Loneliness, Social Isolation, and Living Alone Associations With Mortality Risk in Individuals Living With Cardiovascular Disease: A Systematic Review, Meta-Analysis, and Meta-Regression.

OBJECTIVE: This study aimed to conduct a systematic review and meta-analysis of associations between loneliness, social isolation, and living alone and risk of mortality among individuals with established cardiovascular disease. METHODS: Five electronic databases were searched (MEDLINE [Ovid], PsycINFO, EMBASE, PubMed, and SCOPUS) from inception to November 25, 2021. In all, 35 studies were included in a narrative synthesis and, where appropriate, a meta-analytic evaluation using a random-effects model. RESULTS: Living alone was associated with increased risk of all-cause mortality ( k = 15, n = 80,243, hazard ratio [HR] = 1.48, 95% confidence interval [CI] = 1.20-1.83, I2 = 83%), and meta-regressions found that the effects were stronger in studies from Europe and with longer follow-up. However, there was evidence of publication bias. Social isolation was associated with increased risk of all-cause mortality, measured both as a dichotomous variable ( k = 3, n = 2648, HR = 1.46, 95% CI = 1.08-2.04, I2 = 31%) and as a continuous variable ( k = 5, n = 2388, HR = 1.11, 95% CI = 1.02-1.24, I2 = 51%). Meta-analysis was not feasible for loneliness as exposure, but narrative synthesis of four studies suggested a tentative association between loneliness and increased risk of all-cause mortality. CONCLUSIONS: Supporting public health concerns, our review finds that loneliness, social isolation, and living alone are associated with premature mortality among individuals with established cardiovascular disease. However, evidence of publication bias and large methodological differences across studies point to the need for more rigorous research.

Associations between transient and chronic loneliness, and depression, in the understanding society study.

OBJECTIVES: Loneliness has a long-established link with depression; however, patterns of loneliness, specifically transient (short-term) and chronic loneliness (longer-term), have seldom been researched in terms of their associations with depression and psychiatric distress. We investigated whether chronic loneliness could predict higher levels of psychiatric distress and higher chance of depression diagnosis (via self-report) than transient and no loneliness. METHODS: We used data from 18,999 participants in Waves 9 and 10 of the Understanding Society survey: a nationally representative study of adults in the United Kingdom. The study used a between-subjects, cross-sectional, design, where participants' scores on loneliness measures across two time points were combined to form patterns of loneliness, and participants were compared on their levels of psychiatric distress and depression diagnoses across the three loneliness groups: chronic loneliness (lonely at both time points), transient loneliness (lonely at one time point) and no loneliness. RESULTS: Regression analyses revealed that patterns of loneliness predicted both the likelihood of participants reporting a history of depression diagnosis and participants' levels of psychiatric distress. The chronic loneliness group had the highest likelihood of self-reported depression diagnosis and had the highest levels of psychiatric distress, compared to both the transient and no loneliness groups. Transient loneliness, in turn, predicted higher likelihood of reporting a history of depression diagnosis and higher levels of psychiatric distress than the no loneliness group. CONCLUSIONS: The study replicates and extends prior findings, suggesting that prolonged loneliness even over the course of one year is a risk factor for poorer mental health.

Unemployment, employment precarity, and inflammation.

Unemployment has been associated with poorer health, but few studies have examined the biological mechanisms that confer these health decrements. Further, no studies to date have examined differences across employment groups to consider whether employment (in whatever means) is preferential in terms of health. The present study utilised secondary data from Understanding Society: The Household Longitudinal Survey during the aftermath of the recent global recession. Two markers of peripheral inflammation: C-reactive protein (CRP) and fibrinogen were assessed across employment groups (unemployed; permanent, temporary, and self-employed), controlling for individual, socio-demographic and health variables to give greater context to our understanding of how employment status influences health. After controlling for relevant confounds, unemployment was associated with higher levels of fibrinogen but not CRP. Subsequent analyses of employment subgroup revealed the temporary employed have similar levels of fibrinogen to the unemployed, and may therefore be at a similar health disadvantage. The findings confirm that unemployment is associated with increases in one marker of peripheral inflammation, but that this health protection is not conferred to those in precarious employment.

Longitudinal associations between parental incarceration and children's emotional and behavioural development: Results from a population cohort study.

BACKGROUND: Parental incarceration (PI) is associated with adverse developmental outcomes for children affected. However, research in this area often reports conflicting results with few studies following children across time in non-U.S. POPULATIONS: Additionally, more research is called for using multi-informant perspectives rather than relying on adult reports of child outcomes alone. METHODS: This study used data from the first two waves of a nationally representative cohort study of 8,568 children aged 9 years and followed up at age 13 living in the Republic of Ireland (2007-2012). Propensity score matching was used to match children who had experienced PI by the age of nine to children who had not experienced PI by sociodemographics and experience of other stressful events. Mental health, as measured by self-concept (Piers-Harris II) and externalizing and internalizing difficulties (strength and difficulties questionnaire), was compared across both groups. RESULTS: Fifty of the 8,568 children (weighted percentage 0.9%) reported experiencing PI by the age of nine. These children came from more socially disadvantaged homes and were more likely to have experienced other potentially stressful life events. In comparison to a matched sample of children not affected by PI, children affected by PI reported higher levels of anxiety at age nine. Longitudinal analysis indicated these children affected by PI also reported lower levels of happiness at age 13 with higher levels of emotional difficulties reported by their primary caregiver. CONCLUSIONS: Children of incarcerated parents face a greater array of life challenges. PI had an association with child-reported levels of anxiety at age nine. PI also had a medium-term association on caregiver assessments of emotional difficulties of children affected as well child-reported levels of happiness over time.

Living with invisible illness: social support experiences of individuals with systemic lupus erythematosus.

PURPOSE: Because symptoms are not immediately visible to others, systemic lupus erythematosus (SLE) is often considered an invisible illness. This invisibility can reduce the social support received from network members and adversely affect the quality of life. In the light of this, social support from formal support groups and from medical professionals can be particularly important; however, literature examining support from these sources is scarce. The purpose of this study was to explore the nature and impact of social support from medical professionals and from support groups for individuals with SLE. METHODS: Participants responded to open-ended questions on an online survey administered by Lupus UK and Lupus Group Ireland. Qualitative data from 133 participants (77% of respondents) were analysed. RESULTS: Thematic analysis revealed three overarching themes: invisibility, inadequate care, and validation. Respondents felt that their SLE was invisible to social ties and to medical professionals. In addition, treatment and organisational factors in health care contributed to the sense of inadequate care. Finally, validation was derived from informational and emotional support from both support groups, and from some medical professionals. CONCLUSIONS: The findings suggest that individuals with SLE have mixed experiences in terms of contact with medical professionals and involvement with support groups. Furthermore, low public awareness of lupus appears to contribute to feelings of invisibility for patients, leading to loneliness and isolation. Medical professionals might benefit from skills training in terms of managing the psychosocial consequences of lupus.

Dyadic concordance in mother and preschooler resting cardiovascular function varies by risk status.

This study examined concordance in heart rate (HR) and respiratory sinus arrhythmia (RSA) in a sample of 104 child-maltreating (CM) and nonCM mother-preschooler dyads (208 individuals). In a laboratory setting, mother and child cardiac physiology was simultaneously monitored via ECG in a 5-min resting period. Mothers ranged in age from 20 to 49 years; children ranged in age from 3 to 5 years. Significant within-dyad (WD) and between-dyad (BD) associations were observed for mother HR and both child HR and RSA, and the associations were moderated by CM status. Only CM dyads exhibited BD associations: Higher average maternal HR was associated with higher child HR and lower child RSA. By contrast, when the time interval was divided into 30 s epochs, nonCM dyads exhibited positive WD (dynamic) associations in mother and child HR, and both CM and nonCM dyads showed negative WD associations in mother HR and child RSA. Further, mothers' mean HR levels moderated the extent of epoch-by-epoch WD concordance observed in mother and child, such that elevated average maternal HR was associated with lower levels of WD (dynamic) concordance. No BD or WD concordance in maternal and child RSA was observed. The findings suggest that measures of intraindividual variation provide useful, alternate perspectives in the study of dyadic processes in at-risk families.

Social network size moderates the association between loneliness and cardiovascular reactivity to acute stress.

Loneliness and objective measures of social isolation (e.g., social network size) have been associated with increased risk of cardiovascular disease (CVD). However, the evidence is mixed and the precise causal mechanisms remain unclear. Cardiovascular reactivity (CVR) to acute stress has been posited as a proposed mechanism. This study aimed to investigate: (i) effects of loneliness and social isolation on CVR to stress and, (ii) whether the loneliness - CVR relationship was moderated by social network size. Two hundred and six participants from the Pittsburgh Cold Study underwent a modified version of the Trier Social Stress Task. Cardiovascular measures of systolic (SBP) and diastolic blood pressure (DBP) and heart rate (HR) were taken throughout the laboratory stress trial. Hierarchical regression analyses found that social network size was positively associated with DBP reactivity (ß = 0.19 95 % CI [0.05, 0.29] p = 0.005), while loneliness was not. In addition, social network size moderated the loneliness - DBP reactivity relationship such that a higher number of outer social network ties were beneficial at lower levels of loneliness but not higher. The current study contributes new evidence linking loneliness and social network size to cardiovascular psychophysiology but raises questions about the loneliness - CVD relationship. The findings confirm the importance of social network size and highlight that the characteristics of the networks may be more important than the number of networks.

Teaching open and reproducible scholarship: a critical review of the evidence base for current pedagogical methods and their outcomes.

In recent years, the scientific community has called for improvements in the credibility, robustness and reproducibility of research, characterized by increased interest and promotion of open and transparent research practices. While progress has been positive, there is a lack of consideration about how this approach can be embedded into undergraduate and postgraduate research training. Specifically, a critical overview of the literature which investigates how integrating open and reproducible science may influence student outcomes is needed. In this paper, we provide the first critical review of literature surrounding the integration of open and reproducible scholarship into teaching and learning and its associated outcomes in students. Our review highlighted how embedding open and reproducible scholarship appears to be associated with (i) students' scientific literacies (i.e. students' understanding of open research, consumption of science and the development of transferable skills); (ii) student engagement (i.e. motivation and engagement with learning, collaboration and engagement in open research) and (iii) students' attitudes towards science (i.e. trust in science and confidence in research findings). However, our review also identified a need for more robust and rigorous methods within pedagogical research, including more interventional and experimental evaluations of teaching practice. We discuss implications for teaching and learning scholarship.

Loneliness and cardiovascular reactivity to acute stress in older adults.

Loneliness has been linked to cardiovascular health outcomes in older adulthood. One proposed mechanism by which loneliness influences cardiovascular health is through atypical cardiovascular reactivity (CVR) to stress. This study is an examination of loneliness and CVR in older adults, comparing associations across two stressors and two commonly used measures of loneliness, with a particular focus on underlying hemodynamic variables including cardiac output, total peripheral resistance, and ejection time (EJT). Eighty older adults, ranging in age from 55 to 88 years (M = 68.93, SD = 8.28), completed two versions of the UCLA loneliness scale (a 20-item and a briefer, three-item) and took part in a laboratory stress-testing procedure which included a mental arithmetic challenge and a public speaking task. Cardiovascular activity was monitored continuously throughout. For the 20-item version of the UCLA loneliness scale, loneliness was not significantly related to CVR, and was only significantly associated with lower levels of overall EJT. For the three-item version of the UCLA, no associations withstood adjustment for multiple testing. Loneliness was not reliably associated with CVR. Further, although greater loneliness was related to lower levels of overall EJT, this was only observed for the 20-item scale. The findings do not strongly provide support for reactivity to acute stress as a pathway linking loneliness to disease outcomes, and highlight key methodological issues related to the assessment of loneliness-reactivity associations for future.

Anxiety following myocardial infarction: A systematic review of psychological interventions.

OBJECTIVE: Anxiety is highly prevalent following myocardial infarction (MI) and is linked with adverse effects on a person's recovery, quality of life, physical health, and life expectancy. The primary objective of this systematic review was to assess the effectiveness of psychological interventions for anxiety following MI. METHOD: CINAHL, Medline, PsycINFO, PsycARTICLES, Cochrane Library, EMBASE, and Web of Science were systematically searched for studies that provided information on anxiety pre and post psychological intervention following MI. RESULTS: Eighteen studies were included (15 randomized controlled trials [RCTs] and three non-RCTs). Within these studies, psychological interventions comprised cognitive behavioral therapy, eye movement desensitization reprocessing, counseling, psychotherapy, psychological/psychosocial cardiac rehabilitation, illness perception interventions, relaxation training, mindfulness, stress management, and other psychological-based programmes. Ten studies reported a significant decrease in anxiety following a psychological intervention, when compared with usual care. Three studies noted mixed results, and five studies reported no significant difference in anxiety following a psychological intervention. The interventions varied in length, setting, facilitation, and format. Poor reporting of information increased the risk of bias within studies. CONCLUSION: Psychological interventions may be beneficial to individuals who experience anxiety following a MI. No particular type of psychological intervention appears to be superior to others within the existing literature. Further rigorous research is needed to identify the needs of this population and the specific form of psychological intervention that is most effective in alleviating anxiety following MI. Clinical implications and recommendations for future research are provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Cardiovascular reactivity to acute stress: Attachment styles and invisible stranger support.

While the benefits of social support for physiological health are well established, the underlying pathways by which support can influence cardiovascular reactivity (CVR) are still being elucidated. In the present study, we adapted an attachment framework to further explore the support-CVR link. Specifically, we experimentally tested the effect of attachment and social support on CVR by manipulating the provision of invisible support from a stranger, across individuals with secure, anxious and avoidant attachment styles. Employing a 3 × 2 design, a sample of young adults (N = 138) from across each of the three attachment styles were randomly assigned to either an invisible support (from a stranger), or no support, condition. All participants were subject to an acute standardised stress testing protocol where cardiovascular indices were monitored throughout. Results from a factorial ANOVA showed no significant interaction between support and attachment on any cardiovascular reactivity parameter (SBP, DBP, HR) or any main effect of attachment or support. These findings suggest that, in this case, social support was not effective in buffering the effects of stress across various attachment styles. The benefits of incorporating a developmental perspective to the study of social support and health are discussed.

Gratitude, social support and cardiovascular reactivity to acute psychological stress.

The pathways linking gratitude to cardiovascular reactivity (CVR) to acute stress are not fully understood. We examine whether this association is mediated by social support. Healthy adults (N = 178) completed measures of trait gratitude and perceived social support and participated in a standardised mental arithmetic and speech stress testing protocol. Their CVR (i.e., systolic and diastolic blood pressure [SBP, DBP], heart rate [HR], cardiac output [CO] and total peripheral resistance [TPR]) were monitored throughout. Gratitude was positively associated with SBP, DBP and TPR reactivity, with those reporting higher gratitude showing higher CVR. Social support was positively associated with TPR to the maths task. The association between gratitude and TPR was mediated by social support but this was only evident in response to the maths task and not the speech task. These novel findings suggest that CVR may be a potential mechanism underlying the gratitude-physical health link.

Making the leap and finding your feet: A qualitative study of disclosure and social support in university students with type 1 diabetes.

University poses unique challenges surrounding disclosure for students living with type 1 diabetes, with implications for social support and self-management. Semi-structured interviews with students and peer interviewers living with type 1 diabetes explored university experiences of disclosure and social support. Thematic analysis identified three major themes: disclosure as a measured process, the need for lived experience for true understanding and personal growth and self-awareness. Findings emphasize the need to scaffold the university transition for individuals with type 1 diabetes as disclosure can elicit effective social support. In addition, the importance of lived experience suggests support from students with type 1 diabetes could considerably impact diabetes management.

Stressful life events and adolescent well-being: The role of parent and peer relationships.

It is well established that stressful life events (e.g., family bereavements or moving to a new country) are damaging to psychological health and well-being. Indeed, social relationships are often noted as an important factor that can influence well-being and buffer the negative effects of stress. However, the quality and source of these relationships, particularly for adolescents, are often overlooked. Using the Growing Up in Ireland Survey, a population-based study of 13-year-old Irish adolescents (N = 7,525; 51.1% female), the current study examines the quality of both parent and peer relationships as potential mechanisms explaining the association between stressful life events and psychological well-being indices in adolescents. As expected, results showed that stressful life events negatively impacted the psychological well-being of adolescents. Parallel mediation analyses indicated that both parent and peer relationship quality mediated this association. Further exploratory analyses found that for girls, greater numbers of stressful life events were associated with poorer quality relationships with both their parents and peers, and in turn, these were linked to lower levels of psychological well-being. For boys, this effect was only evident for parental relationship quality, but not peers. The implication of these findings for adolescent's psychological well-being, particularly for girls, is discussed.

Perceived social support mediates the association between attachment and cardiovascular reactivity in young adults.

To understand the influence of social relationships on cardiovascular responses to stress, the present study investigated perceived affectionate support as a mediating variable explaining the association between specific attachment bonds (i.e., mother, father, partner, best friend) and cardiovascular reactivity (CVR). Utilizing a standardized stress testing protocol, 138 young adults completed measures of attachment and social support, with continuous cardiovascular measurements obtained using the Finometer Pro hemodynamic monitor. Results showed that the association between anxious and avoidant attachment and reactivity were mediated by perceived affectionate support; insecure attachment was linked to lower levels of perceived social support, which in turn was associated with lower CVR. For anxious attachment, this was noted only for mothers (SBP: B = -0.94, 95% CI [-1.94, -0.20]; DBP: B = -0.57, [-1.27, -0.10]), fathers (SBP: B = -0.72, [-1.42, -0.17]; DBP: B = -0.48, [-1.01, -0.13]), and best friends (SBP: B = -0.64, [-1.23, -0.18]; DBP: B = -0.40, [-0.81, -0.12]). For avoidant attachment, it was evident only for fathers (SBP: B = -0.70, [-1.33, -0.17]; DBP: B = -0.48, [-0.92, -0.15]) and partners (SBP: B = -0.78, [-1.64, -0.09]; DBP: B = -0.53, [-1.10, -0.11]). These findings suggest that insecure attachment is associated with lower levels of reactivity, which have been linked to negative health outcomes such as poor self-reported health, depression, and obesity. Overall, this research expands on the support and relationship science literature by incorporating under-researched aspects of social relationships (i.e., specific attachment styles) and focusing on the mechanisms by which they are associated with physiological stress responses.

Social support, social participation, and cardiovascular reactivity to stress in the Midlife in the United States (MIDUS) study.

This study tested two hypotheses of associations between dimensions of social connectedness and cardiovascular reactivity to acute stress: (1) high social support predicts diminished cardiovascular responses to stress (i.e., the stress-buffering model of social support), and (2) diminished cardiovascular responses predict lower social participation, a form of motivated behaviour. Participants (N = 606) in the main Midlife in the United States study completed measures of social support and social participation and underwent psychophysiological stress testing. In unadjusted analyses, social support was positively, rather than inversely, associated with reactivity. Results withstood adjustment for several control variables, but not for depressive symptoms, which was associated with diminished reactivity. Further, diminished reactivity was associated with lower social participation, but not in fully adjusted models. No robust evidence was observed for either the stress-buffering model, or for an association between diminished reactivity and lower social participation. The implications for our understanding of links between social connectedness and cardiovascular reactivity are discussed.

Personality, cardiovascular, and cortisol reactions to acute psychological stress in the Midlife in the United States (MIDUS) study.

Recent research has suggested that diminished, as well as elevated reactivity to acute psychological stress is maladaptive. These differences in stress reactions have been hypothesized to relate to the Big Five personality traits, which are said to be biologically-based and stable across adulthood; however, findings have been inconclusive. This study sought to replicate the findings of the largest study conducted to date (Bibbey et al., 2013), with a sample of participants from the Midlife in the United States Study (MIDUS), aged between 35 and 84 years (M = 56.33, SD = 10.87). Participants (N = 817) undertook a standardized, laboratory-based procedure during which their cardiovascular and neuroendocrine reactivity to acute stress was measured. In contrast to Bibbey et al. (2013), associations between neuroticism and blunted reactivity did not withstand adjustment for confounding variables. Further, following adjustment for multiple tests, no significant positive association between agreeableness and HR reactivity was observed. Methodological differences between the studies, which may account in part for the contrasting findings, are discussed. Further conceptual replication research is needed to clarify associations between the Big Five personality traits and stress reactivity, across the lifespan.

Loneliness and cardiovascular reactivity to acute stress in younger adults.

Loneliness is connected to poorer health outcomes with stress reactivity proposed as an underlying mechanism. The present study explored whether the relationship between loneliness and cardiovascular reactivity (CVR) varies across acute psychological stress tasks. Eighty-eight healthy younger adults completed a psychometric measure of loneliness and participated in a standardised cardiovascular stress-testing protocol, with a public speaking and a mental arithmetic task. Cardiovascular functioning was assessed before and during the acute stress exposure. Higher levels of loneliness significantly predicted lower total peripheral resistance (TPR) reactivity to the public speaking task but not to the arithmetic challenge. This suggests that the effect of loneliness on cardiovascular reactivity to acute stress may vary by stressor type. These findings are discussed in relation to future research.