The relationships between social support and loneliness: A meta-analysis and review

Impact of Loneliness and Social Support on Acute Health Service Use and Symptom Exacerbation Among Adults with Asthma and COPD

Loneliness and low social support are associated with negative health outcomes among adults with asthma or COPD. Although social support is correlated with loneliness, low social support is neither necessary nor sufficient for the experience of loneliness. This study compares the relative association of loneliness and social support on symptom exacerbation (i.e., acute deteriorations in respiratory health) and acute health service utilization (i.e., hospitalizations, emergency department visits) among 206 adults with asthma and 308 adults with COPD. Separate logistic regression models were used to simultaneously examine the association of loneliness and social support with each outcome. Among adults with asthma, loneliness was associated with greater odds of hospitalization (AOR = 2.81, 95%CI [1.13, 7.02]), while low social support was not (AOR = 1.44, 95%CI [0.78, 2.65]). However, neither loneliness nor social support were associated with any other acute health service use or symptom exacerbation among adults with asthma. Among adults with COPD, loneliness, and greater social support were associated with increased odds of symptom exacerbation (AOR = 1.67, 95%CI [1.03, 2.69]; AOR = 1.36, 95%CI 1.02, 1.83]) and hospitalization (AOR = 3.46, 95%CI [1.65, 7.24]; AOR = 1.92, 95%CI [1.15, 3.22]), but only social support was significantly associated with ED visits (AOR = 1.72, 95%CI 1.12, 2.66]). These findings support prior research demonstrating that loneliness and social support are related but separate determinants of patients' physical symptoms and service utilization.

The status of readiness for hospital discharge of patients with post-stroke cognitive impairment and its relationship with post-discharge social isolation

BACKGROUND

The current status of readiness for hospital discharge (RHD) in patients with post-stroke cognitive impairment (PSCI) is not clear. This study aimed to investigate the current status of RHD in patients with PSCI, identify potential influencing factors, and explore the relationship between RHD and social isolation after discharge.

METHODS

This was an observational study reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. We selected patients with post-stroke cognitive impairment from the Department of Neurology at a tertiary hospital in Zhejiang Province, China, from August to December 2023. Data were collected via a general information questionnaire, the Montreal Cognitive Assessment, the Readiness for Hospital Discharge Scale, and the Lubben Social Network Scale.

RESULTS

We surveyed a total of 170 patients, and collected complete data from 155 patients. The total Readiness for Hospital Discharge Scale score ranged from 67 to 111 (mean ± SD: 87.46 ± 9.64), with 58 (37.4%) patients identified as underprepared. Multivariate linear regression analysis of the significant variables identified via univariate analysis revealed that annual household income, residence, and Montreal Cognitive Assessment scores significantly affected RHD. Correlation analysis revealed that National Institutes of Health Stroke Scale scores were significantly negatively correlated with Lubben Social Network Scale scores, whereas Montreal Cognitive Assessment scores were positively correlated. There was also a significant positive correlation between RHD and social isolation.

CONCLUSION

Readiness for hospital discharge among patients with post-stroke cognitive impairment is at a medium level. Patients with higher annual household income, urban residence, and lower Montreal Cognitive Assessment scores had greater readiness for discharge. There is a significant correlation between readiness for discharge and social isolation after discharge. Improving patients' readiness for hospital discharge may help reduce social isolation.

Exploring the Role of Workaholism and Social Support in Social Anxiety and Loneliness. Findings and Implications From a Cross-Sectional Study in a Romanian Sample

The aim of the present cross-sectional study was to address a gap in the literature regarding the potential role of workaholism and social support in the development of social anxiety and loneliness. This study involved 338 individuals from Romania, with 53.8% females and 45.9% males, ranging in age from 18 to 45 (M = 24.79, SD = 4.75). Participants completed instruments assessing workaholism, social anxiety, loneliness, social support, and socio-demographic data. Our findings showed that workaholism and social support predicted social anxiety and loneliness. This study may contribute to the existing body of knowledge on key constructs related to workaholism, while highlighting its potential negative impact on mental health. Theoretical and practical implications are discussed, along with recommendations, while acknowledging the limitations of the research design and the inability to infer causal relationships from the data.

Daily patterns of loneliness and binge eating and food addiction using ecological momentary assessment

OBJECTIVE

Binge-spectrum eating disorders (BSEDs) are characterized by recurrent binge-eating episodes and have grown vastly in prevalence. Many individuals with BSEDs also report elevated food addiction (FA), which is described as a strong, irresistible urge to consume highly palatable processed food. Many studies have found individuals with BSEDs and/or FA often use food to soothe negative emotions-including loneliness, yet loneliness as a specific emotion associated with disordered eating is understudied. This study investigated trajectories of loneliness across the day and how loneliness trajectories were associated with daily binge-eating and FA symptoms using ecological momentary assessment (EMA).

METHODS

Adults with BSEDs and/or FA (N = 49; Mage=34.9 ± 12.1; 77.1% cisgender female) completed an 11-day EMA protocol, which assessed loneliness, binge eating, and FA. Multilevel latent growth mixture models were used to empirically derive daily loneliness trajectories and evaluate associations with binge eating and FA.

RESULTS

Six daily trajectories of loneliness were found, which differed in intercept and slope of loneliness across the day. Compared to "stable low loneliness" days, "elevated early loneliness, decreasing then increasing" and "elevated early loneliness, decreasing" days showed higher daily FA symptoms. There were no significant differences between trajectories on daily binge-eating symptoms.

CONCLUSIONS

The results support daily loneliness, particularly days with elevated early loneliness, as a salient factor associated with elevated daily FA symptoms. Thus, interventions targeting morning loneliness should be considered for FA intervention. There were several study limitations, such as inability to make causal conclusions, moderate between-subjects sample size, and lack of clinical interview assessment.

The Influence of Loneliness, Social Support and Income on Mental Well-Being

Mental well-being is a multifaceted concept that reflects emotional stability, psychological resilience and social connectedness. This study examines how demographic factors, perceived loneliness, and social support influence mental well-being in Spain. Participants were surveyed online and provided personal information along with responses to the University of California, Los Angeles (UCLA) Loneliness Scale, the Medical Outcomes Study Social Support Survey (MOS-SSS), and the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS). Our findings support previous research on mental well-being in Spain and again show significant associations between income, loneliness, social support and overall mental health. In particular, perceived loneliness was found to be a strong predictor of mental well-being. Furthermore, income and social support were found to partially mediate the relationship between loneliness and mental well-being. These findings highlight the critical role of social connections and financial stability in promoting mental health. Overall, this research contributes to the growing understanding of the factors influencing mental well-being and provides valuable insights for improving mental health outcomes.

The relationship between racial discrimination in healthcare, loneliness, and mental health among Black Philadelphia residents

BACKGROUND

Black individuals in the U.S. report experiencing the highest levels of racial discrimination in healthcare. Racial discrimination in healthcare contributes to mental health issues and has been shown to be associated with loneliness. Despite this, there is limited research on the role loneliness plays in the relationship between racial discrimination in healthcare settings and mental health outcomes. This study explored the relationship between racial discrimination in healthcare, loneliness, and mental health outcomes (depression and anxiety) among Black individuals.

METHODS

This study was part of the PhillyCEAL (Community Engagement Alliance) initiative. Between February 2024 and April 2024, 327 Black Philadelphia residents completed online surveys. Multiple linear regression analyses examined the associations between racial discrimination in healthcare, loneliness, depression, and anxiety. Covariates included Hispanic ethnicity, age, insurance, lesbian, gay, bisexual, transgender, queer or questioning, and other sexual and gender diverse (LGBTQ+) status, sex assigned at birth, relationship status, employment, medical conditions, income, and education.

RESULTS

Racial discrimination in healthcare was positively associated with loneliness (b = 0.66, 95% CI: 0.29 to 1.04), depression (b = 0.52, 95% CI: 0.19 to 0.86), and anxiety (b = 0.85, 95% CI: 0.50 to 1.19). When controlling for loneliness, the association between racial discrimination in healthcare and depression became non-significant (b = 0.29, 95% CI: -0.03 to 0.61), while the association between racial discrimination in healthcare and anxiety remained significant (b = 0.62, 95% CI: 0.29 to 0.94).

CONCLUSION

Addressing racial discrimination within healthcare settings is crucial for improving mental health outcomes among Black populations. Given the significant role of loneliness in this relationship, interventions aimed at reducing loneliness may help mitigate the adverse mental health effects of racial discrimination in healthcare for Black populations.

Perceived social support and relationship quality predict loneliness in older adults: a social network approach

OBJECTIVES

Loneliness negatively impacts older adults' mental and physical health. Though loneliness is associated with perceived social support, its relationship to received support is unclear. This might be because received support has been defined sparsely, overlooking types of support and overall relationship quality. The current study addressed this gap.

METHOD

Older adults recruited from the community (N = 142) and the Indiana Alzheimer's Disease Research Center (ADRC) (N = 176) completed an expanded PhenX social network interview to identify social network size, types of received support (emotional, instrumental), and relationship quality (network closeness, contact frequency). They also completed well-validated measures of loneliness and perceived social support. Data were analyzed with hierarchical linear regressions.

RESULTS

In both samples, loneliness was negatively related to perceived social support but was not related to either received support type. Contact frequency predicted loneliness in both samples, but network closeness predicted loneliness in the ADRC sample only. Dementia status did not affect results.

CONCLUSION

Social network size, emotional received support, and instrumental received support were not related to loneliness, but perceived social support and relationship quality were. These findings suggest that loneliness is influenced by perceived social support and some types of received support.

Can social isolation alleviate symptoms of anxiety and depression disorders?

This study examines the complex interplay between social behavior and mental health, focusing on the neurobiological mechanisms underlying human interactions and their alterations associated with anxiety and depression disorders. These conditions are characterized by heightened threat perception, pervasive worry, physiological responses, emotional dysregulation, and maladaptive behaviors. Through narrative review, this study examines both aspects, addressing social isolation as both a risk factor and an avoidance behavior that may provide temporary relief but ultimately perpetuate the clinical condition in the long term. The findings offer valuable insights for clinical practice, emphasizing interventions that enhance cognitive flexibility to foster stable and supportive interpersonal relationships.

Network analysis of loneliness, mental, and physical health in Czech adolescents

BACKGROUND

The increasing urgency to address rising loneliness among adolescents has become a critical issue, underscoring the need for further studies on its association with mental and physical health. The objective was to examine the changes in loneliness and its relation to mental and physical health issues in three adolescent age groups.

METHODS

A total sample of 14,588 Czech pupils (50.7% boys, mean age 13.6 ± 1.7 years) in grades 5, 7 and 9 was used from a representative dataset of the Health Behaviour in School-aged Children (HBSC) study. The network analysis based on undirected graphical models was used as an exploratory technique to assess and test the structure of the data.

RESULTS

The association between loneliness and health decreased with age. There was a significant positive association between loneliness, feeling low, and irritability. No significant direct association between loneliness and physical health complaints was found.

CONCLUSION

Further studies, preferably of longitudinal character, are needed to confirm the changes in associations between loneliness and mental and physical health outcomes.

Migrant-Local Differences in the Relationship Between Oral Health, Social Support, and Loneliness Among Older Adults in Weifang, China: Cross-Sectional Study

Background

Increased aging and accelerated urbanization have led to the migration of older adults within China. Migrant older adults (MOAs) may experience physical and psychological discomfort in influx cities, and they are a vulnerable group that has emerged in the course of fast urbanization. Previous studies have confirmed the association between oral health and loneliness as well as the relationship between social support and loneliness; however, no research has been done to clarify the underlying mechanisms and the migrant-local difference between oral health, social support, and loneliness.

Objective

This study aimed to test the association between oral health, social support, and loneliness among Chinese older adults, as well as the migrant-local difference on the above relationship.

Methods

Multistage cluster random sampling was used to enroll a total of 1205 participants, including 613 MOAs and 592 local older adults (LOAs). Loneliness was assessed by the 6-item short-form UCLA Loneliness Scale; oral health was measured via the Chinese version Geriatric Oral Health Assessment Index (GOHAI); social support was evaluated by the Social Support Rating Scale (SSRS). Descriptive analysis, χ2 tests, and t tests were conducted. Multigroup structural equation modeling (SEM) was employed to clarify the migrant-local difference on the association between oral health, social support, and loneliness among MOAs and LOAs.

Results

The mean score of loneliness was 8.58 (SD 3.032) for MOAs and 8.00 (SD 2.790) for LOAs. Oral health and social support were found to be negatively related to loneliness among MOAs and LOAs; the standardized direct effects for MOAs were -0.168 and -0.444 (P<.001), and they were -0.243 and -0.392 (P<.001) for LOAs, respectively. Oral health generated a direct positive effect on social support, and the direct effect was 0.186 for MOAs (P<.001) and 0.247 for LOAs (P<.001).

Conclusions

Loneliness was fairly low among older adults in Weifang, China, while MOAs showed higher loneliness than LOAs. Oral health had both direct and indirect negative effects on loneliness among MOAs and LOAs, with no significant path differences between MOAs and LOAs. Social support was found to be negatively associated with loneliness for both MOA and LOA, while the association was stronger among MOAs than LOAs. Oral health exerted a significantly positive effect on social support for both MOAs and LOAs, while no significant difference existed between them. Measures should be taken by the government, society, and families to increase social support, improve oral health, and further reduce loneliness among MOAs and LOAs.

The association of pre-COVID-19 social isolation and functional social support with loneliness during COVID-19: a longitudinal analysis of the Canadian Longitudinal Study on Aging

OBJECTIVES

We evaluated the association between two measures of social connection prior to COVID-19-social isolation and functional social support-and loneliness during the pandemic.

METHOD

The study was a retrospective longitudinal analysis of 20,129 middle-aged and older adults enrolled in the Canadian Longitudinal Study on Aging (CLSA). We drew upon two waves of CLSA data spanning three years and the supplemental COVID-19 Questionnaire Study of eight months to conduct our analysis.

RESULTS

Social isolation prior to COVID-19 was associated with loneliness during COVID-19 only among persons who were lonely before the pandemic (adjusted odds ratio [aOR]: 1.17; 95% confidence interval [CI]: 1.02, 1.35). Higher functional social support prior to COVID-19 was inversely associated with loneliness during the pandemic, when adjusting for pre-COVID-19 loneliness (aOR: 0.37; 95%CI: 0.34, 0.41) and when assessing incident loneliness during the pandemic (adjusted relative risk: 0.59; 95% CI: 0.55, 0.63).

CONCLUSION

Policies are needed to identify people who are both socially isolated and lonely, and provide them with functional social support, to prevent worsening loneliness during public health crises.

Social Support for Grief, Attachment, and Mental Health Among Bereaved Spouses During COVID-19 Pandemic

This study explored the associations of grief support between social support for grief and pandemic grief symptoms, attachment, and mental health through accounting for sociodemographic factors among bereaved spouses widowed as a result of the COVID-19 pandemic. From September 10 to November 23, 2020, a cross-sectional mobile online survey was conducted, involving 92 participants with a mean age of 44.21 years. The sample was predominantly Islamic (91%) and female (88.8%), with an average marriage duration of 18.73 years. Participants completed assessments, including the Grief Support Assessment Scale, Brief Symptom Rating Scale-5, Pandemic Grief Scale, Revised Adult Attachment Scale, and Couple Interaction Scale for Marital Support. Results showed that the extent to which grief support was received (β = -0.36, p = 0.03) and that bereaved spouses were satisfied with (β = -0.29, p = 0.03) grief support were negatively correlated with pandemic grief. Age, education, and attachment directly influenced mental health. A k-means cluster analysis identified a younger cluster (Mage = 34.76 ± 4.63) experiencing greater mental health difficulties (14.84 ± 3.9), pandemic grief (7.23 ± 3.06), and attachment needs (51.80 ± 8.06). The findings highlight that the grief support needed was higher than the support received and the satisfaction with that support during the COVID-19 pandemic. Additionally, participants were dissatisfied with the higher demand for resources from governmental and nongovernmental organizations. The study emphasizes the importance of accessible, high-quality grief support services that are culturally and religiously sensitive, especially in diverse contexts like Indonesia.

The mediating effect of social support between self-perceptions of aging and fear of dementia in community-dwelling older adults

OBJECTIVES

This study aimed to examine the mediating effect of social support between self-perceptions of aging and fear of dementia among community-dwelling older adults.

METHODS

A total of 656 older adults were recruited in this cross-sectional study. The Brief Aging Perceptions Questionnaire, Social Support Rating Scale, and Fear of Dementia Scale were used to collect data. Data were analyzed using SPSS 27.0 and PROCESS macro.

RESULTS

Fear of dementia was positively correlated with self-perceptions of aging (β=0.266) and negatively correlated with social support (β=-0.326), and self-perceptions of aging were negatively correlated with social support (β=-0.105). Mediation analysis showed that social support had a partial mediating effect between self-perceptions of aging and fear of dementia, and the mediating effect accounted for 11.33 % of the total effect.

CONCLUSIONS

These findings highlighted the significant role of improving social support in developing interventions to reduce older adults' fear of dementia.

Changes in psychological well-being among older adults: a latent transition analysis from China

BACKGROUND

Psychological well-being is becoming an increasingly important part of the public health mission, and is multifaceted and has various interrelated dimensions. A thorough understanding of its presentation patterns (i.e., subtypes) and change process is essential for effective interventions. However, longitudinal research examining the subtypes of psychological well-being among Chinese older adults remains scarce, and little is known about the factors influencing the belonging and transition of these subtypes.

METHODS

We used two waves of national longitudinal data (2011 and 2014) from the Chinese Longitudinal Healthy Longevity Survey, with 5778 respondents aged 65 and above. Psychological well-being was assessed by eight indicators from three dimensions: quality of life, positive feelings, and negative feelings. Latent profile transition analysis was used to identify subtypes of psychological well-being and explore the transition of older adults among different subtypes over time.

RESULTS

Four distinct subtypes of psychological well-being were identified, with the Mainly Unhappy Subtype being prevalent among Chinese older adults. Unhappiness and uselessness were indicative; eliminating unhappiness was vital to complete psychological recovery; feeling of uselessness was found as a crossroads in the process of psychological health. The psychological well-being of older adults was unstable; emotion blunting was found in the transition from the Mainly Unhappy Subtype to the Satisfied and Positive Subtype, and emotion augmentation was found in the transition from the Resilient yet Useless Subtype to the Discontented and Negative Subtype. A paradox in aging was observed in the membership of the Mainly Unhappy Subtype and the Discontented and Negative Subtype. Marital status, residence, education, household income, exercise, and leisure activity were significantly positively related to both initial membership and transition of the psychological well-being subtypes. Smoking status, drinking status, and social support were significantly associated with the transition between subtypes. Physical health was significantly correlated with the initial subtype membership.

CONCLUSIONS

Our findings suggest some indicators and critical steps in improving psychological well-being among older adults. These provide insight for healthcare professionals and policymakers to develop tailored interventions considering subtypes and individual characteristics.

Frailty and Social Isolation in Breast Cancer Patients: The Moderated Mediating Role of Self-Perception of Aging and Menopausal Symptoms

AIMS

To investigate the status of social isolation among middle-aged and elderly breast cancer patients and identify its influencing factors. Additionally, to explore the mediating role of self-perception of aging between frailty and social isolation, as well as the moderating effect of menopausal symptoms.

DESIGN

A cross-sectional study guided by the Strengthening the Reporting of Observational Studies in Epidemiology.

METHODS

This study was conducted on middle-aged and elderly breast cancer patients from September 2022 to February 2023 in Guangzhou, China. Related data were assessed by structural questionnaires. Correlation analysis and regression analysis were performed by SPSS 26.0 while PROCESS macro v4.0 was used to test the moderated mediation model.

RESULTS

Breast cancer patients aged 45-82 years experienced moderate social isolation. It was influenced by educational level, residence, menopause symptoms, self-perception of aging, and frailty. The moderated mediation model involving self-perception of aging and menopausal symptoms for explaining how frailty causes social isolation was supported. The mediating role of self-perception of aging gradually strengthens as menopausal symptoms become severe.

CONCLUSION

Social isolation resulting from frailty in middle-aged and elderly breast cancer patients is mediated by self-perception of aging, with menopausal symptoms amplifying this effect. Interventions focused on improving self-perception of aging and managing menopausal symptoms may help reduce social isolation by mitigating the impact of frailty.

IMPACT

This study highlights the importance of addressing frailty, self-perception of aging, and menopausal symptoms in clinical nursing practice, which may help reduce social isolation among breast cancer patients.

PATIENT OR PUBLIC CONTRIBUTION

Patients contributed by completing the questionnaire, ensuring the accuracy and completeness of the information with assistance from the research team.

Lonely but not alone: Examining correlates of loneliness among Canadian post-secondary students

Objective: Loneliness is increasingly acknowledged as a public health concern due to its association with morbidity and mortality. The prevalence of loneliness is highest in the post-secondary population. Understanding the correlates of loneliness may assist in developing policy and program interventions. Participants and Methods: Post-secondary students (n = 28,975) from the Winter 2022 Canadian Campus Wellbeing Survey (CCWS) cycle. A multi-level logistic regression controlling for the institution was built to determine how demographic, health behaviors, mental health and institutional level factors are associated with loneliness. Results: The prevalence of loneliness was 31% in our sample. Demographic (e.g., gender, sexual orientation, social economic status), health behaviors (e.g., physical activity and substance use), mental health (e.g., mental distress and social support) and institutional factors (e.g., college or university institution) impacted the odds of reporting loneliness (p < 0.05). Conclusion: Our findings suggest loneliness might require greater attention by institutional staff and administrators.

Latent profile analysis of fatalism and its influencing factors among community-dwelling disabled elderly individuals

Objective

This study aims to explore the latent profiles of fatalism among community-dwelling disabled elderly individuals and identify the key factors influencing these profiles. The findings will provide valuable insights for formulating tailored care management strategies for this population.

Design

A cross-sectional survey study.

Methods

A random sampling approach was used to survey disabled elderly individuals residing in 109 communities across eight urban districts in Sichuan Province. Data were collected through a general information questionnaire and a Fatalism Scale. Latent profile analysis was performed to identify distinct fatalism profiles, and multivariate unordered regression analysis was conducted to assess their influencing factors.

Results

Three distinct latent profiles of fatalism were identified: high fatalism and pessimism tendency (35.6%), moderate fatalism and low optimism tendency (9.6%), and low fatalism with relative optimism tendency (54.8%). Multivariate analysis revealed that living arrangements, number of children, educational level, duration of disability, and self-reported economic stress were significant factors influencing these fatalism profiles.

Conclusion

There is significant heterogeneity in fatalism among community-dwelling disabled elderly individuals. Caregivers and healthcare managers can develop more precise and personalized management strategies by considering the different latent profiles and their associated influencing factors.

Psychological Compensation or Drinking Poison to Quench Thirst: The Dual Effects of Smartphone Use Habits on Depression in Chinese Left-Behind Adolescents

With the popularity of smartphones, their impact on the physical and mental health of left-behind adolescents has become the focus of social attention. Some believe that smartphone use will provide emotional compensation for left-behind adolescents, while others believe that the lack of supervision of smartphone use among left-behind adolescents will exacerbate their psychological problems. To explore the mechanisms of the dual effects, we conducted a field survey of 848 left-behind adolescents (male = 446, age between 12 and 19) in Shicheng County in Gannan Region of China. It was found that social smartphone use, recreational smartphone use, frequency, and duration of smartphone use, mediated by smartphone dependence, were positively associated with social anxiety, stress perception, and sleep disorder, and further with depression of left-behind adolescents. Although social uses of smartphones were positively associated with online social support, they were not related to loneliness and depression. Based on our results, left-behind adolescents' smartphone use habits have shown more harmful than good effects on their psychological well-being.

Loneliness-associated factors among older adults: Focus on friendship type and number of friends

AIM

Loneliness among older people is prevalent. Few studies have examined the association of loneliness with the type of friendship and number of friends. This study aimed to clarify the loneliness-related factors among older adults by gender focusing on the type of friendship and number of friends.

METHODS

An anonymous, self-administered questionnaire survey was conducted on 1610 older adults in Japan. The questionnaire included basic characteristics, health status used by the self-administered dementia checklist, type of friendship and number of friends evaluated by the Lubben Social Network Scale, and loneliness evaluated using the University of California, Los Angeles Loneliness Scale. Univariate analysis was performed with loneliness as the dependent variable, and multiple logistic regression analysis was also performed.

RESULTS

A total of 1082 older adults were included for analysis. The loneliness rate was 16.8%. Regarding the type of friendship and number of friends, having <3 close friends to call on for help (tangible aid) was most associated with loneliness (men odds ratio [OR]: 2.88, women OR: 3.10). Higher awareness of the participants of subjective symptoms of dementia was proportionally related to loneliness (men, OR: 3.06; women, OR: 2.40). Among women, economic insecurity (OR: 1.68), subjective health (OR: 2.12), having <3 friends with whom they feel easy to talk about private matters (emotional support) were related to loneliness (OR: 2.38).

CONCLUSION

The results suggested that the type of friendship and number of friends, economic insecurity, and health status might be associated with loneliness among older adults. Several factors related to loneliness might differ by gender.

Social support and depressive symptoms among migrant elderly following children: the chain mediating role of resilience and loneliness

BACKGROUND

Migrant elderly following children (MEFC) is an emerging special elderly mobile migrant population in China. MEFC face multiple dilemmas of distress, which makes their depressive symptoms more prominent. To explore ways to alleviate depressive symptoms, this study aimed to investigate the chain mediating effects of resilience and loneliness on the relationship between social support and depressive symptoms among MEFC.

METHODS

A cross-sectional study was conducted using purposive sampling from Changsha, Hunan Province, China, and 298 MEFC were included. The 15-item Geriatric Depression Scale, Social Support Rating Scale, University of California Los Angeles Loneliness Scale, and Connor-Davidson Resilience Scale were used to measure depressive symptoms, social support, loneliness, and resilience, respectively. Pearson's correlation analysis was conducted to clarify the association between the variables. The PROCESS macro model 6 was applied to analyze the multiple mediating effects.

RESULTS

The prevalence of depressive symptoms among MEFC was 29.86%. Social support (r = -0.354, P < 0.001), resilience (r = -0.373, P < 0.001), and loneliness (r = 0.483, P < 0.001) were significantly associated with depressive symptoms. Social support not only had a direct negative effect (Effect= -0.086, 95% CI: -0.149 to -0.023) on depressive symptoms, but also had an indirect effect on depressive symptoms through resilience (Effect= -0.045, 95% CI: -0.076 to -0.015), loneliness (Effect= -0.053, 95% CI: -0.091 to -0.020), and the chain mediating effects of resilience and loneliness (Effect= -0.019, 95% CI: -0.037 to -0.007), respectively.

CONCLUSIONS

The prevalence of depressive symptoms was relatively high. Resilience and loneliness partially mediated the association between social support and depressive symptoms. In the future, interventions could focus on increasing social support to enhance resilience and reduce loneliness, thereby reducing depressive symptoms in MEFC.

Virtual friendly visitor program: combatting loneliness in community dwelling older adults

Introduction

Loneliness is a critical public health issue affecting older adults, with significant impacts on their mental and physical health, including increased risks of depression, cognitive decline, and higher mortality rates, necessitating distinct approaches for each condition given their unique implications and the exacerbation of these issues during the COVID-19 pandemic. We examine the implementation and outcomes of a Friendly Visitor Program (FVP) designed to mitigate loneliness among older adults. The program involved social work student interns providing virtual visits to older adults using computers and tablets, with the goal of enhancing social interaction and support.

Methods

The study utilized a qualitative narrative design for process evaluation and a longitudinal non-experimental, prospective research design for outcome evaluation, employing a three-level cross-classified longitudinal growth model to assess changes in loneliness among VFVP participants while also testing potential predictors of these changes.

Results

Findings indicated that the program was associated with reduced loneliness over time. Younger and White participants performed better in the program than older participants from other races and ethnicity. Satisfaction with visits and willingness to recommend the program were significant predictors of reduced loneliness. Unexpectedly, greater comfort with technology correlated with increased loneliness, suggesting overreliance on digital interactions may not substitute for in-person contact. Furthermore, improved social networks was associated with reduced loneliness, highlighting the importance of strong social networks.

Discussion

The study underscores the potential of friendly visitor interventions in addressing the challenges of lonely older adults and provides insights for optimizing such programs in the future.

Family resilience and social support as mediators of caregiver burden and capacity in stroke caregivers: a cross-sectional study

Introduction

Caring for stroke survivors poses significant challenges to survivors and caregivers; understanding these relationships can inform targeted interventions and support systems.

Aim

This study investigates the influencing factors of caregiver burden and the potential mediating roles of family resilience and perceived social support between caregiver burden and caregiver capacity.

Design

This is a cross-sectional study.

Methods

The participants in this study included 462 stroke survivors and their primary caregivers from Ningbo Lihuili Hospital in Zhejiang Province, China. Primary caregivers completed several assessments, including the Shortened Chinese Version of the Family Resilience Assessment Scale (FRAS), the Perceived Social Support Scale (PSSS), the Zarit Caregiver Burden Interview (ZCBI), and the Family Caregiver Task Inventory (FCTI). The ZCBI was used to evaluate caregiver burden, while the activities of daily living (ADL) were assessed for stroke survivors to measure their actual level of dependence. The mediating effect of family resilience was estimated using the bootstrap method through Jamovi version 2.3.0 with the mediation plug-in, while controlling for sociodemographic variables.

Results

The results showed that caregiver burden was influenced by stroke survivors' level of dependence on activities of daily living (ADL), caregiver education level, caregiver health status, and average daily care time. The family resilience mediated the relationship between caregiver burden and caregiver capacity (b = 0.141; 95% confidence interval: 0.091 to 0.176). Additionally, perceived social support mediated the relationship between caregiver burden and caregiver capacity (b = 0.080; 95% confidence interval: 0.041 to 0.110).

Conclusion

These findings indicate that enhancing family resilience and perceived social support can be strategies for alleviating caregiver burden. Clinical practitioners should actively assess the family resilience and social support of stroke survivors, and implement interventions that promote resilience and strengthen social support, thereby reducing caregiver burden and improving the health outcomes of stroke survivors.

Social isolation, perceived social support, and type D personality among gastrointestinal cancer survivors in China: A mediating model analysis

Objective

To explore the mediating effect of social isolation between perceived social support and type D personality in gastrointestinal cancer survivors based on the WHITE heuristic cognitive-behavioral model of emotion cognition theory.

Methods

The study utilized a convenience sampling method to recruit 183 survivors of gastrointestinal cancer who were undergoing chemoradiotherapy. SPSS 26.0 was used to analyze the correlation among social isolation, perceived social support, and type D personality. Additionally, SmartPLS 3.0 was utilized to analyze the mediating role of social isolation in the relationships between perceived social support and type D personality.

Results

The study found that gastrointestinal cancer survivors scored 60.58 ​± ​10.94 for perceived social support, 36.25 ​± ​4.71 for social isolation, and 26.26 ​± ​5.84 for type D personality. We discovered that perceived social support has a negative correlation with social isolation and type D personality (r ​= ​-0.593, -0.396, both P ​< ​0.001), while social isolation was positively correlated with type D personality (r ​= ​0.564, P ​< ​0.001). The association between type D personality and perceived social support was partially mediated by social isolation (VAF ​= ​59.67%).

Conclusions

The association between type D personality and perceived social support is mediated by social isolation in gastrointestinal cancer survivors undergoing chemoradiotherapy. Clinical staff should prioritize evaluating social isolation among these survivors to enhance social support and potentially reduce the prevalence of type D personality traits.

On a healing journey together and apart: A Swedish critical incident technique study on family involvement from a patient perspective in relation to elective open-heart surgery

BACKGROUND

As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement.

AIM

The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden.

METHODOLOGICAL DESIGN AND JUSTIFICATION

The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not.

ETHICAL ISSUES AND APPROVAL

Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps.

RESEARCH METHODS

Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method.

RESULTS

Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support.

CONCLUSIONS

As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.

Social and Mental Health Factors Involved in the Severity of Loneliness in Older Individuals in a Spanish Rural Area

Background: Loneliness in older people, especially those living in rural areas, is a phenomenon that has received little attention in research and can have detrimental effects on quality of life. The aim of this study was to evaluate loneliness and the psychosocial factors associated with loneliness in rural Spain, which have been minimally studied. Methods: A cross-sectional study was carried out in a sample of permanently resident older people in the Rincón de Ademuz region (Valencia, Spain), a geographic area with very low population density. Emotional and social loneliness were assessed using the de Jong Gierveld Loneliness Scale. We also assessed whether loneliness is associated with sleep quality, depressive symptoms, and autonomy in basic and instrumental activities of daily living. Results: A total of 108 community-dwelling individuals aged 65 years and older participated in the study out of a total sample of 181. Of them, 30.6% experienced feelings of moderate loneliness, while 2.8% presented severe loneliness. A significant correlation was found between loneliness and age (Rho = 0.28, p = 0.003). Significant differences were also observed between emotional loneliness and gender (p = 0.03) but not between social loneliness and the total score on the de Jong Gierveld Scale. Men experienced more emotional loneliness than women. In the multivariate analyses, significant associations were found between the degree of loneliness and having sons/daughters (p = 0.03; odds ratio [OR] = 0.24; 95% CI 0.06-0.89) and the role of caring for a dependent person (p = 0.002; odds ratio [OR] = 0.05; 95% CI 0.009-0.36) but not living with sons/daughters or the presence of grandchildren. Conclusions: There is a high prevalence of loneliness among older people living in rural areas, which is associated with some social factors. Therefore, nursing care plans should include assessments and interventions to prevent or detect and address loneliness in older people. This study was retrospectively registered in ClinicalTrials on 24 April 2024 with registration number NCT06382181.

Association between interpersonal sensitivity and loneliness in college nursing students based on a network approach

BACKGROUND

The symptoms of interpersonal sensitivity and loneliness are prevalent among college nursing students. This study aims to investigate the interactions at the symptom level and elucidate the characteristics of the interpersonal sensitivity and loneliness symptoms network among Chinese college nursing students.

METHOD

A cohort of 864 college nursing students participated in the study. Interpersonal sensitivity was assessed using the Chinese Version of the Short Form of the Interpersonal Sensitivity Measure (IPSM-CS), while loneliness symptoms were evaluated using the three-item Loneliness Scale (T-ILS). Central symptoms and bridge symptoms were determined using centrality and bridge centrality indices, respectively. The stability of the network was evaluated through the case-dropping procedure.

RESULTS

The most robust direct relationship was observed between the interpersonal sensitivity symptoms 'Feel happy when someone compliments' (IPSM-CS9) and 'Make others happy' (IPSM-CS10). 'Feel happy when someone compliments' (IPSM-CS9) exhibited the highest node strength in the interpersonal sensitivity and loneliness network, with 'They would not like me' (IPSM-CS2) following closely behind. Among the loneliness symptoms, 'Relational loneliness' (T-ILS1) demonstrated the highest bridge strength, followed by 'Intimate loneliness' (T-ILS3) and 'Social loneliness' (T-ILS2). The entire network displayed robustness in both stability and accuracy assessments.

CONCLUSION

This study emphasized the importance of central symptoms (e.g., 'Feel happy when someone compliments' and 'They would not like me') and bridge symptoms (e.g., 'Relational loneliness', 'Intimate loneliness', and 'Social loneliness'). Intervening in the central symptoms may effectively enhance the self-confidence of nursing students and foster harmonious relationships with others, thereby facilitating better adaptation to interpersonal relationships. Furthermore, by addressing bridge symptoms (e.g., meeting the need for approval and providing social support), nursing students can better adjust to their studies and practice with a more positive attitude during their college years.

A Longitudinal Study of Loneliness Before the End of the COVID-19 Pandemic: Trajectories, Predictors, and Impact on Chinese Adolescent Mental Health

Background

COVID-19 threatened global health, however little is known about the long-term courses of loneliness and their effect on mental health in adolescents. This study aimed to explore the trajectories of loneliness among adolescents in Taizhou, Zhejiang Province, China, during the last phase of the pandemic. We also aimed to identify risk factors in each loneliness course and the impact of loneliness on emotional problems, peer problems, hyperactivity and conduct problems.

Methods

The study employed multistage cluster sampling to collect four waves of data from 2347 Chinese adolescents (average baseline age of 14.7 years) covering a period of 20 months (October 2021 - May 2023). The UCLA 3-Item Loneliness Scale and the Strengths and Difficulties Questionnaire were utilized to assess loneliness and mental health problems, respectively. Growth mixture modelling was employed to identify latent classes of loneliness trajectories. Associated risk factors were investigated using multinomial logistic regression model. Mixed-effects logistic regression models were constructed to examine the long-term impact of loneliness classes on mental health outcomes.

Results

The overall percentage of loneliness increased from 22.9% at baseline to 32.2% at the fourth wave in our sample. Three classes of loneliness were identified: Decreasing Low Loneliness (58.71%), Increasing Medium Loneliness (36.52%), and Increasing High Loneliness (4.77%). Risk factors for poorer loneliness trajectories included lack of physical exercise habits, poorer mental health literacy, medium or low perceived social support, having study difficulties, being female, higher grades, and lower economic status. Loneliness classes were associated with the severity and variability of emotional problems, peer problems, hyperactivity and conduct problems (ORs for the highest loneliness class: 10.24, 4.21, 3.87, 2.68, respectively). Individuals in the higher loneliness classes experienced a significant increase in these mental health problems over time (p < 0.05 for interactions between loneliness classes and time).

Conclusion

During the last phase of the pandemic, a large proportion of adolescents in our study endured medium to high levels of loneliness with no signs of improvement. Both unfavorable loneliness trajectories adversely affected internalizing and externalizing problems and displayed an upward trend in these difficulties. Results highlight the importance of tackling loneliness and improving mental health in adolescents.

Cross-country comparison of depressive symptoms and social-emotional aspects in university students from Brazil and Germany during the COVID-19 pandemic: results from two cross-sectional surveys

BACKGROUND

The COVID-19 pandemic negatively affected students' mental health, increasing pre-existing psychosocial vulnerabilities. University students worldwide have presented differences in their mental health status; however, cross-country studies comparing students' mental health during the pandemic are lacking.

AIMS

To investigate potential differences between university students from Brazil and those from Germany with respect to (a) depressive symptoms and alcohol and drug consumption, (b) social and emotional aspects (loneliness, self-efficacy, perceived stress, social support and resilience) and (c) attitudes towards vaccination.

METHOD

Two online cross-sectional studies were conducted with university students during the COVID-19 pandemic in Brazil (November 2021 to March 2022) and in Germany (April to May 2022). Depressive symptoms, alcohol consumption, loneliness, self-efficacy, perceived stress, social support, resilience, sociodemographic information and attitudes towards vaccination were assessed. Data were analysed using univariate and bivariate models.

RESULTS

The total sample comprised N = 7911 university students, with n = 2437 from Brazil and n = 5474 from Germany. Brazilian students presented significantly more depressive symptoms and suicidal thoughts, higher levels of perceived stress, higher frequency of drug or substance consumption, and lower levels of perceived social support and resilience than German students, whereas German students presented higher levels of loneliness than Brazilian students. A more favourable opinion towards vaccinations in general was found among Brazilian students compared with German students.

CONCLUSIONS

In both countries, low-threshold (online) counselling targeting university students is needed. The differences between the samples could indicate country and/or cultural differences which justify further research in this area.

Social support and health behaviors of older adults during the COVID-19 pandemic in China: a moderated mediation model of loneliness and economic income

BACKGROUND

The literature shows that social support is an important factor influencing health behaviors. This study aimed to explore the relationships and intrinsic pathways of social support, loneliness, economic income, and health behaviors among older adults during the Corona Virus Disease 2019 (COVID-19) pandemic, and to provide a theoretical basis for the implementation of health behaviors interventions for older adults.

METHODS

A cluster-random-sampling survey was adopted within two towns in Dongguan, China. Demographic characteristics, social support, loneliness, economic income and health behaviors were measured. The Social Support Appraisals scale (SS-A), the ULS-8 Loneliness Scale, and the Self-rated abilities for health practice scale (SRAHPS) were used to measure social support, loneliness, and health behaviors in older adults, respectively. A moderated mediation model was built to examine the relationships among social support, loneliness, economic income, and health behaviors using the SPSS PROCESS 4.0 macro. We conducted bootstrapping of regression estimates with 5000 samples and a 95% confidence interval.

RESULTS

621 older adults completed the questionnaire. Most of the participants were female, accounting for 75.0%, and the average age was 81.11 years (SD = 8.11). The median (interquartile range) of the participants' average monthly economic income was 800 (500-1000)RMB. The results of the mediation analysis showed that loneliness partly mediated the relationship between social support and health behaviors (B = 0.024, 95%CI: 0.007, 0.042), with the mediating effect accounting for 4.56% of the total effect. The moderation mediation analysis revealed a positive moderating role of economic income in the relationship between social support and loneliness (B = 0.114, 95%CI: 0.054, 0.174). Specifically, the relationship between social support and loneliness was found to be weaker for older adults with a high economic income compared to those with a lower economic income.

CONCLUSION

The provision of enhanced social support and the alleviation of loneliness among older adults during an epidemic can facilitate the development of healthy behaviours, particularly among those who are economically disadvantaged.

Age Modifies the Interactive Effect of Loneliness and Social Support on Financial Exploitation Vulnerability in Older Adults

Social support and loneliness have been identified as important correlates of financial exploitation vulnerability (FEV) in older adults. However, the potential combined effect of these social factors on FEV remains unclear. Moreover, given that social support and loneliness may become more important as age increases, age may have a moderating effect on the loneliness-social support interaction. Participants were 342 community-living Israeli older adults aged 60 or over (M age = 73.37, SD = 7.82, 69.1% female) who responded to questionnaires assessing FEV (Financial Exploitation Vulnerability Scale), perceived social support (The Multidimensional Scale of Perceived Social Support), loneliness (UCLA Three-item Loneliness Scale), and sociodemographic characteristics. Two hierarchical linear regression models covarying for demographic variables examined study hypotheses. In a first model, a significant interaction between social support and loneliness was discovered such that high levels of perceived social support attenuated the positive loneliness-FEV association. In a second model, a significant three-way interaction between social support, loneliness, and age was discovered. Probing the interaction revealed that the attenuating effect of social support on the loneliness-FEV link increased with increasing age. Findings suggest that effects of social factors on FEV may interact with each other and with age to predict FEV, and provide insights into when social support may be most relevant in mitigating FEV.

High frequency heart rate variability is associated with sensitivity to affective touch

C-tactile afferents (CTs) are a class of unmyelinated, mechanosensitive nerve fibre that respond optimally to skin temperature, slow moving touch typical of a caress. They are hypothesised to signal the rewarding value of affiliative tactile interactions. While CT firing frequency is positively correlated with subjective ratings of touch pleasantness, trait differences in sensitivity to the specific hedonic value of CT targeted touch have been reported. Inter-individual differences in vagally mediated, high frequency heart rate variability (HF-HRV) have been linked to variation in visual social cognition. Thus, the aim of the present study was to examine the relationship between resting state HF-HRV and sensitivity to socially relevant CT targeted touch. 58 healthy participants first had a 5-minute electrocardiogram. They then rated the pleasantness of 5 randomly presented velocities of robotically delivered touch. Three velocities fell within (1, 3, 10 cm/s) and two outside (0.3, 30 cm/s) the CT optimal range. Each velocity was delivered twice. On a group level, affective touch ratings were described by a negative quadratic function, with CT optimal velocities rated as more pleasant than slower and faster speeds. Simple regression analysis confirmed participants' HF-HRV was significantly predicted by the quadratic curve fit of their touch ratings, with higher HF-HRV associated with a better quadratic fit. These findings indicate that, in line with previous observations that higher HF-HRV is associated with enhanced sensitivity to visual social cues, trait differences in autonomic control could account for previously reported individual differences in CT sensitivity.

Loneliness Among Black/African American Adults Living with HIV: Sociodemographic and Psychosocial Correlates and Implications for Adherence

Loneliness, an emerging public health problem, is higher among people living with HIV and is associated with negative health outcomes. Black/African Americans have a high burden of HIV, and little is known about the characteristics of loneliness among Black adults living with HIV; therefore, this study sought to understand the sociodemographic and psychosocial correlates of Black adults living with HIV who are lonely and the implications of loneliness for their health outcomes. A sample of 304 Black adults living with HIV (73.8% sexual minority men) in Los Angeles County, CA, USA, completed the survey items assessing sociodemographic and psychosocial characteristics, social determinants of health, health outcomes, and loneliness. Antiretroviral therapy (ART) adherence was assessed electronically with the medication event monitoring system. Bivariate linear regressions analysis showed higher loneliness scores among those with higher levels of internalized HIV stigma, depression, unmet needs, and discrimination related to HIV serostatus, race, and sexual orientation. In addition, participants who were married or living with a partner, had stable housing, and reported receiving more social support had lower levels of loneliness. In multivariable regression models controlling for correlates of loneliness, loneliness was found to be a significant independent predictor of worse general physical health, worse general mental health, and greater depression. Loneliness was marginally associated with lower ART adherence. Findings suggest that Black adults living with HIV, who experience multiple intersectional stigmas, require targeted interventions and resources.

Loneliness as a moderator of the association of affective symptoms and binge eating among college women

Affective symptoms (e.g., depression, anxiety, shame) are a potent risk factor for binge eating. However, less is known on the role of loneliness as a moderator of affective symptoms and binge eating. This objective of the current study was to investigate main effects and interactions of affective symptoms and loneliness in relation to binge eating in college women. A sample of 556 undergraduate women completed self-report questionnaires of affective symptoms, loneliness, and binge eating. Results revealed significant interactions between each affective symptom variable and loneliness in relation to binge eating, such that loneliness strengthened the positive association of affective symptoms and greater binge eating. The findings of this study demonstrate an important role of loneliness to binge eating among college women, especially those with underlying affective vulnerabilities. More theoretical and treatment-oriented work on the role of loneliness in binge eating is needed to understand mechanisms and interventions/preventions.

Mapping the factors behind ongoing war stress in Ukraine-based young civilian adults

While the literature on well-being and stress following natural disasters is well-developed, it is less so when it comes to ongoing war experiences. Between September and October of 2022, 223 Ukraine-based civilian adults (156 women and 67 men) completed a survey measuring symptoms of post-traumatic stress disorder (PTSD), peritraumatic experiences, paranoia, quality of life, death anxiety, anxiety about weapons of mass destruction and depression (i.e. assumed 'war consequence' factors), as well as perceived social support, resilience, loneliness and expected military support from the West (i.e. assumed 'buffer' factors). Our exploratory structural equation model (SEM) suggests that Perceived Social Support predicted fewer PTSD Symptoms and more Peritraumatic Experiences. The regression modelling, however, shows that Perceived Social Support was also positively correlated with Peritraumatic Experiences. Highlighting the need for a civilian war stress buffer disruption theory, we argue that when composed of one's circle of family and friends, social support could likely mean greater exposure to war stressors through the mutual sharing of ongoing war experiences with no end in sight. Such a possible war stress sharing deterioration effect would imply that Perceived Social Support may compound peritraumatic distress if the support in question is offered by those facing the same grim reality.

A brief but comprehensive three-item social connectedness screener for use in social risk assessment tools

BACKGROUND

The 2014 IOM report "Capturing Social and Behavioral Domains and Measures in Electronic Health Records" described three subdomains of social relationships that affect patient health and well-being. However, most social risk screeners currently assess only one subdomain, frequency of social connections. We are proposing a three-item Brief Social Connectedness (SC) screener that additionally assesses risks in social/emotional support and loneliness/social isolation subdomains.

METHODS

For this cross-sectional study, we used data from a 2021 Kaiser Permanente Northern California (KPNC) social risk survey for 2244 members ages 35-85 years. The survey included three validated questions that covered the SC subdomains (frequencies of social contacts with people they care about, feeling lonely/socially isolated, and getting enough social/emotional support). Variables representing moderate/high versus low risk were created for each subdomain. We used weighted data for bivariate analyses and modified log-Poisson regression models that adjusted for age, sex, race, and ethnicity to examine cross-sectional associations among the three subdomain risks, as well as with two structural SC risks, living alone and not being in a committed relationship. We then used modified log-Poisson regression models to study cross-sectional associations of these five SC variables with three single-item self-report measures of emotional health.

RESULTS

In regression models that included all five SC variables, loneliness/social isolation and social/emotional support risks were significantly associated with all three emotional health measures, while frequency of social contacts, living alone, and no committed relationship were not. However, low frequency of social contacts and no committed relationship significantly increased risk of often feeling lonely/socially isolated and lacking in social/emotional support.

CONCLUSIONS

A three-item social connectedness screener that assessed risks of loneliness/social isolation, inadequate social/emotional support, and low frequency of social contacts provided more comprehensive information about emotional health risks than social connection frequency alone.

The association of social isolation and loneliness with sarcopenia among the middle-aged and elderly in China

OBJECTIVES

This study examined the relationship of social isolation and loneliness on sarcopenia among Chinese middle-aged and elderly people.

METHODS

Social isolation, loneliness, and sarcopenia were measured at baseline. Follow-up measures of new-onset sarcopenia were obtained 4 years later. Then used logistic regression to evaluate the association between social isolation, loneliness and sarcopenia.

RESULTS

In cross-sectional analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.88 (95% CI = 1.54-2.28)]. In longitudinal analysis, social isolation and loneliness are significantly associated with sarcopenia [OR = 1.09 (95% CI = 0.71-1.69)]. Social isolation and loneliness have a synergistic effect. Among them, individuals over 60 years old [OR = 2.01 (95% CI = 1.37-2.96)] and those without social support [OR = 2.64 (1.61-4.32), P-for interaction < 0.001] are at higher risk.

CONCLUSION

Social isolation and loneliness were significantly associated with sarcopenia, and there was a synergistic effect between social isolation and loneliness.

Usual source and better quality of primary care are associated with lower loneliness scores: a cross-sectional study

BACKGROUND

Loneliness is a global issue, and primary care physicians play an important role in assessing and intervening with loneliness. This study aimed to examine the association between having a usual source of care (USC) or a good quality of primary care, and loneliness.

METHODS

This cross-sectional study was conducted in Japan in 2022. A total of 6,000 residents were randomly sampled from the general population, aged 20-74 years. The outcome was the total score of the University of California, Los Angeles (UCLA) 3-item loneliness scale. The exposure included USC and the Person-Centered Primary Care Measure (PCPCM), which assesses the quality of primary care. We conducted a linear regression analysis to adjust for age, sex, educational status, annual household income, self-rated health, living status (whether alone or not), and the existence of physical health problems.

RESULTS

Of the 6,000 residents, 1,277 responded to the survey. The median score of the UCLA 3-item loneliness scale was 6.0 and the mean total score of the PCPCM was 2.62. Of the 1,277 individuals, 713 (55.8%) had USC. Having USC was significantly associated with lower scores on the UCLA 3-item loneliness scale; the coefficient was -0.34 (95% confidence interval (CI): -0.57 to -0.12). Also, the total PCPCM score was significantly associated with lower loneliness scores; the coefficient was -0.56 (P < 0.001, 95% CI: -0.78 to -0.35).

CONCLUSIONS

Having USC and a better quality primary care were associated with a lower loneliness score. The quality of primary care could be a factor to mitigate patient loneliness.

Validation of the Chinese version of the Oslo-3 Social Support Scale among nursing students: a study based on Classical Test Theory and Item Response Theory models

BACKGROUND

Nursing students are encountering a range of health issues. Assessing social support is a key component in most questionnaire surveys related to health status, aiming to investigate the relationships and mechanisms between health status and social support to enhance overall health. Therefore, it is essential to seek out appropriate instruments to evaluate social support for nursing students. The Oslo-3 Social Support Scale (OSSS-3) is a reliable and concise instrument for evaluating social support. To date, there have been no studies validating the OSSS-3 based on Item Response Theory (IRT) models. Also, an officially validated Chinese version has not been found. The current research intended to verify the Chinese version of the OSSS-3.

METHODS

The OSSS-3 was translated into Chinese and culturally adapted. Subsequently, the OSSS-3 was validated by employing the Classical Test Theory (CTT) and IRT models.

RESULTS

The split-half reliability was 0.622. The Cronbach's α coefficient was 0.687. The correlations between each item and total scores varied from 0.723 to 0.835. The retest coefficient was 0.907. The content validity index was 0.933. A single common factor was extracted and accounted for 61.559% of the variance. The item loading values on the single factor were between 0.743 and 0.814. The communalities were between 0.552 and 0.663. There was no variance between males and females (P = 0.055). The difference in scores between the top (30%) and bottom (30%) groups attained significance. IRT models results revealed that the discrimination parameters ranged from 1.39 to 2.33 and difficulty parameters increased monotonically.

CONCLUSION

The OSSS-3 demonstrates satisfying psychometric properties and is a proper instrument for measuring social support in Chinese nursing students.

Health equity in urban and rural settings: implementation of the place standard tool in Spain

The physical, social, and economic characteristics of neighborhoods and municipalities determine the health of their residents, shaping their behaviors and choices regarding health and well-being. Addressing local environmental inequalities requires an intersectoral, participatory, and equity-focused approach. Community participation plays a vital role by providing deeper insights into local contexts, integrating community knowledge and values into processes, and promoting healthier, fairer, and more equitable actions. In recent years, various tools have been developed to assess places and transform them into health-promoting settings. One such tool, the Place Standard Tool (PST), facilitates discussions on Social Determinants of Health grouped into 14 themes, serving as a starting point for local health interventions. In this study, that took place between August 2019 and February 2020, we described the resident's perceptions of two municipalities in the Valencian Community, Spain, using the validated Spanish version of the PST. A mixed-method convergent-parallel design was used to gain a holistic insight into residents' experiences concerning their physical, economic, and social environment. A total of 356 individuals from both municipalities participated in the study through discussion groups, structured interviews, and online survey. Descriptive analysis of the individual questionnaire answers was conducted, and differences between municipalities were explored. Qualitative thematic analysis was conducted on structured interviews and discussion groups. Quantitative and qualitative data were integrated to facilitate their comparison and identify areas of convergence or divergence in the findings. Overall, rural areas received more favorable evaluations compared to urban ones. Public Transport as well as Work and Local Economy were consistently rated the lowest across all groups and contexts, while Identity and Belonging received the highest ratings. In the urban area, additional negative ratings were observed for Traffic and Parking, Housing and Community, and Care and Maintenance. Conversely, Identity and Belonging, Natural Spaces, Streets and Spaces, Social Interaction, and Services emerged as the highest-rated themes overall. In the rural context, positive evaluations were given to Walking or Cycling, Traffic and Parking, Housing and Community, and Influence and Sense of Control. Significant differences (p < 0.01) between urban and rural settings were observed in dimensions related to mobility, spaces, housing, social interaction, and identity and belonging. Our study illustrated the capacity of the PST to identifying aspects within local settings that influence health, revealing both positive and challenging factors. Successful implementation requires appropriate territorial delineation, support from local authorities, and effective management of expectations. Furthermore, the tool facilitated community participation in decision-making about local environments, promoting equity by connecting institutional processes with citizen needs.

Factors associated with loneliness in middle-aged and older patients with breast cancer

Objective

Loneliness is associated with adverse mental and physical health conditions and increased mortality. In this study, we identified significant factors associated with loneliness in middle-aged and older patients with breast cancer (BC).

Methods

For this cross-sectional study, we enrolled 200 patients (aged from 20 to 60 years) with BC from two hospitals in Indonesia through convenience sampling. Demographic characteristics, distress symptoms (Symptom Distress Scale), social support (Multidimensional Scale of Perceived Social Support), frailty (Groningen Frailty Indicator), and loneliness (UCLA Loneliness Scale, version 3) were measured. Multivariate logistic regression was performed to identify significant factors associated with loneliness in our cohort.

Results

Loneliness risk was negatively correlated with social support but positively correlated with unemployment and frailty. Thus, the patients received a high level of social support (odds ratio [OR]: 0.96; 95% confidence interval [CI]: 0.92-0.99) and had a low risk of severe loneliness. By contrast, patients who were unemployed (OR: 4.00; 95% CI: 1.65-9.66) and those who had frailty (OR: 5.79; 95% CI: 2.50-13.42) had an elevated risk of severe loneliness.

Conclusions

Unemployment, social support, and frailty may significantly influence the risk of loneliness in patients with BC. Early and regular assessments of loneliness should be integrated in the care of these patients. Suitable strategies aimed at increasing social support and mitigating frailty may benefit middle-aged and older patients with BC, particularly unemployed patients, by reducing their risk of loneliness.

Network analysis of symptoms, physiological, psychological and environmental risk factors based on unpleasant symptom theory in patients with chronic heart failure

BACKGROUND

Somatic symptoms and related factors in patients with chronic heart failure have been extensively researched. However, more insight into the complex interconnections among these constructs is needed, as most studies focus on them independently from each other.

AIMS

The aim of this study is to gain a comprehensive understanding of how somatic symptoms and related factors are interconnected among patients with chronic heart failure.

METHODS

A total of 379 patients were enrolled. Network analysis was used to explore the interconnections among the somatic symptoms and related risk factors.

RESULTS

The four core symptoms of chronic heart failure were daytime dyspnea, dyspnea when lying down, fatigue and difficulty sleeping. Within the network, the edge weights of depression-anxiety, subjective social support-objective social support, and subjective social support-social support availability were more significant than others. Among physiological, psychological and environmental factors, the edge weights of NYHA-dyspnea, depression-difficulty sleeping, and social support availability-dyspnea when lying down were more significant than others. Depression and anxiety had the highest centrality, indicating stronger and closer connections with other nodes.

CONCLUSIONS

Psychological and environmental factors stood out in the network, suggesting the potential value of interventions targeting these factors to improve overall health.

The effect of self-disclosure on loneliness among patients with coronary heart disease: The chain mediating effect of social support and sense of coherence

BACKGROUND

Loneliness is prevalent in patients with coronary heart disease (CHD). It has a serious impact on the physical and mental health and the quality of life of patients with CHD. However, what factors contribute to loneliness and the mechanism of action still need to be explored.

OBJECTIVES

To explore the chain mediating effect among self-disclosure, social support, sense of coherence and loneliness in patients with CHD through a chain mediating model.

METHODS

This cross-sectional study included 248 patients with CHD from three tertiary hospitals in Shiyan, Hubei Province, China. Self-reported scales were used to assess feelings of loneliness, self-disclosure, social support and sense of coherence. The Amos 26.0 software was used to construct the chain mediating effect.

RESULTS

Self-disclosure cannot directly affect patients' loneliness (β = -0.60, P>0.05). Social support and sense of coherence play a significant complete mediating role between self-disclosure and loneliness, with an overall mediating effect value of -0.479.

CONCLUSION

Self-disclosure in CHD patients indirectly affect loneliness through social support and sense of coherence (β = -0.479, P = 0.001). Improving patient self-disclosure and modulation of social support and sense of coherence help reduce in loneliness.

Reducing Loneliness and Improving Social Support among Older Adults through Different Modalities of Personal Voice Assistants

This study examines the potential of AI-powered personal voice assistants (PVAs) in reducing loneliness and increasing social support among older adults. With the aging population rapidly expanding, innovative solutions are essential. Prior research has indicated the effectiveness of various interactive communication technologies (ICTs) in mitigating loneliness, but studies focusing on PVAs, particularly considering their modality (audio vs. video), are limited. This research aims to fill this gap by evaluating how voice assistants, in both audio and video formats, influence perceived loneliness and social support. This study examined the impact of voice assistant technology (VAT) interventions, both audio-based (A-VAT) and video-based (V-VAT), on perceived loneliness and social support among 34 older adults living alone. Over three months, participants engaged with Amazon Alexa™ PVA through daily routines for at least 30 min. Using a hybrid natural language processing framework, interactions were analyzed. The results showed reductions in loneliness (Z = -2.99, p < 0.01; pre-study loneliness mean = 1.85, SD = 0.61; post-study loneliness mean = 1.65, SD = 0.57), increases in social support post intervention (Z = -2.23, p < 0.05; pre-study social support mean = 5.44, SD = 1.05; post-study loneliness mean = 5.65, SD = 1.20), and a correlation between increased social support and loneliness reduction when the two conditions are combined (ρ = -0.39, p < 0.05). In addition, V-VAT was more effective than A-VAT in reducing loneliness (U = 85.50, p < 0.05) and increasing social support (U = 95, p < 0.05). However, no significant correlation between changes in perceived social support and changes in perceived loneliness was observed in either intervention condition (V-VAT condition: ρ = -0.24, p = 0.37; A-VAT condition: ρ = -0.46, p = 0.06). This study's findings could significantly contribute to developing targeted interventions for improving the well-being of aging adults, addressing a critical global issue.

The Impact of Social Media on Users' Self-Efficacy and Loneliness: An Analysis of the Mediating Mechanism of Social Support

Purpose

The integration of social media into all areas of society has become a typical phenomenon of the Internet era. This study's core objective is to dissect the relationship between social media, self-efficacy and loneliness, especially emphasizing the mediating function of social support.

Patients and Methods

The research data is derived from the pooled cross-sectional data combined from the four-period data of the China Family Panel Studies (CFPS). The study employs Ordinary Least Squares (OLS) regression as the basic research method, and utilizes Instrumental Variables (IV) and other methods to conduct robustness checks.

Results

Social media usage frequency (SMUF) enhances self-efficacy and loneliness through social support. Social support promotes self-efficacy and alleviates users' loneliness. In self-efficacy, social support plays a fully mediating role. Moreover, education (human capital) has a significant moderating effect. There are noticeable differences in the response of different characteristics groups to SMUF.

Conclusion

This study reveals how social media impacts self-efficacy and loneliness through social support. Based on the research results, avoiding prolonged usage of social media and improving digital literacy are the crucial means to exert the positive benefits of social media.

Reliability and validity evaluation of the stigma of loneliness scale in Chinese college students

BACKGROUND

The stigma of loneliness exacerbates the negative effect of loneliness, reduces the willingness to seek help, damages interpersonal relationships, and threatens health status. However, there is currently no valid scale for measuring the stigma of loneliness in China. The study aims to translate the Stigma of Loneliness Scale (SLS) and evaluate the reliability and validity of the Chinese version.

METHODS

The investigation was conducted in two phases. In the first phase, the SLS was used to conduct a questionnaire survey on 657 college students aged 17 to 24; in the second phase, the SLS, the UCLA Loneliness Scale (ULS-8), the Distress Disclosure Index (DDI), the Revised Cheek and Buss Shyness Scale (RCBS), the Self-Concealment Scale (SCS), the Social Interaction Anxiety Scale (SIAS), the Social Phobia Scale (SPS), the Kessler Psychological Distress Scale (K10), and the Rosenberg Self-Esteem Scale (RSES) were used to conduct the questionnaire survey on 801 college and graduates students aged 18 to 39.

RESULTS

Two dimensions of Self-stigma of Loneliness and Public Stigma of Loneliness were extracted with a cumulative factor interpretation rate of 74.60% when conducting exploratory factor analysis on the first-stage data. The factor loading of each item ranged from 0.585 to 0.890, and the commonality ranged from 0.609 to 0.735. The confirmatory factor analysis and reliability and validity test were carried out on the data gathered in the second phase, indicating that the two-factor model fits well. In addition, the scores of SLS and all dimensions were significantly positively correlated with the total scores of ULS-8, RCBS, SCS, SIAS, SPS, and K10, and negatively correlated with those of DDI and RSES. The Cronbach's alpha coefficients for SLS and SSL and PSL dimensions were 0.957, 0.941, and 0.955. The cross-group invariance test found that the SLS was equivalent for males and females. Meanwhile, males scored significantly higher than females on both the total scores of SLS score and each dimension.

CONCLUSIONS

The Chinese version of SLS displayed satisfactory psychometric properties and can be a valid tool to assess the stigma of loneliness among Chinese young people.

Do Social Support and Loneliness Influence Emerging Adults' Mental Health during the First Year of the COVID-19 Pandemic?

Youths' mental health is at a crisis level, with mental health problems doubling in the US since the pandemic began. To compound the mental health crisis, there is a global loneliness epidemic, with emerging adults worldwide experiencing some of the highest rates. One study with two phases examined the influence of social support and loneliness on mental health in US emerging adults during the pandemic, including changes in these relationships over one year. Emerging adults (N = 449) completed online questionnaires via Prolific in May 2020 (Phase 1) and again from January to May 2021 (N = 253; Phase 2). More perceived support was related to reduced loneliness, with family support having the most significant influence. Loneliness mediated the link between perceived support and adverse health outcomes. Higher loneliness predicted more perceived stress and sleep difficulties concurrently and over time. There was a bidirectional relationship between loneliness and depression, such that higher levels of either variable at Time 1 predicted increases in the other over time. Results highlight the detrimental impact of loneliness on emerging adults' mental health.

A systematic review of reviews on the psychometric properties of measures of older persons' ability to build and maintain social relationships

BACKGROUND

Within the scope of the World Health Organisation's (WHO) world report on ageing and health and how healthy ageing was conceptualised, the WHO has been working with academia towards producing reviews of the psychometric properties of instruments that measure different domains of functional ability. This study aimed to conduct a review of reviews to examine existing and validated instruments measuring the ability of older persons to build and maintain social relationships and to evaluate the psychometric properties of these instruments.

METHODS

We searched for studies published in the English, Spanish and Portuguese languages. No restrictions were placed on the year of publication. The following databases were searched: PubMed, Embase, Psyinfo and Cumulated Index to Nursing and Allied Health Literature. Titles and abstracts were screened and selected articles were screened and reviewed independently by two reviewers.

RESULTS

A total of 3,879 records were retrieved, of which 39 records were retrieved for full-text analysis. None of the reviews met the inclusion criteria, thus resulting in an empty review.

CONCLUSIONS

Considering the current definition of older persons' functional ability to build and maintain social relationships, this review did not identify instruments that can measure both constructs simultaneously. We suggest the development of an instrument that simultaneously assesses the ability of older persons to build and maintain relationships.

Quarantine experience of healthcare workers in close contact with COVID-19 patients in China: a qualitative study

BACKGROUND

This study investigated the experiences of front-line healthcare workers who had been in close contact with COVID-19 patients and had been quarantined in order to provide guidance on quarantine measures with more humanistic care when dealing with future public health emergencies.

METHODS

We conducted a qualitative study using semistructured, qualitative, in-depth interviews between April and June 2022. The interviews were recorded and transcribed, followed by a thematic analysis. The study followed the Standards for Reporting Qualitative Research.

RESULTS

This study identified the following four themes: (1) personal psychological changes, (2) increased reflection on life and work during quarantine, (3) the important role of others' support and (4) different types of demands during quarantine and isolation. Each theme is supported by several subthemes that further illustrate the participants' experiences.

CONCLUSIONS

Quarantine of close contacts is necessary to prevent outbreaks. Front-line doctors and nurses are at a greater risk of COVID-19 infection than others. The results showed the psychological reactions of ordinary close contacts, and the unique feelings and experiences of doctors and nurses during the epidemic. Therefore, future research should cooperate with multiple departments to assess their needs, provide them with individualised care and love and give them incentives in order to reduce their psychological burden, improve their quality of life and allow them to engage in healthcare with a healthy mind.

Put your phone down! Perceived phubbing, life satisfaction, and psychological distress: the mediating role of loneliness

The recent literature highlights the need to explore phubbing, a worrying growing phenomenon, and the potential associated factors and outcomes. Thus, the present study focused on perceived phubbing and the potential associations with life satisfaction and psychological distress. Additionally, this study examined the mediating role of loneliness. The cross-sectional, web-based study involved 720 Romanian adults aged 18 to 77 (M = 24.12, SD = 8.80, 74% females) who completed self-reported scales measuring perceived phubbing, and life satisfaction. Results suggested positive associations between perceived phubbing, loneliness, and psychological distress. A significant negative association was also found between loneliness and life satisfaction. Further analyses suggested that loneliness partially mediated the link between perceived phubbing and life satisfaction and between perceived phubbing and psychological distress. The study highlights the significant role of perceived phubbing when discussing psychological distress and life satisfaction, underlining the need to address further the (mis)use of digital devices (e.g., smartphones) within interpersonal relationships, as well as the need to understand better the outcomes of such behaviors to shape effective interventions in this regard.

Social Support and Daytime Sleepiness Among Chinese Medical Students: Mediating Roles of Loneliness and Problematic Smartphone Use

Background

Sleep problems have become a serious threat to public health worldwide. Daytime sleepiness is an important indicator of many sleep problems, which have a significant impact on academic performance, physical and mental health, and wellbeing among medical students. We aimed to explore the factors associated with daytime sleepiness among medical students.

Methods

We conducted a cross-sectional survey of 466 medical students recruited via convenience sampling. Self-rated psychometric scales, including the Social Support Rate Scale, the Epworth Sleepiness Scale, the Chinese version of the UCLA loneliness scale, and the Mobile Phone Addiction Index (MPAI), were utilized to evaluate social support, daytime sleepiness, loneliness, and problematic smartphone use. A sequential mediation model was constructed with daytime sleepiness as the dependent variable, social support as the independent variable, and loneliness and problematic smartphone use as mediating variables. Age, gender, and grade were taken as covariates.

Results

Social support among medical students was negatively associated with loneliness, problematic smartphone use, and daytime sleepiness (p < 0.01). A sequential mediation analysis showed that loneliness (the first mediator) and problematic smartphone use (the second mediator) sequentially mediated the path from social support to daytime sleepiness among medical students (β = -0.008; 95% CI = -0.016, -0.002). Moreover, there were also significant mediating roles observed in the relationship between social support and daytime sleepiness via loneliness only (β = -0.037; 95% CI = -0.062, -0.015) and problematic smartphone use only (β = -0.022; 95% CI = -0.041, -0.008).

Conclusion

Social support, loneliness, and problematic smartphone use among medical students influenced their daytime sleepiness. Interventions targeting medical student loneliness and problematic smartphone use behaviors might attenuate the effects from low levels of social support and further improve daytime sleepiness.