Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies.

Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.

Lonely Alone or Lonely Together? A Cultural-Psychological Examination of Individualism-Collectivism and Loneliness in Five European Countries.

Average levels of loneliness have been suggested to differ between collectivistic and individualistic countries. However, we know little about how individual-level collectivism (i.e., perceiving the self or one's social environment as collectivistic) is related to loneliness. As individualism and collectivism imply different ideals about how individuals should be embedded in social relationships, they may imply distinct risks for loneliness. Specifically, less demanding ideals in individualism should imply the risk of lower actual social embeddedness; more demanding ideals in collectivism should imply the risk of higher perceived discrepancies from such ideals. Two cross-sectional survey studies in five European countries (Study 1: Austria, N = 239; Study 2: Italy, Portugal, Sweden, The Netherlands, total N = 860) revealed that higher collectivism was related to lower loneliness. Individualism indeed implied lower social embeddedness, but collectivism did not imply higher discrepancies from ideal embeddedness. We discuss implications for reducing loneliness in different cultural contexts.