Article

Loneliness in middle age and biomarkers of systemic inflammation: Findings from Midlife in the United States

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Abstract

Objective: Middle-aged adults who are lonely have an elevated likelihood of death. Systemic inflammation may contribute to these increased odds. Using population-level data, this study tested if systemic inflammation is associated with loneliness in a broad age range of middle-aged adults in the United States. Methods: This study used data from the Midlife in the US (MIDUS) survey Biomarker Project, which collected data on psychological, social, and physiological measures from a sample of middle-aged adults. This sample included the 927 participants who were 35-64 years at Biomarker Project data collection. MIDUS collected baseline data from 1995-1996 and a follow-up survey was conducted from 2004-2006. The baseline Milwaukee sample of African Americans was collected in 2005-2006 and the biomarker database was collected in 2004-2009. Biomarkers were obtained from a fasting blood sample. Self-reported loneliness was categorized as feeling lonely or not feeling lonely. Hierarchical regressions examined the association between biomarkers of systemic inflammation (interleukin-6, fibrinogen, C-reactive protein) and feeling lonely, adjusted for covariates. Results: Twenty-nine percent of the sample reported feeling lonely most or some of the time. There was a positive significant relationship between loneliness and the three systemic inflammation biomarkers after controlling for covariates: interleukin-6 (n = 873) (b [se] = 0.07 [0.03], p = .014); fibrinogen (n = 867) (b [se] = 18.24 [7.12], p = .011); and C-reactive protein (n = 867) (b [se] = 0.08 [0.04], p = .035). Conclusions: Feeling lonely is associated with systemic inflammation in middle-aged community-dwelling US adults.

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... IL-6 levels have been found positively associated with loneliness in multiple studies [43,[66][67][68][69][70][71][72][73]. The cytokine has been described to have pleiotropic activity, as it promotes the production of acute-phase reactants such as CRP, fibrinogen, serum amyloid A and hepcidin in hepatocytes, and inhibits albumin synthesis [74]. ...
... CRP has been associated with the induction of atherosclerosis, as well as having an antiinflammatory function in autoimmunity [85]. CRP levels were found positively associated with loneliness [42,70,72,86]. ...
... It was found to increase autoimmune reactions, through the presentation of antigens and the release of chemokines [87]. Fibrinogen was found both positively [70,88], and negatively [89], associated with loneliness. In other studies, no association was found with loneliness and fibrinogen [67,90]. ...
Article
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Loneliness has been defined as an agonizing encounter, experienced when the need for human intimacy is not met adequately, or when a person’s social network does not match their preference, either in number or attributes. This definition helps us realize that the cause of loneliness is not merely being alone, but rather not being in the company we desire. With loneliness being introduced as a measurable, distinct psychological experience, it has been found to be associated with poor health behaviors, heightened stress response, and inadequate physiological repairing activity. With these three major pathways of pathogenesis, loneliness can do much harm; as it impacts both immune and metabolic regulation, altering the levels of inflammatory cytokines, growth factors, acute-phase reactants, chemokines, immunoglobulins, antibody response against viruses and vaccines, and immune cell activity; and affecting stress circuitry, glycemic control, lipid metabolism, body composition, metabolic syndrome, cardiovascular function, cognitive function and mental health, respectively. Taken together, there are too many immunologic and metabolic manifestations associated with the construct of loneliness, and with previous literature showcasing loneliness as a distinct psychological experience and a health determinant, we propose that loneliness, in and of itself, is not just a psychosocial phenomenon. It is also an all-encompassing complex of systemic alterations that occur with it, expanding it into a syndrome of events, linked through a shared network of immunometabolic pathology. This review aims to portray a detailed picture of loneliness as an “immunometabolic syndrome”, with its multifaceted pathology.
... Stress and troubled interpersonal connections could possibly heighten inflammatory responses synergistically (Jaremka et al., 2013a). Pro-inflammatory cytokines such as TNFα (Moieni et al., 2015;Jaremka et al., 2013b), IL-6 ( Moieni et al., 2015;Jaremka et al., 2013b;Smith et al., 2020a;Hackett et al., 2012;Theeke et al., 2016;Nersesian et al., 2018;Balter et al., 2019;Loucks et al., 2006) and acute-phase reactants such as CRP (Nersesian et al., 2018;Loucks et al., 2006;Vingeliene et al., 2019), fibrinogen (Nersesian et al., 2018;Steptoe et al., 2004;Mezuk et al., 2016) and IL-1RA (Hackett et al., 2012) levels have been found significantly affected by loneliness. ...
... Stress and troubled interpersonal connections could possibly heighten inflammatory responses synergistically (Jaremka et al., 2013a). Pro-inflammatory cytokines such as TNFα (Moieni et al., 2015;Jaremka et al., 2013b), IL-6 ( Moieni et al., 2015;Jaremka et al., 2013b;Smith et al., 2020a;Hackett et al., 2012;Theeke et al., 2016;Nersesian et al., 2018;Balter et al., 2019;Loucks et al., 2006) and acute-phase reactants such as CRP (Nersesian et al., 2018;Loucks et al., 2006;Vingeliene et al., 2019), fibrinogen (Nersesian et al., 2018;Steptoe et al., 2004;Mezuk et al., 2016) and IL-1RA (Hackett et al., 2012) levels have been found significantly affected by loneliness. ...
... Stress and troubled interpersonal connections could possibly heighten inflammatory responses synergistically (Jaremka et al., 2013a). Pro-inflammatory cytokines such as TNFα (Moieni et al., 2015;Jaremka et al., 2013b), IL-6 ( Moieni et al., 2015;Jaremka et al., 2013b;Smith et al., 2020a;Hackett et al., 2012;Theeke et al., 2016;Nersesian et al., 2018;Balter et al., 2019;Loucks et al., 2006) and acute-phase reactants such as CRP (Nersesian et al., 2018;Loucks et al., 2006;Vingeliene et al., 2019), fibrinogen (Nersesian et al., 2018;Steptoe et al., 2004;Mezuk et al., 2016) and IL-1RA (Hackett et al., 2012) levels have been found significantly affected by loneliness. ...
Article
The emergence of the novel coronavirus (SARS-CoV-2) and the worldwide spread of the coronavirus disease (COVID-19) have led to social regulations that caused substantial changes in daily life. The subsequent loneliness and concerns of the pandemic during social distancing, quarantine, and lockdown are psychosocial stressors that negatively affect the immune system. These effects occur through mechanisms controlled by the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenocortical (HPA) axis that alter immune regulation, namely the conserved transcriptional response to adversity (CTRA), which promotes inflammation and diminishes antiviral responses, leading to inadequate protection against viral disease. Unhealthy eating habits, physical inactivity, sleep disturbances, and mental health consequences of COVID-19 add to the pathological effects of loneliness, making immunity against this lethal virus an even tougher fight. Therefore, social isolation, with its unintended consequences, has inherently paradoxical effects on immunity in relation to viral disease. Though this paradox can present a challenge, its acknowledgment can serve as an opportunity to address the associated issues and find ways to mitigate the adverse effects. In this review, we aim to explore, in detail, the pathological effects of the new social norms on immunity and present suggested methods to improve our physical, psychological, and healthcare abilities to fight a viral infection in the context of the COVID-19 pandemic.
... Lastly, loneliness could elicit heightened low-grade systemic inflammation, through elevating c-reactive protein (CRP). 24,25 Apart from having significant associations with loneliness, these biomarkers have also been shown to be risk factors for and precede CI and dementia onset. [16][17][18]26,27 On the other hand, contradictory empirical and meta-analytic findings separately associating loneliness with biomarkers and CI persist in the literature, with some studies showing non-significant associations. ...
... However, it is noteworthy that many of the evidence were gleaned from studies of cross-sectional nature. [19][20][21][22][23][24][25] In our study, we validated the presence of significant cross-sectional associations between all biomarkers separately with loneliness and cognitive status (see Table 2-correlation matrix of main variables). However, in the model without covariates, except HbA1C, loneliness did not have significant prospective associations with all four other biomarkers. ...
Article
BACKGROUND Loneliness precedes the onset of cognitive impairment (CI) in older adults. Although the mechanisms through which loneliness “gets under the skin” to influence the risk of developing CI has been conceptually proposed, they are rarely empirically examined. The Evolutionary Theory of Loneliness posits that loneliness as a stressor could cause dysregulations in multiple physiological systems. The current study investigated whether inflammatory, cardiovascular, and kidney biomarkers mediate the longitudinal association between loneliness and CI. METHODS Cross-lagged panel models (CLPM) were used to examine the hypothesized relationships, using 2006, 2010, and 2014 waves of data from the Health and Retirement Study (N=7,037). Loneliness was measured with the 3-item UCLA loneliness scale. CI was assessed with the modified telephone interview for cognitive status. Biomarkers included HbA1C, LDL cholesterol, HDL cholesterol, CRP, and Cystatin C. Using a stepwise model-building approach, first, the model included only loneliness, CI, and biomarker variables; then, sociodemographic covariates were added; lastly, health and behavioral covariates were controlled for. RESULTS In unadjusted and partially adjusted models, loneliness was associated with higher odds of worse cognitive status in an 8-year follow-up. Only HbA1C mediated the longitudinal association between loneliness and CI. However, after further controlling for health status, all associations became non-significant. CONCLUSIONS Examining a large number of participants and linking a limited number of biological markers with cognition and loneliness longitudinally, our empirical data did not support theoretical propositions, highlighting the critical importance of controlling for confounders in future studies examining longitudinal mediational relationships underlying loneliness and CI.
... However, findings from studies linking loneliness to systemic, circulating inflammatory markers are less consistent. Some studies have reported significant associations between loneliness and higher circulating (basal) levels of inflammatory markers (Nersesian et al., 2018;Zilioli and Jiang, 2021), but there are also null findings in this literature (Hackett et al., 2012;Mezuk et al., 2016;Zilioli and Jiang, 2021). A recent meta-analysis found that a significant association between loneliness and circulating IL-6 levels has been observed consistently, whereas associations between loneliness and C-reactive protein (CRP) or fibrinogen have not been consistent (Smith et al., 2020). ...
... (or, in exploratory analyses, with individual cytokines). Our findings are in contrast to past work linking loneliness to higher cytokine levels during midlife (Nersesian et al., 2018) and past null findings with CRP for adults ages 18-85 years old (for meta-analysis, see: Smith et al., 2020). However, our results are in line with past longitudinal work that has found significant associations between trait loneliness and CRP among different age samples [50-99 years: (Vingeliene et al., 2019) and 50-67 years: (Cole et al., 2007)]. ...
Article
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Loneliness has been linked to poor mental and physical health outcomes. Past research suggests that inflammation is a potential pathway linking loneliness and health, but little is known about how loneliness assessed in daily life links with inflammation, or about linkages between loneliness and inflammation among older adults specifically. As part of a larger investigation, we examined the cross-sectional associations between loneliness and a panel of both basal and LPS-stimulated inflammatory markers. Participants were 222 socioeconomically and racially diverse older adults (aged 70–90 years; 38% Black; 13% Hispanic) systematically recruited from the Bronx, NY. Loneliness was measured in two ways, with a retrospective trait measure (the UCLA Three Item Loneliness Scale) and an aggregated momentary measure assessed via ecological momentary assessment (EMA) across 14 days. Inflammatory markers included both basal levels of C-reactive protein (CRP) and cytokines (IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α) and LPS-stimulated levels of the same cytokines. Multiple regression analyses controlled for age, body-mass index, race, and depressive symptoms. Moderation by gender and race were also explored. Both higher trait loneliness and aggregated momentary measures of loneliness were associated with higher levels of CRP (β = 0.16, p = 0.02; β = 0.15, p = 0.03, respectively). There were no significant associations between loneliness and basal or stimulated cytokines and neither gender nor race were significant moderators. Results extend prior research linking loneliness with systemic inflammation in several ways, including by examining this connection among a sample of older adults and using a measure of aggregated momentary loneliness.
... El aislamiento social percibido induce una mayor reactividad al estrés, que se asocia a una activación prolongada del eje hipotálamo-hipofisario-adrenal (HHA), entre otros. Dicha alteración conduce a problemas de sueño, alteraciones en el sistema inmunológico, aumento de los niveles de estrés oxidativo y sobreexpresión de genes proinflamatorios Darweesh et al., 2018;Nersesian et al., 2018). Además, publicaciones recientes han aportado evidencias sobre los mecanismos genéticos que vinculan la soledad y · Las personas se pueden sentir atrapadas por las limitaciones físicas que la fragilidad impone, lo que hace que se «plieguen» hacia dentro de sí mismas, aumentando su percepción de soledad. ...
... Como resumen de este apartado, podemos decir que se observan marcadores de inflamación elevados en personas que experimentan sensación de soledad, siendo estos la PCR, el fibrinógeno, el FNT-α y, también, la interleucina 6 (Nersesian et al., 2018). Estos marcadores también han sido vinculados a la presencia de la fragilidad física y a la aparición de enfermedades crónicas altamente prevalentes en los adultos mayores. ...
... Some research finds that inflammation mediates the association between social integration and health (Uchino et al., 2018). However, this association varies by subpopulations such as race/ethnicity (Nersesian et al., 2018). Despite this scholarly work, studies that examine the relationship between social integration, inflammation, and depressive symptoms have mixed findings and have not yet considered variation by race/ethnicity. ...
... The association between social integration and inflammation differs by gender (Y. C. Yang et al., 2013), age (Ford et al., 2006), and race (Nersesian et al., 2018). ...
Article
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This study evaluates whether the associations between social integration, inflammation, and depressive symptoms vary by race/ethnicity in the United States. Our study includes 5,634 respondents age 40 and older from the National Health and Nutrition Examination Survey for 2005-2008. We fit multivariate logistic regression models with interactions between C-reactive protein (CRP) and race/ethnicity as well as social integration and race/ethnicity to test our hypotheses. We find that social integration and CRP operate independently in their associations with depressive symptoms by race/ethnicity. Higher levels of social integration are associated with lower predicted probability of depressive symptoms for White and Black populations. This association is not statistically significant for the Hispanic population. CRP is associated with depressive symptoms for the White population, but not the Black or Hispanic populations. Our results suggest that studying depressive symptoms, and other mental health outcomes, among the US population without considering variation by race/ethnicity may restrict scholarly understanding of health disparities. Population-based assessments of associations between physiological processes or social integration should consider whether these variables operate differently by race/ethnicity and work to explain why differences may emerge. Furthermore, interventions aimed at social integration may improve mental health among older adults in the United States; especially for the least socially integrated.
... Loneliness was measured using a signaling question ("Do you experience feelings of loneliness?"), This measurement method has been widely used in studies worldwide as a quick measure of loneliness [43][44][45]. There were four answers to the question: (1) none, (2) rarely, (3) sometimes, and (4) often. ...
Article
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Strong relationship exists between loneliness and depression in older adults. However, the effect of multifaceted social relationships on the relationship between loneliness and depression has not been explored. The purpose of the current study was to find out how multifaceted social relationships affect the aforementioned processes. We investigated and evaluated the loneliness status, depression symptoms, social relationships, and demographic information of 1116 older adults aged ≥65 years living in rural Japan. The final 555 participants were included in the analysis. Statistical evidence showed a direct effect between loneliness and depression symptoms. Additionally, the mediation model found that social curiosity and participation acted as mediators between loneliness and depression symptoms. Further, independence and participation, independence, and feeling safe played a conditional moderating role in the model of loneliness–social curiosity–depression symptoms and loneliness–participation–depression symptoms, respectively. Interaction can be an individual moderator in the link between loneliness and depression symptoms without any mediator. The moderated mediation model suggests that social curiosity and participation could mediate the association between loneliness and depression symptoms. In this process, independence, participation, and feeling safe may act as moderators.
... At a deeper physiological level, inflammatory processes may provide a logical link between loneliness and accelerated aging in PTSD. Elevated inflammatory indices such C-reactive protein (CRP), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNFα), have been found associated with loneliness [107][108][109][110] and with PTSD [111][112][113][114][115][116][117][118][119][120][121][122][123][124][125][126]. The same is true of elevated indices of oxidative damage [127][128][129]. ...
Article
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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.
... Research that has examined the relationship between loneliness and physical health has found that somatic complaints, sleep disturbances (Cacioppo et al., 2002;Cacioppo et al., 2015), fatigue (Jaremka et al., 2014), poorer cardiovascular functioning (Cacioppo et al., 2002) and chronic illness (Petitte et al., 2015) have all been found to be associated with higher levels of loneliness. This relationship is potentially explained by lonely individuals exhibiting higher systemic inflammation biomarkers (see Nersesian et al., 2018). Similarly, loneliness has been associated with poor health behaviours (e.g., substance use, smoking, less exercise, poor nutrition) (Christiansen et al., 2016;Stickley et al., 2013). ...
Chapter
In this chapter, we discuss two conceptualisations of loneliness: a singular construct and a multidimensional construct that can be experienced in both social and emotional forms. Based on these two views of loneliness, we discuss measurement approaches and difficulties capturing loneliness, which can be a highly subjective experience. We review two key theories that may help to explain how loneliness arises, is maintained and may be overcome. These are cognitive theories of loneliness and the social identity approach. The chapter goes on to highlight the significant physical and mental health implications of loneliness, including proposed mechanisms by which health affects loneliness and conversely how loneliness can affect health. Finally, we discuss research about the relationship between loneliness and various forms of psychopathology, including depression, anxiety, psychosis and substance use disorders. Empirical studies are reviewed throughout, and clinical implications of this evidence are highlighted.
... This finding is consistent with the results reported in a recent meta-analytic review (e.g., Smith et al., 2020). The excessive inflammation associated with the lonely phenotype has also been verified by Nersesian et al. (2018) in a large prospective study. Two papers in this collection focused on the behavioral and endocrine-immune effects of early-life social isolation in rodents (prairie voles) with (Sailer et al.) or without (Donovan et al.) concomitant exposure to a chronic stressor. ...
... and pain (Lee et al., 2019;Park et al., 2020;Santos-Orlandi et al., 2019). In addition, loneliness promotes inflammation and is correlated with increased synthesis of proinflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in adults exposed to acute stress (Jarmka, et al., 2013;Nersesian et al., 2018). Moreover, the association of loneliness and mortality has been well-documented; there is an estimated 26% and 29% increased likelihood of death for those reporting loneliness and social isolation, respectively (Holt-Lunstad et al., 2015). ...
Article
Older adults are at an increased risk of loneliness. Many also serve as informal caregivers for persons with dementia and other disabling conditions, further predisposing them to loneliness. The primary objective was to assess current loneliness interventions for caregivers to inform development of effective therapies to improve their quality of life. An integrative review of the literature was conducted using five electronic databases and 12 studies were included for further analysis. Data were extracted regarding the type of intervention implemented, caregiver characteristics, and intervention effects. Five main intervention types emerged: mindful meditation, computer applications, music therapy, peer support, and community programs. Most care recipients had dementia, and most caregivers were spouses. Peer support was the most frequently utilized intervention, and common intervention strategies included providing emotional support, expanding one's social network, and supplying psychoeducational materials. Most interventions had methodological limitations and demonstrated small effect sizes. Hence, there remains a continued need for well-designed interventions that target loneliness in informal caregiver. Caregivers may benefit from interventions that expand their social network to improve their emotional regulation and understanding of their role. Further research on the role of group versus individual therapy is necessary to strengthen interventions and broaden their application.
... Personality characteristics, such as neuroticism, have been shown to increase the risk of loneliness and to moderate the risk of depression [9,10]. In addition, greater loneliness is associated with higher levels of Interleukin-6(IL-6), C-reactive protein (CRP) [11], and lower responsivity of cortisol [12]. Higher levels of Il-6, CRP, and dysregulation of the cortisol response are linked with cardiovascular disease and depression [13]. ...
Article
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Purpose Loneliness is a subjective feeling by which an individual perceives a lack of closeness in interpersonal relationships. An isolated living status is linked with higher odds of risky health behavior. The conflicting impacts of loneliness and isolated living status on stress-related biomarkers, depressive symptoms, and disability remain unexplained. Methods Six hundred twenty-nine participants aged 66.0 (SD=7.3) separated into four groups: “Lonely and Isolated,” “Not Lonely, but Isolated,” “Lonely, but Not Isolated,” and “Neither Lonely, nor Isolated,” were retrieved from the Social Environment and Biomarkers of Aging Study conducted in 2000. Follow-up health indicators in 2006 included three stress-related biomarkers, depressive symptoms, and two physical disability indicators. A hierarchical regression was performed for the analysis. Results Firstly, compared to the “Neither Lonely nor Isolated” group, only the “Lonely, but Not Isolated” participants at baseline retained positive associations with the stress-related biomarkers levels 6 years later (urine cortisol level (B=9.25, 95% CI=3.24-15.27), serum Interleukin-6 level (B=2.76, 95% CI=0.72-4.79) and the serum high sensitivity C-reactive protein (hsCRP) level (B=0.40, 95% CI=0.17-0.62)). However, such associations were not observed in the “Lonely and Isolated” participants. Secondly, only “Lonely and Isolated” participants at baseline were positively associated with depressive symptoms 6 years later (B=1.70, 95% CI=0.11-3.30). Finally, the associations between combinations of loneliness and isolated living status and physical disability were eliminated after adjusting the covariables. Conclusion Four combinations of loneliness and isolated living status were associated with different impacts on stress-related biomarkers, depressive symptoms, and physical disability. Further dynamic investigations are warranted.
... Most of the studies with biomarkers and health interventions focus on high-income countries and cover a wide range of purposes and methods [23][24][25][26][27][28][29][30][31][32]. This study aimed to contribute to a better understanding of the channels by which the ESF program affects individual health in Brazil using the results of the laboratory tests described above. ...
Article
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Background Although the use of biomarkers to assess health outcomes has recently gained momentum, literature is still scarce for low- to middle-income countries. This paper explores the relationship between primary care coverage and individual health in Brazil using a dataset of blood-based biomarkers collected by the Brazilian National Health Survey. Both survey data and laboratory results were crossed with coverage data from the Family Health Strategy (ESF) program, the most important primary care program in Brazil; the coverage measures aim to capture both direct (household) and indirect (spill-over) effects. Methods The empirical strategy used a probit model to estimate the relationship between ESF program coverage and the likelihood of abnormal biomarker levels while controlling for a rich set of individual and household characteristics based on data from the national survey. Results Household ESF coverage was associated with a lower likelihood of abnormal results for biomarkers related to anemia (marginal effect between − 2.16 and − 2.18 percentage points), kidney failure (between − 1.01 and − 1.19 p.p.), and arterial hypertension (between − 1.48 and − 1.64 p.p). The likelihood of abnormal levels of white blood cells and thrombocytes was negatively related to primary care coverage (marginal effect between − 1.8 and − 2 p.p.). The spillover effects were relevant for kidney failure and arterial hypertension, depending on the regional level. Although not sensitive to household coverage, diabetes mellitus was negatively associated with the state supply of primary care, and abnormal cholesterol levels did not present any relationship with ESF program coverage. Conclusions The presence of spillover effects of ESF program coverage regarding these conditions reveals that the strengthening of primary care by increasing the household registration and the regional density of ESF teams is an efficient strategy to address important comorbidities.
... Sustained activation of the sympathetic adrenal medullary system resulting in overexposure to epinephrine and norepinephrine contributes to the development of CVD (Lundberg 1999). Loneliness also raises the levels of three systemic inflammation biomarkers (Nersesian et al. 2018), interleukin-6, fibrinogen, and C-reactive protein (Smith et al. 2020). Studies have found alterations in inflammatory gene expression (Powell et al. 2013), with genes responsible for anti-inflammatory glucocorticoid response elements being under-expressed, and genes bearing response elements for pro-inflammatory NF-κB/Rel transcription factors, being over-expressed (Cole et al. 2007). ...
Article
Loneliness is a silent social epidemic that affects more than one third of the US population. Cardiovascular diseases impart a huge morbidity, mortality, and financial burden on our society. The detrimental role of loneliness in cardiovascular diseases is being increasingly recognized. Besides having a direct molecular effect on cardiovascular diseases, loneliness also encourages poor compliance with healthy lifestyles, that play a significant role in preventing and improving cardiovascular diseases. This brief review highlights the ominous effects of loneliness on cardiovascular diseases.
... To test the potential physical health implications of social media use for HSEs and LSEs, the present research focused on systemic inflammation as a key health indicator. The reason to focus on inflammation is that chronic psychological stress, such as experienced by LSEs relative to HSEs when using social media, can lead to elevated levels of systemic inflammation over time (Johnson et al., 2013;Nersesian et al., 2018;Walker et al., 2019). Such inflammation is a potent driver of diseases such as cardiovascular disease, cancers, and diabetes (Emerging Risk Factors Collaboration, 2010;Kiecolt-Glaser et al., 2010;Uchino et al., 2018;Zhou et al., 2012). ...
Article
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Social media use has become an important part of social life. However, little is known about its relation to physical health. Extending prior work on social media use and psychological well-being, the present research investigated how social media use is associated with a key indicator of health, systemic inflammation. Based on research on self-esteem and work on inflammation, the current study examined whether the link between social media use and inflammatory biomarkers would be moderated by self-esteem. A nationally probablistic sample of middle-aged adults (N = 863) completed self-report questionnaires on social media use, self-esteem, socio-demographic information, and health related behaviors. Approximately two years later, they provided a blood sample that was analyzed for C-reactive protein (CRP) and interleukin-6 (IL-6), biomarkers of systemic inflammation. Consistent with our hypothesis, self-esteem moderated the association between social media use and these markers of inflammation. Specifically, as self-esteem decreased, the positive association of social media use with CRP and IL-6 became stronger. These results held after controlling for socio-demographic information, health status, depressive symptoms, and medication usage. Social media use was not significantly correlated with either CRP or IL-6. The present research demonstrates physical health correlates of social media use and suggests self-esteem as a key variable that can moderate the relation between social media use and health.
... Similarly, the Framingham Offspring Study group by Kim [12]. In addition, Nersesian et al. found high fibrinogen levels to be associated with loneliness and lack of social connection in their study of middle-aged men and women [19]. Prior studies have investigated the potential mechanisms underlying the relationship between social isolation and inflammation. ...
Article
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Background: This study evaluates the role of social isolation on inflammation and cancer mortality among women. Methods: Data were abstracted from the U.S. National Health and Nutrition Examination Survey from 1988 to 1994. The Social Network Index was used to assess participants' degree of social isolation. C-reactive protein and fibrinogen levels were included as markers of inflammation. We used the National Death Index to identify causes and dates of mortality. Chi-square and multivariable Cox regressions were employed for statistical analyses. Results: Of 3360 women (median age: 54 years), the most isolated, very isolated, somewhat isolated, and not isolated comprised 14.5, 30.2, 37.1, and 18.2% of the sample, respectively. The most isolated participants were more likely to have low income (56.8% vs 12.2%, p < 0.001), have fewer years of education (40.8% vs 12.3%; p < 0.001), have low physical activity (27.3% vs 14.7%; p < 0.003), be obese (32.5% vs 24.4%; p = 0.02), and be current smokers (34.2% vs 10.3%; p < 0.001) compared to the not isolated ones. Mean fibrinogen levels increased with degree of social isolation (p = 0.003), but C-reactive protein showed no association (p = 0.52). Kaplan-Meier estimates indicated higher cancer mortality rates among participants with elevated fibrinogen levels, though not with statistical significance (p = 0.08). Furthermore, there was no association between social isolation and cancer mortality (p = 0.54). On multivariate analysis, obesity (HR = 1.56; 95% CI: 1.11-2.18), higher education (HR = 1.36; 95% CI: 1.01-1.83), and smoking (HR = 4.42, 95% CI: 2.84-6.88) were independent predictors for cancer mortality, while high physical activity predicted for lower mortality from cancer (HR = 0.67, 95% CI: 0.51-0.87). However, social isolation was not a predictor. Conclusion: Social isolation among women was associated with an increased level of fibrinogen, but not associated with cancer mortality. The relationship between inflammation and cancer mortality warrants further investigation.
... As humans grow older, a thirst for social embeddedness persists and may even intensify 2,3 . At midlife, roughly between the ages of 40-70 [4][5][6][7] , adults have gathered decades of social experience that shape how they navigate their daily social encounters. For example, the ability to form accurate social judgments about other individuals is known to mature throughout life 8 . ...
Article
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In any stage of life, humans crave connection with other people. In midlife, transitions in social networks can relate to new leadership roles at work or becoming a caregiver for aging parents. Previous neuroimaging studies have pinpointed the medial prefrontal cortex (mPFC) to undergo structural remodelling during midlife. Social behavior, personality predisposition, and demographic profile all have intimate links to the mPFC according in largely disconnected literatures. Here, we explicitly estimated their unique associations with brain structure using a fully probabilistic framework. We weighed against each other a rich collection of 40 UK Biobank traits with their interindividual variation in social brain morphology in ~10,000 middle-aged participants. Household size and daily routines showed several of the largest effects in explaining variation in social brain regions. We revealed male-biased effects in the dorsal mPFC and amygdala for job income, and a female-biased effect in the ventral mPFC for health satisfaction.
... Inclusion criteria for our systematic review are: ► Cross-sectional and longitudinal observational studies investigating the association between informal caregiving for adults (≥18 years) and loneliness or social isolation. ► Assessment of key variables with established tools (eg, three item version of the UCLA Loneliness Scale V. 3 33 or validated single item measures 34 ). ► Studies in English or German language, published in a peer-reviewed, scientific journal. ...
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Introduction Some empirical studies have identified an association between informal caregiving for adults and loneliness or social isolation. However, there is a lack of a review systematically synthesising empirical studies that have examined these associations. Hence, the aim of this systematic review is to provide an overview of evidence from observational studies. Methods and analysis Three electronic databases (Medline, PsycINFO, CINAHL) will be searched (presumably in May 2021), and reference lists of included studies will be searched manually. Cross-sectional and longitudinal observational studies examining the association between informal caregiving for adults and loneliness or social isolation will be included. Studies focusing on grandchildren care or private care for chronically ill children will be excluded. Data extraction will include information related to study design, definition and measurement of informal caregiving, loneliness and social isolation, sample characteristics, statistical analysis and main results. The quality of the studies will be evaluated using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Two reviewers will perform the selection of studies, data extraction and assessment of study quality. Figures and tables will be used to summarise and report results. A narrative summary of the findings will be provided. If data permit, a meta-analysis will be conducted. Ethics and dissemination No primary data will be collected. Therefore, approval by an ethics committee is not required. We plan to publish our findings in a peer-reviewed journal. PROSPERO registration number CRD42020193099.
... Similarly, the Framingham Offspring Study group by Kim et al. found elevated brinogen levels in those with less social connection [12]. In addition, Nersesian et al. found high brinogen levels to be strongly associated with more socially isolated, middle-aged men and women [19]. Prior studies have investigated the potential mechanisms underlying the relationship between social isolation and in ammation. ...
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Background To evaluate the relationships of social isolation, inflammatory biomarkers, and cancer mortality among women. Methods Data were abstracted from the U.S. National Health and Nutrition Examination Survey from 1988-1994. The Social Network Index was used to assess participants’ degree of social isolation. C-reactive protein and fibrinogen levels were included as markers of inflammation. We used the National Death Index to identify causes and dates of mortality. Chi-square and multivariable Cox regressions were employed for statistical analyses. Results Of 3,446 women (median age: 55 years), the most isolated, very isolated, somewhat isolated, and not isolated comprised 14.5%, 30.3%, 37.0%, and 18.2% of the sample, respectively. The most isolated participants were more likely to have low income (57.1% vs 12.2 %, p<0.001), have fewer years of education (40.6% vs 12.2%; p<0.001), have low physical activity (27.3% vs 14.6%; p<0.003), be obese (32.3% vs 24.2%; p=0.02), and be current smokers (33.8% vs 10.2 %; p<0.001) compared to the not isolated ones. Mean fibrinogen levels increased with degree of social isolation (p=0.02), but C-reactive protein showed no association (p=0.58). Kaplan-Meier estimates indicated higher cancer mortality rates among participants with elevated fibrinogen levels, though not statistically significant (p=0.07). Furthermore, there was no correlation between social isolation and cancer mortality (p=0.55). On multivariate analysis, obesity (HR=1.39; 95% CI: 1.05-1.83; p=0.02) and lower education (HR=1.48; 95% CI: 1.04-2.11; p=0.03) were independent predictors for cancer mortality, while high physical activity predicted for lower mortality from cancer (HR=0.67, 95% CI: 0.49-0.91; p=0.01). However, social isolation was not a predictor (p=0.88). Conclusion Social isolation among women was associated with an increased level of fibrinogen, but not associated with cancer mortality. The relationship between inflammation and cancer mortality warrants further investigation.
... If they are socially connected, then they are not lonely. Loneliness is a perceived lack in quality or quantity of one's relationships [18] and predicts various health outcomes, including: systemic inflammation, increased blood pressure, depression, weight gain, smoking alcohol/drug use, physical inactivity, and alone time [19][20][21][22][23][24]. Social connectedness is defined as feelings of interpersonal connection and meaningful, close, and constructive relationships with others (i.e., individuals, groups, and society). ...
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Background Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness. Methods CTM is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n = 458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults to understand how CTM facilitated or impeded their PA and social connectedness. Results PA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3 to 6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability. Conclusion Health promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the ‘epidemic of loneliness’ that plagues many countries currently, these kinds of interventions are timely and important. Research that further delineates mechanisms (e.g., sharing experiences vs. lectures), that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.
... doi: bioRxiv preprint is a subjective perception that can have wide ranging consequences, including decreased mental and psychological well-being (Bzdok & Dunbar, 2020), and even increased mortality (Holt-Lunstad et al., 2015). Indeed, a cohort study on loneliness in ~900 middle-aged participants (Nersesian et al., 2018) found that loneliness was linked to higher levels of stress and systemic inflammation. The authors suggest that these observations are in line with poor health outcomes, with increased risk for morbidity and mortality. ...
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In any stage of life, humans crave social connection with other people. In midlife, transitions in social networks can be related to new leadership roles at work or becoming a caregiver for aging parents. Previous neuroimaging studies have reported that during midlife, especially the medial prefrontal cortex (mPFC) undergoes structural remodeling changes. Social behavior, personality predisposition, and demographic profile all bear intimate relation with the mPFC according to separate literature streams. To integrate these three areas commonly studied in isolation, we explicitly modeled their unique links with brain structure using a fully probabilistic framework. We weighed against each other a rich collection of 40 traits with their interindividual variation in social brain morphology in ~10,000 middle-aged UK Biobank participants (40-69 years at recruitment). Across conducted analyses, household size and daily routine schedules showed several of the largest effects in explaining variation in social brain regions. We revealed male-biased effects in the dorsal mPFC and amygdala for job income, and a female-biased effect in the ventral mPFC for health satisfaction. Our population investigation offers a more complete perspective into how adults at the midlife milestone may navigate life depending on their identity and status.
... If they are socially connected, then they are not lonely. Loneliness is a perceived lack in quality or quantity of one's relationships (18) and predicts various health outcomes, including: systemic in ammation, increased blood pressure, depression, weight gain, smoking alcohol/drug use, physical inactivity, and alone time (19)(20)(21)(22)(23)(24). Social connectedness is de ned as feelings of interpersonal connection and meaningful, close, and constructive relationships with others (i.e., individuals, groups, and society). ...
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Background: Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness. Methods:  Choose to Move is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n=458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults at baseline (n=43), mid-intervention (n=38) and post-intervention (n=19). Results: PA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3-6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability. Conclusion: Health promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the ‘epidemic of loneliness’ that plagues many countries currently, these kinds of interventions are timely and important. Research that clearly delineates mechanisms that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.
... Caring and respect in social relationships prompts a sense of well-being-together they act as a buffer against health problems (4) and catalyze myriad health bene ts. Loneliness is a perceived lack in quality or quantity of one's relationships (5) and predicts various health outcomes, including; systemic in ammation, increased blood pressure, depression, weight gain, smoking alcohol/drug use, and alone time (6)(7)(8)(9)(10). Loneliness is also closely linked with accelerated loss of physical functioning and health with age, and an increased likelihood that an older person discontinues PA over time (11,12). ...
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Background: Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and social connectedness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) describe features of CTM that promote social connectedness. Methods:  Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n=458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults at baseline (n=43), mid-intervention (n=38) and post-intervention (n=19). Results: PA increased from baseline to 3 months in lonely and not lonely participants. PA decreased from 3-6 months in lonely participants; however, PA at 6 months remained above baseline levels in both groups. Loneliness decreased from baseline to 3 and 6 months in participants identifying as lonely at baseline. Features of CTM that influence social connectedness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability. Conclusion: PA interventions that focus on social connectedness, through group-based activities can improve the health of older adults by addressing both loneliness and PA. Building social connectedness within a PA intervention for older adults may support long term changes in PA behaviours.
... (84) Loneliness has also been associated with higher levels of interleukin-6, fibrinogen and C-reactive protein in a midlife sample. (85) Loneliness has been associated with greater expression of pro-inflammatory genes in older adults, (86) an effect that was downregulated by mindfulness-based stress reduction in a randomized controlled trial. (87) The role of the health care sector in addressing the impacts of SI/L in older adults. ...
Article
The authors of this review both served on the National Academy of Science, Engineering, and Medicine Committee that produced the report, “Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System”. In 2018, the AARP Foundation commissioned the National Academies to establish a committee to research and develop a report on social isolation and loneliness in persons 50 years of age and older. Emphasis was placed upon the role of the health care system in addressing this fundamental public health problem. The committee released the report in February 2020 as the COVID-19 pandemic was beginning to spread to North America. In this review, the authors share central findings and conclusions from the report as well as how these findings may be relevant to the care and well-being of older adults during this historic pandemic. The health protective benefits of social distancing must be balanced by the essential need for sustaining social relationships.
... Moreover, because perceptions of social isolation denote a lower degree of safety in the environment, loneliness can also serve as a stressor that elevates stress hormones and has adverse effects on biologically restorative systems, such as sleep (Drake, Sladek, and Doane 2016;Hawkley and Cacioppo 2010). The risk of loneliness for health has been demonstrated with links to objective outcomes, including biomarkers of health dysfunction and mortality (Holt-Lunstad et al. 2015;Nersesian et al. 2018;Rico-Uribe et al. 2018;Whisman 2010). Not surprisingly, given the association between these objective outcomes and self-rated health, loneliness is also associated with self-rated health. ...
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This article argues that the COVID-19 pandemic and associated social distancing measures intended to slow the virus’ rate of transmission resulted in greater subjective isolation and community distrust, in turn adversely impacting psychological distress. To support this argument, we examine data from the Canadian Quality of Work and Economic Life Study, two national surveys of Canadian workers—one from late September of 2019 (N= 2,477), and the second from mid-March of 2020 (N=2,446). Analyses show that subjective isolation and community distrust increased between the two surveys, which lead to a substantial rise in psychological distress. Increases in subjective isolation were stronger in older respondents, resulting in a greater escalation in psychological distress. These findings support a Durkheimian perspective on the harm to social integration and mental health caused by periods of rapid social change, but also illustrate how a life course context can differentiate individual vulnerability to disintegrative social forces.
... The impact of such findings overall resonates with contemporary research highlighting the negative effects of social isolation and loneliness on physical health issues such as increased inflammatory disease (Hawkley and Cacioppo 2010;Nersesian et al. 2018) and depression in general (Hawkley and Cacioppo 2010). Indeed, among people living with SMI, more than half have reported feelings of loneliness (Perese and Wolf 2005), which is alarming considering that loneliness has been found to severely effect lower quality of life (Weiner et al. 2010) as well as having been uniquely identified as a barrier to illness remission and recovery (Barut et al. 2016). ...
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Approximately 4.5% of U.S. adults live with a serious mental illness (SMI) (Substance Abuse and Mental Health Services Administration, 2018). Creating a place for people seeking structure, connection, and purpose following psychiatric hospitalization or for mental health recovery is difficult given several factors associated with illness trajectories, lack of community-based support programs, and reliance on traditional models of care. Using semi-structured interviews, the current study examined the reasons people attend community programs referred to as psychosocial "clubhouses." Interviews with 140 people across 10 clubhouse programs in one state were conducted. Qualitative analyses revealed that social connections and the need to reduce social isolation were driving forces for attending. Further, individuals noted that the “structure” of engaging in meaningful activities and roles was a main reason for participating. Authors discuss the continued need for community models that provide a “place” for all people to successfully engage and recover from psychiatric illnesses.
... There are several possible reasons why adults in late-midlife may be particularly vulnerable to food insecurity, especially in the presence of health challenges. Poor health may restrict employment which reduces the financial resources for food as well as the potential for engagement in the social world, which further decreases health [59]. Moreover, with few social welfare options, the need to remain in the work force places additional strain on financial well-being and, ultimately, increases the risk and severity of food insecurity [60,61]. ...
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Background Food insecurity, limited access to adequate food, in adulthood is associated with poor health outcomes that suggest a pattern of accelerated aging. However, little is known about factors that impact food insecurity in midlife which in turn could help to identify potential pathways of accelerated aging. Methods Low-income adults (n = 17,866; 2014 National Health Interview Survey), ages 18 to 84, completed a 10-item food security module and answered questions regarding health challenges (chronic conditions and functional limitations) and financial worry. We used multinomial logistic regression for complex samples to assess the association of health challenges and financial worry with food insecurity status and determine whether these associations differed by age group, while adjusting for poverty, sex, race/ethnicity, education, family structure, social security, and food assistance. Results Food insecurity rates were highest in late- (37.5%) and early- (36.0%) midlife, relative to younger (33.7%) and older (20.2%) age groups and, furthermore, age moderated the relationship between food insecurity and both risk factors (interaction p-values < .05, for both). The effects of poor health were stronger in midlife relative to younger and older ages. Unlike younger and older adults, however, adults in midlife showed high levels of food insecurity regardless of financial worry. Conclusions Findings suggest that food insecurity in midlife may be more severe than previously thought. Greater efforts are needed to identify those at greatest risk and intervene early to slow premature aging.
... CRP averaged 2.78 ug/mL, well below the cutoff for concern of 8 ug/mL (Mayo Medical Laboratories, 2018). Lastly, IL-6 levels averaged 2.71 pg/mL, comparable to previous studies of proinflammatory cytokines in midlife and well below the cutoff for concern of 5 pg/mL (Mayo Medical Laboratories, 2018;Nersesian et al., 2018). ...
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Background and objectives: This cross-sectional study examines associations of social integration and daily discrimination with 4 biological markers of inflammation and cardiovascular health and tests whether self-esteem may mediate any of these effects. Research design and methods: Data came from 746 participants of the National Survey of Midlife Development in the United States (MIDUS) Refresher (2011-2014) and MIDUS Refresher Biomarker Project (2012-2016). Structural equation modeling estimated direct and indirect associations of social integration and daily discrimination with glycosylated hemoglobin (HbA1c), high-density lipoprotein (HDL), C-reactive protein, and interleukin-6. Results: Social integration and daily discrimination were both significantly associated with self-esteem, which was in turn associated with HbA1c, HDL, and interleukin-6 levels. Social integration was indirectly associated with HbA1c, HDL, and interleukin-6 via self-esteem. Daily discrimination was directly associated with HbA1c, C-reactive protein, and interleukin-6 and was indirectly associated with HDL and interleukin-6 via self-esteem. Discussion and implications: Findings identify social correlates of inflammation and cardiovascular risk and suggest that self-esteem may serve as a pathway for effects. Overall, results were somewhat mixed: Daily discrimination was directly associated with both self-esteem and 3 of the 4 biological markers of health; however, although social integration was strongly associated with self-esteem, it was only weakly and indirectly associated with biological health markers. Moreover, the indirect effects of daily discrimination on the biomarker outcomes-while significant-were notably smaller than its direct effects. Implications for theory, practice, and future research are discussed, including the need for further study of self-esteem and physical health across mid- and later life.
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Spousal bereavement is one of the most stressful experiences in adulthood. In a sample of 183 widow(er)s, bereaved about three months prior, we examined the intersection of employment, family income, and health outcomes (proinflammatory marker production, perceived stress, and grief symptoms). Bereaved employees had higher levels of monocyte-stimulated interleukin-6, tumor necrosis factor-α, chemokine ligands 4, and perceived stress than bereaved retirees. We also found an interaction such that family income was positively associated with perceived stress and grief symptoms for employed window(er)s, but not for retirees. These findings align with the reserve capacity model, which states that people at higher levels of socioeconomic status have more psychosocial resources to address psychosocial stressors. Employment likely served as an added psychological and inflammatory burden for all bereaved workers, except those with the highest incomes.
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As a strong risk factor for mortality, individual differences in loneliness are of clear public health significance. Four of the Big Five traits have emerged as cross-sectional correlates, but the etiology of these links is unclear, as are relations with more specific personality facets. Thus, we estimated phenotypic, genetic, and environmental associations between loneliness and both broader and narrower personality dimensions. Traits that indexed Negative Emotionality (e.g., Neuroticism, Stress Reactivity, Alienation) and low Positive Emotionality (e.g., low Extraversion, low Well-Being) had the strongest associations with loneliness, though low Conscientiousness, low Agreeableness, and high Aggression were also implicated. These associations were explained by both genetic (0.30.<.|rg|.<.0.80) and unique environmental (0.10.<.|re|.<.0.35) influences, consistent with an etiology of loneliness involving several personality domains.
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Background A symptom cluster is a group of two or more symptoms that occur together and are related to each other. Family caregivers of allogeneic hematopoietic stem cell transplant (HSCT) recipients experience multiple concurrent symptoms, but the majority of symptom research in this population has focused on assessing and managing individual symptoms. Objectives The purpose of this analysis was to determine (1) if clusters of five highly prevalent symptoms (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) in allogeneic HSCT caregivers could be identified and (2) what caregiver and patient characteristics influence membership in the identified symptom cluster groups. Study Design Baseline cross-sectional data were collected from allogeneic HSCT caregivers participating in a randomized controlled trial at the National Institutes of Health Clinical Center. Measures included: Caregiver Reaction Assessment (CRA), the Health-Promoting Lifestyle Profile II (HPLP-II), Fatigue Symptom Inventory (MFSI), Pittsburgh Sleep Quality Index (PSQI), and PROMIS® (depression, anxiety, applied cognition, and self-efficacy). Cluster analysis was used to identify symptom clusters, and univariate analyses and multiple logistic regression were conducted to identify factors that contribute to symptom clusters. Results Caregivers’ (N=44) were on average 45.20 ± 15.05 years; primarily white (52.3%), female (88.6%), and spouse/partner of the patient (50.0%). Two symptom cluster groups were identified: low symptom burden (n=24, 54.5%) and high symptom burden (n= 20, 45.5%). Caregivers with higher levels of loneliness (OR = 1.12, CI = [1.04, 1.22], p = .004) were more likely to be in the high symptom burden group. Conclusions This study provides evidence that five symptoms commonly found in family caregivers (fatigue, sleep disturbance, depression, anxiety, and cognitive impairment) tend to occur in clusters. Therefore, clinicians should be aware that caregivers experiencing one or more of these symptoms may be at higher risk for developing the others, and caregivers reporting high levels of loneliness may be at particular risk. Future research is needed to identify novel interventions that target multiple, co-occurring symptoms. Such interventions might also include components that decrease loneliness.
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To address the gap of lacking research on the association between coping self-efficacy and loneliness, this study examined this relationship to inform future research and intervention on loneliness. Using data from 151 community-dwelling older adults ages 65 and older, we estimated multivariate logistic regression models with age, race/ethnicity, sex, body mass index, chronic disease composite score, social support, coping self-efficacy, and depression symptoms. Loneliness was reported in 32.1% of participants and negatively associated with coping self-efficacy (OR = 0.68, 95% CI: 0.50–0.93) while controlling for age, race, sex, chronic disease composite score, and body mass index. Our findings suggest that coping self-efficacy may be a target for intervention involving loneliness in future research; however, the causal relationship between coping self-efficacy and loneliness should be explored further.
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Given the important associations between couple conflict and various physical and mental health outcomes, it is essential to explore factors that may catalyze or exacerbate the frequency and impact of conflict in romantic relationships. One such factor may be relationship mindfulness, or the tendency to have a nonjudgmental awareness of one’s experiences in romantic relationships. Previous research has demonstrated a link between relationship mindfulness and various relational outcomes, but its association with relationship conflict has not yet been explored. Additionally, the current study sought to explore the mechanisms that link relationship mindfulness and relational outcomes. Based on previous research connecting conflict to negative partner attributions, the study examined how relationship mindfulness may predict conflict through negative partner attributions. Furthermore, the study aimed to incorporate loneliness as a potential mediator between relationship mindfulness and negative partner attributions. A sample of 116 different-sex middle-aged married couples were recruited to complete an online assessment. Using an actor–partner interdependence mediation model, the results indicated several significant associations among relationship mindfulness, negative partner attributions, loneliness, and relationship conflict. For example, a significant indirect effect was found; that is, female relationship mindfulness was associated with decreased relationship conflict via its prior association with both male loneliness and additionally through male loneliness and subsequent male negative partner attributions. The results indicate that by employing interventions that increase relationship mindfulness, it may be possible to both reduce loneliness and encourage more charitable partner attributions which, in turn, may reduce couple conflict.
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Even before increased social isolation associated with the COVID-19 pandemic, 43% of adults aged 60 and older reported experiencing loneliness. Depression and loneliness often co-exist and are significant issues faced by middle-aged as well as older adults because each condition is likely to worsen health outcomes. This study of middle-aged and older adults examined how depression and loneliness affect diabetes (DM) control (A1C levels). This study is a secondary analysis of data from the Midlife in the United States Refresher (MIDUS-R) survey, a national survey of adults aged 25–74 years. Correlation analyses were conducted, and a hierarchical logistic regression was estimated to predict A1C levels ≤7% (recommended goal) or >7 using 1) demographics and physical health (ethnicity, gender, education, age, and comorbidities), 2) family and friend support, and 3) depression and loneliness. The sample of 92 participants with DM and A1C data from the MIDUS-R had mean age = 57.37, were 51% male, 68% non-Hispanic White; 39.1% had A1C >7. The average level of depression was low (CES-D mean 9.42) and loneliness was moderate (UCLA scale mean 12.43). Loneliness was correlated with A1C (r= .26, p< .05); depressive symptoms (r= .71, p< .001), family and friends support (r= −.36, r= −.38, respectively, both p< .001). Only loneliness significantly predicted higher A1C levels. People with higher levels of loneliness had increased odds of having A1C >7 (OR = 1.18, p < .05) after controlling for depression and all other variables. Loneliness had a greater impact than depression on A1C level among persons with DM. Healthcare providers should assess patients for loneliness as well as depression and reduce adverse health impacts by referring to psychosocial support as needed.
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Objectives : Since there is limited knowledge with regard to the frequency and correlates of mild cognitive impairment and dementia among the oldest old based on large representative data (including institutionalized individuals), our objective was to fill this research gap. Methods : For our study, data came from the representative “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)”. This study included community-dwelling and institutionalized individuals aged 80 years and over (n=1,173, mean age: 86 years) residing in the most populous state of Germany (North Rhine-Westphalia). The DemTect was used to quantify cognitive impairment (i.e., probable mild cognitive impairment and probable dementia). Results : Overall, 73.1% of the individuals were not cognitively impaired, 17.0% of the individuals had probable mild cognitive impairment and 9.9% of the individuals had probable dementia. Compared to individuals without cognitive impairment, individuals with probable mild cognitive impairment were more likely to be male, live in an institutionalized setting, have a lower educational level, have a smaller network size, and have lower functional abilities. Moreover, compared to individuals without cognitive impairment, individuals with probable dementia were more likely to be older, live in an institutionalized setting, have a lower educational level, have a smaller network size, not be multimorbid, and have lower functional abilities. Conclusions : Our study identified several sociodemographic and health-related factors which are associated with probable mild cognitive impairment and probable dementia among the oldest old. This knowledge may help to address individuals at risk for mild cognitive impairment and dementia.
Article
Objective: Loneliness represents a public health threat given its central role in predicting adverse mental and physical health outcomes. Prior research has established four of the Big Five personality traits as consistent cross-sectional predictors of loneliness in largely western, White samples. However, it is not clear if the personality predictors of loneliness vary across cultures. Method: The present study estimates associations between the Big Five traits and loneliness across distinct samples of White American, Black American, and Japanese adults (n = 6051 at T1). Confirmatory factor analysis and exploratory structural equation modeling were used to examine measurement invariance properties of the Big Five and loneliness across these groups. The factor structures were then carried forward to estimate associations between personality and loneliness across two assessments waves using structural equation modeling. Results: While Neuroticism was a strong predictor across groups, low Extraversion was more predictive of loneliness in Japan than in the U.S., and low Conscientiousness was only a significant predictor in the U.S. Conclusions: Previous literature offers a framework for interpreting these findings in that loneliness may be shaped comparatively more through interconnectedness in Japanese culture, while, in the U.S., individual goals and personal romantic expectations are more salient.
Chapter
Social isolation is defined, in psychological terms, as the absence of meaningful social interactions, contacts, and relationships with family and friends, with neighbors. It can occur on an individual level and, on a broader level, within “society at large.” In the United States, three main groups of socially isolated individuals can be identified: people who reside in assisted-living facilities, nursing homes, or hospices, people suffering from “persistent loneliness” and people incarcerated in jails or prisons who are housed in involuntary solitary confinement. In this chapter, we discuss the psychological and neurobiological effects of isolation, using both animal models as well as direct studies of humans experiencing these conditions. Only by understanding the impact of isolation on the brain and the mechanisms that underlie these changes can we hope to develop interventions that prevent them from occurring in the first place. This knowledge may also contribute to the efforts of psychologists, clinicians, and community health leaders to employ evidence-based prevention programs to mitigate the risk of isolation-induced physical and psychological damage in humans.
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Circulating levels of inflammatory biomarkers may be influenced by chronic psychological stressors such as those experienced by family caregivers. However, previous studies have found mostly small and inconsistent differences between caregivers and control samples on individual measures of systemic inflammation. Latent variables of inflammation were extracted from six biomarkers collected from two blood samples over 9 years apart for 502 participants in a national cohort study. One-half of these participants transitioned into a sustained family caregiving role between the blood samples. Two latent factors, termed “up-regulation” and “inhibitory feedback,” were identified, and the transition to family caregiving was associated with a lower increase over time on the inhibitory feedback factor indexed by interleukin (IL)-2 and IL-10. No caregiving effect was found on the up-regulation factor indexed primarily by IL-6 and C-reactive protein. These findings illustrate the advantages of using latent variable models to study inflammation in response to caregiving stress.
Article
Objectives Our aim was to examine socioeconomic and health-related variables associated with psychosocial factors among the oldest old. Methods Cross-sectional data were used from the representative “Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+)” consisting of individuals aged 80 years and over (n=952, average age was 86 years) living in North Rhine-Westphalia (most populous state of Germany). Established tools were used to quantify loneliness, life satisfaction and depressive symptoms. Socioeconomic and health-related correlates were included in regression analysis. Results Multiple linear regressions showed that higher life satisfaction was associated with a greater network size, higher functional impairment and better self-rated health. Moreover, higher loneliness was associated with being unmarried, a smaller network size, worse self-rated health and higher functional impairment. Additionally, more depressive symptoms were associated with lower age (i.e., 80 to 84 years compared to 90 years and over), asset poverty, the presence of multimorbidity, higher functional impairment and worse self-rated health. Conclusions Our study identified various socioeconomic and health-related factors associated with worse psychosocial factors among the oldest old. This knowledge may assist in targeting oldest old individuals at risk for worse psychosocial factors. This article is protected by copyright. All rights reserved.
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Social isolation and loneliness are both established risk factors for mortality, but it remains unclear how these two conditions interact with each other. We used data from 3975 adults aged 25–74 years who completed self-administered questionnaires (SAQs) for the Midlife in the United States (MIDUS) National Study Wave 2 (2004–2006). Loneliness was measured by asking participants how often they felt lonely. A shortened version of the Berkman-Syme Social Network Index that captured partnerships, friends/family, religious participation, and other forms of social connection was used to assess social isolation. Follow-up for all-cause mortality was censored at the end of 2016. We used progressively adjusted Cox proportional hazard models to examine the mortality risks of loneliness, social isolation, the components of social isolation, and combinations of loneliness and isolation. We adjusted for sociodemographic characteristics in our first models and then added health behaviors and physical and mental health conditions in subsequent models. In the minimally adjusted model, loneliness was associated with higher mortality risk (HR, 1.34; 95% CI, 1.22–1.47), but the association was not significant in the fully adjusted model. Social isolation was significantly associated with mortality in the minimally adjusted model (HR, 1.24; 95% CI, 1.15–1.34) and the fully adjusted model (HR, 1.13; 95% CI, 1.04–1.23). Having infrequent contact with family or friends was the component of isolation that had the strongest association with mortality. Contrary to prior literature, which has found either no interaction or a synergistic interaction between isolation and loneliness, we identified a significant, negative interaction between the two measures, indicating that loneliness and social isolation may partially substitute for one another as risk factors for mortality. Both are associated with a similar increased risk of mortality relative to those who express neither; we find no evidence that the combined effect is worse than experiencing either by itself.
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Background Elevated levels of inflammatory marker and a lack of social connectedness are two prominent risk factors for developing dementia and depression. Horticultural therapy (HT) has been shown to improve social connectedness and inflammatory markers. However, the underpinning mechanisms of HT remained unknown. Within this study, we hypothesized that improved social connectedness mediates the effects of HT on IL-6 levels. Methods The present study is a secondary analysis of a randomized controlled trial investigating the bio-psycho-social effects of HT. Social connectedness was operationalized as positive relationships with others (PRWO), a sub-scale of the Ryff's scale of psychological well-being. IL-6 was quantified using a commercial ELISA kit. Outcomes were assessed at baseline, 3-month and 6-month post-intervention. Mediation analyses with bootstrapping were run to investigate our primary hypothesis. All analyses were controlled for covariates. Results We recruited 59 participants (78% women; 67.10 ± 4.31years). 29 participants partook in HT and 30 participants were included in the waitlist control group. At baseline, social connectedness was significantly correlated with IL-6 levels (β = −0.12, 95% CI = −0.21 to −0.03, p = 0.008). Furthermore, social connectedness at 3-month significantly mediated the effects of HT on IL-6 levels at 6-month (β = 0.32, 95% CI = 0.09 to 0.54, p = 0.005; β = −0.25, 95% CI = −0.45 to −0.05, p = 0.016). Conclusions These findings highlight the critical roles of social connectedness as a social determinant of health in eliciting HT's biological effects. When administering HT, interventionalists should consider social connectedness as a modifiable factor for ameliorating increased inflammation in older adults.
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Existing cardiovascular disease (CVD) and its modifiable risk factors are associated with increased mortality from coronavirus 2019 (COVID-19). Clinical attention has focused on acute interventions for COVID-19, but reducing upstream risks associated with poor outcomes must occur in parallel. This is particularly urgent because risk factors for COVID-19 death are prevalent, and the pandemic has negatively impacted lifestyle and socioeconomic factors that augment these risks. Evidence-based lifestyle interventions have a generally short time-to-benefit, and lower risk of CVD and improve markers of immune function. Wider promotion of healthy lifestyle practices will improve the CVD health of the population and could favorably impact COVID-19 outcomes. Research examining how lifestyle modification affects COVID-19 susceptibility and severity is urgently needed.
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Experimental and observational evidence agreed on two interconnected biological mechanisms responsible for the links between social isolation/loneliness and health: alterations in the activity of the hypothalamic-pituitary-adrenal (HPA) axis and compromised functioning of the innate immune system. However, most existing studies did not consider the simultaneous impact of social isolation and loneliness on biological outcomes. Further, they only assessed one biological outcome at a time and did not test any moderation by age, despite empirical and theoretical evidence supporting the plausibility of this hypothesis. To address these gaps in the literature, we tested the associations between two indicators of social isolation (living status and frequency of social contacts) and loneliness and daily cortisol secretion and two markers of systemic inflammation (C-reactive protein [CRP] and interleukin-6 [IL-6]) in a sample of adults aged between 25 and 75 years old. Data were drawn from the Midlife in the United States (MIDUS) Refresher study (N = 314). We found that, above and beyond loneliness, living alone was associated with a flattened diurnal cortisol slope (i.e., reduced changes in cortisol levels during waking hours that are indicative of a dysregulated HPA axis) and higher CRP levels. On the other hand, higher loneliness was associated with higher IL-6 levels, above and beyond our measures of social isolation. Loneliness did not mediate any of the effects of social isolation on either cortisol or CRP, and age did not moderate any of the relationships reported above. Our findings support the idea that social isolation and loneliness have unique and independent endocrine and immune effects despite being linked to each other. Understanding the specific biological pathways through which these aspects of social well-being exert their effects on health across the lifespan has critical consequences for both intervention development and public health policies.
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Loneliness is a key determinant in the etiology of mental health disorders such as depression and has profound impacts on health, quality of life, and economic productivity. This narrative review uses extant neurobiology and evolutionary literature to propose a construct through which loneliness may induce depression in adulthood via the reward system (including symptom and treatment aspects). Early childhood (distal) factors were found to be important in influencing adult (proximal) factors, which lead to the formulation of the construct. Due to the heterogenous and comorbid nature of depression, a new subtype known as 'reward depression' was distinguished along with distinct symptoms to aid practitioners when assessing patient treatment options. Furthermore, an evolutionary perspective was applied to the current impaired reward construct to discuss how the ancestral purpose and environment (in terms of reward) clashes with the modern one. Finally, theoretical treatment and prevention ideas were examined and discussed, leading into future work that needs to build upon and confirm the outlined construct.
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Despite a well-documented relationship between social isolation and health among men, this link has been understudied among marginalized populations such as undocumented immigrant men whose structural social exclusion may impede the cultivation and maintenance of social connections in the United States. This may be particularly so in new immigrant settlement cities that may lack an established Latina/o community or the social infrastructure often needed to ease the process of social integration. Studies that have examined social disconnectedness, social isolation, and/or loneliness have largely focused on individual level factors (i.e., older age) that may precipitate or contextualize experiences of social isolation, social support and social networks. Missing from such conceptualizations is a consideration of the role of structural factors, such as “illegality” among undocumented immigrant men, on experiences of social disconnection, social exclusion, social isolation and loneliness and resultant adverse health behaviors. This study, through in-depth qualitative participant narratives, explores the social condition of one group of “illegal” immigrant men, Latino immigrant day laborers (LIDL), and their experiences of social exclusion, social isolation, loneliness and health in the new immigrant settlement city of Baltimore. Using an ethnographic methodological approach, eight focus groups (N=37) were conducted with participants recruited from two day labor sites from 2016 – 2019. Thematic analysis revealed a structural process of social exclusion and disconnection that exposed LIDLs to experiences of racism, structural vulnerability, and dehumanization which in turn may have heightened social isolation and loneliness and patterned substance use and sexual risk taking. Findings further emphasize the potential conceptual significance of structurally induced social disconnection, as distinct from lack of social support, in the study of LIDLs’ social isolation, loneliness and health.
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Background: Despite the well-known health benefits of physical activity (PA), older adults are the least active citizens. Older adults are also at risk for loneliness. Given that lonely individuals are at risk for accelerated loss of physical functioning and health with age, PA interventions that aim to enhance social connectedness may decrease loneliness and increase long-term PA participation. The objectives of this mixed-method study are to: (1) evaluate whether an evidence-based PA intervention (Choose to Move; CTM) influenced PA and loneliness differently among self-identified ‘lonely’ versus ‘not lonely’ older adults and (2) to describe factors within CTM components most likely to promote social connectedness/reduce loneliness. Methods:  CTM is a flexible, scalable, community-based health promoting physical activity intervention for older adults. Two community delivery partner organizations delivered 56 CTM programs in 26 urban locations across British Columbia. We collected survey data from participants (n=458 at baseline) at 0 (baseline), 3 (mid-intervention) and 6 (post-intervention) months. We conducted in depth interviews with a subset of older adults to understand how CTM facilitated or impeded their PA and social connectedness. Results: PA increased significantly from baseline to 3 months in lonely and not lonely participants. PA decreased significantly from 3-6 months in lonely participants; however, PA at 6 months remained significantly above baseline levels in both groups. Loneliness decreased significantly from baseline to 3 and 6 months in participants identifying as lonely at baseline. Factors within CTM components that promote social connectedness/reduce loneliness include: Activity coach characteristics/personality traits and approaches; opportunity to share information and experiences and learn from others; engagement with others who share similar/familiar experiences; increased opportunity for meaningful interaction; and accountability. Conclusion: Health promoting interventions that focus on PA and social connectedness through group-based activities can effectively reduce social isolation and loneliness of older adults. Given the ‘epidemic of loneliness’ that plagues many countries currently, these kinds of interventions are timely and important. Research that further delineates mechanisms (e.g., sharing experiences vs. lectures), that modify the effect of an intervention on social connectedness outcomes for older adults engaged in community-based PA programs would be a welcome addition to the literature.
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Background: Even in the era of suppressive antiretroviral therapy, people with HIV (PWH) suffer greater exposure to inflammation than their uninfected peers. Although poor social support and social isolation have been linked to systemic inflammation in the general population, it is not known if this is true also among PWH. Methods: People with and without HIV infection were enrolled in a community-based, single center study. Primary predictors were the Medical Outcomes Study (MOS) Social Support Survey and outcomes were a panel of inflammatory biomarkers (ICAM-1, MCP-1, IL-6, IL-8, IP-10, CRP, D-Dimer, VEGF, sCD14 and uPAR) in blood plasma and cerebrospinal fluid (CSF). Results: PWH had worse Positive Social Support (p = 0.0138) and Affectionate Support (p = 0.0078) than did HIV- individuals. A factor analysis was used to group the biomarkers into related categories separately for each fluid. Levels of three of the four Plasma Factors were significantly higher in in PWH than HIV- (ps = 0.007, 0.001 and 0.0005, respectively). Levels of one of the three CSF Factors also were significantly higher in PWH than HIV- p = 0.0194). In the combined PWH and HIV- cohort, poorer social support was associated with higher levels of a factor in plasma loading on MCP-1, IL-8 and VEGF (p = 0.020), and with a CSF factor loading on MCP-1 and IL-6 (p = 0.006). Conclusion: These results suggest that enhancing social support might be an intervention to reduce inflammation and its associated adverse outcomes among PWH.
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Purpose Rural residents may be at higher risk for loneliness than urban residents due to factors such as social isolation, poorer health, and socioeconomic disadvantage. To date, there have been few studies examining rural‐urban differences in loneliness among adults in the United States. We examined differences in loneliness across the rural‐urban continuum among adult residents living in Washington State. Methods Stratified random sampling was used to select 2,575 adults from small rural, large rural, suburban, and urban areas who were invited to complete a survey on factors affecting health. Data were obtained from 616 adults (278 from small rural, 100 from large rural, 98 from suburban, and 140 from urban areas) from June 2018 through October 2019. Loneliness was measured using the UCLA Loneliness Scale (3rd version). Multivariable linear and logistic regressions were used to examine geographic differences in loneliness (measured continuously and dichotomously). Findings Mean unadjusted loneliness scores were lower in suburban compared to urban areas (35.06 vs 38.57, P = .03). The prevalence of loneliness was 50.7%, 59.0%, 40.8%, and 54.3% in small rural, large rural, suburban, and urban areas, respectively. Suburban living was associated with lower odds for being lonely compared to urban living (unadjusted OR = 0.58; 95% CI = 0.34‐0.98), but this association was not statistically significant in the adjusted model (OR = 0.63; 95% CI = 0.33‐1.19). Conclusion Loneliness is a prevalent health issue across the rural‐urban continuum among Washington State adults.
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Pain and loneliness are consistently associated, but the direction of the relationship is uncertain. We assessed bidirectional associations over a 4 year period in a sample of 4,906 men and women (mean 65.1 ± 8.72 years) who were participants in the English Longitudinal Study of Ageing. The role of inflammation in these links was also investigated. Pain was defined by reports of being often troubled by pain at a moderate or severe intensity, while loneliness was measured using the shortened UCLA scale. Age, sex, ethnicity, educational attainment, wealth as a marker of socioeconomic resources, marital status, physical activity, and depressive symptoms were included as covariates. We found that baseline loneliness was associated with pain 4 years later after adjusting for baseline pain and other covariates (odds ratio (OR) = 1.25, 95%CI 1.06-1.47, P = 0.007). Similarly, baseline pain independently predicted loneliness 4 years later (OR = 1.34, 95%CI 1.14-1.58, P = 0.001). Associations remained significant after additional adjustment for baseline mobility impairment. Likelihood of pain on follow-up was heightened when baseline loneliness was accompanied by elevated C-reactive protein concentration (OR = 1.50, 95%CI 1.13-2.00, P = 0.006), while inflammation did not predict future loneliness or contribute to the association between baseline pain and future loneliness. Both pain and loneliness are distressing experiences that impact well-being and quality of life. We conclude that there were bidirectional longitudinal relationships between pain and loneliness in this representative sample of older men and women, but that the mechanisms underlying these processes may differ.
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Social isolation (SI) is a major health risk in older people leading to cognitive decline. This study examined how SI and age influence performance in the novel object recognition (NOR) and elevated plus maze (EPM) tasks in C57BL/6 mice aged 3 or 24 months. Mice were group-housed (groups of 2–3) or isolated for 2 weeks prior to experimentation. Following NOR and EPM testing hippocampal norepinephrine (NE), 5, hydroxytryptamine (5-HT), 5, hydroxyindole acetic acid (5-HIAA), corticosterone (CORT) and interleukin-6 (IL-6) were determined and serum collected for basal CORT analysis. A separate set of mice were exposed to the forced swim test (FST), sacrificed immediately and serum CORT determined. SI impaired performance in the NOR and the FST, reduced hippocampal 5-HT, increased hippocampal IL-6 and increased serum CORT post-FST in young mice. Aged mice either failed to respond significantly to SI (NOR, FST, hippocampal 5-HT, serum CORT post FST) or SI had synergistic effects with age (hippocampal NE, 5-HIAA:5-HT). In conclusion, the lack of response to SI in the aged mice may affect health by preventing them adapting to new stressors, while the synergistic effects of SI with age would increase allostatic load and enhance the deleterious effects of the ageing process.
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Rationale: It has long been known that factors of the mind and of interpersonal relationships influence health, but it is only in the last 50 years that an independent scientific field of health psychology appeared, dedicated to understanding psychological and behavioral processes in health, illness, and healthcare. Objective and method: This article (a) reviews important research that answers the question of how human beings can have longer, happier lives; and (b) highlights trends in health psychology featuring articles in Social Science & Medicine as well as other related literature. Results: Since the 1970s, health psychology has embraced a biopsychosocial model such that biological factors interact and are affected by psychological and social elements. This model has illuminated all subjects of health, ranging from interventions to lower stress and/or to improve people's ability to cope with stressors, to mental and physical health. Importantly, a health psychology perspective is behavioral: The majority of chronic diseases of today can be avoided or reduced through healthy lifestyles (e.g., sufficient exercise, proper diet, sufficient sleep). Thus, behavior change is the key target to help reduce the immense public health burden of chronic lifestyle illnesses. Health psychology also focuses on how social patterns influence health behavior and outcomes, in the form of patient-provider interactions or as social forces in communities where people live, work, and play. Health psychology is congenial to other health sciences, especially when allied with ecological perspectives that incorporate factors upstream from individual behavior, such as networks linked to individuals (e.g., peer groups, communities). Over its history, health psychology research has been responsive to societal and medical needs and has routinely focused on understanding health disparities. Conclusion: By relying on a strong interdisciplinary approach, research in health psychology provides a remarkably comprehensive perspective on how people can live healthier lives.
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Objectives: Loneliness is a biopsychosocial determinant of health and contributes to physical and psychological chronic illnesses, functional decline, and mortality in older adults. This paper presents the results of the first randomized trial of LISTEN, which is a new cognitive behavioral intervention for loneliness, on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and measures of physical health. Methods: The effectiveness of LISTEN was evaluated in a sample population comprising 27 lonely, chronically ill, older adults living in Appalachia. Participants were randomized into LISTEN or educational attention control groups. Outcome measures included salivary cortisol and DHEA, interleukin-6, interleukin-2, depressive symptoms, loneliness, perceived social support, functional ability, quality of life, fasting glucose, blood pressure, and body mass index. Results: At 12 weeks after the last intervention session, participants of the LISTEN group reported reduced loneliness (p = 0.03), enhanced overall social support (p = 0.05), and decreased systolic blood pressure (p = 0.02). The attention control group reported decreased functional ability (p = 0.10) and reduced quality of life (p = 0.13). Conclusions: LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.
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Purpose The purpose of this study was to evaluate the effectiveness of LISTEN (Loneliness Intervention) on loneliness, depression, physical health, systemic inflammation, and genomic expression in a sample of lonely, chronically ill, older adults. Methods This was a prospective, longitudinal randomized trial of LISTEN, a novel intervention based on theories of narrative and cognitive restructuring to target specific aspects of loneliness. Twenty-three older, lonely, chronically ill adults were recruited from a family medicine clinic in West Virginia. Participants were randomized to two groups, 13 in LISTEN group (Loneliness Intervention) and 10 in attention control (healthy aging education). Participants attended an enrollment session where they completed consent, survey data (including sociodemographics and chronic illness diagnoses), baseline physical measures, and blood sampling for gene expression analysis. After completing the 5 weekly sessions, all participants attended a 12 week post data collection meeting (17 weeks post-baseline) for survey completion, physical measures and blood sampling. Results The results of this study show that the LISTEN intervention improves measures of physical and psychosocial health. Specifically, subjects enrolled in LISTEN showed reductions in systolic blood pressure, as well as decreased feelings of loneliness and depression. These changes may be due, in part, to a reduction in systemic inflammation, as measured by interleukin-2. Conclusion This study provides support for the use of LISTEN in reducing loneliness in chronically ill, older adults. Further, while some of our results are inconclusive, it provides rationale to expand our study population to evaluate the relationship between loneliness and systemic inflammation. In the future, enhancing knowledge about the relationships among loneliness, chronic illness, systemic inflammation, and gene expression of these particular targets, and how these relationships may change over time with intervention will inform translation of findings to clinical settings.
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Objective: Both objective and subjective aspects of social isolation have been associated with alterations in immune markers relevant to multiple chronic diseases among older adults. However, these associations may be confounded by health status, and it is unclear whether these social factors are associated with immune functioning among relatively healthy adults. The goal of this study was to examine the associations between perceived loneliness and circulating levels of inflammatory markers among a diverse sample of adults. Methods: Data come from a subset of the Multi-Ethnic Study of Atherosclerosis (n = 441). Loneliness was measured by three items derived from the UCLA Loneliness Scale. The association between loneliness and C-reactive protein (CRP) and fibrinogen was assessed using multivariable linear regression analyses. Models were adjusted for demographic and health characteristics. Results: Approximately 50% of participants reported that they hardly ever felt lonely and 17.2% felt highly lonely. Individuals who were unmarried/unpartnered or with higher depressive symptoms were more likely to report being highly lonely. There was no relationship between perceived loneliness and ln(CRP) (β = -0.051, p = 0.239) adjusting for demographic and health characteristics. Loneliness was inversely associated with ln(fibrinogen) (β = -0.091, p = 0.040), although the absolute magnitude of this relationship was small. Conclusion: These results indicate that loneliness is not positively associated with fibrinogen or CRP among relatively healthy middle-aged adults.
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A recent meta-analysis has shown that loneliness and social isolation are risk factors for coronary heart disease and stroke.1 These latest findings, specific to cardiovascular outcomes, are consistent with substantial research indicating broad health risks (eg, immune functioning, cardiovascular functioning, cognitive decline) associated with the quantity and quality of social relationships—including several meta-analyses documenting mortality risk.2 ,3 In the most comprehensive of these,3 the overall odds for mortality was 1.50, similar to the risk from light smoking and exceeding the risks conferred by hypertension and obesity. Thus, the epidemiological data suggest that having more and better quality social relationships is linked to decreased health risks and having fewer and poorer quality relationships increased risk.2 ,3 Research has also documented the influence of social connections (including measures specific to loneliness and isolation) on multiple pathways involved in both the development and progression of coronary heart disease and stroke. As depicted in figure 1, these include lifestyle (eg, nutrition, physical activity, sleep),4 treatment adherence and cooperation,5 and direct effects on surrogate biological markers.6 ,7 Recent longitudinal data from four nationally representative US samples revealed a dose–response effect of social integration on several surrogate biomarkers of cardiovascular disease including hypertension, body mass index, waist circumference and inflammation (hs-CRP).6 Moreover, most epidemiological studies control for lifestyle factors (eg, smoking, physical activity), documenting an independent influence of social relationships on mortality. Taken together, these latest findings specific to loneliness and isolation1 bolster the already robust evidence documenting that social connections significantly predict morbidity and mortality, supporting the case for inclusion as a risk factor for cardiovascular disease (CVD). Figure 1 Simplified model of possible direct and indirect pathways by which social connections influence disease morbidity and mortality. How should these data inform clinical practice? …
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Background The influence of social relationships on morbidity is widely accepted, but the size of the risk to cardiovascular health is unclear. Objective We undertook a systematic review and meta-analysis to investigate the association between loneliness or social isolation and incident coronary heart disease (CHD) and stroke. Methods Sixteen electronic databases were systematically searched for longitudinal studies set in high-income countries and published up until May 2015. Two independent reviewers screened studies for inclusion and extracted data. We assessed quality using a component approach and pooled data for analysis using random effects models. Results Of the 35 925 records retrieved, 23 papers met inclusion criteria for the narrative review. They reported data from 16 longitudinal datasets, for a total of 4628 CHD and 3002 stroke events recorded over follow-up periods ranging from 3 to 21 years. Reports of 11 CHD studies and 8 stroke studies provided data suitable for meta-analysis. Poor social relationships were associated with a 29% increase in risk of incident CHD (pooled relative risk: 1.29, 95% CI 1.04 to 1.59) and a 32% increase in risk of stroke (pooled relative risk: 1.32, 95% CI 1.04 to 1.68). Subgroup analyses did not identify any differences by gender. Conclusions Our findings suggest that deficiencies in social relationships are associated with an increased risk of developing CHD and stroke. Future studies are needed to investigate whether interventions targeting loneliness and social isolation can help to prevent two of the leading causes of death and disability in high-income countries. Study registration number CRD42014010225.
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Significance Perceived social isolation (PSI) (loneliness) is linked to increased risk of chronic disease and mortality, and previous research has implicated up-regulated inflammation and down-regulated antiviral gene expression (the conserved transcriptional response to adversity; CTRA) as a potential mechanism for such effects. The present studies used integrative analyses of transcriptome regulation in high-PSI humans and rhesus macaques to define the basis for such effects in neuroendocrine-related alterations in myeloid immune cell population dynamics. CTRA up-regulation also preceded increases in PSI, suggesting a reciprocal mechanism by which CTRA gene expression may both propagate PSI and contribute to its related disease risks.
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Background: Research supports an association between smoking and negative affect. Loneliness is a negative affective state experienced when a person perceives themselves as socially isolated and is associated with poor health behaviors and increased morbidity and early mortality. Objectives: In this article, we systematically review the literature on loneliness and smoking and suggest potential theoretical and methodological implications. Methods: PubMed and PsycINFO were systematically searched for articles that assessed the statistical association between loneliness and smoking. Articles that met study inclusion criteria were reviewed. Results: Twenty-five studies met inclusion criteria. Ten studies were conducted with nationally representative samples. Twelve studies assessed loneliness using a version of the UCLA Loneliness Scale and nine used a one-item measure of loneliness. Seventeen studies assessed smoking with a binary smoking status variable. Fourteen of the studies were conducted with adults and 11 with adolescents. Half of the reviewed studies reported a statistically significant association between loneliness and smoking. Of the studies with significant results, all but one study found that higher loneliness scores were associated with being a smoker. Conclusions/Importance: Loneliness and smoking are likely associated, however, half of the studies reviewed did not report significant associations. Studies conducted with larger sample sizes, such as those that used nationally representative samples, were more likely to have statistically significant findings. Future studies should focus on using large, longitudinal cohorts, using measures that capture different aspects of loneliness and smoking, and exploring mediators and moderators of the association between loneliness and smoking.
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Increasing evidence suggests that perceived social isolation or loneliness is a major risk factor for physical and mental illness in later life. This review assesses the status of research on loneliness and health in older adults. Key concepts and definitions of loneliness are identified, and the prevalence, correlates, and health effects of loneliness in older individuals are reviewed. Theoretical mechanisms that underlie the association between loneliness and health are also described, and illustrative studies examining these mechanisms are summarized. Intervention approaches to reduce loneliness in old age are highlighted, and priority recommendations for future research are presented.
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Interleukin-6 and C-reactive protein are commonly assessed biomarkers linked to illness, obesity, and stressful life events. However, relatively little is known about their heritability. By comparing Caucasian twins from the Midlife in the US project (MIDUS), we estimated the heritability of IL-6, its soluble receptor, and CRP. Based on the hypothesis that adiposity might contribute more to IL-6 than to sIL-6r, we fit heritability models quantifying the extent to which each reflected genetic and environmental factors shared with obesity. Genetic influences on IL-6 and its receptor proved to be distinct. Further, the appearance of a heritable basis for IL-6 was mediated largely via shared paths with obesity. Supporting this conclusion, we confirmed that when unrelated adult controls are carefully matched to twin participants on BMI, age, gender and socioeconomic indices, their IL-6 is similar to the corresponding twins. In contrast, the effect of BMI on CRP was split between shared genetics and environmental influences. In conclusion, IL-6 is strongly affected by factors associated with obesity accounting for its lability and responsiveness to diet, life style and contemporaneous events. Copyright © 2015. Published by Elsevier Inc.
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Sociality permeates each of the fundamental motives of human existence and plays a critical role in evolutionary fitness across the lifespan. Evidence for this thesis draws from research linking deficits in social relationship-as indexed by perceived social isolation (i.e. loneliness)-with adverse health and fitness consequences at each developmental stage of life. Outcomes include depression, poor sleep quality, impaired executive function, accelerated cognitive decline, unfavourable cardiovascular function, impaired immunity, altered hypothalamic pituitary-adrenocortical activity, a pro-inflammatory gene expression profile and earlier mortality. Gaps in this research are summarized with suggestions for future research. In addition, we argue that a better understanding of naturally occurring variation in loneliness, and its physiological and psychological underpinnings, in non-human species may be a valuable direction to better understand the persistence of a 'lonely' phenotype in social species, and its consequences for health and fitness. © 2015 The Author(s) Published by the Royal Society. All rights reserved.
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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 Abstracts, 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. © The Author(s) 2015.
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Objective: Social relationships are widely understood to be important for sustaining and improving health and longevity, but it remains unclear how different dimensions of social relationships operate through similar or distinct mechanisms to affect biophysiological markers of aging-related disease over time. Method: This study utilized longitudinal data on a nationally representative sample of older adults from the National Social Life, Health, and Aging Project (2005-2011) to examine the prospective associations between social integration and social support and change in systolic blood pressure (SBP) and hypertension risk over time. Results: Although both social relationship dimensions have significant physiological impacts, their relative importance differs by outcome. Low social support was predictive of increase in SBP, whereas low social integration was predictive of increase in risk of hypertension. Discussion: The different roles of relationship characteristics in predicting change in physiological outcomes suggest specific biophysiological stress response and behavioral mechanisms that have important implications for both scientific understandings and effective prevention and control of a leading chronic condition in late life.
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Midlife in the United States (MIDUS) is a national longitudinal study of health and well-being (http://midus.wisc.edu/). It was conceived by a multidisciplinary team of scholars interested in understanding aging as an integrated bio-psycho-social process, and as such it includes data collected in a wide array of research protocols using a variety of survey and non-survey instruments. The data captured by these different protocols (comprising around 20,000 variables) represent survey measures, cognitive assessments, daily stress diaries, clinical, biomarker and neuroscience data which are contained in separate flat or stacked data files with a common ID system that allows easy data merges among them. All MIDUS datasets and documentation are archived at the ICPSR (http://www.icpsr.umich.edu/) repository at the University of Michigan and are publicly available in a variety of formats and statistical packages. Special attention is given to providing clear user-friendly documentation; the study has embraced the Data Documentation Initiative (DDI) metadata standard and produces DDI-Lifecycle compliant codebooks. Potential for secondary use of MIDUS is high and actively encouraged. The study has become very popular with the research public as measured by data downloads and citation counts (see Reuse Potential below).
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Objective: The objective of this study was to test a conceptual model of loneliness in which social structural factors are posited to operate through proximal factors to influence perceptions of relationship quality and loneliness. Methods: We used a population-based sample of 225 White, Black, and Hispanic men and women aged 50 through 68 from the Chicago Health, Aging, and Social Relations Study to examine the extent to which associations between sociodemographic factors and loneliness were explained by socioeconomic status, physical health, social roles, stress exposure, and, ultimately, by network size and subjective relationship quality. Result: Education and income were negatively associated with loneliness and explained racial/ethnic differences in loneliness. Being married largely explained the association between income and loneliness, with positive marital relationships offering the greatest degree of protection against loneliness. Independent risk factors for loneliness included male gender, physical health symptoms, chronic work and/or social stress, small social network, lack of a spousal confidant, and poor-quality social relationships. Discussion: Longitudinal research is needed to evaluate the causal role of social structural and proximal factors in explaining changes in loneliness.
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Earlier studies on gender differences in loneliness appear to have produced contradictory results. However, when 39 existing data sets were classified according to whether they used the UCLA scale (N = 28) or a self-labeling measure (N = II) of loneliness, the results revealed a clear pattern. Statistically significant sex differences are not usually found with the UCLA scale, but, when they are found, males typically have higher loneliness scores. In terms of self-labeling, women more frequently than men admit being lonely. Sex role factors may help explain these seemingly contradictory results. Of the various possible explanations of the gender differences in self-labeled loneliness, most assume that social influence processes play a crucial role. To test this viewpoint, an experiment was conducted. Subjects (N = 117) were presented with a case history of a lonely person, which varied only the target person's sex. The subjects were more rejecting of a lonely male than of a lonely female. These results support the view that women are more apt to acknowledge their loneliness than men because the negative consequences of admitting loneliness are less for women.
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