Relationship Between Physical Symptoms and Loneliness in Patients with Heart Failure: The Serial Mediating Roles of Activities of Daily Living and Social Isolation

The Chinese version of the stigma of loneliness scale in people with chronic diseases: an assessment of psychometric characteristics

BACKGROUND

Loneliness is prevalent in patients with chronic diseases and can threaten their health status, treatment process and quality of life. The stigma of loneliness stems from a derogatory and stigmatizing label that individuals possess towards loneliness with the possibility of being socially disadvantaged, which exacerbates the negative impact of loneliness on patients with chronic diseases and jeopardizes social support. However, few studies focused on this theme in patients with chronic diseases. This study aimed to assess the psychometric characteristics of the Chinese version of the Stigma of Loneliness Scale (SLS) among patients with chronic diseases, to provide a validated tool for related research.

METHODS

The current study consisted of a two-phase questionnaire survey of 704 patients with chronic diseases. Sample 1 comprised 318 patients (Age:40.87 ± 18.55) with chronic diseases, and the data obtained were used for item analysis and exploratory factor analysis. Sample 2 included 386 patients (Age:40.65 ± 17.08) with chronic diseases, and the resulting data were of use for confirmatory factor analysis, criterion validity, incremental validity, and Cronbach's α coefficient test. Moreover, in Sample 2, the equivalence of SLS in male and female cohorts and in outpatient and inpatient groups was further examined.

RESULTS

In the exploratory factor analysis, two dimensions were extracted: Self-Stigma of Loneliness (SSL) and Public Stigma of Loneliness (PSL). The confirmatory factor analysis revealed that the first-order two-factor model demonstrated good fit indices (χ2/df = 2.754, RMSEA = 0.067, SRMR = 0.023, CFI = 0.988, IFI = 0.989, TLI = 0.983, PNFI = 0.677, PCFI = 0.681), and it was superior to both the one-factor model and the two-factor orthogonal model. The criterion validity test indicated that the SLS scores were significantly positively correlated with the scores of UCLA Loneliness Scale, Brief Illness Perception Questionnaire, Self-Concealment Scale, Social Interaction Anxiety Scale, Social Phobia Scale, Acceptance and Action Questionnaire-Second Edition, Kessler Psychological Distress Scale-6 scores. The Cronbach's α coefficient values for the SLS, SSL, and PSL were 0.961, 0.949, and 0.960, respectively. The results of the incremental validity tests indicated that stigma of loneliness and loneliness differ in psychological construct. In addition, the SLS showed measurement equivalence in populations of patients with chronic diseases of different genders, as well as ways of seeking medical care.

CONCLUSIONS

The Chinese version of the SLS showed favorable reliability and validity in patients with chronic disease populations, which can provide instrumental endorsement for recognition and intervention studies of stigma of loneliness.

Risk factors and prognostic impact of unwanted loneliness in heart failure

Heart failure (HF) is associated with a high prevalence of unwanted loneliness. This study aimed to assess whether unwanted loneliness was associated with adverse clinical endpoints in HF patients. Additionally, we also aimed to examine the risk factors associated with unwanted loneliness in HF. We included 298 patients diagnosed with stable HF. Clinical, biochemical, echocardiographic parameters and loneliness using ESTE II scale were assessed. We analyzed the association between the exposure and adverse clinical endpoints by Cox (death or any hospitalization), and negative binomial regressions (recurrent hospitalizations or visits to the emergency room). Risk factors associated with loneliness were analyzed using logistic regression. The mean age was 75.8 ± 9.4 years, with 111 (37.2%) being women, 53 (17.8%) widowed, and 154 (51.7%) patients having preserved ejection fraction. The median (p25-p75%) ESTE II score was 9.0 (6.0-12.0), and 36.9% fulfilled the loneliness criteria (> 10). Both women (OR = 2.09; 95% CI 1.11-3.98, p = 0.023) and widowhood (OR = 3.25; 95% CI 1.51-7.01, p = 0.003) were associated with a higher risk of loneliness. During a median follow-up of follow-up of 362 days (323-384), 93 patients (31.3%) presented the combined episode of death or all-cause admissions. Loneliness was significantly related to the risk of time to the composite of death or any readmission during the composite (HR = 1.83; 95% CI 1.18-2.84, p = 0.007). Women and widowhood emerge as risk factors for unwanted loneliness in HF patients. Unwanted loneliness is associated with higher morbidity during follow-up.

The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit

BACKGROUND

A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being.

AIM

The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU).

DESIGN

This is a prospective, descriptive and correlational study.

METHODS

The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS).

RESULTS

The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05).

CONCLUSIONS

The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.

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.