Baseline Loneliness Research Articles

Associations Between Loneliness, Epigenetic Aging, and Multimorbidity Through Older Adulthood.

Loneliness is a pressing public health concern, but the mechanisms by which it leads to declining physical health are uncertain. Prior work has begun to explore epigenetic pathways, with some evidence suggesting a link between loneliness and DNA methylation, though it is unclear whether epigenetic variation can help explain loneliness-health associations. Associations between loneliness and epigenetic age acceleration (EAA) were estimated, as well as the degree to which EAA mediated and moderated the association between loneliness and the development of chronic physical health conditions (multimorbidity) in older adulthood. The sample consisted of Health and Retirement Study participants who provided blood draws and consented to methylation profiling (n = 4,018). Baseline loneliness was associated with greater EAA in the GrimAge measure net of demographic and behavioral covariates (β = 0.07, p = .003). Loneliness and GrimAge each predicted increasing condition counts, but there was no evidence of an interactive effect. The association between loneliness and increasing condition counts was, however, significantly mediated by GrimAge (indirect path β = 0.020, p = .003). These results suggest that the impact of loneliness on multimorbidity may, in part, operate through DNA methylation. The specific intermediary, physiological mechanisms that are involved will require further research, but EAA measures like GrimAge are promising in helping to understand the health impacts of loneliness.

Supportive-leadership training to improve social connection: A cluster-randomized trial demonstrating efficacy in a high-risk occupational context.

The high, and still rising, rate of loneliness is a threat to public health (Office of the Surgeon General, 2023), with negative mental and physical health consequences (e.g., Holt-Lunstad, 2021). Given that loneliness is a risk factor for poor mental health, efforts to address loneliness are urgently needed. Workplaces can facilitate an employee's social connection through supervisor support training, which can help mitigate loneliness. Among occupational groups, the military is at higher risk for mental health disorders, suicide, and loneliness (Fikretoglu et al., 2022; Naifeh et al., 2019). This study evaluated the efficacy of an evidence-based supportive-leadership training intervention targeting active-duty U.S. Army platoon leaders and targeting both proactive support behaviors that help bolster employee social connection and responsive support behaviors, including destigmatizing mental health. Ninety-nine platoon leaders (69.7% of eligible leaders) completed the 90-min training that consisted of both in-person and computer-based components. Using a cluster-randomized controlled trial design, intervention effects were tested using an intent-to-treat approach and revealed a significant effect, whereby loneliness of service members whose leaders were randomized to the intervention group (N = 118) was significantly reduced compared to loneliness reports for service members in the control group (N = 158). Additionally, service members with higher baseline loneliness were more strongly and positively impacted by the supervisor training, reporting higher levels of supportive behaviors from their leaders at 3 months postbaseline. In sum, these results suggest how workplaces, especially those that are considered high-risk occupations, and their leaders play a critical role in a national strategy to address Americans' well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of an intergenerational program to improve loneliness and social isolation in older adults initiated at the time of emergency department discharge: study protocol for a three-arm randomized clinical trial

BackgroundSocial isolation and loneliness (SIL) worsens mortality and other outcomes among older adults as much as smoking. We previously tested the impact of the HOW R U? intervention using peer support from similar-aged volunteers and demonstrated reduced SIL among older adults discharged from the emergency department (ED). Generativity, defined as “the interest in establishing and guiding the next generation,” can provide an alternative theoretical basis for reducing SIL via intergenerational programs between members of younger and older generations. The current protocol will examine the impact of younger intergenerational volunteers providing the HOW RU? intervention.MethodsIn this randomized clinical trial, we will compare the following three arms: (1) the standard same-generation peer support HOW R U? intervention, (2) HOW R U? intervention delivered by intergenerational volunteers, and (3) a common wait-list control group. Outcome assessors will be blinded to the intervention. Trained volunteers will deliver 12 weekly telephone support calls. We will recruit participants ≥ 70 years of age with baseline loneliness (six-item De Jong loneliness score of 2 or greater) from two EDs. Research staff will assess SIL, depression, quality of life, functional status, generativity, and perceived benefit at baseline, at 12 weeks, and 24 weeks post-intervention.DiscussionWe hypothesize participants receiving the intergenerational intervention will show improved outcomes compared to the control group and peer support HOW R U? intervention. We also hypothesize that participants with higher perceptions of generativity will have greater reductions in SIL than their lower generativity counterparts. Aging is experienced diversely, and social interventions combatting associated SIL should reflect that diversity. As part of a program of research following the Obesity-Related Behavioral Intervention Trials (ORBIT) model, the findings of this RCT will be used to define which intervention characteristics are most effective in reducing SIL.Trial registrationClinicalTrials.gov NCT05998343 Protocol ID:21-0074E. Registered on 24 July 2023.

Chronic loneliness and the risk of incident stroke in middle and late adulthood: a longitudinal cohort study of U.S. older adults

Loneliness has been implicated as a stroke risk factor, yet studies have examined loneliness at only one time point. The association of loneliness changes and risk of incident stroke remains understudied. Our aim was to examine the association of loneliness with incident stroke, particularly the role of loneliness chronicity. This prospective cohort study examined data from the Health and Retirement Study during 2006-2018. For analyses examining baseline loneliness only, we included U.S. adults aged 50 years or older and stroke-free at baseline and excluded individuals missing data on loneliness and those who experienced death at baseline. For analyses examining loneliness changes over two time points, we included those aged 50 years or older at baseline and stroke-free through the exposure measurement period. Individuals missing a loneliness scale measure or those who experienced death during the exposure measurement period were excluded. Loneliness was measured with the 3-item Revised UCLA Loneliness Scale. We constructed loneliness scores (range 3-9), dichotomized loneliness measures (high vs low using a >6 cutoff), and loneliness patterns across two time points (consistently low, remitting, recent onset, consistently high). Cox regression models estimated associations of baseline loneliness (N=12,161) with incident stroke over a 10-12-year period, and loneliness change patterns (N=8936) with incident stroke over a subsequent 6-8-year period, adjusting for demographics, health behaviors and health conditions. Higher loneliness scores at baseline were associated with incident stroke for continuous (hazard ratio [HR]: 1.05, 95% confidence interval [CI]: 1.01-1.08) and dichotomized (HR: 1.25, 95% CI: 1.06-1.47) loneliness measures, and persisted after adjustment for social isolation but not depressive symptoms. Only individuals with a consistently high loneliness pattern over time (vs consistently low) had significantly higher incident stroke risk (HR: 1.56, 95% CI: 1.11-2.18) after adjusting for depressive symptoms and social isolation. Chronic loneliness was associated with higher stroke risk independent of depressive symptoms or social isolation. Addressing loneliness may have an important role in stroke prevention, and repeated assessments of loneliness over time may help identify those particularly at risk. National Institute on Aging (NIA U01AG009740).

Loneliness predicts decreased physical activity in widowed but not married or unmarried individuals.

Physical activity is associated with improved health and function in older adults, yet most older adults are sedentary. Loneliness is associated with decreased physical activity at the cross-section, but longitudinal studies are scarce. We examined longitudinal associations between loneliness and physical activity-and whether they were modified by marital status and network size (the number of children, relatives, and friends a person interacts with at least once a month). We analyzed data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project with a mean follow-up of 4.8 years (mean age 79.6 ± 7.7, 74.9% women). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Physical activity was assessed as the frequency with which participants engaged in five categories of activities (e.g., walking, gardening, calisthenics, bicycling, and swimming). Linear mixed effects models examined associations between baseline loneliness and change in physical activity over time after adjusting for demographics, depressive symptoms, global cognition, disability, network size, marital status, social support, and social and cognitive activities. We assessed for effect modification by marital status and network size. Associations between loneliness and physical activity differed by marital status. In widowed individuals, baseline loneliness was associated with a 0.06 h/week greater decrease in physical activity per year compared to those who were not lonely (p = 0.005, CI -0.1, 0.02)-which equaled a 150% decrease in physical activity per year. Loneliness did not predict a statistically significant decrease in physical activity in married or unmarried individuals. Loneliness is associated with decreased physical activity in widowed older adults and should be considered in the design of interventions to prevent or slow the decline in physical activity and promote healthy aging.

Loneliness in narcissistic vulnerability: Examining domains of personality functioning.

Research has indicated loneliness to be a detrimental correlate of narcissistic vulnerability. However, no research has examined if this relationship persists across time or why it occurs. The present study explores the link between narcissistic vulnerability and loneliness across time and examines which domains of personality dysfunction (i.e., identity, self-direction, empathy, and intimacy) may account for why narcissistic vulnerability is related to loneliness. Adult participants (N = 298) were recruited from Prolific and completed study questionnaires assessing narcissistic vulnerability, narcissistic grandiosity, loneliness, domains of self and interpersonal functioning, and neuroticism. Two months later, participants repeated the measure of loneliness. Correlations among all study variables were calculated, followed by linear regression analyses to investigate how personality functioning domains may mediate the longitudinal relationship between narcissistic vulnerability and loneliness. The effects of baseline loneliness, relationship status, and trait neuroticism were controlled for. Narcissistic vulnerability, but not narcissistic grandiosity, was associated with loneliness at baseline and 2 months later. Intimacy functioning, but not identity, self-direction, or empathy functioning, was a significant mediator of the relationship between narcissistic vulnerability and loneliness over time. These findings suggest that narcissistic vulnerability may contribute to the development or maintenance of loneliness across time, highlighting the role of impaired intimacy functioning in this relationship. The impact of these findings on our understanding of interpersonal functioning in narcissistic vulnerability, as well as clinical implications, is discussed.

Postpartum loneliness predicts future depressive symptoms: a nationwide Japanese longitudinal study.

The COVID-19 pandemic has intensified feelings of loneliness, especially among postpartum women. This nationwide Japanese longitudinal study assessed the impact of such feelings on depressive symptoms and mother-to-infant bonding difficulties (MIBD), two pivotal determinants of maternal and infant well-being. Starting with a baseline survey conducted between July and August 2021, we tracked 1254 postpartum Japanese women who initially reported minimal depressive symptoms (i.e., Edinburgh Postnatal Depression Scale < 9) and MIBD (i.e., Mother-to-Infant Bonding Scale < 5), over a follow-up period of approximately 6months. Baseline loneliness was evaluated with the UCLA Loneliness Scale Short-Form (UCLA-LS3-SF3). Forty-nine percent of the sample reported the presence of baseline feelings of loneliness. After propensity score matching on sociodemographics and various pregnancy, childbirth, and COVID-19-related aspects, baseline loneliness was associated with increased risks of later depressive symptoms but not MIBD. Using restricted cubic spline logistic regression and considering loneliness as a continuous variable, we found a positive increasing quadratic relationship with depressive symptoms. As loneliness increased, so did the risk of later depressive symptoms. However, there was no significant association between loneliness and MIBD. These results were confirmed through a sensitivity analysis using inverse probability weighting to address attrition bias. Feelings of postpartum loneliness are associated with future risks of depressive symptoms. The data suggests that addressing loneliness in postpartum women early is crucial to safeguarding their well-being and that of their infants.

Loneliness Predicts Progression of Frailty in Married and Widowed, but Not Unmarried Community Dwelling Older Adults.

Loneliness is highly prevalent among older adults and is associated with frailty. Most studies consider loneliness in isolation without consideration for structural and functional measures of social relationships - and longitudinal studies are scarce. This study examined longitudinal associations between loneliness and frailty and analyzed how structural and functional social measures influence these associations. Linear mixed effects models examined longitudinal associations between loneliness and frailty assessed with the frailty index (scale 0-100). Models were adjusted for baseline age, gender, education, depressive symptoms, global cognition, and structural (e.g., social network, marital status), and functional social measures (e.g., social, cognitive, and physical activity, and social support). Loneliness and frailty data from 1,931 older adults without dementia at baseline from the Rush Memory and Aging Project were examined (mean age 79.6 ± 7.7 years, 74.9% female). Baseline loneliness assessed by the de Jong Gierveld Loneliness Scale was the predictor of interest. Frailty increased significantly over a mean follow-up period of 4.6 years. Effects of loneliness on frailty were modified by marital status. Loneliness predicted an additional accumulation of 0.37 and 0.34 deficits on the frailty index per year in married and widowed individuals respectively, compared to those who were not lonely (married: p=0.009, CI 0.09, 0.64; widowed: p=0.005, CI 0.1, 0.58). Loneliness did not predict frailty progression in unmarried individuals. Loneliness predicts frailty progression, highlighting the importance of social determinants on physical health in aging.

Impact of a peer-support programme to improve loneliness and social isolation due to COVID-19: does adding a secure, user friendly video-conference solution work better than telephone support alone? Protocol for a three-arm randomised clinical trial

IntroductionThe COVID-19 pandemic has forced the implementation of physical distancing and self-isolation strategies worldwide. However, these measures have significant potential to increase social isolation and loneliness. Among older people, loneliness...

LONGITUDINAL ASSOCIATIONS OF LONELINESS AND FRAILTY IN COMMUNITY DWELLING OLDER ADULTS

Abstract Loneliness is highly prevalent among older adults and is associated with poor health outcomes. This study examined longitudinal associations between loneliness and frailty and the influence of other objective and subjective social measures on these associations. We analyzed data from 1,3111 older adults without dementia at baseline from the Rush Memory and Aging Project (mean age 78.3 ±7.5 years, 72.5% female). Loneliness was assessed using the de Jong Gierveld Loneliness Scale. Frailty was defined using a 39-item cumulative deficit frailty index. Linear mixed effects models were used to examine the association of baseline loneliness and change in frailty over time adjusted for baseline age, gender, education, depressive symptoms, global cognition, social network, marital status, social support, and social, cognitive, and physical activity. Loneliness and frailty both increased significantly over a mean follow-up period of 4.6 years. Baseline loneliness was associated with an additional increase in frailty by 0.3 deficits per year compared to those who were not lonely (p&amp;lt; 0.001, CI 0.2, 0.5). The 0.3 increase in frailty per 1-point increase in loneliness equaled a 27% increase in frailty per year. Loneliness is associated with accelerated frailty and should be considered in the design of interventions to prevent frailty and promote healthy aging.

Predictors and moderators of outcome of ICBT for loneliness with guidance or automated messages - A secondary analysis of a randomized controlled trial

Internet-based cognitive behavioral therapy (ICBT) is promising in alleviating loneliness in adults. Identifying individuals who benefit from ICBT for loneliness is pivotal to offering this intervention in a more targeted way and improving the intervention for those who do not benefit. This secondary analysis of a randomized controlled trial (RCT) aimed to identify predictors and moderators of outcome of an ICBT with guidance or automated messages for loneliness. In the RCT, 243 participants suffering from loneliness were randomly assigned to an ICBT with guidance (n = 98), automated messages (n = 97), or a waitlist-control condition (n = 48). In total, 180 participants completed the post-assessment (i.e., 10 weeks post-randomization). Outcomes were treatment outcome assessed with the UCLA-9 Loneliness Scale at post-assessment and treatment response, i.e., reliable improvement on the UCLA-9 from pre- to post. The relationship between a wide range of patient characteristics (grouped into socio-demographic, clinical, loneliness-specific, and treatment-related variables) and outcome was analyzed using multiple linear and logistic regressions. Feeling less burdened by loneliness resulted in higher odds of reliable improvement in guided ICBT compared to the waitlist-control condition. No treatment outcome or response moderators were identified for ICBT with automated messages compared to the waitlist-control group. Across active intervention groups, loneliness at baseline, age and fit between the tasks and goals of the intervention and participants' need predicted treatment outcome. Predictors of treatment response for ICBT with guidance and automated messages were not identified, and no variables differentially predicted the effects of ICBT with guidance or automated messages on the outcomes. In conclusion, individuals less burdened by their feelings of loneliness benefited more from guided ICBT. Lower baseline loneliness scores, younger age, and a better match between tasks and goals of the intervention and participants' needs also predicted a more favorable treatment outcome for both ICBT with guidance and automated messages.

45 The Impact of Loneliness on Amyloid Burden, Cerebrovascular Disease, Neurodegeneration, and Memory Performance in a Community-Based Sample of Older Adults

Objective:The current research framework recommends using biomarkers to further understand Alzheimer’s disease (AD) pathogenesis, including other contributing factors like cerebrovascular disease. In longitudinal studies of people with neuropathological examination after death, baseline loneliness was associated with lower cognition, faster cognitive decline, and future AD risk, independent of AD pathology. Examination of memory impairment along with AD and cerebrovascular biomarkers, could aid risk reduction efforts earlier in the lifecourse and among populations with more exposure to loneliness. We hypothesized that loneliness is associated with amyloid, vascular, and neurodegeneration biomarkers; with worse memory; and that loneliness increases the susceptibility to biomarker-related memory impairment.Participants and Methods:A subset of cognitively unimpaired older adults with available amyloid PET, vascular MRI (white matter hyperintensity volume, WMH), structural MRI (cortical thickness in AD signature regions), neuropsychological testing (memory factor score), dichotomized loneliness data (one item from CES-D), and relevant medical data were drawn from the community-based Washington Heights-Inwood Columbia Aging Project (WHICAP; n=169; covariates included age=81±6 years; 63% women; 49/31/20% Non-Hispanic Black/Non-Hispanic White/Hispanic; education=13±4 years; 32% APOE-e4 carriers). General linear models in the overall sample and stratified by race and ethnicity tested the association between loneliness and AD and cerebrovascular biomarkers, loneliness and memory, and the interaction of loneliness and biomarkers on memory, adjusting for covariates.Results:Loneliness was endorsed in 18% of participants, marginally associated with older age (2.1 [-0.2, 4.4], p=0.08), was more likely in those with untreated diabetes (13/0.1% lonely/not lonely, p=0.001), associated with lower cortical thickness (-0.05 [-0.09, -0.02], p=0.01), and associated with lower memory (0.3 [-0.6, -0.001], p=0.05). In Non-Hispanic White participants, loneliness was associated with greater WMH volume (0.5 [0.07, 0.82], p=0.03), while in Hispanic participants, loneliness was associated with lower cortical thickness (-0.16 [-0.24, -0.08], p=0.0006). In Non-Hispanic Black participants, loneliness was associated with lower memory (-13 [-26, -0.5], p=0.05), and the association between lower cortical thickness and lower memory was stronger in those that endorse loneliness (5 [0.2, 10], p=0.05). In Hispanic participants, loneliness was associated with higher memory (13 [4, 22], p=0.009), but the association between higher amyloid burden and lower memory was stronger in those that endorse loneliness (-12 [-20, -4], p=0.006); further, loneliness was marginally associated with lower memory (-0.7 [-1.4, 0.1], p=0.09), independently of WMH.Conclusions:Associations between loneliness and biomarkers may relate to health seeking behavior, reported as treatment status for diabetes, for cerebrovascular burden and general neurodegeneration, but might be more complex for amyloid. The degree to which loneliness increased the susceptibility to amyloid and neurodegeneration-related, but not cerebrovascular-related, memory impairment, specifically, may suggest that domains beyond memory should be considered. Future work should be longitudinal to disentangle the effects of loneliness from related constructs like depression and anxiety, incorporate other AD biomarkers such as hyperphosphorylated tau, and incorporate biological mechanisms (e.g., stress, inflammation) into models of loneliness and AD pathogenesis. Older adults from all backgrounds may be more susceptible to loneliness, which was associated with lower memory; culturally-humble, social support-based interventions may reduce the risk of cognitive impairment.

Associations Between Longitudinal Loneliness, DNA Methylation Age Acceleration, and Cognitive Functioning.

Loneliness may influence aging biomarkers related to cognitive functioning, for example, through accelerated DNA methylation (DNAm) aging. In the present study, we tested whether six common DNAm age acceleration measures mediated the effects of baseline loneliness and five different longitudinal loneliness trajectories on general cognitive ability, immediate memory recall, delayed memory recall, and processing speed in 1,814 older adults in the Health and Retirement Study. We found that baseline loneliness and individuals who belong to the highest loneliness trajectories had poorer general cognitive ability and memory scores. Only DNAm age acceleration measures that index physiological comorbidities, unhealthy lifestyle factors (e.g., smoking), and mortality risk-mediated effects of baseline loneliness on general cognitive ability and memory functioning but not processing speed. These same DNAm measures mediated effects of the moderate-but-declining loneliness trajectory on cognitive functioning. Additionally, immediate and delayed memory scores were mediated by GrimAge Accel in the lowest and two highest loneliness trajectory groups. Total and mediated effects of loneliness on cognitive functioning outcomes were mainly accounted for by demographic, social, psychological, and physiological covariates, most notably self-rated health, depressive symptomatology, objective social isolation, and body mass index. Current findings suggest that DNAm biomarkers of aging, particularly GrimAge Accel, have promise for explaining the prospective association between loneliness and cognitive functioning outcomes.

The Impact of Digital Mental Health Services on Loneliness and Mental Health: Results from a Prospective, Observational Study

BackgroundLoneliness has increased since the COVID-19 pandemic and negatively impacts mental health. This study examined relationships between loneliness and mental health among adults using a digital mental health platform.MethodsA purposive sample of 919 participants (97% response rate) who were newly enrolled in the platform completed a survey on loneliness, depression, anxiety, well-being, stress, social support, and comorbidities at baseline and 3 months. Platform engagement was tracked during this period. We examined baseline differences between lonely and non-lonely participants; associations between loneliness, mental health symptoms, and comorbidities; and changes in loneliness and mental health through engagement in any form of care.ResultsAt baseline, 57.8% of the sample were categorized as lonely. Loneliness was associated with younger age, fewer years of education, and the presence of a comorbidity (p values < .05). Baseline loneliness was associated with greater depression, anxiety, and stress and lower well-being and social support (ps < .001). The percentage of lonely participants decreased at follow-up (57.6% to 52.9%, p = .03). Those who improved in loneliness improved in mental health symptoms, well-being, and social support (ps < .001). Lonely participants who engaged in any form of care reported a greater reduction in loneliness than those who did not engage (p = .04).ConclusionsThis study confirms previous findings of the high prevalence of loneliness among adults and risk factors for increased loneliness. Findings highlight the potential of digital platforms to reach lonely individuals and alleviate loneliness through remote mental health support.

An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study.

More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested. In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness. We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on "what really matters" in one's life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform "Unipark," on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS). We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (β=4.14; t248=1.74; 1-tailed P=.04). Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116.

Psychosocial factors associated with loneliness change during COVID‐19 pandemic in Italian older‐old individuals: Findings from the InveCe.Ab cohort

AbstractBackgroundLoneliness is an issue for many older adults, significantly affecting physical, cognitive and mental health. The aim of the present study was to evaluate if loneliness worsened in older‐old individuals during the COVID‐19 nationwide lockdown in Italy, compared to their pre‐pandemic status. Moreover, we explored which pre‐pandemic psychosocial factors predict loneliness change.MethodThe present investigation was conducted on 409 older adults without dementia and aged between 79 and 84 years, participating in the fourth evaluation wave of the InveCe.Ab study in 2018 (NCT01345110) and then performing a telephone survey between March and May 2020, during the first Italian nationwide lockdown. Loneliness was evaluated with the UCLA 3‐item loneliness scale both in 2018 and 2020. The following pre‐pandemic measures, collected as part of the in‐person multidimensional assessment in 2018, were considered: age, sex, education, social contact, leisure and physical activity, digital technology usage (yes/no), perceived support from family network (yes/no), personality traits (psychoticism, extraversion, neuroticism), depressive symptoms (Geriatric Depression Scale, GDS), global cognition (Mini Mental State Examination, MMSE) and baseline loneliness. To compare pre‐post pandemic loneliness, we performed the Wilcoxson signed‐rank test. Kendal tau rank correlations were calculated to preliminarily explore the associations between each psychosocial factors and loneliness change (delta). Finally, stepwise multiple linear regression based on the p‐value criteria was used to test which variables independently predicted loneliness change.ResultLoneliness showed a significant increase during the lockdown (p&lt;0.001). Loneliness change was associated with lower GDS (τ = ‐0.221, p&lt;0.001), psychoticism (τ = ‐0.086, p = 0.024), neuroticism (τ = ‐0.116, p = 0.002) and higher extraversion (τ = 0.079, p = 0.035), MMSE (τ = 0.106, p = 0.006), social contacts (τ = 0.091, p = 0.015) leisure activities (τ = 0.103, p = 0.006). Multiple regression showed that only 2 psychosocial factors explained 27% of the variance (R2 = 0.27, F = 74,7, p&lt;0.001). Specifically, baseline loneliness (β = ‐0.70, p&lt;0.001) and perceived support from family network (β = ‐0.50, p = 0.007) predicted loneliness change.ConclusionLoneliness increased during the first nationwide lockdown among older‐old individuals in Italy, compared to their pre‐pandemic level. This change was most prominent among those with lower pre‐pandemic loneliness levels and it was mitigated by perceived support by family network.

The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness

Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy-based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI -0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI -1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI -0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI -0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI -0.17 to 0.18; P=.98) or depression (B=-0.08, 95% CI -0.19 to 0.03; P=.14). Loneliness was not found to affect young adults' engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8. RR2-10.2196/23655.

Psychological correlates of perceived loneliness in college students before and during the COVID-19 stay-at-home period: a longitudinal study

BackgroundLoneliness is increasingly acknowledged as a serious public health issue. This longitudinal study aimed to assess the extent to which psychological distress and alexithymia can predict loneliness among Italian college students before and one year after the COVID-19 outbreak.MethodsA convenience sample of 177 psychology college students were recruited. Loneliness (UCLA), alexithymia (TAS-20), anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), and somatic symptoms (PHQ-15) were assessed before the COVID-19 outbreak and one year after the spread of COVID-19 worldwide.ResultsAfter controlling for baseline loneliness, students with high levels of loneliness during lockdown showed worsening psychological distress and alexithymic traits over time. Suffering from depressive symptoms before COVID-19 and the aggravation of alexithymic traits independently predicted 41% of perceived loneliness during the COVID-19 outbreak.ConclusionsCollege students with higher levels of depression and alexithymic traits both before and one year after the lockdown were more at risk of suffering from perceived loneliness and may constitute the target sample for psychological support and intervention.

Associations Between Loneliness and Cognitive Resilience to Neuropathology in Older Adults.

Loneliness in the aging population is associated with decreased cognitive function and increased neuropathology; less is understood about the association of loneliness and cognitive resilience (CR), defined as the discordance between a person's actual and expected cognition given their neuropathology. Here we assess the effect of loneliness and change in loneliness on CR at end of life and across older adulthood. Data were combined from 2 longitudinal studies of older adults. CR proximate to death (CRlast_level) and across time (CRslope) was obtained by independently regressing global cognition and change in cognition onto multiple neuropathology indicators and extracting the resulting residuals. We used a series of simple linear regression models to assess the effect of loneliness level and change on CRlast_level and CRslope. Higher baseline loneliness was associated with lower CRlast_level (β = -0.11, 95% confidence interval [95% CI; -0.18, -0.04], p < .01); higher baseline loneliness and increasing loneliness over time was associated with lower CRslope (β = -0.13, 95% CI [-0.22, -0.05], p < .01 and β = -0.12, 95% CI [-0.20, -0.04], p < .01, respectively). Results were robust to covariate inclusion and independent of objective social isolation. Higher and increasing loneliness was associated with lower CR in the face of neuropathology. These results suggest that some individuals are less resilient to the accumulation of neuropathology than others, and experiencing high/increasing loneliness is a key factor putting some at risk. Interventions aimed at optimizing cognitive function across older adults should include loneliness reduction as a potential area of focus.

Pilot study of Qigong/Tai Chi Easy acute effects of meditative movement, breath focus and “flow” on blood pressure, mood and oxytocin in older adults

BackgroundOlder adults are increasingly lonely and at risk for hypertension. Endogenous oxytocin levels are associated with lowering blood pressure (BP), suggesting value in increasing oxytocin. Regular practice of Tai Chi improves BP and mood; we explored a single session of Tai Chi Easy (TCE) with older adults and feasibility of measuring oxytocin as a key biomarker. MethodIn a single-arm pre-post design pilot study, 21 older adults (age 55–80) with mild-moderate hypertension practiced a single session (50-min) TCE. BP, psychosocial measures, and saliva samples were collected pre/post to examine feasibility of acute measures of oxytocin and explore effect sizes of outcomes. Participants (N = 21; 19 % Latinx, 76.2 % female, mean age 66.76). ResultsBP systolic: 138.43–134.86; diastolic 78.48–78.00 (p > .05; Cohen’s d −0.23; −0.08 respectively). Total Mood Disturbance (TMD) and Connection (CN) improved [TMD mean pre 41.891 (SD=19.60) to post 35.00 (SD=10.21), p = .01; Cohen’s d − 0.67); CN mean 7.85 (SD=2.01) to post 9.05 (SD=1.00), p = .01; Cohen’s d 0.70]. Baseline oxytocin was positively correlated with baseline loneliness (N = 14, r = .599); pre/post oxytocin changes were negatively correlated with baseline loneliness (N = 14, r = −.585). BP decrease was associated with characteristics of the intervention: “flow” (coef=.=0.58N = 17) and meditative/breath focus (coef=−1.78; N = 17). Discussion/ConclusionMedium to large effect sizes indicating change in mood and connection were found for this single session intervention. Knowing that Tai Chi improves BP when practiced over time, this TCE intervention shows promise for planning a fully powered, randomized controlled study of BP, mood and perceptions of connection in hypertensive older adults. Feasibility of assessing acute salivary oxytocin is less promising. Increase in oxytocin levels occurred for those less lonely, but declined for lonelier participants. With different responses based on baseline loneliness scores, no mean change in oxytocin levels was found. Seemingly unstable levels (possibly related to interaction with study staff) suggests the need for further testing in more controlled study designs. Finally, BP associations with meditative/breath focus and flow could be further explored in future study designs addressing mediation.