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Perceived Social Support, Loneliness, and Later Life Telomere Length Following Wartime Captivity
Abstract
Objectives:
Telomere length (TL) is a robust indicator of cellular aging. TL erosion has been associated with exposure to social and traumatic stressors. Loneliness and perceived social support are strongly linked to increased morbidity and mortality, but have yet to be investigated in relation to TL after extreme stress. The present study examined whether loneliness and lack of perceived social support following wartime captivity may be associated with TL as repatriated prisoners of war (ex-POWs) enter old age and contribute to its prediction.
Method:
A cohort of Israeli ex-POWs from the 1973 Yom Kippur War (n = 83) were assessed. Questionnaires were utilized to assess loneliness and perceived social support 18 years after the repatriation (T1), and Southern blotting was used to measure TL 24 years later (T2). A zero-order Pearson correlation test and a hierarchical regression analysis were utilized in order to examine the research questions.
Results:
Loneliness and lack of perceived social support each significantly predicted shorter TL in later life, and together added 25.8% to the overall explained variance.
Conclusions:
This is the first study to empirically demonstrate that loneliness and lack of perceived social support in early adulthood may be associated with shorter TL during transition to old age in a population that has endured extreme stress. Although the study design precludes causal inferences, several psychobiological mechanisms may explain the findings. The potential clinical significance of social deficits for longevity and heath in related populations is therefore addressed, and an agenda for future investigations is suggested. (PsycINFO Database Record
... The immune profile of stressed animals and upregulation of proinflammatory cytokines was examined in one of the studies [45]. In the two human longitudinal studies conducted by the same research group [51,52], the telomere length of prisoners of war with PTSD was examined 42 years (T2) after war captivity (T0) with an intermediate survey of perceived social isolation (T1) 18 years after trauma occurrence. ...
... The immune profile of stressed animals and upregulation of proinflammatory cytokines was examined in one of the studies [45]. In the two human longitudinal studies conducted by the same research group [51,52], the telomere length of prisoners of war with PTSD was examined 42 years (T 2 ) after war captivity (T 0 ) with an intermediate survey of perceived social isolation (T 1 ) 18 years after trauma occurrence. Wistar rat pups (male/female till pnd9, after that only male rat pups) divided into four groups (n = 8-10 per group) (i) repeated maternal separation (MS) in home-environment (HOME-SEP), with the pups remaining together Contextual fear-conditioning on pnd 240 in a fear-conditioning box. ...
... Telomeres are nucleoproteins located at the end of chromosomes protecting them from oxidative stress. Although not a neurobiological marker, telomere length (TL) is considered a substantial biomarker of cellular senescence, of immune system integrity and predictor of mortality [51], as well as a reliable peripheral biological measure of stress and hostility of PTSD patients [53,54]. In two retrieved studies, Stein et al. [51,52] showed that, in ex-prisoners of war (POW), solitary confinement during captivity as well as feelings of loneliness, loss of role in the family, lack of social support, and being accused at homecoming were associated with a shortening of telomere length in later life, compared to ex-POWs who did not share these experiences and feelings. ...
Social isolation (SI) stress has been recognized as a major risk factor of morbidity in humans and animals, exerting damaging effects at the physical and mental health levels. Posttraumatic stress disorder (PTSD), on the other hand, occurs as a result of experiencing serious, life-threatening, traumatic events and involves involuntary re-experiencing trauma (intrusion), avoidance symptoms, and distortions of cognition and emotional arousal. The literature shows that PTSD is affected by genetic predisposition and triggers a large neurocircuitry involving the amygdala, insula, hippocampus, anterior cingulate- and prefrontal-cortex, and affects the function of the neuroendocrine and immune systems. Social isolation seems to influence the predisposition, onset and outcome of PTSD in humans, whereas it constitutes a valid model of the disorder in animals. According to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) protocol, we systematically reviewed all original studies involving the neurobiological trajectories between SI and PTSD published till July 2019 (database: PubMed/Medline). Out of 274 studies, 10 met the inclusion criteria. We present the results of the retrieved studies in terms of hypothalamic-pituitary-adrenal (HPA)-axis and endocannabinoid system function, immune reactions, neuroplasticity, novel pharmacological targets, and shortening of telomere length, which confirm a synergistic effect on a neurobiological level between the two entities.
... Loneliness is a subjective feeling of social disconnectedness. If loneliness persists, it can have significant negative consequences including accelerated cognitive loss, morbidity, and mortality (Stein et al., 2018;Stroebe, Schut, & Stroebe, 2007). In a marriage, particularly during later life, spousal partners spend much of their lives together. ...
... Although these findings are novel and provide important contributions to the relatively invisible population of spouses of veterans, this study has several limitations that should be considered in interpreting our results. First, although perceived social support from friends and loneliness are distinctly different concepts (Stein et al., 2018) and are not statistically correlated in our sample (results available upon request), the measures available in this study do not allow us to fully account for how individuals' emotional feelings of social connectedness are related to the quality and quantity of their friendships, and the indirect role of the military in facilitating these effects. Consequently, further research may be needed, particularly qualitative studies, to better understand the differences in the social support structures of veteran and nonveteran spouses. ...
Objectives:
Increased loneliness is a common consequence of widowhood in later life. However, individuals with high levels of perceived social support from friends tend to cope more effectively following major social losses like widowhood. Military service is associated with cultivation of strong social support structures. This effect may not only influence those who serve, but also their spouses. Roughly half of older women today are married to veterans, which could shape how they cope with widowhood. We tested two hypotheses: 1) widows of veterans will be less lonely following widowhood compared to their nonveteran counterparts, and 2) this effect will be explained by perceived social support from friends.
Methods:
We used the Health and Retirement Study (HRS) to examine changes in loneliness following widowhood among wives of veterans and nonveterans. We used OLS regression and mediation tests to address our hypotheses.
Results:
Net of baseline differences, widows of veterans reported statistically lower levels of loneliness (p<0.05) following widowhood compared to widows of nonveterans. Widows of veterans retained the same level of perceived social support from friends pre- and post-widowhood, whereas nonveteran wives experienced a loss. Perceived social support from friends mediated the association between veteran status of the deceased spouse and loneliness.
Discussion:
Our findings suggest wives of veterans may have more resilient social support structures than nonveteran spouses, helping them cope at widowhood. Future research should explore whether these effects persist in association with other major stressful events in later life.
... Mitchell et al. (77) reported that, among perinatal women, lower perceived support from family (but not from a romantic partner or friends) was associated with shorter PBMC TL, averaged across early, middle, and late pregnancy, and 7-11 weeks postpartum, as TL did not change during this period. In a small sample of former Israeli prisoners of war, Stein et al. (115) found that lower perceived social support assessed 18 years after repatriation was associated with shorter LTL measured 24 years later, in older adulthood, even when accounting for perceived loneliness. ...
... To date, however, only three studies have investigated associations between loneliness and TL. In a small sample of former Israeli prisoners of war, Stein et al. (115) found that higher reported feelings of loneliness assessed 18 years after repatriation were moderately associated with shorter LTL measured 24 years later, in older adulthood, while also accounting for perceived social support. In contrast, in two large European samples of male older adults, Rius-Ottenheim et al. (103) found that loneliness was not associated with LTL or change in LTL over a seven-year period in one of the samples. ...
A growing literature suggests that exposure to adverse social conditions may accelerate biological aging, offering one mechanism through which adversity may increase risk for age-related disease. As one of the most extensively studied biological markers of aging, telomere length (TL) provides a valuable tool to understand potential influences of social adversity on the aging process. Indeed, a sizeable literature now links a wide range of stressors to TL across the life span. The aim of this article is to review and evaluate this extant literature with a focus on studies that investigate psychosocial stress exposures and experiences in early life and adulthood. We conclude by outlining potential biological and behavioral mechanisms through which psychosocial stress may influence TL, and we discuss directions for future research in this area.
Expected final online publication date for the Annual Review of Public Health, Volume 41 is April 1, 2020. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... The laboratory of Solomon and colleagues has been the most active group in terms of studying loneliness and PTSS. In particular, they have found important associations of loneliness and PTSS in combat veterans and POWs from the 1982 Lebanon War [43,[49][50][51][52][53]78]. Overall Solomon's research group has found loneliness to be commonly associated with symptoms of PTSD, and that soldiers who received frontline treatment for post-traumatic stress demonstrated less loneliness over time. ...
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.
... Other publications refer to aging (Shnoor et al., 2017;Rimmerman, 2020) and gender (Harel-Shalev & Daphna-Tekoah, 2021;Koren et al., 2015). Considerable research has been done about veterans with post-trauma (PTSD) in various aspects of their life by different Israeli scholars (Ginzburg et al., 2009;Ritov & Barnetz, 2014 ;Solomon et al., 2018). The lack of awareness of attention to the population of DIDF veterans in HE was also reflected in a follow-up study that was conducted over four years to evaluate the success of the "Revolution in Higher Education" project. ...
Even though military service in Israel is mandatory and common among the state population, Israeli Defense Forces (IDF) veterans with disabilities are rarely represented in the literature regarding their experience in Israeli higher education (HE). This study aimed to fill this gap by investigating the experiences of disabled IDF (DIDF) veteran students, their experiences as students, identities, challenges, and utilization of support resources on their campuses. The relevant fields of Disability Studies, Veteran Studies, and the use of disability support services on campus are discussed in this study, focusing on the implementation of accessibility regulations and practices in the Israeli HE system concerning the target population of DIDF veterans. This dissertation study aimed to understand the perceptions, needs for disability services, and experiences of DIDF-veteran students within the general student population in Israeli HE. This study applied a qualitative method with a small quantitative component. Participants were recruited to respond to an online survey and then were offered to participate in in-depth interviews. The qualitative sample included 13 participants who had a range of disabilities and attended different HE institutions including colleges and universities. They had varied military service backgrounds and educational experiences during undergraduate and graduate studies. All participants were officially recognized as DIDF veterans by the MoD, having a single or multiple disabilities. This population mainly receives rehabilitation and support services from the Israeli Ministry of Defense (MoD), but not necessarily in HE. The interview transcripts were analyzed using an inductive approach. The findings revealed that many of the participants had learning disabilities (LDs) or attention deficit hyperactivity disorder (ADHD) and other impairments or medical conditions on top of their military disability that impacted their ability to function as students. The study findings were displayed first by the four (sub) research questions and then were organized into three major themes: Disability as a Complex Category, Negotiating Disability, Choice of Support. In conclusion, my study calls for a greater awareness of this unique population and its needs in HE, which has the potential to serve as a rehabilitation site for many of them.
... Of note, these effects on TL were evident even after adjustment for depression (19), posttraumatic stress disorder symptoms, and traumatic life events (20), suggesting that positivity and resilience represent constructs that are not merely the absence of negative psychological states. Social support has also been associated with TL in adults in multiple studies, with greater levels of perceived social support predicting longer telomeres (24)(25)(26)(27), including during pregnancy (28), although one study has found the opposite association (29). However, as stated above, the question of the role of positive psychological states in telomere biology, also understudied in adults as compared with negative states, has yet to be addressed in the context of fetal programming of the telomere system. ...
Objective:
In the context of the importance of elucidating the determinants of the initial, newborn setting of telomere length (TL), it is increasingly evident that maternal stress and stress-related processes during pregnancy play a major role. Although psychological resilience may function as a buffer, research in this area has not yet examined its potential role vis-à-vis that of stress. The authors examined the relationship between maternal psychological resilience during pregnancy and newborn TL.
Methods:
In a sample of 656 mother-child dyads from the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction cohort, multiple serial assessments were conducted over the course of pregnancy to quantify maternal stress, negative and positive emotional responses to pregnancy events, positive affect, and perceived social support. Principal component analysis identified two latent factors: stress and positivity. A measure of resilience was computed by regressing the positivity factor on the stress factor, in order to quantify positivity after accounting for stress. TL was measured using quantitative polymerase chain reaction in leukocytes extracted from cord blood shortly after birth. Linear regression was used to predict newborn TL from maternal resilience during pregnancy, adjusting for other potential determinants.
Results:
Maternal stress significantly predicted shorter newborn TL (β=-0.079), and positivity significantly predicted longer TL (β=0.135). Maternal resilience (positivity accounting for stress) was significantly and positively associated with newborn TL (β=0.114, 95% CI=0.035, 0.189), with each standard deviation increase in resilience predicting 12% longer newborn TL.
Conclusions:
The results indicate that maternal psychological resilience may exert a salubrious effect on offspring telomere biology and highlight the importance of enhancing maternal mental health and well-being during pregnancy.
... The significance of social support is not strictly limited to mental health, as a study by Taft, Stern, King, and King (1999) found evidence that combat exposure among Vietnam Veterans was related to worse self-reported functional health status, in part, through lower levels of social support, and higher levels of PTSD. Further evidence among former Israeli prisoners of war suggests that feelings of loneliness and lack of social support are associated with objective risk factors for poor immune function and early mortality later in life in the form of shorter telomere length (Stein et al., 2018). ...
Poor mental health and quality of life (QOL) are common among service members exposed to trauma and may be more pronounced among those injured on combat deployment. It is vital to identify factors that attenuate these issues. This study examined whether perceived support from friends and family buffer associations between level of trauma exposure, mental health symptoms (i.e., posttraumatic stress disorder [PTSD], depression), and QOL. Military health care records and cross-sectional web-assessment data were collected for 1,643 individuals who were participating in a large-scale surveillance project of patient-reported outcomes of Service members injured on combat deployment. General linear models revealed perceived support from family and friends were independently related to lower depression and PTSD symptoms, and higher QOL. Perceived support from friends buffered associations between trauma exposure and depression symptoms and QOL, but not PTSD symptoms. In contrast, individuals with high family support reported the lowest levels for both PTSD and depression symptoms at low levels of trauma exposure. At high levels of trauma exposure, however, symptoms were similar across levels of family support. A similar trend was observed for QOL. Such evidence reinforces the importance of interpersonal relationships and support for injured service members, and highlights the need to address these topics in existing treatment and rehabilitation programs.
En este trabajo se hace una revisión bibliográfica sobre el desarrollo evolutivo humano y longevidad, desde un enfoque biopsicosocial (Engel, 1977; Gliedt et al., 2017; Lehman et al., 2017). Tras aplicar el método de análisis PRISMA, se obtuvieron diversos resultados relacionados con un desarrollo evolutivo más longevo; así, en el área biológica, 3 factores: los SNPs, los telómeros y la química del estrés; en el área psicológica, 5 factores: la metacognición, la resiliencia, la espiritualidad, las relaciones personales y la depresión; y en el área social, 8 factores: la pseudo-heredabilidad, las relaciones conyugales, la maternidad, el nivel educativo, estilos de vida, dieta y restricción calórica, actividad física y mental y tecnología sanitaria. Ante los datos obtenidos en las tres áreas, de este enfoque biopsicosocial, y el repetido solapamiento entre factores del área psicológica y del área social, se plantea que pudieran considerarse estas dos como una conjunta, proponiéndose un enfoque explicativo con dos áreas: bio-psicosocial que, por factores encontrados en este trabajo, quedarían un 18,7% de biológica y un 81,3% psicosocial. Actualmente, hay suficiente información sobre desarrollo evolutivo humano y longevidad, pero una ausencia de investigaciones que estudien esos factores desde una perspectiva integrada. Mucha de esa información privilegiada se podría aplicar ya, psicológica y socialmente, a la población en general, para una mejora de su salud, en cualquier fase del desarrollo evolutivo humano.
Previous studies have shown that lower social support is associated with higher all-cause mortality (Holt-Lunstad et al. in PLoS ONE Medicine 7:e1000316, 2010). While social support has been associated with system-specific biological measures (e.g., cardiovascular), there is the need to elucidate more general biological mechanisms linking social support to health risk across a number of diseases. In this meta-analytic review, the link between social support and telomere length (Cawthon et al. in Lancet 361:393–395, 2003) was conducted based on the updated PRISMA guidelines (Page et al., 2021). Across 17 studies, higher social support was not significantly related to longer telomere length (Zr = 0.010, 95% CI [− 0.028, 0.047], p > 0.05). The confidence interval indicated that the bulk of plausible values were small to null associations. Little evidence for bias was found as shown by funnel plots and Kendall’s Tau. Moderator analyses focusing on the measure of support, health of sample, age, type of assay specimen, and gender were not significant. In conclusion, this review showed no significant relationship between social support and telomere length and highlights important future directions.
Considering that telomere length can be determined not only by issues related to cell biology, but also by aspects related to social factors and environmental exposures, studies on the relationship between social aspects and telomere length can help to better understand the still little-known aspects of the human aging process. Thus, this research seeks to verify whether social support network is associated with telomere length in older adults. This is a cross-sectional study conducted with 448 individuals aged 60 years or older living in the urban area of a municipality in Brazil's countryside. The relative quantification of telomere length was obtained through real-time qPCR. Social support was assessed through the Medical Outcomes Study Social Support Scale. Descriptive statistics and multiple logistic regression were used in the data analysis. The evaluated social support networks for older adults are composed, on average, of 16.4 people and the percentage of older adults who reported up to five members in the network was 27.75%. The shorter telomere length was identified in 25% of the participants, and older adults who reported having up to five members in the support network were more likely to have shorter telomere length than the ones who reported more numerous networks (OR: 1.89, p=0.011), regardless of gender, age, household arrangement, cognitive decline and dependence for basic and instrumental activities of daily life, which suggests that measures that stimulate the creation and maintenance of social support networks should be implemented in order to improve the health of the older adults.
Loneliness is usually defined as a distressing feeling that accompanies the perception that one’s social needs are not being met by meaningful relationships. Although it is often trivialized, it has recently been acknowledged as a public health issue. Moreover, the prevalence doubled in the last decade, expectably aggravated in the context of COVID-19. However, the effects of loneliness on health remain unknown and understudied. The chapter provides an analysis of the main effects of loneliness on health, their underlying mechanisms, and moderators based on the recent literature. A thorough review was conducted using Web of Science and Semantic Scholar as main databases using “loneliness” and “health” as main keywords. Full-text articles published in English, Spanish and Portuguese were included in the review. In addition, landmark studies were also included in the review. Evidence based on this review indicates that an increasing number of well-conducted studies highlight the deleterious effect of loneliness on a wide range of health problems. Moreover, the negative impact of loneliness on health is comparable to well-established factors such as smoking for both men and women after controlling for confounding variables. The effect of loneliness on health seems to be mainly mediated by the stress-response, suggesting the crucial role of lack of social support as a key stressor in humans. Furthermore, loneliness affects cognition impairing social and executive functions such as inhibitory control associated with a healthy and successful life. Finally, this chapter discusses how to design loneliness-based interventions to improve public health policies and promote health.
People who are socially isolated or lonely report having lower levels of social support. Supportive social networks help buffer individuals against the deleterious effects of negative events and stressors. Supportive social networks also help individuals maximize the benefits of positive events and accomplishments. In short, those who are socially isolated suffer more when bad things happen and gain less when good things happen than those who are more socially connected.
The current COVID-19 pandemic is causing direct and indirect effects in the global population. In this paper, fear and its possible forthcoming consequences on health will be investigated and discussed. Fear is an innate reactive emotion to the immediate threats produced by danger. It is hardwired within subcortical survival circuits and originally had to defend the organism from predators. Besides, fear is a cognitive emotional process mediated by the cortical structures, and implies a subjective evaluation both at implicit (subsymbolic, unconscious) and explicit (symbolic, conscious) levels. Within a defensive taxonomy framework, fear can be defined as a reflex triggering a prompt behavior aimed at surviving from predating attacks (freezing), whereas anxiety as a deliberate pattern aimed at planning behaviors for anticipating and avoiding future harm. Fear and anxiety overlap at a subjective level, but are generated by different neurobiological networks and serve different evolutionary goals. The current viral danger and the need for social distancing worsen the sense of loneliness. A wide body of experimental and epidemiological literature evidence that psychological stress, social isolation, and loneliness have a detrimental effect on multiple health-related outcomes including comorbidity, multimorbidity, and mortality. The negative effects can be even higher for people currently living a massive limitation of physical and interpersonal contacts. A strong effort to integrate psychological and medical care is needed to face post-pandemic health issues.
En este trabajo se hace una revisión bibliográfica sobre el desarrollo evolutivo humano y longevidad, desde un enfoque biopsicosocial (Engel, 1977; Gliedt et al., 2017; Lehman et al., 2017). Tras aplicar el método de análisis PRISMA, se obtuvieron diversos resultados relacionados con un desarrollo evolutivo más longevo; así, en el área biológica, 3 factores: los SNPs, los telómeros y la química del estrés; en el área psicológica, 5 factores: la metacognición, la resiliencia, la espiritualidad, las relaciones personales y la depresión; y en el área social, 8 factores: la pseudo-heredabilidad, las relaciones conyugales, la maternidad, el nivel educativo, estilos de vida, dieta y restricción calórica, actividad física y mental y tecnología sanitaria. Ante los datos obtenidos en las tres áreas, de este enfoque biopsicosocial, y el repetido solapamiento entre factores del área psicológica y del área social, se plantea que pudieran considerarse estas dos como una conjunta, proponiéndose un enfoque explicativo con dos áreas: bio-psicosocial que, por factores encontrados en este trabajo, quedarían un 18,7% de biológica y un 81,3% psicosocial. Actualmente, hay suficiente información sobre desarrollo evolutivo humano y longevidad, pero una ausencia de investigaciones que estudien esos factores desde una perspectiva integrada. Mucha de esa información privilegiada se podría aplicar ya, psicológica y socialmente, a la población en general, para una mejora de su salud, en cualquier fase del desarrollo evolutivo humano.
Purpose of review:
Recent research on childhood trauma has focused on the effects of in-utero and early life stress (ELS) as well as improving access to care. This review includes the previous year's clinically relevant research with attention to gaps that require further research that should improve patient care.
Recent findings:
The current article focuses on the latest understanding of ELS effects on the neuroendocrine, inflammatory, immune, and neurologic systems, as well as epigenetic effects with a focus on research examining sex-specific differences. Resilience and innovative treatment delivery models are reviewed with emphasis on integrated care models and technology-based treatments.
Summary:
The findings reviewed point toward clinically relevant research avenues. The call for more and better treatment options can only be realized with a better understanding of ELS effects. There is a specific need for more in depth exploration and application of sex-specific differences as well as an examination of the effects of age of onset and chronicity of stressors. New developments in the delivery of interventions and treatment allow the potential to provide broader early access to care.
Background:
The adverse effects of loneliness and of poor perceived social support on physical health and mortality are established, but no systematic synthesis is available of their relationship with the outcomes of mental health problems over time. In this systematic review, we aim to examine the evidence on whether loneliness and closely related concepts predict poor outcomes among adults with mental health problems.
Methods:
We searched six databases and reference lists for longitudinal quantitative studies that examined the relationship between baseline measures of loneliness and poor perceived social support and outcomes at follow up. Thirty-four eligible papers were retrieved. Due to heterogeneity among included studies in clinical populations, predictor measures and outcomes, a narrative synthesis was conducted.
Results:
We found substantial evidence from prospective studies that people with depression who perceive their social support as poorer have worse outcomes in terms of symptoms, recovery and social functioning. Loneliness has been investigated much less than perceived social support, but there is some evidence that greater loneliness predicts poorer depression outcome. There is also some preliminary evidence of associations between perceived social support and outcomes in schizophrenia, bipolar disorder and anxiety disorders.
Conclusions:
Loneliness and quality of social support in depression are potential targets for development and testing of interventions, while for other conditions further evidence is needed regarding relationships with outcomes.
Veterans' loneliness may persist decades after the war and may be detrimental, particularly when deployment has been traumatic. Indeed, mitigating loneliness via social support may be essential for alleviating war-induced posttraumatic stress disorder (PTSD). Nevertheless, rarely has veterans' loneliness been empirically investigated, and its unique features have never been systematically delineated. Since experiences of loneliness vary qualitatively, and these variations may have implications regarding the kind of support and clinical intervention necessary for their amelioration, understanding its nature may be critical. The current chapter fills this gap by delineating this experience's developmental course and the underlying relational deficits at its infrastructure throughout that course. Based on veterans' accounts and extant multidisciplinary literature, the veteran's loneliness is traced from enlistment, through deployment, war, and homecoming. An experiential loneliness bound to the "veteran identity" is depicted, and the significance of transitions between social contexts and experiential worlds is underscored. Comparing the characteristics of this loneliness to those of other types of loneliness the chapter highlights the necessity of understanding the veteran's experience as a specific form of loneliness, with implications for intervention, both clinical and societal. The chapter therefore concludes with implications for practitioners and social support networks, as well as desirable directions for future research.
Purpose:
There is growing evidence of significant harmful effects of loneliness. Relatively little work has focused on how best to reduce loneliness in people with mental health problems. We aim to present an overview of the current state of the art in loneliness interventions in people with mental health problems, identify relevant challenges, and highlight priorities for future research and implementation.
Methods:
A scoping review of the published and grey literature was conducted, as well as discussions with relevant experts, to propose a broad classification system for types of interventions targeting loneliness.
Results:
We categorised interventions as 'direct', targeting loneliness and related concepts in social relationships, and 'indirect' broader approaches to well-being that may impact on loneliness. We describe four broad groups of direct interventions: changing cognitions; social skills training and psychoeducation; supported socialisation or having a 'socially-focused supporter'; and 'wider community approaches'. The most promising emerging evidence appears to be in 'changing cognitions', but, as yet, no approaches have a robust evidence base. Challenges include who is best placed to offer the intervention, how to test such complex interventions, and the stigma surrounding loneliness.
Conclusions:
Development of clearly defined loneliness interventions, high-quality trials of effectiveness, and identifying which approaches work best for whom is required. Promising future approaches may include wider community initiatives and social prescribing. It is important to place loneliness and social relationships high on the wider public mental health and research agenda.
Background:
Feelings of loneliness are common among young adults, and are hypothesized to impair the quality of sleep. In the present study, we tested associations between loneliness and sleep quality in a nationally representative sample of young adults. Further, based on the hypothesis that sleep problems in lonely individuals are driven by increased vigilance for threat, we tested whether past exposure to violence exacerbated this association.
Method:
Data were drawn from the Environmental Risk (E-Risk) Longitudinal Twin Study, a birth cohort of 2232 twins born in England and Wales in 1994 and 1995. We measured loneliness using items from the UCLA Loneliness Scale, and sleep quality using the Pittsburgh Sleep Quality Index. We controlled for covariates including social isolation, psychopathology, employment status and being a parent of an infant. We examined twin differences to control for unmeasured genetic and family environment factors.
Results:
Feelings of loneliness were associated with worse overall sleep quality. Loneliness was associated specifically with subjective sleep quality and daytime dysfunction. These associations were robust to controls for covariates. Among monozygotic twins, within-twin pair differences in loneliness were significantly associated with within-pair differences in sleep quality, indicating an association independent of unmeasured familial influences. The association between loneliness and sleep quality was exacerbated among individuals exposed to violence victimization in adolescence or maltreatment in childhood.
Conclusions:
Loneliness is robustly associated with poorer sleep quality in young people, underscoring the importance of early interventions to mitigate the long-term outcomes of loneliness. Special care should be directed towards individuals who have experienced victimization.
As most research devoted to the aftermath of war captivity discusses physical and intrapersonal ramifications, the interpersonal domain is left largely underrepresented in research. Our aim in this chapter is to shed light on this realm of psychosocial deficit. Indeed, throughout this chapter we highlight the manner in which various dimensions of interpersonal pernicious and malicious conduct during captivity are weaved into a tapestry of dysfunctional interpersonal relationships in the life that is to come after repatriation. In order to accomplish this we first elaborate in some detail the ingenuity of torture and misconduct of war captivity. Next, we address multifarious dimensions of interpersonal disruption that POWs may undergo after repatriation. Throughout the chapter we provide findings from a longitudinal study that has examined such aspects in a prospective cohort of Israeli ex-POWs who fell captive in 1973 in Egypt and Syria. Concomitantly we survey various interpersonal aspects that include attachment injury, marital and familial adjustment, loneliness and betrayal following captivity. Once these dimensions of post-repatriation become evident, it is then simple to see the devastation that war captivity instills in concentric circles of interpersonal relationships: family, friend, society and state. It is from these realizations that we suggest directions for researchers, clinicians, and policy makers to work towards the mending of interpersonal bonds, the communalization of trauma, and reinstatement of trust. Hopefully with such efforts where detachment was, there attachment will once again be, and where loneliness reigned there connection will once again rule.
Psychosocial stress has been associated with an increased risk for mental and somatic health problems across the life span. Some studies in younger adults linked this to accelerated cellular aging, indexed by shortened telomere length (TL). In older adults, the impact of psychosocial stress on TL may be different due to the lifetime exposure to competing causes of TL-shortening. This study aims to assess whether early and recent psychosocial stressors (childhood abuse, childhood adverse events, recent negative life events, and loneliness) were associated with TL in older adults.
Data were from the Netherlands Study of Depression in Older Persons (NESDO) in which psychosocial stressors were measured in 496 persons aged 60 and older (mean age 70.6 (SD 7.4) years) during a face-to-face interview. Leukocyte TL was determined using fasting blood samples by performing quantitative polymerase chain reaction (qPCR) and was expressed in base pairs (bp).
Multiple regression analyses, adjusted for age, sex, and chronic diseases, showed that childhood abuse, recent negative life events and loneliness were unrelated to TL. Only having experienced any childhood adverse event was weakly but significantly negatively associated with TL.
Our findings did not consistently confirm our hypothesis that psychosocial stress is associated with shorter TL in older adults. Healthy survivorship or other TL-damaging factors such as somatic health problems seem to dominate a potential effect of psychosocial stress on TL in older adults.
The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.
Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter century. The brain is the key organ of social connections and processes, however, and the same objective social relationship can be experienced as caring and protective or as exploitive and isolating. We review evidence that the perception of social isolation (i.e., loneliness) impacts brain and behavior and is a risk factor for broad-based morbidity and mortality. However, the causal role of loneliness on neural mechanisms and mortality is difficult to test conclusively in humans. Mechanistic animal studies provide a lens through which to evaluate the neurological effects of a member of a social species living chronically on the social perimeter. Experimental studies show that social isolation produces significant changes in brain structures and processes in adult social animals. These effects are not uniform across the brain or across species but instead are most evident in brain regions that reflect differences in the functional demands of solitary versus social living for a particular species. The human and animal literatures have developed independently, however, and significant gaps also exist. The current review underscores the importance of integrating human and animal research to delineate the mechanisms through which social relationships impact the brain, health, and well-being. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Telomere length has been hypothesized to be a marker of cumulative exposure to stress, and stress is an established cause of depression and anxiety disorders. The aim of this study was to examine the relationship between depression, anxiety and telomere length, and to assess whether this relationship is moderated by race/ethnicity, gender and/or antidepressant use. Data were from the 1999-2002 National Health and Nutrition Examination Survey. Telomere length was assessed using the quantitative PCR method of telomere length relative to standard reference DNA. Past-year major depression (MD), generalized anxiety disorder (GAD) and panic disorder (PD), as well as depressed affect and anxious affect, were assessed using the Composite International Diagnostic Inventory (N=1290). Multiple linear regression was used to assess the relationship between depression and anxiety disorders and telomere length. Among women, those with GAD or PD had shorter telomeres than those with no anxious affect (β: -0.07, P<0.01), but there was no relationship among men (β: 0.08, P>0.05). Among respondents currently taking an antidepressant, those with MD had shorter telomeres than those without (β: -0.26, P<0.05), but there was no association between MD and telomere length among those not using antidepressants (β: -0.00, P>0.05). Neither depressive nor anxiety disorders were directly associated with telomere length in young adults. There was suggestive evidence that pharmacologically treated MD is associated with shorter telomere length, likely reflecting the more severe nature of MD that has come to clinical attention.Molecular Psychiatry advance online publication, 2 September 2014; doi:10.1038/mp.2014.89.
Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter of a century. Although the focus of research has been on objective social roles and health behavior, the brain is the key organ for forming, monitoring, maintaining, repairing, and replacing salutary connections with others. Accordingly, population-based longitudinal research indicates that perceived social isolation (loneliness) is a risk factor for morbidity and mortality independent of objective social isolation and health behavior. Human and animal investigations of neuroendocrine stress mechanisms that may be involved suggest that (a) chronic social isolation increases the activation of the hypothalamic pituitary adrenocortical axis, and (b) these effects are more dependent on the disruption of a social bond between a significant pair than objective isolation per se. The relational factors and neuroendocrine, neurobiological, and genetic mechanisms that may contribute to the association between perceived isolation and mortality are reviewed. Expected final online publication date for the Annual Review of Psychology Volume 66 is November 30, 2014. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
Objective:
Social control in the health domain refers to attempts by social network members to get an individual to modify their health behaviors. According to the dual effects model of social control, having one's health behavior controlled by others should be related to healthier behavioral change, but might arouse psychological distress as one may resent being controlled. Despite potential healthy behavior change, the stress of social control may thus be detrimental as interpersonal stress has been related to negative health outcomes. In the present study, the association between perceived social control and telomere length was tested to examine its association to biological outcomes.
Method:
In this cross-sectional study, a relatively healthy community sample of 140 middle age and older adults completed measures of perceived social control, perceived stress, and health behaviors. Peripheral blood mononuclear cells were used to determine telomere length.
Results:
Main results showed that higher levels of perceived direct social network control were associated with shorter telomere length. These links were not influenced by statistical controls for medication use, self-rated health, trait hostility, and optimism. Perceived social control was also related to greater perceived stress but not health behaviors overall. However, neither perceived stress nor health behaviors mediated the link between social control and telomere length.
Conclusions:
Although the study design precludes strong inferences, these results suggest that perceived social control may be associated with cellular aging. These data also highlight the utility of integrating biological outcomes into social control models. (PsycINFO Database Record
Telomere length, a reliable predictor of disease pathogenesis, can be affected by genetics, chronic stress and health behaviors. Cross-sectionally, highly stressed postmenopausal women have shorter telomeres, but only if they are inactive. However, no studies have prospectively examined telomere length change over a short period, and if rate of attrition is affected by naturalistic factors such as stress and engagement in healthy behaviors, including diet, exercise, and sleep. Here we followed healthy women over 1 year to test if major stressors that occurred over the year predicted telomere shortening, and whether engaging in healthy behaviors during this period mitigates this effect. In 239 postmenopausal, non-smoking, disease-free women, accumulation of major life stressors across a 1-year period predicted telomere attrition over the same period-for every major life stressor that occurred during the year, there was a significantly greater decline in telomere length over the year of 35 bp (P<0.05). Yet, these effects were moderated by health behaviors (interaction B=0.19, P=0.04). Women who maintained relatively higher levels of health behaviors (1 s.d. above the mean) appeared to be protected when exposed to stress. This finding has implications for understanding malleability of telomere length, as well as expectations for possible intervention effects. This is the first study to identify predictors of telomere length change over the short period of a year.Molecular Psychiatry advance online publication, 29 July 2014; doi:10.1038/mp.2014.70.
Loneliness may be seen as the epitome of relational deficit, and as an
experience that may hold dire ramifications for health and well-being. Hence, it has
become a phenomenon of growing interest in psychology, nursing, and healthcare.
While loneliness literature in numerous disciplines is replete with attempts to define
and conceptualize the experience, a close examination of existing conceptualizations
suggests they are lacking. Moreover, while researchers demonstrate how various
theoretical approaches relate to loneliness, they have yet to examine how the various
approaches relate to each other. We (a) address those shortcomings and suggest that
they may be attributed to adherence to a positivistic view of the experience, (b)
demonstrate manners in which previous conceptualizations and their construal
mechanisms may be traced to their disciplinary traditions, and (c) argue for an
interpretative social-constructionistic point of view by breaking down the experience
of loneliness into its fundamental components. The result is an experiential model
depicting seven components essential to the experience of loneliness as it is
constructed within a western interdisciplinary academic milieu: (a) a sense of
isolation, (b) a relationship, (c) an experiencing self, (d) a representation of an Other,
(e) a deficiency of relational need(s), (f) a sense of discrepancy, and (g) psychological
pain or aversion. Interrelations among the elements, the model's utility for qualitative
investigations and clinical practice, and its implications for future research
investigating loneliness are discussed.
For the article: http://www.tandfonline.com/eprint/gh9pvDayvx8gKWVz9fJq/full
Loneliness holds detrimental ramifications for health and well-being. Nevertheless, loneliness references in the literature addressing combat-related trauma are few. Consequentially, the qualities and characteristics of such experiences in these posttraumatic realities remain uninvestigated empirically. In the current qualitative study we began filling this gap in the literature. We utilized thematic content analysis of life-stories of 19 combat veterans and 7 ex-POWs that have given testimony at the Israel Trauma Center for Victims of Terror and War (NATAL). Our findings suggest that the loneliness in the contexts at hand is primarily characterized by a sense of experiential isolation, rather than social, emotional, or existential. This is the sensation that due to the extraordinary nature of traumatic experiences the fulfillment of needs such as empathy and intersubjectivity may be unattainable. Integrating our findings with existing interdisciplinary literature regarding social sharing, trauma, and loneliness, we discuss implications for clinical interventions and further research. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Significance
These findings indicate that the combination of shorter leukocyte telomeres with high telomerase activity is associated with stress-related impairment of function at both the biological and psychological levels. Slow poststress recovery in cardiovascular activity in inflammatory responses and reduced stress responsivity in blood pressure and cortisol are indicative of a state of heightened allostatic load. Older men with the shorter telomere/high telomerase phenotype also show impoverished resources for dealing with stress, including low levels of social support and optimism and higher levels of hostility. The integrated approach taken in this study advances our understanding of the cellular substrate of stress-related processes and documents the dynamic interplay between social environmental exposures and the mechanisms underlying chromosomal integrity.
The ability to distinguish danger from safety is crucial for survival. On the other hand, anxiety disorders can result from failures to dissociate safe cues from those that predict dangerous outcomes. The amygdala plays a major role in learning and signaling danger, and recently, evidence accumulates that it also acquires information to signal safety. Traditionally, safety is explored by paradigms that change the value of a previously dangerous cue, such as extinction or reversal; or by paradigms showing that a safe cue can inhibit responses to another danger-predicting cue, as in conditioned-inhibition. In real-life scenarios, many cues are never paired or tested with danger and remain neutral all along. A detailed study of neural responses to unpaired conditioned-stimulus (CS-) can therefore indicate whether information on safety-by-comparison is also acquired in the amygdala. We designed a multiple-CS study, with CS- from both visual and auditory modalities. Using discriminative aversive-conditioning, we find that responses in the primate amygdala develop for CS- of the same modality and of a different modality from that of the aversive CS+. Moreover, we find that responses are comparable in proportion, sign (increase/decrease), onset, and magnitude. These results indicate that the primate amygdala actively acquires signals about safety, and strengthen the hypothesis that failure in amygdala processing can result in failure to distinguish dangerous cues from safe ones and lead to maladaptive behaviors.
Social relationships have been reliably related to physical health outcomes. More specifically, relationship positivity and negativity have been associated with disease morbidity and mortality. Our program of research has also highlighted the potential value of considering both positivity and negativity (ambivalence) in linking relationships to health. However, stronger links are needed between relationship science and health researchers – especially to ask important "second-generation" questions. I argue that systematic attention to two basic questions is of importance. Firstly, what are the health-relevant antecedent processes that influence relationship positivity and negativity from a relationship science perspective? Secondly, what are the coordinated biological processes responsible for such links? Future interdisciplinary training and research in these areas can help to stabilize and strengthen the crucial bridge between relationship science and health.
The current study aims to (1) assess the long-term impact of war captivity on mortality and various health aspects and (2) evaluate the potential mediating role of posttraumatic stress disorder (PTSD) and depressive symptoms. Israeli ex-prisoners of war (ex-POWs) (N = 154) and a matched control group of combat veterans (N = 161) were assessed on health conditions and self-rated health 18 years post-war (1991: T1). The whole population of ex-POWs, and the T1 sample of controls were then contacted 35 years after the war (2008: T2), and invited to participate in a second wave of measurement (ex-POWs: N = 171; controls: N = 116) Captivity was implicated in premature mortality, more health-related conditions and worse self-rated health. PTSD and depressive symptoms mediated the relationship between war captivity and self-rated health, and partially mediated the relationship between war captivity and health conditions, and these effects were amplified with age. Aging ex-POWs who develop psychiatric symptomatology should be considered a high-risk group entering a high-risk period in the life cycle. It is important to monitor ex-POWs and provide them with appropriate medical and psychological treatment as they age.
Social integration and social support have a substantial influence on individual health and longevity, an effect assumed to be mediated through reduced stress reactivity in support recipients. However, considerable variability in individual responses to social support has been documented, suggesting that the beneficial effect of social support interacts with early experiences, genetically influenced differences in biological systems mediating social behavior, personality traits, and psychopathology. Here we outline the historical background of social support research, including epidemiological studies, laboratory studies, and field studies on the subject of social support and health, with regard to different psychobiological effect or systems. Most recent research has focused on central nervous system mechanisms which link social integration or social support with reduced neural threat responses. As numerous mental disorders are associated with considerable social impairment, understanding the potentially underlying mechanisms of neural plasticity in relation to social support, stress buffering and health in these disorders can help tailor new diagnostic and treatment strategies. Thus, theories of socially-driven emotional learning and memory, as presented in this review, might eventually lead to psychobiology-based treatment concepts for mental disorders involving social deficits.
Background
Shorter telomere length and poor sleep are more prevalent at older ages, but their relationship is uncertain. This study explored associations between sleep duration and telomere length in a sample of healthy middle and early old age people.
Methods
Participants were 434 men and women aged 63.3 years on average drawn from the Whitehall II cohort study. Sleep duration was measured by self-report.
Results
There was a linear association between sleep duration and leukocyte telomere length in men but not in women (P = 0.035). Men reporting shorter sleep duration had shorter telomeres, independently of age, body mass index, smoking, educational attainment, current employment, cynical hostility scores and depressive symptoms. Telomeres were on average 6% shorter in men sleeping 5 hours or fewer compared with those sleeping more than 7 hours per night.
Conclusion
This study adds to the growing literature relating sleep duration with biomarkers of aging, and suggests that shortening of telomeres might reflect mechanisms through which short sleep contributes to pathological conditions in older men.
We describe the Cacioppo Evolutionary Theory of Loneliness (ETL) and its manifestations in contemporary society. The early conceptualizations of loneliness were as an individual difference characterizing a relatively small subset of the population. The ETL characterizes loneliness as not simply addressing an individual difference, but also as addressing the effects of loneliness on people generally. The progression motivated by the ETL to animal models and comparative analyses broadens the focus further to periods long before hominids evolved. The premise underlying our ETL is that an organism's perception of being socially isolated (i.e., lonely) automatically signals an environment in which the likelihood is low of encountering social behaviors categorized in terms of evolutionary fitness as mutual benefit or altruism. As a result, the likelihood is high of the organism exhibiting behaviors categorized in terms of evolutionary fitness as selfish. This shift in the fitness consequences of behavior is posited to be evolutionarily old and to operate in humans in part through nonconscious processes. The ETL addresses the adaptive functions of loneliness that foster short-term survival but that in the modern world can have deleterious long-term consequences. In doing so, the ETL places the social level of organization front and center in scientific investigations of the human brain and behavior. The centrality of the social world highlighted by the ETL is not attributed to social construction but to social and biological processes, including evolutionary forces operating across social species long before humans walked the earth.
We present a theory of communal coping that describes an optimal pathway to patient adjustment among couples in which one person faces a chronic illness. Communal coping consists of a shared illness appraisal (i.e., person perceives illness as a joint rather than individual problem) and collaboration with a partner to manage the illness. We present a model of the communal coping process that links patient and partner shared illness appraisals to collaboration and a set of supportive interactions that might be reframed as collaboration in the presence of shared illness appraisals. We then outline a model that identifies potential antecedents of communal coping and mechanisms that link communal coping to patient illness adjustment (i.e., enhanced psychological well-being, improved health behaviors, better physical health) and partner psychological well-being. We review the empirical evidence for this model and conclude by identifying several moderator variables, noting potential limitations, and outlining future research directions.
Social relationships are adaptive and crucial for survival. This review presents existing evidence that our social connections to others have powerful influences on health and longevity and that lacking social connection qualifies as a risk factor for premature mortality. A systems perspective is presented as a framework by which to move social connection into the realm of public health. Individuals, and health-relevant biological processes, exist within larger social contexts including the family, neighborhood and community, and society and culture. Applying the social ecological model, this review highlights the interrelationships of individuals within groups in terms of understanding both the causal mechanisms by which social connection influences physical health and the ways in which this influence can inform potential intervention strategies. A systems approach also helps identify gaps in our current understanding that may guide future research. Expected final online publication date for the Annual Review of Psychology Volume 69 is January 4, 2018. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
A robust body of scientific evidence has indicated that being embedded in high-quality close relationships and feeling socially connected to the people in one's life is associated with decreased risk for all-cause mortality as well as a range of disease morbidities. Despite mounting evidence that the magnitude of these associations is comparable to that of many leading health determinants (that receive significant public health resources), government agencies, health care providers and associations, and public or private health care funders have been slow to recognize human social relationships as either a health determinant or health risk marker in a manner that is comparable to that of other public health priorities. This article evaluates current evidence (on social relationships and health) according to criteria commonly used in determining public health priorities. The article discusses challenges for reducing risk in this area and outlines an agenda for integrating social relationships into current public health priorities.
Pain is common in older adults, is frequently experienced as stressful, and is associated with increased morbidity and mortality. Stress regulatory systems are adaptive to challenge and change, allostasis, until demands exceed the adaptive capacity contributing to dysregulation, resulting in a high allostatic load. A high allostatic load is associated with increased risk of morbidity and mortality. Pain severity, based on the average intensity of frequent pain, was hypothesized to be positively associated with AL. Four formulations of AL were investigated. Cross-sectional data from Wave 4 (2008–2009) of the English Longitudinal Study of Aging (ELSA) were analysed. Covariates in the model included age, sex, education, smoking status, alcohol consumption, activity level, depression and common comorbid health conditions. A total of 5341 individuals were included; mean age 65.3(± 9.2) years, 55% female, 62.4% infrequent or no pain, 12.6% mild pain, 19.1% moderate pain, and 5.9% severe pain. Severe pain was associated with greater AL defined by all four formulations. The amount of variance explained by pain severity and the covariates was highest when allostatic load was defined by the high risk quartile (12.9%) and by the clinical value (11.7%). Findings indicate a positive relationship between pain severity and AL. Further investigation is needed to determine if there is a specific AL signature for pain that differs from other health conditions.
Dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis and disruptions of restorative processes (e.g., sleep) have been implicated as two key mechanisms through which loneliness leads to medical morbidity in adults and late adolescents. Whether loneliness acts through these biological and behavioral intermediaries in children as well remains unexplored. In a sample of 645 children aged 8–15 affected by parental HIV/AIDS in rural China, trait and state (i.e., daily) loneliness were measured in a 3-day diary study, wherein participants also provided cortisol samples and sleep measures. Whereas high levels of trait loneliness were found to predict lower morning cortisol levels, longer time in bed, lower sleep quality, and a higher number of night awakenings, daily loneliness was associated with a flatter diurnal cortisol slope and shorter time in bed. Although the association between trait loneliness and daily loneliness with HPA activity remained significant after controlling for psychological constructs that overlap with loneliness (e.g., depression and daily negative affect), some of the associations between loneliness and sleep measures became non-significant after including these additional covariates. These findings provide the first empirical evidence to our knowledge of associations between trait and state loneliness and health-related outcomes among school-aged children and young adolescents.
Objectives:
Allostatic load (AL) represents cumulative wear-and-tear on the body and is operationalized as a multisystem index of biomarkers. Allostatic load is associated with morbidities and mortality, leading to a growing body of literature that uses AL as an outcome in its own right. Psychosocial resources (PSRs), such as mastery and social support, may influence health outcomes in part via AL, and the current review seeks to characterize the relations between PSRs and AL.
Methods:
A systematic review was conducted by searching PubMed, CINAHL Plus, PsycINFO, Scopus, and Embase for studies examining the relation between PSR(s) and AL in humans. From 1,417 abstracts screened, 60 full-text articles were reviewed, and 24 studies met inclusion criteria.
Results:
Mixed evidence exists for a relationship between PSRs and AL. Most (14/24) studies used a cross-sectional design, and only one study investigated whether a PSR predicted change in AL. Compared to cross-sectional studies, longitudinal studies were more likely to report a significant relationship (8/14 versus 8/10, respectively). Studies with statistically significant main or moderated effects had larger sample sizes than those reporting null effects. Whether a study reported a significant main or moderated relationship did not differ by whether psychological (8/11) or social (10/16) resources were assessed.
Conclusions:
Evidence for a relationship between PSRs and AL is equivocal, and obtained significant relationships are generally small in magnitude. Gaps in the current literature and directions for future research are discussed. Longitudinal studies are needed that repeatedly assess PSRs and AL.
Low social support is associated with greater prevalence and severity of posttraumatic stress disorder (PTSD). However, the factors that explain the association between social support and PTSD are not well understood. In the current study, 741 VA patients who presented to a PTSD clinic between 2005 and 2013 completed assessments of symptom severity and social support. Analysis of variance and linear regression tested the associations between social support, sociodemographic characteristics, and PTSD symptom severity. In adjusted analyses, social support was robustly associated with PTSD severity (β = -0.30, p < 0.001). After stratification by combat era, this association remained significant for all era veterans except veterans of the post-Vietnam/Desert Storm era. Other sociodemographic characteristics did not affect the association between social support and PTSD. Our findings suggest that the detrimental effects of poor social support pervade across sociodemographic groups and that efforts to improve social support in veterans with PTSD are needed.
Social support is associated with better health but it is unknown whether the health advantages of social support depend on the support source. Using a probability sample of older U.S. adults (n = 1,430) we compared leukocyte telomere length, a biomarker of cellular aging, between married adults whose support sources either did or did not include their spouse. Despite having social support from other sources, participants who lacked spousal support had shorter telomeres relative to those with spousal support. The size of this telomere difference was comparable to differences between men and women and was independent of sociodemographic variables, coronary heart disease risk, diagnosed chronic disease and other social relationship resources such as the number of support sources, the number of friends, or the availability of financial support. Our findings suggest that relative to other sources of social support, spousal support may be especially important for cellular aging, a general biological mechanism that is implicated in age-related chronic disease risk.
Telomeres are the protective end-complexes at the termini of eukaryotic chromosomes. Telomere attrition can lead to potentially
maladaptive cellular changes, block cell division, and interfere with tissue replenishment. Recent advances in the understanding
of human disease processes have clarified the roles of telomere biology, especially in diseases of human aging and in some
aging-related processes. Greater overall telomere attrition predicts mortality and aging-related diseases in inherited telomere
syndrome patients, and also in general human cohorts. However, genetically caused variations in telomere maintenance either
raise or lower risks and progression of cancers, in a highly cancer type–specific fashion. Telomere maintenance is determined
by genetic factors and is also cumulatively shaped by nongenetic influences throughout human life; both can interact. These
and other recent findings highlight both causal and potentiating roles for telomere attrition in human diseases.
United States military prisoners of war (POW) held in Southeast Asia from 1964 through 1973 were held longer than any previous group of American POWs—an average of 5 years, compared to the 3 years for World War II POWs, 2 years for those held in North Korea during the late 1950s, and approximately a year for the Pueblo crew (1960s). Those men held the longest in Southeast Asia were imprisoned there for almost 9 years.
Background
Telomeres protect the ends of chromosomes, and shorter leukocyte telomeres are associated with poor health. Depression may be associated with the shortening of leukocyte telomeres. The present study set out to consolidate the varying effect sizes found so far in studies of depression and telomere length and to identify moderators of the relationship between depression and telomere length.MethodsA meta-analytic investigation of the relationship between depression and leukocyte telomere length used information from 21,040 participants.ResultsA significant effect size, r = −.12, P < .001, indicated that depression was associated with shorter telomere length. Several variables significantly moderated effect size. Concurrent associations (k = 25) between depression and telomere length were significantly stronger than longitudinal associations (k = 5). Studies that used the Southern blot (k = 3) and fluorescent in situ hybridization (FISH; k = 2) assays to measure telomere length showed larger effect sizes than studies that used quantitative polymerase chain reaction (qPCR; k = 25). Finally, study reports that indicated that the telomere assays were conducted blind to depression level of participants (k = 11) had significantly lower effect sizes than those of other studies (k = 19).Conclusions
The significant relationship between depression and shorter telomere length is consistent with a theoretical model positing that distress, such as experienced in depression, results in physiological changes leading to shortened telomeres.
Background:
There is increasing evidence that chronic stress accelerates telomere erosion in leukocytes/peripheral blood mononuclear cells (PBMCs). However, functional changes associated with telomere shortening are poorly understood. We hypothesized that war veterans with PTSD would have shorter telomeres in PBMCs and that these cells might exhibit changes in measures of immune reactivity such as proliferation, cytokine production and expression of regulators of immune responses.
Methods:
We measured relative telomere length and basal telomerase activity in PBMCs of 62 individuals (PTSD patients (N=30); age-matched healthy controls (N=17), elderly volunteers (N=15)). In parallel, we have assessed proliferation of activated T cells, interferon (IFN)-γ, interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-α and IL-6 cytokine production and expression of programmed death 1 (PD-1) receptor and its ligand PD-L1 on activated T cells.
Results:
Middle-aged war veterans with current PTSD had shorter PBMC telomere length than their age-matched healthy controls while the elderly had the shortest telomeres. There was no difference in telomerase activity between PTSD patients and healthy controls while telomerase activity was significantly lower in the elderly. While the elderly group exhibited robust changes in immune activity such as increased production of proinflammatory cytokines (TNF-α, IL-6) and reduced proliferation of all T cells, the PTSD group showed reduced proliferative response of CD8(+) T cells to high concentrations of mitogen and reduced spontaneous production of IL-2 and IFN-γ.
Conclusions:
This study adds to the accumulating evidence that psychological trauma and chronic stress are associated with accelerated telomere attrition. However, changes in immune function associated with stress-related telomere shortening are not well understood. Although much less pronounced in PTSD patients than in elderly persons, reduced proliferative responses of T cells accompanied by shorter telomeres might be a sign of early immunosenescence. Together with reduced production of Th1 cytokines, observed immune changes may contribute to health risks associated with PTSD.
Objectives:
To assess the long-term effects of the prisoner of war (POW) experience on U.S. World War II (WWII) veterans.
Design:
Exploratory study.
Setting:
Participants were recruited through the Hines Veterans Affairs Hospital; a POW reunion in Orlando, Florida; and the WWII veterans periodical, "The QUAN."
Participants:
One hundred fifty-seven American military veterans who were former WWII POWs.
Measurments:
Participants completed a mailed survey describing their POW experiences, POW effects on subsequent psychological and physical well-being, and ways in which these experiences shaped major decisions in their lives.
Results:
Participants from the European and Pacific theaters reported that their captivity during WWII affected their long-term emotional well-being. Both groups reported high rates of reflection, dreaming, and flashbacks pertaining to their POW experiences, but Pacific theater POWs did so at higher rates in the present than in the past. Large portions of both groups reported greater rumination on POW experiences after retirement. Finally, 16.6% of participants met the requirements of a current, clinical diagnosis of posttraumatic stress disorder (PTSD) based on the Mississippi PTSD scale, with PTSD rates in Pacific theater POWs (34%) three times those of European theater POWs (12%).
Conclusion:
Traumatic memories and clinical levels of PTSD persist for WWII POWs as long as 65 years after their captivity. Additionally, rumination about these experiences, including flashbacks and persistent nightmares, may increase after retirement, particularly for those held in the Pacific theater. These findings inform the current therapeutic needs of this elderly population and future generations of POWs from other military conflicts.
This study investigated the effect of loneliness on depression and further tested the mediating effect of social support. A total of 320 elderly persons completed the Emotional and Social Loneliness Scale, Multidimensional Scale of Perceived Social Support, and Self-Rating Depression Scale. Results revealed that loneliness and social support significantly correlated with depression. Structural Equation Modeling indicated that social support partially mediates loneliness and depression. The final model illustrated a significant path from loneliness to depression through social support. This study sheds light on the concurrent effects of loneliness and social support on depression, providing evidence on how to reduce depression among the elderly.
Monte Carlo computer simulations were used to investigate the performance of three χ–2 test statistics in confirmatory factor analysis (CFA). Normal theory maximum likelihood χ–2 (ML), Browne's asymptotic distribution free χ–2 (ADF), and the Satorra-Bentler rescaled χ–2 (SB) were examined under varying conditions of sample size, model specification, and multivariate distribution. For properly specified models, ML and SB showed no evidence of bias under normal distributions across all sample sizes, whereas ADF was biased at all but the largest sample sizes. ML was increasingly overestimated with increasing nonnormality, but both SB (at all sample sizes) and ADF (only at large sample sizes) showed no evidence of bias. For misspecified models, ML was again inflated with increasing nonnormality, but both SB and ADF were underestimated with increasing nonnormality. It appears that the power of the SB and ADF test statistics to detect a model misspecification is attenuated given nonnormally distributed data. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Research in social epidemiology suggests that the absence of positive social relationships is a significant risk factor for broad-based morbidity and mortality. The nature of these social relationships and the mechanisms underlying this association are of increasing interest as the population gets older and the health care costs associated with chronic disease escalate in industrialized countries. We review selected evidence on the nature of social relationships and focus on one particular facet of the connection continuum – the extent to which an individual feels isolated (i.e., feels lonely) in a social world. Evidence indicates that loneliness heightens sensitivity to social threats and motivates the renewal of social connections, but it can also impair executive functioning, sleep, and mental and physical well-being. Together, these effects contribute to higher rates of morbidity and mortality in lonely older adults.
Objective:
This study examines how the social environment is related to allostatic load (AL), a multisystem index of biological risk.
Method:
A national sample of adults (N = 949) aged 34-84 rated their relationships with spouse, family, and friends at 2 time points 10 years apart. At the second time point, participants completed a biological protocol in which indices of autonomic, hypothalamic-pituitary-adrenal axis, cardiovascular, inflammatory, and metabolic function were obtained and used to create an AL summary score. Generalized estimating equations were used to examine the associations among 3 aspects of social relationships-social support, social negativity, and frequency of social contact-and AL.
Results:
Higher levels of spouse negativity, family negativity, friend contact, and network level contact were each associated with higher AL, and higher levels of spouse support were associated with lower AL, independent of age, sociodemographic factors, and health covariates. Tests for age interactions suggested that friend support and network support were each associated with higher AL among older adults, but at younger ages there appeared to be no association between friend support and AL and a negative association between network support and AL. For network negativity, there was a marginal interaction such that network negativity was associated with higher AL among younger adults but there was no association among older adults.
Conclusions:
These findings demonstrate that structural and functional aspects of the social environment are associated with AL, and extend previous work by demonstrating that these associations vary based on the type of relationship assessed and by age.
In general, our findings in army special operations personnel
provide additional evidence of an association of LTL with PTSD,
in accordance with the previous observations in the civilian
population,1 and support the hypothesis that traumatic stress may
result in not only PTSD but also cellular aging. In addition, the
relative shortening of LTL among some PTSD patients compared
with controls suggests that cellular aging may occur in some PTSD
subjects but not all. The nature of this relationship warrants
further study.
Although we generally experience our bodies as being biologically stable across time and situations, an emerging field of research is demonstrating that external social conditions, especially our subjective perceptions of those conditions, can influence our most basic internal biological processes-namely, the expression of our genes. This research on human social genomics has begun to identify the types of genes that are subject to social-environmental regulation, the neural and molecular mechanisms that mediate the effects of social processes on gene expression, and the genetic polymorphisms that moderate individual differences in genomic sensitivity to social context. The molecular models resulting from this research provide new opportunities for understanding how social and genetic factors interact to shape complex behavioral phenotypes and susceptibility to disease. This research also sheds new light on the evolution of the human genome and challenges the fundamental belief that our molecular makeup is relatively stable and impermeable to social-environmental influence.
Although evidence suggests that loneliness may increase risk for health problems, the mechanisms responsible are not well understood. Immune dysregulation is one potential pathway: Elevated proinflammatory cytokines such as interleukin-6 (IL-6) increase risk for health problems. In our first study (N = 134), lonelier healthy adults exposed to acute stress exhibited greater synthesis of tumor necrosis factor-alpha (TNF-α) and IL-6 by peripheral blood mononuclear cells (PBMCs) stimulated with lipopolysaccharide (LPS) than their less lonely counterparts. Similarly, in the second study (N = 144), lonelier posttreatment breast-cancer survivors exposed to acute stress exhibited greater synthesis of IL-6 and interleukin-1 beta (IL-1β) by LPS-stimulated PBMCs than their counterparts who felt more socially connected. However, loneliness was unrelated to TNF-α in Study 2, although the result was in the expected direction. Thus, two different populations demonstrated that lonelier participants had more stimulated cytokine production in response to stress than less lonely participants, which reflects a proinflammatory phenotype. These data provide a glimpse into the pathways through which loneliness may affect health.
Discovering the stress-buffering effects of social relationships has been one of the major findings in psychobiology in the last century. However, an understanding of the underlying neurobiological and psychological mechanisms of this buffering is only beginning to emerge. An important avenue of this research concerns the neurocircuitry that can regulate the activity of the hypothalamic-pituitary-adrenocortical (HPA) axis. The present review is a translational effort aimed at integrating animal models and human studies of the social regulation of the HPA axis from infancy to adulthood, specifically focusing on the process that has been named social buffering. This process has been noted across species and consists of a dampened HPA axis stress response to threat or challenge that occurs with the presence or assistance of a conspecific. We describe aspects of the relevant underlying neurobiology when enough information exists and expose major gaps in our understanding across all domains of the literatures we aimed to integrate. We provide a working conceptual model focused on the role of oxytocinergic systems and prefrontal neural networks as 2 of the putative biological mediators of this process, and propose that the role of early experiences is critical in shaping later social buffering effects. This synthesis points to both general future directions and specific experiments that need to be conducted to build a more comprehensive model of the HPA social buffering effect across the life span that incorporates multiple levels of analysis: neuroendocrine, behavioral, and social. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
Statistical procedures for missing data have vastly improved, yet misconception and unsound practice still abound. The authors frame the missing-data problem, review methods, offer advice, and raise issues that remain unresolved. They clear up common misunderstandings regarding the missing at random (MAR) concept. They summarize the evidence against older procedures and, with few exceptions, discourage their use. They present, in both technical and practical language, 2 general approaches that come highly recommended: maximum likelihood (ML) and Bayesian multiple imputation (MI). Newer developments are discussed, including some for dealing with missing data that are not MAR. Although not yet in the mainstream, these procedures may eventually extend the ML and MI methods that currently represent the state of the art. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Objective
The primary goal was to test the hypothesis that limited social support (SS) is related to shorter leukocyte telomere length (LTL), particularly in an older adult population.Methods
Cross-sectional analyses were performed on 948 participants aged 45 to 84 years at Examination 1 of the Multi-Ethnic Study of Atherosclerosis (18.4% white, 53.1% Hispanics, and 28.5% African American). LTL was determined by using quantitative polymerase chain reaction, and SS was measured with the Enhancing Recovery in Coronary Heart Disease SS inventory.ResultsAcross the entire sample, SS was not associated with LTL (p = .87) after adjusting for demographic (age, sex, race/ethnicity, socioeconomic status), age × sex, age × race, health (body mass index, diabetes, pulse pressure), and life-style factors (smoking, physical activity, diet); however, the interaction term age (dichotomized) × SS was significant (p = .001). Stratification by age group revealed a positive association between SS (score range, 5-25) and LTL in the older (65-84 years; B[SE] = .005[.002]; p = .007) but not younger participants (45-64 years; p = .12) after adjusting for covariates.Conclusions
These results from a racially/ethnically diverse community sample of men and women provide initial evidence that low SS is associated with shorter LTL in adults aged 65 years and older and is consistent with the hypothesis that social environment may contribute to rates of cellular aging, particularly in late life.
Objective:
To provide a systematic review of the relationship between age and leukocyte telomere length (LTL) in adults.
Methods:
Relevant studies were identified by a systematic search of Medline, EMBASE and ISI Web of Knowledge databases. Key data, such as age and LTL, were extracted from the studies along with correlation coefficients and yearly attrition rates where available. Obtained data were used to calculate weighted means and correlation coefficients.
Results:
Overall, 124 cross-sectional studies and 5 longitudinal studies were identified. A statistically significant inverse correlation between mean age and mean LTL across cross-sectional studies was observed for both absolute (r=-0.338, p<0.0001) and relative LTL (r=-0.295, p=0.0088). From mean LTL and ages, a yearly telomere loss of 24.7 base pairs (BP)/year was estimated by weighted linear regression. Weighted means of within study correlation of age and TL and yearly telomere loss rate estimates from cross-sectional studies were also in a similar order of magnitude (-0.380 and 21.91 BP/year). The few longitudinal studies reported somewhat higher mean telomere loss rates (between 32.2 and 45.5 BP/year).
Conclusion:
While a decrease of LTL with age is out of question, data on variation of the decrease according to sex, age and other potential determinants especially from longitudinal data are still sparse.