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Loneliness Among Older Veterans in the United States: Results from the National Health and Resilience in Veterans Study

Authors:
  • Psychoanalyst in private practise

Abstract

This study examined the current prevalence, and demographic, military, health, and psychosocial correlates of loneliness in a contemporary nationally representative sample of older U.S. veterans. Two thousand twenty-five veterans aged 60 years and older participated in the National Health and Resilience in Veterans Study. Loneliness was assessed using a questionnaire adapted from the Revised UCLA Loneliness Scale. A broad range of demographic, military, health, and psychosocial variables was also assessed. 44% of veterans reported feeling lonely at least some of the time (10.4% reported often feeling lonely). Greater age, disability in activities of daily living, lifetime traumas, perceived stress, and current depressive and post-traumatic stress disorder symptoms were positively associated with loneliness, and being married/cohabitating, higher income, greater subjective cognitive functioning, social support, secure attachment, dispositional gratitude, and frequency of attending religious services were negatively associated with loneliness. The largest magnitude associations were observed for perceived social support, secure attachment style, and depressive symptoms. Loneliness is prevalent among older veterans in the United States, and associated with several health and psychosocial variables. These results suggest that multifactorial interventions that emphasize bolstering of social support and reduction of depressive symptoms may help mitigate loneliness in the rapidly growing population of older veterans.
Loneliness Among Older
Veterans in the United
States: Results from
the National Health
and Resilience in
Veterans Study
Philipp Kuwert, M.D.,
Christine Knaevelsrud, Ph.D.,
Robert H. Pietrzak, Ph.D., M.P.H.
Objectives: This study examined the current preva-
lence, and demographic, military, health, and psycho-
social correlates of loneliness in a contemporary
nationally representative sample of older U.S. veterans.
Methods: Two thousand twenty-ve veterans aged 60
years and older participated in the National Health
and Resilience in Veterans Study. Loneliness was
assessed using a questionnaire adapted from the
Revised UCLA Loneliness Scale. A broad range of
demographic, military, health, and psychosocial vari-
ables was also assessed. Results: 44% of veterans re-
ported feeling lonely at least some of the time (10.4%
reported often feeling lonely). Greater age, disability in
activities of daily living, lifetime traumas, perceived
stress, and current depressive and post-traumatic stress
disorder symptoms were positively associated with
loneliness, and being married/cohabitating, higher
income, greater subjective cognitive functioning,
social support, secure attachment, dispositional grati-
tude, and frequency of attending religious services
were negatively associated with loneliness. The largest
magnitude associations were observed for perceived
social support, secure attachment style, and depressive
symptoms. Conclusions: Loneliness is prevalent
among older veterans in the United States, and asso-
ciated with several health and psychosocial variables.
These results suggest that multifactorial interventions
that emphasize bolstering of social support and
reduction of depressive symptoms may help mitigate
loneliness in the rapidly growing population of older
veterans. (Am J Geriatr Psychiatry 2013; -:-e-)
Key Words: Loneliness, veterans, old age, PTSD, war,
trauma, correlates
Leading a socially connected life is a core aspect of
human nature.
1
Some individuals, however, may
experience difculties in forming meaningful social
relations, and others may lose them during the course
of their lives through divorce/separation, widow-
hood, or death of relatives and close friends. These
individuals are consequently at greater risk for lone-
liness, which has been dened as perceived social
isolation
2
or a discrepancy between a persons desired
and actual social relationships.
3
Feeling lonely is a common experience in older
persons, with 40% of adults aged 65 years or older
reporting feeling lonely at least sometimes, with this
proportion increasing with age.
2,4,5
Despite the high
prevalence of loneliness in the elderly population,
contemporary geriatric mental health research has
typically focused on characterizing the prevalence
and determinants of major psychiatric disorders, and
has only recent begun to explore factors associated
with broader, more pervasive psychosocial issues
such as loneliness.
4
Several health and psychosocial variables associated
with loneliness have been identied.
2,4
These include
risk variables such as greater medical burden, depres-
sion, and cognitive dysfunction; as well as putative
protective variables, such as greater social support. A
number of other positive psychosocial factors, such as
optimism, resilience, and religiosity, which have been
Received June 28, 2012; revised December 7, 2012; accepted February 15, 2013. From the Ernst-Moritz-Arndt-University Greifswald,
Department of Psychiatry and Psychotherapy at the HELIOS Hansehospital Stralsund (PK), Germany; Treatment Centre for Torture Victims,
and Free University Berlin, Department of Clinical Psychology and Psychotherapy (CK), Berlin, Germany; U.S. Department of Veterans Affairs
National Center for Posttraumatic Stress Disorder, VA Connecticut Healthcare System, and Department of Psychiatry, Yale University, School of
Medicine (RHP), New Haven, CT. Send correspondence and reprint requests to Philipp Kuwert, M.D., Department of Psychiatry and Psycho-
therapy, Ernst-Moritz-Arndt University Greifswald, Rostocker Chaussee 70, D-18437 Stralsund, Germany. e-mail: kuwert@uni-greifswald.de
Supplemental digital content is available for this article in the HTML and PDF versions of this article on the journals Web site (www.
ajgponline.org).
Ó2013 American Association for Geriatric Psychiatry
http://dx.doi.org/10.1016/j.jagp.2013.02.013
Am J Geriatr Psychiatry -:-,-2013 1
identied as protective against psychopathology,
6
may also be negatively related to loneliness, although
no study of which we are aware has examined this
possibility. Characterization of potentially modiable
factors associated with loneliness may help identify
targets for preventive interventions, which may ulti-
mately help reduce the deleterious effect of loneliness
on morbidity and mortality in older persons.
1,4,7
Given their increased risk for psychiatric disorders
and negative behavioral outcomes,
8
older veterans
may be at increased risk for loneliness in later life.
Although data are lacking on the prevalence and
correlates of loneliness in older veterans, available
research has underscored the importance of loneliness
as a predictor of health-related outcomes in this pop-
ulation. For example, one study found that loneliness
is one of the most prominent factors associated with
the reactivation of combat-related post-traumatic
stress disorder (PTSD) in older combat veterans.
9
Another study found that loneliness mediated the
relationship between PTSD and marital adjustment in
elderly combat veterans and former prisoners of war.
10
Although these studies offer some insight into the role
of loneliness in older veterans, they are based on small
and highly selective samples. Research on population-
based samples of older veterans is needed to evaluate
more basic questions regarding the prevalence, and
demographic, military, health, and psychosocial
correlates of loneliness in this population. Character-
ization of factors associated with loneliness may help
identify targets for prevention efforts that may help
mitigate risk for more severe health-related outcomes.
The purpose of the current study was to examine the
prevalence and correlates of loneliness in a large,
contemporary, nationally representative sample of
older U.S. veterans. Correlates examined in relation to
loneliness included those identied as being differen-
tially related to this outcome in prior research,
2,4
as
well as additional factors that have been found to be
protective against psychopathology, such as opti-
mism, resilience, and religiosity.
6
METHODS
Sample
Data were drawn from the National Health and
Resilience in Veterans Study (NHRVS), a nationally
representative study of 3,157 U.S. veterans that was
conducted in October to December 2011. Participants
in the NHRVS completed an anonymous 60-minute
Web survey. The majority of this sample (N ¼2,025;
64.1%) consisted of veterans aged 60 years or older
(mean age: 71.0 years; SD: 7.1; range: 60e96); data
from these respondents were analyzed in this study.
The NHRVS sample was drawn from a research panel
of more than 80,000 households that is developed and
maintained by Knowledge Networks, Inc., a survey
research rm based in Menlo Park, CA. Knowledge
Networks maintains KnowledgePanel, a probability-
based, online non-volunteer access survey panel of
a nationally representative sample of U.S. adults that
covers approximately 98% of U.S. households,
including cell-phoneeonly households. Knowledge
Networks, who rst began recruiting survey panelists
in 1999, established the rst online research panel
based on probability sampling that covered both
online and ofine populations in the United States.
Panel members are recruited through national
random samples, originally by telephone and now
almost entirely by postal mail. Households are
provided with computer hardware and Internet access
if needed. Unlike Internet convenience panels, also
known as opt-inpanels, that include only individ-
uals with Internet access who volunteer themselves
for research, KnowledgePanel recruitment uses dual
sampling frames that includes both listed and unlisted
telephone numbers, telephone and non-telephone
households, cell-phoneeonly households, and house-
holds with and without Internet access. Only persons
sampled through these probability-based techniques
are eligible to participate on KnowledgePanel. Unless
invited to do so as part of these national samples, no
one on their own can volunteer to be part of the panel.
A total of 3,188 individuals in the Knowledge
Networks panel answered Yesto an initial screening
question that conrmed veteran status: Have you
ever served on active duty in the U.S. Armed Forces,
Military Reserves, or National Guard?Of these, 3,157
(99.0%) completed the survey. To permit generaliz-
ability of study results to the entire population of U.S.
veterans, post-stratication weights were applied
based on demographic distributions (i.e., age, gender,
race/ethnicity, education, Census region, and metro-
politan area) from the most contemporaneous
(October 2010) Current Population Survey (U.S.
Census Bureau, 2010).
2 Am J Geriatr Psychiatry -:-,-2013
Loneliness Among Older Veterans in the U.S.
Demographic characteristics of the NHRVS sample
were highly consistent with those observed in prior
population-based surveys of veterans, such as the U.S.
Census Bureau American Community Survey (ACS
11
).
For example, the median age of male veterans in the
NHRVS sample versus the ACS sample were both 64
years; the median age of female veterans was 50 versus
49 years. The proportion of white, non-Hispanic male
veterans was 77.4% versus 82.0%; proportion of white,
non-Hispanic female veterans was 64.6% versus 69.6%.
The proportion of male veterans who completed some
college or higher education was 65.5% versus 60.3%;
proportion of female veterans who completed some
college or higher education was 79.0% versus 77.4%.
Finally, the proportion of male veterans who were
married was 72.3% versus 67.7%; the proportion of
female veterans who were married was 54.7% versus
47.4%. All participants provided informed consent and
the study was approved by the institutional review
board of the VA Connecticut Healthcare System.
Measures
Veterans completed a comprehensive survey con-
taining measures of demographics, military charac-
teristics, and health and psychosocial variables. The
main outcome measure in the current study was
a three-item loneliness questionnaire adapted from the
Revised UCLA Loneliness Scale.
3
This measure
assesses three components of loneliness, including the
extent to which an individual feels left out, isolated, or
that he or she lacks companionship.
12
Each item is
scored as 1(hardly ever); 2(some of the time); or
3(often). These items are summed to yield
a summary loneliness measure (Cronbachs
a
in the
current sample: 0.84). Variables examined in relation to
loneliness are shown in Table 1 and described in detail
in the Supplemental Digital Content (available online).
Data Analysis
Distributions of all variables were examined to
ensure suitability for parametric analysis; non-
normally distributed data (e.g., psychiatric symptom
variables) were transformed using logarithmic base 10
transformations. There were minimal missing item-
level data (<5% across variables); the expectation-
maximization algorithm was used to impute these
missing data prior to analysis. Pearson correlations
were computed to examine associations between
explanatory variables and scores on the summary
measure of loneliness. Explanatory variables associ-
ated with summary loneliness scores at the p less than
0.05 level in bivariate analyses were then entered into
a stepwise linear regression analysis with backward
elimination to identify variables independently asso-
ciated with these scores.
RESULTS
The mean age in the sample was 71.0 years (SD:
7.1, range: 60e96); the majority was male (96.2%);
white, non-Hispanic (84.7%); completed high school
or higher level of education (95.3%); were married/
cohabitating (77.7%) and retired (80.3%); resided in
a metropolitan area (80.8%); and had a household
income less than $60,000/year (60.4%). The majority
of the sample (78.7%) enlisted in the military; served
in the Army (41.2%), Navy (24.9%), or Air Force
(23.9%); and 37.9% were combat veterans.
A total of 929 (weighted percentage: 44.0%)
veterans endorsed a response of some of the timeor
oftenfor one or more of the questions on the three-
item loneliness questionnaire that assessed current
frequency of feeling left out, isolated, or lacking
companionship; 210 (10.4%) endorsed a response of
oftenfor one or more of these questions.
Results of bivariate correlations and linear regres-
sion analysis are shown in Table 1. In the regression
model, 50.9% of the variance in loneliness scores was
explained. Greater age, activities of daily living (ADL)
disability, number of lifetime traumatic events,
perceived stress, and current depressive and PTSD
symptoms were positively associated with loneliness
scores, whereas being married/living with partner,
higher income, greater subjective cognitive func-
tioning, greater number of close friends, greater
perceived social support, secure attachment, disposi-
tional gratitude, and frequency of attending religious
services. The largest magnitude associations were
observed for perceived social support, secure attach-
ment style, and depressive symptoms.
DISCUSSION
Results of this study suggest that loneliness is
prevalent, and associated with several health and
Am J Geriatr Psychiatry -:-,-2013 3
Kuwert et al.
psychosocial variables among older veterans in the
United States. Consistent with previous work in
nonveteran samples,
1,2,4
a total of 44.0% of this sample
reported feeling lonely at least sometimes, and 10.4%
reported feeling lonely often. Further, greater age,
ADL disability, and depressive symptoms were posi-
tively associated with loneliness, whereas greater
subjective cognitive functioning and perceived social
support was negatively associated with this outcome.
Results further suggested that, after adjustment for
these known correlates of loneliness, a greater number
of traumatic events, perceived stress, and PTSD
symptoms were positively associated with loneliness,
whereas secure attachment, dispositional gratitude,
and greater frequency of engagement in religious
services were negatively associated with this outcome.
TABLE 1. Results of Bivariate Correlation and Multivariate Regression Analysis Examining Variables Associated with Loneliness in
Older Veterans (N [2,025)
Scale Used to
Measure Construct
Bivariate Analyses Regression Analysis
r
b
tp
Demographic and military variables
Age e0.07** 0.07*** 4.18 <0.001
Male sex e0.03 eee
White, non-Hispanic ethnicity e0.04 eee
High school or higher education e0.01 eee
Married/living with partner e0.28*** 0.11*** 6.09 <0.001
Currently working e0.01 eee
Household income >$60K e0.10*** 0.04* 2.47 0.013
Metropolitan residence e0.03 eee
Enlisted into military e0.01 eee
Combat veteran e0.05* eee
Medical and cognitive variables
Number of medical conditions e0.15*** eee
Current somatic symptoms BSI-18-Somatization 0.28*** eee
Any ADL disability e0.08** 0.05** 2.90 0.004
Any IADL disability e0.21*** 0.02 0.73 0.47
Cognitive functioning MOS-CFS-R 0.38*** 0.08** 3.04 0.002
Psychiatric variables
Number of lifetime traumatic events THS 0.28*** 0.07*** 3.70 <0.001
Perceived stress PSS-4 0.42*** 0.12*** 5.72 <0.001
Current depressive symptoms PHQ-4 0.49*** 0.18*** 7.99 <0.001
Current PTSD symptoms PCL 0.41*** 0.09* 4.01 <0.001
Current GAD symptoms PHQ-4 0.40*** eee
Alcohol consumption severity AUDIT-C 0.01 eee
Protective psychosocial variables
Resilience CD-RISC-10 0.29*** eee
Optimism LOT-R 0.28*** eee
Number of close friends e0.23*** 0.04* 2.16 0.030
Perceived social support MOS-SSS-5 0.55*** 0.26*** 12.25 <0.001
Secure attachment e0.48*** 0.19*** 9.39 <0.001
Curiosity/Exploration CEI-II 0.21*** eee
Dispositional gratitude GQ-6 0.36*** 0.07** 3.44 0.001
Community Integration e0.34*** eee
Purpose in life PIL-SF 0.38*** eee
Frequency of attending religious activities DUREL 0.19*** 0.04* 2.30 0.021
Frequency of engagement in private spiritual activities DUREL 0.10*** eee
Intrinsic religiosity DUREL 0.13*** eee
Notes: ADL: activity of daily living; IADL: instrumental activity of daily living; PTSD: posttraumatic stress disorder; GAD: generalized
anxiety disorder.
BSI-18-Somatization: Brief Symptom Inventory-18 Somatization subscale; MOS-CFS-R: Medical Outcomes Survey Cognitive Functioning
Scale-Revised; THS: Trauma History Screen; PSS-4: Perceived Stress Scale-4; PHQ-4: Patient Health Questionnaire-4; PCL: PTSD Checklist;
AUDIT-C: Alcohol Use Disorders Identication Test-Consumption; CD-RISC-10: Connor-Davidson Resilience Scale-10; LOT-R: Life Orien-
tation Test-Revised; MOS-SSS-5: Medical Outcomes Survey Social Support Survey-5; CEI-II: Curiosity and Exploration Inventory-II; GQ-6:
Gratitude Questionnaire-6; PIL-SF: Purpose in Life Test-Short Form; DUREL: Duke University Religion Index. Details regarding covariates,
including how they were operationalized and scored, are provided in Supplemental Digital Content (available online). Degrees of freedom
(df) for Pearson rs: 1,809; df for t tests in regression model: 1,708.
Signicant association with scores on summary measure of loneliness: *p <0.05; **p <0.01; ***p <0.001.
4 Am J Geriatr Psychiatry -:-,-2013
Loneliness Among Older Veterans in the U.S.
Although the directionality of the observed asso-
ciations cannot be ascertained on the basis of cross-
sectional data, these results contribute to a growing
body of research concerning the role of putative
protective factors on psychosocial problems such as
loneliness in older persons.
6
The largest magnitude
associations with loneliness were observed for
perceived social support (
b
¼0.26), secure attach-
ment (
b
¼0.19), and depressive symptoms (
b
¼
0.18). Older veterans who have a secure attachment
style may be better able to form lasting relationships
with others and consequently benet from greater
social support. Depressive symptoms, which have
been reciprocally linked to loneliness in longitudinal
studies, may act synergistically to affect emotional
well-being.
13,14
Dispositional gratitude and engage-
ment in religious services were additionally nega-
tively related to loneliness, even after adjustment
for perceived social support, attachment style, and
depressive symptoms. Greater dispositional grati-
tude may be associated with greater ability to
appreciate ones relationships and other positive
aspects of ones life, whereas greater engagement
in religious services may provide veterans with
a broader social network, which may in turn help
prevent loneliness. That a broad range of health
and psychosocial factors were associated with
loneliness underscores the importance of multifacto-
rial approaches to the prevention and treatment of
loneliness in older veterans. Loneliness may arise in
part from a combination of intrinsic traits, such as
dispositional gratitude, extrinsic factors such as social
support and engagement in religious services, and
factors that may combine both such as attachment
style. Longitudinal studies will be useful in teasing
apart directional associations among these variables,
and in identifying optimal strategies for the preven-
tion and treatment of loneliness.
Methodological limitations of this study must be
noted. First, all assessments were obtained via self-
report, so it is unclear if results would differ if
clinician interviews were conducted. Second, recall
bias may have negatively affected responses to
certain questions (e.g., recollection of past traumatic
events). Third, use of a cross-sectional study design
precludes an understanding of the temporal or causal
associations between health and psychosocial vari-
ables associated with loneliness. Fourth, independent
associations between some explanatory variables
such as depressive symptoms and loneliness may, at
least in part, be related to their assessing overlapping
constructs. Nevertheless, prior research has found
that depressive symptoms and loneliness are distinct
constructs; for example, although lonely persons
often present with depression, depressed persons do
not consistently report feeling lonely. Further, prior
longitudinal work has revealed that loneliness and
depressive symptoms are reciprocally related over
time.
13,14
Notwithstanding these limitations, this study is
the rst of which we are aware to characterize the
current prevalence and health and psychosocial
correlates of loneliness in a contemporary, nationally
representative sample of U.S. older veterans. Results
suggest that two out of ve older veterans in the
United States experiences at least some loneliness,
and that in addition to well-known risk factors for
loneliness such as physical and mental health dif-
culties, greater perceived social support, secure
attachment, gratitude, and engagement in religious
services are inversely related with this outcome. The
high prevalence of loneliness observed in this
sample underscores the importance of assessing for
it in healthcare settings, as it may identify older
veterans with or at risk for psychopathology. Addi-
tional research is needed to evaluate temporal and
causal associations among multifarious health and
psychosocial factors associated with loneliness; and
the effect of targeting these factors in psychothera-
peutic interventions
1,15
on mitigation of loneliness in
older veterans, as well as other at-risk elderly
populations.
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6 Am J Geriatr Psychiatry -:-,-2013
Loneliness Among Older Veterans in the U.S.
... Extant studies thus far have largely focused on older Veterans, with results indicating that over 50% of our older Veterans are affected by loneliness, 9 a proportion that is nearly twice as high as the loneliness prevalence reported by civilians. 10,11 This is particularly alarming because older Veterans who reported feeling lonely at least some of the time tended to have more somatic symptoms and medical conditions, 12 and a greater risk of suicidal ideation 9 and other mental health concerns such as PTSD, depression, and anxiety. [12][13][14] Limited research examining younger Veterans also supports the link between loneliness and worse mental health. ...
... 10,11 This is particularly alarming because older Veterans who reported feeling lonely at least some of the time tended to have more somatic symptoms and medical conditions, 12 and a greater risk of suicidal ideation 9 and other mental health concerns such as PTSD, depression, and anxiety. [12][13][14] Limited research examining younger Veterans also supports the link between loneliness and worse mental health. 15,16 Notably, the subjective experience of loneliness in Veterans may serve as a distinct predictor of poor health outcomes, as associations between loneliness, depression, and suicidality have been found to remain even after adjusting for Veterans' perceived social support and social isolation. ...
... 19 However, few studies have examined how negative experiences such as military trauma may influence Veteran loneliness. This is surprising, because studies have found links between PTSD and loneliness in both older and younger Veterans, 12,16 and with 8-25% of Veterans likely to experience PTSD, 20,21 this suggests that a sizeable number of Veterans may be at greater risk for experiencing loneliness. ...
Article
Introduction Loneliness is a powerful predictor of several medical and psychiatric conditions that are highly prevalent in Veterans, including depression and PTSD. Despite this, few studies have examined loneliness in Veterans or how best to intervene upon Veteran loneliness. Additional empirical research is needed in these areas in order to define clear intervention targets and improve Veteran care. Materials and Methods In this pilot study, we used 62 Veterans’ self-reported loneliness and symptoms of post-traumatic stress to examine whether specific symptom clusters of post-traumatic stress were associated with greater loneliness. Post-traumatic stress was measured using the PTSD Checklist for DSM-5, and responses were further parsed into four symptom clusters: intrusions, avoidance, negative alterations in mood and cognition (excluding the social withdrawal item), and alterations in arousal and reactivity. Results Results revealed that only the negative alterations in mood and cognition symptom cluster was associated with increased Veteran loneliness, even after adjusting for sociodemographic factors, social isolation, and symptoms of depression. These analyses were also repeated using a subset of our sample (n = 29) who completed repeated measures of the PTSD Checklist. Results again revealed that the same symptom cluster predicted Veteran loneliness over 1 year later. Conclusions This pilot study demonstrates the value of a publicly available PTSD measure for identifying lonely Veterans and highlights how reducing negative alterations in mood and cognition may serve as a potentially critical target for future Veteran loneliness interventions.
... Previous studies have documented that sociodemographic characteristics, such as being female, older age and unemployment, are linked to people's loneliness during the pandemic [25][26][27][28][29]. Poor mental and physical health, anxiety and depression can increase loneliness [25,30,31]. ...
... Previous studies have documented that sociodemographic characteristics, such as being female, older age and unemployment, are linked to people's loneliness during the pandemic [25][26][27][28][29]. Poor mental and physical health, anxiety and depression can increase loneliness [25,30,31]. Besides, chronic conditions and functional disability have been associated with higher perceived loneliness among older adults [25,26,28,29]. One study demonstrated that more worry about COVID-19 infection and more financial strain because of the pandemic was linked to greater loneliness [32]. ...
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Aims Worldwide, loneliness is one of the most common psychological phenomena among older adults, adversely affecting their physical and mental health conditions during the COVID-19 pandemic. This study aims to assess changes in the prevalence of loneliness in the two timeframes (first and second waves of COVID-19 in Bangladesh) and identify its correlates in pooled data. Methods This repeated cross-sectional study was conducted on two successive occasions (October 2020 and September 2021), overlapping with the first and second waves of the COVID-19 pandemic in Bangladesh. The survey was conducted remotely through telephone interviews among 2077 (1032 in the 2020-survey and 1045 in the 2021-survey) older Bangladeshi adults aged 60 years and above. Loneliness was measured using the 3-item UCLA Loneliness scale. The binary logistic regression model was used to identify the factors associated with loneliness in pooled data. Results We found a decline in the loneliness prevalence among the participants in two survey rounds (51.5% in 2021 versus 45.7% in 2020; P = 0.008), corresponding to 33% lower odds in the 2021-survey (AOR 0.67, 95% CI 0.54–0.84). Still, nearly half of the participants were found to be lonely in the latest survey. We also found that, compared to their respective counterparts, the odds of loneliness were significantly higher among the participants without a partner (AOR 1.58, 95% CI 1.20–2.08), with a monthly family income less than 5000 BDT (AOR 2.34, 95% CI 1.58–3.47), who lived alone (AOR 2.17, 95% CI 1.34–3.51), with poor memory or concentration (AOR 1.58, 95% CI 1.23–2.03), and suffering from non-communicable chronic conditions (AOR 1.55, 95% CI 1.23–1.95). Various COVID-19-related characteristics, such as concern about COVID-19 (AOR 1.28, 95% CI 0.94–1.73), overwhelm by COVID-19 (AOR 1.53, 95% CI 1.14–2.06), difficulty earning (AOR 2.00, 95% CI 1.54–2.59), and receiving routine medical care during COVID-19 (AOR 2.08, 95% CI 1.61–2.68), and perception that the participants required additional care during the pandemic (AOR 2.93, 95% CI 2.27–3.79) were also associated with significantly higher odds of loneliness. However, the odds of loneliness were significantly lower among the participants with formal schooling (AOR 0.71, 95% CI 0.57–0.89) and with a family of more than four members (AOR 0.76, 95% CI 0.60–0.96). Conclusions The current study found a decreased prevalence of loneliness among Bangladeshi older adults during the ongoing pandemic. However, the prevalence is still very high. The findings suggest the need for mental health interventions that may include improving social interactions increasing opportunities for meaningful social connections with family and community members and providing psychosocial support to the vulnerable population including older adults during the pandemic. It also suggests that policymakers and public health practitioners should emphasise providing mental health services at the peripheral level where the majority of older adults reside.
... In contrast to the limited number of reports on loneliness among persons with DSM diagnoses of PTSD, a number of studies have shown a significant correlation between loneliness and severity of post-traumatic stress symptoms (PTSS) (for example, see [34,36,40,45,[56][57][58]). There is also evidence that loneliness significantly contributes to PTSS and loneliness may be a risk factor for later development of PTSD [40,60,61,73,74]. ...
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Prior research suggests that people with Posttraumatic Stress Disorder (PTSD) may experience a form of accelerated biological aging. In other populations, loneliness has been shown to elevate risk for many of the same components of accelerated biological aging, and other deleterious outcomes, as seen in people with PTSD. Although standard diagnostic criteria for PTSD include “feelings of detachment or estrangement from others”, the relationship of such feelings to the concept of loneliness remains uncertain, in par potentially due to a failure to distinguish between loneliness versus objective social isolation. In order to catalyze wider research attention to loneliness in PTSD, and the potential contribution to accelerated biological aging, the present paper provides three components: (1) a conceptual overview of the relevant constructs and potential interrelationships, (2) a review of the limited extant empirical literature, and (3) suggested directions for future research. The existing empirical literature is too small to support many definitive conclusions, but there is evidence of an association between loneliness and symptoms of PTSD. The nature of this association may be complex, and the causal direction(s) uncertain. Guided by the conceptual overview and review of existing literature, we also highlight key areas for further research. The ultimate goal of this line of work is to elucidate mechanisms underlying any link between loneliness and accelerated aging in PTSD, and to develop, validate, and refine prevention and treatment efforts.
... The R-UCLA scale is considered the gold standard for measuring loneliness given (1) its ease of administration, (2) acceptable reliability and validity [56], and (3) ability to measure change over time [56,57]. The prevalence of loneliness in many studies using the R-UCLA indicate feeling lonely "at least some of the time" [58], with a threshold of 44 or greater for the full 20-item UCLA scale [59]. Therefore, it is the scale most often used in studies of loneliness, particularly as those pertaining to SUD [13]. ...
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Loneliness is a significant risk factor for substance use, however, impacts of treatments on loneliness are relatively unexplored. Living in a rural location is a greater risk factor for loneliness. This study examined data from a quasi-experimental study in rural Appalachia, comparing the effectiveness of Mindfulness-Based Relapse Prevention (MBRP) versus Treatment as Usual (TAU) among adults receiving MOUD in outpatient therapy. Our objective was to determine whether observed reductions in self-reported craving, anxiety, depression, and increased perceived mindfulness would also improve loneliness reports. Eighty participants (n = 35 MBRP; n = 45 TAU) were included in the analysis from a group-based Comprehensive Opioid Addiction Treatment program. Outcomes tracked included craving, anxiety, depression, mindfulness, and loneliness as measured by the Revised UCLA Loneliness Scale (R-UCLA). A linear mixed model ANOVA determined the significance of the treatments on changes in loneliness scores at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. Both groups reported significantly reduced loneliness over the course of the study (F = 16.07, p < 0.01), however there were no significant differences between groups. Loneliness was also significantly positively (p < 0.01) correlated with anxiety (0.66), depression (0.59), and craving (0.38), and significantly (p < 0.01) inversely correlated (−0.52) with mindfulness. Results suggest that participation in MOUD group-based outpatient therapy has the potential to diminish loneliness and associated poor psychological outcomes. Thus, it is possible that a more targeted intervention for loneliness would further diminish loneliness, which is important as loneliness is linked to risk for relapse.
... Based on national surveys, 7.68-9.88% of Swedish older adults (aged 70 years) had feelings of loneliness [6], and 11.6% of 2052 home-dwelling older persons (aged 65 years) often felt lonely in Norway [7]. In addition to European countries, studies in the USA also found that the prevalence of loneliness in the elderly population was 26.2% in Chinese immigrants, 43% in people aged 60 years in a nationally representative study, and 44% in elderly veterans [4,8,9]. Similarly, the prevalence of loneliness in older adults was also high, at 38.7% (moderate level of loneliness) and 16.9% (severe level of loneliness), in community-dwelling older adults in Nepal [10]. ...
... Based on national surveys, 7.68-9.88% of Swedish older adults (aged ≥ 70 years) had feelings of loneliness [6], and 11.6% of 2052 home-dwelling older persons (aged ≥ 65 years) often felt lonely in Norway [7]. In addition to European countries, studies in the USA also found that the prevalence of loneliness in the elderly population was 26.2% in Chinese immigrants, 43% in people aged ≥60 years in a nationally representative study, and 44% in elderly veterans [4,8,9]. Similarly, the prevalence of loneliness in older adults was also high, at 38.7% (moderate level of loneliness) and 16.9% (severe level of loneliness), in community-dwelling older adults in Nepal [10]. ...
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Loneliness has become one of the most common psychological problems experienced by older adults. Previous studies have indicated that loneliness is correlated with poor physical and psychological health outcomes; therefore, it is important to pay attention to people experiencing loneliness. However, there is a lack of information regarding the prevalence of loneliness, and its associated factors, among community-dwelling older adults in Indonesia, which this study aimed to understand. This study used a cross-sectional, descriptive, and correlational research design. Stratified random sampling was applied to 1360 participants, aged ≥ 60 years, in 15 community health centers in Kendari City, Indonesia. The following questionnaires were used to collect data, including demographic and characteristic information, Short Portable Mental Status Questionnaire, Multidimensional Scale of Perceived Social Support, Geriatric Depression Scale Short Form, and a single-item loneliness question. The prevalence of loneliness among older adults was 64.0%. The multivariate logistic regression showed that older adults who were female, lived with family, had fewer children, had a poor health status, had a poor oral status, had more chronic diseases, had no hearing problems, had poor cognitive function, and had depression had a higher chance of feeling lonely. Loneliness is a serious health issue among the older population in Indonesia. The government, social workers, and healthcare professionals should pay immediate attention to this psychological problem. The study also suggests that appropriate strategies for the prevention of loneliness should be developed in the near future.
... Related to these and other factors, 42% of US adults reported gaining unwanted weight during the pandemic, with an average gain of 29 pounds (8). With high rates of mental health conditions, food insecurity, and limited social support, veterans may be especially vulnerable to COVID-19-related behavior change and weight gain (14)(15)(16)(17)(18). Weight management programs, including MOVE!, may need to incorporate additional strategies to help participants overcome the challenges to modifying health behaviors in the context of heightened pandemic-related stress and anxiety (19). ...
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... This relationship has been investigated in various racial/ethnic groups across different countries. 54,55 However, the results have been inconsistent with some studies showing similar results with our study while others finding no associations. 56 The associations between receipt of social support and the absence of feelings of loneliness in this study was in the expected direction, but it was not statistically significant. ...
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The present study examined the main and interactive effects of relationship-specific (i.e., spouses, friends, parents, and children) social support and strain on positive (happiness and well-being) and negative (loneliness and depressive symptoms) psychological well-being, and whether the associations varied by age and gender. A dataset was collected from 1033 adults (20–69 years; 50.1% female) from South Korea regarding social support and strain and indicators of psychological well-being. Results revealed that spousal and friend support was associated with enhanced happiness and well-being and reduced loneliness, whereas spousal and friend strain was associated with heightened depressive symptoms. Relationship-specific social support and strain showed interactive effects. Social support from parents and spouses buffered the adverse effects of social strain on psychological well-being, but their protective effects diminished when they experienced high levels of parental or spousal strain. These patterns were dependent on age and gender, with protective effects of friend support being greater for younger adults and women than for older adults and men.
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The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.
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We examine and refine the Fagerström Tolerance Questionnaire (FTQ; Fagerström, 1978). The relation between each FTQ item and biochemical measures of heaviness of smoking was examined in 254 smokers. We found that the nicotine rating item and the inhalation item were unrelated to any of our biochemical measures and these two items were primary contributors to psychometric deficiencies in the FTQ. We also found that a revised scoring of time to the first cigarette of the day (TTF) and number of cigarettes smoked per day (CPD) improved the scale. We present a revision of the FTQ: the Fagerström Test for Nicotine Dependence (FTND).
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Although depression is the strongest predictor for the full spectrum of suicidal ideation, several other mental disorders, eg, posttraumatic stress disorder (PTSD), are associated with suicidal ideation too. This study investigates whether suicidal ideation is specifically associated with PTSD or if this association is fully or partially mediated by comorbid depressive disorders. A representative sample of 1,659 people aged 60-85 years from the German general population was examined by using self-rating instruments for PTSD, depression, and suicidal ideation in May and June 2008 in a cross-sectional study. Participants were diagnosed with PTSD when they met criteria A, B, C, and D for PTSD according to DSM-IV-TR. Suicidal ideation was used as the primary outcome measure. In our sample, 7.3% of subjects reported suicidal ideation within the last 2 weeks. Suicidal ideation was associated with a higher number of traumatic experiences (mean = 1.13 vs 0.78; t = -3.20; P ≤ .001) and prevalence of PTSD (12.4% vs 3.4%, χ2 = 23.39, P < .001) than in subjects without suicidal ideation. In logistic regression analyses including age and sex, traumatic experiences were associated with suicidal ideation (OR = 1.16, P = .011). After including PTSD in the model, this association was fully explained by PTSD. Moreover, PTSD was associated with suicidal ideation (OR = 3.33, P < .001), but after including depression in the model, the association of PTSD and suicidal ideation was fully mediated by depression (OR = 1.61, P < .001). The results of our study indicate that PTSD is associated with suicidal ideation, but this association was fully explained by comorbid depressive symptoms in the elderly general population. Thus, screening for depressive symptoms as well as administering an appropriate therapy seems the best way to prevent suicide attempts in the elderly, even in those patients with traumatic experiences and/or PTSD.
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Objective The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989–93).Methods Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres.ResultsStockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study. Copyright © 2001 John Wiley & Sons, Ltd.
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Background: The United States military has lost more troops to suicide than to combat for the second year in a row and better understanding combat-related risk factors for suicide is critical. We examined the association of killing and suicide among war veterans after accounting for PTSD, depression, and substance use disorders. Methods: We utilized a cross-sectional, retrospective, nationally representative sample of Vietnam veterans from the National Vietnam Veterans Readjustment Study (NVVRS). In order to perform a more in depth analysis, we utilized a subsample of these data, the NVVRS Clinical Interview Sample (CIS), which is representative of 1.3 million veterans who were eligible for the clinical interview by virtue of living in proximity to an interview site, located within 28 standard metropolitan regions throughout the United States. Results: Veterans who had higher killing experiences had twice the odds of suicidal ideation, compared to those with lower or no killing experiences (OR = 1.99, 95% CI = 1.07-3.67), even after adjusting for demographic variables, PTSD, depression, substance use disorders, and adjusted combat exposure. PTSD (OR = 3.42, 95% CI = 1.09-10.73), depression (OR = 11.49, 95% CI = 2.12-62.38), and substance use disorders (OR = 3.98, 95% CI = 1.01-15.60) were each associated with higher odds of suicidal ideation. Endorsement of suicide attempts was most strongly associated with PTSD (OR = 5.52, 95% CI = 1.21-25.29). Conclusions: Killing experiences are not routinely examined when assessing suicide risk. Our findings have important implications for conducting suicide risk assessments in veterans of war. Depression and Anxiety 00:1-6, 2012. © 2012 Wiley Periodicals, Inc.
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The relationships between military service and suicide are not clear, and comparatively little is known about the characteristics and correlates of suicide ideation and attempts among those with history of military service. We used data from a national health survey to estimate the prevalence and correlates of suicidal behaviors among veterans and service members in 2 states. The prevalence of suicidal behaviors among Veterans was similar to previous estimates of ideation and attempts among adults in the US general population.
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Suicide crisis lines have a respected history as a strategy for reducing deaths from suicide and suicidal behaviors. Until recently, however, evidence of the effectiveness of these crisis lines has been sparse. Studies published during the past decade suggest that crisis lines offer an alternative to populations who may not be willing to engage in treatment through traditional mental health settings. Given this promising evidence, in 2007, the Department of Veterans Affairs in collaboration with the Department of Health and Human Services' Substance Abuse and Mental Health Administration implemented a National Suicide Hotline that is staffed 24 hours a day, 7 days a week, by Veterans Affairs clinical staff. We report here on the implementation of this suicide hotline and our early observations of its utilization in a largely male population.