Translation and Validation of the De Jong Gierveld Loneliness Scale Among Older Migrants Living in the Netherlands

Age and Gender Identity in the Relationship Between Minority Stress and Loneliness: A Global Sample of Sexual and Gender Minority Adults

Loneliness is prevalent among sexual minority adults and is associated with minority stress. Yet there is limited understanding of how loneliness and minority stress vary across key demographic variables. This cross-sectional study explored age and gender differences in a minority stress model linking sexual orientation marginalization to social and emotional loneliness via proximal stress (internalized homonegativity, concealment, and stigma preoccupation) and via social anxiety and inhibition. The study also assessed age and gender differences in the protective influence of LGBTQ community involvement. 7,856 sexual minority adults from 85 countries completed an online survey. They were categorized as emerging adults (18-24, n = 3,056), young adults (25-34, n = 2,193), midlife adults (35-49, n = 1,243), and older adults (50-88, n = 1,364). Gender identity groups were cisgender men (n = 4,073), cisgender women (n = 3,017), and transgender individuals (n = 766). With each successive age group, there was a lower prevalence of sexual orientation marginalization, proximal stress, social anxiety, inhibition, and emotional loneliness, along with more community involvement. Sexual orientation marginalization was more pronounced among cisgender women and, especially, transgender individuals. The latter also exhibited the most social anxiety, inhibition, loneliness, and community involvement. Proximal stress was more prevalent among cisgender men than cisgender women and transgender individuals. Multiple group structural equation modeling supported the applicability of the loneliness model across age and gender groups, with only a few variations; these mainly related to how strongly community involvement was linked to marginalization, internalized homonegativity, and social loneliness.

Effects of the COVID-19 Pandemic on the Wellbeing of LGBTQ+ Individuals in Moldova: A Mixed Methods Analysis

Research on the effects of the COVID-19 pandemic for LGBTQ+ people is limited, particularly in eastern Europe. This mixed methods study explored the direct and indirect effects of the pandemic on the mental and physical wellbeing of LGBTQ+ individuals in Moldova. From June to the end of July 2022, 86 surveys and 12 interviews were completed by self-identified LGBTQ+ adults in Moldova. Survey data were analyzed with descriptive statistics and interviews were coded and analyzed using the grounded theory methodology. The two data sets were interpreted concurrently to identify emergent themes. Overall, data suggest LGBTQ+ people experienced both negative and positive effects on their mental wellbeing due to the pandemic. Participants expressed feelings of anxiety, loneliness, and depression, and an inability to be their authentic selves. Conversely, participants had more capacity to explore their identities and they demonstrated social support within the LGBTQ+ community. Regarding physical impacts, there were interruptions to transgender medical care and concerns about housing affordability. Findings highlight the unique impacts of the pandemic on LGBTQ+ people and stress the importance of further research in this area and policies and plans to address the needs of LGBTQ+ people in response to the pandemic and future health crises.

Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): a pragmatic randomised controlled trial

BACKGROUND

Older adults were more likely to be socially isolated during the COVID-19 pandemic, with increased risk of depression and loneliness. We aimed to investigate whether a behavioural activation intervention delivered via telephone could mitigate depression and loneliness in at-risk older people during the COVID-19 pandemic.

METHODS

BASIL+ (Behavioural Activation in Social Isolation) was a pragmatic randomised controlled trial conducted among patients recruited from general practices in England and Wales, and was designed to assess the effectiveness of behavioural activation in mitigating depression and loneliness among older people during the COVID-19 pandemic. Eligible participants were aged 65 years and older, socially isolated, with a score of 5 or higher on the Patient Health Questionnaire-9 (PHQ-9), and had multiple long-term conditions. Participants were allocated in a 1:1 ratio to the intervention (behavioural activation) or control groups by use of simple randomisation without stratification. Behavioural activation was delivered by telephone; participants were offered up to eight weekly sessions with trained BASIL+ Support Workers. Behavioural activation was adapted to maintain social connections and encourage socially reinforcing activities. Participants in the control group received usual care with existing COVID-19 wellbeing resources. The primary clinical outcome was self-reported depression severity, assessed by the PHQ-9, at 3 months. Outcomes were assessed masked to allocation and analysis was by treatment allocation. This trial is registered with the ISRCTN registry (ISRCTN63034289).

FINDINGS

Between Feb 8, 2021, and Feb 28, 2022, 449 eligible participants were identified and 435 from 26 general practices were recruited and randomly assigned (1:1) to the behavioural activation intervention (n=218) or to the control group (usual care with signposting; n=217). The mean age of participants was 75·7 years (SD 6·7); 270 (62·1%) of 435 participants were female, and 418 (96·1%) were White. Participants in the intervention group attended an average of 5·2 (SD 2·9) of eight remote behavioural activation sessions. The adjusted mean difference in PHQ-9 scores between the control and intervention groups at 3 months was -1·65 (95% CI -2·54 to -0·75, p=0·0003). No adverse events were reported that were attributable to the behavioural activation intervention.

INTERPRETATION

Behavioural activation is an effective and potentially scalable intervention that can reduce symptoms of depression and emotional loneliness in at-risk groups in the short term. The findings of this trial add to the range of strategies to improve the mental health of older adults with multiple long-term conditions. These results can be helpful to policy makers beyond the pandemic in reducing the global burden of depression and addressing the health impacts of loneliness, particularly in at-risk groups.

FUNDING

UK National Institute for Health and Care Research.

Eliciting preferences of persons with dementia and informal caregivers to support ageing in place in the Netherlands: a protocol for a discrete choice experiment

INTRODUCTION

Ageing in place (AIP) for persons with dementia is encouraged by European governments and societies. Healthcare packages may need reassessment to account for the preferences of care funders, patients and informal caregivers. By providing insight into people's preferences, discrete choice experiments (DCEs) can help develop consensus between stakeholders. This protocol paper outlines the development of a Dutch national study to cocreate a healthcare package design methodology built on DCEs that is person-centred and helps support informal caregivers and persons with dementia to AIP. A subpopulation analysis of persons with dementia with a migration background is planned due to their high risk for dementia and under-representation in research and care.

METHODS AND ANALYSIS

The DCE is designed to understand how persons with dementia and informal caregivers choose between different healthcare packages. Qualitative methods are used to identify and prioritise important care components for persons with dementia to AIP. This will provide a list of care components that will be included in the DCE, to quantify the care needs and preferences of persons with dementia and informal caregivers. The DCE will identify individual and joint preferences to AIP. The relative importance of each attribute will be calculated. The DCE data will be analysed with the use of a random parameters logit model.

ETHICS AND DISSEMINATION

Ethics approval was waived by the Amsterdam University Medical Center (W23_112 #23.137). A study summary will be available on the websites of Alzheimer Nederland, Pharos and Amsterdam Public Health institute. Results are expected to be presented at (inter)national conferences, peer-reviewed papers will be submitted, and a dissemination meeting will be held to bring stakeholders together. The study results will help improve healthcare package design for all stakeholders.

Students' academic engagement during COVID-19 times: a mixed-methods study into relatedness and loneliness during the pandemic

The COVID-19 outbreak forced higher education students to study online-only. Previous research indicates that forced solitude or loneliness can cause a variety of problems for students, among which is reduced academic engagement. The Basic Psychological Needs Theory, a sub-theory of Self-Determination Theory, relates academic engagement to three basic psychological needs (autonomy, competence and relatedness), whereas varying theories on loneliness highlight the complexities of engaging in a learning environment whilst feeling lonely. As university staff members have been struggling to keep students on task since the COVID-19 outbreak, the need arose for more knowledge about to what extent students have felt lonely, frustrated or satisfied in their need for relatedness and to what extent this affected their academic engagement. A convergent Mixed Methods research study was conducted among university students (N = 228) and an online questionnaire was administered to collect both quantitative and qualitative data. A series of multiple hierarchical regression analyses were performed, considering demographic characteristics, to analyze the quantitative data. Qualitative data was coded using a hybrid approach of deductive and inductive coding. Themes were generated that depicted in-depth issues of relatedness, loneliness, and academic engagement. Quantitative analysis demonstrated the importance for academic engagement of both (a) 'basic need satisfaction and frustration' of relatedness in life and in 'social study context', and (b) feeling (emotionally) lonely. The negative impact of frustration of relatedness seemed to be dominant but also overlapped with the effects of loneliness. The qualitative outcomes support and complement these quantitative results. The results showed that students' academic engagement suffered from the loss of a shared physical space and from uncertainty about university policies. For a minority of students, however, the relief from social obligations that came along with social distancing was a blessing in disguise.

A systematic review evaluating loneliness assessment instruments in older adults

Introduction and objectives

The experiences and changes that come along with old age may lead to a feeling of loneliness, usually followed by negative physical and mental manifestations. In this systematic review, we evaluated the existing tools to assess loneliness in older adults.

Methods

We performed a literature search in the Web of Science, Medline, and PsycINFO, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. After, we examined the psychometric properties of the instruments with a focus on reliability, validity, and main conclusions.

Results

We included 27 articles published between 1996 and 2021.

Conclusion

To date, there are few instruments to assess loneliness in older adults. In general, they present adequate psychometric properties, although it is true that some scales show somewhat low levels of reliability and validity.

Pornography Use among Lebanese Adults: Association with Loneliness and Fear of Commitment

(1) Background: Sexuality is a prohibited topic about which knowledge is highly lacking among Arabs compared to Westerners, due to religious restrictions. A majority of people believes that any use of pornography is a toxic conduct that will have negative repercussions; these beliefs only shame those who engage in this behavior. Consumption of pornography can be attributed to self-reported reasons such as loneliness and fear of commitment. To date, there has been a dearth of research in Lebanon concerning pornography use. Hence, this study aims to assess the correlation between loneliness, fear of commitment, and internet pornography use among Lebanese adults. (2) Methods: This cross-sectional study conducted between October and November 2020 assessed pornography use through the Cyber-Pornography Use Inventory, Jong Gierveld Loneliness Scale, and Fear of commitment scale. It enrolled 653 adults from all Lebanese geographic areas. (3) Results: Women compared to men and Muslims compared to Christians were significantly associated with lower pornography addictive patterns scores, whereas more fear of commitment was significantly associated with higher pornography addictive patterns scores. More fear of commitment and more loneliness were significantly associated with higher having guilt regarding online porn use scores. Muslims compared to Christians had significantly lower online sexual behaviors scores. (4) Conclusions: Further research is recommended to properly assess internet pornography use and develop appropriate treatment options.

Evaluation of bio-psycho-social and socio-cultural problems of Syrian elderly living in Turkey

BACKGROUND

Older persons are among the vulnerable groups most affected by war and migration due to physical weakness, illness, social environment, and cultural adaptation difficulties.

AIMS

The aim of this study is to determine the economic, biopsychosocial, and socio-cultural problems of the older Syrians living in Turkey.

METHODS

Convergent mixed design was used within the scope of the research. For the qualitative phase of the research, 19 older persons migrants were interviewed. A semi-structured interview form was used to collect data in the interviews. For the quantitative phase of the research, 432 participants were reached. In order to collect data, Geriatric Depression Scale (GDS-15) and Socio-cultural Adaptation Scale (SCAS-R) were used together with the demographic information form.

RESULTS

The mean age of the participants was 66.2 ± 7.10 (Min: 60; Max: 91), the majority (87%) between the ages of 60 to 74 and 53.2% were male. The mean SCAS-R score of the older Syrians was 2.48 ± 0.88 (Min: 1; Max: 5) and the mean GDS-15 was 2.63 ± 3.84 (Min: 0; Max: 15). About 22.7% of older Syrian participants had mild or severe depressive symptoms. Experienced traumatic events, changing economic situation, and family relationships affected both physical and mental health of the older persons. The socio-cultural adaptation of the older persons was affected by language, temporary protection, and exposure to exclusion. The Older Syrians, who lacked information on social services, were experiencing problems with nutrition, clothing, bill payment, and rent due to economic problems. However, they mostly did not want to return to Syria because their living order in Syria was deteriorating and they were afraid.

CONCLUSION

Syrian elderly immigrants living in Turkey have biopsychosocial, economic, and cultural problems. National and international support programs and policies should be developed for elderly Syrian refugees who are expected to live in Turkey unless a safe living environment is provided.

Psychometric Properties of the 11-Item De Jong Gierveld Loneliness Scale in a Representative Sample of Mexican Older Adults

Recent studies have focused on the negative effects of loneliness on health and quality of life in older adults. The De Jong Gierveld Loneliness Scale (DJGLS) has been widely used and has proven to be a valid and reliable instrument for loneliness assessment. However, research on this topic and on the validation of measurement scales among the older population is still incipient. The objective of this study was to examine the psychometric properties of the Spanish version of the 11-item DJGLS in Mexican older adults. Data from a representative sample of cognitively intact older adults aged 60 years and over (mean, standard deviation [SD]) age = 72.0 years (SD 8.1) from two Mexican cities (n = 1913), interviewed face to face at their homes during 2018-2019, were analyzed. The psychometric properties of the DJGLS were examined, including (1) construct validity, examined by Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA), discriminate validity and convergent validity, (2) reliability, calculated using Cronbach's alpha. The overall data quality was high, and the scaling assumptions were generally met with few exceptions. Using EFA and CFA, the findings showed that the DJGLS presents a two-factor structure (Social Loneliness and Emotional Loneliness), with 11 items that explain 67.2% of the total variance. Reliability is adequate at the full-scale level (Cronbach´s α = 0.899), also for the two subscales Social and Emotional Loneliness (Cronbach´s α = 0.892 and 0.776, respectively). These results highlight that most participants with a low score for depressive symptoms and or with a high social support score belonged to the "No loneliness" group. The results showed that the Spanish version of the 11-item DJGLS is adequate for use in Mexican older adults and should be used not only for loneliness screening but also for social and emotional loneliness assessment.

Neighbourhood Ethnic Density, Local Language Skills, and Loneliness among Older Migrants-A Population-Based Study on Russian Speakers in Finland

So far, little attention has been paid to contextual factors shaping loneliness and their interaction with individual characteristics. Moreover, the few existing studies have not included older migrants, identified as a group who are vulnerable to loneliness. This study examined the association between neighbourhood ethnic density (the proportion of own-group residents and the proportion of other ethnic residents in an area) and loneliness among older migrants. Furthermore, we investigated whether local language skills moderated this association. A population-based representative survey (The CHARM study, n = 1082, 57% men, mean age 63.2 years) and postal code area statistics were used to study Russian-speaking migrants aged 50 or older in Finland. The study design and data are hierarchical, with individuals nested in postcode areas. We accounted for this by estimating corresponding mixed models. We used a linear outcome specification and conducted logistic and ordinal robustness checks. After controlling for covariates, we found that ethnic density variables (measured as the proportion of Russian speakers and the proportion of other foreign speakers) were not associated with loneliness. Our interaction results showed that increased own-group ethnic density was associated with a higher level of loneliness among those with good local language skills but not among those with weaker skills. Good local language skills may indicate a stronger orientation towards the mainstream destination society and living in a neighbourhood with a higher concentration of own-language speakers may feel alienating for those who wish to be more included in mainstream society.

Validation of the De Jong Gierveld Loneliness Scale in Peruvian old adults: a study based on SEM and IRT multidimensional models

Loneliness is a public health problem. Its assessment is important to identify older adults who experience greater loneliness and appropriate interventions can be carried out. The De Jong Gierveld Solitude Scale (DJGLS) is one of the most widely used, at least in the European context, to measure loneliness. Although the Spanish version of the DJGLS has shown reliability and validity in Spanish samples of older adults, there is no evidence of adequacy in the Latin American context. Therefore, this study aims to evaluate the psychometric properties of the DJGLS in Peruvian older adults. Specifically, factorial validity, internal consistency and criterion-related validity were studied, based on a double analytical perspective: Classical Test Theory (SEM models) and Item Response Theory. The participants were 235 Peruvian older adults with ages ranging from 61 to 91 years old (Mean = 72.69, SD = 6.68) that assisted to Centers for the Elderly in the city of Trujillo, Peru. Together with the DJGLS, information from the three-item UCLA loneliness scale, Satisfaction with Life Scale, Brief Resilient Coping Scale and the Patient Health Questionnarie-2 was also gathered. The results support a one-dimensional structure of the DJGLS but with the presence of method effects associated to the negatively worded items. Additionally, the IRT multidimensional model applied also indicated the presence of a second dimension related to these negative items. Finally, other evidences of reliability and validity were adequate. In summary, the DJGLS may be considered a reliable and valid instrument to be used in the Peruvian (older adults) context.

Climate Anxiety, Loneliness and Perceived Social Isolation

AIM

The goal of this study was to investigate the association of climate anxiety with loneliness and perceived social isolation (also stratified by age group).

METHODS

Data were taken from the general adult population aged 18 to 74 years (n = 3091). Data collection took place in March 2022. Climate anxiety was measured using the Climate Anxiety Scale. The De Jong Gierveld tool was used to quantify loneliness and the Bude and Lantermann tool was used to assess perceived social isolation.

RESULTS

Multiple linear regressions revealed an association between higher climate anxiety and higher loneliness (β = 0.06, p < 0.001) as well as higher perceived social isolation (β = 0.10, p < 0.001) among the total sample. A similar picture was identified in age-stratified regressions (i.e., among individuals aged 18 to 29 years, 30 to 49 years, and among individuals aged 50 to 64 years). However, climate anxiety was neither associated with loneliness nor with perceived social isolation among individuals aged 65 to 74 years.

CONCLUSIONS

Our current study adds first evidence regarding the link between climate anxiety and loneliness as well as perceived social isolation and can serve as a basis for upcoming studies.

Multicountry study protocol of COCOON: COntinuing Care in COVID-19 Outbreak global survey of New, expectant, and bereaved parent experiences

INTRODUCTION

Globally, the COVID-19 pandemic has significantly disrupted the provision of healthcare and efficiency of healthcare systems and is likely to have profound implications for pregnant and postpartum women and their families including those who experience the tragedy of stillbirth or neonatal death. This study aims to understand the psychosocial impact of COVID-19 and the experiences of parents who have accessed maternity, neonatal and bereavement care services during this time.

METHODS AND ANALYSIS

An international, cross-sectional, online and/or telephone-based/face-to-face survey is being administered across 15 countries and available in 11 languages. New, expectant and bereaved parents during the COVID-19 pandemic will be recruited. Validated psychometric scales will be used to measure psychosocial well-being. Data will be analysed descriptively and by assessing multivariable associations of the outcomes with explanatory factors. In seven of these countries, bereaved parents will be recruited to a nested, qualitative interview study. The data will be analysed using a grounded theory analysis (for each country) and thematic framework analysis (for intercountry comparison) to gain further insights into their experiences.

ETHICS AND DISSEMINATION

Ethics approval for the multicountry online survey, COCOON, has been granted by the Mater Misericordiae Human Research Ethics Committee in Australia (reference number: AM/MML/63526). Ethics approval for the nested qualitative interview study, PUDDLES, has been granted by the King's College London Biomedical & Health Sciences, Dentistry, Medicine and Natural & Mathematical Sciences Research Ethics Subcommittee (reference number: HR-19/20-19455) in the UK. Local ethics committee approvals were granted in participating countries where required. Results of the study will be published in international peer-reviewed journals and through parent support organisations. Findings will contribute to our understanding of delivering maternity care services, particularly bereavement care, in high-income, lower middle-income and low-income countries during this or future health crises.

How (Not) to Measure Loneliness: A Review of the Eight Most Commonly Used Scales

Loneliness affects well-being and has long-term negative impacts on physical and mental health, educational outcomes, and employability. Because of those current and long-term impacts, loneliness is a significant issue for which we need reliable and appropriate measurement scales. In the current paper, psychometric properties of the eight most commonly used loneliness scales are reviewed both descriptively and meta-analytically. Results suggest that for many of the scales, the psychometric properties are promising. However, for some psychometric features, especially test-retest reliability and measurement invariance, evidence is rather scarce. Most striking, however, is the fact that all of the scales included items that do not measure loneliness. Surprisingly, for many (sub)scales, this was even the case for about half of the items. Because our measures are the foundation of our research work, it is crucial to improve the way loneliness is being measured.

Minority Stress and Loneliness in a Global Sample of Sexual Minority Adults: The Roles of Social Anxiety, Social Inhibition, and Community Involvement

Research suggests that loneliness among sexual minority adults is associated with marginalization, but it is unclear which processes may underlie this relationship. This cross-sectional study examined five possibilities: stigma preoccupation, internalized homonegativity, sexual orientation concealment, social anxiety, and social inhibition. The study also examined the possible protective role of LGBTQ community involvement. Respondents were 7856 sexual minority adults aged 18-88 years from 85 countries who completed an online survey. Results of structural equation modeling indicated that marginalization was positively associated with both social and emotional loneliness, and that part of this relationship was indirect via proximal minority stress factors (especially stigma preoccupation) and, in turn, social anxiety and social inhibition. Moreover, while LGBTQ community involvement was associated with greater marginalization, it was also associated with lower levels of proximal stress and both forms of loneliness. Among those who were more involved in the LGBTQ community, the associations between marginalization and proximal stress were somewhat weaker, as were those between stigma preoccupation and social anxiety, and between social inhibition and social loneliness. In contrast, the associations between concealment and social anxiety were somewhat stronger. Model fit and patterns of association were similar after controlling for the possible confounding effect of dispositional negative affectivity, but several coefficients were lower. Findings underscore the continuing need to counter marginalization of sexual minorities, both outside and within the LGBTQ community, and suggest possible avenues for alleviating loneliness at the individual level, such as cognitive-behavioral interventions targeting stigma preoccupation and social anxiety.

Psychometrics of Persian version of the 11 items De Jong Gierveld loneliness scale among an Iranian older adults population

Background

Older adults duo to circumstances of aging such as relationship losses, medical morbidities, and functional declines, are prone to social isolation and loneliness more than any other age group. Furthermore, with The recent outbreak of the COVID-19 pandemic and the need to quarantine, the possibility of feelings of loneliness, especially in older adults, became an important nursing priority. Therefore, it is important to quickly identify loneliness and respond appropriately to prevent, reduce, or treat it. The aim of this study was to translate the De Jong Gierveld loneliness scale into Persian for older adults.

Methods

The sample was 400 adults aged 65 and older with a mean age of 71.32 (SD= ± 6.09) years. Recruitment and data collection was done via online methods. The original scale was translated into Persian using the World Health Organization (WHO) protocol of forward-backward translation technique. Face validity and content validity; was followed by exploratory and confirmatory factor analysis. Lastly, reliability was assessed using the Average Inter-Item Correlation, Cronbach’s alpha, and McDonald’s Omega.

Results

The results showed that the Persian version of the loneliness scale had two factors namely social loneliness (5 items) and emotional loneliness (3 items) and the combined score explained 45.66% of the total variance of this scale. In addition, all goodness of fit indices confirmed a two factors model fit and all of the reliability indices were excellent.

Conclusions

The Persian version of the loneliness scale is useful and suitable for detecting social loneliness and emotional loneliness in older Iranian adults.

¡Mi Vida Saludable! A randomized, controlled, 2 × 2 factorial trial of a diet and physical activity intervention among Latina breast cancer survivors: Study design and methods

BACKGROUND

Most Latina breast cancer survivors do not meet diet and physical activity (PA) guidelines for cancer survivors and effective lifestyle interventions to adopt and maintain these recommendations are limited, especially among underserved populations. Here we describe the design, methods and enrollment of a 2 × 2 factorial-designed trial testing the separate effects of the ¡Mi Vida Saludable! (My Healthy Life!) intervention program on changes in diet and PA behaviors among Latina breast cancer survivors.

METHODS

Latinas with a history of stage 0-III breast cancer, no evidence of recurrent/metastatic disease, and > 90 days post-treatment were primarily identified via cancer registries and physician referral. Participants were randomized to four arms: 1) 4 weeks of in-person group sessions plus 11 months of eHealth communication, 2) in-person group sessions alone, 3) eHealth alone, or 4) control. All participants received a Fitbit to self-monitor PA. Assessments at baseline, 6 and 12 months include diet, PA, anthropometrics, predictors and mediators of behavior change, psychosocial and quality of life outcomes, and blood draw.

RESULTS

Of 884 women screened between January 2016 and September 2018, 27% were eligible. Primary reasons for ineligibility included not being willing/able to participate due to work/life responsibilities, health reasons, or transportation. Of 241 eligible women, 167 completed baseline assessment and enrolled.

CONCLUSIONS

We successfully enrolled a diverse group of breast cancer survivors representing more than 15 Latin American nationalities to a diet and physical activity trial. If effective, the ¡Mi Vida Saludable! program can be implemented by community groups and medical centers.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02780271, registered May 2016.

Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: in search for an explanation

The prevalence of loneliness among Turkish-Dutch and Moroccan-Dutch older adults is higher than among Dutch older adults of non-migrant origin. Three explanations may account for this difference: (1) differential item functioning might result in scores that vary in intensity and in meaning across categories; (2) the position of migrants is much more vulnerable than that of non-migrants; (3) the lack of protective factors has more severe consequences for older migrants. The Longitudinal Aging Study Amsterdam interviewed 176 persons born in Morocco and 235 born in Turkey, aged 55-66 and living in urban areas. They are compared with a matched sample of 292 Dutch persons. The psychometric properties of the loneliness scale are satisfying, although there is some differential item functioning. Older migrants have more frequent social contacts but are at a disadvantage in other domains. Taking into account differences in social participation, satisfaction with income, mastery and depressive symptoms, the difference between older migrants' and non-migrants' loneliness is reduced by more than half. Protective factors are equally important for older migrants and non-migrants. Exceptions are marriage (less protective for Moroccans), frequent contact with children/children-in-law (mostly for Turks), a higher educational level (protects Moroccans and Turks) and better physical functioning (less for Turks). Being an older migrant and belonging to a minority might further contribute to feelings of loneliness. Interventions can be directed at stimulating social contact, but also at aspects like enhancing the appreciation of their social status and avoiding negative interpretations of a situation.

Psychological distress, cardiometabolic diseases and musculoskeletal pain: A cross-sectional, population-based study of syndemic ill health in a Dutch fishing village

Background

Disease clustering is a growing public health concern and is increasingly linked to adverse socioeconomic conditions. Few population-based studies have focussed on interaction between non-communicable diseases. In this cross-sectional study, we examine clustering of, and synergistic interactions between, frequently occurring non-communicable diseases in Katwijk, a former fishing village in the Netherlands. Additionally, our study identifies contextual variables associated with these clusters of non-communicable diseases.

Methods

In a survey among adults (>19 years) living in the former fishing village Katwijk, Netherlands, were asked about non-communicable diseases, psychological distress, self-rated health scores and contextual factors, eg, socio-demographic, psychosocial and health behavior characteristics. Interaction was measured on the additive and the multiplicative scale. We used generalized ordered logistic regression analysis to examine associations with contextual variables.

Results

Three disease clusters were found to be most prevalent among the study participants (n = 1408). Each cluster involved a combination of frequently occurring conditions in this population: psychological distress (n = 261, 19%), cardiometabolic diseases (n = 449, 32%) and musculoskeletal pain (n = 462, 33%). These three diseases interact synergistically on the additive scale to increase the odds of reporting a low self-rated health. None of the disease clusters showed a statistically significant positive interaction on a multiplicative scale. Multiple contextual factors were associated with these disease clusters, including gender, loneliness, experiencing financial stress, and a BMI≥30.

Conclusion

Our findings imply that psychological distress, cardiometabolic diseases and musculoskeletal pain synergistically interact, leading to a much lower self-rated health than expected. Several contextual factors are related to this interaction emphasizing the importance of a multicomponent, ecological approach.

Loneliness in mid-life and older adults from ethnic minority communities in England and Wales: measure validation and prevalence estimates

We investigated the prevalence of loneliness among 1206 adults aged 40 + from six minority communities in England and Wales: Black Caribbean, Black African, Indian, Pakistani, Bangladeshi and Chinese. Replicating the approach from the previous studies, we demonstrate robust acceptability, reliability and validity for both the six-item De Jong Gierveld (DJG) and single-item loneliness scales in our six ethnic groups. The prevalence of loneliness using a single-item question (loneliness reported as often/always) ranges from 5% (Indian) to 14% (Chinese) compared with approximately 5% for the general population aged 40 + in Britain. Levels of loneliness are very much higher using the DJG scale. Using a loneliness threshold score of 5 +, the percentage ranged from 13% (Indian) to 36% (Chinese). We explored the importance of six established loneliness vulnerability factors for our sample using regression modelling. Three factors were not associated with loneliness-number of children, gender and health rating, and three factors were protective: younger age, being married and low financial strain. The addition of ethnicity did not change these relationships or enhance statistical power of our models. Being a member of the African Caribbean group was protective against loneliness but not for the other groups included in our study. We suggest that exposure to loneliness vulnerability factors rather than ethnicity per se or measurement artefact underpins differences in loneliness across ethnic groups.

Meditation program mitigates loneliness and promotes wellbeing, life satisfaction and contentment among retired older adults: a two-year follow-up study in four South Asian cities

OBJECTIVES

To examine the impact of a meditation program in mitigating loneliness and promoting wellbeing, life satisfaction and contentment among retired South Asian older adults.

METHOD

Intervention group older adults (IN₂ =166) underwent weekly classes of the customized meditation program for 2 years as compared to the control group (CN₂ =157) who underwent no intervention. Four scales were used to measure the outcomes: De Jong Gierveld Loneliness Scale (six-items), Warwick-Edinburgh Mental Wellbeing Scale, Satisfaction with Life Scale and Contentment with Life Assessment Scale.

RESULTS

There were significant mean differences in the post-test scores on loneliness, wellbeing, life satisfaction and contentment outcomes of the intervention group, with high observed effect sizes (Cohen's d range = 2.43-8.78, p≤.01). The intervention group older adults reported that they were less lonely and experienced greater wellbeing, life satisfaction and contentment post-test (η_p² =.71-.78, p≤.01). Within the intervention cohort, post-test scores were higher for men, Hindus, middle class, married, living with spouse/children/kin, with acquired treatable lifestyle ailments, who attended 76-100 meditation lessons and regularly practiced at home. Results of the hierarchical regression models indicated that home practice was the strongest predictor explaining 17% (±.82%) variation in the outcomes. The structural equation models indicated that meditation lessons attended and home practice mediated the relationship between demographic variables and outcomes.

CONCLUSION

The customized meditation program is an effective loneliness-mitigating intervention for retired older adults. Identifying social cognition as a function of loneliness, this intervention addresses negative thoughts and feelings associated with a mental perception of loneliness.

Cross-Cultural Equivalence of De Jong Gierveld Loneliness Scale Among Older Native and Diasporic Chinese Adults

Background and Objectives

Loneliness is prevalent among older adults and known to be detrimental to mental health. The objective of this study was to determine the psychometric properties of the Chinese 6-item De Jong Gierveld Loneliness Scale (DJGLS) in the older native and diasporic Chinese community.

Research Design and Methods

Participants were recruited from a local community in urban Tianjin, China and urban Chinese communities of older adults in the Netherlands. Scale properties, including reliability, were calculated with Cronbach’s alpha and multiple-group confirmatory factor analysis to examine the 2-dimensional structure of the scale and the cross-cultural equivalence between both countries. Item response analysis was employed to plot the relationships between the item response and expected total scale score.

Results

A total of 193 older adults from China and 135 older adults from the Netherlands were included. The Cronbach’s alphas were 0.68 (China) and 0.71 (the Netherlands). The DJGLS’s 2-dimensional structure was validated by the goodness of fit and the factor loadings. Cross-cultural equivalence was demonstrated with the multiple-group confirmatory analysis. In addition, sufficient discriminative power of the individual items was demonstrated by item response analysis in both countries.

Discussion and Implications

This study is the first to provide a detailed item behavior analysis with an item response analysis of the DJGLS. In conclusion, the findings of this study suggest that the DJGLS has an adequate and similar item and scalar equivalence for use in Chinese populations.

Psychological Resilience in the Context of Disability: A Study With Turkish and Moroccan Young-Old Immigrants Living in the Netherlands

BACKGROUND AND OBJECTIVES

The disability paradox postulates that some individuals with severe functional limitations demonstrate psychological resilience, that is, good mental health and quality of life. Resilience to disabilities has been linked to psychological (e.g., mastery) and social factors (e.g., social provisions). It is, however, less clear whether cultural factors can provide additional resources for resilience building in older immigrants. We investigated the extent to which sociodemographic, psychosocial, and cultural factors contributed to psychological resilience to disabilities among immigrants of Turkish and Moroccan descent in the Netherlands.

RESEARCH DESIGN AND METHOD

The sample included 478 older immigrants aged 55-65 years. Data were analyzed using latent profile analysis and multinomial logistic regressions.

RESULTS

Five categories were identified: (a) High physical and emotional functioning; (b) High physical but poor emotional functioning; (c) Low physical but high emotional functioning (resilient); (d) Low physical and emotional functioning; and (e) Low physical and very low emotional functioning. Resilient functioning (reference category) was associated with poorer Dutch language proficiency, lower levels of loneliness, greater mastery, and more religious coping.

DISCUSSION AND IMPLICATIONS

Findings provide support for the disability paradox and highlight social provisions, mastery, and religiosity/spirituality as important resources for psychological resilience in older labor migrants. Poor Dutch language proficiency is discussed as a potential factor contributing to severe functional limitations in the resilient category.

The Longitudinal Aging Study Amsterdam: cohort update 2019 and additional data collections

The Longitudinal Aging Study Amsterdam (LASA) is a prospective cohort study of older adults in the Netherlands, initially based on a nationally representative sample of people aged 55-84 years. The study has been ongoing since 1992, and focuses on the determinants, trajectories and consequences of physical, cognitive, emotional and social functioning. Strengths of the LASA study include its multidisciplinary character, the availability of over 25 years of follow-up, and the cohort-sequential design that allows investigations of longitudinal changes, cohort differences and time trends in functioning. The findings from LASA have been reported in over 600 publications so far (see www.lasa-vu.nl). This article provides an update of the design of the LASA study and its methods, on the basis of recent developments. We describe additional data collections, such as additional nine-monthly measurements in-between the regular three-yearly waves that have been conducted among the oldest old during 2016-2019, and the inclusion of a cohort of older Turkish and Moroccan migrants.

[Stronger feelings of loneliness among Moroccan and Turkish older adults in the Netherlands: A search for an explanation]

The prevalence of loneliness among Turkish- and Moroccan-Dutch older adults is higher than among Dutch older adults of non-migrant origin. Two explanations may account for this difference. (1) The meaning of the concept may differ, or there is differential item functioning. This might result in scores that not only differ in intensity but also in meaning across groups. (2) The position of older migrants is much more vulnerable than of non-migrant older people. Data from the Longitudinal Aging Study Amsterdam were used to examine support for both explanations. Feelings of loneliness are explored among 176 people born in Morocco and 235 people born in Turkey, aged 55-66 years, and living in urban areas. They migrated on average 35 years ago to the Netherlands. They are compared with a matched sample of 292 older people of Dutch origin. The psychometric properties of the loneliness scale are satisfying, although there is some differential item functioning. Older migrants have more frequent social contacts, but are at a disadvantage in other domains. Taking into account differences in social participation, satisfaction with their income, mastery and depressive symptoms, the difference between older migrants' and non-migrants' loneliness is reduced to more than half. Being an older migrant and belonging to a minority might further contribute to feelings of loneliness. Interventions should not be directed at stimulating social contact, but rather, for example, at enhancing the appreciation of their social status and at avoiding negative interpretations of the situation.

Assessing the relative importance of correlates of loneliness in later life. Gaining insight using recursive partitioning

OBJECTIVES

Improving the design and targeting of interventions is important for alleviating loneliness among older adults. This requires identifying which correlates are the most important predictors of loneliness. This study demonstrates the use of recursive partitioning in exploring the characteristics and assessing the relative importance of correlates of loneliness in older adults.

METHOD

Using exploratory regression trees and random forests, we examined combinations and the relative importance of 42 correlates in relation to loneliness at age 68 among 2453 participants from the birth cohort study the MRC National Survey of Health and Development.

RESULTS

Positive mental well-being, personal mastery, identifying the spouse as the closest confidant, being extrovert and informal social contact were the most important correlates of lower loneliness levels. Participation in organised groups and demographic correlates were poor identifiers of loneliness. The regression tree suggested that loneliness was not raised among those with poor mental wellbeing if they identified their partner as closest confidante and had frequent social contact.

CONCLUSION

Recursive partitioning can identify which combinations of experiences and circumstances characterise high-risk groups. Poor mental wellbeing and sparse social contact emerged as especially important and classical demographic factors as insufficient in identifying high loneliness levels among older adults.

National and transnational belonging among Turkish and Moroccan older migrants in the Netherlands: protective against loneliness?

This research investigates how a sense of belonging functions as protective mechanism against loneliness. Inspired by the work of Berry (1980) on acculturation strategies (i.e. integration, assimilation, separation and marginalization), we distinguish migrants who feel a relatively strong or weak sense of belonging to larger society and those who feel a strong or weak belonging to the "own group." We expect that more national belonging contributes to less loneliness. We add a transnational perspective by arguing that feelings of belonging to the own group can take place in the country of settlement, but can also be transnational, i.e. a feeling of belonging to the country of origin. Transnational belonging can protect against loneliness, as it acknowledges the importance of place attachment. Using data from the Longitudinal Aging Study Amsterdam on older migrants aged 55-66, we employ latent class analysis and find five national belonging clusters, interpretable in terms of Berry's acculturation strategies. Further analyses reveal mixed evidence: some aspects of transnational belonging vary with belonging to the own group, but other aspects point to a third dimension of belonging. Regression analysis shows that those marginalized are loneliest and that a transnational sense of belonging contributes to more loneliness. We conclude that Berry's (1980) typology is useful for interpreting older migrants' national belonging and that a transnational sense of belonging is apparent among older migrants, but needs to be explored further.