Loneliness in older Chinese adults amid the COVID-19 pandemic: Prevalence and associated factors

Media consumption patterns and depressive and anxiety symptoms in the Chinese general population during the COVID-19 outbreak

BACKGROUND

Examining patterns of media consumption and their associations with mental health outcomes in the general population during the coronavirus disease 2019 (COVID-19) pandemic has implications for public mental health in future pandemics.

AIM

To investigate patterns of media consumption and their associations with depressive and anxiety symptoms among adults affected by the COVID-19 pandemic.

METHODS

A total of 8473 adults were recruited through snowball sampling for an online cross-sectional survey. The participants were asked to report the three media sources from which they most frequently acquired knowledge about COVID-19 from a checklist of nine media sources. Depression and anxiety were assessed with the Patient Health Questionnaire and the Generalized Anxiety Disorder Scale, respectively. A two-step cluster analysis was performed to identify distinct clusters of consumption of media sources.

RESULTS

Seven clusters were identified. The lowest prevalence of depression and anxiety (29.1% and 22.8%, respectively) was observed in cluster one, which was labeled "television and news portals and clients, minimal social media". The highest prevalence of depression (43.1%) was observed in cluster three, labeled "WeChat, MicroBlog, and news portals, minimal traditional media". The greatest prevalence of anxiety (35.8%) was observed in cluster seven, which was labeled "news clients and WeChat, no newspaper, radio, or news portals". Relative to cluster one, a significantly elevated risk of depression and anxiety was found in clusters three, six (labeled "news portals and clients, WeChat, no newspaper and radio") and seven (adjusted odds ratio = 1.28-1.46, P ≤ 0.011). Multiple logistic regression analyses revealed that the risk of COVID-19 infection and knowledge about COVID-19 partially explained the variations in the prevalence of depression and anxiety across the seven clusters.

CONCLUSION

Communication policies should be designed to channel crucial pandemic-related information more effectively through traditional and digital media sources. Encouraging the use of these media and implementing regulatory policies to reduce misinformation and rumors on social media, may be effective in mitigating the risk of depression and anxiety among populations affected by the pandemic.

Factors Associated with Loneliness and Psychological Distress in Older Adults During the COVID-19 Pandemic in Kazakhstan: A Cross-Sectional Study

Background and Objectives: In Kazakhstan, during the COVID-19 pandemic, older adults faced unique challenges, such as limited healthcare resources and prolonged periods of social isolation. The aim of our study was to evaluate the sociodemographic and health-related factors associated with loneliness and psychological distress in older adults during the COVID-19 pandemic in Kazakhstan. Materials and Methods: In this cross-sectional study, a total of 445 participants aged 60 and above were recruited from Kazakhstan during the COVID-19 pandemic. The Patient Health Questionnaire-4 (PHQ-4) was used to measure psychological distress, anxiety, and depression. Loneliness was assessed using the UCLA Loneliness Scale (UCLA-3). The sociodemographic and health-related variables of the tested participants were analyzed. Results: Mean values from the UCLA-3 (p < 0.001), PHQ-4 (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001) scores significantly differed between different categories of self-reported overall health. Significantly higher mean values were found in older adults with hypertension for UCLA-3 (p = 0.025), PHQ-4 (p = 0.001), anxiety (p = 0.001), and depression (p = 0.017); diabetes for UCLA-3 (p = 0.023), PHQ-4 (p = 0.029), and depression (p = 0.001); chronic heart failure for UCLA-3 (p = 0.005), PHQ-4 (p < 0.001), anxiety (p = 0.001), and depression (p < 0.001); cerebrovascular disease for UCLA-3 (p = 0.024), PHQ-4 (p = 0.002), anxiety (p = 0.001), and depression (p = 0.027); cardiovascular disease for UCLA-3 (p < 0.001), PHQ-4 (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001); dementia for anxiety (p = 0.046); being single for UCLA-3 (p = 0.009), PHQ-4 (p = 0.031), and depression (p = 0.028); other ethnic backgrounds for PHQ-4 (p = 0.004) and anxiety (p = 0.013); and living in an urban place for PHQ-4 (p = 0.043). Being single was shown to be a significant predictor for loneliness (OR 2.21; 95%CI 1.28-3.84), anxiety (OR 2.09; 95%CI 1.14-3.84), and depression (OR 4.23; 95%CI 1.95-9.15). Below-average (OR 5.79; 95%CI 1.09-30.90) self-reported overall health was shown to be a significant predictor of anxiety. Conclusions: Our study demonstrated that numerous sociodemographic and health-related factors were associated with loneliness, anxiety, and depression in older adults from Kazakhstan during the COVID-19 pandemic.

Epidemiology of Hikikomori: A systematic review and meta-analysis of 19 studies

AIM

Hikikomori, a severe form of social withdrawal, has been recognized as an important global public health problem. However, estimates of the worldwide Hikikomori prevalence have been inconsistent. This study aimed to provide a comprehensive assessment of the cross-cultural prevalence of Hikikomori through a meta-analysis and systematic review.

METHODS

We systematically searched multiple databases (including PubMed, EMBASE, PsycINFO, and Web of Science) for relevant studies. Pooled prevalence estimates were calculated using a random-effects model. Subgroup analyses for categorical variables and meta-regression analyses for continuous variables were performed to identify potential moderators of Hikikomori prevalence estimates.

RESULTS

A total of 19 studies based on 58,229 participants were included for analysis. The overall prevalence of Hikikomori was 8.0% (95% CI, 4.9%-12.9%). The prevalence of Hikikomori did not differ significantly between regions (East Asia and Western), time periods (pre- and post-COVID-19 pandemic), sex, sample size, or presence versus absence of psychiatric disorders. In contrast, higher prevalence rates were reported in studies using the 25-item Hikikomori Questionnaire (HQ-25) (21.7%; 95% CI, 11.8%-36.4%) versus other questionnaires (5.0%; 95% CI, 3.1%-7.9%, [P < 0.01]) and nonprobability sampling (12.5%; 95% CI, 7.9%-19.2%) versus probability sampling methods (3.1%; 95% CI, 1.4%-6.9% [P < 0.01]). Lower study quality (coefficient = -0.45, P = 0.03) and older age were also linked to higher prevalence (coefficient = 0.10, P = 0.01).

CONCLUSION

This meta-analysis suggests that Hikikomori is a common problem globally. The results highlight the importance of using standardized diagnostic tools as well as further research on moderating factors and intervention methods to alleviate disabling experiences associated with Hikikomori.

Psychosocial wellbeing and risk perception of older adults during COVID-19 pandemic in Nigeria: perspectives on the role of social workers

Background

The COVID-19 pandemic presented a 'double-edged sword' for older adults: not only were they more susceptible to the virus, but its broader consequences also exacerbated other challenges, particularly those related to psychosocial well-being. Limited evidence exists on how older adults perceive the pandemic and its impact on their well-being and the role of social workers in addressing these challenges, particularly in resource-limited settings like Nigeria.

Aim

This study explored older adults' perceived risks regarding COVID-19, its impact on their psychosocial well-being, and the role of social workers in addressing these challenges in Nigeria.

Methods

A phenomenological and exploratory research design was used. In-depth interviews (IDIs) were conducted with 16 older adults and 4 social workers in Onitsha metropolis, Anambra State, Southeast Nigeria. Data were analyzed through reflexive thematic analysis.

Results

The findings revealed that the COVID-19 restrictive measures negatively impacted the psychosocial well-being of older adults, where social isolation, lack of support, the inability to engage in wellbeing activities, and emotional trauma collectively contributed to a significant decline in their mental and emotional health. Additionally, widespread misconceptions about the origin of COVID-19 led to reluctance in adopting preventive measures. While social workers provided some awareness and counselling sessions, their involvement was limited. Social workers were not recognized as part of the frontline response team, and their efforts were primarily constrained by governmental and institutional neglect.

Conclusion

The findings highlight the need for policy initiatives to enhance social workers involvement in strengthening the psychosocial resilience of older adults and addressing misconceptions during public health emergencies. Comprehensive strategies are essential for safeguarding the psychosocial well-being of older adults in future pandemics or similar crises.

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Long-Lasting Effect of Multidisciplinary Interventions for Emotional and Social Loneliness in Older Community-Dwelling Individuals: A Systematic Review

BACKGROUND

Loneliness can occur at any age, but it is more prevalent among older adults due to the associated risk factors. Various interventions exist to improve this situation, but little is known about their long-term effects. Our aims were to determine if these interventions have long-lasting effects and for how long they can be sustained. Additionally, we aimed to analyze if the interventions carried out by volunteers affected the outcomes regarding loneliness and psychological impact.

METHODS

A systematic review was performed by searching the literature in the MEDLINE PubMed, SCOPUS, Web of Science, PsycINFO, and Web of Science databases for interventions focused on the lonely population. The inclusion criteria for this review were the assessment of loneliness using a validated tool, and loneliness being the primary or secondary outcome. The CASPe checklist was used to assess the risk of bias in the selected studies, and the PRISMA-ScR recommendations were followed to present and synthesize the results.

RESULTS

Thirty articles were included. The interventions identified were classified into five categories: psychosocial, technological, health promotion, physical exercise, and multicomponent interventions. Loneliness improved in 24 studies during the post-intervention analysis. Social connectivity and depressive symptoms also improved in most interventions. Long-term follow-ups were conducted with positive results in a total of 16 interventions. Depressive symptoms and social connectivity were also improved. Eight of the interventions were carried out by volunteers and showed good results regarding loneliness.

CONCLUSIONS

The results obtained in this work suggested that multidisciplinary interventions can reduce loneliness, but more controlled clinical studies are needed.

Adaptation of a Chinese Version of the Relational Needs Satisfaction Scale Based on Item Response Theory Among Chinese Adults Aged 18-30

Purpose

The satisfaction of relational needs is an important indicator of the quality of interpersonal relationships, but few studies on this topic have been conducted in China. The Relational Needs Satisfaction Scale (RNSS) was developed and used in three countries.

Patients and Methods

In this study, the scale was standardized. A total of 2136 Chinese adults aged 18-30 years were recruited to complete the RNSS-Chinese (RNSS-C) and the Satisfaction with Life Scale (SWLS) online, and classical test theory and item response theory (IRT) were used to analyze the psychometric characteristics of the RNSS-C. The measurement invariance of the Chinese and Czech RNSSs was analyzed.

Results

(1) The RNSS still has good reliability (Cronbach's alpha = 0.935) and validity (CFI=0.948, TLI=0.940, RMSEA=0.049, and SRMR=0.032) in China. (2) The RNSS-C revealed differences in the perceptions of relational needs construct between the two groups (ΔCFI=0.014>0.01).

Conclusion

These findings contribute to a deeper understanding of the cultural factors that shape interpersonal relationships and satisfaction in China.

Declining Time-Trend in Loneliness Levels Among Migrant Children in Urban China, 2006-2019: A Cross-Temporal Meta-Analysis of 40 Studies Published From 2006 to 2022

Loneliness has long been a significant psychosocial problem for migrant children in urban China. In recent years, social changes and enhancements in social welfare equity have lessened the disadvantages faced by these migrant children. The current study investigated the time-trend of loneliness levels among migrant children from 2006 to 2019. A literature search was performed within major Chinese- and English-language databases, and studies that reported the means and standard deviations of Children's Loneliness Scale (CLS) scores among Chinese migrant children were included in this cross-temporal meta-analysis. Weighted linear regression was conducted to examine the trend of mean CLS scores over the survey year, and Cohen's d value was calculated to assess the magnitude of change. In total, 40 cross-sectional studies conducted between 2006 and 2019 (published by 2022), consisting of 47 cohorts of migrant children and a total sample size of 17,090, were included. Overall, there was a significant downward trend between the survey year and mean CLS score (unstandardized coefficient [β] = -0.342, P  < 0.001), and Cohen's d value of this decline from 2006 to 2019 was 0.411. Similar declining time-trends were also observed among subgroups when broken down by sex, school type, and geographic regions (β = -0.182 to -0.589, P  < 0.001, d = 0.222-0.719). The loneliness levels of migrant children in urban China decreased from 2006 to 2019. Nevertheless, sustained measures and inclusive policies are still needed to mitigate the loneliness levels of Chinese migrant children.

Depressive Symptoms and Cognitive Function in Older Adults: A Cross-Lagged Network Analysis

Background: Depressive symptoms commonly co-occur with cognitive decline in older adults. However, prospective interrelationships between different cognitive function domains and depressive symptoms are not well understood. This study evaluated prospective interrelationships between depressive symptoms and cognitive functioning components among individuals aged 50 years or older from a perspective of network analysis. Method: Longitudinal data from the English Longitudinal Study of Aging were analyzed. Depressive symptoms were measured with the eight-item Center for Epidemiologic Studies Short-Depression Scale. Cognitive functions assessed included memory, orientation, and executive function. Contemporaneous network analyses were conducted using mixed graphical model, while a temporal network model was assessed using cross-lagged panel network model. To identify important predictors and outcomes, centrality indices, including expected influence, out-expected influence, and in-expected influence, were calculated. Results: A total of 6,433 older adults were included in the network analysis. Baseline "Not enjoy life" (CESD-6) was negatively associated with executive function at the follow-up assessment. Moreover, improvements in "Everything was an effort" (CESD-2) and "Loneliness" (CESD-5) were related to less future decline of executive function and memory ability. Furthermore, analyses suggested targeting "Lack of happiness" (CESD-4) could be useful in reducing the co-occurrence of depression and cognitive decline among older adults. Conclusions: This network analysis study highlighted dynamic interrelationships between depressive symptoms and cognitive decline in older adults. Findings suggest that interventions targeting specific depressive symptoms may have the potential to alleviate declines in executive function and memory for this population.

Psychological resilience and related factors among primary care workers in Wuhan, China: A cross-sectional study

PURPOSE

Primary medical workers constitute a high-risk group for mental health problems, and psychological resilience might protect them from the negative psychological impacts of their work. Therefore, this study aimed to investigate the current situation of psychological resilience among primary care workers in Wuhan, China, as well as related factors.

METHODS

In this cross-sectional study, a total of 417 primary care workers (30.0 % men; 38.5 ± 8.5 years old) were randomly selected to complete a questionnaire. The brief version of the National Mental Health Literacy Questionnaire and the Psychological Resilience Scale were used to assess participants' mental health literacy and psychological resilience, respectively. Multiple linear regression was performed to identify factors associated with the psychological resilience of primary care workers.

RESULTS

More than four-fifths of the primary care workers included in this study exhibited appropriate levels of mental health knowledge. In terms of mental health skills, participants' attainment rates, ranging from high to low, were 60.9 % for distracting attention, 45.3 % for interpersonal support and 43.9 % for cognitive reappraisal. The average psychological resilience score obtained by primary care workers was 27.81 ± 5.71, and the factors associated with increased psychological resilience included being male, being older, and possessing higher mental health skills, including skills pertaining to interpersonal support and distracting attention.

CONCLUSION

The psychological resilience of primary care workers in Wuhan is at a moderate level and thus requires further improvement. Although these medical staff exhibit appropriate levels of mental health knowledge, their mental health skills are relatively poor, despite the fact that interpersonal support and distracting attention are significantly associated with psychological resilience. Hence, interventions targeting mental health skills are recommended to promote psychological resilience among primary care workers.

Elevated levels of loneliness in migrant children compared to nonmigrant children in urban China: a systematic review and meta-analysis of comparative studies

PURPOSE OF REVIEW

About one in four children in China is a migrant child. This population has a higher risk of experiencing loneliness. However, existing studies present conflicting findings regarding the levels of loneliness among migrant children as compared to local urban children in urban China. This review performs a meta-analysis of studies comparing loneliness levels between these two groups.

RECENT FINDINGS

A literature search of major Chinese- and English-language databases revealed 27 eligible comparative studies. These studies reported the means and standardized deviations of loneliness scores for both migrant and nonmigrant children in urban China. Meta-analysis results showed that migrant children experienced significantly higher levels of loneliness than their urban nonmigrant counterparts [standardized mean difference (SMD) = 0.21, P  < 0.001]. Subgroup analysis revealed that studies enrolling migrant children from migrant children's schools had significantly higher pooled SMDs than those enrolling children from public schools (0.346 vs. 0.120, P  = 0.047).

SUMMARY

Migrant children in urban China experience higher levels of loneliness compared to their local urban peers. Efforts to create a socially inclusive, migrant-friendly environment and reduce social isolation among migrant children are crucial to help alleviate their feelings of loneliness.

Both people living in the COVID-19 epicenter and those who have recently left are at a higher risk of loneliness

There is little empirical data on the heightened risk of loneliness among individuals residing in the COVID-19 epicenter or those who have recently left. This study compared the risk of loneliness in individuals residing in Wuhan, the COVID-19 epicenter in China, and those who had recently left during the initial outbreak period to those living in non-epicenter regions. During the COVID-19 outbreak in China in 2020, three samples were obtained using snowball sampling. The samples included 2882 epicenter residents, 1028 left residents, and 2963 non-epicenter residents. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale, with a score of two or more indicating the presence of loneliness. 53.5% and 55.2% of epicenter and recently left residents, respectively, experienced loneliness, which was significantly higher than the 43.9% observed in non-epicenter residents. After adjusting for covariates, the risk of loneliness remained statistically significant for both epicenter and left residents (OR = 1.35, P < 0.001 and OR = 1.20, P = 0.017, respectively), when compared to non-epicenter residents. Individuals residing in the COVID-19 epicenter, as well as those who have recently left, are at a heightened risk of loneliness during the outbreak. These individuals need psychosocial support to mitigate their risk of loneliness and promote their psychological wellbeing.

Prevalence of COVID-19 fear and its association with quality of life among fire service recruits after ceasing the dynamic zero-COVID policy in China

Background

In December 2022, China terminated its dynamic zero-COVID policy. To date, however, no research has been conducted upon mental health issues and their relationship with quality of life (hereafter QoL) among fire service recruits since the dynamic zero-COVID policy ended. This study explored fear of COVID-19 (FOC) prevalence and correlates as well as its network structure and interconnections with QoL among fire service recruits.

Methods

A cross-sectional survey design was used to assess fire service recruits in Beijing and Sichuan, Guangxi and Guizhou provinces of China between February 13 and 16, 2023. Fear of COVID-19 was measured using the Fear of COVID-19 Scale, depression was assessed with the Patient Health Questionnaire, anxiety was examined using the Generalized Anxiety Disorder scale, and QOL was evaluated with the World Health Organization Quality of Life-brief version. Univariate and multivariate analyses were used to explore correlates of COVID-19 fear. Network analysis assessed the structure of fear of COVID-19 and its associations with QoL.

Results

A total of 1,560 participants were included in this study. The overall prevalence of fear of COVID-19 was 38.85% (n = 606; 95% CI = 36.42-41.32%). Being afraid of COVID-19 was significantly related to depression (OR = 1.084; p < O.OO1) and physical fatigue (OR = 1.063; p = 0.026). Fire service recruits with more fear of COVID-19 had lower QOL (F = 18.061 p < 0.001) than those with less fear of COVID-19 did. The most central symptoms included FOC6 ("Sleep difficulties caused by worry about COVID-19"), FOC7 ("Palpitations when thinking about COVID-19") and FOC2 ("Uncomfortable to think about COVID-19"). The top three symptoms negatively associated with QoL were FOC4 ("Afraid of losing life because of COVID-19"), FOC6 ("Sleep difficulties caused by worry about COVID-19") and FOC2 ("Uncomfortable to think about COVID-19").

Conclusion

Over one-third of fire service recruits reported fear of COVID-19 after China's dynamic zero-COVID policy had terminated. Poorer QoL was related to fear of COVID-19. Targeting core symptoms of the fear network structure could help improve the physical and mental health of fire service recruits during public health crises.

The Psychological Network of Loneliness Symptoms Among Chinese Residents During the COVID-19 Outbreak

PURPOSE

Social distancing measures implemented during the COVID-19 pandemic have contributed to increased levels of loneliness, but the specific interactions between loneliness symptoms in the context of the pandemic remain unknown. This study characterized the psychological network of loneliness symptoms in residents during the initial wave of COVID-19 outbreak in China.

PATIENTS AND METHODS

The study recruited 8472 Chinese residents (61.5% women, aged 33.0±10.6 years) through online snowball sampling. The Six-item De Jong Gierveld Loneliness Scale (DJGLS) was used to measure loneliness symptoms. Central symptoms of and bridge symptoms between emotional and social loneliness subscales were identified based on centrality and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedures.

RESULTS

The nodes in the loneliness network were separated into two groups, corresponding to the social and emotional loneliness domains of the DJGLS. The strongest direction association was between "no reliable people" and "no trustworthy people" (edge weight=0.546). "No trustworthy people" has the highest node strength (1.047) in the loneliness network, followed by "emptiness sense" (0.767) and "no reliable people" (0.749). "Feeling of rejection" (1.672) and "no close people" (0.403) showed the first and second highest bridge strengths, respectively. Both the stability and accuracy tests supported robustness of the whole network.

CONCLUSION

Interventions targeting central symptoms "no trustworthy people" and "emptiness sense" and central bridge symptom "feeling of rejection" may be effective for alleviating the overall level of loneliness in pandemic-affected Chinese residents.