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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.
Loneliness and social isolation among older adults are emerging public health concerns. Older adults from ethnic minority communities or with immigration backgrounds may be particularly vulnerable when encountering loneliness and social isolation due to the double jeopardy of their old age and minority status. The goal of this study is to conduct a scoping review of published journal articles on ethnic minority/immigrant older adults' loneliness and social isolation experiences to show the extent, range and nature of empirical studies in this area across several high-income countries (i.e. European countries, United States of America (USA), Canada, Australia and New Zealand). This review uses Arksey and O'Malley's five-state framework, a well-established scoping review method. We identify and analyse 76 articles published between 1983 and 2021. This evidence base is largely US-focused (54%) with the vast majority (76%) having a quantitative design. We summarise and map factors of loneliness and social isolation into a multi-dimensional socio-ecological model. By doing so, we show how ethnicity/immigration-specific factors and general factors intersect in multiple dimensions across places and time, shaping ethnic minority/immigrant older adults' heterogeneous experiences of loneliness and social isolation. Several critical gaps that should be at the forefront of future research are highlighted and discussed.
Histories of both emotion and sexuality explore the ways that bodies and embodied practices are shaped by time, culture, and location. This chapter uses the theoretical and methodological insights from the History of Emotions to consider the emotions associated with sexuality and how these have taken cultural form at different moments. It first considers the emotions related to sexual function and desire, noting how different biological models informed what emotions were expected and experienced. It then turns to love as the predominant emotion connected with sexual practices, considering the boundaries of who and what should be incorporated within such feeling. The chapter then turns to an exploration of the emotions, particularly intimacy, of reproductive labour, acknowledging sexual practices, including those are contractual and exploitative, that sometimes sit uneasily within a framework of love. Finally, the chapter highlights some of the emotions produced by the management and policing of sexuality, such as shame and loneliness, recognising that sexuality has been a contested moral domain for many groups. Using diverse examples across time and space, this chapter seeks to denaturalise the emotions of sexuality and to provide a framework upon which further research can build.
Solitude is unique to each person but there are patterns we have observed that we believe shed some light on what kinds of changes we should be aware of and what those mean for well-being in that space during different phases of our lives. Across the lifespan, we tend to seek and tolerate time alone in a nonlinear way throughout our mortal journey from childhood to older adulthood. How we spend that time seems to matter quite a bit in terms of our contentment in solitude, as do the nature of our relationships beyond solitude. Solitude is like a garden in different seasons, what we sow and what we reap changes over time, and we have to be certain to plant what’s most likely to grow and thrive.
What is a stress-related illness? And how does resilience protect us? Most of us are quite resilient against many of life’s stressors for most of our lifespans. So how does something as psychological as loneliness shorten our lives? And how does depression double the risk for death by heart disease? Some of the answers are found in the secrets to healthy aging. Just ask the centenarians.
A theme that comes up time and again in our research is the importance of balance. Being with people 24/7/365 doesn’t benefit anyone, not the person doing it nor the people they’re hanging out with. If we’re constantly marinating in others’ thoughts and opinions, we can lose track of our own. By the same token, being on our own day-in-and-day-out isn’t good either. The trick is to have equilibrium between the two, the right amount of social time to fulfill an evolutionary imperative and the ideal amount of solitude to reap its reward. Ultimately, the needs for both belonging and separation are not opposing drives so, how can we achieve psychological integration? This chapter elaborates on how to do that and on the true cause of loneliness.
Little in mainstream society indicates that when we choose it, solitude can be wonderful, even transformative. Instead, the focus on loneliness in modern life can make us think that solitude is a disease requiring treatment, and maybe cured by avoiding solo moments altogether. Until recently, science has supported those assumptions because decades of prevailing research have focused on humans as “social animals” and the fact that fulfilling relationships are integral to well-being. By comparison, scientists have spent very little time and resources on understanding the role of solitude, and the power of positive solitude in particular, in shaping our lives. That’s why we three researchers with very different backgrounds formed our Solitude Lab and have spent several years researching what time alone means to different people around the world. In Solitude, we share those insights from thousands of people from all walks of life who helped us to redefine and reframe time alone as a chosen place, a zone of truth, sincerity, independence, and intimacy where we can best connect with our values, interests, and emotions.
We aimed to explore the reciprocal effects of social participation, loneliness, and physical inactivity over a period of 6 years in a representative sample of European adults over 50 years old.
Design:
A longitudinal study with a six-year follow-up period was conducted.
Setting:
Four waves of the Survey of Health, Ageing and Retirement in Europe project were used.
Participants:
This study includes 64,887 participants from Europe and Israel, who were aged 50 or older at the first time.
Measurements:
The relationship between participation in social activities, loneliness and physical inactivity was analyzed, controlling for age, gender, and disability. A series of cross-lagged panel models (CLPMs) were applied to analyze the relationships among these variables.
Results:
A CLPM with equal autoregressive cross-lagged effects across waves was the best fit to the data (χ2 = 7137.8, CFI = .972, RMSEA = .049, SRMR = .036). The autoregressive effects for the three variables showed high stability across waves, and all the cross-lagged effects in the model were statistically significant. Social activity and physical inactivity maintained a strong negative cross-lagged effect, while their cross-lagged effects on loneliness were comparatively smaller. Social activity had a positive cross-lagged effect on loneliness, while physical inactivity had a negative cross-lagged effect on loneliness.
Conclusions:
These findings highlight the importance of promoting physical activity and social participation and addressing loneliness through targeted interventions in older adults.
The aim of this systematic review and meta-analysis is to assess the prevalence of loneliness in many countries worldwide which have different ways of assessing it.
Design:
Systematic review and meta-analysis.
Setting:
We searched seven electronic databases for English peer-reviewed studies published between 1992 and 2021.
Participants:
We selected English-language peer-reviewed articles, with data from non-clinical populations of community-dwelling older adults (>60 years), and with “loneliness” or “lonely” in the title.
Measurements:
A multilevel random-effects meta-analysis was used to estimate the prevalence of loneliness across studies and to pool prevalence rates for different measurement instruments, data collection methods, and countries.
Results:
Our initial search identified 2,021 studies of which 45 (k = 101 prevalence rates) were included in the final meta-analysis. The estimated pooled prevalence rate was 31.6% (n = 168,473). Measurement instrument was a statistically significant moderator of the overall prevalence of loneliness. Loneliness prevalence was lowest for single-item questions and highest for the 20-item University of California-Los Angeles Loneliness Scale. Also, differences between modes of data collection were significant: the loneliness prevalence was significantly the highest for face-to-face data collection and the lowest for telephone and CATI data collection. Our moderator analysis to look at the country effect indicated that four of the six dimensions of Hofstede also caused a significant increase (Power Distance Index, Uncertainty Avoidance Index, Indulgence) or decrease (Individualism) in loneliness prevalence.
Conclusions:
This study suggests that there is high variability in loneliness prevalence rates among community-dwelling older adults, influenced by measurement instrument used, mode of data collection, and country.
A large and accumulating body of evidence shows that loneliness is detrimental for various health and well-being outcomes. However, less is known about potentially modifiable factors that lead to decreased loneliness.
Methods
We used data from the Health and Retirement Study to prospectively evaluate a wide array of candidate predictors of subsequent loneliness. Importantly, we examined if changes in 69 physical-, behavioral-, and psychosocial-health factors (from t0;2006/2008 to t1;2010/2012) were associated with subsequent loneliness 4 years later (t2;2014/2016).
Results
Adjusting for a large range of covariates, changes in certain health behaviors (e.g. increased physical activity), physical health factors (e.g. fewer functioning limitations), psychological factors (e.g. increased purpose in life, decreased depression), and social factors (e.g. greater number of close friends) were associated with less subsequent loneliness.
Conclusions
Our findings suggest that subjective ratings of physical and psychological health and perceived social environment (e.g. chronic pain, self-rated health, purpose in life, anxiety, neighborhood cohesion) are more strongly associated with subsequent loneliness. Yet, objective ratings (e.g. specific chronic health conditions, living status) show less evidence of associations with subsequent loneliness. The current study identified potentially modifiable predictors of subsequent loneliness that may be important targets for interventions aimed at reducing loneliness.
The COVID-19 pandemic in Australia has profoundly affected older adults, particularly in the state of Victoria, which experienced strict lockdown restrictions six times since the pandemic began in 2020; totalling 245 days over three years. This study explored the experiences of older adults living in retirement villages during the first three lockdowns in Victoria from March 2020 to February 2021. We draw on the concept of the ‘third age’ to explore how residents’ post-retirement social and lifestyle aspirations were disrupted by the pandemic and associated lockdowns. In-depth qualitative interviews were conducted with 14 residents during January and February 2021. All data were analysed using thematic mapping. Five key themes were identified: (1) benefits and frustrations of retirement village living during a pandemic; (2) the loss of amenities and activities; (3) heightened loneliness and social isolation; (4) reaching out to others; and (5) variable experiences of operators’ response. Although the COVID-19 pandemic has highlighted short-term and long-term issues around social isolation and the management of retirement villages, it has also demonstrated the resilience of residents and the strength of community ties and relationships. Retirement villages are promoted as age-friendly environments that enable an active and healthy post-retirement lifestyle. Yet our findings reveal heterogeneity within village populations. When services closed during lockdowns, this revealed a tension between the policy assumption that retirement villages are a housing consumption choice, and the unmet needs of those residents who depend on village services for day-to-day functioning.
Following the onset of the COVID-19 pandemic, healthcare trusts began to implement remote working arrangements, with little knowledge of their impact on staff well-being.
Aims
To investigate how remote working of healthcare workers during the pandemic may have been associated with stress, productivity and work satisfaction at that time, and associations between loneliness, workplace isolation, perceived social support and well-being.
Method
A questionnaire was developed to explore remote working and productivity, stress and work satisfaction during time spent working remotely. Associations between current loneliness, workplace isolation and well-being, and the influence of perceived social support, were explored with perceived social support as a potential moderator.
Results
A total of 520 participants responded to the study, of whom 112 were men (21.5%) and 406 were women (78.1%), with an age range of 21–77 years (mean 40.0, s.d. = 12.1). Very few (3.1%) worked remotely before the COVID-19 pandemic, and this had increased significantly (96.9%). Those who worked ≥31 h a week remotely reported higher stress and lower workplace satisfaction at that time, compared with office work, yet also felt more productive. Current loneliness, workplace isolation and perceived social support were cross-sectionally associated with lower current well-being.
Conclusions
Those who worked more hours a week remotely during the pandemic reported increased stress, which may be related to the lack of resources in place to support this change in work.
A rise in loneliness among older adults since the COVID-19 outbreak, even after vaccination, has been highlighted. Loneliness has deleterious consequences, with specific effects on perceptions of the ageing process during the COVID-19 pandemic. Coping with stressful life events and the challenges of ageing may result in a perception of acceleration of this process.
Aim
Studies have shown a buffering effect of an internal locus of control in the relationship between COVID-19 stress and mental distress. The current study examined whether loneliness predicts subjective accelerated ageing and whether internal locus of control moderates this relationship.
Method
Two waves of community-dwelling older adults (M = 70.44, s.d. = 5.95; age range 61–88 years), vaccinated three times, were sampled by a web-survey company. Participants completed the questionnaire after the beginning of the third vaccination campaign and reported again 4 months later on loneliness, internal locus of control and subjective accelerated ageing level in the second wave.
Results
Participants with higher levels of loneliness presented 4 months later with higher subjective accelerated ageing. Participants with a low level of internal locus of control presented 4 months later with high subjective accelerated ageing, regardless of their loneliness level. Participants with a high level of internal locus of control and a low level of loneliness presented with the lowest subjective accelerated ageing 4 months later.
Conclusions
The findings emphasise the deleterious effects of loneliness and low internal locus of control on older adults’ perception of their ageing process. Practitioners should focus their interventions not only on loneliness but also on improving the sense of internal locus of control to improve subjective accelerated ageing.