Association of loneliness with all-cause mortality: A meta-analysis

Social isolation, loneliness, and incidence of type 2 diabetes mellitus: A systematic review and meta-analysis

OBJECTIVE

Social isolation and loneliness are forms of social disconnection that have been linked to increased risk of many metabolic disorders, including Type 2 Diabetes Mellitus (T2DM). However, evidence to support this relation is lacking. This study aims to investigate the association between social isolation, loneliness, and the incidence risk of T2DM.

METHODS

We searched various electronic databases including MEDLINE (via PubMed), Embase, the Cochrane Library, and Google scholar to retrieve qualitative studies comparing the incidence of T2DM in patients with social isolation or loneliness. We performed statistical analysis on RevMan 5.4 using the random effect model.

RESULTS

Loneliness was associated with a significantly increased incidence of T2DM (OR: 1.44; 95 % CI: 1.19-1.73; P:0.0001), with high heterogeneity (I² = 95 %). Sensitivity analysis indicated potential variability due to differences in loneliness measurements. Social isolation also showed a significant association with T2DM (OR: 1.88; 95 % CI: 1.38-2.58; P:<0.0001) with high heterogeneity (I² = 98 %).

CONCLUSION

In conclusion, we found social isolation and loneliness are independently associated with a higher incidence of T2DM. These findings underscore the need to address psychosocial elements like social isolation and loneliness in the management of T2DM. However, further studies with larger sample sizes, longer follow-up durations, and uniform criteria is warranted to better understand the association between social isolation, loneliness and T2DM.

Fear of Positive Evaluation and Loneliness: Mediating Role of Social Anxiety and Suppression

Loneliness is a commonly observed problem that is associated with several mental and physical health outcomes. Although research shows that fear of negative evaluation is related to loneliness, no study has examined the role of fear of positive evaluation (FPE) on loneliness. This study investigated the mediator role of social anxiety and suppression in the relationship between FPE and loneliness using an undergraduate sample (N = 467). The results show that FPE is positively associated with loneliness and that this relationship is mediated by social anxiety and suppression. This study highlights the importance of the FPE in understanding loneliness and can guide intervention programs for loneliness.

A three-arm randomized controlled trial protocol: Effects of telephone-based, layperson-delivered wisdom-enhancement narrative therapy and empathy-focused interventions on loneliness, social, and mental health in older adults

Background

Loneliness is an increasingly widespread issue among older adults globally, with significant implications on physical, social, and mental health. While various interventions exist to address this challenge, their long-term effects remain unclear. Using a 3-arm randomized controlled trial, this study aims to evaluate the efficacy of a telephone-based and layperson-delivered wisdom-enhancement narrative therapy (Tele-NT) and empathy-focused program (Tele-EP) against an active control group (ACG) in reducing loneliness.

Methods

282 community-dwelling lonely older adults will be recruited and randomly allocated into 1 of the 3 interventions. Older adults will receive two 30-min intervention per week, over the course of 4 weeks, delivered over the phone by a layperson. Assessments will be conducted in-person at baseline (T0), 1-month (T1), 6-month (T2), and 12-month (T3) post-intervention. The primary outcome will be assessed using the Chinese validated 6-item De Jong Gierveld Loneliness Scale and the Revised UCLA Loneliness Scale. The secondary outcomes will include sleep quality, perceived social support, and depressive symptoms. Potential mediators and moderators will also be explored. The data will be analysed using linear mixed models on an intention-to-treat basis.

Discussion

This RCT is effective, Tele-NT and/or Tele-EP could serve as a model for broader implementation in the community, offering practical solutions to mitigate loneliness and its associated health burdens in the aging populations.

Trial registration

This trial is registered with the Chinese Clinical Trial Registry; ChiCTR2300070179 on April 4, 2024.

Loneliness trajectories and predictors in Spain: Results from the Spanish longitudinal study on aging and health (Edad con Salud)

BACKGROUND

In recent years, loneliness has been recognized as a public health problem, exacerbated by the COVID-19 pandemic. This study aims to identify groups of people with different trajectories of loneliness, and to explore potential determinants (sociodemographic, social, psychological, and health-related) associated with these trajectories.

METHODS

In this 12-year longitudinal study, we analyzed data on 4537 Spanish adults from a nationwide representative survey. A growth mixture modeling approach was used to identify different loneliness trajectories and logistic regressions to explore the determinants of these trajectories.

RESULTS

Two trajectory classes were identified: low-stable (87.86 %) and high-fluctuating (12.14 %). Marital status, living status, migration, social isolation, depression, suicidal ideation, and cognitive complaints were identified as significant determinants of belonging to the high-fluctuating trajectory. Conversely, social support, social trust, and life satisfaction were protective factors for this trajectory.

CONCLUSION

This study revealed the presence of diverse courses of loneliness (each showing some distinctive characteristics from the other), outlining some relevant implications for the assessment, prevention, and management of loneliness.

Loneliness modulates the neural dynamics of language processing in healthy older adults: evidence from event-related potentials

Loneliness, a distressing emotional response to perceived deficiencies in social interactions, has seen a marked increase in prevalence since the COVID-19 pandemic. While previous research has linked loneliness in older adults to affective disorders and cognitive decline, its impact on language comprehension-a crucial aspect of social interaction-remains underexplored. This study addresses this gap by examining the effects of loneliness on semantic retrieval in healthy older adults. Using event-related potentials, we measured participants' neural responses as they verified category membership across three conditions: high typicality, low typicality, and category violations. We found that loneliness was negatively correlated with an N400 amplitude reduction for low-typicality items compared to category violations. Moreover, individuals who reported a high level of loneliness exhibited attenuated and delayed N400 effects within more restricted time windows compared to their less lonely counterparts. These results indicate that loneliness impairs semantic memory retrieval in older adults, potentially compromising language comprehension and further exacerbating social isolation. This research highlights the detrimental impact of loneliness on linguistic abilities, which may contribute to a vicious cycle of increasing social isolation and deepening loneliness.

Ambiguity potentiates effects of loneliness on feelings of rejection

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

Effectiveness of Hearing Aid Adherence on Social Connectivity in Older Adults: A Scoping Review

Age-related hearing loss affects 65% of older adults, and untreated hearing loss is associated with multiple adverse outcomes, including social isolation and loneliness. Thus, it is imperative to target age-related hearing loss. This scoping review assesses whether the use of hearing aids may increase social connectivity and reduce loneliness in adults ages 50 and older living with age-related hearing loss. We identified six qualifying studies across three databases and found that hearing aid adherence improves social connectivity among older adults. Of six studies, one study showed that non-hearing aid use mediated the link between hearing loss and cognitive decline with social isolation acting as a mediating factor, while another found that increased usage improved social participation. Given that hearing aid use is an effective treatment for age-related hearing loss, there is a substantiated need for policy and governmental involvement to improve access and affordability.

Social Support and 10-Year Mortality Following Acute Myocardial Infarction

This study investigates social support type and long-term mortality following AMI. Demographic and clinical data were collected retrospectively from a tertiary hospital for all patients with AMI (2011-2017). Study groups based on support type were defined: (1) employed partner (served as the reference group); (2) unemployed partner; (3) no partner, family support; (4) institutional or benefit-dependent; and (5) non-kin support (caregiver). Ten-year all-cause mortality risk was assessed and compared between the groups. We identified 2652 AMI patients with recorded support type: mean age 67.6 (SD = 14) years, 66% male; 40% had no partner, followed by those with an unemployed partner (31%). Over the follow-up of (median) 7.6 years, 1471 patients died; significantly higher mortality rates were observed in patients without family support (67.9%) or receiving non-kin support (94.9%). Those with non-kin support were at the highest mortality risk, AdjHR = 2.20, 95% CI: 1.67-2.91, p < 0.001, as compared with the reference group. Subgroup analyses found women below age 75 years, Arab women, and those with higher functional status to be most vulnerable to mortality in the absence of family support. Lack of family support was associated with increased long-term mortality among AMI patients. Assessment of support status among AMI patients is integral for secondary prevention.

'Forging healthy communities': a service evaluation of a 12-week community-based exercise, nutrition, behaviour change and peer-support programme

BACKGROUND

Physical inactivity is a leading cause of premature mortality and morbidity worldwide. Primary care settings provide an opportunity for effective lifestyle interventions, including physical activity (PA) promotion. This study aims to evaluate the impact of a rural community-based multi-component, 12-week exercise, nutrition, education and peer-support programme on participants health and wellbeing.

METHODS

This retrospective service evaluation included patients referred to the programme between January 2020 and December 2022 from primary care settings. Quantitative data (including body composition measures, mental wellbeing and patient activation) were collected at the entry and exit of the 12-week program. Participants also self-reported healthcare attendance in the 3 months prior to the baseline and post-intervention data-collection.

RESULTS

Of the 424 people who participated in the programme, 84.7% (n = 359) indicated that they had achieved their goals. Significant improvements in BMI, weight, blood pressure, wellbeing, patient activation, muscle mass, body-fat mass and reduced healthcare attendance over a 12-week intervention were identified by repeated measure ANOVA. Post-hoc tests with a Bonferroni correction found that younger participants were significantly more likely to decrease their BMI and increase their mental wellbeing (as measured by WEMWBS) over the course of the programme. Higher attendance at the programme was also associated with greater reductions in BMI and greater improvements in patient activation.

DISCUSSION

The findings support the effectiveness of multicomponent community-based exercise, nutrition, education and peer support interventions in improving health outcomes and reducing healthcare utilisation. Further research is needed to evaluate the long-term health outcomes of the education-exercise referral programme, across settings, and its potential to contribute to a sustainable healthcare system.

The KIND Challenge community intervention to reduce loneliness and social isolation, improve mental health, and neighbourhood relationships: an international randomized controlled trial

PURPOSE

Loneliness and social isolation are risk factors for poor health, but few effective interventions are deployable at scale. This study was conducted to determine whether acts of kindness can reduce loneliness and social isolation, improve mental health, and neighbourhood social cohesion.

METHOD

Three randomized controlled trials (RCTs) were conducted in the USA, UK, and Australia, involving a total of 4284 individuals aged 18-90 years old, randomized to the KIND challenge intervention or a waitlist control group. Participants allocated to the intervention were asked to do at least one act of kindness per week within a four-week period. The primary outcome was loneliness and secondary outcomes included measures of social isolation, mental health, and neighbourhood social cohesion.

RESULTS

There was a significant, albeit small, intervention effect after four weeks for reduced loneliness in the USA and the UK, but not for Australia. Relative to controls, KIND challenge participants also showed significantly reduced social isolation and social anxiety in the USA, and reduced stress in Australia. There was also reduced neighbourhood conflict in the USA, increased number of neighbourhood contacts in the USA and Australia, greater neighbourhood stability and feelings of neighbourhood importance in the UK, and better neighbourhood social relationships in Australia.

CONCLUSION

Promoting the provision of social support through small acts of kindness to neighbours has the potential to reduce loneliness, social isolation and social anxiety, and promote neighbourhood relationships, suggesting a potential strategy for public health campaigns.

TRIAL REGISTRATION

Clinical Trials Registry. NCT04398472. Registered 21st May 2020.

Intrinsic capacity and loneliness, according to sex, in an upper-middle income country: insights from the ELSI-Brazil cohort

OBJECTIVES

To investigate the association between loneliness and intrinsic capacity, a multidimensional indicator of healthy ageing, in Brazilians aged ≥50 years.

METHOD

This cross-sectional study used baseline data from 7,123 participants of the nationally representative Brazilian Longitudinal Study of Aging (ELSI-Brazil) (2015-2016). Intrinsic capacity (IC) (sensory, mobility, psychological, cognitive, and vitality), was determined using a validated composite z-score (higher scores = better capacity). Loneliness comprised a single-item. Quantile regression models were stratified by sex after adjusting for sociodemographic, and health characteristics.

RESULTS

The median IC were lower in women than in men (-0.54 vs. 0.69, respectively). Loneliness was related to lower IC composite z-scores in both sexes, demonstrating stronger associations at lower quantiles. The IC composite z-score decreased in those experiencing severe loneliness, both in women (quantile 0.75: β = -0.39; 95% CI = -0.47 to -0.31) and men (β = -0.36; 95% CI = -0.54 to -0.17). However, mild loneliness was associated with worse IC among men only at quantile 0.25 (β = -0.12; 95% CI = -0.23 to -0.01), different from women.

CONCLUSION

Loneliness was associated with worse IC. Cross-sectional design limits causal inference, but supports that community engagement, social support, and accessible environments are crucial for promoting healthy ageing in both sexes.

Loneliness and susceptibility to social pain mediate the association between autistic traits and psychotic experiences in young non-clinical adults

Understanding of the mechanisms involved in the occurrence of psychotic experiences (PEs) in highly autistic individuals is crucial for identifying appropriate prevention and intervention strategies. This study aimed to investigate the mediating role of susceptibility to social pain and loneliness in the relationship between autistic traits (ATs) and PEs in adults from the general population of 12 Arab countries. This cross-sectional study is part of a large-scale multi-country research project. A total of 7646 young adults (age range 18-35 years, mean age of 22.55 ± 4.00 years and 75.5% females) from twelve Arab countries (i.e., Algeria, Bahrain, Egypt, Iraq, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Oman, Palestine, and Tunisia) were included. Mediation analyses showed that, after adjusting over confounding variables, both loneliness (indirect effect: Beta = 0.18; Boot SE = 0.02; Boot CI 0.14; 0.21) and social pain (indirect effect: Beta = 0.03; Boot SE = 0.01; Boot CI 0.001; 0.05) partially mediated the association between ATs and PEs. Higher ATs were significantly associated with more loneliness and susceptibility to social pain, and directly associated with more severe PEs. Finally, higher loneliness and susceptibility to social pain were significantly associated with greater PEs scores. Findings indicated that individuals with higher ATs tend to experience greater loneliness and feel more pain from rejection, which can in turn be associated with higher levels of PEs. Interventions targeting susceptibility to social pain and loneliness as a means of mitigating PEs among highly autistic adults should be considered.

Healthcare providers' perceived importance and barriers to addressing social connection in medical settings

Despite the well-established significance of indicators of social connection for health and mortality, healthcare providers' (HCPs) perceptions of the role of social connection in physical health and the extent to which it is considered medically relevant remain unclear. This study examines the perceived importance and barriers to addressing social connection among HCPs in clinical settings. Surveys were completed by 681 HCPs across multiple locations and medical settings. HCPs ranked social connection low in importance among factors known to influence mortality and chronic illness. Furthermore, HCPs report significant barriers to addressing social connection; including lack of time, resources, training, and confidence. The findings have implications for developing educational programs, institutional policies, and structural changes to facilitate the integration of social connection into clinical practices, ultimately improving patient outcomes and overall public health.

Loneliness: A Scoping Review of Reviews From 2001 to 2023

The growing number of primary studies and reviews on loneliness, and the multidisciplinary efforts to comprehend this complex phenomenon from various perspectives, underscore the heightened recognition of its impact on individual and societal well-being and health. To comprehensively assess the size and scope of this research field, we conducted a scoping review of 35 English-language reviews of primary studies on loneliness, published between 2001 and 2023. Focusing specifically on psychological research, these reviews covered a total of N = 1,089 studies, which were conducted between 1986 and 2022. In addition to providing a broad overview of the structure of the field, the present scoping review aimed to explore the methodological landscape of loneliness research, including data collection, sample demographics, and measures, and to present key topics and evidence in the field. By deepening the understanding of loneliness and identifying data gaps and methodological challenges, our analyses provide critical insights for future research endeavors, thereby fostering advances in the field.

Seeking solitude skills: Do memories of intrinsic goals enhance enjoyment of alone time?

OBJECTIVE

Further investigate the application of self-determination theory (SDT) to experiences of solitude by examining the effects of recalling intrinsic versus non-intrinsic memories.

BACKGROUND

SDT research indicates that recalling memories associated with intrinsic goals (e.g., personal growth, relationships, altruism) enhances present moment wellness by satisfying basic psychological needs.

METHOD

Two studies were conducted with American adults. Study 1 included 465 participants (age = 49.49 [SD = 19.01], 49.46% female) and Study 2 comprised 490 participants (age = 54.16 [SD = 18.89], 51.84% female). Both studies assessed the impact of recalling intrinsic versus non-intrinsic memories prior to a five-minute solitude session.

RESULTS

Study 1 found intrinsic memories were linked to more basic psychological need satisfaction than non-intrinsic memories, but both memory types resulted in similar wellness improvements. Contrary to expectations, Study 2 revealed extrinsic memories (e.g., wealth, fame, image) led to the highest basic psychological need satisfaction and least need frustration compared to intrinsic and neutral memories, with all memory conditions showing similar wellness gains.

CONCLUSIONS

Solitude appears beneficial regardless of memory content. While different memories vary in need satisfying quality, this does not seem to impact the benefits of solitude. These findings suggest further exploration is needed before developing a "solitude skill set" for use during inevitable periods of solitude.

Lonely but not alone: Examining correlates of loneliness among Canadian post-secondary students

Objective: Loneliness is increasingly acknowledged as a public health concern due to its association with morbidity and mortality. The prevalence of loneliness is highest in the post-secondary population. Understanding the correlates of loneliness may assist in developing policy and program interventions. Participants and Methods: Post-secondary students (n = 28,975) from the Winter 2022 Canadian Campus Wellbeing Survey (CCWS) cycle. A multi-level logistic regression controlling for the institution was built to determine how demographic, health behaviors, mental health and institutional level factors are associated with loneliness. Results: The prevalence of loneliness was 31% in our sample. Demographic (e.g., gender, sexual orientation, social economic status), health behaviors (e.g., physical activity and substance use), mental health (e.g., mental distress and social support) and institutional factors (e.g., college or university institution) impacted the odds of reporting loneliness (p < 0.05). Conclusion: Our findings suggest loneliness might require greater attention by institutional staff and administrators.

Loneliness is associated with adverse health behaviour and obesity: a Danish population-based study of 122,258 individuals

BACKGROUND

Loneliness is a public health concern associated with increased morbidity and mortality. Adverse health behaviours and a higher body mass index (BMI) have been proposed as key mechanisms influencing this association. The present study aims to examine the relationship between loneliness, adverse health behaviour and a higher BMI, including daily smoking, high alcohol consumption, physical inactivity, unhealthy dietary habits, and obesity in men and women and across different life stages.

METHODS

We conducted a cross-sectional study using data from the 2017 Danish National Health Survey (entitled "How are you?"). Loneliness was assessed using the Three-Item Loneliness Scale. Logistic regression models were employed to analyse the association between loneliness, health behaviour and obesity in a sample of 122,258 individuals (16 + years). The models were adjusted for sex, age, educational attainment, country of origin, and partnership status. Stratified analyses were conducted to investigate differences by sex and life stages.

RESULTS

Loneliness was associated with an increased risk of daily smoking (Adjusted odds ratio (AOR) = 1.30; 95% CI: 1.21-1.40), physical inactivity (AOR = 1.87; 95% CI: 1.75-1.99), unhealthy diet (AOR = 1.58; 95% CI: 1.47-1.70), and obesity (AOR = 1.60; 95% CI: 1.49-1.72). Conversely, loneliness was associated with a reduced risk of high alcohol consumption in men (AOR = 0.82; 95% CI: 0.74-0.0.91).

CONCLUSIONS

Our study provides evidence that loneliness is associated with adverse health behaviour and obesity in both men and women and across the lifespan. These findings suggest that health behaviours and obesity may influence the association between loneliness and poor health outcomes. Longitudinal studies are needed to clarify the causal relationships underlying these associations.

Loneliness, social isolation, and living alone: a comprehensive systematic review, meta-analysis, and meta-regression of mortality risks in older adults

Loneliness, social isolation, and living alone are significant risk factors for mortality, particularly in older adults. This systematic review and meta-analysis aimed to quantify their associations with all-cause and cause-specific mortality in older adults, broadening previous research by including more social factors. Comprehensive searches were conducted in PubMed, APA PsycINFO, and CINAHL until December 31, 2023, following PRISMA 2020 and MOOSE guidelines. Studies included were prospective cohort or longitudinal studies examining the relationship between loneliness, social isolation, living alone, and mortality. Quality was assessed using the Newcastle-Ottawa Scale. Meta-analyses used random-effects models with the Restricted Maximum Likelihood method. Subgroup and meta-regression analyses explored the relationships further. Of 11,964 identified studies, 86 met the inclusion criteria. Loneliness was associated with increased all-cause mortality (HR 1.14, 95% CI 1.10-1.18), with substantial heterogeneity (I² = 84.0%). Similar associations were found for social isolation (HR 1.35, 95% CI 1.27-1.43) and living alone (HR 1.21, 95% CI 1.13-1.30). Subgroup analyses revealed variations based on factors like sex, age, region, chronic diseases, and study quality. Meta-regression identified longer follow-up, female sex, validated social network indices, adjustments for cognitive function, and study quality as significant predictors of mortality risks. These findings highlight the need for public health interventions to address these social factors and improve health outcomes in older adults. However, further research is needed due to variability and heterogeneity across studies. Also studying the cumulative effect of these factors on mortality risks will be of considerable interest.

Trajectories of loneliness in later life - Evidence from a 10-year English panel study

The prevalence of loneliness is higher among older people; however, few studies have examined its longitudinal patterns and associated risk factors, particularly social network resources. Using data from six waves of the English Longitudinal Study of Ageing (2008/09 to 2018/19, N = 4740) and group-based trajectory modelling (GBTM), we identified five groups of loneliness trajectories: three with stable levels (37% "stable low"; 26% "stable medium"; 9% "stable high") and two with time-varying scores of loneliness (8% "increasing"; 20% "decreasing"). Multinomial regression models and GBTM were used to examine baseline and time-varying factors associated with these trajectories. We created composite measures to capture the presence and key facets of social network resources (including size, support, closeness, and frequency of contact) for four different social relationship domains (partner, children, immediate family, and friends). Our results show that, among those with family or friends, older people with higher social network resources and those who maintained or improved them over time reported lower levels of loneliness. Findings also suggest that all social relationship domains contributed to feelings of loneliness in later life. Also, we find that respondents in poor health and depressed, as well as those whose health deteriorated over time, were more likely to have stable high or increasing levels of loneliness. The study highlights the need to investigate loneliness from a life course perspective, account for the complexity of social relationships in later life beyond their mere presence or absence, and include their quality and quantity as well as multiple domains of family and intergenerational relationships.

Psychosocial distress in people with overweight and obesity: the role of weight stigma and social support

We aimed to assess the role of weight stigma and social support in depression, anxiety, and loneliness controlling for sociodemographic and clinical variables. A total of 189 adults with overweight/obesity were included. Participants were recruited from outpatient clinics by general practitioners which covered all regions of Slovakia. Correlation analyses and multiple linear regression were used to analyze the data. Participants experienced weight-related teasing (40.4%), unfair treatment (18.0%), and discrimination (14.1%). We found an association between lower age, female sex and psychological distress. No role of obesity indicators in psychosocial distress was identified, except for a small association between body mass index and depression in correlation analyses. Significant associations between experienced weight stigma/self-stigmatization and psychosocial distress weakened when variables related to the social support system were added to the linear regression. Poor social support was strongly associated with depression, anxiety, and loneliness. The explained variance in the final regression models was 42, 44, and 54%, respectively. Weight stigma negatively affects mental health and a sense of belonging while it seems to be a more significant contributor to psychosocial distress compared to obesity per se. Interventions targeting weight-related self-stigmatization and social relationships may mitigate the negative impact of weight stigma on psychosocial well-being.

Atherosclerosis and the Bidirectional Relationship Between Cancer and Cardiovascular Disease: From Bench to Bedside, Part 2 Management

The first part of this review highlighted the evolving landscape of atherosclerosis, noting emerging cardiometabolic risk factors, the growing impact of exposomes, and social determinants of health. The prominent role of atherosclerosis in the bidirectional relationship between cardiovascular disease and cancer was also discussed. In this second part, we examine the complex interplay between multimorbid cardio-oncologic patients, cardiometabolic risk factors, and the harmful environments that lend a "syndemic" nature to these chronic diseases. We summarize management strategies targeting disordered cardiometabolic factors to mitigate cardiovascular disease and explore molecular mechanisms enabling more tailored therapies. Importantly, we emphasize the early interception of atherosclerosis through multifactorial interventions that detect subclinical signs (via biomarkers and imaging) to treat modifiable risk factors and prevent clinical events. A concerted preventive effort-referred to by some as a "preventome"-is essential to reduce the burden of atherosclerosis-driven chronic diseases, shifting from mere chronic disease management to the proactive promotion of "chronic health".

Psychological Mediators of Reduced Distress: Preregistered Analyses from a Randomized Controlled Trial of a Smartphone-Based Well-Being Training

Understanding why interventions work is essential to optimizing them. Although mechanistic theories of meditation-based interventions (MBIs) exist, empirical evidence is limited. We randomly assigned 662 adults (79.9% reported clinical levels of anxiety or depressive symptoms) to a four-week smartphone-based MBI or wait-list control condition early in the COVID-19 pandemic. Psychological distress and four theory driven preregistered psychological mediators of well-being (mindful action, loneliness, cognitive defusion and purpose) were assessed five times during the intervention period and at three-month follow-up. In preregistered analyses, assignment to the intervention predicted significant gains on all mediators which in turn significantly mediated follow-up distress (21.9%-62.5% of intervention effect on distress). No significant mediation pathway was observed in an exploratory multiple mediator analysis, but reduced loneliness accounted for 61.7% of the combined indirect effect. Multiple psychological pathways may mediate reduced distress in a digital MBI.

Borderline Personality Disorder and Loneliness: Broadening the Scope of Treatment for Social Rehabilitation

ABSTRACT

Borderline personality disorder (BPD) has been described as a condition of intolerance of aloneness. This characteristic drives distinguishing criteria, such as frantic efforts to avoid abandonment. Both BPD and loneliness are linked with elevated mortality risk and multiple negative health outcomes. Psychodynamic theories of BPD emphasize fundamental impairment in attachment and interpersonal functioning. Empirical research demonstrates an association between BPD diagnosis and increased loneliness. Individuals with BPD experience higher levels of loneliness than the general population, and their social networks are systematically smaller, less diverse, and less satisfying. Differences in the subjective experience of loneliness persist when controlling for these relevant social network features, indicating that people with BPD experience more loneliness than others in the same objective social circumstances. According to patients with BPD, increased social connection is often a primary treatment goal and marker of satisfying recovery. There are, however, few evidence-based approaches that primarily target loneliness and building life structures that support durable connections with others. Therefore, loneliness persists as an intractable problem, often failing to remit alongside other symptoms, and few resources are routinely implemented to address this problem. In this article, we argue that loneliness is central to the symptomatic oscillations and subjective experiences of many patients with BPD. We propose that treatment extend beyond the overemphasized therapeutic alliance relationship to also promote socialization and group and vocational settings to enhance patients' social networks. Building larger social networks that rely less on exclusive caregiving and/or romantic relationships and more on role-bound identity building and community relationships would more directly target long-term identity diffusion and relational instability. Such interventions can harness nonclinical community resources, such as group treatment, vocational supports, and peer supports.

Effects of Wisdom-Enhancement Narrative-Therapy and Empathy-Focused interventions on loneliness over 4 weeks among older adults: A Randomized Controlled Trial

OBJECTIVE

In this three-armed RCT, we tested the effects of a telephone-delivered wisdom enhancement narrative therapy-based intervention (Tele-NT) and a telephone-delivered empathy-focused intervention (Tele-EP) in reducing loneliness against an active control group that received regular call (ACG) at the 4-week follow-up assessment.

DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS

To evaluate the effects of the interventions on loneliness, we randomized 287 older adults based in Hong Kong, ages 65 to 90, into Tele-NT (N = 97), Tele-EP (N = 95), or ACG (N = 95).

MEASUREMENT

The primary outcome was loneliness, calculated using the De Jong Gierveld Scale and the UCLA Loneliness Scale. Secondary outcomes were sleep quality, depressive symptoms, social network engagement, and perceived social support. Assessments were done before training and 4 weeks after the intervention period.

RESULTS

Results from linear mixed models showed significant positive effects of Tele-NT on loneliness measured by the De Jong Gierveld Loneliness Scale compared to ACG. Compared to the ACG, the Tele-NT group significantly reduced loneliness at the 4-week follow-up (mean difference = -0.51, p = 0.019, Cohen's d = 0.60). However, the difference between Tele-EP and the ACG at the 4-week follow-up was not significant (MD = -0.34, p = 0.179, Cohen's d = 0.49). Tele-NT and Tele-EP did not show significant effects on the secondary outcomes, compared to the ACG.

CONCLUSIONS

In this randomized clinical trial, we found that a 4-week wisdom enhancement narrative therapy program significantly reduced feelings of loneliness. This effective telephone-based, lay-therapist-delivered program is scalable for broader implementation.

Development of measures to assess listening-related effort and fatigue in daily life among hearing aid users: protocol for a quantitative field trial

INTRODUCTION

Individuals with hearing loss and hearing aid users report higher levels of listening effort and fatigue in daily life compared with those with normal hearing. However, there is a lack of objective measures to evaluate these experiences in real-world settings. Recent studies have found that higher sound pressure levels (SPL) and lower signal-to-noise ratios (SNR) are linked to increased heart rate and decreased heart rate variability, reflecting the greater effort required to process auditory information. This study aims to establish physiological and acoustic predictors of self-reported listening effort and fatigue in daily life. Additionally, the moderating effects of cognitive abilities, personality traits, stress, fatigue, suprathreshold abilities, noise annoyance, lifestyle and health on the development of listening effort and fatigue will be investigated.

METHODS AND ANALYSIS

A 4-week field trial will be conducted, in which physiological responses will be continuously recorded using Empatica Embrace Plus wristbands. Ambient acoustics will be captured every 20 s via the participants' (n=60) personal hearing aids, and the participants will provide self-reported momentary assessments through a mobile app throughout the day. Questionnaires will be used to assess personality traits, fatigue, stress and noise annoyance, and gather relevant background information. Cognitive and suprathreshold abilities will also be evaluated. Associations between physiological responses, ambient acoustics and momentary assessments, as well as the potential influence of participant characteristics, will be analysed using multilevel regression models and time-series analyses.

ETHICS AND DISSEMINATION

Informed consent will be obtained from all participants. The study has been exempted from ethical application by the Science Ethics Committee for the Capital Region of Denmark (journal no. F-23028367). Results will be presented at conferences and submitted for publication in peer-reviewed journals.

Prevalence and predictors of suicide ideation among university and high-school students during India's 2nd wave of the COVID-19 pandemic

Student suicide ideation increased globally during the SARS-CoV-2 pandemic. There is scarce literature addressing suicide ideation during global health crises. Therefore, this study investigates prevalence and predictors of suicide ideation during India's COVID-19 Second Wave. We also examine the 3-Step Theory's assertion that both pain and hopelessness are necessary to have suicidal thoughts. Sample recruitment was through an online anonymous questionnaire. Inclusion criteria included students aged 18 or older, living in India during the time of the study (N = 535). Data collection was through the online questionnaire. Three categories of variables were investigated as potential predictors of suicide ideation: Sociodemographic (e.g., age, gender, education, economic status), COVID-19-specific (e.g., online classes, fear of virus contagion, vaccination status) and Clinical (e.g., sad mood, fear, loneliness, hopelessness). Data analysis (using SPSS-26) included descriptive statistics for describing data characteristics, Spearman Rho Correlation (assess the strength and direction of association between variables), and Binary Logistic Regression to help identify predictors of suicide ideation. Ordinal variables were measured using Likert scales with some recoded into binomial variables for the Regression analysis. Clinical variables predicted suicidal ideation, including fear of failure (OR = 4.17, 95% CI:2.51-6.94; p < .001), sleep disturbance (OR = 3.04, CI:1.67-5.52; p < .001), loneliness (OR = 2.77, CI:1.21-6.32; p < .01), sadness (O = 2.89, CI:1.59-5.32), and loss of interest (OR = 2.60, CI:1.37-4.93). Suicidal thoughts were reported by 48.7% of the student-participants. The Three-Step Theory was partially supported, as students feeling psychological pain but not hopelessness still reported suicidal ideation. Anticipating future global health crises, policy-supported mental health mitigation strategies are critically needed for youth, designed to reduce suicidal ideation, enhance resiliency, and to foster mental skills. These should enable them to successfully manage unexpected life challenges.

Loneliness Gets Under the Skin: A Scoping Review Exploring the Link Between Loneliness and Biological Measures of Inflammation

BACKGROUND

Research suggests that systemic inflammation may link loneliness to adverse health outcomes, yet there is a gap in comprehensively reviewing recent evidence on the relationship between loneliness and biological measures of inflammation in adults. This scoping review synthesizes current research to address the question: Is there a definitive link between loneliness and biological markers of inflammation in adults?

METHODS

Following the methods outlined by Arksey and O'Malley, we developed a protocol, defined our research question, and systematically searched PubMed, CINAHL, Embase, and Scopus for English-language studies conducted from 2018 to 2023 exploring the relationship between loneliness and biomarkers of inflammation in adults.

RESULTS

Twelve studies meeting the inclusion criteria displayed heterogeneity in terms of sample characteristics, loneliness scales, and inflammatory biomarkers. The UCLA Loneliness Scale, in various forms, emerged as the predominant tool for measuring loneliness, while C-reactive protein and interleukin-6 were the most frequently evaluated inflammatory biomarkers. Notably, all 12 studies reported an association between loneliness and at least 1 biological marker of inflammation.

CONCLUSION

Research consistently associates loneliness with poor health outcomes in aging adults, but the underlying mechanisms remain unclear. This scoping review suggests that inflammation may serve as a pathway linking loneliness to adverse health outcomes. However, the variability across studies highlights the need for standardized measurement methods and a consideration of both the duration and extent of loneliness. Enhancing our understanding of how loneliness affects systemic inflammation may help clarify why loneliness is associated with negative health outcomes.

Associations between adolescent perceived loneliness and hair cortisol concentration

INTRODUCTION

Adolescents experience high levels of loneliness, which is linked to poor health in adulthood. Loneliness may contribute to poor health through chronic dysregulation of the hypothalamic-pituitary-adrenal axis. In this analysis, we examined the associations between survey- and ecological momentary assessment (EMA)-based measures of loneliness and hair cortisol concentrations (HCC) in a sample of 1102 adolescents and assessed sex differences in this relationship.

METHODS

Data came from wave 1 of the Adolescent Health and Development in Context study. We conducted a series of multivariable linear regression models to examine the associations between loneliness and HCC. Models were adjusted for adolescent and caregiver demographics, adolescent clinical factors, adolescent hair care practices, and adolescent lifetime mental health diagnosis and current psychotropic medication use. An interaction term between sex and loneliness was added to assess for effect moderation.

RESULTS

In our sample, the mean HCC was 1.35 pg/mg (SD=1.1). The mean for the unstandardized survey loneliness measure was 1.79 (SD=0.79) for the total analytic sample. The unstandardized mean for the EMA loneliness measure was - 0.02 (SD=2.1) for the total analytic sample. In model one testing the bivariate linear relationship between loneliness and HCC, higher loneliness via survey and EMA measures was associated with lower HCC (Survey: b= - 0.10, SE=0.03, p=.004; EMA: b= - 0.09, SE=0.03, p=.005). In model two, higher loneliness remained significantly associated with lower HCC (Survey: b= - 0.07, SE=0.03, p=.023; EMA: b= - 0.07, SE=0.03, p=.037), after controlling for the following covariates: sociodemographic factors, pubertal development and BMI, corticosteroid use, hair care practices, season of collection and assayed hair length. In model 3, youth lifetime mental health diagnosis and current psychotropic medication use were added into the regression model, and higher loneliness remained significantly associated with lower HCC (Survey: b= - 0.07, SE=0.03, p=.029; EMA: b= - 0.07, SE=0.03, p=.039). There was no effect modification by sex (Survey: b=0.04, SE=0.06, p=.552; EMA: b= - 0.01, SE=0.06, p=.843).

CONCLUSIONS

In our analysis, both survey- and EMA-reported loneliness measures were associated with lower HCC. No evidence of an interaction between sex and loneliness was observed. Future research is needed to validate these findings and investigate longitudinal relationships among adolescent loneliness, stress physiology, and downstream health sequelae.

Social isolation and loneliness and their association with all-cause mortality. A population-based longitudinal study in Norway: The Tromsø Study 1994-2023

Objectives

Loneliness and social isolation are associated with increased mortality, but few studies have assessed this association over long time in young adults.

Methods

The study sample comprised 9061 women and 8735 men aged 25 to 69 years who participated in the Tromsø4 survey (1994-95, baseline) of the Tromsø Study, Norway. A subset of the study sample also attended the Tromsø5 (2001), Tromsø6 (2007-08), and Tromsø7 (2015-16) surveys. Participants were followed up for all-cause mortality until November 2023; with 1630 women and 2099 men deceased. Information on social isolation (least isolated, modestly isolated, and most isolated) and loneliness (yes, no) were taken from self-administered questionnaires. Sex-specific, time-varying Cox models were employed, updating exposures and covariates from Tromsø5.

Results

Most-isolated versus least-isolated women and men had hazard ratios of 1.37 (95 % confidence interval 1.18-1.59) and 1.41 (1.25-1.60), respectively, after adjustment for covariates. These hazard ratios were higher in younger adults (HR = 1.55 in women and HR = 1.76 in men aged <50 years at baseline), though the age-isolation interaction was not statistically significant in women (P = 0.26), but in men (P = 0.01). For loneliness, the adjusted hazard ratios were 1.51 (1.23-1.87) and 1.46 (1.16-1.84). Over time, 51 % and 47 % of participants remained most isolated at Tromsø5 and Tromsø7, respectively; 25 % of those initially lonely remained so at Tromsø5, while only 2.6 % of those initially non-lonely became lonely at Tromsø5.

Conclusion

Both social isolation and loneliness are strongly associated with all-cause mortality, particularly among younger adults, underscoring their importance as public health concerns.

Family Resilience in Families of Children With Autism Spectrum Disorders: Ecological Systems Theory Perspective

Drawing on Bronfenbrenner's ecological systems theory (1992), we asked how certain resources contribute to family resilience in families of children with ASD: family quality of life (FQOL; family resources), sense of community and loneliness (informal resources), and family-centered support provided by the state (formal resources). One hundred and twenty-one Israeli parents of children with ASD completed an online survey. Path analysis using AMOS was conducted. FQOL contributed to increased family resilience. Path analysis showed loneliness, sense of community, and services use contributed to family resilience through FQOL. Overall, the research model explained 68% of the variance in family resilience. Implications for research and practice are discussed.

A blended group intervention to promote social connectedness and wellbeing among international university students: an exploratory study

Introduction

Loneliness is a prevalent issue among international university students, often exacerbated by cultural and linguistic barriers. This pilot study aims to assess the feasibility, acceptability and impact of a blended intervention to promote international students' social connectedness and well-being.

Methods

A sample of 49 international students from the University of Padua (Italy) was recruited. The study followed the methodology of a non-randomized controlled trial comparing a blended intervention (comprising group activities and online self-help materials) with two other active conditions (self-help only and peer-to-peer interventions) and a control condition at two times (baseline and at 8 weeks). Participants completed a survey to assess their satisfaction with the interventions, changes in their interactions and wellbeing. They also filled in some questionnaires to measure anxiety, depression, perceived social support, loneliness and satisfaction with life. A mixed-method analysis was conducted.

Results

Results showed that interventions involving in-person activities had significant advantages over self-help intervention in terms of interaction improvement and a higher number of relationships. Participants perceived self-help materials as more relevant, satisfactory, and functional within the blended group compared to the self-help group. Contrary to the control group, the blended and peer-to-peer groups reported lower scores on the standardized measures of loneliness, anxiety, and depression, and higher scores on satisfaction with life, collected pre- and post-intervention. The thematic analysis of the answers to the open-ended questions showed that in-person group activities provided the opportunity to compare themselves with peers and have a direct experience of new social connections.

Discussion

The findings highlight the importance of translating insights from self-help materials into active and direct social experiences, to reduce loneliness through the emergence of new perspectives and shared meaning making.

Is living alone associated with mortality among older primary care patients with or without diabetes?

AIMS

The aim of this study was to evaluate the association between living alone and mortality among older patients with and without diabetes.

METHODS

Electronic patient records were used to identify patients at least 65 years of age with a diagnosis of diabetes and two age- and sex-matched controls without diabetes for each patient with diabetes in 2015. The study population in this analysis consisted of 429 patients with diabetes and 650 controls who returned a questionnaire that contained questions about their diseases, symptoms, and functions. The mortality (2015-2019) data were based on the national registry of Statistics Finland. Cumulative mortality was estimated with Kaplan-Meier's method and compared with the log-rank test. Cox proportional hazards regression was used to estimate the adjusted hazard ratios (HR) and their 95% confidence intervals (CI).

RESULTS

The median follow-up time was 4.3 years. 208 of the controls (32%) and 156 (36%) of the patients with diabetes lived alone. Of the controls, 8.1% (95% CI 5.9-11.1) of those not living alone and 20.2% (95% CI 15.3-26.3) living alone died. The corresponding numbers for patients with diabetes were 15.1% (95% CI 11.3-19.8) and 28.8% (95% CI 22.4-36.7). Among all patients, living alone was associated with increased mortality (HR = 1.84; 95% Cl 1.30-2.61), whereas the diagnosis of diabetes was not (HR = 1.31; 95% Cl 0.94-1.81).

CONCLUSIONS

The results of this study show that living alone had a significant impact on the mortality of older patients, regardless of whether they had diabetes or not. Diabetes was not clearly associated with the increased mortality among these older home-dwelling patients.

The impact of retirement on loneliness in Europe

This article investigates the short- and long-term impacts of retirement on loneliness using panel data from the Survey of Health, Aging, and Retirement in Europe. To identify causal effects, we exploit differences in retirement rules across and within countries and use retirement thresholds in an instrumental variable setting. On average, we find that entering retirement leads to a reduction in loneliness in the long run and no clear effect in the short run. The reduction is driven by individuals being less likely to feel socially isolated and lacking companionship. Our results suggest that individuals adapt to retirement by increasing their activity levels and reap the benefits in terms of reduced loneliness and social isolation. The heterogeneity analysis shows that this is particularly true among the higher educated. The heterogeneity analysis also reveals that retirement increases feelings of loneliness for women in the short term and that the effect seems to be driven by women lacking companionship when their partner is not yet retired.

The Impact of Functionality and Psychological Outcome on Social Engagement 3-months after Intracerebral Hemorrhage

BACKGROUND

Although it is well-known that intracerebral hemorrhage (ICH) is associated with physical and psychological morbidity, there is scant data on factors influencing social engagement after ICH. Understanding the relationship between functionality, psychological outcome and social engagement post-bleed may facilitate identification of patients at high risk for social isolation after ICH.

METHODS

Patients ≥18-years-old with non-traumatic ICH from January 2015-March 2023 were identified from the Neurological Emergencies Outcomes at NYU (NEON) registry. Data on discharge functionality were collected from the medical record. 3-months post-bleed, patients/their legally-authorized representatives (LARs) were contacted to complete Neuro-QoL social engagement, anxiety, depression, and sleep inventories. Patients were stratified by ability to participate in social roles and activities (good=T-score>50, poor=T-score≤50) and satisfaction with social roles and activities (high=T-score>50 and low=T-score≤50). Univariate comparisons were performed to evaluate the relationship between post-bleed social engagement and both functionality and psychological outcome using Pearson's chi-square, Fisher's Exact test, and Mann-Whitney U tests. Multivariate logistic regression was subsequently performed using variables that were significant on univariate analysis (p<0.05).

RESULTS

The social engagement inventories were completed for 55 patients with ICH; 29 (53 %) by the patient alone, 14 (25 %) by a LAR alone, and 12 (22 %) by both patient and LAR. 15 patients (27 %) had good ability to participate in social roles and activities and 10 patients (18 %) had high satisfaction with social roles and activities. Social engagement was associated with both functionality and psychological outcome on univariate analysis, but on multivariate analysis, it was only related to functionality; post-bleed ability to participate in social roles and activities was associated with discharge home, discharge GCS score, discharge mRS score, and discharge NIHSS score (p<0.05) and post-bleed satisfaction with social roles and activities was related to discharge mRS score and discharge NIHSS score (p<0.05).

CONCLUSION

In patients with nontraumatic ICH, social engagement post-bleed was related to discharge functionality, even when controlling for depression, anxiety, and sleep disturbance.

Exploring Resilience Among Midlife and Older Sexual Minority and Heterosexual Adults: A Multidimensional Analysis

Research on resilience in sexual minority midlife and older adults is limited. Using a multidimensional approach, this study examined trait resilience (optimism), resilience as a dynamic process (perceived control), and relational resilience (social support), analyzing their roles in physical and mental health among sexual minority adults. Analyzing data from MIDUS 2 and MIDUS Refresher, we examined a sample of 492 participants, comprising 164 sexual minority and 328 propensity-matched heterosexual individuals. Among sexual minority participants, perceived control was associated with fewer chronic conditions and optimism with lower depressed affect. Among heterosexual participants, perceived control was associated with both outcomes. Subgroup analyses found variations, particularly among lesbian and bisexual women. Resilience measures were not associated with the health outcomes for gay or bisexual men. This study highlighted the complex roles of trait resilience and dynamic resilience processes in association with health outcomes among sexual minority midlife and older adults across diverse subgroups.

Tree-based analysis of longevity predictors and their ten-year changes: a 35-Year mortality follow-up

BACKGROUND

Prior studies on longevity often examine predictors in isolation and rely solely on baseline information, limiting our understanding of the most important predictors and their dynamic nature. In this study, we used an innovative regression tree model to explore the common characteristics of those who lived longer than their age and sex peers in 35-years follow-up. We identified different pathways leading to a long life, and examined to how changes in characteristics over 10 years (from 1979 to 1989) affect the findings on longevity predictors.

METHODS

Data was obtained from the "Tampere Longitudinal Study on Ageing" (TamELSA) in Finland. Survey data was collected in 1979 from 1056 participants aged 60-89 years (49.8% men). In 1989, a second survey was conducted among 432 survivors from the 1979 cohort (40.2% men). Dates of death were provided by the Finnish Population Register until 2015. We employed an individual measure of longevity known as the realized probability of dying (RPD), which was calculated based on each participant's age and sex, utilizing population life tables. RPD is based on a comparison of the survival time of each individual of a specific age and sex with the survival time of his/her peers in the total population. A regression tree analysis was used to examine individual-based longevity with RPD as an outcome.

RESULTS

This relative measure of longevity (RPD) provided a complex regression tree where the most important characteristics were self-rated health, years of education, history of smoking, and functional ability. We identified several pathways leading to a long life such as individuals with (1) good self-rated health (SRH), short smoking history, and higher education, (2) good SRH, short smoking history, lower education, and excellent mobility, and (3) poor SRH but able to perform less demanding functions, aged 75 or older, willing to do things, and sleeping difficulties. Changes in the characteristics over time did not change the main results.

CONCLUSION

The simultaneous examination of a broad range of potential predictors revealed that longevity can be achieved under very different conditions and is achieved by heterogeneous groups of people.

[Loneliness in Bavaria before and during the COVID-19 pandemic]

BACKGROUND

Loneliness represents a significant health risk and is associated with numerous mental and physical conditions. The aim of this paper was to describe the prevalence of loneliness in Bavaria before and during the COVID-19 pandemic with respect to socio-demographic attributes.

METHODS

Data sources were the German Ageing Survey (DEAS) and the Socio-Economic Panel (SOEP). Univariate statistical analyses were carried out for different socio-demographic attributes, such as age, gender, type of household, education, and financial resources.

RESULTS

According to the SOEP, the proportion of adults who are often or very often lonely increased from 2.3% in 2017 to 16.2% in 2021. In 2021, women had a higher prevalence of loneliness than men (21.0% vs. 11.3%), and younger adults had the highest prevalence of loneliness (18 to 25 years: 31.7%) compared to the other age groups.

DISCUSSION AND CONCLUSIONS

During the COVID-19 pandemic, loneliness increased in almost every population subgroup in Bavaria. Further studies are needed to examine whether this development is temporary or represents a long-term effect even after the measures to prevent the spread of COVID-19 have been lifted.

[Loneliness as health risk: a narrative review]

Loneliness is increasingly recognized as a significant health risk. This review provides an overview of current research on the impact of loneliness on mental and physical health. The findings indicate that loneliness is a significant risk factor of both mental and physical health. Previous reviews focusing on mental health effects reveal that loneliness is associated with the onset of depression, social anxiety, and cognitive decline. Furthermore, loneliness can impede recovery from mental disorders in general, which can be partly attributed to the bidirectional interplay between loneliness and mental health. Regarding physical health, consequences of loneliness have been mostly studied in relation to cardiovascular diseases. Loneliness predicts the onset of cardiovascular diseases and impedes recovery from them. Reviews also highlight that loneliness enhances the likelihood of suicidality and mortality. However, this article also points out the shortage of longitudinal studies, complicating the investigation into how loneliness causally affects future health problems. The health implications of loneliness outlined in this review, some of which are irreversible and can induce suffering and impairment, underscore the importance of interventions aimed at alleviating loneliness as a preventive strategy against both mental and physical illnesses.

Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications

Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the public. Despite the breadth of evidence, several challenges remain, including the need for a common language to reconcile the diverse relevant terms across scientific disciplines, consistent multi-factorial measurement to assess risk, and effective solutions to prevent and mitigate risk. The urgency for future health is underscored by the potentially longer-term consequences of the COVID-19 pandemic, and the role of digital technologies in societal shifts, that could contribute to further declines in social, mental and physical health. To reverse these trends and meet these challenges, recommendations are offered to more comprehensively address gaps in our understanding, and to foster social connection and address social isolation and loneliness.

[Strategies against loneliness-examples from an international comparative perspective]

The extent of loneliness differs internationally. Especially in the developed welfare states of Northern Europe, loneliness levels in the population are comparatively low. However, the increase in loneliness in many countries shows that existing concepts are not sufficient to provide effective protection against loneliness. Younger people also need to be strengthened so that they do not withdraw when they experience social exclusion and loneliness. This requires qualified specialists in kindergartens, schools, sports clubs, and other leisure facilities who help children and young people to establish social contacts. Friendship and neighborhood models have proven to be successful when it comes to strategies to combat loneliness. Greater identification with the neighborhood and a feeling of security help build social networks and reduce loneliness. For older people it is important to be able to stay in their usual social environment and maintain their social contacts. To this end, accessible public spaces must be combined with home care and support services that are tailored to the needs and wishes of older people.

Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience

Anisman, H., Doubad, D., Asokumar, A. & Matheson, K. Psychosocial and neurobiological aspects of the worldwide refugee crisis: From vulnerability to resilience. NEUROSCI BIOBEHAV REV, XXXX. Immigration occurs between countries either to obtain employment, for family reunification or to escape violence and other life-threatening conditions. Refugees and asylum seekers are often obligated to overcome a uniquely challenging set of circumstances prior to and during migration. Settlement following immigration may pose yet another set of stressors related to acculturation to the host country, as well as financial insecurity, discrimination, language barriers, and social isolation. Here we discuss the multiple consequences of immigration experiences, focusing on the health disturbances that frequently develop in adults and children. Aside from the psychosocial influences, immigration-related challenges may cause hormonal, inflammatory immune, and microbiota changes that favor psychological and physical illnesses. Some biological alterations are subject to modification by epigenetic changes, which have implications for intergenerational trauma transmission, as might disruptions in parenting behaviors and family dysfunction. Despite the hardships experienced, many immigrants and their families exhibit positive psychological adjustment after resettlement. We provide information to diminish the impacts associated with immigration and offer strength-based approaches that may foster resilience.

[Loneliness at the end of life]

Advanced incurable diseases are often accompanied by numerous losses and burdens as the disease progresses, leading to a loss of autonomy, self-determination, and dignity for those affected, all of which can subsequently promote feelings of loneliness at the end of life. Declining health, increasing symptom burden, loss of social roles, and the fear of death and dying are among the key risk factors for loneliness towards the end of life. In this article, we provide an overview of the different dimensions of loneliness experienced at the end of life. We discuss existential loneliness alongside emotional and social loneliness, explore causes and health implications of loneliness at the end of life, suggest diagnostic tools for assessing loneliness, and finally provide recommendations for addressing emotional, social, and existential loneliness at the end of life. The loneliness of caregivers is also discussed. We suggest that addressing social and emotional loneliness early in the course of a terminal illness is crucial. Palliative, psychological, and spiritual support can strengthen interpersonal relationships, foster a sense of meaning and purpose, and alleviate the adverse effects of loneliness on mental and physical health as well as quality of life. In contrast, existential loneliness is considered an expression of profound emotional maturity and can offer opportunities for inner growth, contributing to a more refined sense of self while reinforcing identity, dignity, and transcendence at the end of life.

The societal cost of 'unwanted' loneliness in Spain

Unwanted loneliness negatively affects people's health and quality of life, increasing morbidity and the risk of premature death; this situation can generate major social costs. The aim of this study is to estimate the social costs of loneliness in Spain for 2021: both tangible costs -monetary value of health costs and production losses- and intangible costs -Quality Adjusted Life Years (QALYs). To estimate costs not derived from mortality, information from a sample of 400 people with unwanted loneliness was compared with that derived from two samples of the general population obtained from the Spanish National Health Surveys. To estimate the costs associated with premature deaths, the population attributable fraction was calculated using the relative risks estimated in previous survival studies. In the baseline scenario, the tangible costs of unwanted loneliness are estimated to be around 14,129 million euros in 2021, representing 1.2% of Spain's GDP. Approximately 56.8% of the tangible costs correspond to production losses due to reduced working time, and 43.2% are due to healthcare costs related with increased consultation frequency in healthcare services and higher consumption of medicines related to loneliness. In addition, loneliness generates a reduction in quality of life equivalent to 1.04 million QALYs, which corresponds to 2.8% of the total stock of QALYs of the Spanish population over 15 years of age.

Embracing Connection: A Review of First-Ever Clinical Guidelines on Social Isolation and Loneliness in Older Adults

Social isolation and loneliness are major public health concerns and are associated with morbidity and mortality. As this is an increasing issue in older adults, guidance for healthcare providers is a priority. The Canadian Coalition for Senior's Mental Health (CCSMH) has developed the first Canadian social isolation and loneliness guidelines to help providers recognize, assess, and manage social isolation and loneliness among older adults. We review and summarize these guidelines to support healthcare and social service providers to apply best practices and evidence-based care for older adults experiencing social isolation and loneliness.

Neurobiology and medico-legal aspects of suicides among older adults: a narrative review

The task of preventing suicide in older adults is an important social burden as older adults aged above 65 are exposed to singular psychological aspects that increase suicide risks. Moreover, when an older adult corpse is found, the medico-legal inspection represents a fundamental tool to identify the exact cause of death, classifying or excluding it as suicide. In this scenario, this review aims to explore the neurobiological factors that could be related to suicidal behavior in older adults. A further goal of this review is the exploration of the medico-legal aspects surrounding older adult suicides, clarifying the importance of forensic investigation. Particularly, this review examines issues such as neurotransmitter imbalances, cognitive impairment, neuroinflammation, psychosocial factors related to geriatric suicide, and neurodegenerative diseases. Additionally, medico-legal aspects such as policy considerations, legal frameworks, mental health assessments, ethical implications and forensic investigation were explored. Considering the importance of this phenomenon, especially in western countries, a need has emerged for focused screening tools on suicidal behavior among older adults, in order to contain it. Therefore, this review makes an exhaustive appraisal of the literature giving insights into the delicate interplay between neurobiology as well as mental health in relation to older adult suicide within a medico-legal context. The comprehension of different aspects about this complex phenomenon is fundamental to propose new and more effective interventions, supporting tailored initiatives such as family support and improving healthcare, specifically towards vulnerable ageing societies to reduce older adult suicide risks.

A multistate transition model of changes in loneliness and carer stress among community-dwelling older adults in Aotearoa New Zealand

OBJECTIVES

To identify changes in loneliness and carer stress between two time points for older people of different ethnicities who had repeated interRAI home care assessments.

METHODS

Participants consisted of community-dwelling older adults across New Zealand who received two interRAI-HC assessments between 5 July 2012 and 31 December 2019. Two multistate models were developed: the first model was not lonely versus lonely, and the second model was no carer stress versus carer stress. The one-year transition probabilities were calculated. Mean sojourn times were calculated for each state except death. Paired t-tests assessed the differences in transition probabilities between the different ethnic groups.

RESULTS

The mean age of the cohort was 82.5 years (SD 7.7 years). At first assessment, 14,646 (21%) older people stated they were lonely and 26,789 carers (38%) experienced stress. The most common first transition type was not lonely to not lonely: Māori 42%, Pacific 54%, Asian, 48% and Other 40%. The highest one-year transition probability in the loneliness model was living in aged residential care to death (0.79). The most common first transition type for the carer stress was no carer stress to no carer stress: Māori 35%, Pacific, 46%, Asian, 43% and Other 33%. The highest one-year transition probability in the carer stress model was living in aged residential care to death (0.80). The statuses not lonely and no carer stress had a mean sojourn time of approximately one year, and eight months to one year, respectively.

CONCLUSIONS

Loneliness can change over time due to circumstances and an individual's perception of loneliness at the time of assessment. Carer stress is enduring and has a low probability of improvement.

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

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

Characterizing the momentary association between loneliness, depression, and social interactions: Insights from an ecological momentary assessment study

Evidence suggests that loneliness causes people to feel more depressed. It is unknown, however, why this association occurs and whether momentary versus chronic experiences of loneliness are implicated. Theoretical accounts suggest that momentary feelings of loneliness produce two competing motivations: social reaffiliation and social withdrawal. Social affiliation is protective against depression; social withdrawal, in contrast, is a risk factor. Thus, engaging in frequent and high-quality interactions following experiences of loneliness may protect against subsequent depression. We tested this hypothesis using a random-interval experience sampling design (5x/day/day, 14 days; Nobs = 6568) with a racially/ethnically diverse sample of adults with elevated depression symptoms (N = 102). Momentary loneliness was associated with depressed mood at the same time point and ∼2.5h and ∼5h later. Frequency and quality of social interaction did not moderate these associations. Findings suggest that momentary feelings of loneliness may be an important target for clinical intervention.

Complete Loss of Natural Teeth and Loneliness: A Fixed-Effect Analysis

Psychosocial properties of oral health have been reported. The present study aimed to investigate the causal effect of complete loss of natural teeth on loneliness by using fixed-effects analysis to control for confounding factors, including unmeasured time-invariant factors. Data from older adults participating in at least 2 consecutive waves of the English Longitudinal Study of Ageing in waves 3 (2006/2007), 5 (2010/2011), and 7 (2014/2015) were analyzed (N = 18,682 observations from 7,298 individuals). The association between complete loss of natural teeth and loneliness score (ranging from 3 to 9) was examined using fixed-effect linear regression analysis adjusting for time-varying confounders, including sociodemographic and health characteristics. The prevalence of complete tooth loss was 12.7%, 12.8%, and 10.6% in waves 3, 5, and 7, respectively. Individuals who transitioned to complete tooth loss during any 2 consecutive waves had an increase in loneliness score by 0.27 (95% confidence interval [CI] 0.03, 0.52), which was greater than those who maintained natural teeth (-0.03; 95% CI -0.05, -0.01). Fixed-effects analysis adjusting for time-varying confounders revealed a significant association between complete loss of natural teeth and an increase in loneliness score by 0.31 (95% CI 0.17, 0.46). Complete loss of natural teeth among older adults in England was associated with loneliness, even after accounting for measured time-varying and (un)measured time-invariant confounders. Retaining natural teeth may reduce the risk of loneliness.