Evaluating Workforce Mental Health and Well-Being: A Review of Assessments

OBJECTIVE

Given the importance of mental health and well-being assessments to employers' efforts to optimize employee health and well-being, this paper reviews mental health assessments that have utility in the workplace.

DATA SOURCE

A review of publicly available mental health and well-being assessments was conducted with a primary focus on burnout, general mental health and well-being, loneliness, psychological safety, resilience, and stress.

INCLUSION CRITERIA

Assessments had to be validated for adult populations; available in English as a stand-alone tool; have utility in an employer setting; and not have a primary purpose of diagnosing a mental health condition.

DATA EXTRACTION

All assessments were reviewed by a minimum of two expert reviewers to document number of questions, subscales, fee structure, international use, translations available, scoring/reporting, respondent (ie, employee or organization), and the target of the assessment (ie, mental health domain and organizational or individual level assessments.

DATA SYNTHESIS & RESULTS

Sixty-six assessments across the six focus areas met inclusion criteria, enabling employers to select assessments that meet their self-identified measurement needs.

CONCLUSION

This review provides employers with resources that can help them understand their workforce's mental health and well-being status across multiple domains, which can serve as a needs assessment, facilitate strategic planning of mental health and well-being initiatives, and optimize evaluation efforts.

Pathways Linking Parental Care and Control to Loneliness in Breast Cancer Patients with A History of Childhood Maltreatment: Exploring the Mediating Roles of Ambivalence Over Emotional Expression and Self-Discrepancy

Childhood maltreatment is a risk factor for loneliness and is linked to breast cancer. Parental bonding experienced during one's childhood also plays a significant role in increasing or decreasing the risk of loneliness later in life. Previous research has highlighted the significance of ambivalence over emotional expression (AEE) and self-discrepancy in the psychological adaptation of breast cancer patients, particularly concerning the impact of parental care and control experienced by patients in their relationship with their parents during childhood. Nevertheless, previous studies have not examined the mediating effects of AEE and self-discrepancy on parental care and control, as well as loneliness, in breast cancer patients. This study aimed to investigate whether AEE and self-discrepancy mediate the association of childhood parental care and control with loneliness in breast cancer patients with a history of childhood maltreatment. One hundred and thirty-three breast cancer patients who were receiving chemotherapy within the first 3 months post-diagnosis were recruited from one private and three public hospitals in Tabriz, Iran, to complete questionnaires. Parental bonding, loneliness, AEE, and self-discrepancy were assessed using the Parental Bonding Instrument (PBI), University of California Los Angeles (UCLA) Loneliness Scale, Ambivalence over the Expression of Emotion Questionnaire (AEQ), and Self-Discrepancies Scale (S-DS). Mediation models were tested using structural equation modeling. Effects of parental care (β = -.17, p < .05) and control (β = .21, p < .001) on loneliness were significant. Furthermore, both AEE (β = .19, p < .05) and self-discrepancy (β = .23, p < .01) significantly predicted loneliness. The pathway between parental care and AEE was significant (β = -.21, p < .001), as was the direct effect of parental control on self-discrepancy (β = .19, p < .05). Bootstrapping results showed that AEE significantly mediated the relationship between parental care and loneliness (95% confidence interval [CI] [-0.09, -0.01]). In addition, there was a significant indirect effect from parental control to loneliness via self-discrepancy (95% CI [0.11, 0.01]). These findings suggest that AEE and self-discrepancy could potentially be utilized in preventing or addressing loneliness in breast cancer patients who have a history of childhood maltreatment. Future research could, for example, assess whether integrating psychosocial interventions focusing on these variables as part of medical care can improve the mental health status of this subgroup of breast cancer patients who have experienced childhood maltreatment.

The Association Between Child Maltreatment and Loneliness Across the Lifespan: A Systematic Review and Multilevel Meta-Analysis

While there is evidence that child maltreatment is positively associated with loneliness, the strength of this association is not yet clear. It is also unclear whether the magnitude and statistical significance of this association varies across groups of individuals. Therefore, this meta-analysis examines whether there are differences in loneliness between individuals with and without maltreatment histories, and which factors may influence the association between child maltreatment and loneliness. A three-level meta-analysis was conducted on 52 studies reporting 116 effect sizes (N = 1,705,493; Mage = 30.93; 49.6% females). Results showed a medium overall effect (g = 0.45, p < .001, 95% CI [0.36, 0.53]), indicating that individuals with maltreatment histories, on average, feel lonelier than individuals without maltreatment histories. Moderator analyses showed that effect sizes were larger for emotional abuse and emotional neglect as compared to other types of child maltreatment and decreased when participants were older at the time of loneliness assessment. These findings suggest that individuals with maltreatment histories, especially those who have been emotionally abused and/or emotionally neglected, are vulnerable to experiencing loneliness across the lifespan. The results also suggest that feelings of loneliness warrant attention in prevention and intervention programs for individuals with maltreatment histories.

Effects of volunteering over six months on loneliness, social and mental health outcomes among older adults: The HEAL-HOA Dual Randomized Controlled Trial

OBJECTIVE

To determine the beneficial effects of volunteering as lay counselor via telephone on own loneliness, social network engagement, perceived social support, stress, anxiety, and depressive symptoms among Chinese older adults in Hong Kong during the COVID-19 pandemic. DESIGN, SETTING, INTERVENTION, AND PARTICIPANTS: "Helping Alleviate Loneliness in Hong Kong Older Adults" (HEAL-HOA), a dual randomized controlled trial, was implemented to test effects of telephone-based psychosocial interventions delivered by older-adult volunteers for low-income lonely older adults. To evaluate the effects of volunteering on loneliness, we randomized 375 individuals ages 50-70 into a volunteering condition versus an active control (psychoeducation with social gatherings). Following a 6-week training, participants in the volunteering condition, delivered tele-interventions to older intervention recipients.

MEASUREMENT

The primary outcome was loneliness measured with the UCLA Loneliness Scale. Secondary outcomes were loneliness measured with the De Jong Gierveld Scale (DJG), social network engagement, perceived social support, perceived stress, anxiety, and depressive symptoms. Assessments were completed before training (baseline) and immediately after the 6-month volunteering period.

RESULTS

Results from linear mixed models show significant positive effects of volunteering (significant interactions of condition × time) on both measures of loneliness (dppc2 = -0.41 ULCA Loneliness score, dppc2 = -0.70 total DJG score), social network engagement, stress and depressive symptoms as compared to control participants.

CONCLUSIONS

The HEAL-HOA trial demonstrates beneficial effects of volunteer-delivered tele-interventions on decreasing loneliness on the volunteer interventionists themselves. Communicating these benefits for volunteers may attract more older adults into volunteering. This effective tele-based volunteer program is scalable for wider implementation.

SUMMARY

This RCT tested effects of volunteering on loneliness in Hong Kong during the COVID-19-pandemic. Three hundred seventy-five individuals ages 50-70 were randomized into volunteering (delivering tele-interventions against loneliness) versus an active control condition. After 6 months, volunteers compared to controls, showed benefits on loneliness, social network engagement, stress and depressive symptoms. A program engaging lonely older adults in loneliness intervention delivery has beneficial effects on volunteers themselves and could be a scalable solution for our loneliness epidemic.

Workplace ostracism in healthcare: Association with job satisfaction, stress, and perceived health

AIMS

To examine (1) the association between healthcare workers' workplace ostracism and job satisfaction, stress and perceived health, and (2) whether this relationship is mediated by loneliness and self-esteem.

DESIGN

A cross-sectional study.

METHODS

Healthcare (N = 569) managers and employees (nurses, practical nurses, doctors and social workers) in Finland responded to a semi-structured survey in January 2021 and evaluated their experiences of workplace ostracism, job satisfaction, stress, perceived health, loneliness and self-esteem during the last year. To examine the association of these variables, linear regression and mediator model tests were performed.

RESULTS

Workplace ostracism had a clear direct association with job satisfaction, stress and perceived health. Loneliness fully mediated the relationship between workplace ostracism, stress and perceived health, and partly mediated the association between workplace ostracism and job satisfaction. Self-esteem partly mediated the association between workplace ostracism, stress, job satisfaction and perceived health.

CONCLUSION

The experience of workplace ostracism in organizations is a significant factor in job satisfaction, stress and perceived health. Healthcare organizations could strengthen job satisfaction and increase workers' well-being by strengthening social relationships in the organization and, via that, reducing turnover intention.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

This study gives understanding and information to the healthcare profession on how workplace ostracism affects work well-being and workplace relationships. Workplace ostracism decreases interaction, which can also endanger patient care if information is not openly exchanged.

IMPACT

This study indicated that workplace ostracism weakened job satisfaction more than loneliness. More commonality and consideration for others at work are needed because these factors may help increase work well-being and decrease exits from working life. Further research is needed on why workplace ostracism occurs in healthcare workplaces.

REPORTING METHOD

STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Dying a lonely death: A conceptual and normative analysis

This paper argues that a lonely death is, by definition, a bad death and that society as a whole, as well as individuals in society are obligated to assure a certain degree of well-being, flourishing, or care among and for fellow individuals. Individuals can then be said to have a right against dying a lonely death. Such a right has corresponding duties. The paper further specifies what such duties may entail based on what individuals may need on their deathbed, specifically focusing on the need for human touch. Assuming that human touch might indeed be needed by some individuals in order to avoid a lonely death, the paper explores potential implications from a public health perspective, particularly during infectious disease outbreaks such as COVID.

The correlation between death anxiety, loneliness and hope levels in patients treated in the cardiac intensive care unit

BACKGROUND

A sense of hope plays an important role in relieving stress and psychological distress of cardiology patients, as well as improving their physical well-being.

AIM

The aim of this study is to investigate the correlation between death anxiety, loneliness and hope levels in patients receiving treatment in a cardiac intensive care unit (ICU).

DESIGN

This is a prospective, descriptive and correlational study.

METHODS

The study was completed with 150 cardiac ICU patients in Istanbul, Turkey. The data were collected using a Patient Information Form, the Templer Death Anxiety Scale (TDAS), the Herth Hope Index (HHI) and the UCLA Loneliness Scale (UCLA-LS).

RESULTS

The patients had a mean age of 63.56 ± 12.74 years. Most of the patients (82%) were treated in the ICU for heart failure. There was a statistically significant positive correlation between total scores of TDAS and UCLA-LS (r = .337; p < .001) and a statistically significant negative correlation between total scores of UCLA-LS and HHI (r = -.292; p < .001). Also, there was a statistically significant negative correlation between the scores of UCLA-LS and Positive Readiness and Expectancy Subscale (r = -.164; p = .044). The multiple linear regression indicated that the model was statistically significant (F = 7.177, p < .001). The variables of age and UCLA-LS among those included in the model were statistically significant predictors of the death anxiety scores of the patients (23.1%) (p < .05).

CONCLUSIONS

The cardiology patients who received treatment in the ICU had a high level of death anxiety and moderate levels of loneliness and hope. The age and loneliness level were statistically significant predictors of death anxiety.

RELEVANCE TO CLINICAL PRACTICE

It is recommended that individualized nursing care be planned and provided to conscious cardiology patients who are treated in the ICU, considering their age and loneliness levels and that nursing care be planned for individuals who are at risk of fear, anxiety, loneliness and hopelessness by periodically assessing their death anxiety, loneliness and hope levels.

Approachability and Credibility of Virtual Character Faces: The Role of the Horizontal Viewing Angle

OBJECTIVE

The present work explores how the horizontal viewing angle of a virtual character's face influences perceptions of credibility and approachability.

BACKGROUND

When encountering virtual characters, people rely both on credibility and approachability judgments to form a first impression of the depicted virtual character. Research shows that certain perceptions are preferred either on frontal or tilted faces, but not how approachability or credibility judgments relate to horizontal viewing angles in finer granularity between 0° and 45°.

METHOD

52 participants performed a two-alternative forced choice (2AFC) task rating 240 pairwise comparisons of 20 virtual character faces shown in four horizontal viewing angles (0°, 15°, 30°, and 45°) on approachability and credibility. They also rated scales on individual differences based on the BIS-BAS framework (behavioral inhibition system, drive, and reward responsiveness), self-esteem, and personality traits (neuroticism, loneliness).

RESULTS

Both approachability and credibility were negatively related to the horizontal viewing angle, but the negative relationship was less pronounced for approachability. Notably, 15° tilted faces were associated with higher approachability than frontal faces by people scoring high in reward responsiveness, drive, and self-esteem, and scoring low in neuroticism and loneliness.

CONCLUSION

Our findings highlight the conditions under which showing a virtual character's face is preferred in a horizontally 15° tilted over a frontal position.

APPLICATION

The differential impact of the horizontal viewing angle on approachability and credibility should be considered when displaying virtual character faces.

Demographic, lifestyle, social, and psychological factors associated with worry-related sleep problems among school-going adolescents in Timor-Leste

OBJECTIVE

Adolescent sleep problems are a worldwide public health issue. The present study examines factors associated with worry-related sleep problems among school-going adolescents. The country of interest is Timor-Leste, a low-income country, where studies pertaining to adolescent sleep problems are lacking.

DESIGN AND MEASURES

Data were analysed from the Global School-Based Student Health Survey Timor-Leste (n = 3455). An ordered probit model was used to assess the effects of demographic, lifestyle, social, and psychological factors on different levels of worry-related sleep problems (i.e., no, mild and severe sleep problems).

RESULTS

School-going adolescents were more likely to face mild or severe worry-related sleep problems if they were older, passive smokers, alcohol drinkers and moderately active. School-going adolescents who sometimes or always went hungry were more likely to experience worry-related sleep problems than those who did not. Involvement in physical fights, being bullied, and loneliness were positively associated with the probability of having modest or severe worry-related sleep problems.

CONCLUSION

Age, exposure to second-hand smoke, alcohol consumption, physical activity, going hungry, physical fights, being bullied and loneliness are the important determining factors of adolescent worry-related sleep problems. Policymakers should pay special attention to these factors when formulating intervention measures.

Changes in well-being among socially isolated older people during the COVID-19 pandemic: An outcome-wide analysis

Older adults experienced major changes during the COVID-19 pandemic and ensuing restrictions, and it might be expected that those who were already socially isolated before the pandemic were particularly vulnerable. We apply an outcome-wide longitudinal design on 4,636 participants (mean age 66.8 y) from the English Longitudinal Study of Ageing, observed in 2018/19 and early (June/July 2020) and later (November/December 2020) in the pandemic. Social isolation is defined using an index including marital status, social contact, and social participation in 2018/19. Using mixed models, we compare changes in well-being, health, health behaviors, financial well-being, and Internet use, between isolated and nonisolated participants. From before to during the pandemic, isolated participants (29%) experienced smaller declines in life satisfaction and quality of life and a smaller increase in loneliness. They showed greater declines in smoking and physical activity and were more likely to remain worried about their future financial situation. They also did not change in their likelihood of regular Internet use, contrasting with nonisolated participants who increased in this regard. The groups followed a similar trend for general health and sleep quality (no change), depression and anxiety (increase), and expectations of future financial difficulties (decrease). Although isolated older adults generally show poorer outcomes than their socially connected counterparts, they were somewhat protected during the pandemic on some fronts. Our findings highlight the need to continually care for isolated older adults but also to be attentive in times of unexpected crises to those experiencing extreme changes related to necessary policy responses.

How can care home activities facilitate social connection in residents? A qualitative study

OBJECTIVES

Good social connection is associated with better physical and mental health but care home residents experience barriers to social connection. Activities present a potential avenue for improving social connection in care homes but residents often experience loneliness despite access to activity programmes. We therefore aimed to identify what aspects of activities facilitate social connection in care home residents.

METHOD

Qualitative study using semi-structured interviews that were analysed using Thematic Analysis. A purposive sample of 35 participants, including 12 residents, 10 family caregivers, nine care home staff and four clinicians, recruited from UK care homes.

RESULTS

We found four main themes describing features of activities important for facilitating social connection: (1) personalisation with respect to residents' interests, social preferences, and cognitive ability; (2) activities which foster a sense of community; (3) finding and emphasising things in common that residents share; and (4) facilitating a sense of involvement with others.

CONCLUSION

We identified the key aspects of activities which facilitate social connection in care homes. These findings can be applied to a range of existing and newly designed activities in care homes and inform the development and testing of psychosocial interventions aiming to improve social connection.

The associations between daily reports of loneliness and psychotic experiences in the early risk stages for psychosis

AIM

Bi-directional associations between loneliness and psychotic experiences (PEs) have been reported, but the mechanisms underlying these associations are unknown. This study aims to explore associations between daily reports of loneliness and PEs, and test differences in this association across young adult individuals at different levels of risk for psychosis.

METHODS

We analysed 90-day diary data on loneliness and PEs from N = 96 participants (mean age 24.7, range 18-35, 77% female) divided into 4 subgroups, each indexing increased levels of risk for psychosis according to the clinical staging model: 'psychometric' (n = 25), 'low' (n = 27), 'mild' (n = 24), and 'ultra-high'(n = 20) risk. Multilevel vector autoregressive models examined within-day (contemporaneous) and between-day (temporal) associations between loneliness and PEs for the total sample. Next, these associations were compared across subgroups.

RESULTS

Loneliness and PEs were significantly associated contemporaneously (partial correlation B = 0.14) but not temporally. Subgroup membership moderated both contemporaneous and temporal associations. The contemporaneous association between loneliness and PEs was stronger in the low-risk subgroup compared to the mild-risk (B = -0.35, p < .01) and ultra-high-risk (B = -0.36, p < .01) subgroups. The temporal association between loneliness on the previous day and PEs on the current day was stronger in mild-risk subgroup compared to the ultra-high-risk subgroup (B = -0.03, p = .03). After adjusting for multiple testing, only the contemporaneous-but not the temporal-associations remained statistically significant.

CONCLUSIONS

Loneliness is associated with PEs in individuals at risk for psychosis, particularly in those with low to mild symptoms. Our findings tentatively suggest that especially individuals with low expressions of PEs may be more sensitive to social context, but future studies are needed to replicate and further unravel the potentially stage-specific interplay between social context and PEs.

Loneliness, social isolation, and cardiovascular disease among nonveteran and veteran women

We examined the prospective associations of social isolation and loneliness with incident cardiovascular disease (CVD) among aging nonveteran and veteran women, and effect modification by veteran status. Participants with no history of myocardial infarction (MI), stroke, coronary heart disease (CHD), or coronary heart failure from the Women's Health Initiative Extension Study II self-reported social isolation, loneliness, health behaviors, health status, and veteran status. CVD and CVD subevents were physician adjudicated. Hazard ratios (HR) and 95% confidence intervals (CI) for the Interquartile Range (IQR) in social isolation (IQR = 1) and loneliness (IQR=.33) were calculated using Cox proportional hazard models adjusting for sociodemographic, health behavior, and health status characteristics. Veteran status was tested as an effect modifier. Among 52,442 women (Mean age = 79 ± 6.1; veterans n = 1023; 89.2% non-Hispanic White), 3579 major CVD events occurred over an average 5.8 follow-up years. Compared to nonveterans, veteran women reported higher levels of social isolation (p < .01) and loneliness (p < .01). The CVD HR was 1.07 (95% CI, 1.04-1.10) for the IQR in social isolation and 1.03 (95% CI, 1.10-1.06) for the IQR in loneliness. The HR for the IQR in both social isolation and loneliness was 1.10 (95% CI, 1.05-1.15). Social isolation was associated with CHD (HR = 1.12; 95% CI, 1.03-1.21). The CHD HR for the IQR in social isolation was 1.12 (95% CI, 1.03-1.21). Associations did not differ by veteran status (all p-interactions > 0.08). Findings suggest that the adverse associations of social isolation and loneliness with CVD are similar among veteran and nonveteran women.

COVID-19 Imposed Closure of Rural Co-Housing and Loneliness in Older Adults Living Alone: Longitudinal Evidence From South Korea

This study aimed to examine the impact of COVID-19 on loneliness among rural older women in senior cohousing in Korea. Using a natural experimental study design, we investigated how the pandemic-induced closure of cohousing affected the former residents' loneliness. The sample comprised 84 cohousing residents and 51 individuals in conventional homes. The dependent variable is loneliness, and the independent variables include housing transition, social contact, and support from neighbors and friends. Our findings from fixed effect regression models showed former cohousing residents were less likely to experience loneliness when they had more contact with their friends and neighbors, while negative relationships exacerbated feelings of loneliness. Sharing meals and participating in activities with friends and neighbors in cohousing helped the residents develop effective coping strategies. Senior cohousing in rural areas has the potential to strengthen social ties and protect the most vulnerable subgroup of older adults from social isolation and loneliness.

Adaptation and Implementation of a Volunteer-delivered, Telephone-based, Social Support Program HOW-R-U? during the COVID-19 Pandemic: A Pragmatic Study

BACKGROUND AND OBJECTIVES

Public health concerns surrounding social isolation and loneliness heightened during the COVID-19 pandemic, as infection prevention measures led to increased feelings of loneliness and depression.Our objective was to evaluate the implementation of the HOW-R-U? program, during the pandemic (March 2020-December 2021). HOW-R-U? is a weekly volunteer-delivered telephone program designed to facilitate social connection and ease feelings of social isolation, loneliness and depression in older people.

RESEARCH DESIGN AND METHODS

This pragmatic study used the Implementation Framework for Aged Care to adapt and implement HOW-R-U? in an Australian aged and community care organization and a tertiary health service in Melbourne. The evaluation involved analysis of program data, semi-structured interviews and surveys with program recipients, volunteers, and referrers. A process evaluation was conducted alongside assessment of outcomes including pre- and post- symptoms of isolation, depression, and loneliness.

RESULTS

The implementation evaluation indicated that codesigned systems and processes effectively supported ongoing implementation of HOW-R-U? with transition into business as usual across both organisations. Recipients reported the telephone calls had a positive impact on their lives, while volunteers reported enjoyment supporting others. Several challenges were identified, namely in program reach and fidelity.

DISCUSSION AND IMPLICATIONS

: HOW-R-U? was well regarded by all involved and evaluation learnings have informed implementation into business as usual by both organizations.

Increasing Older Adults' Social Connectedness: Development and Implementation of a Web-Assisted Acceptance and Commitment Therapy-Based Intervention

In this article, we will provide a rationale for a web-assisted acceptance and commitment therapy (ACT) approach to loneliness among older adults, drawing upon theories from the literature on adult development and aging, emotion regulation, and loneliness. The intervention program was developed using the principles of ACT, which is a cognitive behavioral approach and unified model of human behavior change and psychological growth. The ACT intervention focuses on developing nonjudgmental present-focused awareness of internal experiences (thoughts, emotions, and memories) through strategies such as acceptance and mindfulness rather than directly modifying or removing them per se. The ACT intervention appears well-suited to assist older adults in coping with the challenges of aging, as the focus is on an individual’s willingness to sit with internal experiences out of one’s control (ie, acceptance), stepping back from negative or critical thoughts and developing greater kindness toward oneself (ie, defusion), discerning what is most important to one’s true self (ie, values), and building larger patterns of effective action based on such values (ie, committed action). The ACT intervention was developed as a resource for older adults who are socially isolated or having difficulty with social connectedness. Eight modules comprise the web-assisted ACT intervention program, which includes reading materials, video clips, and activities. Each module is followed by a summary, a homework assignment, a short quiz to assess learning, and a moderated discussion with a coach. The intervention program begins with reconnecting participants with their values. The goal of the ACT intervention program is to foster flexibility in a participant’s behavior so they can behave consistently with their chosen values, rather than becoming locked into a pattern of behavior that is driven by avoiding distress or discomfort. The ACT intervention approach is both novel and innovative, as it is based on ACT and leverages a behavioral health web platform that is flexible and inclusive in its design. The ACT intervention aims to help older adults become more socially connected, less lonely, and more satisfied with their relationships with other people. The emphasis that ACT places on values and living life in accordance with one’s values renders it an approach ideally suited to older adults. Finally, recommendations for future research regarding this approach to addressing loneliness among older adults is addressed.

Association between perceived stress, loneliness and sleep disorders among breast cancer patients: the moderating roles of resilience

Sleep disorders are prevalent and often neglected among breast cancer patients. This study aimed to identify the association among perceived stress, loneliness, resilience and sleep disorders and to further explore whether resilience could be a moderator in the association between them and sleep disorders. A cross-sectional study was conducted by 492 female breast cancer patients. Patients were asked in response to the questionnaires including the Pittsburgh Sleep Quality Index, Perceived Stress Scale-10, the Three-Item Loneliness Scale and Resilience Scale-14. The association among perceived stress, loneliness, resilience and perceived stress/loneliness × resilience interaction with sleep disorders were examined by hierarchical multiple regression analysis. The interaction was visualized by using simple slope analysis. 36.58% of the female breast cancer patients reported sleep disorders in our study. Perceived stress and loneliness were related to sleep disorders. Resilience could moderate the relationship between them and sleep disorders. When resilience was higher, perceived stress and loneliness had a weaker impact on sleep disorders. Medical staff should systematically evaluate the internal environmental factors related to patients' sleep quality and help patients relieve their emotional distress caused by the disease through positive psychological guidance.

Association between Levels of Loneliness, Laboratory Measurements, and Behavioral Aspects in a Primary Care Setting in Crete, Greece

This paper examines potential associations of loneliness with laboratory data and specific psychosocial and behavioral attitudes. The sample collection took place in an urban Primary Health Care unit between May and July 2023, consecutively, and once exclusion criteria were implemented. Participants were aged between 40 and 75 years. Routine laboratory test results upon study initiation and six months before were used. The University of California, Los Angeles (UCLA), Loneliness Scale (Version 3), blood glucose, serum lipids, Fibrosis-4 index, and Creatinine Clearance (CrCl) were assessed through hierarchical multiple logistic regression analysis. Based on full model (3rd) analysis, those who were engaged in an individual sport or activity or had contacts with more friends presented significantly lower odds for increased loneliness levels (odds ratio (OR): 0.28 [95% confidence interval (CI) 0.09-0.91], p = 0.034 and OR: 0.76 [95%CI 0.66-0.88], p < 0.001, respectively). The consumption of alcohol was associated with increased loneliness (OR: 5.55 [95%CI 1.42-21.63], p = 0.014). Elevated triglyceride levels were linked with moderate or no loneliness (OR: 0.20 [95%CI 0.05-0.83], p = 0.026), while an increased LDL/HDL atherosclerotic index was related to increased subjective loneliness (OR: 4.50 [95%CI 1.12-18.13], p = 0.035). The need for holistic approaches-involving primary care personnel-in understanding and addressing loneliness, recognizing its multifaceted nature as well as the diverse factors that contribute to this issue, is considered challenging.

Young adults with vision impairment in India: Loneliness and social networks

PURPOSE

To examine the prevalence of loneliness and associated factors in young adults with vision impairment (VI), including quality of life (QoL) in India.

METHODS

Two hundred and three VI young adults (18-35 years) and 219 age-matched non-VI (controls) adults completed the loneliness scale, WHOQOL-BREF, Social Network Index (SNI) (network diversity, people in network size and number of embedded network subscales) and questions regarding sociodemographic characteristics and independent mobility. Rasch analysis was used to validate the questionnaires and interval-level scores were generated. Generalised linear models were used to estimate independent associations of sociodemographic factors, VI characteristics, social networks and QoL with loneliness.

RESULTS

The prevalence of moderate and severe loneliness in the VI group was 10% (95% CI: 6.5, 15.4) and 4.4% (95% CI: 2.0, 8.2), respectively, and higher than that of controls. The VI group had a worse loneliness score than controls (-1.66 ± 2.25 vs. -2.13 ± 1.85 logits; p = 0.03). Those with ≤12 years and >12 years of education had loneliness scores of -1.58 ± 2.45 and -1.82 ± 1.99 logits, respectively (p = 0.01). Compared with controls, the VI group reported fewer extended family members, neighbours and friends leading to significantly smaller networks and network diversity (all p < 0.001). Loneliness scores demonstrated a significant correlation with only two SNI subscales for both groups: people in network size (r = -0.28 for VI; r = -0.30 for non-VI; p < 0.001 for both) and number of embedded networks (r = -0.22 for VI; r = -0.21 for non-VI; p = 0.002 for both). Both education (β = 0.45; p = 0.04) and QoL (β = -0.27, p = 0.02) were predictors of loneliness.

CONCLUSIONS

Loneliness was commonly experienced by young VI adults and was higher among those with lower levels of education. Loneliness decreased with the presence of a larger number of people in network, suggesting that interventions to increase social activity and participation may be valuable in young VI adults.

The Association of Vision and Hearing Impairment on Cognitive Function and Loneliness: Evidence From the Mexican Health and Aging Study

Objectives: We investigated whether self-reported vision and hearing were associated with cognitive function and loneliness among Mexican adults aged 50 and older. Methods: Mexican Health and Aging Study data. Vision/hearing status was self-reported (excellent-very good, good, fair-poor). Cognition was measured using nine tasks. Loneliness was measured using the UCLA Loneliness Scale. Analyses controlled for demographic and health characteristics. Results: Among 12,353 participants (mean age = 67, 58% female), poor vision, but not hearing, was associated with lower global cognition (β = -0.03, p < .05). Poor vision (OR = 1.57, 95% CI = 1.30-1.91) and hearing (OR = 1.35, 95% CI = 1.14-1.61) were associated with higher odds of being lonely after adjusting for demographics and comorbidities, but not when adjusting for limitations in daily activities and depressive symptoms. Discussion: Poor vision is a potentially modifiable risk factor for lower cognition and loneliness among Mexican adults. These associations are partly due to functional characteristics of older adults with poor vision.

Is matching or discrepancy between filial piety expectation and filial support better? The role of filial support of children and social support

Filial piety in traditional Chinese culture is an essential variable in explaining intergenerational interaction. However, previous studies have not clarified whether older adults' filial responsibility expectations matched children's filial support and the effects of the filial discrepancy on their life satisfaction and loneliness. The latent profile analysis showed that older adults were divided into two groups: (1) high expectations and support, and (2) low expectations and support. The results showed that compared with older adults with low expectations and low support, those with high expectations and high support reported higher life satisfaction and lower loneliness. Additionally, social support played a moderating role in the effect of the groups of older adults on life satisfaction and loneliness. Our conclusion shows that filial support is an essential factor influencing older adult life satisfaction and loneliness, and social support is an effective supplement to filial support.

Social participation in Australian residential aged care: A human rights perspective

The Royal Commission into Aged Care Quality and Safety emphasised the critical need for a human rights-based approach to protect the rights of older people in the Australian aged care context, including 'the right to social participation'. This topic is important because of the widespread social isolation and loneliness in Australian residential aged care. This article demonstrates how a human rights-based framework can provide guidance to governments in approaching issues involving the protection of older people's need for social connection in aged care. In doing so, the article considers examples of how the Australian government can ensure choice of living arrangement, individualised support and access to community services and facilities in the residential aged care context to better protect the right to social participation.

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

IMPORTANCE

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

DESIGN

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

SETTING

Previously occupied villages in Eastern and Southern Ukraine.

PARTICIPANTS

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

EXPOSURE

Participants were exposed to Russian occupation of Ukrainian villages.

MAIN OUTCOME AND MEASURES

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

RESULTS

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

CONCLUSIONS AND RELEVANCE

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

The effect of intergenerational support from children on loneliness among older adults-the moderating effect of internet usage and intergenerational distance

Objective

Loneliness is a key social and public health issue, mainly affecting the mental health of older adults. The article aimed to explore the influence of intergenerational support from children on loneliness among older adults. Meanwhile, the article also analyzed the moderating effects of internet usage and intergenerational distance in this process.

Methods

Based on the data received from 2018 China Longitudinal Aging Social Survey (CLASS), the ordinary least square (OLS) regression model was used to analyze the influence of intergenerational support from children on loneliness among older adults. Furthermore, the Bootstrap method was used to test the moderating effect of internet usage and intergenerational distance on the relationship between intergenerational support from children on loneliness among older adults.

Results

Baseline regression showed that economic support (β = -0.059, p < 0.001), caregiving support (β = -0.070, p < 0.001), and emotional support (β = -0.108, p < 0.001) from children can positively influence loneliness among older adults. Meanwhile, the results of the moderated effects analysis showed that internet usage and intergenerational distance moderates the relationship between caregiving support, emotional support from children and loneliness among older adults.

Conclusion

The article demonstrates that family support, particularly intergenerational support from children plays a pivotal role in alleviating loneliness among older adults, so the government should further regulate the behavior of children's alimony support, improve the digital infrastructure, these measures help to reduce loneliness among older adults and expand the depth and breadth of family care of older adults.

Longitudinal Problematic Social Media Use in Students and Its Association with Negative Mental Health Outcomes

Purpose

Social media has become increasingly part of our everyday lives and is influential in shaping the habits, sociability, and mental health of individuals, particularly among students. This study aimed to examine the relationship between changes over time in problematic social media use and mental health outcomes in students. We also investigated whether resilience and loneliness moderated the relationship between social media use and mental health.

Patients and Methods

A total of 103 participants completed a baseline virtual study visit, and 78 participants completed a follow-up visit, 4-weeks later. Participants completed a comprehensive set of questionnaires measuring symptoms of depression and anxiety, perceived stress, loneliness, and resilience.

Results

Our results showed that problematic social media use at baseline was significantly negatively correlated with resilience and positively correlated with all other mental health outcomes. Furthermore, increases in problematic social media use were significantly associated with increased depressive symptoms and loneliness between visits. Resilience significantly moderated the relationship between increased problematic social media use and heightened perceived stress. Poor mental health at baseline did not predict increased problematic social media use over time. Contrarily to problematic use, frequency of social media use was not significantly correlated with any mental health measures at baseline.

Conclusion

This study offers a longitudinal perspective, providing valuable insights into the potential protective role of resilience against the detrimental mental health effects seen with increases in problematic social media use.

Reciprocal and Dynamic Associations between Social Isolation, Loneliness, and Disability among Chinese Older Adults

OBJECTIVES

This study aimed to examine reciprocal and dynamic associations between Social Isolation (SI), loneliness, and disability among Chinese older adults.

DESIGN

This is a prospective cohort study.

SETTING AND PARTICIPANTS

The global trend of population aging has resulted in a significant rise in the prevalence of disabilities, SI, and loneliness among older adults. These factors can severely impact the health and well-being of older adults. Therefore, it is crucial to implement more efficient interventions aimed at reducing disabilities, addressing SI, and combating loneliness among older adults in order to improve their overall health and well-being.

METHODS

Using a large, nationally representative sample spanning 16 years, we employed the general cross-lagged panel model to explore the relationships among 50,348 older adults with a mean age of 81.83 at baseline. Disability was measured by a comprehensive index tool that incorporated multiple dimensions. SI was measured using an SI index, and loneliness was evaluated using a single-item measure.

RESULTS

SI emerged as a stronger predictor of disability than loneliness. Longitudinal analysis revealed accumulative disadvantages in the association between SI and disability. Additionally, disability was found to contribute to increased SI and loneliness. However, our study did not detect any variance in the strength of the cross-lagged effects between social isolation and disability.

CONCLUSIONS AND IMPLICATIONS

The findings suggest that reducing SI is crucial for reducing disability among older adults. Initiating early interventions to minimize initial SI could aid in preventing later-life disability. Additionally, addressing disabilities may positively impact the reduction of loneliness and SI within this population.

Social participation, loneliness, and physical inactivity over time: evidence from SHARE

OBJECTIVES

We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old.

DESIGN

A longitudinal study with a six-year follow-up period was conducted.

SETTING

Four waves of the Survey of Health, Ageing and Retirement in Europe project were used.

PARTICIPANTS

This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time.

MEASUREMENTS

The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables.

RESULTS

A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness.

CONCLUSIONS

These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.

Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning

OBJECTIVE

The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70.

DESIGN

Cross-sectional analysis.

SETTING

Four outpatient psychiatry clinics in New York City.

PARTICIPANTS

Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder.

MEASUREMENTS

Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life.

RESULTS

Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01).

CONCLUSION

Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.

Rejection Sensitivity and Reactive Aggression in Early Adults: The Mediating Role of Loneliness and Maladaptive Coping

Reactive aggression is an aggressive response to a perceived threat or provocation. It has detrimental effects on individuals and society. Rejection sensitivity, a disposition that one tends to anxiously expect, readily perceive, and intensely react to social rejection, has been associated with reactive aggression. Considering that the mechanism underlying this link remains unclear, this study explores the mediating role of loneliness and maladaptive coping. Participants included 1104 early adults between the ages of 17-23 (Mage = 20.35, SD = 1.11, 33.6% men) in China who completed the Chinese version of the Tendency to Expect Rejection Scale, Loneliness Scale, Ways of Coping Questionnaire, and Reactive-Active Aggression Questionnaire. The serial mediation model revealed that loneliness and maladaptive coping independently mediated the association of rejection sensitivity with reactive aggression. More importantly, the chain mediating effect of "loneliness-maladaptive coping" also accounted for this link. The above findings contribute to a deeper understanding of the relationships among these factors and suggested that rejection sensitivity could positively be related to reactive aggression through loneliness and maladaptive coping.

Unveiling the relationship between social anxiety, loneliness, motivations, and problematic smartphone use: A network approach

BACKGROUND

Previous studies suggested social anxiety as an essential risk factor for problematic smartphone use, but the complex interactions and the most influential components affecting this relationship remain unclear. This study capitalizes on network analysis to identify the central factors and possible mediating paths among social anxiety, loneliness, five types of motivation, and problematic smartphone use.

MATERIAL AND METHODS

Employing 549 emerging adults, we obtained a stable network of the above variables. The central components and the stability of this network were also identified.

RESULTS

Within this network, the edge linking withdrawal behavior and use of application (APP) exhibits the most robust edge intensity. The central components include social comfort, use of APP, withdrawal behavior, and companionship while the bridge central nodes include social anxiety and escapism motivation. The direct link between social anxiety and PSU revealed only fragile edges with both withdrawal behavior and use of APP. Considering the possible mediating pathways, three pathways were observed in our network. Loneliness and escapism mediated the relationship between social anxiety and social comfort. Moreover, another mediating way was from social anxiety, loneliness, social interaction motivation, and escapism motivation to social comfort.

DISCUSSION

Based on the above identification of related components and pathways, future researchers could intervene against problematic smartphone usage in this socially anxious population.

Stigma salience increases loneliness among ethnic minorities

Research shows that ethnic minorities are at increased risk of loneliness compared to the general population of the United Kingdom. We hypothesized that stigma salience increases loneliness among ethnic minorities, conducting two experimental studies with ethnic minorities (Study 1: N = 134, Study 2: N = 267) in which participants were randomly assigned to a stigma salience (recalling a personal experience of discrimination based on ethnicity) or control condition (recalling a past meal in Study 1 and the experience of reading a book in Study 2). Across these two studies, we demonstrated that stigma salience consistently increased self-reported loneliness relative to the control conditions. Study 1 additionally showed evidence for an indirect effect of stigma salience on loneliness through feelings of anxiety. Study 2 replicated the effect of self-relevant (but not non-self-relevant) stigma salience on loneliness and provided suggestive evidence for a more specific indirect effect through identity-related social anxiety.

The relationship between loneliness and the experiences of everyday stress and stressor-related emotion

Loneliness influences how people experience and respond to stressors, which may account for its role as a risk factor for morbidity and mortality. The present study was motivated by emerging evidence that affective responses to minor daily events have long-term implications for health and well-being. Specifically, we evaluated how individual differences in loneliness relate to the frequency of everyday stressors and stressor-related negative emotions. A diverse community sample of 255 adults (age 25-65 years) completed ecological momentary assessments (EMA), during which they reported recent stressors and current negative affect (NA) five times a day for 14 days. Multilevel logistic analyses indicated that there was a quadratic association between loneliness and likelihood of reporting stressors, controlling for demographics, social isolation, depressive symptoms, and context (current activities, current location). Multilevel regression indicated that loneliness was unrelated to the concurrent effect of stressors on NA but significantly larger lagged stressor effects were observed among individuals in the low and high ranges of loneliness. These findings suggest that individuals with high levels of loneliness are more likely to experience everyday stressors and have prolonged emotional responses following stressors.

myHealthHub for older adult inpatients to reduce loneliness, and improve patient engagement and mental health: protocol of a pilot randomized controlled trial

OBJECTIVES

Older Canadian adults make up 85% of hospital stays which are associated with increased loneliness, stress, anxiety, and/or depression. There is a need for novel approaches to reduce loneliness and mental health outcomes in older adult hospital inpatients to prevent further strain on an already overwhelmed healthcare system.

METHODS

This is a pilot randomized controlled trial (RCT) exploring the efficacy of a bedside multimodal interaction system, myHealthHub, on loneliness, quality of life (QOL), patient engagement, and other mental health outcomes compared to an active control group in older adult inpatients (n = 60) from baseline to 5-days. Qualitative analyses will be conducted through semi-structured interviews with older adults (n = 8-10) and hospital staff, nurses, and clinicians (n = 4-5) facilitating the service to evaluate patient engagement and experience with myHealthHub.

RESULTS

Not applicable.

CONCLUSION

This novel pilot clinical trial will obtain preliminary data on the efficacy of myHealthHub in reducing loneliness, QOL, patient engagement, and mental health outcomes in older adult inpatients. If successful, this could provide a potential means to improve patient experience in hospitals and reduce the burden and additional expense on the healthcare system.

Examining the association of student mental health and food security with college GPA

BACKGROUND

Low food security and poor mental health are a persistent concern for college students.

OBJECTIVE

Examine how food security and mental health are associated with college student's grade point average (GPA).

METHODS

American College Health Association (ACHA)-National College Health Assessment III survey data Spring 2020 of students from 75 US universities (n = 48,103) were utilized to examine relationships among mental health, food security and academic performance (GPA).

RESULTS

The majority of the population self-reported high food security (58.3%) and moderate psychological distress (50.8%). Very low food security (B = -.523, OR = .59, p < .001) and moderate psychological distress (B = -0.19, OR = .83, p < .001) were inversely associated with high GPA. Reduced food security was associated with worse mental health measures.

CONCLUSIONS

Food security and mental health are negatively associated with GPA. To improve student success, universities must enhance services that address food insecurity and mental health.

Increased belongingness among college students during COVID-19: a potential cohort effect?

OBJECTIVE

Speculation about the effects of COVID-19, especially on youth social development, has been mixed. This study aimed to examine change in loneliness and belongingness into the first month of stay-at-home orders (January through April 2020).

PARTICIPANTS

College students (N = 73, mean age = 19.03 years, SD = 1.44 years) enrolled in a life-span development course.

METHODS

Participants completed online surveys at the beginning and the end of the semester assessing change in well-being.

RESULTS

Results revealed that loneliness scores significantly decreased, and belongingness scores significantly increased from Time 1 to Time 2. Among those who experienced increased belongingness, loneliness significantly decreased while there was not a significant change in loneliness among those who decreased in belongingness.

CONCLUSIONS

These findings suggest that increasing belongingness should be a focus when trying to combat loneliness, especially in young adults experiencing a dramatic life event during a critical time for social development.

Factors Leading to a Decrease in Grip Strength Among the Oldest Old: A Large, Representative, Longitudinal Survey

OBJECTIVES

Grip strength is an indicator for physical performance and highly correlated with general health among older adults. To date, there is limited knowledge regarding the factors contributing to grip strength exclusively among the oldest old based on data from large representative samples and also including institutionalized individuals. Consequently, the purpose of our current study was to address this gap in knowledge.

DESIGN

A large representative, longitudinal study.

SETTING AND PARTICIPANTS

Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+), including individuals ≥80 years (residing in institutionalized settings and living in private households) in North Rhine-Westphalia (n = 1824, mean age was 86.7 years, 80 to 104 years).

METHODS

In accordance with other large cohort studies, isometric grip strength was measured using a dynamometer (Smedley Dynamometer, 100 kg).

RESULTS

Linear fixed effects regressions showed that decreases in grip strength were significantly associated with increases in age (β = -0.70, P < .001), decreases in social network size (β = 0.08, P < .05), and worsening self-rated health (β = 0.80, P < .01). In contrast, decreases in grip strength were not significantly associated with changes in marital status, changes in living situation, changes in the number of chronic conditions, changes in depressive symptoms, and changes in health literacy.

CONCLUSIONS AND IMPLICATIONS

It has been shown that age, social network size, and self-rated health were associated with grip strength among the oldest old longitudinally. Our current study may assist in identifying individuals at risk for low grip strength. For example, efforts to maintain social contacts may be beneficial to maintain grip strength. This is relevant because low grip strength contributes to unfavorable outcomes such as poor quality of life, functional impairment, cognitive decline, and reduced longevity.

School belonging and depressive symptoms: the mediating roles of social inclusion and loneliness

BACKGROUND

Loneliness and depressive symptoms are prevalent among Finns.

OBJECTIVES

This study, which analyzes nationwide data from 149,986 students aged 13-18 years in Finland, focuses on the mediating effects of social inclusion and loneliness in the association between school belonging and depressive symptoms.

METHOD AND RESULTS

The analysis of variance showed that boys reported higher levels of school belonging and social inclusion, whereas girls reported higher levels of loneliness and depressive symptoms. Mediation analysis showed that social inclusion and loneliness partially mediated the effect of school belonging on depressive symptoms, but that social inclusion's effect was much greater than loneliness's. By focusing on the moderating role of sex, it was discovered that social inclusion significantly mediated depressive symptoms in girls more than boys.

CONCLUSION

The importance of social inclusion in preventing depressive symptoms was highlighted in the discussion.

An account of loneliness while living with an eating disorder

WHAT IS KNOWN ON THE SUBJECT?: Severe and prolonged loneliness is known to be detrimental to mental well-being. Eating disorders and loneliness are linked to each other with loneliness often acting as a barrier during the recovery journey. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This paper explores the experience of loneliness while recovering from an eating disorder, as framed within the context of childrearing and challenging family dynamics. While loneliness has negative connotations, it may act as a 'companion' to the person experiencing it. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The first visible need is that for public figures to raise awareness of loneliness and mental well-being. Another emerging issue is the need to re-think automatic negative assumptions associated with loneliness. Importantly, professionals and caregivers have to consider the co-morbidity of loneliness and mental illness. Links between loneliness and unhealthy family dynamics also need to be assessed when providing support.

"Absolutely No One Else, Other Than Yourself": Experiences of Adolescents and Young Adults with Cancer During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic caused widespread disruption to the provision of health care in the United Kingdom. It posed two risks to AYACs: disruption of care and long-term adverse consequences compounding late effects. This study sought to better understand the experiences of AYACs receiving care during the pandemic and identify areas where greater support is needed. Methods: In-depth semistructured interviews with AYACs (n = 6), 16-22 years at diagnosis. Interviews were transcribed verbatim and analyzed using the principles of Giorgi's phenomenological analysis. Results: Four major themes and an interconnected theme were identified. Changes to health care meant AYACs were isolated and loss of in-person follow-up caused anxiety (theme 1). AYACs had to adapt to life with COVID-19 restrictions (theme 2). Support during the pandemic came from a variety of sources (theme 3). AYACs reported poor mental health due to a fear of relapse and contracting COVID-19 (theme 4). An additional burden for AYACs was the loss of the third person (e.g., parent) in consultations (interconnected theme). Conclusion: This study has wider implications for delivery of AYAC care, despite being set during the COVID-19 pandemic. The mental health implications will impact long-term care of these patients, and health care professionals must be aware of these to meet AYACs' holistic care needs.

CATCH-ON Connect: a tablet intervention to address social isolation and loneliness

Technology can aid in alleviating social isolation and loneliness among older adults, however some older adults lack the knowledge and necessary skills to use the technology.

OBJECTIVES

The purpose of this study was to examine the impact of CATCH-ON Connect, a cellular enabled tablet technical assistance program, on social isolation and loneliness among older adults.

METHODS

This is a single-group pre-post program evaluation of the CATCH-ON Connect program.

RESULTS

While there was no statistically significant change in social isolation, older adult participants reported significantly lower levels of loneliness following intervention.

CONCLUSION

This project demonstrates that tablet programs with technical assistance may benefit older adults. Further investigation is warranted to determine the impact of the internet access itself, the technical assistance, or both.

Daily use of digital technologies to feel better: Adolescents' digital emotion regulation, emotions, loneliness, and recovery, considering prior emotional problems

INTRODUCTION

Adolescents report using digital technologies for emotion regulation (digital ER), with the aim of feeling better (i.e., improving emotions and reducing loneliness). In this 7-day diary study, we investigated associations of digital ER, emotions, and loneliness, and tested whether prior emotional problems moderated these associations.

METHOD

Participants were 312 Australian adolescents (Mage = 13.91, SD = 1.52; 44% boys). Daily surveys measured digital ER; end-of-day happiness, sadness, worry, anger, and loneliness; and peak sadness, worry, and anger. End-of day emotions were subtracted from peak emotions to calculate emotion recovery for sadness, worry, and anger. Participants were randomly selected from two symptom strata (high/low) defined by depression and social anxiety measures collected before the diary. Data were analyzed using multilevel path modeling. Cross-level interactions tested whether symptom strata moderated associations.

RESULTS

Digital ER was associated with more recovery from peak to end-of-day sadness and worry, but also with increased sadness, worry, anger, and loneliness by the next end-of-day. Higher end-of-day loneliness was associated with increased next-day digital ER. Prior emotional symptoms were not a significant moderator of daily digital ER and emotion associations.

CONCLUSION

Adolescents who report more digital ER in a day show more recovery from the peak of negative emotion that day, but this recovery dissipates, with digital ER also associated with increased negative emotion and loneliness by the next day for all adolescents, regardless of prior symptom status. Lonelier adolescents use more digital ER by the next day, suggesting they need support to make social connections-online or offline.

Understanding and mitigating negative affect in preventive health behaviors: Evidence from the COVID-19 vaccination process

The study investigated the willingness for vaccine uptake during the COVID-19 pandemic (April-June 2021), and explored the effect of both mindfulness and health education in managing negative affect post-vaccination. In study 1, a sample of 468 Chinese college students completed a one-time survey, assessing loneliness, stress, medical fear, and vaccination likelihood. Results showed that medical fear mediated the relationship between loneliness, stress and vaccination likelihood. In study 2, 70 college students were randomly assigned to one of three intervention conditions (mindfulness, health education, and control) during vaccination. Participants in mindfulness group showed lower negative affect scores than the control group post-intervention (p = 0.019). However, no significant difference was reported between health education with the other two conditions. As such, medical fear would be an important factor to target for improving the likelihood of vaccine uptake. Furthermore, a short mindfulness intervention was effective to improve experience of vaccination through mitigating negative affect.

Sex-based trajectories of health system use in lonely and not lonely older people: A population-based cohort study

BACKGROUND

There is growing interest in understanding the care needs of lonely people but studies are limited and examine healthcare settings separately. We estimated and compared healthcare trajectories in lonely and not lonely older female and male respondents to a national health survey.

METHODS

We conducted a retrospective cohort study of community-dwelling, Ontario respondents (65+ years) to the 2008/2009 Canadian Community Health Survey-Healthy Aging. Respondents were classified at baseline as not lonely, moderately lonely, or severely lonely using the Three-Item Loneliness Scale and then linked with health administrative data to assess healthcare transitions over a 12 -year observation period. Annual risks of moving from the community to inpatient, long-stay home care, long-term care settings-and death-were estimated across loneliness levels using sex-stratified multistate models.

RESULTS

Of 2684 respondents (58.8% female sex; mean age 77 years [standard deviation: 8]), 635 (23.7%) experienced moderate loneliness and 420 (15.6%) severe loneliness. Fewer lonely respondents remained in the community with no transitions (not lonely, 20.3%; moderately lonely, 17.5%; and severely lonely, 12.6%). Annual transition risks from the community to home care and long-term care were higher in female respondents and increased with loneliness severity for both sexes (e.g., 2-year home care risk: 6.1% [95% CI 5.5-6.6], 8.4% [95% CI 7.4-9.5] and 9.4% [95% CI 8.2-10.9] in female respondents, and 3.5% [95% CI 3.1-3.9], 5.0% [95% CI 4.0-6.0], and 5.4% [95% CI 4.0-6.8] in male respondents; 5-year long-term care risk: 9.2% [95% CI 8.0-10.8], 11.1% [95% CI 9.3-13.6] and 12.2% [95% CI 9.9-15.3] [female], and 5.3% [95% CI 4.2-6.7], 9.1% [95% CI 6.8-12.5], and 10.9% [95% CI 7.9-16.3] [male]).

CONCLUSIONS

Lonely older female and male respondents were more likely to need home care and long-term care, with severely lonely female respondents having the highest probability of moving to these settings.

Guidelines for evaluating and reporting social isolation and loneliness interventions

Given the unpleasant nature of social isolation and loneliness (SIL) and their negative effects on health and wellbeing, interventions are needed. However, persistent issues in the design, evaluation, and reporting of SIL interventions preclude conclusive evidence and commentary on the effectiveness of SIL interventions. Here, we propose guidelines for evaluating SIL interventions, firstly by operationalising them into two categories: (1) interventions aiming to reduce SIL as a primary outcome and (2) interventions aiming to improve non-SIL outcomes in the lives of individuals experiencing SIL. Secondly, we evaluate instruments for measuring SIL and research designs for studying intervention effectiveness. Thirdly, guidelines for reporting information about the intervention, study design, results, and discussion in SIL intervention studies are presented. These guidelines will help researchers to better and more consistently report on SIL interventions and improve comparability of SIL interventions, ultimately contributing to the improvement of interventions and to the mitigation of SIL.

The relationship between fear of missing out and mobile phone addiction among college students: the mediating role of depression and the moderating role of loneliness

Background

Mobile phone addiction has adverse influences on the physical and mental health of college students. However, few studies shed light on the effect of fear of missing out on mobile phone addiction and the underlying mechanisms among college students.

Methods

To explore their associations, the present study used the Fear of Missing Out Scales (FoMOS), Loneliness Scale (USL-8), Mobile Phone Addiction Index Scale (MPAI), and Depression-Anxiety-Stress Questionnaire (DASS-21) to investigate 750 college students.

Results

The results suggested that fear of missing out significantly positively predicted mobile phone addiction. This direct effect could be mediated by depression, and the indirect effect of fear of missing out on mobile phone addiction could be moderated by loneliness. Specifically, the indirect effect was stronger for students with high levels of loneliness.

Conclusion

This study provides a theoretical basis for developing future interventions for mobile phone addiction in higher education students.

COVID-19 Pandemic-Related Stress and Subjective Well-Being Across Age: The Mediating Role of Social Resources

Stress associated with the COVID-19 pandemic and the measures implemented to prevent its spread dramatically shifted our social networks, interactions, and contexts, all of which influence the assessment of one's subjective well-being (SWB). Drawing on data collected from 1,318 adults between April and May 2020, we used structural equation modeling to analyze the relationship between pandemic-related stress and SWB (life satisfaction, positive affect, negative affect), and examined how these relationships vary across age. Pandemic-related stress was associated with lower life satisfaction and higher negative affect. However, no evidence of age moderation emerged. Subsequent analysis examined different aspects of social resources as potential mediating variables. Loneliness fully mediated the relationship between stress and life satisfaction, while social support demonstrated evidence of partial mediation. Further, loneliness and social support partially mediated the relationship between stress and negative affect. Findings suggest that pandemic-related stress impacts SWB, and social resources help explain these impacts.

Reducing Loneliness and Social Isolation of Older Adults Through Voice Assistants: Literature Review and Bibliometric Analysis

BACKGROUND

Loneliness and social isolation are major public health concerns for older adults, with severe mental and physical health consequences. New technologies may have a great impact in providing support to the daily lives of older adults and addressing the many challenges they face. In this scenario, technologies based on voice assistants (VAs) are of great interest and potential benefit in reducing loneliness and social isolation in this population, because they could overcome existing barriers with other digital technologies through easier and more natural human-computer interaction.

OBJECTIVE

This study aims to investigate the use of VAs to reduce loneliness and social isolation of older adults by performing a systematic literature review and a bibliometric cluster mapping analysis.

METHODS

We searched PubMed, Embase, and Scopus databases for articles that were published in the last 6 years, related to the following main topics: voice interface, VA, older adults, isolation, and loneliness. A total of 40 articles were found, of which 16 (40%) were included in this review. The included articles were then assessed through a qualitative scoring method and summarized. Finally, a bibliometric analysis was conducted using VOSviewer software (Leiden University's Centre for Science and Technology Studies).

RESULTS

Of the 16 articles included in the review, only 2 (13%) were considered of poor methodological quality, whereas 9 (56%) were of medium quality and 5 (31%) were of high quality. Finally, through bibliometric analysis, 221 keywords were extracted, of which 36 (16%) were selected. The most important keywords, by number of occurrences and by total link strength; results of the analysis with the Association Strength normalization method; and default values were then presented. The final bibliometric network consisted of 36 selected keywords, which were grouped into 3 clusters related to 3 main topics (ie, VA use for social isolation among older adults, the significance of age in the context of loneliness, and the impact of sex factors on well-being). For most of the selected articles, the effect of VA on social isolation and loneliness of older adults was a minor theme. However, more investigations were done on user experience, obtaining preliminary positive results.

CONCLUSIONS

Most articles on the use of VAs by older adults to reduce social isolation and loneliness focus on usability, acceptability, or user experience. Nevertheless, studies directly addressing the impact that using a VA has on the social isolation and loneliness of older adults find positive and promising results and provide important information for future research, interventions, and policy development in the field of geriatric care and technology.

The silent epidemic of loneliness: identifying the antecedents of loneliness using a lagged exposure-wide approach

BACKGROUND

A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.

METHODS

We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).

RESULTS

Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.

CONCLUSIONS

Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.

Social Contact and Belonging Among Older People Receiving Home Care Nursing

Purpose

Support of social contact and a sense of belonging may be essential for older persons who need help, to take care of their wellbeing and reduce the feeling of loneliness. The aim of this qualitative study was to explore the features that influence social contact and belonging among older persons who received home care nursing.

Patients and Methods

The study involved nine individual in-depth interviews with older persons residing in Norway. The interviews were analyzed in accordance with a model of content analysis.

Findings

Social contact and belonging among the older persons depended on the availability of necessary resources that foster social activity, contact with family and friends, and housing quality. Interaction with helpers and accommodation of their needs as necessary were important for these persons. Reflecting on the past and considering life in context may be essential as a basis for their present and future life.

Conclusion

The results of the present study indicated that a sense of being cared for and supported are important for social contact and belonging. Social activity, engagement in family and contact with friends and neighbors are valued. However, a proportion of older persons are not engaged in such activities. Volunteer help may be a key factor for improving social contact. Moreover, contact and communication with home care nurses are important for recognition as valued persons and as a link to the community.