Hostname: page-component-745bb68f8f-cphqk Total loading time: 0 Render date: 2025-01-13T02:06:31.264Z Has data issue: false hasContentIssue false
  • English
  • Français

High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor

Published online by Cambridge University Press:  18 December 2018

Ellen E. Lee ,
Colin Depp ,
Barton W. Palmer ,
Danielle Glorioso ,
Rebecca Daly ,
Jinyuan Liu ,
Xin M. Tu ,
Ho-Cheol Kim ,
Peri Tarr  and
Yasunori Yamada
...Show all authors
Ellen E. Lee
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA
Colin Depp
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
Barton W. Palmer
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
Danielle Glorioso
Affiliation:
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA
Rebecca Daly
Affiliation:
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA
Jinyuan Liu
Affiliation:
Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
Xin M. Tu
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
Ho-Cheol Kim
Affiliation:
IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA Accessibility Research, IBM Research Division, San Jose, CA, USA
Peri Tarr
Affiliation:
Accessibility Research, IBM Research Division, Yorktown Heights, NY, USA
Yasunori Yamada
Affiliation:
Accessibility and Aging, IBM Research Division, Tokyo, Japan
Dilip V. Jeste*
Affiliation:
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA Sam and Rose Stein Institute for Research on Aging, University of California San Diego, La Jolla, CA, USA IBM-UCSD Artificial Intelligence for Healthy Living Center, La Jolla, CA, USA Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
*
Correspondence should be addressed to: Dilip V. Jeste, Senior Associate Dean for Healthy Aging and Senior Care, Distinguished Professor of Psychiatry and Neurosciences, Estelle and Edgar Levi Chair in Aging, Director, Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, Co-Director of IBM-UCSD Artificial Intelligence for Healthy Living Center, 9500 Gilman Drive #0664, La Jolla, CA 92023-0664, USA. Phone: (858) 534-4020. Fax: (858) 534-5475. Email: djeste@ucsd.edu
Get access

Abstract

Objectives:

This study of loneliness across adult lifespan examined its associations with sociodemographics, mental health (positive and negative psychological states and traits), subjective cognitive complaints, and physical functioning.

Design:

Analysis of cross-sectional data

Participants:

340 community-dwelling adults in San Diego, California, mean age 62 (SD = 18) years, range 27–101 years, who participated in three community-based studies.

Measurements:

Loneliness measures included UCLA Loneliness Scale Version 3 (UCLA-3), 4-item Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Scale, and a single-item measure from the Center for Epidemiologic Studies Depression (CESD) scale. Other measures included the San Diego Wisdom Scale (SD-WISE) and Medical Outcomes Survey- Short form 36.

Results:

Seventy-six percent of subjects had moderate-high levels of loneliness on UCLA-3, using standardized cut-points. Loneliness was correlated with worse mental health and inversely with positive psychological states/traits. Even moderate severity of loneliness was associated with worse mental and physical functioning. Loneliness severity and age had a complex relationship, with increased loneliness in the late-20s, mid-50s, and late-80s. There were no sex differences in loneliness prevalence, severity, and age relationships. The best-fit multiple regression model accounted for 45% of the variance in UCLA-3 scores, and three factors emerged with small-medium effect sizes: wisdom, living alone and mental well-being.

Conclusions:

The alarmingly high prevalence of loneliness and its association with worse health-related measures underscore major challenges for society. The non-linear age-loneliness severity relationship deserves further study. The strong negative association of wisdom with loneliness highlights the potentially critical role of wisdom as a target for psychosocial/behavioral interventions to reduce loneliness. Building a wiser society may help us develop a more connected, less lonely, and happier society.

Keywords

aginggender differencesresiliencedepressionanxiety
Type
Original Research Article
Information
International Psychogeriatrics , Volume 31 , Issue 10: Issue Theme: Dementia and the Society , October 2019 , pp. 1447 - 1462
Copyright
© International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Aanes, M. M., Hetland, J., Pallesen, S. and Mittelmark, M. B. (2011). Does loneliness mediate the stress-sleep quality relation? The Hordaland health study. International Psychogeriatrics, 23, 994–1002. doi: 10.1017/S1041610211000111.CrossRefGoogle ScholarPubMed
Abedellaoui, A., et al. (2018). Phenome-wide investigation of health outcomes associated with genetic predisposition to loneliness. bioRxiv.Google Scholar
Abramson, A. and Silverstein, M. (2006). Images of Aging in America 2004. Washington, D.C.: AARP and the University of Southern California.Google Scholar
Arber, S. and Ginn, J. (1994). Women and aging. Reviews in Clinical Gerontology, 4, 349–358. doi: 10.1017/S0959259800002483.CrossRefGoogle Scholar
Ben-Zur, H. (2012). Loneliness, optimism, and well-being among married, divorced, and widowed individuals. The Journal of Psychology, 146, 23–36. doi: 10.1080/00223980.2010.548414.CrossRefGoogle ScholarPubMed
Beutel, M. E., et al. (2017). Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry, 17, 97. doi: 10.1186/s12888-017-1262-x.CrossRefGoogle ScholarPubMed
Boss, L., Kang, D. H. and Branson, S. (2015). Loneliness and cognitive function in the older adult: a systematic review. International Psychogeriatrics, 27, 541–553. doi: 10.1017/S1041610214002749.CrossRefGoogle ScholarPubMed
Broadbent, D. E., Cooper, P. F., FitzGerald, P. and Parkes, K. R. (1982). The Cognitive Failures Questionnaire (CFQ) and its correlates. British Journal of Clinical Psychology , 21, 1–16.CrossRefGoogle ScholarPubMed
Cacioppo, J. and Patrick, W. (2008). Loneliness: Human Nature and the Need for Social Connection. New York, NY: W.W. Norton & Company, Inc.Google Scholar
Cacioppo, J. T., et al. (2002). Loneliness and health: potential mechanisms. Psychosomatic Medicine, 64, 407–417. doi: 10.1097/00006842-200205000-00005.CrossRefGoogle ScholarPubMed
Chen, T., Xu, M., Tu, J., Wang, H. and Niu, X. (2018). Relationship between Omnibus and Post-hoc tests: an investigation of performance of the F test in ANOVA. Shanghai Archives of Psychiatry, 30, 60–64. doi: 10.11919/j.issn.1002-0829.218014.Google Scholar
Chen, T., et al. (2016). Variable selection for distribution-free models for longitudinal zero-inflated count responses. Statistics in Medicine, 35, 2770–2785. doi: 10.1002/sim.6892.CrossRefGoogle ScholarPubMed
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396. doi: 10.2307/2136404.CrossRefGoogle ScholarPubMed
Cohen-Mansfield, J., Hazan, H., Lerman, Y. and Shalom, V. (2016). Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. International Psychogeriatrics, 28, 557–576. doi: 10.1017/S1041610215001532.CrossRefGoogle ScholarPubMed
Connor, K. M. and Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depress Anxiety, 18, 76–82. doi: 10.1002/da.10113.CrossRefGoogle Scholar
Dahlberg, L., Andersson, L., McKee, K. J. and Lennartsson, C. (2015). Predictors of loneliness among older women and men in Sweden: a national longitudinal study. Aging and Mental Health, 19, 409–417. doi: 10.1080/13607863.2014.944091.CrossRefGoogle ScholarPubMed
De Jong-Gierveld, J. and Kamphuis, F. (1985). The development of a Rasch-type loneliness scale. Applied Psychological Measurement, 9, 289–299. doi: 10.1177/014662168500900307.CrossRefGoogle Scholar
De Jong Gierveld, J. and Van Tilburg, T. (2010). The De Jong Gierveld short scales for emotional and social loneliness: tested on data from 7 countries in the UN generations and gender surveys. European Journal of Ageing, 7, 121–130. doi: 10.1007/s10433-010-0144-6.CrossRefGoogle Scholar
De Jong Gierveld, J., van Tilburg, T. and Dykstra, P. A. (2006). Loneliness and social isolation. In: Vangelisti, A. L. and Perlman, D. (eds.) The Cambridge Handbook of Personal Relationships (pp. 485–499, Chapter xxii, 891 Pages). New York, NY: Cambridge University Press.CrossRefGoogle Scholar
Derogatis, L. R. and Melisaratos, N. (1983). The brief symptom inventory: an introductory report. Psychological Medicine, 13, 595–605. doi: 10.1017/S0033291700048017.CrossRefGoogle Scholar
Diener, E., Emmons, R. A., Larsen, R. J. and Griffin, S. (1985). The satisfaction with life scale. Journal of Personality Assessment, 49, 71–75. doi: 10.1207/s15327752jpa4901_13.CrossRefGoogle ScholarPubMed
Djukanovic, I., Sorjonen, K. and Peterson, U. (2015). Association between depressive symptoms and age, sex, loneliness and treatment among older people in Sweden. Aging and Mental Health, 19, 560–568. doi: 10.1080/13607863.2014.962001.CrossRefGoogle ScholarPubMed
Dykstra, P. A. (2009). Older adult loneliness: myths and realities. European Journal of Ageing, 6, 91–100. doi: 10.1007/s10433-009-0110-3.CrossRefGoogle ScholarPubMed
Dykstra, P. A., van Tilburg, T. G. and de Jong Gierveld, J. (2005). Changes in older adult loneliness: results from a seven-year longitudinal study. Research on Aging, 27, 725–747. doi: 10.1177/0164027505279712.CrossRefGoogle Scholar
Eglit, G. M. L., Palmer, B. W., Martin, A. S., Tu, X. and Jeste, D. V. (2018). Loneliness in schizophrenia: construct clarification, measurement, and clinical relevance. PLoS One, 13, e0194021. doi: 10.1371/journal.pone.0194021.CrossRefGoogle ScholarPubMed
Ernst, J. M. and Cacioppo, J. T. (1999). Lonely hearts: psychological perspectives on loneliness. Applied & Preventive Psychology, 8, 1–22. doi: 10.1016/S0962-1849(99)80008-0.CrossRefGoogle Scholar
Erogul, M., Singer, G., McIntyre, T. and Stefanov, D. G. (2014). Abridged mindfulness intervention to support wellness in first-year medical students. Teaching and Learning in Medicine, 26, 350–356. doi: 10.1080/10401334.2014.945025.CrossRefGoogle ScholarPubMed
Fees, B. S., Martin, P. and Poon, L. W. (1999). A model of loneliness in older adults. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 54, P231–P239. doi: 10.1093/geronb/54B.4.P231.CrossRefGoogle ScholarPubMed
Fokkema, T., De Jong Gierveld, J. and Dykstra, P. A. (2012). Cross-national differences in older adult loneliness. The Journal of Psychology, 146, 201–228. doi: 10.1080/00223980.2011.631612.CrossRefGoogle ScholarPubMed
Fung, A. W. T., Lee, A. T. C., Cheng, S.-T. and Lam, L. C. W. (in press). Loneliness interacts with family relationship in relation to cognitive function in Chinese older adults. International Psychogeriatrics.Google Scholar
Hawkley, L. C. and Cacioppo, J. T. (2004). Stress and the aging immune system. Brain, Behavior, and Immunity, 18, 114–119. doi: 10.1016/j.bbi.2003.09.005.CrossRefGoogle ScholarPubMed
Hawkley, L. C. and Cacioppo, J. T. (2010). Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40, 218–227. doi: 10.1007/s12160-010-9210-8.CrossRefGoogle ScholarPubMed
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10, 227–237. doi: 10.1177/1745691614568352.CrossRefGoogle ScholarPubMed
Houtjes, W., van Meijel, B., van de Ven, P. M., Deeg, D., van Tilburg, T. and Beekman, A. (2014). The impact of an unfavorable depression course on network size and loneliness in older people: a longitudinal study in the community. International Journal of Geriatric Psychiatry, 29, 1010–1017. doi: 10.1002/gps.4091.CrossRefGoogle Scholar
Jakobsson, U. and Hallberg, I. R. (2005). Loneliness, fear, and quality of life among elderly in Sweden: a gender perspective. Aging Clinical and Experimental Research, 17, 494–501. doi: 10.1007/BF03327417.CrossRefGoogle ScholarPubMed
Jeste, D. and Lee, E. E. (2018). Emerging empirical science of wisdom: definition, measurement, neurobiology, longevity, and interventions. Harvard Review of Psychiatry (In Press).Google Scholar
Jeste, D. V., Ardelt, M., Blazer, D., Kraemer, H. C., Vaillant, G. and Meeks, T. W. (2010). Expert consensus on characteristics of wisdom: a Delphi method study. Gerontologist, 50, 668–680. doi: 10.1093/geront/gnq022.CrossRefGoogle ScholarPubMed
Jeste, D. V. and Vahia, I. V. (2008). Comparison of the conceptualization of wisdom in ancient Indian literature with modern views: focus on the Bhagavad Gita. Psychiatry, 71, 197–209. doi: 10.1521/psyc.2008.71.3.197.CrossRefGoogle ScholarPubMed
Jeste, D. V., et al. (2013). Association between older age and more successful aging: critical role of resilience and depression. American Journal of Psychiatry, 170, 188–196. doi: 10.1176/appi.ajp.2012.12030386.CrossRefGoogle ScholarPubMed
Joseph, J., et al. (2015). Associations of high sensitivity C-reactive protein levels in schizophrenia and comparison groups. Schizophrenia Research, 168, 456–460. doi: 10.1016/j.schres.2015.08.019.CrossRefGoogle ScholarPubMed
Jylha, M. (2004). Old age and loneliness: cross-sectional and longitudinal analyses in the Tampere longitudinal study on aging. Canadian Journal on Aging, 23, 157–168. doi: 10.1353/cja.2004.0023.CrossRefGoogle ScholarPubMed
Kharicha, K., Manthorpe, J., Iliffe, S., Davies, N. and Walters, K. (2018). Strategies employed by older people to manage loneliness: systematic review of qualitative studies and model development. International Psychogeriatrics, 1–15. doi: 10.1017/s1041610218000339.Google ScholarPubMed
Kong, X., et al. (2015). Neuroticism and extraversion mediate the association between loneliness and the dorsolateral prefrontal cortex. Experimental Brain Research, 233, 157–164. doi: 10.1007/s00221-014-4097-4.CrossRefGoogle ScholarPubMed
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. doi: 10.1046/j.1525-1497.2001.016009606.x.CrossRefGoogle ScholarPubMed
Lee, E. E., Hong, S., Martin, A. S., Eyler, L. T. and Jeste, D. V. (2016b). Inflammation in schizophrenia: cytokine levels and their relationships to demographic and clinical variables. The American Journal of Geriatric Psychiatry, 25, 50–61. doi: 10.1016/j.jagp.2016.09.009.CrossRefGoogle ScholarPubMed
Lee, E. E., Martin, A. S., Tu, X., Palmer, B. W. and Jeste, D. V. (2018). Childhood adversity and schizophrenia: the protective role of resilience in mental and physical health and metabolic markers. The Journal of Clinical Psychiatry, 79, 17m11776. doi: 10.4088/jcp.17m11776.CrossRefGoogle ScholarPubMed
Lee, E. E., et al. (2016a). Elevated plasma F2-isoprostane levels in schizophrenia. Schizophrenia Research, 176, 320–326. doi: 10.1016/j.schres.2016.06.011.CrossRefGoogle Scholar
Luhmann, M. and Hawkley, L. C. (2016). Age differences in loneliness from late adolescence to oldest old age. Developmental Psychology, 52, 943–959. doi: 10.1037/dev0000117.CrossRefGoogle ScholarPubMed
McGregor, J. (2017). This former surgeon general says there’s a ‘loneliness epidemic’ and work is partly to blame. Washington Post.Google Scholar
Meeks, T. W. and Jeste, D. V. (2009). Neurobiology of wisdom: a literature overview. Archives of General Psychiatry, 66, 355–365. doi: 10.1001/archgenpsychiatry.2009.8.CrossRefGoogle ScholarPubMed
Musich, S., Wang, S. S., Hawkins, K. and Yeh, C. S. (2015). The impact of loneliness on quality of life and patient satisfaction among older, sicker adults. Gerontology and Geriatric Medicine, 1, 233372141558211. doi: 10.1177/2333721415582119.CrossRefGoogle ScholarPubMed
Myers, L. and Palmarini, N. (2017). Loneliness: findings from IBM’s Institute for business value 2017 study on loneliness in the aging population. Public Policy & Aging Report, 27, 158–159. doi: 10.1093/ppar/prx022.CrossRefGoogle Scholar
Nicolaisen, M. and Thorsen, K. (2014a). Loneliness among men and women–a five-year follow-up study. Aging and Mental Health, 18, 194–206. doi: 10.1080/13607863.2013.821457.CrossRefGoogle ScholarPubMed
Nicolaisen, M. and Thorsen, K. (2014b). Who are lonely? Loneliness in different age groups (18-81 years old), using two measures of loneliness. The International Journal of Aging and Human Development, 78, 229–257. doi: 10.2190/AG.78.3.b.CrossRefGoogle Scholar
Palmer, B. W. (in press). The effects of loneliness and social isolation on cognitive functioning in older adults: a need for nuanced assessments. International Psychogeriatrics.Google Scholar
Penninx, B. W., van Tilburg, T., Kriegsman, D. M., Deeg, D. J., Boeke, A. J. and van Eijk, J. T. (1997). Effects of social support and personal coping resources on mortality in older age: the longitudinal aging study Amsterdam. American Journal of Epidemiology, 146, 510–519. doi: 10.1093/oxfordjournals.aje.a009305.CrossRefGoogle ScholarPubMed
Perlman, D. and Peplau, L. A. (1984). Loneliness reserach: a survey of empirical findings. In: Peplau, L. A. and Goldston, S. E. (eds.), Preventing the harmful consequences of severe and persistent loneliness. Washington, D.C.: US Government Printing Office.Google Scholar
Pinquart, M. and Sorensen, S. (2001). Gender differences in self-concept and psychological well-being in old age: a meta-analysis. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 56, P195–P213. doi: 10.1093/geronb/56.4.P195.CrossRefGoogle ScholarPubMed
Radloff, L. (1977). The CES-D scale: a self report depression scale for research in the general population. Applied Psychological Measurements, 1, 385–401. doi: 10.1177/014662167700100306.CrossRefGoogle Scholar
Rast, P., Zimprich, D., Van Boxtel, M. and Jolles, J. (2009). Factor structure and measurement invariance of the cognitive failures questionnaire across the adult life span. Assessment, 16, 145–158.CrossRefGoogle ScholarPubMed
Rokach, A. (2000). Loneliness and the life cycle. Psychological Reports, 86, 629–642. doi: 10.2466/pr0.2000.86.2.629.CrossRefGoogle ScholarPubMed
Russell, D. W. (1996). UCLA loneliness scale (Version 3): reliability, validity, and factor structure. Journal of Personality Assessment, 66, 20–40. doi: 10.1207/s15327752jpa6601_2.CrossRefGoogle ScholarPubMed
Samuelsson, G., Andersson, L. and Hagberg, B. (1998). Loneliness in relation to social, psychological and medical variables over a 13-year period: a study of the elderly in a Swedish rural district. Journal of Mental Health and Aging, 4, 361–378.Google Scholar
Scheier, M. F., Carver, C. S. and Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): a reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078. doi: 10.1037/0022-3514.67.6.1063.CrossRefGoogle ScholarPubMed
Sheehan, D. V., et al. (1998). The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59, 22–33; quiz 34–57.Google ScholarPubMed
Simon, M. A., Chang, E. S., Zhang, M., Ruan, J. and Dong, X. (2014). The prevalence of loneliness among U.S. Chinese older adults. Journal of Aging and Health, 26, 1172–1188. doi: 10.1177/0898264314533722.CrossRefGoogle ScholarPubMed
Springer, M. B., et al. (2003). Spirituality, depression, and loneliness among Jewish seniors residing in New York City. Journal of Pastoral Care & Counseling, 57, 305–318. doi: 10.1177/154230500305700306.CrossRefGoogle ScholarPubMed
Tabue Teguo, M., et al. (2016). Feelings of loneliness and living alone as predictors of mortality in the elderly: the PAQUID study. Psychosomatic Medicine, 78, 904–909. doi: 10.1097/PSY.0000000000000386.CrossRefGoogle ScholarPubMed
Theeke, L. A. (2009). Predictors of loneliness in U.S. adults over age sixty-five. Archives of Psychiatric Nursing, 23, 387–396. doi: 10.1016/j.apnu.2008.11.002.CrossRefGoogle ScholarPubMed
Theeke, L. A. and Mallow, J. (2013). Loneliness and quality of life in chronically ill rural older adults. American Journal of Nursing, 113, 28–37; quiz 38. doi: 10.1097/01.NAJ.0000434169.53750.14.CrossRefGoogle ScholarPubMed
Thomas, M. L., et al. (2016). Paradoxical trend for improvement in mental health with aging: a community-based study of 1, 546 adults aged 21-100 years. The Journal of Clinical Psychiatry, 77, e1019–e1025. doi: 10.4088/JCP.16m10671.CrossRefGoogle ScholarPubMed
Thomas, M. L., et al. (2017). A new scale for assessing wisdom based on common domains and a neurobiological model: the San Diego wisdom scale (SD-WISE). Journal of Psychiatric Research, 108, 40–47.CrossRefGoogle Scholar
Tijhuis, M. A., De Jong-Gierveld, J., Feskens, E. J. and Kromhout, D. (1999). Changes in and factors related to loneliness in older men. The Zutphen elderly study. Age Ageing, 28, 491–495. doi: 10.1093/ageing/28.5.491.CrossRefGoogle ScholarPubMed
Tornas, S., Lovstad, M., Solbakk, A. K., Schanke, A. K. and Stubberud, J. (2016). Goal management training combined with external cuing as a means to improve emotional regulation, psychological functioning, and quality of life in patients with acquired brain injury: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 97, 1841–1852.e3. doi: 10.1016/j.apmr.2016.06.014.CrossRefGoogle ScholarPubMed
Tornstam, L. (1992). Loneliness in marriage. Journal of Social and Personal Relationships, 9, 197–217. doi: 10.1177/0265407592092003.CrossRefGoogle Scholar
van Beljouw, I. M., et al. (2014). “Being all alone makes me sad”: loneliness in older adults with depressive symptoms. International Psychogeriatrics, 1–11. doi: 10.1017/s1041610214000581.Google ScholarPubMed
van Roekel, E., Verhagen, M., Engels, R., Scholte, R. H. J., Cacioppo, S. and Cacioppo, J. T. (2016). Trait and state levels of loneliness in early and late adolescents: examining the differential reactivity hypothesis. Journal of Clinical Child & Adolescent Psychology, 1–12. doi: 10.1080/15374416.2016.1146993.Google ScholarPubMed
Victor, C. R. and Bowling, A. (2012). A longitudinal analysis of loneliness among older people in Great Britain. The Journal of Psychology, 146, 313–331. doi: 10.1080/00223980.2011.609572.CrossRefGoogle ScholarPubMed
Victor, C. R. and Yang, K. (2012). The prevalence of loneliness among adults: a case study of the United Kingdom. The Journal of Psychology, 146, 85–104. doi: 10.1080/00223980.2011.613875.CrossRefGoogle ScholarPubMed
Wang, H., et al. (2017). Inconsistency between univariate and multiple logistic regressions. Shanghai Archives of Psychiatry, 29, 124–128. doi: 10.11919/j.issn.1002-0829.217031.Google ScholarPubMed
Ware, J. E. Jr. and Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30, 473–483. doi: 10.1097/00005650-199206000-00002.CrossRefGoogle ScholarPubMed
Wilson, C. and Moulton, B. (2010). Loneliness among Older Adults: A National Survey of Adults 45+. Washington, D.C.: AARP.Google Scholar
Yan, Z., Yang, X., Wang, L., Zhao, Y. and Yu, L. (2014). Social change and birth cohort increase in loneliness among Chinese older adults: a cross-temporal meta-analysis, 1995-2011. International Psychogeriatrics, 26, 1773–1781. doi: 10.1017/S1041610214000921.CrossRefGoogle ScholarPubMed
Yu, J., Lam, C. L. and Lee, T. M. (2016). Perceived loneliness among older adults with mild cognitive impairment. International Psychogeriatrics, 28, 1681–1685. doi: 10.1017/S1041610216000430.CrossRefGoogle ScholarPubMed
Zebhauser, A., et al. (2014). How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age study. International Journal of Geriatric Psychiatry, 29, 245–252. doi: 10.1002/gps.3998.CrossRefGoogle ScholarPubMed