Social Isolation Measures Research Articles

Social isolation: development and validation of measures

PurposeThe purpose of this paper is to develop and empirically validate items on social isolation. The comprehensive literature review of existing studies on the measures of social isolation, loneliness and the related construct was conducted. The paper seeks to conceptualize, validate and present items to measure social isolation.Design/methodology/approachThe paper is based on theoretical and empirical investigation of the measures of social isolation, loneliness and related constructs such as social others, social loneliness and feeling of sociability. The items were generated through theoretical exploration of previous literature and later modified. The author examined the items through exploratory factor analysis, confirmatory factor analysis and further checked for external criterion validity. Data collected from 128 individuals, in India, were examined to design and validate the scale.FindingsThe finding of the paper is a ten-item social isolation scale. Using structural equation modeling, we have found extraversion and well-being significantly associated with final items in the present study, confirming the external quality of the scale.Practical implicationsOrganizations may benefit by close examination of the presence of social isolation in employees along with providing support and assistance to employees so as to reduce negative consequences of social isolation and can address the well-being of the employee.Originality/valueThere is a dearth of developed and validated measures of social isolation in the literature. The study reveals the conceptualization and empirical validation of measures of social isolation in the Indian context so that researchers can move forward to develop theories on social isolation.

Development and Concurrent Validity of a Composite Social Isolation Index for Older Adults Using the CLSA.

ABSTRACTSocial isolation, given its established association with mortality, and risk of poor physical and/or mental health over the life course, has attracted the attention of researchers. However, such measures have been highly variable and often lack conceptual clarity. This study, which drew on a conceptual framework for classifying social isolation measures, provides a rationale for the development and validation of a composite Social Isolation Index (SII) using the Canadian Longitudinal Study on Aging (CLSA), together abbreviated as CLSA-SII. CLSA-SII was developed using standard methodology for developing other measures, including the multimorbidity resilience and successful aging indices. Associations of the CLSA-SII and four key outcome variables (life satisfaction scale, depression, perceived mental health, and perceived health) were performed using regression analyses. Associations between the CLSA-SII index and the four outcome variables resulted in statistically significant moderate associations in the expected direction, and are consistent with prior research, demonstrating good concurrent validity.

THE ASSOCIATION OF NEIGHBORHOOD DISADVANTAGE AND LIFE-SPACE MOBILITY: RESULTS FROM THE UAB STUDY OF AGING

AbstractThe neighborhood environments where older adults live are a critical factor in their aging process. Aging persons may experience physical impairment, limiting their ability to travel within and outside of their neighborhoods. This increases their susceptibility to risk factors in that environment. While this is a well-established concept, the relationship between neighborhood disadvantage (ND) and life-space mobility has not been previously examined. Therefore, using the UAB Study of Aging, a prospective cohort study of 1000 community-dwelling Alabama older adults age 65+, we examined the effects neighborhood disadvantage on life-space mobility. We used a two-item measure of neighborhood disadvantaged at the census tract level and included individual-level demographic factors such as poverty, measures of social isolation, and other indicators of health. Using generalized estimating equations, we found that in unadjusted models participants in both the mid and highest tertiles of ND had lower life-space mobility levels (b= -6.332 and b=-7.357, respectively) relative to those in the lowest level of ND. However, in adjusted models, accounting for individual-level poverty, the effect of neighborhoods was diminished and not significant. These findings suggest that while neighborhood disadvantage is an indicator of life-space mobility limitations, the underlying cause may be individual-level factors such as poverty. The relationship may be cyclical wherein neighborhood disadvantage limits life-space mobility, which in turn makes it difficult to overcome the effects of neighborhood disadvantage since one is not able to leave the neighborhood even temporarily. These hypothesis should be explored in future analyses.

INVESTIGATING THE RELATIONSHIP BETWEEN LONELINESS AND SOCIAL ISOLATION WITH INFLAMMATION: A SYSTEMATIC REVIEW

Loneliness and social isolation have been linked with an increased risk of the development of chronic illness, however, the mechanisms driving this association remain unclear. One possible reason could be that they are linked with increased inflammation. Seven databases were searched by two reviewers for synonyms of “loneliness” and “inflammation”. Inclusion criteria included a population of adults aged 16 or older, examining the association of loneliness or social isolation with an outcome of inflammation. Eleven studies were identified that examined loneliness and inflammation, of which six indicated a significant relationship. Thirteen studies were identified that examined social isolation and inflammatation, of which twelve noted a significant association. There was notable heterogeneity between studies for population studied, confounder control, study design, measures of loneliness or social isolation and inflammatory outcome. Implications of these results in terms of understanding the link between loneliness and social isolation with chronic illness will be discussed.

Persistent social isolation reflects identity and social context but not maternal effects or early environment

Individuals who are well integrated into society have greater access to resources and tend to live longer. Why some individuals are socially isolated and others are not is therefore puzzling from an evolutionary perspective. Answering this question requires establishing the mix of intrinsic and contextual factors that contribute to social isolation. Using social network data spanning up to half of the median adult lifespan in a gregarious primate, we found that some measures of social isolation were modestly repeatable within individuals, consistent with a trait. By contrast, social isolation was not explained by the identity of an animal’s mother or the group into which it was born. Nevertheless, age, sex and social status each played a role, as did kin dynamics and familiarity. Females with fewer close relatives were more isolated, and the more time males spent in a new group the less isolated they became, independent of their social status. These results show that social isolation results from a combination of intrinsic and environmental factors. From an evolutionary perspective, these findings suggest that social isolation could be adaptive in some contexts and partly maintained by selection.

The Influence of Social Isolation and Medical Comorbidities on Geriatric Congestive Heart Failure Hospital Readmissions

CONTEXTSocial isolation and comorbidities are likely to have a significant level of influence on the healthcare use patterns of geriatric patients with ongoing congestive heart failure (CHF)-related needs.METHODSA retrospective study was conducted in a specialized emergency department (ED) with a sample of 286 geriatric CHF patients who initially received CHF-related care over a six-month period. Social isolation levels were assessed using a pre-existing four-point screening tool used in the study setting and composite comorbidity was gauged using the Charlson Comorbidity Index method. Subjects were categorized into either “less than 30-day readmission” or “greater than 30-day readmission/non-readmitted” sample subgroups. The setting was a single 304-bed community hospital with approximately 45,000 annual ED visits. The analytic sample was comprised of geriatric patients 65+ years of age with an ICD-9 code corresponding to CHF.RESULTSThere were no statistically significant differences between earlier hospital readmission versus later/non-readmitted sample patients when grouped by age, race, gender or level of measured social isolation. However, composite comorbidity scores were significantly lower for patients in the >30-day/non-readmitted subgroup compared to earlier readmission patients.CONCLUSIONSThese initial study results suggest that a larger proportion of CHF hospital readmissions may be more heavily influenced by clinical factors than social living arrangements. Future studies with larger samples and validated measures of social isolation are needed to inform the development and testing of programs for geriatric CHF patients striving to avoid unnecessary hospital readmissions and adverse health outcomes.

An analysis of magnetic resonance venographic drainage patterns of intracranial venous sinuses

Survey researchers have long hypothesized that social isolation negatively affects the probability of survey participation and biases survey estimates. Previous research, however, has relied on proxy measures of isolation, such as being a marginalized group member within a population. We re-examine the relationship between social isolation and survey participation using direct measures of social isolation derived from social network data; specifically, instrumental research and expressive friendship connections among faculty within academic departments. Using a reconceptualization of social isolation, we find that social network isolation is negatively associated with unit response. Among women (a numerical minority group within the organization), we further find that social group isolation (i.e., lacking instrumental network connections to men, the majority group in the organization) is negatively associated with survey participation. Finally, we show that some survey estimates are systematically biased due to nonparticipation from socially isolated people.

Trajectory of social isolation following hip fracture: an analysis of the English Longitudinal Study of Ageing (ELSA) cohort.

social isolation is defined as a lack of meaningful and sustained communication or interactions with social networks. There is limited understanding on the prevalence of social isolation and loneliness in people following hip fracture and no previous understanding of how this changes over time. to determine the prevalence and trajectory of social isolation and loneliness before a hip fracture, during the recovery phase and a minimum of 2 years post-hip fracture in an English population. data were from the English Longitudinal Study of Ageing (ELSA) cohort (2004/5-2014/15). The sample comprised of 215 participants who had sustained a hip fracture. Measures of social isolation and loneliness were analysed through multilevel modelling to determine their trajectories during three-time intervals (pre-fracture; interval at hip fracture and recovery; minimum 2 years post-fracture). The prevalence of social isolation and loneliness were determined pre- and post-fracture. prevalence of social isolation was 19% post-hip fracture and loneliness 13% post-hip fracture. There was no statistically significant change in social isolation pre-fracture compared to a minimum of 2 years post-fracture (P = 0.78). Similarly, there was no statistically significant change in loneliness pre-fracture compared to a minimum of 2 years post-fracture (P = 0.12). this analysis has determined that whilst social isolation and loneliness do not change over time following hip fracture, these remain a significant problem for this population. Interventions are required to address these physical and psychological health needs. This is important as they may have short and longer term health benefits for people post-hip fracture.

Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial.

What is the effectiveness of gym-based exercise versus home-based exercise with telephone follow-up amongst adults with chronic conditions who have completed a short-term exercise program supervised by a health professional? A randomised, controlled trial with concealed allocation, intention-to-treat analysis, and blinded outcome assessment at baseline and 3, 6, 9 and 12 months. The participants were recruited following a 6-week exercise program at a community health service. One group of participants received a gym-based exercise program for 12 months (gym group). The other group received a home-based exercise program for 12 months with telephone follow-up for the first 10 weeks (home group). Outcome measures included European Quality of Life Instrument (EQ-5D), the Friendship Scale, the Hospital and Anxiety and Depression Scale, Phone-FITT, 6-minute walk test, body mass index and 15-second sit-to-stand test. There was no significant difference between study groups in the primary outcome (EQ-5D visual analogue scale, 0 to 100) across the 12-month intervention period, with an estimate (adjusted regression coefficient) of the difference in effects of 0 (95% CI -5 to 4). The gym group demonstrated slightly fewer symptoms of depression over the 12-month period compared to the home group (mean difference 0.8 points on a 21-point scale, 95% CI 0.1 to 1.6). Similar long-term clinical outcomes and long-term exercise adherence are achieved with the two approaches examined in this study. Participation in gym-based group exercise may improve mental health outcomes slightly more, although the mechanisms for this are unclear because there was no change in the selected measure of social isolation or other measures of health and wellbeing. This finding may also be a Type 1 error. Further research to reproduce these results and that investigates the economic efficiency of these models of care is indicated. ACTRN12610001035011. [Jansons P, Robins L, O'Brien L, Haines T (2017) Gym-based exercise and home-based exercise with telephone support have similar outcomes when used as maintenance programs in adults with chronic health conditions: a randomised trial. Journal of Physiotherapy 63: 154-160].

The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD

Despite the 8–18.5% of returning Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) veterans who are suffering from posttraumatic stress disorder (PTSD), few receive empirically supported treatments. Among those that do, the dropout rate is high and more than 50% retain their diagnosis after treatment. This study evaluated the efficacy of Trauma Management Therapy (TMT), delivered in a 3-week intensive outpatient (IOP) format. TMT combines virtual-reality augmented individual exposure therapy with a group intervention to address social isolation, anger, and depression. One hundred twelve (112) OIF/OEF/OND veterans and active duty personnel participated. Assessment included measures of PTSD, sleep, depression, anger, guilt, and social isolation, administered at post-treatment, 3-month, and 6-month follow-up. The effect size for TMT delivered in an IOP format was 2.06, with 65.9% no longer meeting diagnostic criteria for PTSD. There were similar positive effects in other domains and treatment gains were maintained at 6-month follow-up. The results are discussed regarding the need for efficacious, multi-component interventions that can be delivered safely and rapidly, and the potential of this approach towards that end.

Harnessing Peer Support in an Online Intervention for Older Adults with Depression

This pilot study evaluated the feasibility and efficacy of two methods of delivering a cognitive behaviorally informed Internet intervention for depression for adults 65 years and older. Forty-seven participants were enrolled and assigned to receive one of two versions of the Internet intervention, either delivered individually (III) or with peer support (II+PS), or to a wait list control group (WLC). Primary outcomes included change in depressive symptoms from baseline to post-intervention (week 8), site use, self-reported usability, and coach time. Secondary outcomes included measures of social support and isolation and anxiety. Follow-up data were provided by 85.1% (40 of 47) of enrolled participants. There were significant differences in depression change across groups (F(2,37) = 3.81, p = 0.03). Greater reductions in depressive symptoms were found for the III (p = 0.02) and II+PS (p = 0.03) compared with WLC, and significantly less coach time was required in the II+PS (p = 0.003). These results highlight the potential of cognitive-behaviorally informed Internet interventions for older adults with depression, and indicate that peer-supported programs are both acceptable and equivalent to individually delivered Internet interventions. Including peer support may be a viable and potentially more cost-effective option for disseminating online treatments for depression for older adults.

Social Isolation, Depression, and Psychological Distress Among Older Adults.

To investigate the impact of objective and subjective social isolation from extended family members and friends on depressive symptoms and psychological distress among a national sample of older adults. Data for older adults (55 years and above) from the National Survey of American Life ( N = 1,439) were used to assess level of objective social isolation and subjective social isolation and to test regression models examining their impact on depressive symptoms (Center for Epidemiologic Studies Depression [CES-D] Scale) and psychological distress (Kessler 6 [K6] Scale). The majority of respondents were not socially isolated from family or friends; 5% were objectively isolated from family and friends, and less than 1% were subjectively isolated from family and friends. Regression analyses using both social isolation measures indicated that objective social isolation was unrelated to depressive symptoms and psychological distress. However, subjective social isolation from both family and friends and from friends only was associated with more depressive symptoms, and subjective social isolation from friends only was associated with higher levels of psychological distress. Assessments of social isolation among older populations should account for both subjective and objective dimensions, as well as both family and friend social networks. Social isolation from friends is an important, but understudied, issue that has significant consequences for older adult mental health.

I get so lonely, baby: The effects of loneliness and social isolation on romantic dependency

ABSTRACTIndividuals lacking fulfilling interpersonal interactions may experience feelings of loneliness. Consequently, these individuals may over-rely on their romantic partners to fulfill the need to belong. This study examined the effects of loneliness and social isolation on dependency on a romantic partner in a sample of college students (N = 104). Participants who were in a romantic relationship completed measures of loneliness, social isolation, and romantic dependency near the beginning of the semester (Time 1) and approximately 6 weeks later toward the end of the semester (Time 2). Toward the beginning of the semester, there were no significant predictors of dependency. Toward the end of the semester, individuals who reported higher social isolation reported higher levels of dependency. Time 1 dependency also predicted Time 2 dependency. Future methodological directions and suggestions regarding the examination of perceptions of loneliness and relationship expectations are discussed.

Social isolation, survey nonresponse, and nonresponse bias: An empirical evaluation using social network data within an organization

Survey researchers have long hypothesized that social isolation negatively affects the probability of survey participation and biases survey estimates. Previous research, however, has relied on proxy measures of isolation, such as being a marginalized group member within a population. We re-examine the relationship between social isolation and survey participation using direct measures of social isolation derived from social network data; specifically, instrumental research and expressive friendship connections among faculty within academic departments. Using a reconceptualization of social isolation, we find that social network isolation is negatively associated with unit response. Among women (a numerical minority group within the organization), we further find that social group isolation (i.e., lacking instrumental network connections to men, the majority group in the organization) is negatively associated with survey participation. Finally, we show that some survey estimates are systematically biased due to nonparticipation from socially isolated people.

Is Hearing Loss Associated with Poorer Health in Older Adults Who Might Benefit from Hearing Screening?

Hearing screening programs may benefit adults with unacknowledged or unaddressed hearing loss, but there is limited evidence regarding whether such programs are effective at improving health outcomes. The objective was to determine if poorer audiometric hearing thresholds are associated with poorer cognition, social isolation, burden of physical or mental health, inactivity due to poor physical or mental health, depression, and overnight hospitalizations among older American adults with unacknowledged or unaddressed hearing loss. The authors performed a cross-sectional population-based analysis of older American adults with normal hearing or unacknowledged or unaddressed hearing loss. Data was obtained from the 1999 to 2010 cycles of the National Health and Nutrition Examination Survey. Participants with a pure-tone average (PTA in the better hearing ear of thresholds at 0.5, 1, 2, and 4 kHz) > 25 dB HL who self-reported their hearing ability to be "good" or "excellent" were categorized as having "unacknowledged" hearing loss. Those who had a PTA > 25 dB HL and who self-reported hearing problems but had never had a hearing test or worn a hearing aid were categorized as having "unaddressed" hearing loss. Multivariate regression was performed to account for confounding due to demographic and health variables. A 10 dB increase in PTA was associated with a 52% increased odds of social isolation among 60- to 69-year-olds in multivariate analyses (p = 0.001). The average Digit Symbol Substitution Test score dropped by 2.14 points per 10 dB increase in PTA (p = 0.03), a magnitude equivalent to the drop expected for 3.9 years of chronological aging. PTA was not associated significantly with falls, hospitalizations, burden of physical or mental health, or depression, or social isolation among those ages 70 years or older in these samples. Unacknowledged or unaddressed hearing loss was associated with a significantly increased risk of social isolation among 60- to 69-year-olds but not those 70 years or older. It was also associated with lower cognitive scores on the Digit Symbol Substitution Test among 60- to 69-year-olds. This study differs from prior studies by focusing specifically on older adults who have unacknowledged or unaddressed hearing loss because they are the most likely to benefit from pure-tone hearing screening. The finding of associations between hearing loss and measures of social isolation and cognition in these specific samples extends previous findings on unrestricted samples of older adults including those who had already acknowledged hearing problems. Future randomized controlled trials measuring the effectiveness of adult hearing screening programs should measure whether interventions have an effect on these measures in those who have unacknowledged or unaddressed pure-tone hearing loss.

Measures of Social Isolation

Social isolation is a deprivation of social connectedness. It is a crucial aspect that continues to be named by people as a core impediment for achieving well-being and as a relevant factor for understanding poverty. However it is not routinely included in surveys that provide data on multidimensional poverty measurement. Although the challenge of measuring social connectedness is daunting, this paper argues that existing research in several fields provides solid ground for the construction of basic internationally comparable indicators that measure specific aspects of social isolation. In particular, this paper synthesises the relevant literature on the measurement of social isolation and related phenomena, and on the basis of this synthetic review, proposes a module of indicators to measure social connectedness that could be feasibly incorporated into an internationally comparable multi-topic household survey.

Social isolation and risk for malnutrition among older people.

Social isolation and loneliness are emerging issues among the geriatric population. The relationships between both, and their impact on health and nutritional status in older people are complex. The purpose of the present study was to evaluate the association between three components of social isolation: social network, feeling of loneliness, commensality and nutritional status. A total of 1200 randomly selected elderly individuals aged ≥65 years and living in rural areas of Lebanon participated in the present study. Data were collected during a face-to-face interview including nutritional status (Mini-Nutritional Assessment), measures of social isolation (Lubben Social Network Scale), subjective loneliness (Jong-Gierveld Loneliness Scale), sociodemographic conditions, and health and functional status. Both social isolation and loneliness were independently associated with a higher risk of malnutrition (OR 1.58, P = 0.011; OR 1.15, P = 0.020, respectively). However no association was found between the frequency of sharing meals and the risk of malnutrition. The present study showed that social isolation and subjective loneliness are two independent risk factors for malnutrition among older people. Geriatr Gerontol Int 2017; 17: 286-294.

Acute Stress among Healthcare Staff during a Public Health Emergency in México

The United Nations through the World Health Organization has shown that crises or disasters can have a profound impact on the population’s physical and mental health(World Health Organization, 2003). In 2009 a new strain of the human influenza virus (AH1N1) appeared and reached pandemic levels, initiating an epidemiological alert in Mexico in April of the same year. Its impact was significant because it was a new subtype of the virus, especially for the severity of the symptoms and number of deaths, which required taking security, hygiene and social isolation measures to reduce the risk of contagion. In critical periods, clear, direct, objective and timely information is the most important preventive measure. However, when the available information is inadequate, depressive or anxious emotional reactions and distress may be observed in risk behaviours among the general population. Straus and collaborators (2004) suggested that during an outbreak, limited availability of information about the disease can have a negative impact on healthcare staff. In addition, Maunder (2004) highlights the importance of effective risk communication. In the case of healthcare providers, when they are overwhelmed by the emergency, the capacity and quality of the service provided may be affected.

Beyond resistance: social factors in the general public response to pandemic influenza.

BackgroundInfluencing the general public response to pandemics is a public health priority. There is a prevailing view, however, that the general public is resistant to communications on pandemic influenza and that behavioural responses to the 2009/10 H1N1 pandemic were not sufficient. Using qualitative methods, this paper investigates how members of the general public respond to pandemic influenza and the hygiene, social isolation and other measures proposed by public health. Going beyond the commonly deployed notion that the general public is resistant to public health communications, this paper examines how health individualism, gender and real world constraints enable and limit individual action.MethodsIn-depth interviews (n = 57) and focus groups (ten focus groups; 59 individuals) were conducted with community samples in Melbourne, Sydney and Glasgow. Participants were selected according to maximum variation sampling using purposive criteria, including: 1) pregnancy in 2009/2010; 2) chronic illness; 3) aged 70 years and over; 4) no disclosed health problems. Verbatim transcripts were subjected to inductive, thematic analysis.ResultsRespondents did not express resistance to public health communications, but gave insight into how they interpreted and implemented guidance. An individualistic approach to pandemic risk predominated. The uptake of hygiene, social isolation and vaccine strategies was constrained by seeing oneself ‘at risk’ but not ‘a risk’ to others. Gender norms shape how members of the general public enact hygiene and social isolation. Other challenges pertained to over-reliance on perceived remoteness from risk, expectation of recovery from infection and practical constraints on the uptake of vaccination.ConclusionsOverall, respondents were engaged with public health advice regarding pandemic influenza, indicating that the idea of public resistance has limited explanatory power. Public communications are endorsed, but challenges persist. Individualistic approaches to pandemic risk inhibit acting for the benefit of others and may deepen divisions in the community according to health status. Public communications on pandemics are mediated by gender norms that may overburden women and limit the action of men. Social research on the public response to pandemics needs to focus on the social structures and real world settings and relationships that shape the action of individuals.

Loneliness and Social Isolation as Risk Factors for Mortality

Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work s, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.