same period (adjusted odds ratio, AOR = 0.49 and 0.47; 95% confidence interval, CI = 0.34-0.73 and 0.29-0.75, respectively). However, when considered together, perceived social support and hope display a positive and statistically significant combined effect on loneliness (AOR = 1.03; 95% CI = 1.01-1.06). Holding all covariates constant, individuals reporting loneliness for 5-7 days exhibit a relative risk ratio of 1.24 (95% CI = 1.06-1.46) for a one-unit increase in physical problem severity compared to those who do not experience loneliness. Moreover, being 65 years old or older (AOR = 0.16, 95% CI = 0.03-0.84), and having been born in Mexico and lived in the US for less than 30 years (AOR = 0.12, 95% CI = 0.02-0.74) are associated with negative main effects on loneliness when comparing individuals who experienced loneliness 1-2, and 5-7 days in the preceding week with those who did not feel loneliness during the same timeframe, respectively. Recognizing the crucial role of loneliness in shaping health outcomes for Mexican-origin adults, our findings underscore the significance of fostering supportive environments that not only enhance well-being but also cultivate robust community bonds within the US-Mexico border region.

Emotional competencies and psychological distress: Is loneliness a mediating factor?

Emotional competencies, such as emotion regulation and empathy, are essential for social interaction. Impairment of these skills has been associated with increased rates of anxiety/depressive symptoms and loneliness, which has been defined as the discrepancy between the desired and actual quality and quantity of social relationships a person maintains. The aim of the present study was to shed light on the associations between these constructs and to examine the possible mediating role of loneliness in the relationship between emotional competencies and anxiety/depressive symptoms in a sample of non-clinical individuals. A total of 298 participants were recruited for this study and were asked to complete a series of measures assessing difficulties in emotion regulation, empathy, loneliness, and anxiety/depressive symptoms. Regression and mediation models were tested to analyze the associations between these variables. Results showed that reduced emotional competencies in emotion regulation and empathy were both directly and indirectly associated with increased anxiety/depressive symptoms and emotional loneliness, which in turn was related to higher levels of psychological distress (with a partial mediation of loneliness). Overall, the present findings seem to indicate that emotional competencies play a key role in the experience of loneliness and psychological distress. Therefore, individuals reporting high levels of loneliness in combination with anxious/depressive symptoms should receive appropriate assessment and treatment of emotion regulation and empathic skills.

Intergenerational continuity of loneliness and potential mechanisms: Young Finns Multigenerational Study

Evidence on the intergenerational continuity of loneliness and on potential mechanisms that connect loneliness across successive generations is limited. We examined the association between loneliness of (G0) parents (859 mothers and 570 fathers, mean age 74 years) and their children (G1) (433 sons and 558 daughters, mean age 47 years) producing 991 parent-offspring pairs and tested whether these associations were mediated through subjective socioeconomic position, temperament characteristics, cognitive performance, and depressive symptoms. Mean loneliness across parents had an independent effect on their adult children's experienced loneliness (OR = 1.72, 95% CI 1.23-2.42). We also found a robust effect of mothers' (OR = 1.64, 95% CI 1.17-2.29), but not of fathers' loneliness (OR = 1.47, 95% CI 0.96-2.25) on offspring's experienced loneliness in adulthood. The associations were partly mediated by offspring depressive (41-54%) and anxiety (29-31%) symptoms. The current findings emphasize the high interdependence of loneliness within families mediated partly by offspring's mental health problems.

Associations between social loneliness trajectories and chronotype among adolescents

Late chronotype during adolescence is a critical risk factor for poor physical and mental health among adolescents. While social loneliness is confirmed to negatively influence sleep behaviors, the long-term effect of social loneliness on chronotype remains unknown. This study aims to investigate whether social loneliness trajectories from middle childhood to adolescence are associated with chronotype in late adolescence and examine the potential sex differences in these associations. Data were obtained from 2398 adolescents who participated in the Child and Adolescent Behaviors in Long-Term Evolution project. Chronotype was calculated as the midpoint of sleep on free days adjusted for sleep debt. Group-based trajectory modeling and multiple linear regression were employed to establish social loneliness trajectories and determine their associations with chronotype. Social loneliness trajectories were significantly associated with chronotype and varied by sex. Specifically, boys following a high-decreasing trajectory had earlier chronotype during late adolescence than did those following a low-decreasing trajectory (B =  - 0.07; p < 0.05). By contrast, girls following a low-to-moderate-increasing trajectory exhibited later chronotype than did those following a low-stable trajectory (B = 0.07; p < 0.01). Social loneliness trajectories, especially those displaying significant fluctuations over time, are critical indicators influencing chronotype among adolescents. Furthermore, these trajectories and their associations with chronotype display sex differences. These findings highlight the need for early interventions for psychological factors such as social loneliness to ensure that the late chronotype can be prevented. In addition, sex variations must be considered.

The Association Between Emotion Recognition and Internalizing Problems in Children and Adolescents: A Three-Level Meta-Analysis

Numerous studies have explored the link between how well youth recognize emotions and their internalizing problems, but a consensus remains elusive. This study used a three-level meta-analysis model to quantitatively synthesize the findings of existing studies to assess the relationship. A moderation analysis was also conducted to explore the sources of research heterogeneity. Through a systematic literature search, a total of 42 studies with 201 effect sizes were retrieved for the current meta-analysis, and 7579 participants were included. Emotion recognition was negatively correlated with internalizing problems. Children and adolescents with weaker emotion recognition skills were more likely to have internalizing problems. In addition, this meta-analysis found that publication year had a significant moderating effect. The correlation between emotion recognition and internalizing problems decreased over time. The degree of internalizing problems was also found to be a significant moderator. The correlation between emotion recognition and internalizing disorders was higher than the correlation between emotion recognition and internalizing symptoms. Deficits in emotion recognition might be relevant for the development and/or maintenance of internalizing problems in children and adolescents. The overall effect was small and future research should explore the clinical relevance of the association.

Knowledge acquisition following internet-based cognitive behavioural therapy for loneliness - A secondary analysis of a randomised controlled trial

BACKGROUND AND OBJECTIVES

Knowledge about a condition and how to treat it is part of most cognitive behavioural therapies. This is particularly relevant for self-help treatments such as internet-based CBT, which is commonly delivered in the form of didactic materials. The role of knowledge acquisition in treatment outcomes is an understudied area. The present study sought to investigate knowledge acquisition as part of an ICBT trial targeting loneliness and discern its role in the outcome of treatment.

METHODS

We used secondary data from a randomised controlled trial of ICBT targeting loneliness with 73 participants. A knowledge test including certainty ratings was constructed and used to investigate whether knowledge increased for the treatment group in comparison to the control group, whether changes in knowledge predicted changes in loneliness during the treatment phase, and how the acquired knowledge related to outcomes at a two-year follow-up. Multiple linear regression models were used to analyse the data.

RESULTS

The treatment group had significantly higher knowledge scores compared to the waitlist group at posttreatment, both in terms of correct answers (Cohen's d = 0.73) and certainty-weighted sum scores (Cohen's d = 1.20). Acquired knowledge did not predict reductions in loneliness in the short-term, and neither loneliness ratings nor use of treatment techniques in the long-term.

LIMITATIONS

The sample size was relatively small, which limits the statistical inferences.

CONCLUSIONS

Knowledge of treatment relevant principles increase as part of the treatment in ICBT for loneliness. This increase was not related to other short- and long-term outcomes.

Social interpretation inflexibility moderates emotional reactions to social situations in children and adolescents

Interpretation biases and inflexibility (i.e., difficulties revising interpretations) have been linked to increased internalizing symptoms. Although adolescence is a developmental period characterized by novel social situations and increased vulnerability to internalizing disorders, no studies have examined interpretation inflexibility in adolescents. Additionally, no studies (on adolescents or adults) have examined interpretation flexibility as a protective factor against adverse outcomes of interpersonal events. Using a novel task and a 28-day diary we examined relations among interpretation bias and inflexibility, internalizing symptoms, and negative interpersonal events in a sample of children and adolescents (N = 159, ages 9-18). At baseline, negative interpretation bias was positively correlated with social anxiety symptoms, and positive interpretation bias negatively correlated with social anxiety and depressive symptoms. Inflexible positive interpretations were correlated with higher social anxiety and depressive symptoms, while inflexible negative interpretations were correlated with higher social anxiety. Finally, interpretation inflexibility moderated daily associations between negative interpersonal events and depressive symptoms in daily life, such that higher inflexibility was associated with stronger associations between interpersonal events and subsequent depressive symptoms, potentially increasing depressive symptom instability. These results suggest that interpretation biases and inflexibility may act as both risk and protective factors for adolescent anxiety and depression.

Profiles and Transitions of Loneliness and Depressive Symptoms among Migrant Children: Predictive Role of Bullying Victimization

Although loneliness and depressive symptoms are particularly prominent among migrant children and often occur simultaneously, little is known about the co-occurring and transitional nature of loneliness and depressive symptoms among migrant children, and the role of bullying victimization on their profiles and transitions. This study examined the profiles and transitions of loneliness and depressive symptoms among migrant children using latent profile analysis and latent transition analysis, as well as how bullying victimization predicted their profile memberships and transitions. A total of 692 migrant children (55.3% males, Mage = 9.41, SD = 0.55, range = 8 to 12 years old at T1) participated in both two waves of the study over six months. The results indicated that low profile (59.2%), moderate profile (22.0%), moderately high profile (14.3%), and high profile (4.5%) were identified at Time 1; low profile (69.4%), predominantly loneliness profile (16.8%), predominantly depressive symptoms profile (6.5%), and high profile (7.3%) were identified at Time 2. Migrant children in at-risk profiles displayed varying degrees of transition. Migrant children experiencing more bullying victimization were more likely to belong or transition to at-risk profiles. The findings highlight the importance of subgroup differences considerations in understanding the co-occurring and transitional nature of loneliness and depressive symptoms, as well as the predictive role of bullying victimization, informing effective strategies for prevention and intervention.

Comorbidity of loneliness and social anxiety in adolescents: Bridge symptoms and peer relationships

RATIONALE

Previous research investigating the comorbidity of loneliness and social anxiety symptoms in population samples has relied on latent variable modeling in which averaged scores representing dimensions were derived from observed symptoms. Studies have not examined how loneliness and social anxiety co-occur at the symptom level or their relations with peer relationships.

OBJECTIVE

This study examined the comorbidity of loneliness and social anxiety and the role of peer relationships (i.e., the number of reciprocated friends, friendship quality, and bullying victimization) in adolescents' co-occurring network using a large sample of Chinese adolescents.

METHODS

We performed a network analysis in a sample of Chinese adolescents (N = 2601, 51.6% male, M age = 13.9 years, SD = 0.60). Participants completed self-report measures of loneliness, social anxiety, bullying victimization, and friendship quality as well as peer nomination measures of the number of reciprocated friends.

RESULTS

Network analysis revealed that feeling ridiculed, fear of being rejected, having difficulty asking others to do things together, and feeling left out at school were essential bridge symptoms in the co-occurrence of loneliness and social anxiety. Bullying victimization had more positive associations with symptoms of social anxiety, and friendship quality had more negative associations with symptoms of loneliness.

CONCLUSIONS

The findings provide preliminary evidence for the comorbidity of loneliness and social anxiety symptoms in adolescents. The results also highlight the potential importance of targeting peer relationships in the prevention and intervention of loneliness and social anxiety symptoms. The combination of longitudinal networks and interventions on bridge symptoms may provide further insight into the development of the links between peer relationships, loneliness, and social anxiety symptoms.

Joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence: associations with suicidal ideation

This study examined the joint trajectories of loneliness, depressive symptoms, and social anxiety from middle childhood to early adolescence and their associations with suicidal ideation. A total of 643 Chinese elementary school students (55.2% male; Mage = 9.01; SD = 0.75; range = 7 to 11 years at T1) completed measures on six occasions at 6-month intervals. Parallel process latent class growth models revealed five distinct trajectories of loneliness, depressive symptoms, and social anxiety: "congruent-low" (45.1%), "moderately low with predominant loneliness and depressive symptoms" (15.7%), "moderate with predominant loneliness and depressive symptoms" (4.2%), "moderately low with predominant social anxiety" (24.9%), and "congruent-high" (10.1%). The highest suicidal ideation was observed among adolescents who persistently experienced two or three symptoms, followed by those who persistently experienced one predominant symptom, and finally, adolescents who persistently experienced low levels of all three symptoms. The findings highlight the importance of individual differences considerations in understanding the joint patterns of loneliness, depressive symptoms, and social anxiety among youth during the transition into adolescence and the need for more sophisticated intervention programs tailored to the unique characteristics of the relevant trajectories to reduce the risk of suicidal ideation.

[Loneliness in childhood and adolescence. On the prevalence of a mental health risk factor among 11- to 15-year-old German students]

BACKGROUND

Loneliness is an increasingly present topic in both public and scientific discourse. There is increasing research on the prevalence of loneliness and health-related correlates in adults. However, there are only a few findings on loneliness in childhood and adolescence in Germany. Therefore, this study aims to present findings on the prevalence of loneliness among 11- to 15-year-old German students and examines associations with socio-demographic characteristics.

METHODS

The Health Behaviour in School-aged Children (HBSC) study is a global research collaboration under the auspices of the World Health Organization (WHO). In the federal state of Brandenburg, Germany, the study collected data from 3819 children and adolescents in grades 5, 7, and 9 (M_age = 13.5, SD = 1.6) at schools for general education. Loneliness was assessed using the University of California, Los Angeles (UCLA) Loneliness Scale and a single item.

RESULTS

Of the respondents, 13.2% reported feeling lonely most of the time and 3.6% always. Loneliness was more prevalent among girls and non-binary students, as well as among older students and children and adolescents of lower socioeconomic status.

DISCUSSION

The findings indicate that loneliness is a widespread phenomenon among children and adolescents. The result that girls, older pupils and children, and adolescents with lower family wealth report feeling lonelier is consistent with findings from other countries and provides starting points for planning prevention measures. Further research is needed in Germany on possible health-related correlates of loneliness.

Loneliness and Well-Being in Children and Adolescents during the COVID-19 Pandemic: A Systematic Review

Concerns have been raised about the loneliness and well-being of children and adolescents during the COVID-19 pandemic. The extent to which the ongoing pandemic has impacted loneliness and the association between loneliness and well-being is unclear. Therefore, a systematic review of empirical studies on the COVID-19 pandemic was conducted to examine the (1) prevalence of loneliness in children and adolescents, (2) associations between loneliness and indicators of well-being, and (3) moderators of these associations. Five databases (MEDLINE, Embase, PsycInfo, Web of Science, ERIC) were searched from 1 January 2020 to 28 June 2022 and 41 studies met our inclusion criteria (cross-sectional: n = 30; longitudinal: n = 11; registered on PROSPERO: CRD42022337252). Cross-sectional prevalence rates of pandemic loneliness varied, with some finding that over half of children and adolescents experienced at least moderate levels of loneliness. Longitudinal results reflected significant mean increases in loneliness compared to pre-pandemic levels. Cross-sectional results indicated that higher levels of loneliness were significantly associated with poorer well-being, including higher depression symptoms, anxiety symptoms, gaming addiction, and sleep problems. Longitudinal associations between loneliness and well-being were more complex than cross-sectional associations, varying by assessment timing and factors in the statistical analyses. There was limited diversity in study designs and samples, preventing a thorough examination of moderating characteristics. Findings highlight a broader challenge with child and adolescent well-being that predates the pandemic and the need for future research to examine underrepresented populations across multiple timepoints.

Loneliness and depressive symptoms among men who have sex with men in China: A cross-sectional study

Background

While psychosocial problems and their related factors in men who have sex with men (MSM) have been well documented in developed countries, there are still not many studies addressing this issue in China and the results are inconsistent. This study aimed to assess the prevalence of loneliness and depressive symptoms among MSM, examine their associated factors, and investigate potential factors moderating the link between depressive symptoms and loneliness.

Methods

A cross-sectional study was conducted in Taizhou of Zhejiang Province in China between April and November 2021. Loneliness was assessed using the 3-item UCLA Loneliness Scale (UCLA-3), and depressive symptoms were measured using the Patient Health Questionaire-9 (PHQ-9). Data from 655 MSM were eligible for analysis. Logistic regression models were used to examine the associations between independent variables and the outcomes of loneliness and depression. The interaction terms were added in the models to assess the moderating effects.

Results

Of the MSM sample, 13.28 and 7.48% perceived loneliness and reported moderate-to-severe depressive symptoms, respectively. We found that participants who experienced loneliness were more likely to have younger age (OR 0.44, 95% CI 0.21, 0.93, 15-32 years as reference group), low social support (OR 3.60, 95% CI 2.14, 6.04), low self-esteem (OR 3.03, 95% CI 1.45, 6.32) and moderate-to-severe depressive symptoms (OR 5.45, 95% CI 2.66, 11.15). The participants with moderate-to-severe depressive symptoms were more likely to have low self-esteem (OR 6.78, 95% CI 3.08, 14.95) and feelings of loneliness (OR 5.51, 95% CI 2.66, 11.40). Stratified analyzes showed that the magnitude of the associations between depressive symptoms and loneliness varied in MSM with different age, marital status, and self-esteem.

Conclusion

Our study suggests that we need to pay attention to feelings of loneliness and depressive symptoms and their closely associated factors such as social support and self-esteem among MSM in China. The MSM who were young, not married, and had low self-esteem were especially vulnerable to the impact of depressive symptoms on loneliness.

Social anxiety and depression symptoms in Chinese left-behind children after the lifting of COVID-19 lockdown: A network analysis

BACKGROUND

Returning to social life after the lifting of COVID-19 lockdown may increase risk of social anxiety, which is highly co-morbid with depression. However, few studies have reported the association between them.

AIMS

To explore the complex relationship between social anxiety and depression symptoms in left-behind children after the lifting of the COVID-19 lockdown.

METHODS

A cross-sectional survey was conducted 6 months after the lockdown removal. A total of 3,107 left-behind children completed the survey with a mean age of 13.33 and a response rate of 87.77%. Depression and social anxiety severity were assessed by the DSM-5 Patient Health Questionnaire for Adolescents and the DSM-5 Social Anxiety Disorder Questionnaire, respectively. The symptom-level association between the two disorders was examined using network analysis.

RESULTS

After the lifting of COVID-19 lockdown, the prevalence of depression and social anxiety in left-behind children was 19.57% and 12.36%, respectively, with a co-morbidity rate of 8.98%. Network analysis showed that "Social tension" and "Social avoidance" had the greatest expected influence; "Humiliation" and "Motor" were bridge symptom nodes in the network. The directed acyclic graph indicated that "Social fright" was at the upstream of all symptoms.

CONCLUSION

Attention should be paid to social anxiety symptoms in left-behind children after the lifting of COVID-19 lockdown. Prevention and intervention measures should be taken promptly to reduce the comorbidity of social anxiety and depression symptoms in the left-behind children after the lifting of lockdown.

The influence of outdoor play spaces in urban parks on children's social anxiety

Urban green spaces are critical to the healthy development of children's social interactions and activities. However, the relationship between urban green spaces for children's activities and the alleviation of children's social anxiety remains unclear. In this study, we aimed to explore the link between spatial characteristics and social anxiety in children. To explore the coupling relationships among green space, play space, and social anxiety, an assessment of children's play spaces and levels of social anxiety was performed using self-reported data, OpenStreetMap captured the characteristic indicators of urban parks, and the ArcGIS and SPSS softwares were used for the mathematical analysis. The results showed that (1) both the NDVI and 10-min accessibility were significantly negatively related to children's social anxiety; (2) the diversity of service facilities, surfacing materials, and the attractiveness and challenge of the environment were negatively related to children's social anxiety; (3) there were significant differences between activity types and social anxiety. These results provide design references and a theoretical basis for improving the benefits of urban green space on children's health and wellbeing.

The effects of the Unified Protocol and Unified Protocol skills on loneliness in the COVID-19 pandemic

BACKGROUND

Loneliness is a significant public health concern with no established first-line intervention although modular, transdiagnostic, cognitive-behavioral interventions, such as the Unified Protocol (UP), are promising candidates. The UP contains skill modules to target anxiety, depression, and related conditions, although it is unclear if the UP can reduce loneliness and if UP skill use contributes to these reductions.

METHODS

Using data from the first-stage randomization of a sequential multiple assignment randomized trial, we tested whether the UP led to reductions in loneliness and whether specific dimensions of UP skill use predicted session-to-session changes in loneliness. Participants (N = 70; M_age  = 33.74, 67% female, 74% white) completed six sessions of core UP modules, reporting how frequently they felt lonely and used UP skills before each session. Using hierarchical linear modeling, we examined the trajectory of change in loneliness and disaggregated between- from within-person variability to test session-to-session effects of skill use.

RESULTS

Loneliness significantly decreased during treatment with the UP. Using more UP skills than one's personal average, but not frequency of skill use, predicted session-to-session decreases in loneliness.

CONCLUSIONS

Therapists may be encouraged to guide patients toward using a large quantity of different skills to specifically address loneliness.

Parental Psychological Control and Children's Prosocial Behavior: The Mediating Role of Social Anxiety and the Moderating Role of Socioeconomic Status

Complementing internalizing and externalizing developmental outcomes of parental psychological control, in this study, we shift the focus to children's prosocial behaviors. Drawing on self-determination theory and problem-behavior theory, this study addresses the relationship between parental psychological control, social anxiety, socioeconomic status (SES), and children's prosocial behavior. The parental psychological control scale, social anxiety scale for children, and prosocial behavior were applied in the study. Participants were 1202 elementary school-age children in China. The present study showed that parental psychological control was negatively associated with prosocial behavior and social anxiety played a partial mediating role between parental psychological control and prosocial behavior. Meanwhile, SES moderated the relationship between parental psychological control and prosocial behavior. The effect of parental psychological control on prosocial behavior was more significant among students with low levels of SES than the higher ones. The findings showed that parenting plays an essential role in the development of children's prosociality.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4–20.7) in HP students and 24.4% (95% CI = 22.3–26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3–29.5) and 36.9% (95% CI = 32.9–40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.

Examining Whether Social Anxiety Influences Satisfaction in Romantic Relationships

Research investigating social anxiety and the impacts on romantic relationships remains scarce. An online questionnaire examining romantic relationship status, social anxiety and depression symptomology, relationship satisfaction, and several relationship processes was completed by 444 adults. Individuals with higher social anxiety were less likely to be in romantic relationships. For the 188 adults in our sample in current relationships, relationship satisfaction was not influenced by social anxiety when controlling for depression. Although it was proposed that self-disclosure, social support, trust, and conflict initiation might influence romantic relationship satisfaction, none of these mechanisms interacted with social anxiety to explain additional variance in relationship satisfaction. These findings indicate that depression symptomology may be a treatment target for socially anxious individuals wishing to improve romantic relationship satisfaction.

Trajectories of Loneliness and Psychosocial Functioning

The present study examined the relationship between developmental patterns of loneliness and psychosocial functioning among adolescents (9-21 years; N = 110, 52% male). Four-wave longitudinal data were obtained from the Nijmegen Longitudinal Study (NLS) on Infant and Child Development. Loneliness was measured at 9, 13, 16, and 21 years of age and anxiety, depression and self-esteem at 9 and 21 years of age. Using k-means cluster analysis, three trajectories of loneliness were identified as "stable low" (56% of the subjects), "high decreasing" (22% of the subjects), and "low increasing" (22% of the subjects). Importantly, trajectories of loneliness across adolescence significantly predicted psychosocial functioning in young adulthood. Both the "high-decreasing" and "low-increasing" loneliness clusters were associated with higher risk of depression and lower self-esteem compared to the "stable low" loneliness cluster. The "low-increasing" loneliness cluster was associated with higher risk of anxiety compared to the "stable low" loneliness cluster. These results indicate that loneliness in adolescence is a vulnerability that manifests itself in higher levels of anxiety and depression and lower self-esteem in young adulthood.

A Longitudinal Study on Generalized Anxiety Among University Students During the First Wave of the COVID-19 Pandemic in Switzerland

OBJECTIVE

The COVID-19 pandemic and government measures implemented to counter the spread of the infection may be a major stressor affecting the psychological health of university students. This study aimed to explore how anxiety symptoms changed during the pandemic.

METHODS

676 students (76% females) at Zurich University of Applied Sciences participated in the first (T0) and second (T1) survey waves. Anxiety symptoms were assessed using the Generalized Anxiety Disorder-Scale-7 (GAD-7). Risk and protective factors (e.g., COVID-19-related variables) were examined.

RESULTS

GAD-7 scores decreased significantly from T0 to T1 (mean change: -0.446, SE = 0.132, 95% CI: -0.706, -0.186, t = -3.371, df = 659, p = 0.001). Participants with moderate-to-severe anxiety score were 20.2 and 15.6% at T0 and T1, respectively. The following positively predicted anxiety: older age, female gender, non-Swiss nationality, loneliness, participants' concern about their own health, and interaction between time and participants' concern about their own health. Resilience and social support negatively predicted anxiety.

CONCLUSIONS

Our findings provide information for public health measures and psychological interventions supporting the mental health of university students during the COVID-19 emergency.

Spotting Loneliness at School: Associations between Self-Reports and Teacher and Peer Nominations

In two independent studies, we aimed to examine the extent to which teacher and peer nominations of loneliness are associated with children’s and adolescents’ self-reported loneliness, respectively. Additionally, we examined whether loneliness nominations from teachers and peers were informative above and beyond peer status and social behaviors associated with loneliness. In Study 1 (N = 1594, M_age = 9.43 years), teacher nominations of loneliness showed a small to moderate correlation with children’s self-reported loneliness as assessed using the Loneliness and Social Dissatisfaction Questionnaire (LSDQ). The results of a hierarchical regression analysis showed that teacher nominations of loneliness predicted children’s self-reported loneliness above and beyond teacher nominations of peer status and social behaviors. In Study 2 (N = 350, M_age = 13.81 years), peer nominations of loneliness showed a small to moderate correlation with adolescents’ self-reported loneliness as assessed using the peer-related loneliness subscale of the Loneliness and Aloneness Scale for Children and Adolescents (LACA). The results of a hierarchical regression analysis showed that peer nominations of loneliness predicted adolescents’ self-reported loneliness above and beyond peer nominations of peer status and social behaviors. We conclude that loneliness nominations are valuable, but caution is needed when they are used exclusively to identify lonely children and adolescents.