Advancing loneliness and social isolation as global health challenges: taking three priority actions.

Loneliness and social isolation have been identified as critical global health issues in the aftermath of the coronavirus disease 2019 (COVID-19) crisis. While there is robust scientific evidence demonstrating the impact of loneliness and social isolation on health outcomes and mortality, there are fundamental issues to resolve so that health authorities, decision makers, and practitioners worldwide are informed and aligned with the latest evidence. Three priority actions are posited to achieve a wider and more substantial impact on loneliness and social isolation. They are 1) strengthening the evidence base; 2) adopting a whole-of-systems approach; 3) developing policy support for governments worldwide. These priority actions are essential to reduce the pervasive impact of loneliness and social isolation as social determinants of health.

The prevalence of chronic and episodic loneliness and social isolation from a longitudinal survey.

Loneliness and social isolation, experienced more long-term, has been shown to increase mortality and lead to poorer health outcomes in specific cohorts. However, it is unclear what the prevalence of chronic loneliness and social isolation is, and which demographic groups are most at risk of reporting more chronic forms. A psychometrically validated classification system was used to identify people who met criteria for episodic and chronic loneliness and social isolation using the Household Income and Labour Dynamics in Australia (HILDA) survey waves 14-18. The prevalence of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded that of social isolation (overall 17%; 13% episodic, 4% chronic). There was consistency in the demographic characteristics (from age, sex, household type, income) of those who experienced loneliness and social isolation. However, people with a long-term health condition had an elevated risk of episodic loneliness (AOR 1.24, 95% CI 1.11-1.39) and a markedly higher risk of chronic loneliness (AOR 2.01, 95% CI 1.76-2.29), compared with those without a long-term health condition. Loneliness, both episodic and chronic subtypes, is more prevalent than social isolation. However, both chronic loneliness and social isolation remains neglected and poorly targeted within current practice and policy.

The state of loneliness and social isolation research: current knowledge and future directions.

In this editorial, we consider the current state of loneliness and social isolation research around the world, including knowledge gaps in the empirical literature.

PROTOCOL: In-person interventions to reduce social isolation and loneliness: An evidence and gap map.

This is the protocol for an evidence and gap map. The objectives are as follows: This EGM aims to map available evidence on the effects of in-person interventions to reduce social isolation and/or loneliness across all age groups in all settings.

The relationship between social isolation, social support, and loneliness with cardiovascular disease and shared risk factors: A narrative review.

BACKGROUND: Cardiovascular disease (CVD) is the greatest contributor to global morbidity and mortality. Poor social health plays a critical role in CVD incidence. Additionally, the relationship between social health and CVD may be mediated through CVD risk factors. However, the underlying mechanisms between social health and CVD are poorly understood. Certain social health constructs (social isolation, low social support and loneliness) have complicated the characterisation of a causal relationship between social health and CVD. AIM: To provide an overview of the relationship between social health and CVD (and its shared risk factors). METHOD: In this narrative review, we examined published literature on the relationship between three social health constructs (social isolation, social support, and loneliness) and CVD. Evidence was synthesised in a narrative format, focusing on the potential ways in which social health affects CVD, including shared risk factors. RESULTS: The current literature highlights an established relationship between social health and CVD with a likelihood for bi-directionality. However, there is speculation and varied evidence regarding how these relationships may be mediated through CVD risk factors. CONCLUSIONS: Social health can be considered an established risk factor for CVD. However, the potential bi-directional pathways of social health with CVD risk factors are less established. Further research is needed to understand whether targeting certain constructs of social health may directly improve the management of CVD risk factors. Given the health and economic burdens of poor social health and CVD, improvements to addressing or preventing these interrelated health conditions would have societal benefits.

Loneliness and social anxiety in young adults: The moderating and mediating roles of emotion dysregulation, depression and social isolation risk.

OBJECTIVES: We aimed to investigate the mechanisms underlying loneliness, social anxiety, depression and emotion dysregulation, as well as how these relationships differ based on social isolation risk. DESIGN: We employed an online survey study to measure variables cross-sectionally. METHODS: A total of 1239 (77.2% Female, Mage = 21.52, SD = 2.32) participants completed measures of loneliness, social isolation risk, social anxiety, depression and emotion dysregulation. A moderated serial mediation model was conducted to determine whether emotion dysregulation and depression jointly mediate the relationship between loneliness and social anxiety and to determine whether these relationships are moderated by risk of social isolation. RESULTS: Loneliness was found to predict social anxiety and was mediated by emotion dysregulation and depression both independently and combined. Participants with a low risk of social isolation were found to be protected against poor mental health. CONCLUSIONS: Our studies replicate previous findings showing a relationship between loneliness and social anxiety. We also extend current knowledge to show the importance of social contact for protecting against elevated levels of social anxiety and depression. Overall, we provide empirical evidence for the role of social connection in managing mental health symptoms.

Evaluating the impact of loneliness and social isolation on health literacy and health-related factors in young adults.

Objectives: In current study, we aim to extend previous research by investigating the unique impact of loneliness on health literacy and health-related factors of young adults, after controlling for social isolation, depressive symptomology, and social anxiety, as well as evaluate how social isolation and loneliness differ in their impact on health literacy, and health-related factors among young adults, after accounting for abovementioned concomitant variables. Methods: Using a cross-sectional study design, 521 young adults completed an online survey in 2020, where they self-reported their loneliness, social isolation, health-related factors, and health literacy data. Results: Increased loneliness was associated with decrease in several health literacy domains (e.g., poorer social support for health, lower appraisal of health information, among others) and increase in some health-related factors (e.g., higher perceived stress, higher negative affect), among young adults, even after controlling for social anxiety, depressive symptomology, and social isolation. Contrastingly, increase in social isolation was associated with changes in some health-related factors - more somatic health complaints, higher alcohol use, poorer cognitive and physical functioning, and lower scores for only one health literacy domain (i.e., social support for health) among young adults, after adjusting for the influence of social anxiety, depressive symptomology, and loneliness. Conclusion: Even after accounting for the influence of several co-occurring social and mental health symptoms, higher loneliness was associated poorer health literacy and health-related factors in young adults. We also found loneliness and social isolation may differ in the mechanisms through which they impact health literacy and health-related factors in young adults.

A pilot randomised controlled trial of the Peer Tree digital intervention targeting loneliness in young people: a study protocol.

BACKGROUND: Young people are vulnerable to experiencing problematic levels of loneliness which can lead to poor mental health outcomes. Loneliness is a malleable treatment target and preliminary evidence has shown that it can be addressed with digital platforms. Peer Tree is a strength-based digital smartphone application aimed at reducing loneliness. The study aim is to reduce loneliness and assess the acceptability, usability, and feasibility of Peer Tree in young people enrolled at university. METHODS: This will be a pilot randomised controlled trial (RCT) comparing a strength-based digital smartphone application (Peer Tree) with a control condition. Forty-two young people enrolled at university will be recruited for this pilot RCT. Participants with suicidal ideation or behaviours, acute psychiatric symptoms in the past month, or a current diagnosis of a mood or social anxiety disorder will be excluded. Allocation will be made on a 1:1 ratio and will occur after the initial baseline assessment. Assessments are completed at baseline, at post-intervention, and at follow-up. Participants in the control condition complete the same three assessment sessions. The primary outcome of the study will be loneliness. Depression, social anxiety, quality of life, acceptability, usability, feasibility, and safety of Peer Tree will also be measured as secondary outcomes. DISCUSSION: This trial will report the findings of implementing Peer Tree, a smartphone application aimed at reducing loneliness in university students. Findings from this trial will highlight the initial efficacy, acceptability, and feasibility of using digital positive psychology interventions to reduce subthreshold mental health concerns. Findings from this trial will also describe the safety of Peer Tree as a digital tool. Results will contribute evidence for positive psychology interventions to address mental ill-health. TRIAL REGISTRATION: Australian New Zealand Clinical Trial Registry ACTRN12619000350123. Registered on 6 March 2020.

Loneliness and Cognitive Function in Older Adults Without Dementia: A Systematic Review and Meta-Analysis.

BACKGROUND: Loneliness has been highlighted as a risk factor for dementia. However, the nature of the relationship between loneliness and cognitive function prior to onset of dementia is unclear. OBJECTIVE: The aim of this systematic review and meta-analysis was to examine the relationship between loneliness and cognitive function in samples screened for dementia at study commencement. METHODS: Five electronic databases (PubMed, PsycNET, Web of Science, EBSCOhost, Scopus) were searched from inception to August 31, 2021. A narrative review and random-effects meta-analysis were conducted on studies meeting search criteria. PROSPERO registration number: CRD42020155539. RESULTS: The sixteen studies that met inclusion criteria involved 30,267 individuals, with mean age ranging from 63.0 to 84.9 years. Studies varied in dementia screening criteria, measurement of loneliness and cognitive function, and statistical modeling approach. The narrative review indicated that loneliness was associated with poorer global cognition, episodic memory, working memory, visuospatial function, processing speed, and semantic verbal fluency. Results of the meta-analysis indicated that loneliness was negatively associated with global cognitive function (overall r = -0.08; 95% CI = -0.14, -0.02; n = 6). Due to lack of sufficient data and heterogeneity between studies, we were unable to explore associations with other cognitive domains or longitudinal associations. CONCLUSION: Loneliness is associated with subtle impairment across multiple cognitive domains in older adults who were screened for dementia. Better characterization of this relationship will provide important information about how loneliness contributes to the clinical and pathological sequalae of AD and be informative for risk reduction and early detection strategies.

Measuring Loneliness in Different Age Groups: The Measurement Invariance of the UCLA Loneliness Scale.

Age differences in the prevalence of loneliness have been a key focus among researchers, practitioners, and policy makers. However, the degree to which those reflect genuine differences in the experience of loneliness or the way individuals understand and respond to loneliness measures is yet to be examined. The current study explored the age measurement invariance of the 20-item Revised University of California Los Angeles, Loneliness Scale (UCLA-LSR) and its shorter forms in a U.K. sample of adults aged 18 to 99 years (M = 50.6, SD = 19.7). The fit of different structures/versions was explored through multigroup confirmatory factor analysis (CFA; N = 4,375) and local structural equation modeling (N = 19,521). Results indicated a poor and/or inconsistent structure for the 20-item UCLA-LSR and many of its shorter forms. Of the structures considered, 12 showed acceptable model fit and received age measurement invariance testing through multigroup CFA and alignment; 10 of these achieved full, partial, or approximate measurement invariance. Our findings suggest that the age measurement invariance of loneliness measures should not be assumed, and crucially, this must be explored before accurate and meaningful age comparisons can be made. Implications for measurement research, and clinical and community practice, are discussed.

Impact of loneliness on health-related factors in Australia during the COVID-19 pandemic: A retrospective study.

COVID-19 pandemic and its associated social and physical distancing restrictions may have had a severe impact on health. In the present study, we investigate the changes in physical, social and mental health, as well as the health literacy of Australians subsequent to the onset of COVID-19 pandemic, and examine the influence of loneliness on these health-related factors. Using a retrospective cross-sectional study design, 607 Australian adults completed a self-report online survey which assessed their health-related factors before and after onset of the COVID-19 pandemic (data collected between June 2020 to November 2020). Australians reported statistically significant increase in a number of (poorer) health-related factors (e.g., weight gain, sleeping difficulties, poor somatic health, higher loneliness, more issues navigating the healthcare system) post onset of COVID-19 pandemic. Further, after adjusting for covariates, higher loneliness during pandemic predicted poorer health-related outcomes (e.g., more somatic health complaints, poorer quality of diet, poorer social support for health). The COVID-19 pandemic and its associated social and physical distancing restrictions may have contributed towards poorer health-related factors among Australian adults. Further, increased loneliness during the pandemic may have further worsened physical health and health literacy outcomes among Australians.

A Global Longitudinal Study Examining Social Restrictions Severity on Loneliness, Social Anxiety, and Depression.

Purpose: Social restrictions and government-mandated lockdowns implemented worldwide to kerb the SARS-CoV-2 virus disrupted our social interactions, behaviours, and routines. While many studies have examined how the pandemic influenced loneliness and poor mental health, such as depression, almost none have focussed on social anxiety. Further, how the change in social restrictions affected change in mental-health and well-being has not yet been explored. Methods: This is a longitudinal cohort study in community dwellers who were surveyed across three timepoints in the first six months of the pandemic. We measured loneliness, social anxiety, depression, and social restrictions severity that were objectively coded in a sample from Australia, United States, and United Kingdom (n = 1562) at each time point. Longitudinal data were analysed using a multivariate latent growth curve model. Results: Loneliness reduced, depression marginally reduced, and social anxiety symptoms increased as social restrictions eased. Specific demographic factors (e.g., younger age, unemployment, lower wealth, and living alone) all influenced loneliness, depression, and social anxiety at baseline. No demographic factors influenced changes for loneliness; we found that those aged over 25 years reduced faster on depression, while those younger than 25 years and unemployed increased faster on social anxiety over time. Conclusion: We found evidence that easing social restrictions brought about additional burden to people who experienced higher social anxiety symptoms. As country-mandated lockdown and social restrictions eased, people are more likely report higher social anxiety as they readjust into their social environment. Mental health practitioners are likely to see higher levels of social anxiety in vulnerable communities even as social restrictions ease.

Psychometric assessment of scales for measuring loneliness and social isolation: an analysis of the household, income and labour dynamics in Australia (HILDA) survey.

BACKGROUND: Loneliness and social isolation are increasingly recognised as global public health threats, meaning that reliable and valid measures are needed to monitor these conditions at a population level. We aimed to determine if robust and practical scales could be derived for conditions such as loneliness and social isolation using items from a national survey. METHODS: We conducted psychometric analyses of ten items in two waves of the Household, Income and Labour Dynamics in Australia Survey, which included over 15,000 participants. We used the Hull method, exploratory structural equation modelling, and multidimensional item response theory analysis in a calibration sample to determine the number of factors and items within each factor. We cross-validated the factor structure using confirmatory factor analysis in a validation sample. We assessed construct validity by comparing the resulting sub-scales with measures for psychological distress and mental well-being. RESULTS: Calibration and cross-validation consistently revealed a three-factor model, with sub-scales reflecting constructs of loneliness and social isolation. Sub-scales showed high reliability and measurement invariance across waves, gender, and age. Construct validity was supported by significant correlations between the sub-scales and measures of psychological distress and mental health. Individuals who met threshold criteria for loneliness and social isolation had consistently greater odds of being psychologically distressed and having poor mental health than those who did not. CONCLUSIONS: These derived scales provide robust and practical measures of loneliness and social isolation for population-based research.

The impact of loneliness and social isolation on health state utility values: a systematic literature review.

BACKGROUND: Loneliness and social isolation are recognised as social problems and denote a significant health burden. The aim of this study was to conduct a systematic literature review to explore the health state utility values (HSUVs) associated with loneliness and/or social isolation. METHOD: Peer-reviewed journals published in English language that reported both HSUVs along with loneliness and/or social isolation scores were identified through five databases. No restrictions were made relating to the population, study design or utility estimation method used. RESULTS: In total, 19 papers were included; 12 included a measure of loneliness, four studies included a measure of social isolation and three studies considered both loneliness and social isolation. All studies focused on individuals with pre-existing health conditions-where the EQ-5D-3L instrument was most frequently used to assess HSUVs. HSUVs ranged from 0.5 to 0.95 in those who reported not being lonely, 0.42 to 0.97 in those who experienced some level of loneliness, 0.3 to 0.87 in those who were socially isolated and 0.63 to 0.94 in those who were not socially isolated. CONCLUSION: There was significant variation in HSUVs complicated by the presence of co-morbidities, population heterogeneity, variations in methods used to derive utility scores and differences in the measurement of loneliness and/or social isolation. Nevertheless, the lower HSUVs observed should be considered to significantly impact quality of life, though we also note the need for further research to explore the unique impact of loneliness and social isolation on HSUVs that can be used in the future economic evaluations.

Lived experience of loneliness in psychosis: A qualitative approach.

BACKGROUND: Loneliness impedes recovery from mental illness. Despite increased interest in loneliness in psychosis, qualitative methods are underused in clinical research on this topic. AIMS: We used qualitative interviews to explore loneliness among persons with schizophrenia spectrum disorders (SSDs). We examined which aspects of living with psychosis were associated with the experience of loneliness, including symptomatology, social relationships, and disruptions in school/work. METHODS: Sixteen participants diagnosed with SSDs engaged in semi-structured, qualitative interviews about loneliness. Participants commented on current activities and social relationships, including their perceptions of the quantity, quality and types of relationships. Important demographic and clinical information was acquired through communication with participants and/or through medical record review. Thematic analysis was used to examine interview content. RESULTS: Our analyses revealed four key topic areas and several sub-themes related to loneliness across participants, including aspects of the physical environment (e.g. financial limitations), social context (e.g. lacking a romantic partner), and psychological functioning (e.g. psychotic/symptoms) that impact lonely feelings. Participants commented on coping strategies to manage loneliness and provided suggestions for possible interventions. CONCLUSIONS: Persons diagnosed with SSDs report significant and impactful feelings of loneliness. This study highlights the need for novel and effective treatments targeting loneliness in this population.

A randomised controlled trial of the Nextdoor Kind Challenge: a study protocol.

BACKGROUND: Community interventions are often promoted as a way of reducing loneliness and social isolation in our neighbourhoods. However, those community interventions are rarely examined within rigorous study designs. One strategy that holds the potential to reduce loneliness and can promote health and wellbeing is doing acts of kindness. The current study involves evaluating the impact of kindness acts on loneliness in community-dwelling individuals using an online social networking platform. METHODS: This study is made up of three randomised controlled trials conducted in three countries. Each randomised controlled trial has two arms (intervention vs waitlist control) and is designed to compare the effectiveness of the KIND challenge, which involves doing at least one act of kindness per week within a four-week period. This study will recruit users of an online community, be randomised online, and will be conducted using online assessments. We will first explore the effects of the intervention on the primary outcome of loneliness, followed by secondary outcomes, social isolation, neighbour relationship quality and contact, mental health symptoms, stress, quality of life, and positive affect. Further, we will assess the feasibility, acceptability, and safety of the KIND Challenge. DISCUSSION: This study, designed to evaluate the impact of kindness on the community, will be the first large scale randomised control trial conducted across three countries, Australia, UK, and USA. It will examine the potential of community-led interventions to reduce loneliness, improve social isolation, and promote neighbourhood cohesion, health, and wellbeing, which is especially crucial during the COVID-19 public health crisis. TRIAL REGISTRATION: Clinical Trials Registry. NCT04398472 . Registered 21st May 2020.

Social Anxiety Disorder and Social Support Behavior in Friendships.

Relationship quality is a strong predictor of health outcomes, and individuals with social anxiety disorder (SAD) report increased interpersonal impairment. However, there are few studies testing the effect of SAD on friendships and it is thus unclear whether there are behavioral differences that distinguish friendships in which a target individual has SAD from friendships in which the target individual does not have SAD. We tested for differences in the provision and receipt of support behaviors as a function of having a SAD diagnosis and accounting for comorbid depressive symptoms. Participants with SAD (n = 90) and their friends engaged in support conversations that were coded using the Social Support Interaction Coding System. Structural equation modeling revealed some differences between participants and friends when accounting for depression. Specifically, friends of participants with SAD and comorbid depression engaged in fewer positive helper behaviors than the friends of participants who did not have SAD or comorbid depression. Additionally, dyads in which the primary participant had SAD engaged in more off-task behaviors. Results suggest that SAD does not result in global interpersonal impairment, but that receipt of positive support behaviors from friends may differ as a function of SAD and comorbid depression. Interpersonal interventions aimed at increasing adaptive friendships and aspects of CBT that target subtle avoidance (e.g., safety behaviors) may be useful in facilitating more satisfactory relationships for these individuals.