"I'm more than my sport": Exploring the dynamic processes of identity change in athletic retirement.

Retirement is one of the most impactful career transitions athletes face. Researchers recognise the role that athletic identity plays in this, but analysis of identity content and change processes is limited. Addressing this gap, we conducted a qualitative study exploring the experience of identity change in 21 competitive and successful elite athletes who had retired from sport. All participated in a one-session psychoeducational program that explored the challenges of transitioning out of sport before being interviewed about their understanding of identity in sport, and their experiences negotiating identity loss and change in retirement. Using reflexive thematic analysis, we identified three themes: (i) the role of identity and self-categorizations in shaping sport performance, (ii) adjusting to identity loss (with subthemes indicating that this experience varied depending on the extent to which a person had multiple or exclusive identities), and (iii) attempts to remoor identity in the transition (with subthemes of searching for a new identity and actively repurposing identity). We interpret these themes through the lens of the Social Identity Model of Identity Change and show that this provides a framework for extending our understanding the complexities of identity change associated with retirement from elite sport.

Understanding and Improving Athlete Mental Health: A Social Identity Approach.

Understanding and positively influencing athlete mental health have become key goals for researchers and sporting stakeholders (e.g. coaches, support staff, clubs and governing bodies). In this article, we outline a novel perspective for tackling these challenges, drawing on an influential theory of group processes. This social identity approach can, we argue, help explain when and why the characteristics and demands of sport, which is typically a collective endeavour, pose a threat to athlete mental health and provide a guiding framework for efforts to protect and enhance athlete mental health. Here, we seek to illustrate the value of a social identity analysis of athlete mental health through three key points that speak to its analytical and practical value. Specifically, we propose: (1) that social identities can act as psychological resources that support athlete mental health, (2) that social identities are critical to athlete mental health during and after sporting transitions and (3) that leadership informed by a social identity approach can facilitate athlete mental health. With a view to maximising the value of our analysis both for those working with athletes and for researchers, we also identify practical steps that relevant stakeholders could take to support athlete mental health, and key avenues for future research to further test our propositions and advance understanding. Our analysis provides a new lens through which all those invested in understanding and supporting athlete mental health can approach these challenges, and a foundation for novel solutions.

Discrimination and social identity processes predict impairment and dysfunction among heavy drinkers.

BACKGROUND: Previous research has linked discrimination to poorer health. Yet health risk behaviours such as heavy alcohol consumption are often targeted with stigmatising public health campaigns. The current study sought to establish the link between experiencing discrimination and health outcomes among heavy drinkers, with a focus on exploring the multiple social identity processes that might underpin this relationship. METHODS: A survey was conducted with 282 people who self-reported consuming alcohol above recommended guidelines. We measured discrimination experienced as a drinker, components of social identification as a drinker (centrality, satisfaction, solidarity, homogeneity, and self-stereotyping), and two health outcomes: psychological distress and severity of alcohol use disorder symptomatology. RESULTS: Discrimination was a moderate-large predictor of psychological distress and alcohol use disorder symptoms. Three social identity constructs were implicated in the link between discrimination and ill-health: identity centrality and homogeneity positively mediated this relationship while identity satisfaction was a negative mediator. The model explained a large proportion of the variance (39-47%) in health outcomes. DISCUSSION: Results are interpreted with an emphasis on the need to avoid stigmatising messaging and to prioritise social identity processes to prevent and treat substance use disorders. We further highlight the need for social identity researchers to consider the multidimensional nature of social identities, especially in the context of stigmatised groups.

Measuring civilian moral injury: Adaptation and validation of the Moral Injury Events Scale (Civilian) and Expressions of Moral Injury Scale (Civilian).

OBJECTIVE: Moral injury (MI) research has been expanded to populations beyond the military in recent years. A key barrier to further research into MI in civilian populations is the lack of valid, reliable measures of the construct appropriate for general civilian use. This article addresses this barrier by adapting two existing military measures and exploring their psychometrics in a general civilian sample: the Moral Injury Events Scale-Civilian (MIES-C) and Expressions of Moral Injury Scale-Military (EMIS-C). METHOD: A sample of civilian women (n = 192) and men (n = 88) completed the above measures, and additional scales designed to capture theoretically supported primary and secondary markers of MI (guilt, shame, anger; depression, posttraumatic stress symptoms, anxiety). RESULTS: Confirmatory factor analyses found that the factor structure of the MIES-C and EMIS-C replicated well within our civilian sample. Discriminant validity was indicated through a significant negative correlation with well-being. Both measures correlated as predicted with each other and measures of MI markers at the total score level. Correlations of individual subscales with each of these measures were more varied. CONCLUSIONS: Results shed light on differential relationships between the type of MI event and clinical outcomes, suggesting some conceptual differences in how MI is experienced in general civilian populations. Results suggest that civilian populations are also susceptible to MI, but that existing measures may have problems capturing this effectively. While the MIES-C and EMIS-C are supported for civilian use, further scale construction efforts for this population are warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Predictors of individual mental health and psychological resilience after Australia's 2019-2020 bushfires.

AIMS: We assessed the mental health effects of Australia's 2019-2020 bushfires 12-18 months later, predicting psychological distress and positive psychological outcomes from bushfire exposure and a range of demographic variables, and seeking insights to enhance disaster preparedness and resilience planning for different profiles of people. METHODS: We surveyed 3083 bushfire-affected and non-affected Australian residents about their experiences of bushfire, COVID-19, psychological distress (depression, anxiety, stress, post-traumatic stress disorder) and positive psychological outcomes (resilient coping, wellbeing). RESULTS: We found high rates of distress across all participants, exacerbated by severity of bushfire exposure. For people who were bushfire-affected, being older, having less financial stress, and having no or fewer pre-existing mental disorders predicted both lower distress and higher positive outcomes. Being male or having less income loss also predicted positive outcomes. Severity of exposure, higher education and higher COVID-19-related stressors predicted both higher distress and higher positive outcomes. Pre-existing physical health diagnosis and previous bushfire experience did not significantly predict distress or positive outcomes. RECOMMENDATIONS: To promote disaster resilience, we recommend investment in mental health, particularly for younger adults and for those in rural and remote areas. We also recommend investment in mechanisms to protect against financial distress and the development of a broader definition of bushfire-related impacts than is currently used to capture brushfires' far-reaching effects.

Street soccer and homelessness: Exploring social identities, health, and well-being.

Membership in social and physical activity groups has the potential to help people with a range of physical and mental health challenges. The purpose of this study was to examine the experiences of members of a unique physical activity group: people who were formerly or currently homeless participating in a street soccer program in Western Canada. Ten participants in the Vancouver Street Soccer League (VSSL) were interviewed about the extent to which this program fostered a sense of community, social connectivity, and quality of life among people with experience of homelessness. Interviews were augmented with a Social Identity Mapping activity and observations from the first author who took part in weekly practice with the VSSL for over a year. The data were analysed using thematic analysis, in which four themes were developed to reflect the findings. These included (1) Coming together through soccer, (2) Dynamics motivating continued involvement in the league, (3) Leaders and leadership: Social influence in the league, and (4) The league and health outcomes. The findings provide insight into how a street soccer program which fostered shared social identity, psychological safety, friendly competition, and social support contributed to the well-being of people impacted by homelessness, various traumas, and marginalisation.

Connecting to Community: A Social Identity Approach to Neighborhood Mental Health.

ACADEMIC ABSTRACT: Integrative theorizing is needed to advance our understanding of the relationship between where a person lives and their mental health. To this end, we introduce a social identity model that provides an integrated explanation of the ways in which social-psychological processes mediate and moderate the links between neighborhood and mental health. In developing this model, we first review existing models that are derived primarily from a resource-availability perspective informed by research in social epidemiology, health geography, and urban sociology. Building on these, the social identity model implicates neighborhood identification in four key pathways between residents' local environment and their mental health. We review a wealth of recent research that supports this model and which speaks to its capacity to integrate and extend insights from established models. We also explore the implications of the social identity approach for policy and intervention. PUBLIC ABSTRACT: We need to understand the connection between where people live and their mental health better than we do. This article helps us do this by presenting an integrated model of the way that social and psychological factors affect the relationship between someone's neighborhood and their mental health. This model builds on insights from social epidemiology, health geography, and urban sociology. Its distinct and novel contribution is to point to the importance of four pathways through which neighborhood identification shapes residents' mental health. A large body of recent research supports this model and highlights its potential to integrate and expand upon existing theories. We also discuss how our model can inform policies and interventions that seek to improve mental health outcomes in communities.

Are Parents the Key? How Parental Suicide Stigma and Suicide Literacy Affect Help-Seeking Attitudes and Intentions for their Child.

Suicide is the leading cause of death among Australian young people, yet rates of help-seeking for suicidal ideation and behaviors in this population are concerningly low. In this study, the relationships between parental suicide stigma, parental suicide literacy, and their attitudes and intentions toward seeking professional help for their child if they were to express thoughts of suicide are investigated. Understanding this influence is critical given parents are key facilitators of their child's access to and engagement with professional mental health services. An online survey was administered to 302 parents of children aged-12-18 (Mage = 45.36, SDage = 6.23; 91.4% female). Parental suicide stigma was significantly associated with more negative help-seeking attitudes and lower help-seeking intentions. Other significant predictors of more positive help-seeking attitudes included parental self-efficacy and having a child with no history of suicidal ideation. Higher help-seeking intentions were associated with female gender, living in an urban area, and positive help-seeking attitudes. Parental suicide literacy was not significantly associated with help-seeking. Practically, outcomes of this study may inform the development and implementation of targeted education programs to increase parental help-seeking for their children.

Social group connections support mental health following wildfire.

PURPOSE: As environmental disasters become more common and severe due to climate change, there is a growing need for strategies to bolster recovery that are proactive, cost-effective, and which mobilise community resources. AIMS: We propose that building social group connections is a particularly promising strategy for supporting mental health in communities affected by environmental disasters. METHODS: We tested the social identity model of identity change in a disaster context among 627 people substantially affected by the 2019-2020 Australian fires. RESULTS: We found high levels of post-traumatic stress, strongly related to severity of disaster exposure, but also evidence of psychological resilience. Distress and resilience were weakly positively correlated. Having stronger social group connections pre-disaster was associated with less distress and more resilience 12-18 months after the disaster, via three pathways: greater social identification with the disaster-affected community, greater continuity of social group ties, and greater formation of new social group ties. New group ties were a mixed blessing, positively predicting both resilience and distress. CONCLUSIONS: We conclude that investment in social resources is key to supporting mental health outcomes, not just reactively in the aftermath of disasters, but also proactively in communities most at risk.

A longitudinal examination of the role of social identity in supporting health and well-being in retirement.

Social factors are major determinants of the success of retirement transitions. However, we do not yet fully understand the nature and basis of this impact, particularly as it relates to social group belonging. To address this issue the present article investigated the role that social group memberships play in supporting people's health and well-being in the early phase of transitioning to retirement. More specifically, we drew on the social identity model of identity change (SIMIC) to examine two pathways in which social group processes are theorized to influence adjustment to life change-social identity continuity and social identity gain. To test these pathways, a sample of Australian workers who had transitioned to retirement in the last 12 months (N = 170) were surveyed about their (a) preretirement multiple group memberships and postretirement maintained and new group memberships and (b) their perceived physical health, mental health, and life satisfaction after retirement. While preretirement group memberships did not affect retirement outcomes directly, they supported them indirectly by enabling people both to maintain some existing group memberships and to gain some new group memberships postretirement; as predicted by SIMIC. These findings confirm the importance of social factors and of social group membership in particular, for retiree health and well-being. Theoretically, they support the generalizability of SIMIC and its capacity to explain adjustment to diverse life changes including retirement. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Therapists who foster social identification build stronger therapeutic working alliance and have better client outcomes.

BACKGROUND: For decades we have known that therapeutic working alliance is a key contributor to client engagement and positive outcomes in therapy. However, we have made little progress in narrowing down its determinants, which is critical in supporting trainees to optimize such alliance. We make a case for the value of incorporating social psychological frameworks into models of alliance and explore the role of social identity processes in the development of therapeutic alliance. METHOD: Across two studies, over 500 psychotherapy clients completed validated measures of alliance, social identification with their therapist, positive therapy outcomes, and a range of client and therapist characteristics. FINDINGS: Social identification strongly predicted alliance in both samples, whereas client and therapist characteristics showed few such associations. Alliance mediated the relationship between social identification and positive therapy outcomes. In addition, we found evidence that (a) personal control is a key psychological resource in therapy that arises from social identification, and (b) therapists who engage in identity leadership (i.e., who represent and build a social identity that they share with clients) are more likely to foster social identification and its downstream benefits. INTERPRETATION: These data show that social identity processes are key to the emergence of working alliance. We conclude with a discussion of how recent social identity and identity leadership interventions might be adapted to train therapists in relevant identity-building skills.

Interest in Digital Peer-Delivered Interventions and Preferences to Improve Pain Self-efficacy and Reduce Loneliness Among Patients With Chronic Pain: Mixed Methods Co-design Study.

BACKGROUND: Two important factors that prolong and exacerbate chronic noncancer pain (CNCP) and disability are low pain self-efficacy and loneliness. Yet, few interventions have shown long-term sustained improvements in pain self-efficacy, and there are no evidence-based treatments that target social connectedness in people living with CNCP. More effective and accessible interventions designed to target self-efficacy and social connectedness could ease the burden of CNCP. OBJECTIVE: To co-design accessible interventions to increase pain self-efficacy, social connection, pain-related outcomes, and quality of life, this study explored patients' interest and preferences for digital peer-delivered interventions for CNCP as well as implementation barriers and enablers. METHODS: This cross-sectional mixed methods study was part of a larger longitudinal cohort study. Adult Australian residents (N=186) with CNCP diagnosed by a medical professional or pain specialist were included. Participants were initially recruited through advertising on professional pain social media accounts and websites. Questions examined whether patients were interested in digital peer-delivered interventions and their preferences for specific features (eg, Newsfeed). Pain self-efficacy and loneliness were assessed using validated questionnaires, and the association between these factors and interest in digital peer-delivered support was explored. Open-ended questions explored implementation barriers, enablers, and suggestions for consideration in intervention design. RESULTS: There was interest in accessing digital peer-delivered interventions, with almost half of the sample indicating that they would access it if it was available. Those who indicated an interest in digital peer interventions reported both lower pain self-efficacy and greater loneliness than those who were not interested. Intervention content that incorporated education, links to health services and resources, and delivery of support by peer coaches were the most frequently preferred intervention features. Three potential benefits were identified: shared experience, social connection, and shared pain management solutions. Five potential barriers were identified: negative focus on pain, judgment, lack of engagement, negative impact on mental health, privacy and security concerns, and unmet personal preferences. Finally, there were 8 suggestions from participants: moderation of the group, interest subgroups, professional-led activities, psychological strategies, links to professional pain resources, newsletter, motivational content, live streaming, and online meetups. CONCLUSIONS: Digital peer-delivered interventions were of particular interest to those with CNCP who had lower levels of pain self-efficacy and higher levels of loneliness. Future co-design work could tailor digital peer-delivered interventions to these unmet needs. Intervention preferences and implementation barriers and enablers identified in this study could guide further co-design and the development of such interventions.

'They don't really know why they're here' mental health professionals' perspectives of consumer representatives.

There are several barriers to meaningful, non-tokenistic consumer representation in mental health, including stigma and negative attitudes towards consumers. The aim of this study was to examine mental health professionals' perspectives about collaborating with consumer representatives. Semi-structured interviews were conducted with 11 mental health professionals across Australia. Informed by the social identity framework, the findings are discussed in relation to the themes of (1) the need for greater clarity about the roles of consumer representatives, (2) perceptions about whether consumer representatives are held to equal professional standards, (3) understandings of consumers' place in organizational hierarchies, (4) facilitating more meaningful collaboration between consumer representatives and non-consumer health professionals and (5) the blurring of these identities when mental health professionals have lived experience. Findings suggest that the social identities of mental health consumer representatives (along with their organizational roles) are often unclear and need development within healthcare organizations. Leaders can provide guidance on group boundaries to enable effective collaboration. The implications for healthcare organizations and policy include the provision of clear frameworks for collaborative mental healthcare and clear roles, terminology and responsibilities for mental health consumer representatives.

The reciprocal relationship between social identity and adherence to group norms.

Previous research has focused on how social identification influences people's adherence to group norms, but has rarely considered how norm adherence might in turn influence how strongly people identify with the group. We proposed a reciprocal relationship between social identification and norm adherence that is shaped by the salience of the social identity in question. Drawing on data from a longitudinal field study of young people attending a mass gathering (N = 661, 1239 unique observations), we used cross-lagged panel modelling across five timepoints to test the reciprocal relationship between social identification with friends and anticipated adherence to perceived drinking norms among friends before (T0), during (T1-T3), and after (T4) the event. Greater social identification at T1 significantly predicted greater norm adherence at T2 which, in turn, predicted greater social identification at T3. These bidirectional effects were only significant during the mass gathering event, when the referent social identity was salient and thus relevant and meaningful in the social context. Findings indicate a complex interplay between social identity and norm adherence that is context dependent and evolves over time. Not only does social identity promote norm adherence but also adherence to those same norms can reinforce a sense of connection to the group.

The group mechanism in treatment: group identification and cohesion contributes to reducing chronic lower back pain by increasing personal control.

PURPOSE: There is increasing recognition of the contribution that group processes, particularly identification and cohesion, make to outcomes of group delivered health treatments. This study examined the role that these particular group processes play in the treatment of lower back pain, and a theorised mechanism of personal control through which group treatment might enhance outcomes. METHODS: Participants (N = 85) elected to either receive NeuroHAB®, a defined functional movement therapy of 8 weeks duration, or continue with treatment-as-usual (TAU). Pain intensity and disability were assessed at baseline (T1) and post-intervention or 8 weeks later (T2), as well as at a 1-month follow-up (T3). Only the NeuroHAB® participants additionally completed weekly questionnaires that measured treatment group identification, cohesion, and personal control. RESULTS: NeuroHAB® was significantly more effective than TAU in reducing pain intensity and disability at T2 and T3. Furthermore, among NeuroHAB® recipients, stronger treatment group identification and cohesion early in the program predicted better pain outcomes over time, and this relationship was fully mediated by perceptions of personal control. CONCLUSION: These data provide further support for the role of group identification and cohesion as a contributing mechanism of change in group-based treatments and extend this to the domain of pain management.Implications for RehabilitationA focus on defined functional movement therapy, as offered by the NeuroHAB® group program, was found to improve pain outcomes in patients with lower back pain.A key ingredient in the NeuroHAB® rehabilitation program was its group delivery.Group delivery supported treatment group identification and cohesion which, through enhancing the perception of personal control, reduced pain intensity and disability.

Disciplinary differences in the study of the relationship between social variables and mental health: A systematic mapping review.

There has been sustained interest in the intersection between social constructs and mental health from diverse disciplines including psychiatry, sociology and public health. However, no systematic attempt has been made to catalogue what is meant by 'social' by different researchers, how variables deemed 'social' constructs are linked to mental health, nor whether these patterns differ by academic discipline. Understanding interdisciplinary differences and commonalities may reveal opportunities for interdisciplinary collaboration to enhance our understanding of how social factors relate to mental health. This article presents a prospectively registered systematic map of social approaches to mental health using an innovative synthesis methodology (coding all sentences from a random selection of N = 287 articles). Results indicated that although approaches are diverse, disciplinary overlap is substantial. Psychology and psychiatry led articles tend to focus on social skills or emotions as features of mental (ill-)health, while public health and social sciences led articles tend to focus on social relationships, status or context as determinants of mental (ill-)health. Medicine led articles were most likely to focus on social outcomes of mental (ill-)health. Potential growth areas are noted, particularly the relative dearth of intervention research drawing upon social approaches. The findings are discussed with a view towards enabling more effective interdisciplinary collaboration.

Measuring "we-ness" in couple relationships: A social identity approach.

Research on couple relationships has increasingly focused on the concept of "we-ness", the subjective closeness of the couple bond, as crucial to predicting relationship outcomes including satisfaction and dissolution. However, diverging perspectives on the definition, terminology, and measurement of this concept persist. We drew upon social identity theorizing to clarify the nature of we-ness and investigate its predictive utility. Participants were 375 members of the general community in long-term intimate relationships. The sample were aged 18-74 (M = 37.22; SD = 12.00) and 69% were women. Participants completed seven measures of we-ness drawn from both the couple literature and the social identity literature. We used exploratory factor analyses to establish the latent structure of we-ness, and regression analyses to examine the utility of each we-ness factor in predicting relationship satisfaction and likelihood of dissolution. A four-factor solution was extracted and the factors were labeled couple identity, partner liking, relationship orientation, and partner similarity. Each of the four factors explained unique variance in relationship quality, with couple identity being most strongly associated with positive outcomes. We conclude that couple research can fruitfully draw upon social identity theorizing in conceptualizing we-ness. This has implications both for more effectively measuring key concepts and for more precisely targeting interventions in couple therapy.

How conceptualizing obesity as a disease affects beliefs about weight, and associated weight stigma and clinical decision-making in health care.

OBJECTIVES: This study empirically investigated how conceptualizing obesity as a disease (i.e., pathologizing obesity) affects beliefs about weight, and weight stigma and discrimination among health professionals. DESIGN: An experiment that manipulated the pathologization of obesity was completed by a multi-nation sample of health professionals from Australia, UK, and USA (N = 365). METHODS: Participants were randomly assigned to one of two conditions where they were asked to conceptualize obesity as a disease or not a disease; then presented with a hypothetical medical profile of a patient with obesity who was seeking care for migraines. We measured biogenetic causal beliefs about obesity, endorsement of weight as a heuristic for health, negative obesity stereotypes, and treatment decisions. RESULTS: Participants in the disease (vs. non-disease) condition endorsed biogenetic causal beliefs more strongly and made more migraine-related treatment recommendations. No effect of the manipulation was found for the remaining outcomes. Biogenetic causal beliefs about obesity were associated with less weight stigma. Endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment recommendations focused more on the patient's weight and less on their migraines. CONCLUSIONS: Pathologizing obesity may reinforce biogenetic explanations for obesity. Evidence demonstrates complex associations between weight-related beliefs and weight stigma and discrimination. Biogenetic causal beliefs were associated with less weight stigma, while endorsing weight as a heuristic for health was associated with greater weight stigma and differential treatment. Further research is needed to inform policies that can promote health without perpetuating weight-based rejection in health care.

Aspirational leaders help us change: Ingroup prototypicality enables effective group psychotherapy leadership.

OBJECTIVES: Research suggests that leaders are effective when they are ingroup prototypical (represent the identity of the group they seek to lead). However, it is unclear whether leaders should represent the group's current identity ("who we are") or aspired identity ("who we want to be"). This study investigated which of these forms of prototypicality best predicted leadership effectiveness in group psychotherapy. DESIGN: Longitudinal study. METHODS: 519 questionnaire responses were obtained from 112 women attending a four-session body acceptance program. Focal measures included participant ratings of how often they thought their psychotherapy leaders and fellow group members would (a) engage in dieting thoughts and behaviours and (b) approve of dieting. Given the program's body acceptance focus, leader prototypicality was conceptualized as the difference between participants' perceptions of how often their leaders, versus group members, would diet at the start of therapy. Leadership effectiveness was conceptualized as reductions in perceived group approval of dieting across therapy. Two therapeutic outcomes were considered: body satisfaction and dieting intentions. RESULTS: A mixed-effects repeated measures analysis indicated that group approval of dieting decreased more rapidly when participants perceived their leaders to be aspirational (thought that group leaders dieted less frequently than group members) than when they perceived them to be exemplary (thought that group leaders dieted as frequently as group members). Changes in group approval of dieting mediated the relationship between leader prototypicality and improved therapeutic outcomes. CONCLUSIONS: Findings suggest that group psychotherapy leaders may increase their effectiveness by striving to embody their group's aspired identity.

Misery loves company: Predictors of treatment response to a loneliness intervention.

OBJECTIVE: The last 10 years have seen a surge of interest in loneliness and interventions to reduce it. However, there is little evidence regarding differential treatment effectiveness and predictors of treatment outcome. This paper aimed to investigate possible predictors of treatment response. METHODS: We analysed data from two clinical trials of an evidence-based loneliness intervention: Groups 4 Health (G4H). Study 1 had 163 observations across two timepoints, n = 94; Study 2 had 297 observations across four timepoints; n = 84. Theorised predictors-symptom severity at baseline, program engagement, and demographic characteristics-were assessed for their effect on the primary outcome: loneliness. RESULTS: Across both trials, participants with more severe baseline loneliness or social anxiety, or who attended more sessions, experienced greater improvement in loneliness. In Study 2, those with diagnosed mental illness or more severe baseline depression also tended to have better outcomes. There was no evidence that age, gender, or ethnicity predicted program efficacy. CONCLUSION: Overall, those with greater need-reflected in either severity of loneliness or psychological distress-tended to show greater improvement over time. This was due, in part, to greater engagement with the program among those who were lonelier. We discuss how loneliness interventions can be deployed most effectively to combat this profound public health challenge.