Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness.

BACKGROUND: Social isolation and loneliness are urgent public health concerns associated with negative physical and mental health outcomes. Understanding effective remedies is crucial in addressing these problems. This umbrella review aimed to synthesize and critically appraise scientific evidence on the effectiveness of social isolation and loneliness interventions overall and across subgroups. We focused on systematic reviews (SRs) of randomized controlled trials (RCTs). METHODS: We searched seven databases (June 2022 and updated June 2023) and supplemented the search with grey literature and reference screening to identify SRs published since 2017. Screening, data extraction, and quality assessment using the AMSTAR2 tool were conducted independently by author pairs, with disagreements resolved through discussion. RESULTS: We included 29 SRs, 16 with meta-analysis and 13 with narrative synthesis. All SRs focused on loneliness, with 12 additionally examining social isolation. Four SRs focused on young people, 11 on all ages, and 14 on older adults. The most frequently examined intervention types were social (social contact, social support), psychological (therapy, psychoeducation, social skills training), and digital (e.g., computer use and online support). Meta-analyses indicated small-to-moderate beneficial effects, while narrative synthesis demonstrated mixed or no effect. Social interventions for social isolation and psychological interventions for loneliness were the most promising. However, caution is warranted due to the effects' small magnitude, significant heterogeneity, and the variable quality of SRs. Digital and other interventions showed mixed or no effect; however, caution is advised in interpreting these results due to the highly diverse nature of the interventions studied. CONCLUSIONS: This overview of SRs shows small to moderate effectiveness of social interventions in reducing social isolation and psychological ones in tackling loneliness. Further rigorously conducted RCTs and SRs are needed to guide policy decisions regarding the implementation of efficacious and scalable interventions. Evaluation should focus on both preventive structural interventions and tailored mitigating strategies that address specific types and causes of loneliness.

Stability and change in maternal wellbeing and illbeing from pregnancy to three years postpartum.

PURPOSE: Motherhood affects women's mental health, encompassing aspects of both wellbeing and illbeing. This study investigated stability and change in wellbeing (i.e., relationship satisfaction and positive affect) and illbeing (i.e., depressive and anxiety symptoms) from pregnancy to three years postpartum. We further investigated the mutual and dynamic relations between these constructs over time and the role of genetic propensities in their time-invariant stability. DATA AND METHODS: This four-wave longitudinal study included 83,124 women from the Norwegian Mother, Father, and Child Cohort Study (MoBa) linked to the Medical Birth Registry of Norway. Data were collected during pregnancy (30 weeks) and at 6, 18 and 36 months postpartum. Wellbeing and illbeing were based on the Relationship Satisfaction Scale, the Differential Emotions Scale and Hopkins Symptoms Checklist-8. Genetics were measured by the wellbeing spectrum polygenic index. Analyses were based on random intercept cross-lagged panel models using R. RESULTS: All four outcomes showed high stability and were mutually interconnected over time, with abundant cross-lagged predictions. The period of greatest instability was from pregnancy to 6 months postpartum, followed by increasing stability. Prenatal relationship satisfaction played a crucial role in maternal mental health postpartum. Women's genetic propensity to wellbeing contributed to time-invariant stability of all four constructs. CONCLUSION: Understanding the mutual relationship between different aspects of wellbeing and illbeing allows for identifying potential targets for health promotion interventions. Time-invariant stability was partially explained by genetics. Maternal wellbeing and illbeing develop in an interdependent way from pregnancy to 36 months postpartum.

A Web-Based Intervention Using "Five Ways to Wellbeing" to Promote Well-Being and Mental Health: Randomized Controlled Trial.

BACKGROUND: Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). OBJECTIVE: This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being-promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. METHODS: In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. RESULTS: After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=-0.17, 95% CI -0.30 to -0.04; P=.001) with an effect size (Cohen d) of -0.20. CONCLUSIONS: The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. TRIAL REGISTRATION: ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871.

The double-edged sword of becoming a caregiver: dynamic impact on four dimensions of well-being in Norway.

BACKGROUND: Becoming a caregiver can be a transformative journey with profound, multifaceted implications for well-being. However, existing research predominantly emphasizes the negative aspects of caregiving, paying less attention to the positive sides. This study aims to explore the impact of transitioning into a caregiving role on various well-being indicators, such as negative hedonic, positive hedonic, eudaimonic, and social well-being. METHODS: We use Norwegian panel data (2019-2021) and employ a combination of nearest-neighbour matching and a difference-in-differences approach to analyse well-being trajectories among new caregivers (n = 304) and non-caregivers (n = 7822). We assess ten items capturing the dimensions of negative hedonic (anxiousness, sadness, and worriedness), positive hedonic (happiness and life satisfaction), eudaimonic (contributing to others' happiness, engagement, and meaning), and social (strong social relations and loneliness) well-being. RESULTS: Our results show a general increase in negative hedonic well-being and a decline in positive hedonic well-being for new caregivers. These impacts are larger for caregivers providing daily care, compared to those providing weekly and monthly care, and for those providing care inside rather than outside their own household. We observe only minor differences regarding gender and age. Interestingly, we also notice neutral or beneficial changes for eudaimonic aspects of well-being; of note, caregivers generally experience an increased sense of contributing to others' happiness. CONCLUSION: Our study reveals that adopting a caregiving role often leads to significant psychosocial challenges, especially in intensive caregiving situations. However, it also uncovers potential positive influences on eudaimonic aspects of well-being. Future research should explore underlying explanatory mechanisms, to inform strategies that enhance caregivers' well-being.

Stressful life events exhibit complex patterns of associations with depressive symptoms in two population-based samples using network analysis.

BACKGROUND: Stressful life events (SLEs) constitute key risk factors for depression. However, previous studies examining associations between SLEs and depression have been limited by focusing on single events, combining events into broad categories, and/or ignoring interrelationships between events in statistical analyses. Network analysis comprises a set of statistical methods well-suited for assessing relationships between multiple variables and can help surpass several limitations of previous studies. METHODS: We applied network analysis using mixed graphical models combining two large-scale population-based samples and >34,600 randomly sampled adults to investigate the associations between SLEs and current depressive symptoms in the general population. RESULTS: Numerous SLEs were uniquely associated with specific symptoms. Strong pairwise links were observed between SLEs during the past year and individual symptoms, e.g., between having experienced illness or injury and sleeping problems, having been degraded or humiliated and feeling blue, and between financial problems and hopelessness and being worried and anxious. Several SLEs, such as financial problems, sexual abuse, and having been degraded or humiliated, were associated with symptoms across more than one timepoint. More recent SLEs were generally more strongly associated with depressive symptoms. Several life events were strongly interrelated, such as multiple forms of abuse, and financial problems, unemployment, divorce, and serious illness or injury. LIMITATIONS: Limitations include a retrospective SLE measure, cross-sectional data, a brief self-report measure of depressive symptoms, and possible attrition bias in the sample. CONCLUSIONS: Our findings may have implications for public health efforts seeking to improve population mental health.