Social mobile sensing and problematic alcohol consumption: Insights from smartphone metadata.

BACKGROUND: Alcohol is often consumed in a social context. We aim to investigate whether social mobile sensing is associated with real-world social interactions and alcohol consumption. In addition, we investigate how social restriction policies implemented during the COVID-19 pandemic have influenced these associations. METHODS: We conducted a smartphone-based ecological momentary assessment (EMA) study for 7 days over a 213-day period from 8 August 2020 to 9 March 2021 in Germany, including both no-lockdown and lockdown stages. Participants used a smartphone application which passively collects data on social behavior (e.g., app usage, phone calls, SMS). Moreover, we assessed real-world social interactions and alcohol consumption via daily questionnaires. RESULTS: We found that each one-hour increase in social media usage was associated with a 40.2% decrease in the average number of drinks consumed. Mediation analysis suggested that social media usage decreases alcohol intake through decreased real-world social interactions. Notably, we did not find that any significant influence of the lockdown stage on the association between social mobile sensing and alcohol intake. CONCLUSIONS: Our study suggests that people who use more social media drink less, likely due to reduced face-to-face social interactions. This highlights the potential of social mobile sensing as an objective measure of social activity and its implications for understanding alcohol consumption behavior.

Evidence-based health messages increase intention to cope with loneliness in Germany: a randomized controlled online trial.

Loneliness poses a formidable global health challenge in our volatile, post-pandemic world. Prior studies have identified promising interventions to alleviate loneliness, however, little is known about their effectiveness. This study measured the effectiveness of educational entertainment ("edutainment") and/or evidence-based, written health messages in alleviating loneliness and increasing intention to cope with loneliness. We recruited 1639 German participants, aged 18 years or older. We compared three intervention groups who received: (A) edutainment and written health messages, (B) only edutainment, or (C) only written health messages, against (D) a control group that received nothing. The primary outcomes were loneliness and intention to cope with loneliness. Participants were also invited to leave comments about the interventions or about their perception or experiences with loneliness. We found a small (d = 0.254) but significant effect of the written messages on increased intention to cope with loneliness (b = 1.78, t(1602) = 2.91, P = 0.004), while a combination of edutainment and written messages significantly decreased loneliness scores (b = -0.25, t(1602) = -2.06, P = 0.04) when compared with the control, even after adjusting for covariables including baseline values, self-esteem, self-efficacy, and hope. We also observed significantly higher self-esteem scores after exposure to a combination of edutainment and written messages (b = 0.821, t(1609) = 1.76, one-tailed P = 0.039) and significantly higher hope scores after exposure to edutainment-only (b = 0.986, t(1609) = 1.85, one-tailed P = 0.032) when compared with the control group. Our study highlights the benefits of using written messages for increasing intention to cope with loneliness and a combination of edutainment and written messages for easing loneliness. Even in small "doses" (less than 6 min of exposure), edutainment can nurture hope, and edutainment combined with written messages can boost self-esteem.

High-mind wandering correlates with high risk for problematic alcohol use in China and Germany.

Everyone experiences the natural ebb and flow of task-unrelated thoughts. Given how common the fluctuations in these thoughts are, surprisingly, we know very little about how they shape individuals' responses to alcohol use. Here, we investigated if mind wandering is associated with a risk of developing problematic alcohol use. We undertook an online survey among the general population in China (N = 1123) and Germany (N = 1018) from December 2021 to February 2022 and examined the subjective experience of mind wandering and problematic alcohol use through the Mind Wandering Questionnaire (MWQ) and the Alcohol Use Disorders Identification Test (AUDIT). We compared mind wandering and problematic alcohol use between two countries and investigated the association between MWQ scores with AUDIT scores. We found higher scores on the MWQ and a high percentage of problematic alcohol use (i.e., AUDIT score ≥ 8) in Germany (22.5%) as compared to in China (14.5%). Higher self-reported mind wandering was associated with higher AUDIT scores. AUDIT scores were increased mostly in male, elder, and high-mind wandering people. Our findings highlight that mind wandering and problematic alcohol use enhanced in Germany as compared to in China. Our study sheds light on the relationship between mind wandering and problematic alcohol use that may help to further investigate causal effects of interventions.

Involuntary social isolation and alcohol consumption: an ecological momentary assessment in Germany amid the COVID-19 pandemic.

AIMS: Alcohol consumption often occurs in a social setting, which was affected by social distancing measures amid the coronavirus disease-2019 (COVID-19) pandemic. In this study, we examine how involuntary social isolation (i.e. comparing a no-lockdown stage with a lockdown stage) affects the association between loneliness, social activities, and drinking behavior. METHOD: We performed an ecological momentary assessment eight times per day for 7 days amid the COVID-19 pandemic in Germany. We recruited 280 participants and assessed their trait loneliness, daily state loneliness, social activities, and drinking behaviors. RESULTS: We found that a lockdown condition moderates the association between trait and daily state loneliness and alcohol consumption. During a lockdown stage, trait loneliness was positively associated, whereas state loneliness was negatively associated with alcohol consumption. During a no-lockdown stage, trait and state loneliness were both negatively associated with alcohol consumption. For both no-lockdown and lockdown stages, duration of social interaction, male gender, and weekends was positively associated with alcohol consumption. CONCLUSION: Our study suggests that an involuntary social isolation condition (i.e. a lockdown stage) changes how trait loneliness is associated with alcohol consumption.

An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study.

BACKGROUND: More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested. OBJECTIVE: In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness. METHODS: We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on "what really matters" in one's life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform "Unipark," on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS). RESULTS: We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (ß=4.14; t248=1.74; 1-tailed P=.04). CONCLUSIONS: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. TRIAL REGISTRATION: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116.

Negative and positive self-beliefs in social anxiety: The strength of believing mediates the affective response.

BACKGROUND AND OBJECTIVES: Current cognitive models of social anxiety disorder (SAD) propose that individual, situation-specific self-beliefs are central to SAD. However, the role of differences in the degree to which individuals with social anxiety are convinced of self-beliefs, in particular positive ones, is still not fully understood. We compared how much high and low socially anxious individuals agree with their own negative and positive self-beliefs. Furthermore, we investigated whether agreeing with one's self-belief can explain the relation between negative affect in response to self-beliefs and social anxiety. Specifically, we were interested whether social anxiety increases negative affect in response to self-beliefs through an increase in agreement. METHODS: We developed a new experimental self-belief task containing positive and negative semi-idiosyncratic, situation specific self-beliefs typical of high social anxiety and included a direct measure of agreement with these beliefs. Using extreme group sampling, we a-priori selected high (n = 51) and low (n = 50) socially anxious individuals. By multi-level mediation analysis, we analyzed agreement with self-beliefs in both groups and its association with affect. RESULTS: High and low socially anxious individuals chose similar self-beliefs. However, high socially anxious individuals (HSA) agreed more with negative self-beliefs and less with positive self-beliefs compared to low socially anxious individuals (LSA). HSA individuals reported increased negative affect after both, exposition to negative and positive self-beliefs compared to LSA. We found that social anxiety increases affective responses towards negative-self beliefs through an increase in agreeing with these self-beliefs. CONCLUSIONS: These findings suggest that cognitive models of social anxiety can be improved by including not only the content of a self-belief but also the strength of such a belief. In addition, they emphasize the relevance of positive self-beliefs in social anxiety, which has frequently been overlooked.

The effects of momentary loneliness and COVID-19 stressors on hypothalamic-pituitary adrenal (HPA) axis functioning: A lockdown stage changes the association between loneliness and salivary cortisol.

The COVID-19 pandemic can be characterized as a chronic stressor affecting the hypothalamic-pituitary-adrenal (HPA) axis, indexed by glucocorticoids (e.g., cortisol). We investigated whether salivary cortisol level is increased during a lockdown and whether a lockdown condition affects the association between loneliness, specific COVID-19 related stressors and salivary cortisol level. We conducted a smartphone-based ecological momentary assessment (EMA) study with 280 participants in Germany who experienced at least mild loneliness and distress amid COVID-19 from August 2020 to March 2021. We measured their momentary loneliness and COVID-related stressors including worries, information seeking behaviors and feelings of restriction during "no-lockdown" or "lockdown" stages amid COVID-19. Their salivary cortisol was measured 4 times on the last day of a 7-day EMA study. We found a significant increase in salivary cortisol levels during lockdown compared to no-lockdown. Lockdown stage was found to moderate the relationship between momentary loneliness and salivary cortisol level, i.e., loneliness was positively related to cortisol level specifically during lockdown. Mechanisms explaining the effect of forced social isolation on the association between loneliness and salivary cortisol need to be investigated in future studies.

Smartphone-Based Ecological Momentary Assessment of Coping with Loneliness amid COVID-19 in Germany.

The COVID-19 pandemic may have caused people to feel isolated, left out, and in need of companionship. Effective strategies to cope with such unrelenting feelings of loneliness are needed. In times of COVID-19, we conducted a smartphone-based ecological momentary assessment (EMA) study with 280 lonely participants in Germany over 7 months, where a long and hard second national lockdown was in place. Each participant reported their daily loneliness and coping strategies for loneliness once in the evening for 7 consecutive days. We found that managing emotions and social relationships were associated with decreased feelings of loneliness, while using a problem-focused coping strategy was associated with increased feelings of loneliness amid COVID-19. Interestingly, managing emotions was particularly effective for easing loneliness during the second lockdown. Females tend to use more emotion-focused coping strategies to overcome their loneliness compared to males. Our study highlights the importance of managing emotions against loneliness throughout the COVID-19 pandemic in Germany. Designing technology that provides emotional support to people may be one of the keys to easing loneliness and promoting well-being.

The Impact of COVID-19 Lockdown on Daily Activities, Cognitions, and Stress in a Lonely and Distressed Population: Temporal Dynamic Network Analysis.

BACKGROUND: The COVID-19 pandemic and its associated lockdown measures impacted mental health worldwide. However, the temporal dynamics of causal factors that modulate mental health during lockdown are not well understood. OBJECTIVE: We aimed to understand how a COVID-19 lockdown changes the temporal dynamics of loneliness and other factors affecting mental health. This is the first study that compares network characteristics between lockdown stages to prioritize mental health intervention targets. METHODS: We combined ecological momentary assessments with wrist-worn motion tracking to investigate the mechanism and changes in network centrality of symptoms and behaviors before and during lockdown. A total of 258 participants who reported at least mild loneliness and distress were assessed 8 times a day for 7 consecutive days over a 213-day period from August 8, 2020, through March 9, 2021, in Germany, covering a "no-lockdown" and a "lockdown" stage. COVID-19-related worry, information-seeking, perceived restriction, and loneliness were assessed by digital visual analog scales ranging from 0 to 100. Social activity was assessed on a 7-point Likert scale, while physical activity was recorded from wrist-worn actigraphy devices. RESULTS: We built a multilevel vector autoregressive model to estimate dynamic networks. To compare network characteristics between a no-lockdown stage and a lockdown stage, we performed permutation tests. During lockdown, loneliness had the highest impact within the network, as indicated by its centrality index (ie, an index to identify variables that have a strong influence on the other variables). Moreover, during lockdown, the centrality of loneliness significantly increased. Physical activity contributed to a decrease in loneliness amid the lockdown stage. CONCLUSIONS: The COVID-19 lockdown increased the central role of loneliness in triggering stress-related behaviors and cognition. Our study indicates that loneliness should be prioritized in mental health interventions during lockdown. Moreover, physical activity can serve as a buffer for loneliness amid social restrictions.

Long-Term Impact of Economic Downturn and Loneliness on Psychological Distress: Triple Crises of COVID-19 Pandemic.

BACKGROUND: The COVID-19 crisis poses global mental health and global economy challenges. However, there is a lack of longitudinal research investigating whether financial instability and social disruption may increase the risk of developing mental health problems over time that may potentially outlast the pandemic. METHODS: We conducted an online survey for members of the general population (n = 2703) in Germany during the twelve months spanning from April 2020 to March 2021. We investigated the development of COVID-19 related psychological distress, the number of unemployed people, federal government debt, income distribution, and loneliness over the time period. RESULTS: Over a period of twelve months, 53.6% of respondents in Germany reported experiencing psychological distress, varying from mild levels, 34.2%, to severe levels, 19.4%, of distress. High federal government debt, high incident COVID-19 cases, low incomes, and the prevalence of loneliness were found to be associated with increased long-term mental health problems. Psychological distress scores were most strongly increased in female and young respondents as well as those who reported fewer years of education, low income, and higher loneliness. CONCLUSIONS: Our study highlights factors that have a long-term impact on mental health amid the COVID-19 pandemic. We suggest that specific mental-health services could be offered to support high-risk groups experiencing financial fragility and loneliness. For purposes of safeguarding their mental health there is a need to monitor and track such risk factors in real time.

When numbers fail: do researchers agree on operationalization of published research?

Current discussions on improving the reproducibility of science often revolve around statistical innovations. However, equally important for improving methodological rigour is a valid operationalization of phenomena. Operationalization is the process of translating theoretical constructs into measurable laboratory quantities. Thus, the validity of operationalization is central for the quality of empirical studies. But do differences in the validity of operationalization affect the way scientists evaluate scientific literature? To investigate this, we manipulated the strength of operationalization of three published studies and sent them to researchers via email. In the first task, researchers were presented with a summary of the Method and Result section from one of the studies and were asked to guess the hypothesis that was investigated via a multiple-choice questionnaire. In a second task, researchers were asked to rate the perceived quality of the study. Our results show that (1) researchers are better at inferring the underlying research question from empirical results if the operationalization is more valid, but (2) the different validity is only to some extent reflected in a judgement of the study's quality. These results combined give partial corroboration to the notion that researchers' evaluations of research results are not affected by operationalization validity.

The Persistence of the Impact of COVID-19-Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study.

BACKGROUND: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. OBJECTIVE: We aim to investigate whether COVID-19-related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. METHODS: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19-related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. RESULTS: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. CONCLUSIONS: The mental health of a vulnerable population is still challenged by COVID-19-related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods.

[The global impact of the COVID-19 pandemic on the care provision for people with mental health problems]. / Globale Auswirkungen der COVID-19-Pandemie auf die Versorgung von Menschen mit psychischen Erkrankungen.

There are increasingly comprehensive data on recognition of the psychological impact of the coronavirus disease 2019 (COVID 19) pandemic on global populations. In most regions of the world, the economic and psychological burden on the general population and persons with mental disorders has risen sharply over the course of the pandemic. Beyond anxieties regarding severe acute respiratory syndromes due to coronavirus type 2 (SARS-CoV-2) infections, in many countries the measures for containing the pandemic also led to psychological burdens. It was shown that social distancing and contact restrictions were risk factors for the development or deterioration of mental health problems on a global scale. Simultaneously, the COVID-19 pandemic has disrupted or reduced mental health services in many countries. Thus, there is a substantial need for low threshold offers of assistance and for coping strategies. Current studies could show that certain coping strategies, such as virtual social contacts and physical activity, appear to be useful in counteracting the negative psychological sequelae of the pandemic; however, in order to improve care provision for people with psychological burden and mental illness in the medium term, it is necessary to offer targeted treatment, such as online psychotherapy in particular. Collaborative research tackles poverty, social isolation and loneliness.

Increased Psychological Distress, Loneliness, and Unemployment in the Spread of COVID-19 over 6 Months in Germany.

Background: The COVID-19 pandemic poses a challenge to global mental health. Loneliness and isolation may put people at higher risk for increased psychological distress. However, there is a lack of research investigating the development of COVID-19-related distress over time. Materials and Methods: We undertook an online survey among general population (N = 1903) in Germany throughout 6 months from the peak transmission period in April to the off-peak period by September 2020. Results: We found that the average prevalence of psychological distress caused by the COVID-19 pandemic significantly rose from 24% to 66% between the peak and off-peak transmission period, respectively. Unemployment rate and loneliness increased negative mental health outcomes, although the number of active COVID-19 cases decreased from April to September. Psychological distress scores increased mostly in female, young, and lonely people. Conclusions: Our results underline the importance of considering innovative alternatives to facilitate employment opportunities, distant contacts, and self-help over the course of the pandemic. Our study highlights the urgent need to pay attention to mental health services specifically targeting female, young, unemployed, and lonely people.