Compassion Fatigue, Loneliness, and Hopelessness in Healthcare Workers: What Remains of the COVID-19 Pandemic?

Although the end of the critical phase of the COVID-19 pandemic has been declared, its consequences are still observed in the general population and some categories of workers. HCWs have had to face the battle against this disease on the front lines. In our study, we evaluated the current state of the consequences of the pandemic on compassion fatigue, loneliness, empathy, anxiety, and hopelessness in a group of 71 HCWs from a rehabilitation center. This data, collected in the time of May-June 2024 (T2), was compared in the same sample in 2020 (T0) and 2023 (T1). The results highlighted increased burnout (P-Bonferroni: 0.005) and feelings of loneliness in T2 (P-Bonferroni: 0.005). Importantly, the results of the compassion satisfaction remained stable, providing reassurance about the resilience of HCWs. Secondary Trauma results decreased in T2, indicating less psychological pressure associated with COVID-19 pathology.

Participants' baseline characteristics and feedback of the nature-based social intervention "friends in nature" among lonely older adults in assisted living facilities in finland: a randomised controlled trial of the RECETAS EU-project.

BACKGROUND: Loneliness is common among older adults in institutional settings. It leads to adverse effects on health and wellbeing, for which nature contact with peers in turn may have positive impact. However, the effects of nature engagement among older adults have not been studied in randomised controlled trials (RCT). The "Friends in Nature" (FIN) group intervention RCT for lonely older adults in Helsinki assisted living facilities (ALFs) aims to explore the effects of peer-related nature experiences on loneliness and health-related quality of life (HRQoL). In this study we aim describe the participants' baseline characteristics of the RCT, feasibility of FIN intervention and intervention participants' feedback on the FIN. METHODS: Lonely participants were recruited from 22 ALFs in Helsinki area, Finland, and randomised into two groups: 1) nature-based social intervention once a week for nine weeks (n = 162) and 2) usual care (n = 157). Demographics, diagnoses and medication use were retrieved from medical records, and baseline cognition, functioning, HRQoL, loneliness and psychological wellbeing were assessed. Primary trial outcomes will be participants' loneliness (De Jong Giervald Loneliness Scale) and HRQoL (15D). RESULTS: The mean age of participants was 83 years, 73% were female and mean Minimental State Examination of 21 points. The participants were living with multiple co-morbidities and/or disabilities. The intervention and control groups were comparable at baseline. The adherence with intervention was moderate, with a mean attendance of 6.8 out of the nine sessions. Of the participants, 14% refused, fell ill or were deceased, and therefore, participated three sessions or less. General subjective alleviation of loneliness was achieved in 57% of the intervention participants. Of the respondents, 96% would have recommended a respective group intervention to other older adults. Intervention participants appreciated their nature excursions and experiences. CONCLUSIONS: We have successfully randomised 319 lonely residents in assisted living facilities into a trial about the effects of nature experiences in a group-format. The feedback from participants was favourable. The trial will provide important information about possibilities of alleviating loneliness with peer-related nature-based experiences in frail residents. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT05507684. Registration 19/08/2022.

The temporal sequence and reciprocal relationships of frailty, social isolation and loneliness in older adults across 21 years.

BACKGROUND: It is unclear whether social isolation and loneliness may precede frailty status or whether frailty may precipitate social isolation and loneliness. We investigated the reciprocal and temporal sequence of social isolation, loneliness, and frailty among older adults across 21 years. METHODS: We used seven waves of the Longitudinal Aging Study Amsterdam from 2302 Dutch older adults (M = 72.6 years, SD = 8.6, 52.1% female) ages 55 or older. Using random intercept cross-lagged panel models, we investigated between- and within-person associations of social isolation and loneliness with frailty. Frailty was measured using the Frailty Index. Loneliness was measured using the 11-item De Jong Gierveld Loneliness Scale. Social isolation was measured using a multi-domain 6-item scale. RESULTS: Social isolation and loneliness were weakly correlated across waves. At the between-person level, individuals with higher levels of frailty tended to have higher levels of social isolation but not loneliness. At the within-person level, the cross-lagged paths indicated that earlier frailty status predicted future social isolation and loneliness over time. However, prior social isolation was not associated with subsequent frailty except at time point 5 (T5). Loneliness at specific time points (T1, T4 and T6) predicted greater frailty at later time points (T2, T5 and T7). The results also supported reciprocal and contemporaneous relations between social isolation, loneliness and frailty. CONCLUSIONS: Social isolation and loneliness are potential outcomes of frailty. Public health policies and health practitioners should prioritise interventions targeting social connection among older adults with pre-frailty or frailty.

Suicidal Ideation, Social Participation, Loneliness, and Mobility Limitations: Longitudinal Evidence in Older European Adults.

BACKGROUND: Suicide behavior represents a major public health problem for the older population. Within the continuum of suicidal behavior, suicidal ideation may lead to a suicide attempts/death. Risk factors for developing suicidal ideation include mobility limitations, lack of social participation and loneliness. However, there is a need for longitudinal studies to examine these relationships over time. METHOD: 50423 older people from three waves of the SHARE project formed the sample (60 years in the first wave; ± = 71.49 ± 8.15; 55% female). RESULTS: A series of nested Cross-Lagged Panel Models (CLPM) of suicidal ideation, mobility limitations, social participation and loneliness were tested. The best fitting model was that with equal autoregressive and cross-lagged effects across waves (( = 1220.56, CFI = .982, RMSEA = .028, SRMR = .024). The autoregressive effects showed high stability across waves. The cross-lagged effects between suicidal ideation and mobility limitations were strong, while the cross-lagged effects between suicidal ideation and social participation were comparatively smaller. In the case of loneliness, statistical significance was not achieved. CONCLUSIONS: These findings highlight the importance of promoting mobility programs and social activities to prevent suicidal ideation among older adults.

Problematic and Harmful Social Media Use among Adolescents Receiving Intensive Psychiatric Care.

Although research has shown both positive and negative mental health correlates of social media use, few studies focus on adolescents who are receiving intensive psychiatric care. The purpose of this study was to describe problematic media use, experiences of cybervictimization and sextortion, and correlates with adolescents' health in a sample of adolescents (N = 97; 53.6% female) in a partial psychiatric hospitalization program. Approximately one-quarter of participants reported being cybervictimized at least once over the past month and 17.5% of participants reported ever experiencing sextortion. Greater problematic media use was associated with lower physical activity and greater feelings of loneliness. In a subsample of 51 participants, questions were asked regarding who they had gone to for support regarding experiences of online harm, and barriers to disclosing such experiences. The majority of youth who experienced cybervictimization indicated going to a friend for support but rarely endorsed telling a mental health clinician about it. Even fewer disclosed their experience of sextortion, with nearly half reporting not telling anyone (44.4%). Given the rates of online harm experienced by youth in acute psychiatric treatment, screening for and conducting brief interventions on problematic or risky social media use is recommended.

The association between loneliness and frailty among community-dwelling older adults in five European countries: a longitudinal study.

BACKGROUND: Loneliness is described as the subjective experience of unfulfilled personal and social needs, with emotional and social domains. Frailty is a state of vulnerability to stressors, which is often characterised by impairment in the physical, psychological and/or social domain. OBJECTIVE: This study aims to examine the bidirectional association between loneliness and frailty across the different domains. METHODS: The study included 1735 older adults from the Urban Health Centres Europe project. Loneliness was assessed using the six-item De Jong Gierveld Loneliness Scale. Frailty was assessed by the Tilburg Frailty Indicator. Multivariate linear regression and cross-lagged panel models were used to explore the associations between the social and emotional loneliness dimensions and overall, physical, psychological and social frailty. RESULTS: A bidirectional association existed between overall loneliness and overall frailty (loneliness to frailty: ß = 0.09, 95% CI: 0.03, 0.15; frailty to loneliness: ß = 0.05, 95% CI: 0.004, 0.10). Higher levels of overall loneliness at baseline were associated with higher levels of psychological frailty at follow-up (ß = 0.05, 95% CI: 0.00, 0.10). The reverse association was not significant. A bidirectional association existed between overall loneliness and social frailty (loneliness to social frailty: ß = 0.05, 95% CI: 0.01, 0.10; social frailty to loneliness: ß = 0.05, 95% CI: 0.00, 0.09). CONCLUSION: This study confirms the importance of addressing loneliness among older adults. Interventions that increase social support, exercise engagement and promote healthy behaviours may be effective in reducing the risk of frailty among older adults and simultaneously preventing loneliness.

Effectiveness of a supervised group-based walking program on physical, psychological and social outcomes among older adults: a randomised controlled trial protocol.

INTRODUCTION: To minimise adverse health events among older adults, physical activity (PA) is considered one of the most fundamental and effective forms of lifestyle. Therefore, an urgent effort to promote a physically active lifestyle among our older adults is needed, in which walking could be a better choice, especially for mass promotion. Besides, the types of PA interventions were also shown to affect their effectiveness on older adults' psychosocial outcomes. Hence, the overall aim of the project is to examine the effectiveness of supervised group-based walking intervention by comparing it with unsupervised group-based walking and unsupervised individual-based walking interventions on improving physical, psychological and social outcomes among older adults in Hong Kong. METHODS AND ANALYSIS: The research will conduct a four-group (supervised group-based, unsupervised group-based walking, unsupervised individual-based, control group), double-blind, randomised control trial, targeting 184 older adults in Hong Kong. The primary outcomes will be measured by participants' changes in resting heart rates, body compositions, resting blood pressures, walking performance, loneliness, perceived social support and PA enjoyment. The results will be analysed using repeated analysis of variance and one-way analysis of covariance, as well as by conducting in-depth interviews with selected participants. Also, the outcomes of the research will be used as references for designing an effective walking operation manual for promoting healthy ageing among older adults in the community. ETHICS AND DISSEMINATION: The current study involves human participants, and the research protocol has been approved by the research ethics committee at Hong Kong Baptist University (Ref: R2022-2023-0013). All participants will be provided with written informed consent to participate. The outcomes of the intervention protocol will be disseminated through manuscript publications. TRIAL REGISTRATION NUMBER: The trial is registered at the ClinicalTrials.gov PRS (Trial ID: NCT05907252; date of first posted: 16 June 2023).

Urbanization, loneliness and mental health model - A cross-sectional network analysis with a representative sample.

With increasing urbanization, more people are exposed to mental health risk factors stemming from the urban social or physical environment. However, research on the relationship between urbanization and mental health is lacking. This cross-sectional study aimed to explore the relationships of the physical environment (spatial cohesion and urban environment) and social factors (neighborhood cohesion) with mental health (stress, anxiety and depression symptoms) and physical health and the mediating role of loneliness based on the proposed theoretical model. The study was conducted in Metropolis GZM (Silesia, Poland) in a representative sample of 3296 residents (48% women). The measurements used were the PSS-10, GAD-7, PHQ-9, R-UCLA3 and neighborhood cohesion scale. ANOVA results showed that city residents had better mental health indices than residents of villages and small towns. The network approach revealed that urbanization was one of the most influential nodes and played the role of a bridge between all other nodes. The model was confirmed and showed that the relationships between the physical environment and mental health were consecutively mediated by neighborhood cohesion and loneliness. Spatial cohesion related to factors of the physical environment and physical health, while physical health was directly connected to sociodemographic factors and weakly to stress. Anxiety was the strongest risk factor. Mental health can be improved by social and architectural factors, such as strengthening neighborhood cohesion and improving neglected buildings.

Psychometric properties of the variants of the Chinese UCLA Loneliness Scales and their associations with mental health in adolescents.

Loneliness is a pervasive and distressing emotional experience that affects individuals of all ages and can have significant consequences for both physical and mental health. The UCLA Loneliness Scale (UCLA-LS) is widely used to assess the subjective feelings of loneliness, but concerns have been raised about its structure and applicability in diverse cultural contexts. This study analysed the reliability and validity of the five Chinese versions of the UCLA-LS in a representative sample of 2,643 adolescents and young adults with Chinese as their first language in Hong Kong. The results showed high internal consistency across all versions and content validity for most items. Factor analysis revealed a two-factor structure for the longer versions and a unidimensional structure for the shorter versions. However, the fit statistics suggested that the models did not meet good fit criteria, indicating item loading or model specification requires further review. The scales demonstrated strong associations with mental health conditions such as depression and anxiety, as well as psychosocial factors like hopelessness and aggression. Notably, the 8-item version's total scores were associated with mental health and psychological attributes comparable to those of the 20-item version, suggesting its potential suitability as a screening tool in population settings. Future research is needed to improve the generalisability of these scales to other Chinese populations, particularly for items with lower content validity.

Loneliness and pain among community-dwelling middle-aged and older Black, Latino, and White adults in the United States.

Background: Prior research has demonstrated a strong and independent association between loneliness and pain, but few studies to date have explored this relationship in racially and ethnically diverse groups of midlife and older adults. We drew on the diathesis stress model of chronic pain and cumulative inequality theory to examine the relationship of loneliness and the presence and intensity of pain in a nationally representative sample of Black, Latino, and White adults aged 50 or older in the United States. Methods: Data were from Wave 3 of the National Social Life, Health, and Aging Project (n = 2,706). We used weighted logistic and ordinary least squares regression analyses to explore main and interactive effects of loneliness and race and ethnicity while adjusting for well-documented risk and protective factors (e.g., educational attainment, perceived relative income, inadequate health insurance, perceived discrimination) and salient social and health factors. Results: Almost half (46%) of the participants reported feeling lonely and 70% reported the presence of pain. Among those who reported pain (n = 1,910), the mean intensity score was 2.89 (range = 1-6) and 22% reported severe or stronger pain. Greater loneliness was associated with increased odds of pain presence (AOR = 1.154, 95% CI [1.072, 1.242]) and higher pain intensity (ß = 0.039, p < 0.01). We found no significant interaction effects involving Black participants. However, Latino participants who reported greater loneliness had significantly higher levels of pain (ß = 0.187, p < 0.001) than their White counterparts with similar levels of loneliness. Discussion: Loneliness is an important correlate of pain presence and intensity and may have a stronger effect on pain intensity among Latino adults aged 50 or older. We discuss clinical and research implications of these findings, including the need for more fine-grained analyses of different types of loneliness (e.g., social, emotional, existential) and their impact on these and other pain-related outcomes (e.g., interference). Our findings suggest a need for interventions to prevent and manage pain by targeting loneliness among middle-aged and older adults, particularly Latino persons.

United Voices Group-Singing Intervention to Address Loneliness and Social Isolation Among Older People With HIV During the COVID-19 Pandemic: Intervention Adaption Study.

BACKGROUND: People living with HIV experience HIV stigma alongside a spectrum of aging-related health conditions that accelerate their vulnerability to the ill effects of loneliness and social isolation. Group-singing interventions are efficacious in improving psychosocial well-being among older people in the general population; however, the social curative effects of group singing have not been explored in relation to HIV stigma. By promoting group identification, bonding, and pride, group singing may reduce loneliness, social isolation, and other negative impacts of HIV stigma among older people living with HIV. Access to group-singing programs may be enhanced by technology. OBJECTIVE: While group singing has been extensively studied in older adults, group-singing interventions have not been adapted for older people living with HIV to target loneliness and social isolation in the context of HIV stigma. The objective of this study was to describe the systematic development of a group-singing intervention to reduce loneliness and social isolation among older people living with HIV. METHODS: In the San Francisco Bay Area between February 2019 and October 2019, we engaged older people living with HIV in a rigorous, 8-stage, community-engaged intervention adaptation process using the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing (ADAPT-ITT) framework. On the basis of a formative assessment of the needs and preferences of older people living with HIV, we selected an evidence-based group-singing intervention for older adults and systematically adapted the intervention components by administering them to a community advisory council (n=13). RESULTS: The result was United Voices, a 12-week hybrid (web-based and in-person) group-singing intervention for older people living with HIV. United Voices comprises 12 web-based (ie, via Zoom [Zoom Video Communications]) rehearsals, web-based and in-person drop-in helpdesk sessions, and a professionally produced final concert recording. CONCLUSIONS: Through an iterative process and in consultation with stakeholders and topic experts, we refined and manualized United Voices and finalized the design of a pilot randomized controlled trial to evaluate the feasibility and acceptability of the intervention protocol and procedures. The findings provide insights into the barriers and facilitators involved in culturally tailoring interventions for older people living with HIV, implementing intervention adaptations within web-based environments, and the promise of developing hybrid music-based interventions for older adults with HIV.

Association between loneliness and incident atrial fibrillation across different genetic predisposition: findings from the UK Biobank.

BACKGROUND: Loneliness has garnered significant attention globally, with extensive exploration of its association with cardiovascular disease. However, a notable research gap persists concerning loneliness and its potential link to atrial fibrillation (AF). METHODS: This prospective cohort study utilized data from the UK Biobank (UKB), encompassing 441,056 participants. Loneliness was assessed through self-reported questionnaires gauging feelings of isolation and willingness to confide. AF diagnoses were ascertained using hospitalization records and cause-of-death registry data. The association between loneliness and AF risk was analyzed through multivariable Cox proportional hazard models. RESULTS: Over a median follow-up period of 13.9 years, 25,386 AF cases were identified. In comparison to individuals without reported loneliness, those in the loneliness group exhibited a significantly higher risk of AF (loneliness vs. non-loneliness: hazard ratio [HR]: 1.11, 95% confidence interval [CI] 1.07-1.16). Subgroup analysis revealed that the association between loneliness and increased AF risk was significant solely in individuals without heart valve disease (HR: 1.12, 95% CI 1.07-1.16). Additionally, significant associations between loneliness and heightened AF risk were noted across strata of genetic susceptibility to AF, with no observable impact on these associations by genetic susceptibility (P for interaction = 0.070). CONCLUSIONS: This study establishes a robust association between loneliness and an elevated long-term risk of AF. Notably, this association is particularly pronounced in individuals without valvular disease and does not appear to be influenced by genetic predisposition to AF.

Social isolation, loneliness, and subjective wellbeing among Chinese older adults during the COVID-19 pandemic.

The COVID-19 pandemic has brought unprecedented challenges to the wellbeing of the older adults worldwide. Both social isolation and loneliness are associated with decreased subjective wellbeing, but it is uncertain whether their effects are independent or if loneliness represents the affective pathway through which social isolation impairs subjective wellbeing. We therefore assessed the extent to which the association between social isolation and subjective wellbeing is mediated by loneliness. We utilized data from the 2020 China Family Panel Studies (CFPS) and focused on a sample of 3,821 individuals aged 60 and above as the participants for our study. The results revealed a significant negative association between social isolation and subjective wellbeing among the older adults during the COVID-19 pandemic. Furthermore, loneliness was found to mediate this relationship, indicating that social isolation led to increased feelings of loneliness, which in turn negatively impacted subjective wellbeing. These findings highlight the detrimental effects of social isolation and loneliness on the wellbeing of the older adults in China during the pandemic. The implications of these results emphasize the need for interventions and support systems that address social isolation and loneliness among the older adults, promoting their wellbeing and overall mental health during challenging times such as the COVID-19 pandemic.

The mediating role of perceived social support on loneliness and depression in community-dwelling Nepalese older adults.

BACKGROUND: Loneliness has been identified as a significant independent predictor of depression among older adults. Social support has been reported to play a protective role against both loneliness and depression in older adults. However, few studies to date have investigated the three constructs concurrently and the mediating role of Perceived Social Support (PSS) on the relationship between loneliness and depression in this age group. The current study aimed to assess the relationship between loneliness and depression among community-dwelling Nepalese older adults based on the mediating role of PSS. METHODS: This descriptive cross-sectional research study included 367 community-dwelling older adults from a randomly selected ward in Kathmandu, Nepal. The University of California, Los Angeles Loneliness Scale, Geriatric Depression Scale, and Multidimensional Scale of Perceived Social Support were used. Correlation analysis, regression analysis, and the PROCESS 4.1 macro developed by Hayes with a bootstrapping procedure were used to test the mediating effect of the PSS on the relationship between loneliness and depression. RESULTS: Loneliness was negatively associated with the PSS (ß = -0.405; 95% CI: -0.473, -0.337; P < 0.001), and the PSS was positively associated with depression (ß = 0.057; 95% CI: 0.014, 0.099; P = 0.009). The direct effect of loneliness on depression was positive and significant (ß = 0.151; 95% CI: 0.117, 0.184; P < 0.001), whereas the indirect effect of loneliness on depression through the PSS was negative (path c; ß = -0.023, 95% CI: -0.041, -0.005). The results indicated that the PSS partially mediated the relationship between loneliness and depression. CONCLUSION: These findings suggest that interventions focusing on reducing loneliness and fostering social support may be able to lessen depressive symptoms in older adults. By addressing these factors, healthcare providers and carers can promote the mental health of older adults.

Efficacy of community groups as a social prescription for senior health-insights from a natural experiment during the COVID-19 lockdown.

Loneliness and associated physical and cognitive health decline among the aging population is an important medical concern, exacerbated in times of abnormal isolation like the 2020-2021 Covid-19 pandemic lockdown. In this backdrop, recent "social prescribing" based health policy initiatives such as community groups as a support structure for the aging population assumes great importance. In this paper, we evaluate and quantify the impact of such social prescribing policies in combatting loneliness and related health degeneration of the aging population in times of abnormal isolation. To this end, we conduct a natural experiment across a sample of 618 individuals aged 65 and over with varying access to community groups during the Covid-19 lockdown period. Using a random-effects, probit model to compare the differences in health outcomes of participants with access to community groups (target) with those without access (control), we find that the target group was 2.65 times less likely to suffer from loneliness as compared to the control group, along with lower incidences of reported cardiovascular and cognitive health decline. These initial findings provide preliminary support in favor of the interventional power of social prescription tools in mitigating loneliness and its consequent negative health impact on the aging population.

Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study.

BACKGROUND: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users' autonomy, competence, and relatedness. OBJECTIVE: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. METHODS: Participants were each prompted with a single question: "What's your struggle?" Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. RESULTS: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. CONCLUSIONS: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options.

The influence of educational transitions on loneliness and mental health from emerging adults' perspectives.

Educational transitions can influence loneliness and increase mental health issues for young people transitioning between educational stages. The aim was to explore the link between educational transitions and emerging adults' loneliness and mental health and how they perceive they can alleviate and/or improve these issues. Semi-structured qualitative interviews with a total of 12 emerging adults, 10 females and two males aged 18-29 (mean age, 22.91) were conducted. Data were analysed using qualitative content analysis. Emerging adults' loneliness and mental health across educational transitions could be influenced by changes to their sense of security, for example concurrent transitions, increased academic demands, changed social network, insufficient attachment, lack of community, or changed physical environment. Transitions can be associated with positive expectations and self-development but also worry, emotional turmoil, loneliness, and mental health issues. A better transition experience can be enabled by increasing resources and activities and promoting a secure environment.

Investigating the prevalence and associated factors of depression, anxiety, and loneliness among people with type-2 diabetes in Bangladesh: a community-based study.

Diabetes mellitus is a major worldwide health concern. Diabetes has been associated with a number of adverse mental health conditions including depression, anxiety, and loneliness that can negatively impact diabetes outcomes. This study aimed to investigate factors associated with depression, anxiety, and loneliness in people, in the community, suffering with diabetes in Bangladesh. A cross-sectional study was conducted with 600 people with type-2 diabetes (54.83% females; mean age: 52.70 ± 11.56 years) between July and September 2022. Purposive sampling method was used to recruit the participants. A validated semi-structured questionnaire was used to collect demographic and other data. Depression, anxiety, and loneliness were measured using the PHQ-9, GAD-7, and UCLA Loneliness scale, respectively. Bivariate and multivariable linear regression analyses were conducted to ascertain factors that were significantly associated with these mental health conditions. The prevalence of depression, anxiety, and loneliness was 31.17%, 21.83%, and 28.00%, respectively. A lack of formal education, and not taking part in physical activities were significantly associated with all three mental health states. Duration of diabetes and being on medication for high cholesterol were also associated with depression and anxiety. Older age and being widowed were significantly associated with loneliness. This study found that depression, anxiety, and loneliness are prevalent among Bangladeshi people with diabetes, with certain sociodemographic and diabetes-related factors associated with increased risk. The findings emphasize the need for targeted interventions to people within the communities, at grassroot levels in order to improve reduce health inequality, and improve the mental health of people living with diabetes.

How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study.

Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study (ρ=-.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 (ρ=-.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology.

Stigma of coronavirus disease 2019 among hospitalized children and their parents: A prospective cohort study.

BACKGROUND: The stigma associated with coronavirus disease 2019 (COVID-19) is a global problem that causes psychosomatic distress, including depression, anxiety, and loneliness. However, few studies have investigated the stigma of COVID-19 and the associated mental health impact on children or parents. METHODS: We conducted a prospective cohort study at the National Center for Child Health and Development in Tokyo, Japan, between November 2021 and October 2022. Children (4-17 years of age) with COVID-19 and parents of hospitalized children (0-17 years of age) with COVID-19 were enrolled in the study. Children with special health-care needs were excluded. The questionnaires on stigma and mental health (depression, anxiety, and loneliness) were administered during hospitalization and at the 1 month follow-up evaluation after discharge. RESULTS: During the study period, 47 children and 111 parents were included. Thirty-eight children (81%) and 105 parents (95%) answered the questionnaires at the 1 month follow up, respectively. Approximately 70% of participants were categorized as a high-stigma group. In children, subjective stigma was associated with loneliness during hospitalization (mean difference [MD] 2.32; 95% confidence interval [CI], 0.11-4.52) and depression at the 1 month follow up (MD 2.44; 95% CI, 0.40-4.48). In parents, presumed stigma was associated with depression, anxiety, and loneliness at 1 month follow up (MD 2.24, 1.68, and 1.15; 95% CI, 0.58-3.89, 0.11-3.25, and 0.08-2.21). CONCLUSION: Our findings suggest that the stigma associated with COVID-19 continues to affect mental health for more than a month after discharge, and the effects of stigma on mental health differed between the children and parents.