Loneliness and subjective physical health among war veterans: Long term reciprocal effects

Evaluating the interpersonal theory of suicide among post-9/11 veterans: Suicidal desire and intent in the early transition to civilian life

Relative to the civilian population, veterans are at elevated risk of dying by suicide. However, there have been few studies using the interpersonal theory of suicide (ITS) to help explain their excess suicide desire (SD). ITS posits that the desire/intent to die by suicide occurs when two risk factors are present - thwarted belongingness (TB) and perceived burdensomeness (PB). A large cohort of post-9/11 veterans were surveyed approximately every six months over several years, beginning soon after transitioning to civilian life. Stable trait-like perceived burdensomeness (T-PB) and stable trait-like passive suicidal ideation (T-PSI) were positively associated with suicide risk (SR), while trait-like thwarted belongingness (T-TB) was not. T-TB predicted subsequent T-TB and T-PB predicted subsequent T-PB over time. T-PSI predicted subsequent T-PSI over time. T-TB inconsistently predicted T-PSI over time, while T-TB predicted T-PSI at all waves with one exception. Thus, there was partial support for ITS with T-PB and T-PSI more highly predictive of SR than T-TB. Temporal state-like perceived burdensomeness (S-PB) and temporal state-like thwarted belongingness (S-TB) were inconsistently associated with temporal state-like passive suicidal ideation (S-PSI). Several study limitations are described, including the use of validated but indirect measures of relevant ITS constructs.

Psychological symptoms and loneliness in unemployed people diagnosed with mental illnesses

PURPOSE

Loneliness is a pervasive phenomenon that is linked to adverse health outcomes. Unemployed individuals with mental illnesses (UMIs) constitute a high-risk group, with substantial implications for both health and vocational (re)integration. This study aims to gain deeper insights into the relationships between psychological problems and symptoms of psychopathology and loneliness in UMIs.

METHODS

Our research is based on a sample from LIPSY, a project that aims to maintain or restore employability. Two regression analyses were conducted on a sample of unemployed participants diagnosed with a mental illness (ICD-10: F-code) with the outcome variable loneliness (UCLA). In the first analysis, age, gender, education, cohabitation status, and social network size (LSNS-6) were used as predictors; in the second one, the nine symptom dimensions (SCL-90) - (1) Somatization, (2) Obsessive-Compulsive, (3) Interpersonal Sensitivity, (4) Depression, (5) Anxiety, (6) Anger-Hostility, (7) Phobic Anxiety, (8) Paranoid Ideation, (9) Psychoticism -were added.

RESULTS

Our sample included 397 participants with an average age of 35.8 years, 53.1% were female. The final regression showed significant positive associations between higher levels of education, Interpersonal Sensitivity, Depression, and the outcome loneliness, and a significant negative relationship between Somatization and loneliness.

CONCLUSION

The high scores on all SCL-90 dimensions, and the links identified between Somatization, Interpersonal Sensitivity, Depression, and loneliness highlight the importance of psychological screening and/or diagnostics in this high-risk group and offer several starting points for prevention measures as well as interventions.

Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages

IMPORTANCE

The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk.

DESIGN

Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF.

SETTING

Previously occupied villages in Eastern and Southern Ukraine.

PARTICIPANTS

UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female).

EXPOSURE

Participants were exposed to Russian occupation of Ukrainian villages.

MAIN OUTCOME AND MEASURES

The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster).

RESULTS

Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036).

CONCLUSIONS AND RELEVANCE

PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.

Longitudinal analyses indicate bidirectional associations between loneliness and health

OBJECTIVES

To evaluate temporal dynamics between loneliness and both objective and subjective health (i.e. functional impairment and self-rated health) in mid- to late-adulthood.

METHOD

We applied bivariate dual-change-score models to longitudinal data from 3 Swedish twin studies (N = 1,939) to explore dynamic associations between loneliness and health across 3 age ranges (50-69, 70-81, and 82+ years) to investigate whether associations between loneliness and health change with age due to increasing incidence of chronic health conditions and bereavement.

RESULTS

Results showed bidirectional associations between loneliness and both objective and subjective health, with adverse impacts of loneliness observed on subsequent subjective and objective health beginning at age 70. Associations between health and subsequent loneliness were observed after age 82 and varied for subjective and objective health, with subjective health associated with less loneliness and objective health associated with greater loneliness.

CONCLUSIONS

Our results indicate dynamic associations between loneliness and health with age in mid- to late-adulthood, with earlier impacts of loneliness on health and later impacts of health on loneliness that vary for objective and subjective measures of health. These findings suggest impacts of health on loneliness may arise later in life when worsening health or mobility interfere with social interaction.

How Migration Status Shapes Susceptibility of Individuals' Loneliness to Social Isolation

Objectives: Our research provides competing hypotheses and empirical evidence how associations between objectively social isolation and subjective loneliness differ between host populations, migrants, and refugees. Methods: The analysis uses data of 25,171 participants from a random sample of the German population (SOEP v.35). We estimate regression models for the host population, migrants, and refugees and test five hypotheses on the association between social isolation and loneliness using a Bayesian approach in a multiverse framework. Results: We find the strongest relative support for an increased need for social inclusion among refugees, indicated by a higher Bayes factor compared to the hosts and migrants. However, all theoretically developed hypotheses perform poorly in explaining the major pattern in our data: The association of social isolation and loneliness is persistently lower for migrants (0.15 SD-0.29 SD), with similar sizes of associations for refugees and the host population (0.38 SD-0.67 SD). Conclusion: The migration history must be actively considered in health service provision and support programs to better cater to the needs of the different groups.

Loneliness in Posttraumatic Stress Disorder: A Neglected Factor in Accelerated Aging?

Prior research suggests that people with Posttraumatic Stress Disorder (PTSD) may experience a form of accelerated biological aging. In other populations, loneliness has been shown to elevate risk for many of the same components of accelerated biological aging, and other deleterious outcomes, as seen in people with PTSD. Although standard diagnostic criteria for PTSD include "feelings of detachment or estrangement from others", the relationship of such feelings to the concept of loneliness remains uncertain, in par potentially due to a failure to distinguish between loneliness versus objective social isolation. In order to catalyze wider research attention to loneliness in PTSD, and the potential contribution to accelerated biological aging, the present paper provides three components: (1) a conceptual overview of the relevant constructs and potential interrelationships, (2) a review of the limited extant empirical literature, and (3) suggested directions for future research. The existing empirical literature is too small to support many definitive conclusions, but there is evidence of an association between loneliness and symptoms of PTSD. The nature of this association may be complex, and the causal direction(s) uncertain. Guided by the conceptual overview and review of existing literature, we also highlight key areas for further research. The ultimate goal of this line of work is to elucidate mechanisms underlying any link between loneliness and accelerated aging in PTSD, and to develop, validate, and refine prevention and treatment efforts.

Ageing in place and loneliness of older adults in Shanghai, China

OBJECTIVE

This study examined loneliness experiences of older adults and the relationship between ageing in place and their loneliness from the social resources perspective of social capital in Shanghai, China.

METHODS

We used the purposive sampling method and conducted face-to-face individual interviews for 21 older adults who were widowed or living alone. A semi-structured interview was carried out based on a pilot-tested interview guide, and the interviews were audio recorded and transcribed verbatim.

RESULTS

Older adults expressed a feeling of 'lonely pain', and themes identified included lack of intimacy and companionship, fear of declining health, loss and death, and a sense of disconnection from the external world. In the context of ageing in place, they mobilised the social capital embedded in the community to cope with loneliness by obtaining support, participating in activities and experiencing the trust and reciprocity that results from social networks. However, inadequate ageing in place services cannot fully alleviate the risk of loneliness for older adults, especially for those who are widowed or living alone.

CONCLUSIONS

The social capital embedded in the context of ageing in place in Shanghai partially helps older adults deal with loneliness, and future ageing in place policy and services should be improved to make older adults who wish to stay at home or in a familiar community live safely, autonomously and not feel lonely.

National identification, a social cure for COVID-19? Evidence from 67 countries

BACKGROUND

Social distancing and mass quarantines were implemented worldwide in response to the current COVID-19 pandemic. Prior research has shown that such measures bear negative consequences for population mental health and well-being. Conversely, a growing body of evidence suggests that feeling positively identified with a group is associated with physical and mental health benefits.

AIMS

This study tested whether national identification could promote wellbeing and physical health during the COVID-19 pandemic.

METHOD

We used survey data conducted among 67 countries (N = 46,450).

RESULTS

Mixed-model analyses revealed that national identity was associated with wellbeing - despite adjustment on social belonging, COVID-19 perceived risk, exposure and ideology. This effect did not extend to physical health.

CONCLUSIONS

These results suggest that the mere feeling of belonging to a national group may have mental health benefits. We discuss the implications of our findings within the social cure framework and their relevance for population mental health under COVID-19.

Personality and limitations in instrumental activities of daily living in old age: Reciprocal associations across 12 years

Personality traits have been reported to predict difficulties in performing instrumental activities of daily living (IADL) in old age, such as preparing meals or shopping. However, little is known about the reciprocal effects on personality. In this study, we examined bidirectional relationships between personality traits and the capacity to perform IADL using four waves of longitudinal data from 3540 older adults (aged 65 years and older) from the Health and Retirement Study. We applied a random-intercept cross-lagged panel model to separate between- and within-person effects across time and compared it to a traditional cross-lagged panel model. At the between-person level, higher neuroticism and lower conscientiousness were associated with more IADL limitations. Within individuals across time, increases in neuroticism and decreases in conscientiousness and extraversion were associated with increases in IADL limitations 4 years later. In contrast, increases in IADL limitations only predicted increases in neuroticism and decreases in extraversion. These results indicate that some personality traits affect and are affected by limitations in functional capacities in old age. Results of the within-person model build a strong foundation for future personality interventions as a pathway to maintain high functioning in old age.

Ex-military personnel's experiences of loneliness and social isolation from discharge, through transition, to the present day

OBJECTIVES

This study aimed to examine the unique factors of loneliness and social isolation within the ex-military population from discharge, through transition, to the present day.

DESIGN

A qualitative, Phenomenological approach was adopted.

METHODS

In-depth semi-structured interviews were carried out with 11 participants who had all served in the British Armed Forces and represented all three military services (Royal Navy; Army; Royal Air Force). Reflexive Thematic Analysis was used to analyse the data.

RESULTS

Three themes were generated-a sense of loss; difficulty in connecting in civilian life; and seeking out familiarity. The findings of this study were examined through the lenses of the Social Needs Approach and the Cognitive Discrepancy Model.

CONCLUSIONS

Individuals developed close bonds in the military through meaningful and prolonged contact, reducing feelings of loneliness and social isolation during their time in service. The sense of belonging was key to social connection, but transition out of the military severed existing relationships, and a lack of belonging hindered the development of relationships within the civilian community. This study has implications for service provision relating to ex-military personnel and future service leavers.

The roles of mental illness disclosure and disclosure strategies on well-being among college students

ObjectivesTo examine how the degree of mental illness disclosure and disclosure strategies are associated with psychological and physical well-being among college students. Participants: Participants were 181 undergraduate students from two American universities who self-identified as having been diagnosed with mental illness. Method: Participants completed an online survey, which included measures of mental illness disclosure and a range of outcome measures (e.g., life satisfaction, self-report somatic complaints). Results: The degree of mental illness disclosure was positively related to well-being outcomes. After controlling for the effect of the degree of self-disclosure, a direct disclosure strategy was positively associated with well-being outcomes, whereas disclosure strategies involving entrapment, humor, and indirect medium were related to poorer well-being outcomes. Conclusions: Results suggest that the degree of mental illness disclosure and the manner in which individuals disclose their mental illness to others may have implications to the well-being of individuals living with mental illness.

Behavioral Epidemic of Loneliness in Older U.S. Military Veterans: Results From the 2019-2020 National Health and Resilience in Veterans Study

OBJECTIVE

This study aimed to characterize the current prevalence of loneliness, and the relation between loneliness severity and mental and physical health conditions, suicidality, and functional measures in a predominantly older sample of U.S. military veterans.

METHODS

This cross-sectional study used data from the National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of U.S. veterans (N = 4,069; mean age = 62) from November 2019 through March 2020. Veterans were classified into one of 3 groups based on their current level of loneliness (hardly ever, sometimes, often) on an adapted version of the Revised UCLA Loneliness Scale. A comprehensive range of mental and physical health, and functioning variables were assessed using valid and reliable self-report assessments.

RESULTS

A total of 56.9% of veterans endorsed feeling lonely sometimes (37.2%) or often (19.7%). Loneliness severity was independently associated with a range of mental health (odds ratios [ORs] = 1.21-33.30), physical health (ORs = 1.21-6.80), and functional difficulties (d's = 0.09-0.59). Relative to hardly ever feeling lonely, feeling lonely often or sometimes was associated with a more than 12- and three-fold greater likelihood of current suicidal ideation (29.0% versus 7.3% versus 1.5%), even after adjustment for sociodemographic, military, and psychiatric risk factors.

CONCLUSIONS

Loneliness is highly prevalent in U.S. military veterans, with more than half endorsing feeling lonely sometimes or often, and 1-of-5 reporting feeling lonely often. Loneliness severity was independently associated with a broad range of mental and physical health and functional measures, ias well as suicidal ideation. Results underscore the importance of loneliness as a transdiagnostic prevention and intervention target in the U.S. veteran population.

Posttraumatic stress disorder, complex PTSD and subtypes of loneliness among older adults

OBJECTIVES

Research examining the relationship between loneliness and Complex Posttraumatic Stress Disorder (CPTSD) is scarce, particularly among older adults. CPTSD includes the core symptoms of PTSD along with additional symptoms reflecting "disturbances in self-organisation" (DSO). This study examined the cross-sectional relationships between loneliness (emotional and social loneliness) and CPTSD symptoms (i.e., PTSD and DSO symptoms) in older adults.

METHODS

Structural equation modelling was used to examine these relationships in a nationally representative sample of US adults aged 60-70 years (n = 456).

RESULTS

Controlling for covariates, emotional loneliness was associated with PTSD (β = 0.31) and DSO (β = 0.57) symptoms whereas social loneliness was only associated with DSO symptoms (β = 0.25). The model explained 35.0% of the variance in PTSD symptoms and 71.3% in DSO symptoms.

CONCLUSION

These findings have important implications for treating and understanding PTSD/CPTSD and their correlates among older adults.

Changes in the health and broader well-being of U.S. veterans in the first three years after leaving military service: Overall trends and group differences

OBJECTIVES

Scholars have theorized that the initial period after military discharge may be a particularly vulnerable time for veterans. Yet, several recent studies raise the prospect that risk for poor adjustment may actually increase rather than decrease over time. The current study examined whether the U.S. military veteran population experiences improvements or declines in their health and broader well-being during the first three years after leaving military service and documented differences based on gender, military rank, and warzone deployment history.

METHODS

A population-based sample of 3733 newly separated veterans completed a survey within three months of separation (Fall 2016), followed by five additional surveys at six-month intervals. Weighted multilevel logistic regressions were conducted to examine changes in the proportion of veterans reporting good health and broader well-being over time.

RESULTS

Most aspects of veterans' health and broader well-being worsened over time, with a noteworthy increase in reporting of mental health conditions and a decline in veterans' community involvement. Declines in the proportion of veterans reporting good health and well-being were most notable for women, with smaller differences observed for other subgroups.

CONCLUSIONS

The finding that veterans experienced worsening health and broader well-being over time highlights the need for enhanced prevention and early intervention efforts to mitigate these declines. Findings also point to the importance of attending to the unique readjustment concerns of female veterans and other at-risk subgroups.

Widowhood, widowhood duration, and loneliness among older adults in China

BACKGROUND

Widowhood is a distressful life event that is associated with loneliness in older adults. However, widowhood is not a binary event, and little is known about the role of widowhood duration in loneliness and about the relationship between widowhood duration and loneliness in different age and sex groups. Given the increases in aging population and in widowed older adults in China, we examined whether and how widowhood and widowhood duration were associated with loneliness in different age and sex groups among Chinese older adults.

METHODS

Five waves of Chinese Longitudinal Healthy Longevity Survey 2002-2014 were used. The analysis included 34,440 sampled individuals aged 65 and above. Random intercept ordered logistic models were used to examine relations between widowhood, its duration and loneliness in the entire sample and by age and sex groups.

RESULTS

Results show that with a wide set of covariates controlled for, widowhood was a significant correlate of loneliness in older adults (OR = 2.34, p < .001); and those who were remarried after widowhood were less likely to be lonely compared to their not-remarried counterparts (OR = 0.47, p < .001). In addition, widowhood was associated with more than twice greater odds of loneliness in the first couple of years following bereavement of spouse (OR = 3.09, p < .001) compared to the currently married older adults. The increased odds ratio of loneliness slightly decreased with the length of widowhood, but it was still significant, even after 40 years of bereavement (OR = 1.96, p < .001).

CONCLUSIONS

These findings are mostly consistent across age and sex groups. In conclusion, this study sheds light on the relationship between widowhood duration and loneliness and the role of remarriage in widowed older adults' loneliness based on a nationwide survey in China. Widowhood has an acute and long-lasting effect on loneliness in older adults. Remarriage after widowhood could largely reduce or offset the risk of loneliness.

Making the transition: How finding a good job is a risky business for military Veterans in Northern Ireland

Veterans transitioning from the military to civilian life may encounter difficulties in different domains of functioning. Most research in this area comes from the US and Israel, with Veterans in Northern Ireland (NI) in the United Kingdom, remaining an understudied population. This qualitative study aimed to examine the nature of transition experiences of NI Veterans by analyzing responses (N = 252) to an open-ended question related to the transition process, in a self-report survey. Thematic analysis highlighted both positive and negative experiences across high-level themes. These were related to (1a) how good the military life had been, (1b) the transition had been easy for some Veterans, and (1c) the skills gained in the military have been valuable; (2) it was hard to adjust to civilian life/still adjusting; (3) negative employment experiences; (4) lack of trust; (5) transitioning is hard in NI; and (6) inadequate support, post-service. The findings highlight that NI Veterans share some of the same challenges as other Veterans; however, the challenges in NI are compounded by ongoing security concerns and political tensions, which means living under the radar is a reality for many, making finding meaningful work and community integration difficult. The findings indicate that preparation for civilian life and the acculturation process needs to start many months before discharge. Perhaps more crucially, regiments should work closely with and support civilian employers to equip them to recognize and value the skills ex-Services Veterans can offer, and find a good fit for their skills within their organizations.

Impostorism, subjective age, and perceived health among aging veterans

RATIONALE

Aging veterans often suffer from increased vulnerability, manifested among other things in old subjective age and poor perceived health. Though research has documented the contribution of trauma related variables to these negative appraisals, their associations with impostorism (i.e., the subjective experience that one is less adequate than others perceive) remain unexamined.

OBJECTIVE

Filling this gap, this study explored the relations between impostorism and subjective age and perceived health among aging combat veterans.

METHOD

The study was conducted among 146 Israeli veterans of the 1973 Yom Kippur War. Participants were assessed for combat exposure, Posttraumatic Stress Disorder (PTSD) symptoms, and health-related behaviors during middle adulthood (1991; T1), and for subjective age, perceived health, impostorism, PTSD symptoms, and depressive symptoms during old age (2018; T2).

RESULTS

The veterans' impostorism was associated with relatively old subjective age and poor perceived health, above and beyond the effects of age, health-related behaviors, combat exposure, depressive symptoms, and PTSD symptoms.

CONCLUSIONS

The current results suggest that impostorism may contribute to veterans' stress and negatively affect their evaluations regarding age and health.