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Edited by
Richard Pinder, Imperial College of Science, Technology and Medicine, London,Christopher-James Harvey, Imperial College of Science, Technology and Medicine, London,Ellen Fallows, British Society of Lifestyle Medicine
Healthy relationships are interpersonal connections that are mutually beneficial, supportive, and respectful, with an emphasis on open communication and trust. Social isolation and loneliness can negatively impact the development and quality of healthy relationships and are associated with poor physical and mental health outcomes. Social isolation and loneliness are influenced by various risk factors, such as disability, bereavement, family structure, urbanisation, and technology use, and affect different groups of people differently.
Interventions to enhance healthy relationships can include improving social skills, enhancing social support, increasing opportunities for social contact, addressing maladaptive social cognition, and facilitating community engagement and volunteering. The relationship between clinician and patient is also a key factor for health outcomes, and can be improved by continuity of care, empathy, and trust. Clinicians can apply a Lifestyle Medicine approach to identify and address the impact of relationships on health, and support people to develop and maintain healthy relationships.
Creating conditions that facilitate sociality and friendship is an important way to address loneliness. But it is not sufficient in itself, as shown by philosopher Anca Gheaus in a recent article. After highlighting the need for alternative ways to address chronic loneliness, Gheaus offers a promising approach: “[c]reating favourable conditions for the appreciation of solitude […]” (Gheaus, 2022, p. 242). In this article, I first expand Gheaus’ account by articulating different dimensions of solitude experiences. Second, I show how cultivation of philosophic contemplation could enhance one’s ability to appreciate solitude.
A systematic review and meta-analysis was conducted to investigate the prevalence and antecedents/outcomes of loneliness and social isolation among individuals with severe mental disorders (SMD), such as schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder.
Methods
Five well-known electronic databases (PubMed, PsycINFO, CINAHL, Web of Science and Scopus) were searched (plus a hand search). Observational studies that report the prevalence and, if available, antecedents and consequences of loneliness/isolation among individuals with SMD were included. Key characteristics were extracted, and a meta-analysis was performed. Our systematic review was preregistered on PROSPERO (ID: CRD42024559043). The PRISMA guidelines were followed. The Joanna Briggs Institute (JBI) standardized critical appraisal tool developed for prevalence studies was applied to assess the quality of the included studies.
Results
The initial search yielded 4506 records, and after duplicate removal and screening, a total of 10 studies were finally included. The studies included used data from Europe, Asia, North America, and Oceania. Two studies employed a longitudinal design, while all other studies had a cross-sectional design. Most of the studies included between 100 and 500 individuals with SMD. All studies involved both male and female participants, with women typically comprising about 40% of the sample. The average age of participants often ranged from approximately 30 to 40 years. The estimated prevalence of loneliness was 59.1% (95% CI: 39.6% to 78.6%, I2 = 99.3, P < .001) among individuals with any diagnosis of SMD. Furthermore, the estimated prevalence of objective social isolation was 63.0% (95% CI: 58.6% to 67.4%) among individuals with schizophrenia or schizophrenia spectrum disorder. The quality of the studies was moderate to good. Subjective well-being and depressive symptoms in particular were found to contribute to loneliness in the included studies.
Conclusions
The present systematic review with meta-analysis identified high levels of loneliness and objective social isolation among those with SMD. These findings stress the importance of monitoring and addressing social needs in this vulnerable group, which may have a positive effect on the life quality of individuals with SMD. Future research in neglected regions (e.g. South America and Africa) is recommended. Different diagnoses within severe mental disorders should be distinguished in future studies. Furthermore, additional longitudinal studies are required to explore the antecedents and consequences of loneliness and social isolation among individuals with SMD.
Relationship-centred mealtimes can support care home residents, who are at high risk for loneliness. However, care home staff do not consistently promote relationship-centred mealtimes. This secondary analysis examined the impact of factors (selected based on the Theory of Planned Behaviour) upon care home staff interest in making mealtimes more relationship-centred. Data were from a cross-sectional, quantitative survey of 670 care home staff from North America. We used multivariable logistic regression to test hypotheses. The model was statistically significant, and explained 13 per cent of the variance in staff members’ interest in making mealtimes more relationship-centred. Respondents who were more satisfied with current mealtime practices, had used collaborative change strategies in the past, and who perceived organizational support for relationship-centred care were more likely to have interest in making mealtimes more relationship-centred. These are modifiable factors to target in interventions designed to promote care home staff interest in making mealtimes more relationship-centred.
Loneliness can be found in many life experiences, such as loss, rejection, illness, failure, as well as in success, creativity, or meditation. This chapter is unique because it includes loneliness as part of the social and emotional intelligences. The author helps readers shift their perception of loneliness from something to be avoided or defended against to a necessary exploration of their solitude in the universe. Solitude is argued as a necessary experience for developing social and emotional intelligences. This chapter explores the benefits of solitude for wellbeing and growth across the lifespan.
Essentials of the Social and Emotional Intelligences explores the foundations of social and emotional intelligences from a multicultural humanistic psychology perspective. Delving into the spectrum of abilities associated with holistic emotional processes, this book unravels the intricacies of developing self-awareness, regulating emotional states, fostering social awareness and empathy, exercising freedom of choice, and building diverse relationships. Offering a unique theoretical synthesis of humanistic psychology and multicultural education, the text provides diverse perspectives on complex phenomena within social and emotional intelligences, including empathy, spirituality, loneliness, self-awareness, and cultural humility. Through a fusion of empirical research studies and multicultural insights, this book equips readers with the knowledge to cultivate these essential skills within themselves and foster meaningful connections with others. This concise guide is ideal for students, professionals, educators and laypersons hoping to build their fundamental knowledge in utilizing social and emotional intelligences.
Loneliness may lead individuals to spend more time on the internet and increase the likelihood of experiencing internet-use disorders. Similarly, individuals with internet-use disorders may feel lonelier. In the present systematic review and meta-analysis, pre-registered in PROSPERO (CRD42023390483), we quantified associations between internet-use-disorder symptoms (e.g. internet gaming disorder and online gambling disorder) and loneliness. We searched PubMed, Web of Science, and an institutional database aggregator for references that compared degrees of loneliness in groups of individuals with and without symptoms of internet-use disorder. Means and standard deviations of loneliness, or alternatively, odds ratios, were transformed into Cohen’s d for statistical pooling through a random-effects model. After screening 2,369 reports, we extracted data from 23 studies. The total number of individuals across the studies was 36,484. Participants were between 13 and 30 years of age (median 20). The pooled difference between those with and without internet-use-disorder symptoms yielded a standardized effect (Cohen’s d) of 0.53 (95% CI 0.35–0.7). While heterogeneity was high, there was no indication of publication or small sample biases. Similar effect sizes were found when limiting to specific types of internet-use disorder symptoms. Moreover, meta-regressions did not show an effect of age, sex, or sample size. Individuals with symptoms of internet-use disorders scored 49.35 (43.84–54.85) points on the UCLA-Loneliness scale on average, compared to 43.78 (37.47–50.08) in individuals without symptoms of internet-use disorders (Standardized Mean Difference: 5.18, 95% CI = 2.05–8.34). Individuals with internet-use-disorder symptoms experience greater loneliness. The effect appears moderately sized.
Comprehending resilience in the face of mental health issues is important, especially for young people who deal with a variety of psychological pressures. This study aims to investigate the co-occurrence of several mental health conditions and the role of resilience as a potential intervention in youth 14–25 years in the Nairobi metropolitan area. We recruited 1,972 youths. The following self-administered instruments were used: resilience (ARM-R), hopelessness (BHS), depression (BDI, PHQ-9), PTSD (HTQ), loneliness (UCLA Loneliness Scale) and suicidality (C-SSRS). Descriptive statistics, Pearson correlation and hierarchical multiple regression analyses were conducted on the data. The key findings are that depression and hopelessness showed a strong negative association with resilience. PTSD and recent suicidal ideation and behavior showed less negative association with resilience. Building resilience is an important intervention for the conditions reported in our study among the youth. This study contributes novel insights into the intersection of multiple psychological stressors and resilience, paving the way for more targeted, integrative mental health interventions.
A systematic review/meta-analysis synthesising the existing evidence regarding the prevalence of loneliness and social isolation among individuals with mild cognitive impairment (MCI) or dementia is lacking.
Aims
A systematic review and meta-analysis was conducted to investigate the prevalence and factors associated with loneliness and social isolation among individuals with MCI or dementia.
Method
A search was conducted in five established electronic databases. Observational studies reporting prevalence and, where available, factors associated with loneliness/isolation among individuals with MCI and individuals with dementia, were included. Important characteristics of the studies were extracted.
Results
Out of 7427 records, ten studies were included. The estimated prevalence of loneliness was 38.6% (95% CI 3.7–73.5%, I2 = 99.6, P < 0.001) among individuals with MCI. Moreover, the estimated prevalence of loneliness was 42.7% (95% CI 33.8–51.5%, I² = 90.4, P < 0.001) among individuals with dementia. The estimated prevalence of social isolation was 64.3% (95% CI 39.1–89.6%, I² = 99.6, P < 0.001) among individuals with cognitive impairment. Study quality was reasonably high. It has been found that living alone and more depressive symptoms are associated with a higher risk of loneliness among individuals with dementia.
Conclusions
Social isolation, and in particular loneliness, are significant challenges for individuals with MCI and dementia. This knowledge can contribute to supporting successful ageing among such individuals. Future research in regions beyond Asia and Europe are clearly required. In addition, challenges such as chronic loneliness and chronic social isolation should be examined among individuals with MCI or dementia.
Loneliness is a risk factor for late-life dementia. There is less consistent evidence of its association with cognitive performance. This study examined the replicability of the association between loneliness and overall and domain-specific cognitive function and informant-rated cognitive decline in cohorts from seven countries: the United States, England, India, China, South Africa, Mexico, and Chile.
Methods
Data were from the Harmonized Cognitive Assessment Protocol administered in seven population-based studies (total N > 20,000). Participants reported their loneliness, completed a battery of cognitive tests, and nominated a knowledgeable informant to rate their cognitive decline. Random-effect meta-analyses were used to summarize the associations from each cohort.
Results
Loneliness was associated with poor overall cognitive performance and informant-rated cognitive decline controlling for sociodemographic factors (meta-analytic correlation for overall cognition = −.10 [95% CI = −.13, −.06] and informant-rated decline = .16 [95% CI = .14, .17]). Despite some heterogeneity, the associations were significant across samples from Africa, Asia, Europe, North, Central, and South America. The meta-analysis also indicated an association with specific cognitive domains: episodic memory, speed-attention, visuospatial abilities, numeric reasoning, and verbal fluency. The associations were attenuated but persisted when depressive symptoms were added as a covariate. Depression, cognitive impairment, and sociodemographic factors did not consistently moderate the associations across samples.
Conclusions
Loneliness is associated with poor performance across multiple domains of cognition and observer-rated cognitive decline, associations that replicated across diverse world regions and cultures.
Loneliness has emerged as a pervasive public health challenge. Understanding loneliness and its associated risk factors is crucial for developing interventions to address this issue effectively. This study aimed to investigate loneliness among adults living in Australia, comparing different age cohorts.
Method:
This study used 10,815, 11,234, 14,670 and 15,049 records with loneliness measurements taken at 2006, 2010, 2014 and 2018, respectively, from the Household, Income and Labour Dynamics in Australia (HILDA) survey. A supervised machine learning algorithm, CatBoost, was employed to predict loneliness. Model predictions were explained using SHapley Additive exPlanations (SHAP) and partial dependence plots across five age-based subgroups to capture life stage variations.
Results:
Mental well-being, having a life partner, social connectedness and social fulfilment were the most important predictors of loneliness at the whole-population level. Among young adults, the level of friendship fulfilment, financial satisfaction and health status were relatively strong predictors of loneliness, while loneliness in older adults was more strongly associated with spare time fulfilment, community satisfaction and the loss of loved ones. Youth who reported that they did not have a lot of friends were predicted to have a 46.5% (95% CI: 45.9%–47.2%) chance of experiencing loneliness. Seniors have a 44.9% (95% CI: 43.9%–45.8%) chance of experiencing loneliness if they were almost always not fulfilled in their spare time.
Implications:
This study underscores the need to recognise the heterogeneity of loneliness across the lifecourse and the importance of both targeted strategies and efforts to improve broader social cohesion.
Loneliness has become a major public health issue of the recent decades due to its severe impact on health and mortality. Little is known about the relation between loneliness and social anxiety. This study aimed (1) to explore levels of loneliness and social anxiety in the general population, and (2) to assess whether and how loneliness affects symptoms of social anxiety and vice versa over a period of five years.
Methods
The study combined data from the baseline assessment and the five-year follow-up of the population-based Gutenberg Health Study. Data of N = 15 010 participants at baseline (Mage = 55.01, s.d.age = 11.10) were analyzed. Multiple regression analyses with loneliness and symptoms of social anxiety at follow-up including sociodemographic, physical illnesses, and mental health indicators at baseline were used to test relevant covariates. Effects of loneliness on symptoms of social anxiety over five years and vice versa were analyzed by autoregressive cross-lagged structural equation models.
Results
At baseline, 1076 participants (7.41%) showed symptoms of social anxiety and 1537 (10.48%) participants reported feelings of loneliness. Controlling for relevant covariates, symptoms of social anxiety had a small significant effect on loneliness five years later (standardized estimate of 0.164, p < 0.001). Vice versa, there was no significant effect of loneliness on symptoms of social anxiety taking relevant covariates into account.
Conclusions
Findings provided evidence that symptoms of social anxiety are predictive for loneliness. Thus, prevention and intervention efforts for loneliness need to address symptoms of social anxiety.
The COVID-19 pandemic posed an unprecedented global challenge, with past evidence suggesting negative psychological effects with the additional concern that social and physical restrictions might disproportionately affect adolescents.
Aims
To explore mental health and its wider determinants in young people in the UK during 1 year of the COVID-19 pandemic (August 2020–August 2021).
Method
A representative sample of 11 898 participants (48.7% female) aged between 13 and 19 years (mean = 16.1) participated in five waves of data collection. Using validated self-reported questionnaires for loneliness, anxiety and depression, this survey measured the extent and nature of the mental health impacts of the coronavirus pandemic and help-seeking behaviours, and changes over time.
Results
Young people experienced higher levels of anxiety during the summer and fall 2020, followed by higher levels of depression during the winter 2020–2021, with loneliness gradually increasing then peaking during the spring and summer of 2021. Young people who were older, female, with pre-existing mental-health issues and experiencing financial difficulties were at higher risk of anxiety, depression and loneliness. Help-seeking behaviours reduced the risk of depression and loneliness.
Conclusions
The COVID-19 pandemic had substantial impact on young people, whether on their mental health, their social contacts and interactions or their perspective on what the future holds for them. Young people strongly advocated for better teacher training, and a better integration of mental health services, particularly within their schools.
Loneliness and social isolation are prevalent concerns among older adults and can lead to negative health consequences and a reduced lifespan. New technologies are increasingly being developed to help address loneliness and social isolation in older adults, including monitoring systems, social networks, robots, companions, smart televisions, augmented reality (AR) and virtual reality (VR) applications. This systematic review maps human-centered design (HCD) and user-centered design (UCD) approaches, human needs, and contextual factors considered in current technological interventions designed to address the problems of loneliness and social isolation in older adults. We conducted a scoping review and in-depth examination of 98 papers through a qualitative content analysis. We found 12 studies applying either an HCD or UCD approach and observed strengths in continuous user involvement and implementation in field studies but limitations in participant inclusion criteria and methodological reporting. We also observed the consideration of important human needs and contextual factors. However, more research is needed on stakeholder perspectives, the functioning of applications in different housing environments, as well as studies that include diverse socio-economic groups.
This chapter explores the spatial dimensions of the trope of the epic return journey (the nostos) and focuses on the physical and emotive experiences which such a journey produces. Loney first highlights dislocation as an important feature in epic, and a motivating force behind its plot: the feeling of being separated in time or space from a more ideal past or home. Under this single conception of ‘dislocation’, the chapter brings together two poetic themes which scholars have traditionally treated discretely: nostalgia and homesickness. Archaic epics, especially Hesiod’s Works and Days, rely on a narrative of decline—of temporal dislocation—from an antecedent ‘golden age’, for which internal characters and external audiences are nostalgic. Similarly, characters in Homer’s Iliad and Odyssey may be spatially dislocated and homesick, motivating a return journey (prototypically Odysseus, but also at moments Achilles and Helen).
We explored the relationship between neighbourhood and social participation among older adults using a Living Environments and Active Aging Framework. This prospective cohort study used baseline data from the Canadian Longitudinal Study on Aging (CLSA) with a 3-year follow-up. Three aspects of social participation were the outcomes; walkability and greenness at baseline were exposure variables. The sample consisted of 50.0% females (n=16,735, age 72.9± 5.6 years). In males, higher greenness was associated with lower loneliness and less variety in social activities. No significant associations between greenness and social participation were found in females. High walkability was related to a higher variety of social activity and higher loneliness in males but not females, and less desire for more social activity in both sexes. Greenness and walkability impact social participation among older adults. Future research should include sex and gender-based analyses.
To explore the association of cardiovascular-kidney-metabolic (CKM) health with the risk of depression and anxiety and to investigate the joint association of CKM health and social connection with depression and anxiety.
Methods
This prospective cohort study included 344 956 participants from the UK Biobank. CKM syndrome was identified as a medical condition with the presence of metabolic risk factors, cardiovascular disease, and chronic kidney disease, and was classified into five stages (stage 0–4) in this study. Loneliness and social isolation status were determined by self-reported questionnaires. Cox proportional hazards models were applied for analyses.
Results
Compared with participants in stage 0, the HRs for depression were 1.17 (95% CI 1.10–1.25), 1.40 (95% CI 1.33–1.48), and 2.14 (95% CI 1.98–2.31) for participants in stage 1, 2–3, and 4, respectively. Similarly, participants in stage 2–3 (HR = 1.20, 95% CI 1.14–1.26) and stage 4 (HR = 1.63, 95% CI 1.51–1.75) had greater risks of incident anxiety. We found additive interactions between loneliness and CKM health on the risk of depression and anxiety. Participants simultaneously reported being lonely and in stage 4 had the greatest risk of depression (HR = 4.44, 95% CI 3.89–5.07) and anxiety (HR = 2.58, 95% CI 2.21–3.01) compared with those without loneliness and in stage 0. We also observed an additive interaction between social isolation and CKM health on the risk of depression.
Conclusions
Our findings suggest the importance of comprehensive interventions to improve CKM health and social connection to reduce the disease burden of depression and anxiety.
Current guidelines still support the use of an SSRI as first choice for the treatment of depression in older adults. Clinicians should keep in mind the old adage “Start low, go slow, but go” with regard to the prescribing of antidepressants in older patients. With older adults, it is a good idea to start at half or quarter of the normal adult starting dose but to increase the dose to well within the therapeutic range for a given antidepressant. Depression is prevalent in older adults in long-term care with estimated prevalence from 11-45%. Depression is associated with poor overall health outcomes and poor quality of life. Interventions are often effective if these patients are identified but treatment can be challenging and require multiple adjustments in medications or treatment strategies.
Reducing loneliness amongst older people is an international public health and policy priority, with signs of decreasing importance in the UK. A growing body of research on tackling loneliness indicates it is a complex challenge. Most interventions imply they address loneliness, when in fact they offer social connectedness to address social isolation and can inadvertently responsibilise the individual for the causes and solutions for loneliness. This article presents research that explored loneliness in an underprivileged community in South Wales through interviews and focus groups with nineteen older people and eighteen local service providers. Their perspective supports a growing body of evidence that loneliness amongst older people is driven by wider structural and socio-cultural exclusion. Interventions to build social connections will be more effective if coupled with policies that reverse the reduction in public services (including transport and healthcare), and challenge socio-cultural norms, including a culture of self-reliance and ageism.
Despite the growing interest in the prevalence and consequences of loneliness, the way it is measured still raises a number of questions. In particular, few studies have directly compared the psychometric properties of very short measures of loneliness to standard measures.
Methods
We conducted a large epidemiological study of midwife students (n = 1742) and performed a head-to-head comparison of the psychometric properties of the standard (20 items) and short version (3 items) of the UCLA Loneliness Scales (UCLA-LS). All participants completed the UCLA-LS-20, UCLA-LS-3, as well as other measures of mental health, including anxiety and depression.
Results
First, as predicted, we found that the two loneliness scales were strongly associated with each other. Second, when using the dimensional scores of the scales, we showed that the internal reliability, convergent-, discriminant-, and known-groups validities were high and of similar magnitude between the UCLA-LS-20 and the UCLA-LS-3. Third, when the scales were dichotomized, the results were more mixed. The sensitivity and/or specificity of the UCLA-LS-3 against the UCLA-LS-20 were systematically below acceptable thresholds, regardless of the dichotomizing process used. In addition, the prevalence of loneliness was strikingly variable as a function of the cut-offs used.
Conclusions
Overall, we showed that the UCLA-LS-3 provided an adequate dimensional measure of loneliness that is very similar to the UCLA-LS-20. On the other hand, we were able to highlight more marked differences between the scales when their scores were dichotomized, which has important consequences for studies estimating, for example, the prevalence of loneliness.