Brain-body interactions underlying the association of loneliness with mental and physical health

Breaking the vicious cycle: Reciprocal influences between social isolation and functional disability and the buffering effect of digital inclusion

In aging societies like Japan, social isolation (SI) and functional disability (FD) critically impact older adults' health, yet their bidirectional relationship and potential moderators remain underexplored. This prospective cohort study examined the bidirectional SI-FD association and tested digital inclusion's (DI) moderating role among community-dwelling Japanese older adults. We analyzed 480 adults aged ≥65 across three waves (baseline, 3-year, 6-year follow-ups) using multi-group random intercept cross-lagged panel models (RI-CLPM) to disentangle within-person and between-person effects. At the between-person level, SI was positively connected with FD (β = 0.50, p < 0.001). Within individuals, SI and FD demonstrated reciprocal worsening over time, with SI's cross-lagged effect on subsequent FD (T1→T2: β = 0.42, p < 0.001; T2→T3: β = 0.40, p < 0.001) exceeding FD's effect on SI (T1→T2: β = 0.21, p < 0.01; T2→T3: β = 0.29, p < 0.01). DI significantly attenuated SI's adverse impacts: in the digitally included group (n = 291), SI's autoregressive effects and cross-lagged effects on FD became nonsignificant (p > 0.05), SI's cross-lagged effect on subsequent FD also weakened (T1→T2: β = 0.19, p < 0.05; T2→T3: β = 0.22, p < 0.05). Findings suggest bidirectional SI-FD links are partially mitigated by digital engagement. While social interventions remain critical, integrating digital literacy programs may disrupt SI's cascading effects on disability. Study limitations include regional sampling and self-reported measures. Future research should validate these mechanisms across diverse populations and explore targeted digital-social hybrid interventions.

Developing loneliness interventions for people with personality disorders: A call to action

Loneliness is common in personality disorders (PDs) and may contribute to their severity and persistence. Systematic research on loneliness interventions for PD is sparse but clearly needed. According to the Alternative Model of Personality Disorders, loneliness may be related to personality functioning and may link to domains of self (identity and self-direction) and interpersonal functioning (empathy and intimacy). A deeper understanding of the interaction between perceived loneliness and individual dysfunction across these domains is essential for establishing novel psychological interventions that effectively treat loneliness. As a first step in developing a valid therapy model, we suggest a modular framework that encompasses loneliness-associated perceptions, cognitions, feelings, and behaviors that can be targeted with specific strategies. To further develop this framework, additional empirical research, for example, clinical studies on loneliness-tailored interventions in PD, should be performed in parallel with more conceptual research that challenges and integrates current hypotheses and theories.

Association of Social Disconnection With the Incidence and Prognosis of Atrial Fibrillation: A Multistate Analysis

BACKGROUND

Social disconnection, including loneliness and social isolation, is associated with increased morbidity and death. However, its impact on the incidence and prognosis of atrial fibrillation (AF) remains inconclusive.

METHODS AND RESULTS

The present prospective cohort study enrolled 418 656 participants without AF and cardiovascular disease from the UK Biobank. A loneliness scale was constructed with 2 domains (loneliness feeling, inability to confide) and social isolation scale was constructed with 3 domains (living alone, lack of social support, and lack of social activity). We used a multistate model to analyze the impacts of the 2 scales on the progression from baseline to incident AF and subsequent major adverse cardiovascular events and further to death. Over a median follow-up of 14.7 years, 25 539 participants developed incident AF, among whom 7283 developed incident major adverse cardiovascular events, and 5165 died. Social isolation and loneliness scales were associated with both a higher incidence and worse prognosis of AF, with hazard ratios per 1-point increase of 1.06 (95% CI, 1.04-1.09) for the loneliness scale and 1.03 (95% CI, 1.02-1.05) for the social isolation scale for incident AF, and 1.12 to 1.14 for the loneliness scale (all P<0.001) and 1.12 to 1.27 for the social isolation scale (all P<0.001) after AF development. Loneliness feeling and living alone may be important contributors.

CONCLUSIONS

Loneliness and social isolation were both associated with a higher incidence and a worse prognosis of AF but to different extents. These observations highlight the importance of integrating social connection into the prevention and management of AF.

Loneliness and social isolation as risk factors for type 2 diabetes onset: A systematic review and meta-analysis

AIMS

This study sought to analyze the association of social isolation and loneliness with the risk of type 2 diabetes onset.

METHODS

Two authors systematically searched PubMed, EMBASE, and Web of Science databases for studies published until February 2025, assessing the risk of incidence of type 2 diabetes in individuals who are socially isolated or lonely. To quantify the risk of incident diabetes, hazard ratios (HR) for loneliness and social isolation were pooled using a random-effects inverse-variance model with empirical Bayes estimation.

RESULTS

Nine prospective cohort studies were included, comprising 1,112,887 individuals (60.5 % female, mean age = 57.1 years), with 50,961 new cases of type 2 diabetes over a mean follow-up of 10.7 years. Loneliness was associated with a 32% increased risk of type 2 diabetes (HR = 1.32 [95 % confidence interval [CI]:1.11-1.57]). Social isolation was linked to a 20% higher risk (HR = 1.20 [95 %CI:1.01-1.43]). The included studies showed fair-to-good methodological quality (mean score: 10.11/14) based on the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.

CONCLUSIONS

Social isolation and loneliness are significant risk factors for type 2 diabetes. Addressing social connectedness could be a valuable strategy for diabetes prevention, emphasizing the need to incorporate psychosocial factors into public health initiatives.

Loneliness and social conformity: A predictive processing perspective

For social creatures like humans, loneliness-which is characterized by a perceived lack of meaningful social relationships-can result in detrimental health outcomes, especially when experienced over an extended period of time. One potential way to pursue rewarding social connections could be social conformity, the tendency to align one's behavior and opinions to those of others. In this perspective article, we give a broad overview of common and distinct neural mechanisms underlying loneliness and social conformity, and the involvement of the oxytocinergic system therein. Additionally, we consider how loneliness can be understood within a predictive processing framework. Specifically, negative expectations could be related to altered representations of the self and others in the medial prefrontal cortex, whereas diminished bottom-up signals from the insula may contribute to reduced precision in the perception of the social environment. This negatively skewed internal model may perpetuate loneliness and lead to chronicity over time. While acute isolation and loneliness could drive people toward reconnection and increased social conformity, chronic loneliness may lead to distrust and avoidance, eventually resulting in nonconformity. We suggest different mediating mechanisms and moderating factors that warrant further investigation in future research.

Ambiguity potentiates effects of loneliness on feelings of rejection

For social species, having strong and high-quality social relationships is an important safety cue. Loneliness occurs when an individual perceives they have insufficient relationships resulting in feelings of lack of safety. States of perceived unsafety are linked to an increased tendency to construe ambiguous information - information lacking a unique clear interpretation - as threatening. Here, we explore whether the ambiguity of social cues of interpersonal rejection moderates effects of loneliness on feelings of rejection while undergoing social exclusion. Data were collected in 2021; 144 adults completed a progressive social exclusion paradigm where they were randomly assigned to be equally included, excluded, or over-included. Social exclusion/inclusion cues became more pronounced over the course of multiple rounds of a ball-tossing game (Cyberball) resulting in a scenario where ambiguity was highest in earlier rounds and decreased over time. Participants reported feelings of loneliness prior to the task and feelings of rejection throughout the task. Results demonstrated that higher loneliness predicted increased feelings of rejection regardless of exclusion condition. Notably, this positive relationship was strongest during earlier rounds when social cues were most ambiguous. These findings contribute to our understanding of how loneliness modulates social perception to enable organisms to adequately adapt to changing circumstances.

The lonely brain: Aligning theories of loneliness with data from neuroimaging studies

Although loneliness is an unpleasant subjective experience associated with negative consequences, decades of research suggest loneliness is accompanied by adaptive cognitive changes that promote self-preservation and attempts for social reconnection. This review summarizes theoretical accounts that elaborate how loneliness alters attention and social information processing, then reviews whether findings from functional magnetic resonance imaging (fMRI) studies align with these hypothesized effects. We first examined the hypothesis that loneliness should increase general attention to monitor for potential environmental threats. Findings from resting-state studies suggested that loneliness corresponds to greater baseline activity in attention-related regions. Next, we examined the hypothesis that loneliness heightens sensitivity to the social world to protect against social threats and motivate reconnection. Here, studies showed sensitivity toward negative social information increased, whereas sensitivity toward positive social information was stimulus dependent (e.g., strangers, close others). Finally, we examined the hypothesis that loneliness enhances mentalizing to better predict social situations. Although many studies support this hypothesis, the research here is limited. However, studies do find that lonely individuals show idiosyncratic processing of the self and others. To conclude, we lay out future directions addressing some shortcomings of current fMRI studies of loneliness, and provide additional avenues to expand our knowledge of the "lonely brain."

Loneliness and cardiovascular disease incidence: two cohorts of older adults in the USA and South Korea

BACKGROUND

We investigated the relationship between loneliness and cardiovascular disease (CVD) in older adults from the USA and South Korea. We conducted counterfactual mediation analyses to explore the potential mediation of this relationship by health behaviors.

METHODS

We used the Health and Retirement Study (HRS; n = 13 073) from the USA and the Korean Longitudinal Study of Aging (KLoSA; n = 8311) from South Korea. In both cohorts, baseline loneliness was assessed using one item from the Center for Epidemiologic Studies Depression Scale. Incident CVD was defined as reporting new-onset CVD on the biennial questionnaire or CVD death reported by proxies. Within each cohort, we estimated adjusted hazard ratios (aHRs) of incident CVD according to loneliness (yes/no) over 12-14 years of follow-up, adjusting for baseline covariates: social isolation, sociodemographic factors, health conditions, and health behaviors.

RESULTS

Feeling lonely was associated with an increased likelihood of developing CVD in the USA (aHR: 1.15, 95% CI: 1.04, 1.27) and South Korea (aHR: 1.16, 95% CI: 1.00, 1.34). Several behaviors accounted for a proportion of the association: physical activity (14.3%, P = 0.03 in HRS; 1.3%, P = 0.04 in KLoSA) and alcohol (3.9%, P < 0.001 in HRS; 1.3%, P < 0.001 in KLoSA) in both countries, smoking only in HRS (4.7%, P < 0.001).

CONCLUSION

The magnitude of the impact of loneliness on CVD was similar in both countries, but behavioral pathways differed. Loneliness may be a risk factor for CVD regardless of culture; however, different prevention strategies in clinical settings may be required.

Loneliness among dementia caregivers: evaluation of the psychometric properties and cutoff score of the Three-item UCLA Loneliness Scale

Introduction

Dementia is a chronic progressive syndrome, with an entire loss of function in the late stages. The care of this demanding condition is primarily provided by family members, who often suffer from chronic burnout, distress, and loneliness. This instrumental study aimed to examine the factor structure, reliability, convergent validity, criterion validity, and cutoff scores of a short loneliness measure: the Three-Item version of the University of California, Los Angeles, Loneliness Scale (UCLALS3) in a convenience sample of dementia family caregivers (N = 571, mean age = 53 ±12 years, 81.6% females).

Methods

Exploratory and confirmatory factor analyses were used to examine the structure of the UCLALS3 while receiver-operating characteristic (ROC) curve, including caregiving burden and emotional distress as outcomes, was used to examine its cutoff.

Results

One factor accounted for 79.0% of the variance in the UCLALS3; it was perfectly invariant across genders but variant at the metric level across countries. The scale had adequate internal consistency (alpha = 0.87), high item-total correlations (0.69 - 0.79), reduced alpha if item deleted (0.77 - 0.86), and strong positive correlations with caregiving burden and psychological distress scores (r = 0.57 & 0.74, p values = 0.01). Percentile scores and the ROC curve suggested two cutoffs (≥6 and ≥6.5), which classified 59.3 and 59.4% of the participants as having higher levels of loneliness-comparable to global levels of loneliness among informal caregivers. The Mann-Whitney test revealed significantly high levels of caregiving burden and distress in caregivers scoring ≥6.5 on the UCLALS3.

Conclusion

The UCLALS3 is a valid short scale; its cutoff ≥6.5 may flag major clinically relevant symptoms in dementia caregivers, highlighting the need for tailored interventions that boost caregivers' individual perception of social relationships. More investigations are needed to confirm UCLALS3 invariance across countries.

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.

The mediating effects of sleep quality in the relationship between loneliness and depression among middle-aged and older adults

Loneliness has long been recognized as a key predictor of depression in older adults, and both are related to sleep quality. However, to this day, less is known about whether sleep quality mediates their relationship. This study aimed to examine the relationship between loneliness, sleep quality, and depressive symptoms, and to further explore whether sleep quality mediates the relationship between loneliness and depressive symptoms. Using the random cluster sampling method, 1016 permanent residents aged 45 and above in Ankang City, Shaanxi Province were selected. The relationship between loneliness, sleep quality, and depressive symptoms was analyzed using binary logistic regression, and the mediating role of sleep quality between loneliness and depressive symptoms was analyzed using the PROCESS macro in SPSS 25.0 software. The average age of the participants in this study was 60.39 ± 8.50. Regression analyses showed that individuals with loneliness (OR 7.161, 95%CI: 4.889-10.490, P < 0.001) and those with poor sleep quality (OR 4.777, 95%CI: 3.301-6.913, P < 0.001) were more likely to experience depressive symptoms than individuals without loneliness and with good sleep quality. This study also found a significant mediating effect of sleep quality between loneliness and depressive symptoms [effect value = 0.066, bootstrap 95% CI: (0.037, 0.093)] with an effect size of 13.31%. Loneliness may lead to reduced sleep quality in individuals, which in turn may lead to or exacerbate depressive symptoms. Therefore, this study highlights the importance of assessing and improving sleep quality in lonely people.

Public interest and engagement in care for brain health in Slovenia: the role of education

Background and objective

Knowledge gap theory posits that individuals with better education have better opportunities to obtain, understand and utilise available information. In a health-related context, this insight could lead to a more effective disease prevention. The aim of our study was to test the hypothesis that knowledge gap underlies differences in behaviour aimed at maintaining brain health.

Methods

We conducted an online survey investigating Slovenian public view on brain, brain research, and science-based recommendations for brain health. The survey was filled out by a total of 2,568 respondents, of whom 2,450 completed it in full. They were divided into two subgroups based on their self-reported brain-related education, i.e., the lay subgroup (n = 1,012) and a topically educated group (n = 1,438), i.e., the educated subgroup. Among the latter, 728 participants reported to have a Bachelor's degree or higher education. We analysed the views of this sample subgroup on brain, neuroscience, and science-based brain health recommendations, and compared them with age- and education-matched lay subgroup (n = 565) from the same survey.

Results

Educated individuals showed greater awareness and adherence to science-based recommendations compared to the lay respondents, specifically in the perceived importance of following a healthy diet, exercising, ensuring time for rest, relaxation and maintenance of social contacts, acquiring new knowledge and skills and using supplements that are considered to improve mental abilities (all p < 0.005), but not in the perceived importance of getting enough sleep, avoiding drugs and alcohol or injuries and performing mentally-challenging activities or cognitive training (all p > 0.10). Educated individuals more frequently reported following a healthy diet, engaging in physical activity and socialising, acquiring new knowledge and skills, performing mental challenges and cognitive training, and using supplements (all p < 0.005), but not getting sufficient sleep, avoiding drugs, alcohol or injury, or ensuring time for rest and relaxation (all p > 0.08). A larger proportion of lay than educated participants (32 and 17%, respectively) identified lack of information as a reason for not engaging in healthy practices (p < 0.001). Educated participants outperformed lay individuals in identifying diseases amenable to lifestyle modification.

Conclusion

Understanding the differences in brain health perceptions between educated and lay individuals is crucial for developing effective public health strategies. Our results highlight a substantial knowledge gap in the Slovenian population and the need for targeted educational interventions that account for varying degrees of knowledge in different population segments which could lead to better adherence to healthy lifestyle practices.

Plasma proteomic signatures of social isolation and loneliness associated with morbidity and mortality

The biology underlying the connection between social relationships and health is largely unknown. Here, leveraging data from 42,062 participants across 2,920 plasma proteins in the UK Biobank, we characterized the proteomic signatures of social isolation and loneliness through proteome-wide association study and protein co-expression network analysis. Proteins linked to these constructs were implicated in inflammation, antiviral responses and complement systems. More than half of these proteins were prospectively linked to cardiovascular disease, type 2 diabetes, stroke and mortality during a 14 year follow-up. Moreover, Mendelian randomization (MR) analysis suggested causal relationships from loneliness to five proteins, with two proteins (ADM and ASGR1) further supported by colocalization. These MR-identified proteins (GFRA1, ADM, FABP4, TNFRSF10A and ASGR1) exhibited broad associations with other blood biomarkers, as well as volumes in brain regions involved in interoception and emotional and social processes. Finally, the MR-identified proteins partly mediated the relationship between loneliness and cardiovascular diseases, stroke and mortality. The exploration of the peripheral physiology through which social relationships influence morbidity and mortality is timely and has potential implications for public health.

Loneliness is associated with eating disorders among a national sample of U.S. college students during the COVID-19 pandemic

OBJECTIVE

To identify the association between loneliness and eating disorder symptomatology among a national sample of U.S. college students during COVID-19.

PARTICIPANTS

Cross-sectional data from the 2020-2021 Healthy Minds Study (N = 96,645) were analyzed.

METHODS

Loneliness was measured using the UCLA 3-item Loneliness Scale and eating disorder symptomology was measured using the SCOFF questionnaire. Multiple modified Poisson regression analyses were conducted, adjusting for confounding variables.

RESULTS

Greater loneliness was associated with both a positive eating disorder screen (risk ratio [RR] 1.09, 95% confidence interval [CI] 1.09-1.10) and greater number of eating disorder symptoms (RR 1.07, 95% CI 1.06-1.08). Gender modified this relationship, and men who endorsed greater loneliness had higher risk of eating disorder symptomatology compared to women.

CONCLUSIONS

Loneliness during the COVID-19 pandemic was associated with a greater risk of eating disorder symptomatology among college students. Findings underscore the need for social support and eating disorders programming on college campuses.

Association between cumulative loneliness and risk of cardiovascular diseases in middle-aged and older adults: A longitudinal study

OBJECTIVE

Previous longitudinal studies have investigated the association between baseline loneliness and the risk of developing cardiovascular diseases (CVD). Nevertheless, the cumulative effect of loneliness on CVD remains uncertain. The objective of this study is to assess the relationship between the cumulative duration of loneliness and the risk of CVD in middle-aged and older adults.

STUDY DESIGN

Prospective cohort study.

METHODS

The study utilized data from a sample of 8353 adults aged 45 years and older who participated in the China Health and Retirement Longitudinal Study (CHARLS). Loneliness was assessed biennially between 2011 and 2015, and categorized into four groups: never, one time point, two time points, and three time points. The Cox Proportional Hazards Regression Model was employed to estimate hazard ratios (HRs) and corresponding 95 % confidence intervals (CIs).

RESULTS

Following a mean follow-up period of 4.7 years (standard deviation: 0.7 years), a total of 1314 cases of CVD were identified, including 913 cases of heart disease and 504 cases of stroke. After adjusting for potential confounding factors, individuals who experienced loneliness at one time point (HR, 1.21; 95 % CI: 1.06, 1.38), two time points (HR, 1.23; 95 % CI: 1.03, 1.45), and three time points (HR, 1.50; 95 % CI: 1.19, 1.89) had a significantly higher risk of developing CVD compared to those who never experienced loneliness.

CONCLUSIONS

Cumulative loneliness was associated with increased risk of CVD in middle-age and older adults. Additional research is warranted to delve into the underlying mechanisms, while it is advisable to contemplate social interventions aimed at addressing loneliness.

Loneliness and socioemotional memory

Do chronically high-lonely individuals exhibit specific memory biases when recalling past social episodes? We explored negative memory biases, focusing on the recall of unfavourable social experiences and social memory biases, emphasizing the recall of social experiences irrespective of emotional valence. We conducted a dictionary-based semantic analysis of autobiographical episodes obtained from 4095 participants via four datasets. Participants recalled a positive, negative or emotionally neutral episode from their recent past. High-lonely individuals predominantly exhibited a decline in recalling positive social episodes, providing partial support for negative memory biases. However, both high- and low-lonely individuals were similarly inclined to recall negative social episodes. These results suggest that the primary issue among high-lonely individuals is the limited recall of positive social experiences rather than the general negativity in memory biases or the hypersensitivity to general social memories.

A critical analysis of stress-related gene regulation in isolated and connected individuals

This letter responds to the article by Yvonne S. Yang et al. (2024) on the relationship between social isolation, loneliness, and stress-related gene expression, published in Brain, Behavior, and Immunity. The authors' recruitment methods and use of genome-wide transcriptional profiling to assess the Conserved Transcriptional Response to Adversity (CTRA) are highly commendable, offering a comprehensive understanding of how social isolation impacts immune gene expression. However, we raise concerns about the small sample size, demographic limitations, cross-sectional design, and lack of correction for multiple comparisons, which may affect the study's generalizability and validity. Despite these limitations, the study provides valuable insights, paving the way for future research to explore the complex interactions between social isolation, loneliness, and health. We recommend that future studies address these limitations to enhance the robustness of findings and the development of effective interventions.

Observational and genetic evidence disagree on the association between loneliness and risk of multiple diseases

Loneliness-the subjective experience of social disconnection-is now widely regarded as a health risk factor. However, whether the associations between loneliness and multiple diseases are consistent with causal effects remains largely unexplored. Here we combined behavioural, genetic and hospitalization data from the UK Biobank to examine the associations of loneliness with a wide range of non-overlapping diseases. During a median 12.2-year follow-up, loneliness was associated with greater risks in 13 of 14 disease categories and 30 of 56 individual diseases considered. Of the 30 diseases significantly associated with loneliness, 26 had genetic data available for Mendelian randomization (MR) analyses. After Benjamini‒Hochberg correction and multiple sensitivity analyses within the MR framework, non-causal associations were identified between genetic liability to loneliness and 20 out of the 26 specific diseases, including cardiovascular diseases, type 2 diabetes mellitus, obesity, chronic liver diseases, chronic kidney disease, most neurological diseases and the other common diseases. Genetic liability to loneliness was only potentially causally associated with the remaining six diseases. Socioeconomic factors, health behaviours, baseline depressive symptoms and comorbidities largely explained the associations between loneliness and diseases. Overall, our study revealed a dissociation between observational and genetic evidence regarding the associations of loneliness with multiple diseases. These findings suggest that loneliness may serve as a potential surrogate marker rather than a causal risk factor for most diseases tested here.

Association between loneliness and incident atrial fibrillation across different genetic predisposition: findings from the UK Biobank

BACKGROUND

Loneliness has garnered significant attention globally, with extensive exploration of its association with cardiovascular disease. However, a notable research gap persists concerning loneliness and its potential link to atrial fibrillation (AF).

METHODS

This prospective cohort study utilized data from the UK Biobank (UKB), encompassing 441,056 participants. Loneliness was assessed through self-reported questionnaires gauging feelings of isolation and willingness to confide. AF diagnoses were ascertained using hospitalization records and cause-of-death registry data. The association between loneliness and AF risk was analyzed through multivariable Cox proportional hazard models.

RESULTS

Over a median follow-up period of 13.9 years, 25,386 AF cases were identified. In comparison to individuals without reported loneliness, those in the loneliness group exhibited a significantly higher risk of AF (loneliness vs. non-loneliness: hazard ratio [HR]: 1.11, 95% confidence interval [CI] 1.07-1.16). Subgroup analysis revealed that the association between loneliness and increased AF risk was significant solely in individuals without heart valve disease (HR: 1.12, 95% CI 1.07-1.16). Additionally, significant associations between loneliness and heightened AF risk were noted across strata of genetic susceptibility to AF, with no observable impact on these associations by genetic susceptibility (P for interaction = 0.070).

CONCLUSIONS

This study establishes a robust association between loneliness and an elevated long-term risk of AF. Notably, this association is particularly pronounced in individuals without valvular disease and does not appear to be influenced by genetic predisposition to AF.

On social health: history, conceptualization, and population patterning

We propose a psychologically-informed concept of social health to join physical and mental components in a more comprehensive assessment of human health. Although there is an extensive literature on the importance of social relationships to health, a theoretical framework is needed to coalesce this work into a codified conceptualisation of social health, defined here as adequate quantity and quality of relationships in a particular context to meet an individual's need for meaningful human connection. Informing this novel conceptualisation, we outline eight key propositions to guide future research and theory on social health, including five propositions focused on the conceptualisation of social health and three focused on its population patterning. The former five propositions include that social health is an outcome in its own right, that health interventions can have divergent effects on social versus physical and mental aspects of health, that social health has independent effects on quality of life, that it is a dynamic and contextual construct, and that it is embedded and encoded in the human body (and mind). The utility of the social health concept is further revealed in its significance for understanding and addressing population health concerns, such as health inequalities experienced by marginalised groups.

"I'm Trying to Reach Out, I'm Trying to Find My People": A Mixed-Methods Investigation of the Link Between Sensory Differences, Loneliness, and Mental Health in Autistic and Nonautistic Adults

Background

Rates of loneliness are substantially higher among autistic compared with nonautistic individuals. This observation refutes the persistent stereotype that autistic individuals are not motivated to seek meaningful social relationships. More plausibly, social environments systematically exclude people with higher levels of sensory differences, impeding on opportunities for autistic individuals to form meaningful relationships. In this study, we sought to quantify the level of distress associated with loneliness (Study A) and provide complementary qualitative insight into experiences of loneliness in relationship to sensory differences in autistic adults (Study B).

Methods

In Study A, N = 209 participants completed a range of self-report questionnaires. In Study B, nine autistic adults took part in 10-minute unstructured dyadic conversations around the topic of loneliness. We derived a qualitative understanding of autistic individuals' experience of loneliness, enriched by inductive and deductive analyses.

Results

In Study A, the autistic group showed significantly higher levels of loneliness, loneliness distress, anxiety, depression, and sensory reactivity. We found significant positive correlations between variables, but no group differences in differential relationships. The effect of sensory reactivity on anxiety and depression was mediated by levels of loneliness in both groups. In Study B, autistic participants described the pain of feeling lonely and socially disconnected, while simultaneously experiencing a need for restorative solitude after social overstimulation.

Discussion

Our results indicate that sensory differences are related with higher loneliness and associated poor mental health in both autistic and nonautistic adults. This effect was exacerbated in autistic adults due to higher levels of sensory reactivity. First-hand reports from autistic adults on intense loneliness and the obstructive role of sensory environments refute stereotypes about a lack of social motivation in autistic adults. We conclude that to enable meaningful and inclusive social interaction, a societal effort is needed to create spaces that consider the sensory needs of all neurotypes.

A More Connected Future: How Social Connection, Interdisciplinary Approaches, and New Technology Will Shape the Affective Science of Loneliness, a Commentary on the Special Issue

The recent Special Issue of Affective Science considered "The Future of Affective Science," offering new directions for the field. One recurring theme was the need to consider the social nature of emotional experiences. In this article, we take an interdisciplinary approach toward studies of social connection that builds upon current theoretical foundations to address an important public health issue - loneliness. Loneliness is an affective state that is characterized by feelings of isolation and has widespread adverse effects on mental and physical health. Recent studies have established links between loneliness, social connection, and well-being, but most of this work has been siloed in separate fields. We bridge these themes, leveraging advances in technology, such as artificial intelligence-based voice assistants (e.g., Alexa), to illuminate new avenues for detecting and intervening against loneliness "in the wild." Recognizing the power of connection among individuals as social beings and among researchers with shared goals, affective science can advance our understanding of loneliness and provide tangible benefits to society at large.

Loneliness without distress, chosen isolation (solitude) at the workplace, and mental health and job performance: a cross-sectional study of Japanese employees

While loneliness and social isolation in the workplace affect the mental health and job performance of employees, the effects of loneliness without distress and solitude (i.e., chosen isolation) on these outcomes are unclear. The cross-sectional association was examined by using online survey of full-time employees in Japan (n=846). The results showed that the "loneliness with distress" group had significantly higher psychological distress and lower job performance than the other groups. Work engagement was lower both in the "loneliness with distress" and "loneliness without distress" groups, compared to the "non-loneliness" group. The "unchosen isolation" and the "solitude" groups had poorer scores of psychological distress, work engagement, and work performance, compared to the "non-isolation" group. The preliminary findings showed that loneliness without distress and solitude were associated with poor levels of mental health and job performance and should become a target of mental health promotion interventions in the workplace.

Interpersonal Loneliness Predicts the Frequency and Intensity of Nightmares: An Examination of Theoretic Mechanisms

The evolutionary theory of loneliness (ETL) argues that human belongingness is essential to survival and failing to meet belongingness needs constitutes a threat to viability. In two separate studies (total N = 1,609), links between loneliness and nightmares were examined as a test of ETL postulates. As hypothesized, loneliness predicted nightmare frequency (both studies) and nightmare intensity (Study Two only). Although stress mediated the relationship between loneliness and nightmare frequency in Study One, stress was not a significant mediator of this relationship in Study Two. As predicted, in Study Two both hyperarousal and rumination mediated the relationships between loneliness and nightmare frequency and between loneliness and nightmare intensity. Theoretical implications include support for both the aversive signaling and implicit vigilance postulates of ETL.

Evaluation of the effects of pandemic-related fears on anxiety and depression: the mediating roles of traumatic stress and loneliness

BACKGROUND

The detrimental mental health effects which emerged from COVID-19 have profoundly affected healthcare workers (HCWs) worldwide. The aim of this study was to investigate the mediating effects of traumatic stress and loneliness on the fears of contracting and dying from COVID-19, and anxiety and depression of HCWs during the pandemic.

METHODS

A cross-sectional online survey was completed by HCWs in a province of Turkey. The Hospital Anxiety Depression Scale, Impact of Events Scale-Revised and numerical rating scales (for fears of COVID-19 and loneliness) were used and a bootstrap approach was used in the analyses with SPSS PROCESS macro software.

RESULTS

Of the HCWs evaluated, 150 (34.4%) were doctors, with a mean duration of work experience of 10.6 ± 7.5 years. The results indicated that fear of contracting COVID-19 was directly related to anxiety (β = 0.244, p < 0.001) and depression (β = 0.135, p < 0.01) and that traumatic stress and loneliness mediated the relationships between the fear of contracting COVID-19 and anxiety (β = 0.435, p < 0.001; β = 0.235, p < 0.001, respectively) and depression (β = 0.365, p < 0.001; β = 0.294, p < 0.001, respectively). The fear of dying from COVID-19 was determined to be directly associated with anxiety (β = 0.190, p < 0.001) but not with depression (β = 0.066, p = 0.116), and traumatic stress and loneliness mediated the relationships between the fear of dying from COVID-19 and anxiety (β = 0.476, p < 0.001; β = 0.259, p < 0.001, respectively) and depression (β = 0.400, p < 0.001; β = 0.311, p < 0.001, respectively).

CONCLUSIONS

The study results demonstrated the important roles of traumatic stress and loneliness in exacerbating the negative consequences of fears of COVID-19 on anxiety and depression, and provide insights for identifying HCWs at greater risk.

Silence between words: Is solitude important for relatedness?

Chronic loneliness is a risk factor for physical and health problems, in part due to dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system. In contrast, temporary moments of positive solitude (passing good times alone and not feeling lonely) appear to have positive effects on mental health, social life, and creativity, and seems to be a buffer against loneliness. Herein, three ways of how solitude may have positive effects on health and relatedness are discussed, namely effects on enhancement of mind-wandering, interoceptive awareness, and spirituality. Solitude may facilitate (1) activation of the default mode network (DMN) underlying mind-wandering including daydreaming about other people; (2) activation of brain areas supporting interoceptive awareness; (3) deactivation of prefrontal cortex, or deactivation and decreased connectivity of the DMN, giving raise to susceptibility to spiritual experiences. The capacity to handle and enjoy solitude is a developmental process that may be difficult for many persons. Craving for social connections and external stimulation with digital technologies (e.g., internet, smartphones, social media) might be interfering with the development of the capacity for solitude and thereby increasing loneliness; this might be partly due to impaired interoceptive awareness and impaired functional mind-wandering (common in solitude). Congruently, overuse of digital technologies was associated with reduced activity, and reduced gray matter volume and density, in brain areas supporting interoceptive awareness, as well as with decreased connectivity of the DMN supporting creative insights. Solitude has been a relatively dismissed topic in neuroscience and health sciences, but a growing number of studies is highlighting its importance for well-being.

Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial

INTRODUCTION

Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55).

METHODS

Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D).

RESULTS

The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members.

CONCLUSION

Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

Threatened by others or by everything? The effects of momentary and trait loneliness on daily appraisals of social company and being alone in young adults

Theoretical accounts of loneliness suggest that it may lead to psychopathological consequences by increasing the perception of social threat. However, it is unclear whether the real-life effects of both trait and state loneliness are specific to social situations. To answer this question, two experience sampling studies were conducted with prestratified samples of young adults (18-35) with moderate (Study 1, N = 64) or low and high (Study 2, N = 103) levels of loneliness. Participants were asked to report their emotional states and appraisals of social and nonsocial situations. Multilevel modelling of momentary and time-lagged associations revealed that trait loneliness was associated with less positive (Study 1) and more negative (Study 2) company appraisals. Importantly, in Study 2, trait loneliness was also related to less positive and more negative appraisals of being alone. Momentary loneliness was related to less positive and more negative appraisals of both types and predicted negative social appraisals over time in both studies. In Study 2, time-lagged interaction effects on social appraisals were found between the two levels. The results suggest that in highly lonely individuals, both levels of loneliness may lead to a general negativity bias and have a synergistic effect.

Dyadic contagion in cognitive function: A nationally-representative longitudinal study of older U.S. couples

Later-life cognitive function is strongly influenced by one's environment. At this life stage, a partner's behaviors and attributes-including their own cognitive status-are a key environmental determinant. A recent "social allostasis" theory also yields specific predictions on patterns of mutual influence-or "contagion"-in cognitive function. Yet, no population representative studies have examined these coupled dynamics. Using recently developed fixed-effects cross-lagged panel modeling (FE-CLPM) methods and ten-year data from the Health and Retirement Study-nationally-representative of U.S. adults over 50-the current study filled this gap. Results supported dyadic cognitive contagion over the long- but not short-run. Short-term associations suggested intriguing "cognitive cycling" possibilities among both men and women that need further investigation. Overall, results supported a theoretical model of coupled "cognitive careers," and relational inducement of allostatic load. Especially among men, recurrent impulses also cumulatively induced substantial path-dependent cognitive improvements, supporting the added value of repeated over one-time interventions. Theoretical and substantive implications are discussed.

Increased experiences of loneliness during the COVID-19 pandemic, emotional distress and changes in perceived physical and mental health: A structural equation model

AIM

To explore how experiences of increased loneliness during the COVID-19 pandemic affected emotional distress and changes in perceptions of physical and mental health.

DESIGN

Cross-sectional study.

METHODS

Data from the Socio-Economic Impacts of Covid-19 Survey, a national survey administered to 5033 adults in August and September 2020 in the United States, was utilized in this study. Structural equation modelling was used to analyse the associations between increased experiences of loneliness during the pandemic, emotional distress and changes in perceptions of physical and mental health.

RESULTS

Among the 47% of participants who reported increased experiences of loneliness during the pandemic, 31% reported a poorer perceived change in mental health and 12% reported a poorer perceived change in physical health. Increased experiences of loneliness during the pandemic were significantly associated with emotional distress and poorer perceived mental and physical health changes. Emotional distress significantly mediated the effect between increased experiences of loneliness during the pandemic and poorer perceived mental and physical health changes. These findings highlight the importance of producing preventative actions to combat increased loneliness and emotional distress during and after future pandemics in order to improve health perceptions, which can result in negative health outcomes over time.

Remotely-administered resilience and self-compassion intervention targeting loneliness and stress in older adults: a single-case experimental design

OBJECTIVES

Loneliness and chronic stress are prevalent issues for older adults that have been linked to adverse health outcomes. We conducted a remote resilience and self-compassion intervention targeting loneliness and chronic stress.

METHODS

This study utilized a multiple-phase-change single-case experimental design with three consecutive 6-week phases: control, intervention, follow-up. Assessments and biomarker collection (blood pressure, inflammation, sleep actigraphy) were conducted at each phase. Participants completed a 6-week remotely-administered resilience and self-compassion intervention using techniques from cognitive behavioral therapy and resilience training. Repeated measures ANOVAs were conducted over the 12-week period from control (week 0) to intervention completion (week 12) and over the 18-week period from control (week 0) to follow-up (week 18) in supplemental analyses.

RESULTS

Participants reported a reduction in stress (p < 0.001; ηp2 = 0.15), depression (p =  0.02; ηp2 = 0.08), and loneliness (p = 0.003; ηp2 = 0.18), and an increase in self-compassion (p  =  0.01; ηp2 = 0.13) from control to intervention completion (weeks 0-12). Post-hoc tests revealed that stress reduced significantly during the intervention phase (weeks 6-12) and loneliness reduced significantly during the control phase (weeks 0-6). Some improvements in blood pressure, inflammation, and sleep quality were noted in a subsample of participants.

CONCLUSION

Findings indicate that our remote resilience and self-compassion intervention for older adults targeting loneliness and chronic stress was efficacious.

Covid-19 Lockdown and Non-Suicidal Self-Injury: A Mixed Methods Analysis of NSSI During Australia's National Lockdown

OBJECTIVE

The Covid-19 global pandemic has meant large parts of the world's population have been isolated from others for often months at a time due to lockdown measures to stop the spread. The effects of isolation can be damaging and increase risk of self-injury (NSSI) and suicide. We examined the effects of the first Australian national lockdown on NSSI urges and behavior.

METHOD

We asked 345 people with current or past lived experience of NSSI both quantitative and qualitative questions about how their urges and behavior changed during lockdown and assessed how changes were related to demographic variables including work and living conditions.

RESULTS

Women, socially disadvantaged and unemployed people were at greater risk of increased NSSI urges and behavior. Social connection was important, with both quantitative and qualitative responses indicating that for some, decreased social anxiety and social pressures was related to a reduction in NSSI, whereas for others the lack of social connection and engagement was associated with worsening urges and behaviors.

CONCLUSION

Lockdown had mixed impacts on people with lived experience of NSSI, with most reporting no change or a decrease to urges and behavior, however, for socially disadvantaged people in particular, lockdown lead to worsening urges and behavior and even relapse. Future research might examine these effects longitudinally and with greater focus on intersectionality.HighlightsIdentified NSSI risk/protective factors, and an understanding of lived experienceLockdowns have mixed impacts, some people decreased, some increased NSSISocial connection plays an important role in NSSI engagement and reduction.

Correlations between Dementia and Loneliness

This review describes associations between dementia and loneliness on the neurobiological and epidemiological levels according to the recent body of literature. The aim of this study was to highlight major lines of research in this field. Sociocognitive skills and social interactions present complex interdependencies with dementia which may be explained by two theories. According to the first one, not sufficiently engaging in social or cognitive activities results in brain atrophy. The second one claims that brain neurogenesis and synaptic density are being increased by social connections. The relationship between loneliness and dementia could be mediated by sensory loss, including hearing and visual impairment, as well as depression and psychotic symptoms. Loneliness itself might cause a depletion in sensory and cognitive stimulation which results in a decrease in neural reserve. Certain changes in the structures of the brain caused by loneliness were found in imaging examination. Loneliness appears to be a crucial risk factor for dementia in recent times due to the modern lifestyle and consequences of the outbreak of COVID-19. Additional studies are required to understand more completely the key tenets of this topic and therefore to improve the prevention and treatment of dementia.

Attitudes toward COVID-19 restrictions and COVID-19-related stress and fear among college students across three waves

Background and Aims

The COVID-19 pandemic has significantly impacted the mental health of college students, leading to increased psychological distress. This study explored potenital predictors to better understand the factors that influence and mitigate student COVID-19 stress in the evolving landscape of residential colleges. Specifically, we investigated the roles of COVID-19 fear, loneliness, and attitudes toward COVID-19 restrictions.

Methods

Employing a longitudinal online survey design, we collected data over the fall 2020 semester from 122 first-year college students enrolled in a small mid-west liberal arts college. Participants completed the same survey three times: Wave 1 in August, Wave 2 in October, and Wave 3 in November.

Results

Fear of COVID-19 (Time 1) was a significant predictor of increased COVID-19 related stress at both Time 2 and Time 3. Interestingly, loneliness (Time 1) moderated the effect of fear of COVID-19 (Time 1) on attitudes toward COVID-19 restrictions at Time 2. Moreover, students' negative attitudes toward COVID-19 restrictions and feelings of loneliness increased over the course of the semester.

Conclusions

These findings suggest that college students' wellbeing in the context of COVID-19 stress is influenced by a complex interplay of perceptions of COVID-19 (stress, fear, attitudes) and feelings of social isolation (loneliness). Further research in this area is crucial to provide targeted support and interventions to promote students' mental health.

The influence of climate change on mental health in populations of the western Pacific region: An umbrella scoping review

The Western Pacific Region (WPR) is on the front line of climate change challenges. Understanding how these challenges affect the WPR populations' mental health is essential to design effective prevention and care policies. Thus, the present study conducted an umbrella scoping review that examined the influence of climate change on mental health in the WPR, using review articles as a source of information. Ten review articles were selected according to eligibility criteria, and the findings were synthesized according to the socio-economic status of the countries identified: Australia, the Republic of Korea, the Philippines, Vietnam, the Pacific Islands (broadly), and China. The findings revealed that each country and sub-region has its own unique profile of climate change-related challenges and vulnerable populations, highlighting the need for specific approaches to mental health care. Specifically, the influence of climate-related challenges differed according to populations' region (e.g., rural populations), demographic characteristics (e.g., age and gender), culture (e.g., traditional tights to land), and employment (e.g., farmers and fishers). The most frequently reported mental health outcomes in response to climate change-related challenges such as droughts, floods, storms, tornadoes, typhoons, and climate-related migration were the decline in mental well-being and the increase in post-traumatic stress disorder symptoms. In addition, using the GRADE framework for assessing the certainty of the findings, we identified that the number of articles discussing associations between a given climate change challenge and a mental health outcome was overall limited. Based on our findings and findings on a global scale, we identified several key research gaps in WPR and provided recommendations for future research and policy strategies.

Correlation between childhood trauma experience and depressive symptoms among young adults: The potential mediating role of loneliness

BACKGROUND

It is widely recognized that childhood trauma poses a significant risk of developing depressive symptoms. However, the underlying mediation mechanism between childhood trauma and depressive symptoms requires further exploration.

OBJECTIVE

This study focuses on exploring whether loneliness may act as a potential mediator between childhood trauma and depressive symptoms.

PARTICIPANTS AND SETTING

We analyzed a large sample of college students (N = 7293). Participants completed online questionnaires in the WeChat group.

METHODS

Childhood trauma, depressive symptoms, and loneliness were evaluated using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Patient Health Questionnaire-9 (PHQ-9), and the University of California Los Angeles Loneliness Scale (UCLA-LS) respectively. The linear regression method was applied to explore the mediating role.

RESULTS

Gender, relationship with family, and left-behind experience are all substantial depressive symptoms risk factors. Childhood trauma was shown to be highly related to depressive symptoms, and this relationship was potentially mediated by loneliness.

CONCLUSIONS

Our research indicates that treating loneliness in those who have undergone childhood trauma may help prevent or treat depressive symptoms. Therefore, loneliness should be taken into consideration while treating and preventing depressive symptoms.

Sex-related differences in the associations between diurnal cortisol pattern and social and emotional loneliness in older adults

Introduction

Loneliness is a distressful feeling that can affect mental and physical health, particularly among older adults. Cortisol, the primary hormone of the Hypothalamic-Pituitary-Adrenal axis (HPA-axis), may act as a biological transducer through which loneliness affects health. While most previous studies have evaluated the association between loneliness, as a unidimensional construct, and diurnal cortisol pattern, no research has examined this relationship discriminating between social and emotional loneliness in older adults. As sex differences in the negative mental health outcomes of loneliness have been reported, we also investigated whether diurnal cortisol indices and loneliness associations occur in a sex-specific manner.

Methods

We analyzed the diurnal cortisol- pattern in 142 community-dwelling, non-depressed, Caucasian older adults (55,6% female) aged 60-90. Social and emotional (family and romantic) loneliness scores were assessed using the Spanish version of the Social and Emotional Loneliness Scale for Adults (SELSA). Five salivary cortisol samples were used to capture key features of the diurnal cortisol pattern, including: awakening and bedtime cortisol levels, awakening response (CAR), post-awakening cortisol output (post-awakening cortisol [i.e., the area under the curve with reference to the ground: AUCG]), total diurnal cortisol release (AUCG), and diurnal cortisol slope (DCS).

Results

After controlling for sociodemographic variables, the hierarchical linear multiple regression analyses revealed that in male older adults, higher scores on social and family loneliness were associated with elevated awakening cortisol levels, total diurnal cortisol output, and a steeper diurnal cortisol slope (DCS). However, these associations were not observed in female older adults. In addition, feelings of romantic loneliness were positively associated with bedtime cortisol levels and AUCG in older males. Multilevel growth curve modeling showed that experiencing more social and emotional loneliness predicted higher diurnal cortisol output throughout the day in older male adults.

Discussion

The presence of sex differences in the relationship between cortisol indices and loneliness among older adults holds particular significance for diagnostic and screening procedures. Combining loneliness scales as screening tools with diurnal cortisol measures has the potential to be an effective and cost-efficient approach in identifying higher-risk individuals at early stages.

Social Withdrawal, Loneliness, and Health in Schizophrenia: Psychological and Neural Mechanisms

BACKGROUND AND HYPOTHESIS

Some of the most debilitating aspects of schizophrenia and other serious mental illnesses (SMI) are the impairments in social perception, motivation, and behavior that frequently accompany these conditions. These impairments may ultimately lead to chronic social disconnection (ie, social withdrawal, objective isolation, and perceived social isolation or loneliness), which may contribute to the poor cardiometabolic health and early mortality commonly observed in SMI. However, the psychological and neurobiological mechanisms underlying relationships between impairments in social perception and motivation and social isolation and loneliness in SMI remain incompletely understood.

STUDY DESIGN

A narrative, selective review of studies on social withdrawal, isolation, loneliness, and health in SMI.

STUDY RESULTS

We describe some of what is known and hypothesized about the psychological and neurobiological mechanisms of social disconnection in the general population, and how these mechanisms may contribute to social isolation and loneliness, and their consequences, in individuals with SMI.

CONCLUSIONS

A synthesis of evolutionary and cognitive theories with the "social homeostasis" model of social isolation and loneliness represents one testable framework for understanding the dynamic cognitive and biological correlates, as well as the health consequences, of social disconnection in SMI. The development of such an understanding may provide the basis for novel approaches for preventing or treating both functional disability and poor physical health that diminish the quality and length of life for many individuals with these conditions.

The impact of social connectedness on mental health in LGBTQ + identifying individuals during the COVID-19 pandemic in Germany

BACKGROUND

Recent studies report that LGBTQ + people have experienced high levels of mental health problems during COVID-19-related social distancing. Given the well-established association between social isolation and mental health, the main aim of the current study was to investigate differences in mental health and (perceived) social isolation and social support in LGBTQ + individuals compared to heterosexual, cisgender people and to explore whether the hypothesized higher mental health burden in LGBTQ + individuals is (partly) mediated by (perceived) social isolation or social support.

METHODS

N = 531 participants indicating belonging to the LGBTQ + community and N = 1826 not identifying as LGBTQ + participated in a cross-sectional online survey during the initial COVID-19-related lockdown in Germany. Standardized questionnaires were used to assess depression, anxiety, suicidality, loneliness and social support. Further, perceived social isolation and face-to-face communication during the lockdown were assessed.

RESULTS

LGBTQ + people had higher levels of depression, anxiety and suicidal thought, were lonelier and experienced less social support than non-LGBTQ + identifying individuals. Mediation analysis showed that the higher levels of mental health burden in LGBTQ + people were (partly) mediated by reduced social connectedness. Further face-to-face contact positively affected mental health by reducing feelings of loneliness.

CONCLUSION

Given the high impact of loneliness on mental health, governmental actions should be taken to promote social connectedness particularly among LGBTQ + identifying individuals to ensure that the COVID-19 pandemic does not exacerbate the health inequalities that already exist between LGBTQ+-identifying and heterosexual, cisgender people.

Perceived control, loneliness, early-life stress, and parents' perceptions of stress

The COVID-19 pandemic has highlighted the importance of understanding what contributes to individual variability in experiences of stress. Increases in stress related to the pandemic have been especially pronounced in parents, indicating a need for research examining what factors contribute to parents' perceptions of stress. Here, we assessed the relationship between parents' perceptions of stress, control, loneliness, and experiences of childhood trauma in two populations of caregivers. In Study 1, we examined the relationship between perceptions of stress, control, loneliness, and history of early stress, along with indices of socioeconomic risk and resting parasympathetic nervous systema activity, which has been linked to variability in perceptions of stress, in caregivers of young children. Perceived control, loneliness, childhood stress, and resting parasympathetic nervous system activity predicted caregivers' stress. In Study 2, we replicated these initial findings in a second sample of caregivers. Additionally, we examined how these processes change over time. Caregivers demonstrated significant changes in perceptions of control, loneliness, and stress, and changes in control and childhood trauma history were associated with changes in perceptions of stress. Together these results indicate the importance of assessing how caregivers perceive their environment when examining what contributes to increased risk for stress. Additionally, they suggest that caregivers' stress-related processes are malleable and provide insight into potential targets for interventions aimed at reducing parents' stress.

Association Between Types of Loneliness and Risks of Functional Disability in Older Men and Women: A Prospective Analysis

OBJECTIVE

To examine the association between types of loneliness (transient, incident, and chronic) and the risk of functional disability.

METHODS

Data were from the Health and Retirement Study 2006/2008-2016/2018. A total of 7,148 adults aged ≥50 was included. Functional status was measured by activities of daily living (ADL) and instrumental activities of daily living (IADL). Loneliness was assessed using the 3-item UCLA Loneliness Scale. We defined loneliness as no/transient/incident/chronic loneliness based on the pattern and duration of loneliness across 2006/2008 and 2010/2012. We applied multivariate Cox proportional hazard models with the new-onset ADL/IADL disability as outcome.

RESULTS

Overall, 69.3% respondents showed no loneliness; while 10.3%, 8.9%, and 11.5% showed transient, incident, and chronic loneliness, respectively. A total of 1,298 (18.16%) and 1,260 (17.63%) functionally normal respondents developed ADL and IADL disability during 36,294 person-years of follow-up, respectively. After adjusting for socio-demographic, behavioral, and health factors, chronic loneliness was associated with higher risks of ADL (hazard ratio [HR] = 1.37, 95% confidence interval [CI] = 1.16-1.63, p <0.001, χ2 = 3.60, degree of freedom [df] = 1) and IADL disability (HR = 1.25, 95% CI = 1.09-1.44, p = 0.002, χ2 = 3.17, df = 1) compared to no loneliness. By contrast, no significant associations between transient loneliness and ADL (HR = 1.17, 95% CI = 0.88-1.57, p = 0.273, χ2 = 1.10, df = 1) or IADL disability (HR = 1.16, 95% CI = 0.97-1.39, p = 0.112, χ2 = 1.59, df = 1) were found. Chronic loneliness was not associated with the risk of IADL disability in men (HR = 1.13, 95% CI = 0.91-1.40, p = 0.263, χ2 = 1.12, df = 1).

CONCLUSION

Chronic loneliness, rather than transient loneliness, is an independent risk factor for functional disability in middle-aged and older adults, especially for women.

Allostatic-interoceptive anticipation of social rejection

Anticipating social stress evokes strong reactions in the organism, including interoceptive modulations. However, evidence for this claim comes from behavioral studies, often with inconsistent results, and relates almost solely to the reactive and recovery phase of social stress exposure. Here, we adopted an allostatic-interoceptive predictive coding framework to study interoceptive and exteroceptive anticipatory brain responses using a social rejection task. We analyzed the heart-evoked potential (HEP) and task-related oscillatory activity of 58 adolescents via scalp EEG, and 385 human intracranial recordings of three patients with intractable epilepsy. We found that anticipatory interoceptive signals increased in the face of unexpected social outcomes, reflected in larger negative HEP modulations. Such signals emerged from key brain allostatic-interoceptive network hubs, as shown by intracranial recordings. Exteroceptive signals were characterized by early activity between 1-15 Hz across conditions, and modulated by the probabilistic anticipation of reward-related outcomes, observed over distributed brain regions. Our findings suggest that the anticipation of a social outcome is characterized by allostatic-interoceptive modulations that prepare the organism for possible rejection. These results inform our understanding of interoceptive processing and constrain neurobiological models of social stress.

College transition Fall 2020 and 2021: Understanding the relationship of COVID-19 experiences and psychosocial correlates with anxiety and depression

Rates of mental health symptoms, particularly anxiety and depression, have increased significantly in college students in the past decade along with utilization of mental health resources. The COVID-19 pandemic created an additional source of stressors to an already challenging landscape of college transition. COVID-19 has been associated with an increase of anxiety among college students, particularly first year students, entering college in Fall 2020. The shifts in policy (e.g., federal, state, and college) accruing medical data, and vaccine availability between Fall 2020 and Fall 2021 provide an opportunity to examine the role of COVID-19 experiences in the transition to college for these two first-year student cohorts. This study examined two cohorts of first-year students, Fall 2020 and 2021, to better understand the relationship between COVID-19 experiences, psychosocial correlates, and mental health symptoms. Results suggest that for students in our Fall 2020 cohort COVID-19 experiences played a distinct role in the prediction of mental health symptoms while in Fall 2021 COVID-19 experiences did not uniquely contribute to prediction of mental health symptoms. These findings have implications for mental health interventions for first-year students transitioning to college.

Predictors of loneliness onset and maintenance in European older adults during the COVID-19 pandemic

Objectives

Loneliness is a major public health concern. Duration of loneliness is associated with severity of health outcomes, and further research is needed to direct interventions and social policy. This study aimed to identify predictors of the onset vs. the maintenance of loneliness in older adults before and during the pandemic using longitudinal data from the Survey of Health, Age, and Retirement in Europe (SHARE).

Methods

Groupings of persistent, situational, and no loneliness were based on self-reports from an ordinary pre-pandemic SHARE wave and a peri-pandemic telephone interview. Predictors were identified and compared in three hierarchical binary regression analyses, with independent variables added in blocks of geographic region, demographics, pre-pandemic social network, pre-pandemic health, pandemic-related individual, and country level variables.

Results

Self-reported loneliness levels for the persistent, situational, and no loneliness groups were stable and distinct through 7 years preceding the pre-pandemic baseline measure. Shared predictors were chronic diseases, female sex, depression, and no cohabitant partner. Persistent loneliness was uniquely predicted by low network satisfaction (OR: 2.04), functional limitations (OR: 1.40), and a longer country-level isolation period for older adults (OR: 1.24).

Conclusion

Interventions may target persons with depression, functional limitations, chronic health issues, and no cohabitant partner. The added burden of the length of isolation on those who are already lonely should be taken into account when employing social policies that target older adults. Further research should distinguish between situational and persistent loneliness, and seek to identify predictors of chronic loneliness onset.

Social cognitive neuroscience in the digital age

Human interactions are increasingly taking place from a distance through methods of remote interpersonal communication like video chatting and social media. While remote interpersonal communication has existed for millennia-with the first postal system arising in ∼2400 B.C.-accelerated advances in technology and the recent global COVID-19 pandemic have led to a dramatic increase in remote interpersonal communication use in daily life. Remote interpersonal communication presents a challenge to the field of social-cognitive neuroscience, as researchers seek to understand the implications of various types of remote interpersonal communication for the "social brain." The present paper reviews our current understanding of the social-cognitive neural network and summarizes critical differences between the neural correlates of social cognition in remote vs. face-to-face interactions. In particular, empirical and theoretical work is reviewed that highlight disparities in the neural mechanisms of social perception, evaluation of social stimuli, human motivation, evaluation of social reward, and theory of mind. Potential impacts of remote interpersonal communication on the development of the brain's social-cognitive network are also discussed. Finally, this review closes with future directions for research on social-cognitive neuroscience in our digital technology-connected world and outlines a neural model for social cognition in the context of remote interpersonal communication. For the field of social-cognitive neuroscience to advance alongside of the ever-evolving society, it is crucial for researchers to acknowledge the implications and concepts suggested for future research in this review.

Predictors of postoperative pain six months after breast surgery

Breast cancer, with a high prevalence and survival rate, leads to long-term complications. A major sequel is acute or chronic postoperative pain, and we investigated the possible relationship with clinical and psychological variables. Patients undergoing breast surgery filled out the loneliness (ULS-8) and depression (HADS) questionnaires. Patients rated their pain intensity with the Numerical Rating Scale (0-10, NRS) two days, seven days, and six months after surgery. Of 124 patients, the mean age was 45.86 years old, and the pain scores on the second and seventh postoperative days were 5.33 and 3.57, respectively. Sixth-month pain was significantly correlated with the acute scores with a mean of 3.27; and in the multivariate analysis, it was significantly associated with preoperative pain (p-value = 0.007), self-reported loneliness (p-value = 0.010), and adjuvant radiotherapy (p-value = 0.004). In conclusion, loneliness may be a risk factor for postoperative pain in breast surgery.

Homeostatic Regulation of Energetic Arousal During Acute Social Isolation: Evidence From the Lab and the Field

Recent evidence suggests that social contact is a basic need governed by a social homeostatic system. Little is known, however, about how conditions of altered social homeostasis affect human psychology and physiology. Here, we investigated the effects of 8 hr of social isolation on psychological and physiological variables and compared this with 8 hr of food deprivation in a lab experiment (N = 30 adult women). Social isolation led to lowered self-reported energetic arousal and heightened fatigue, comparable with food deprivation. To test whether these findings would extend to a real-life setting, we conducted a preregistered field study during a COVID-19 lockdown (N = 87 adults; 47 women). The drop in energetic arousal after social isolation observed in the lab replicated in the field study for participants who lived alone or reported high sociability, suggesting that lowered energy could be part of a homeostatic response to the lack of social contact.

Association between Social Isolation and Loneliness with Estimated Atherosclerotic Cardiovascular Disease Risk in a UK Biobank Population-Based Study

OBJECTIVE

The association of cardiovascular (CV) risk with social isolation and loneliness remains poorly studied. The purpose of this cross-sectional study was to investigate the associations between social isolation and loneliness with estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk.

METHODS

Among 302,553 volunteers of the UK Biobank population, social isolation and loneliness were assessed with a questionnaire. Associations between social isolation and loneliness with ASCVD risk were estimated using multiple gender regressions.

RESULTS

Men presented a higher estimated 10-year ASCVD risk (8.63% vs. 2.65%, p < 0.001) and higher proportions of social isolation (9.13% vs. 8.45%, p < 0.001) and loneliness (6.16% vs. 5.57%, p < 0.001) than women. In all covariate-adjusted models, social isolation was associated with an increased ASCVD risk in men (B = 0.21 (0.16; 0.26), p < 0.001) and women (B = 0.12 (0.10; 0.14), p < 0.001). Loneliness was associated with an increased ASCVD risk in men (B = 0.08 (0.03; 0.14), p = 0.001) but not in women (p = 0.217). A significant interaction was observed between social isolation and loneliness with ASCVD risk in men (p = 0.009) and women (p = 0.016). After adjustment for all covariates, both social isolation and loneliness were significantly associated with ASCVD risk in men (B = 0.44 (0.28; 0.61), p < 0.001) and women (B = 0.20 (0.12; 0.29), p < 0.001).

CONCLUSION

Social isolation was associated with a higher estimated 10-year ASCVD risk in both genders but only loneliness among men. Social isolation and loneliness can be considered potential added risk factors for CV risk. Health policies should address these notions in prevention campaigns, in addition to traditional risk factors.

Charting the social neuroscience of human attachment (SoNeAt)

This introduction aims to set out the potential as well as some of the pitfalls of the newly emerging area of the Social Neuroscience of Human Attachment (SoNeAt). To organize and interconnect the burgeoning empirical studies in this line of research, including those in this special issue, we outline a programmatic framework including an extension of our conceptual proposals NAMA and NAMDA to guide future research. We hope that this special issue will act as a stimulus for redoubling our efforts advancing the newly emerging SoNeAt area bridging attachment theory and social neuroscience.