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Citation: Borawski, D.; Sojda, M.;
Rychlewska, K.; Wajs, T. Attached but
Lonely: Emotional Intelligence as a
Mediator and Moderator between
Attachment Styles and Loneliness.
Int. J. Environ. Res. Public Health 2022,
19, 14831. https://doi.org/10.3390/
ijerph192214831
Academic Editor: Paul B.
Tchounwou
Received: 22 October 2022
Accepted: 8 November 2022
Published: 11 November 2022
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4.0/).
International Journal of
Environmental Research
and Public Health
Article
Attached but Lonely: Emotional Intelligence as a Mediator and
Moderator between Attachment Styles and Loneliness
Dominik Borawski * , Martyna Sojda, Karolina Rychlewska and Tomasz Wajs
Department of Psychology, Jan Kochanowski University, 25-029 Kielce, Poland
*Correspondence: dborawski@ujk.edu.pl
Abstract:
(1) Background: The aim of the presented research was to examine if emotional intelligence
(EI) could be regarded as a mechanism mediating the relationship between attachment and loneliness.
The authors also tested the moderating role of this variable, investigating whether EI was a protective
factor against loneliness in insecurely attached individuals. (2) Methods: In two cross-sectional
studies (N= 246 in Study 1 and N= 186 in Study 2), participants completed a set of questionnaires
measuring attachment styles, trait emotional intelligence, and loneliness. (3) Results: Both studies
revealed a consistent pattern of results, indicating a dual role of EI in the relationships between
attachment styles and loneliness. Firstly, EI was a mediator between attachment and loneliness—both
anxious and avoidant attachment were associated with a low level of EI, which in turn translated
into increased loneliness. Secondly, EI moderated the relationship between anxious attachment and
loneliness. It turned out that the strength of the positive relationship between anxious attachment
and loneliness decreased with an increase in EI. (4) Conclusions: These results point to EI as an
underlying mechanism between insecure attachment and loneliness. They also suggest that EI is
an important psychological resource protecting anxiously attached individuals against a subjective
sense of social isolation.
Keywords:
loneliness; attachment styles; attachment anxiety; attachment avoidance; emotional
intelligence; self-worth
1. Introduction
Loneliness is defined as subjectively perceived social isolation stemming from the
frustrated need to belong and a sense of discrepancy between the expected and actually
experienced quality of social contacts [
1
]. Thus understood, it is a risk factor for numerous
mental health issues including depression [
2
], suicidality [
3
], anxiety [
4
], and psychological
distress [
5
]. Loneliness has little in common with objective indicators of isolation, such as
the number of friends or acquaintances [
6
]. Its subjective character induces researchers to
look for psychological factors that lead people to perceive and evaluate their interpersonal
relationships differently in similar circumstances [7,8].
One of the conceptualizations that provide a framework for understanding the source
and development of both satisfaction with social relationships and a sense of social isolation
is attachment theory [
9
]. Viewed through the lens of this theory, loneliness is a consequence
of early childhood experiences associated with the non-satisfaction of the need for closeness
and tenderness or with the unavailability of attachment figures [
10
]. Supporting this theory,
research shows that both attachment anxiety and attachment avoidance are positively
correlated with loneliness [9].
Although the attachment–loneliness link is already well documented, there are still
few studies showing the underlying mechanisms and moderators of this relationship [
11
].
Based on both theoretical premises and the results of previous research, the studies pre-
sented in this article were an attempt to establish if emotional intelligence (EI) could be
regarded as a mechanism mediating the relationship between attachment and loneliness.
Int. J. Environ. Res. Public Health 2022,19, 14831. https://doi.org/10.3390/ijerph192214831 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 14831 2 of 18
Additionally, we investigated if this variable was a potentially protective factor against a
sense of loneliness in insecurely attached people.
1.1. Attachment and Loneliness
According to Bowlby, each person has an inborn psychobiological system responsible
for seeking support and closeness from caregivers [
12
]. The primary aim of this system
is to provide the individual with a sense of security, and the importance of its role grows
in conditions of objective or subjective threats. In such circumstances, the individual is
motivated to increase closeness with significant others; in the early stages of development,
this happens through the regulation of physical contact with caregivers, whereas in the
subsequent stages, it takes place via internal representations of attachment figures. Al-
though from the child’s perspective the importance of physical closeness with attachment
figures decreases with age in favor of subjective belief about their availability, the character
of symbolic representations of self and others develops on the basis of earlier tangible
interactions with actual others [
13
]. The quality of the primary bond with caregivers,
formed in early childhood, especially the degree to which the attachment figures were
available, responsive, and supportive, is reflected in internal representations of self and
others. Thus, these original relationships with significant others become prototypes for
subsequent interpersonal relationships. Interactions saturated with warmth and intimacy
translate into a sense of security, a sense of self-worthiness, and positive expectations
regarding their partners in close relationships in adult life. In contrast, when significant
others are absent or insensitive to the child’s needs, the child develops attachment styles
referred to as insecure, different from those based on seeking closeness [
9
]. Two of these are
usually mentioned—namely, attachment-related anxiety and avoidance [
14
]. The former,
anxiety, develops in the course of the child’s experience of uncertainty about the availability
of the attachment figure. It manifests itself in an increased need for closeness and intimacy,
accompanied by an intense fear of rejection rooted in low self-esteem. The other style,
avoidance, develops when the child experiences unavailability of the attachment figure
in situations of danger or experiences caregivers’ insensitivity to his or her needs. What
is characteristic of this attachment style is, above all, a negative view of human nature,
translating itself into a discomfort that accompanies dependence on others, lack of trust,
and emotional distance from interaction with partners. Its essence lies in the deactivation of
the attachment system in such a way as to minimize the risk associated with other people’s
unavailability in situations of danger. Although both styles can initially be functional, for
example as reactions to unsatisfied interpersonal needs in a specific relationship (e.g., with
the caregiver), the problem is that they easily become entrenched and are easily carried over
into other relationships, where more adaptive attitudes would be based on openness and
on seeking support and intimacy. Therefore, early experiences saturated with both insecure
attachment patterns not only make it impossible to perceive closeness, depth, and intimacy
in adult relationships with others but, on the contrary, may actually lead to the frustration
of the sense of belonging and to a subjective feeling of separation from others—namely, to
loneliness [
9
]. In the case of anxiously attached individuals, loneliness may stem from an
excessive desire to compensate for low self-esteem by gaining other people’s acceptance
combined with a high level of rejection anxiety. In the case of avoidantly attached indi-
viduals, the key mechanism seems to be a negative view of human nature and a lack of
interpersonal trust—a mindset that constitutes an important predictor of loneliness [9,15].
1.2. In Search of the Mechanisms Underlying the Attachment–Loneliness Link
The internal representations of self and others, mentioned above, function as the
key underlying mechanism of the attachment–loneliness link. From this perspective, it is
assumed that early childhood experiences with caregivers shape the internal models of self
and others, which in turn become prototypes of subsequent interpersonal relationships
and the experiences resulting from them (such as loneliness) [
16
]. A different, compet-
ing explanation of the link between attachment and loneliness is the level of social and
Int. J. Environ. Res. Public Health 2022,19, 14831 3 of 18
emotional skills lowered due to insecure attachment, translating into a subjective sense of
social isolation. In this context, the results of previous studies suggest that the relationship
between insecure attachment and loneliness is mediated by low social skills [
11
] and by a
weakened tendency to “catch” other people’s positive emotions [
17
] (although the latter is
applied only to avoidantly attached participants). A different study, conducted by Marks
et al. [
18
], suggests that another mediating mechanism may be emotional abilities under-
stood as emotional intelligence (EI). These authors found that EI mediated the relationships
between insecure attachment and subjective mental health outcomes, whose indicators
included social dysfunction. At this point, EI is conceptualized as an ability or as a trait [
19
].
In the former case, it refers to abilities associated with recognizing, expressing, understand-
ing, and regulating emotions, measured using objective tests of maximum performance.
The latter concept, trait EI (as investigated in the already cited study by Marks et al.), is
understood as self-perceptions of emotional abilities, that is, “how good we believe we
are in terms of understanding, regulating, and expressing emotions in order to adapt to
our environment and maintain well-being”, [
19
] (p. 335), which Petrides calls emotional
self-efficacy; thus defined, it is measured using self-report questionnaires. Trait EI is in-
tended to capture the degree to which abilities manifest themselves in the individual’s
everyday experiences, including those in relationships with others [
20
]. For this reason, it
was this concept that we relied on when operationalizing EI in both of our studies. How-
ever, regardless of approach (trait or ability) and regardless of the results reported by Marks
et al. [
18
], viewing EI as a potential mediator between attachment and loneliness is also
theoretically justified. It is assumed that the attachment styles forming in the early stages
of development may influence the later development of EI (both as a trait and as an ability).
Thus, secure attachment patterns resulting from the child’s experience of the availability
of attachment figures, their sensitivity to the child’s needs, and emotional syntony with
the caregiver favor the development of emotional self-awareness and adaptive emotional
self-regulation skills [
21
]. Early insecure attachment experiences, by contrast, impair the
proper recognition, understanding, and regulation of emotions [
22
]. In anxiously attached
individuals, low emotional self-efficacy is the outcome of earlier interpersonal experiences,
particularly the sense of uncertainty stemming from the fact that their attempts to obtain
comfort and support from their caregivers brought the desired results on some occasions
but not on others. As a result of this lack of control over the environment, they developed
hypervigilance to threat cues, which took the form of maximizing both the very experience
and the expression of negative emotions [
23
]. In practice, this manifests itself in a focus on
negative information and events, which in turn triggers negative thoughts and ruminations,
giving a secondary boost to anxiety [
24
]. According to Mikulincer and colleagues, however,
the increased expression of negative emotions is supposed to attract caregivers’ attention
and induce them to soothe these emotions [
23
,
24
]. In the case of avoidant individuals, prob-
lems with adaptive emotional regulation stem from an increased tendency to deactivate
the attachment system associated with the unavailable or rejecting attachment figure. In
practice, this manifests itself in striving to minimize experiences of negative affect and
in turning attention away from threat cues [
23
]. Avoidantly attached people do not want
to depend on others, which is why they suppress or repress all negative emotions that
remind them of their own vulnerability. On the other hand, they have lowered abilities to
empathize with other people and take their perspective. Thus, theoretically, problems with
EI in the case of anxiously attached people consist in lowered ability to control negative
affect, while in avoidantly attached people, they mainly take the form of difficulties in
recognizing and understanding other people’s emotions. Importantly, both insecure at-
tachment styles interfere with individuals deriving emotion regulation benefits from close
interpersonal relationships, which may expose them to a sense of loneliness. Accordingly,
previous research shows that EI prospectively predicts the level of loneliness [25,26].
Int. J. Environ. Res. Public Health 2022,19, 14831 4 of 18
1.3. Moderating Role of EI
Potentially, EI may be not only a mediator but also a moderator of the relationship
between attachment and loneliness. More specifically, assuming—with Petrides et al. [
19
]—
that EI defined as emotional self-efficacy can be developed during the life span, one
can expect that its high level may be a factor protecting individuals with both insecure
attachment styles from the experience of a subjective sense of social isolation in adult
life. This would mean that even unfavorable early attachment-related experience does not
doom individuals to loneliness if, in further stages of development, they manage to acquire
skills associated with the appropriate comprehension, expression, and management of
their emotions. There are data that justify this kind of prediction. First, previous studies
showed that EI buffered various kinds of stress [
27
], and loneliness is, undeniably, a kind
of social distress. Moreover, a recent investigation by Quintana-Orts et al. revealed that
EI was a buffer against loneliness in adolescents experiencing cyber-victimization [
28
].
In the case of anxiously attached individuals, EI may enable more effective regulation of
rejection anxiety and thus make it possible to establish more interpersonal contacts. On the
other hand, it may facilitate recognizing other people’s emotions, thereby facilitating the
selection of potential interaction partners and preventing rejection. In the case of avoidantly
attached people, EI may help reduce the excessive tendency to rely on oneself only; it may
also correct the previously acquired negative models of others and improve the abilities
associated with taking other people’s perspectives. In this way, it may potentially open up
new possibilities for building social connections with others for them, preventing loneliness.
1.4. The Present Research
The aim of the research presented in this article was to examine both the mediating role
and the moderating role of EI in the relationship between attachment styles and loneliness.
Based on the premises presented above, we formulated the following hypotheses:
H1.
Both insecure attachment styles (anxious and avoidant attachment) will be positively related
to loneliness.
H2.
Emotional intelligence will mediate the relationships between both anxious and avoidant
attachment styles and loneliness; in other words, both anxious and avoidant attachment styles will
be associated with decreased emotional intelligence, which in turn will translate into an increase
in loneliness.
H3.
The relationships between both attachment styles and loneliness will be moderated by the level
of EI; namely, with an increase in the level of EI, the strength of the relationships between both
anxious and avoidant attachment styles and loneliness will decrease.
To test our hypotheses, we conducted two online cross-sectional studies. Both studies
included the same measures of loneliness and EI. What they differed in was the use of
different versions of the questionnaire assessing attachment styles and the fact that in the
second study, replicating the mediation effect of EI, we included the already mentioned con-
struct, internal models of self and others, while additionally controlling for the mediating
role of self-worth and beliefs about the benevolence of the people.
2. Materials and Methods
2.1. Participants and Procedure
In both studies (N= 246 in Study 1 and N= 186 in Study 2), participants (aged
18–61 years, M= 22.64, SD = 6.78, and 18–52 years, M= 23.81, SD = 5.04, respectively)
were recruited in Poland using snowball sampling. The study was conducted online
via the Google Forms platform. The link to the survey was distributed via social media.
Participation was voluntary—the subjects were informed that they could withdraw from the
study at any time; they did not receive any remuneration. After providing informed consent,
they were given access (i.e., a link) to the survey. All the required ethical standards were
maintained. The study protocol was approved by the Research Ethics Board at the authors’
Int. J. Environ. Res. Public Health 2022,19, 14831 5 of 18
institution. The respondents were asked to provide demographic information: gender,
age, relationship status, place of residence, education (only in Study 2), and employment
status (only in Study 1). All participants were Polish residents. The sociodemographic
characteristics of the samples are presented in Table 1.
Table 1. Participants’ sociodemographic characteristics.
Variable Study 1 N= 246 Study 2 N= 186
n%n%
Gender Female 215 87.4 152 81.7
Male 29 11.8 34 18.3
Non-binary 2 0.8 - -
Place of residence Village 52 21.1 51 27.4
City with less than
100,000 inhabitants 99 40.2 40 21.5
City with more than
100,000 inhabitants 95 38.6 95 51.1
Relationship status Single 82 33.3 78 41.9
In a relationship 164 66.7 108 58.1
Education Below secondary - - 9 4.8
Secondary - - 102 54.8
Higher - - 75 40.3
Employment status Unemployed 19 7.7 -
Retired 2 0.8 -
Student 140 56.9 -
Employed 85 34.6 -
2.2. Measures
2.2.1. Loneliness
In both studies, we assessed loneliness using the UCLA Loneliness Scale—Revised [
29
]
as adapted into Polish by Kwiatkowska et al. [
30
]. This measure consists of 20 items (e.g.,
“I feel left out”), which participants rate on a 4-point Likert scale (1 = never to 4 = often).
The items (half of them reverse-scored, e.g., “There are people I feel close to”) refer to
individuals’ interpersonal experiences and enable the assessment of subjectively perceived
social isolation. The reliability coefficients for the total loneliness score were 0.90 in Study 1
and 0.91 in Study 2.
2.2.2. Attachment Styles
In Study 1, to measure attachment styles, we used the Experiences in Close Relationships
—Relationship Structures (ECR-RS) Questionnaire [
31
], as adapted into Polish by Marszał [
32
].
It is a self-report measure enabling the assessment of both anxious and avoidant attachment
experiences in various types of interpersonal relationships. The questionnaire consists
of nine items, each of them related to four targets: mother, father (or mother-like figure
and father-like figure, respectively), romantic partner, and best friend (e.g., “I don’t feel
comfortable opening up to this person” for attachment-related avoidance and “I’m afraid
that this person may abandon me” for attachment-related anxiety). Subjects respond
using a 7-point scale (1 = strongly disagree to 7 = strongly agree). For the purposes of our
research, we used global attachment scores, that is, global avoidance and global anxiety
ratings, being the mean scores computed across the four targets. Due to an error in the
construction of the online survey form, Item 6 concerning avoidant attachment to the
father was not included in the study. The Cronbach’s alpha coefficients for the Anxiety
and Avoidance subscales were 0.86 and 0.89, respectively. In Study 2, we administered
a different version of the ECR scale, assessing the same attachment styles, but this time
limited exclusively to parental attachment. It was a version of the measure developed by
Int. J. Environ. Res. Public Health 2022,19, 14831 6 of 18
Brennan et al., modified by Marchwicki [
33
]. While the original version assessed adult
romantic attachment, Marchwicki’s is designed for the retrospective assessment of the
styles of attachment to the mother and the father in childhood. The content of the items
concerns the respondent’s relations with the parents when he or she was 11–12 years old.
In each item, the original expressions such as “romantic partner” or “my partner” were
replaced with “mother and father,” and the verb tense, originally present, was changed to
past in the Polish translation. As in the case of ECR-RS, in Marchwicki’s measure items are
rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree). The questionnaire
consists of 40 questions, 19 of them referring to relations with the mother and 21 referring
to relations with the father. As in Study 1, also in the case of this version of the measure,
we used global scores on anxiety and avoidance attachment styles, calculated by averaging
the scores on relationships with mother and father. The reliability coefficients for both
subscales were acceptable: 0.87 for Anxiety and 0.93 for Avoidance.
2.2.3. EI
In both studies, we measured EI using the Trait Emotional Intelligence Questionnaire—
Short Form (TEIQue-SF) [34], as adapted into Polish by Szczygieł et al. [35]. The question-
naire is a self-report measure and consists of 30 items (e.g., “Many times, I can’t figure out
what emotion I’m feeling”), which subjects respond to on a 7-point scale (1 = completely
disagree to 7 = completely agree). The Polish version of the questionnaire has a one-factor
structure and measures the global level of trait emotional intelligence. The higher the score,
the higher the level of trait EI. The reliability coefficients for global trait EI were acceptable
in both studies, their values being 0.92 in Study 1 and 0.89 in Study 2.
2.2.4. Internal Representations of Self and Others
Additionally, Study 2 included the measurement of internal working models of self
and others, operationalized as faith in and the strength of conviction about both self-worth
and the benevolence of the people. To assess them, we used two subscales of the World
Assumptions Scale (WAS) [
36
] as adapted into Polish by Załuski and Gajdosz [
37
], namely
Self-Worth and Benevolence of the People. Each of them consists of 4 items. In the case of
Self-Worth, the items refer to the belief that one is good, competent, and moral by nature;
in the case of Benevolence of the People, they refer to the faith that other people are—by
nature—good, gentle, helpful, protective, and trustworthy. In both subscales, participants
rated the items on a 6-point Likert scale (1 = strongly disagree to 6 = strongly agree). In the
case of the Self-Worth subscale, reliability was fully acceptable (
α
= 0.85), while in the case
of Benevolence of the People, it was lower, although still nearly acceptable (α= 0.69).
2.3. Data Analysis
The data analysis procedure was similar in both studies. The first stage consisted in
screening for missing data. In the first study, there were no missing answers. In the second
study, because we were interested in global scores on attachment styles, we considered
only those responses that concerned both parents. When the respondent was not able
to complete a questionnaire concerning one of their parents, his or her responses were
excluded from the analysis. This was the case with three participants. We also screened
the data for potential multivariate outliers by checking the standardized residuals from
the regression analyses reported below. Before commencing our research, we decided that
observations would be excluded if their residual was more than three standard deviations
from the predicted value; this was never the case in Study 1, and in Study 2, it was the case
for one respondent. As a result, further analyses included data from 246 and 186 subjects in
Studies 1 and 2, respectively.
Next, we calculated descriptive statistics and correlations between the variables using
JAMOVI software. To test Hypothesis 2, we performed mediation analyses (It should be
noted that TEIQue-SF includes two items (i.e., #9: I feel that I have a number of good
qualities, and #24: I believe I’m full of personal strengths) concerning self-esteem, a variable
Int. J. Environ. Res. Public Health 2022,19, 14831 7 of 18
conceptually similar to self-worth. Therefore, to control for content overlap between
TEIQue-SF and the Self-Worth subscale of the WAS, in Study 2, we performed alternative
mediation analyses, with these two TEIQue-SF items excluded. Moreover, all the mediation
and moderation analyses presented here were also performed in an alternative manner,
with participants’ gender and age controlled for. All of these additional analyses yielded
results essentially the same as those reported in the text. We present them in Supplementary
Materials (see Tables S1–S5)) using jAMM add-on for JAMOVI, which allows for regression-
based path modeling with observed variables (To obtain the observed variables in the tested
models, we averaged the original ordinal variables (i.e., the responses scored on Likert-type
ordinal scales) and treated them as measured on interval scales.). Because of this tool, we
were able to apply advanced models controlling for both attachment styles as independent
variables (Study 1 and Study 2, see Figures 1and 2), with loneliness as a dependent variable,
and with multiple parallel mediators between them (i.e., EI, self-worth, and benevolence of
the people at the same time; Study 2, see Figure 2). All the coefficients in the mediation
analyses were estimated using the maximum likelihood method implemented in jAMM.
Standard errors were based on the expected information matrix. Betas (
β
) were obtained as
completely standardized parameters of the path model.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 7 of 19
study, because we were interested in global scores on attachment styles, we considered
only those responses that concerned both parents. When the respondent was not able to
complete a questionnaire concerning one of their parents, his or her responses were ex-
cluded from the analysis. This was the case with three participants. We also screened the
data for potential multivariate outliers by checking the standardized residuals from the
regression analyses reported below. Before commencing our research, we decided that
observations would be excluded if their residual was more than three standard deviations
from the predicted value; this was never the case in Study 1, and in Study 2, it was the
case for one respondent. As a result, further analyses included data from 246 and 186 sub-
jects in Studies 1 and 2, respectively.
Next, we calculated descriptive statistics and correlations between the variables us-
ing JAMOVI software. To test Hypothesis 2, we performed mediation analyses (It should
be noted that TEIQue-SF includes two items (i.e., #9: I feel that I have a number of good
qualities, and #24: I believe I’m full of personal strengths) concerning self-esteem, a vari-
able conceptually similar to self-worth. Therefore, to control for content overlap between
TEIQue-SF and the Self-Worth subscale of the WAS, in Study 2, we performed alternative
mediation analyses, with these two TEIQue-SF items excluded. Moreover, all the media-
tion and moderation analyses presented here were also performed in an alternative man-
ner, with participants’ gender and age controlled for. All of these additional analyses
yielded results essentially the same as those reported in the text. We present them in Sup-
plementary Materials (see Tables S1–S5)) using jAMM add-on for JAMOVI, which allows
for regression-based path modeling with observed variables (To obtain the observed var-
iables in the tested models, we averaged the original ordinal variables (i.e., the responses
scored on Likert-type ordinal scales) and treated them as measured on interval scales.).
Because of this tool, we were able to apply advanced models controlling for both attach-
ment styles as independent variables (Study 1 and Study 2, see Figures 1 and 2), with
loneliness as a dependent variable, and with multiple parallel mediators between them
(i.e., EI, self-worth, and benevolence of the people at the same time; Study 2, see Figure 2).
All the coefficients in the mediation analyses were estimated using the maximum likeli-
hood method implemented in jAMM. Standard errors were based on the expected infor-
mation matrix. Betas (β) were obtained as completely standardized parameters of the path
model.
Figure 1. Mediation model with two independent variables and a simple mediator, tested in Study
1.
EI
Anxiety
Avoidance
Loneliness
Figure 1.
Mediation model with two independent variables and a simple mediator, tested in Study 1.
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 8 of 19
Figure 2. Mediation model with two independent variables and parallel mediators, tested in Study
2.
In both studies, we also tested the moderating effect of IE using multiple regression
analyses. We performed two such analyses in each study. In the tested models, a particu-
lar attachment style, EI, and the interaction term of these two variables were included as
predictors of loneliness, while the other attachment style (i.e., the one not included in the
interaction) was entered as a covariate (see Figure 3A,B). Both mediating and moderating
effects were examined using the bootstrapping method that relies on 95% bias-corrected
confidence estimates (10,000 bootstrapped resamples). In the case of significant moderat-
ing effects, in order to obtain a more nuanced picture of results, we performed simple
slope tests and provided Johnson–Neyman regions for interaction effects using the inter-
Active data visualization tool [38].
Self-worth
Anxiety
Benevolence
Avoidance
EI
Loneliness
Figure 2.
Mediation model with two independent variables and parallel mediators, tested in Study 2.
Int. J. Environ. Res. Public Health 2022,19, 14831 8 of 18
In both studies, we also tested the moderating effect of IE using multiple regression
analyses. We performed two such analyses in each study. In the tested models, a particular
attachment style, EI, and the interaction term of these two variables were included as
predictors of loneliness, while the other attachment style (i.e., the one not included in the
interaction) was entered as a covariate (see Figure 3A,B). Both mediating and moderating
effects were examined using the bootstrapping method that relies on 95% bias-corrected
confidence estimates (10,000 bootstrapped resamples). In the case of significant moderating
effects, in order to obtain a more nuanced picture of results, we performed simple slope
tests and provided Johnson–Neyman regions for interaction effects using the interActive
data visualization tool [38].
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 9 of 19
Figure 3. Moderation models for attachment anxiety (A) and attachment avoidance (B) tested in
Studies 1 and 2.
3. Results
Descriptive statistics for the variables included in both studies are presented in Table
2. The distribution of all variables in both studies was close to normal, as the absolute
values of skewness and kurtosis did not exceed 1. Both in Study 1 (see Table 3) and in
Study 2 (see Table 4), anxious and avoidant attachment styles were correlated negatively
with EI and positively with loneliness. Loneliness and EI were negatively correlated with
each other. Moreover, in Study 2, self-worth was negatively correlated with both attach-
ment styles and loneliness and positively with EI. Benevolence of the people was nega-
tively correlated with avoidant attachment and loneliness and positively associated with
EI, but it was not significantly related to anxious attachment.
Figure 3.
Moderation models for attachment anxiety (
A
) and attachment avoidance (
B
) tested in
Studies 1 and 2.
3. Results
Descriptive statistics for the variables included in both studies are presented in Table 2.
The distribution of all variables in both studies was close to normal, as the absolute values
of skewness and kurtosis did not exceed 1. Both in Study 1 (see Table 3) and in Study 2 (see
Int. J. Environ. Res. Public Health 2022,19, 14831 9 of 18
Table 4), anxious and avoidant attachment styles were correlated negatively with EI and
positively with loneliness. Loneliness and EI were negatively correlated with each other.
Moreover, in Study 2, self-worth was negatively correlated with both attachment styles
and loneliness and positively with EI. Benevolence of the people was negatively correlated
with avoidant attachment and loneliness and positively associated with EI, but it was not
significantly related to anxious attachment.
Table 2. Descriptive statistics.
Variable Valid M SD Skewness Kurtosis Min. Max. Cronbach’s α
Study 1
Avoidance 246 2.72 0.99 0.57 0.87 1.00 6.96 0.89
Anxiety 246 2.66 1.28 0.95 0.59 1.00 7.00 0.86
EI 246 4.56 1.02 −0.07 −0.33 1.77 6.93 0.92
Loneliness 246 1.90 0.60 0.59 −0.40 1.00 3.65 0.90
Study 2
Avoidance 186 3.74 1.29 0.33 −0.46 1.10 6.80 0.93
Anxiety 186 3.48 1.04 −0.03 −0.22 1.00 6.40 0.87
EI 186 4.55 0.83 0.16 0.10 2.33 6.73 0.89
Self-worth 186 4.00 1.26 −0.34 −0.66 1.00 6.00 0.85
Benevolence 186 3.86 0.89 −0.50 −0.02 1.00 5.75 0.69
Loneliness 186 1.94 0.55 0.44 −0.43 1.00 3.60 0.91
Table 3. Zero-order correlations between the variables (Study 1).
Avoidance Anxiety EI Loneliness
Avoidance Pearson’s r-
pvalue -
Anxiety Pearson’s r0.55 -
pvalue <0.001 -
EI Pearson’s r−0.53 −0.51 -
pvalue <0.001 <0 .001 -
Loneliness Pearson’s r0.54 0.51 −0.73 -
pvalue <0 .001 <0.001 <0 .001 -
Table 4. Zero-order correlations between the variables (Study 2).
Avoidance Anxiety EI Loneliness Self-Worth Benevolence
Avoidance Pearson’s r-
pvalue -
Anxiety Pearson’s r0.24 -
pvalue 0.001 -
EI Pearson’s r−0.56 −0.31 -
pvalue <0.001 <0.001 -
Loneliness Pearson’s r0.44 0.38 −0.69 -
pvalue <0.001 <0.001 <0.001 -
Self-worth Pearson’s r−0.34 −0.31 0.76 −0.65 -
pvalue <0.001 <0.001 <0.001 <0.001 -
Benevolence Pearson’s r−0.205 −0.04 0.28 −0.24 0.20 -
pvalue 0.005 0.576 <0.001 0.001 0.007 -
Both in Study 1 and in Study 2, the indirect effects involving EI as a mediator between
both anxious and avoidant attachment and loneliness were significant (
β
= 0.21,95% CI
[0.05, 0.12] for anxiety and
β
= 0.21, 95% CI [0.08, 0.18] for avoidance in Study 1, and
β= 0.07
, 95% CI [0.01, 0.06] for anxiety and
β
= 0.20, 95% CI [0.05, 0.11] for avoidance in
Int. J. Environ. Res. Public Health 2022,19, 14831 10 of 18
Study 2, respectively; see Table 5for details). In Study 2, in which we tested six mediation
effects, the significant ones also included the two indirect effects involving self-worth,
indicating a mediating role of this variable between both attachment styles and loneliness
(
β
= 0.07, 95% CI [0.01, 0.06] for anxiety and
β
= 0.09, 95% CI [0.01, 0.06] for avoidance,
respectively). Effects involving benevolence of the people as a mediator turned out to be
nonsignificant (see Table 6).
Table 5. Mediation analysis for Study 1.
Type Effect βSE
95% CI p
LL UL
Indirect
Avoidance
⇒
EI
⇒
Loneliness
0.21 0.03 0.08 0.18 <0.001
Anxiety ⇒EI ⇒Loneliness 0.18 0.02 0.05 0.12 <0.001
Component
Avoidance ⇒EI −0.37 0.08 −0.52 −0.22 <0.001
EI ⇒Loneliness −0.58 0.03 −0.40 −0.28 <0.001
Anxiety ⇒EI −0.30 0.05 −0.34 −0.15 <0.001
Direct Avoidance ⇒Loneliness 0.16 0.03 0.04 0.16 0.002
Anxiety ⇒Loneliness 0.12 0.03 0.01 0.11 0.026
Total Avoidance ⇒Loneliness 0.37 0.04 0.15 0.30 <0.001
Anxiety ⇒Loneliness 0.30 0.03 0.08 0.20 <0.001
Table 6. Mediation analysis for Study 2.
Type Effect βSE
95% CI p
LL UL
Indirect Avoidance ⇒EI ⇒Loneliness 0.19 0.02 0.04 0.12 <0.001
Avoidance ⇒Self-worth ⇒
Loneliness 0.08 0.01 0.01 0.06 0.018
Avoidance ⇒Benevolence ⇒
Loneliness 0.01 0.01 −
0.01
0.02 0.397
Anxiety ⇒EI ⇒Loneliness 0.07 0.01 0.01 0.07 0.016
Anxiety
⇒
Self-worth
⇒
Loneliness
0.07 0.01 0.01 0.07 0.014
Anxiety ⇒Benevolence ⇒
Loneliness −
0.00
0.003 −
0.01
0.006 0.944
Component
Avoidance ⇒EI −
0.51
0.04 −
0.41
−
0.24
<0.001
EI ⇒Loneliness −
0.38
0.06 −
0.36
−
0.12
<0.001
Avoidance ⇒Self-worth −
0.28
0.07 −
0.41
−
0.13
<0.001
Self-worth ⇒Loneliness −
0.30
0.04 −
0.19
−
0.05
<0.001
Avoidance ⇒Benevolence −
0.21
0.05 −
0.24
−
0.04
0.005
Benevolence ⇒Loneliness −
0.06
0.03 −
0.10
0.04 0.332
Anxiety ⇒EI −
0.18
0.05 −
0.24
−
0.05
0.002
Anxiety ⇒Self-worth −
0.24
0.09 −
0.45
−
0.12
<0.001
Anxiety ⇒Benevolence 0.01 0.07 −
0.12
0.14 0.919
Direct Avoidance ⇒Loneliness 0.10 0.03 −
0.02
0.10 0.176
Anxiety ⇒Loneliness 0.17 0.03 0.03 0.14 0.003
Total Avoidance ⇒Loneliness 0.37 0.03 0.10 0.21 <0.001
Anxiety ⇒Loneliness 0.29 0.03 0.09 0.22 <0.001
Moderation analyses revealed a similar pattern of results in both studies. While inter-
action effects for anxious attachment and EI were significant, interaction effects involving
avoidant attachment did not predict the level of loneliness (see Tables 7and 8). This means
that EI proved to be a moderator of the relationships between anxious attachment and
loneliness; in both studies, the effect of anxiety attachment on loneliness was qualified
by the level of EI. To obtain a more nuanced picture of moderation effects, we performed
simple slope tests and provided Johnson–Neyman regions for the interaction effects found.
In both studies, simple slope tests showed that the positive effect of anxious attachment on
Int. J. Environ. Res. Public Health 2022,19, 14831 11 of 18
loneliness was the strongest at a low level of EI and gradually weakened with an increase
in the level of this variable (see panel A in Figures 4and 5). Further exploration using the
Johnson–Neyman technique (see panel B in Figures 4and 5) revealed that in Study 1, the
effect of anxious attachment ceased to be significant even in participants who scored
−
0.2
SD above the mean or higher on EI (54.47%), while in the case of Study 2, it was no longer
significant in those who scored 0.55 SD above the mean or higher on EI (30.65%).
Table 7. Moderation analysis for Study 1.
Predictor βSE t95% CI p
LL UL
Intercept 0.09 17.24 1.41 1.60 <0.001
Avoidance 0.17 0.03 3.16 0.04 0.16 0.002
Anxiety 0.09 0.03 1.57 0.01 0.09 0.118
EI −0.59 0.03 −11.41 −0.41 −0.29 <0001
Anxiety ×EI −0.10 0.02 −2.20 −0.08 −0.004 0.029
Model summary R2= 0.58
F(4, 241) = 84.41, p< 0.001
Intercept 0.07 17.24 1.59 1.87 <0.001
Avoidance 0.15 0.03 2.80 0.03 0.15 0.005
Anxiety 0.12 0.02 2.32 0.008 0.10 0.021
EI −0.59 0.03 −11.33 −0.41 −0.29 <0.001
Avoidance ×EI −0.07 0.02 −1.62 −0.07 0.01 0.107
Model summary R2= 0.58
F(4, 241) = 83.10, p< 0.001
Table 8. Moderation analyses for Study 2.
Predictor βSE t95% CI p
LL UL
Intercept 0.10 17.16 1.58 2.00 <0.001
Avoidance 0.08 0.03 1.29 −0.02 0.09 0.199
Anxiety 0.19 0.03 3.53 0.04 0.16 0.001
EI −0.61 0.04 −9.66 −0.49 −0.32 <0.001
Anxiety ×EI −0.13 0.03 −2.41 −0.15 −0.01 0.017
Model summary R2= 0.52
F(4, 181) = 49.82, p< 0.001
Intercept 0.11 14.15 1.35 1.78 <0.001
Avoidance 0.05 0.03 0.78 −0.03 0.07 0.437
Anxiety 0.19 0.03 3.45 0.04 0.16 0.001
EI −0.60 0.04 −9.44 −0.48 −0.32 <0.001
Avoidance ×EI −0.07 0.03 −1.22 −0.08 0.02 0.226
Model summary R2= 0.51
F(4, 241) = 47.62, p< 0.001
Int. J. Environ. Res. Public Health 2022,19, 14831 12 of 18
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 13 of 19
(A)
(B)
Figure 4. Graphical representation of the moderation analysis in Study 1. The interaction between
attachment-related anxiety and EI in predicting loneliness (panel (A)) and Johnson–Neyman regions
representing the threshold of significance for the effect of attachment-related anxiety on loneliness
at different levels of EI (panel (B)). Note: The figures were generated using the interActive data
visualization tool. The shaded regions in panel B indicate 95% confidence intervals. The effect of
attachment-related anxiety on loneliness is statistically significant left of the dashed vertical line (the
confidence bands there do not include zero).
Figure 4.
Graphical representation of the moderation analysis in Study 1. The interaction between
attachment-related anxiety and EI in predicting loneliness (panel (
A
)) and Johnson–Neyman regions
representing the threshold of significance for the effect of attachment-related anxiety on loneliness
at different levels of EI (panel (
B
)). Note: The figures were generated using the interActive data
visualization tool. The shaded regions in panel B indicate 95% confidence intervals. The effect of
attachment-related anxiety on loneliness is statistically significant left of the dashed vertical line (the
confidence bands there do not include zero).
Int. J. Environ. Res. Public Health 2022,19, 14831 13 of 18
Int. J. Environ. Res. Public Health 2022, 19, x FOR PEER REVIEW 14 of 19
(A)
(B)
Figure 5. Graphical representation of the moderation analysis in Study 2. The interaction between
attachment-related anxiety and EI in predicting loneliness (panel (A)) and Johnson–Neyman regions
representing the threshold of significance for the effect of attachment-related anxiety on loneliness
at different levels of EI (panel (B)). Note. The figures were generated using the interActive data
visualization tool. The shaded regions in panel B indicate 95% confidence intervals. The effect of
attachment-related anxiety on loneliness is statistically significant left of the dashed vertical line (the
confidence bands there do not include zero).
4. Discussion
The aim of our research was to examine the potential mediating and moderating roles
of EI between attachment styles and loneliness. The results of the two cross-sectional stud-
ies revealed that both anxious and avoidant attachment styles were positive predictors of
loneliness. These results are in line with previous investigations [9,17]. In the case of anx-
ious attachment, the link with loneliness can easily be explained by the fact that early
childhood experiences of anxiously attached people combine a strong need for acceptance
from others with a fear of being rejected or abandoned. This combination probably favors
the more frequent occurrence of the non-satisfaction of the need to belong, which is
Figure 5.
Graphical representation of the moderation analysis in Study 2. The interaction between
attachment-related anxiety and EI in predicting loneliness (panel (
A
)) and Johnson–Neyman regions
representing the threshold of significance for the effect of attachment-related anxiety on loneliness
at different levels of EI (panel (
B
)). Note. The figures were generated using the interActive data
visualization tool. The shaded regions in panel B indicate 95% confidence intervals. The effect of
attachment-related anxiety on loneliness is statistically significant left of the dashed vertical line (the
confidence bands there do not include zero).
Int. J. Environ. Res. Public Health 2022,19, 14831 14 of 18
4. Discussion
The aim of our research was to examine the potential mediating and moderating roles
of EI between attachment styles and loneliness. The results of the two cross-sectional studies
revealed that both anxious and avoidant attachment styles were positive predictors of
loneliness. These results are in line with previous investigations [
9
,
17
]. In the case of anxious
attachment, the link with loneliness can easily be explained by the fact that early childhood
experiences of anxiously attached people combine a strong need for acceptance from others
with a fear of being rejected or abandoned. This combination probably favors the more
frequent occurrence of the non-satisfaction of the need to belong, which is characteristic of
loneliness. The link between avoidant attachment and loneliness is not so obvious, since
avoidantly attached individuals are, theoretically, less dependent on others, and social
distancing is not necessarily uncomfortable for them. However, both previous results and
the studies presented in this paper show that also avoidantly attached people experience
loneliness. According to Mikulincer and Shaver, this means “that avoidant people may not
deactivate their attachment systems to the point of not caring at all about the absence of
supportive relationships” [9] (p. 40).
As hypothesized, the results of our research indicate that the mechanism explaining
the relationships between anxious and avoidant attachment and loneliness is EI. Both
insecure attachment styles turned out to be associated with a low level of EI, which in
turn translated into increased loneliness. These findings are in line with previous studies,
which showed that insecure attachment styles were associated with emotional regulation
difficulties [
39
,
40
] and that EI prospectively predicted loneliness [
25
]. Importantly, in the
second study, we found this mediation effect when controlling simultaneously for internal
representations of self (i.e., self-worth) and others (i.e., benevolence of the people)—a
different mechanism behind the attachment–loneliness link, suggested both in theory and
in previous research. These results point to EI as a kind of bridge between early childhood
and adult interpersonal experiences. Adaptive emotional regulation strategies develop
on the foundation of secure attachment with caregivers, and in adult life, they make
it possible to form and maintain satisfying social relationships. Avoidant and anxious
attachment, by contrast, leads to the development of two radically distinct but, in both
cases, maladaptive strategies for managing emotions [
41
]. In the case of anxiously attached
people, it is a hyperactivation strategy, characterized by increased sensitivity to negative
emotions from others and excessive focus on one’s own emotional discomfort, which,
in practice, makes it difficult to build social relationships with the other person as an
equal partner. Avoidantly attached individuals develop a deactivating strategy, aimed
at reducing stress through suppression and repression, and when the source of stress is
other people—through distancing oneself from them [
41
]. This is the aftermath of their
experiences, which show that others will not be available to soothe their emotions. In
practice, both strategies hinder the perception, understanding, and regulation of emotions
during social interactions [23], which increase the risk of loneliness [9].
In both studies, we also found the hypothesized moderating role of EI in the rela-
tionship between anxious attachment and loneliness. It turned out that the strength of
the positive relationship between anxious attachment and loneliness decreased with an
increase in EI. Furthermore, both studies revealed that at a high level of EI anxious at-
tachment ceases to be significantly related to loneliness. This suggests that uncertainty
about one’s own worth and doubts about the possibility of being accepted by others, which
are characteristic of anxious attachment, can be effectively reduced through EI resources.
This finding is consistent with the existing results of research on emotional regulation in
people with high EI. Individuals with high EI show a lower level of negative mood as a
result of laboratory-induced stress than those with low EI [
42
]. Moreover, people high
in EI more often use adaptive strategies for coping with stress (e.g., positive reappraisal)
than maladaptive emotional regulation strategies (e.g., self-blame) [
43
]. For example, they
interpret stressful situations as a risk rather than a threat and have stronger faith in their
ability to cope with such situations [
44
]. In a social context, in research on adolescents, it
Int. J. Environ. Res. Public Health 2022,19, 14831 15 of 18
was found that EI buffered the impact of traditional victimization on loneliness [
28
]. In
a different study, Nozaki and Koyasu [
45
] demonstrated that a high level of emotional
self-regulation predicted better inhibition of retaliation for ostracism. Given that anxious
attachment is associated with low self-esteem [
46
], our result is also in line with the inves-
tigation reported by Kashdan et al. [
47
], who found that one of the EI features—emotion
differentiation—neutralized neural responses (i.e., dACC and anterior insula) to social
rejection in people with low self-esteem. These results can be alternatively interpreted as
indicating the moderating role of attachment in the relationship between EI and loneliness.
Viewed from this perspective, our research shows that the strength of the link between EI
and loneliness increases with an increase in the level of anxious attachment. This means
that the higher the level of this attachment style, the more effective the reduction of loneli-
ness through EI. This is consistent with the theoretical assumptions concerning anxious
attachment. A characteristic feature of anxiously attached people is increased vigilance and
sensitivity to signals of social threat combined with higher motivation to obtain support;
this can create perfect conditions for using resources associated with recognizing other
people’s emotions and regulating one’s own moods for the purpose of restoring social
connection. Most importantly, however, both interpretations suggest that EI may effectively
protect individuals with chronic attachment-related anxiety from a sense of loneliness. The
moderation effect of EI was not present in the case of avoidant attachment—the relationship
between this attachment style and loneliness does not change across different levels of EI.
This means that in avoidantly attached people, EI does not show regulatory properties
enabling the reduction of loneliness. Seeking an explanation for this, it is worth referring
to Mikulincer and Shaver’s reflection on loneliness in avoidantly attached people. As
these authors observe, while both insecure attachment styles are associated with increased
loneliness, avoidant people have low motivation to overcome this state, as a result of
which they remain isolated and lonely over time [
9
]. This is well illustrated by research
showing that whereas the level of loneliness in anxiously attached people decreases with
age, in avoidantly attached individuals it remains similar over the years [
46
]. This means
that, being weakly motivated to overcome loneliness, avoidant people do not use the
resources associated with emotional intelligence for this purpose. Given the characteristics
of avoidant attachment (including the low level of trust), it is possible that people with a
high level of this style tend to use emotional intelligence to detect potential signs of hostility
or other social threats rather than to build close relationships with others.
Limitations
While the fact that both studies yielded a consistent pattern of results is an advantage
of our research, several limitations should be noted. Firstly, the weaknesses include the
cross-sectional design, which does not justify conclusions regarding causality, and the
largely retrospective measurement of attachment styles (especially in Study 2), which
carries a risk of memory biases. As regards the former limitation, although the proposed
interpretation of the relationship between the variables is supported both by the attach-
ment theory and by data on the prospective prediction of loneliness from EI, it is worth
performing a longitudinal measurement in the future (optimally, at three time points [
48
]),
particularly in order to replicate the mediation effects detected. Performing this kind of
prospective measurement of attachment styles together with EI and loneliness at different
developmental stages, starting from childhood, would also allow for reducing the second
weakness mentioned above—the risk of memory biases in the evaluation of relations with
caregivers. Secondly, we used snowball sampling, which on the one hand allowed us to
reach a fairly large group of people and conduct two studies instead of only one, but on the
other hand, this sampling resulted in predominantly young and female participants, limit-
ing the possibilities of generalizing the results. In future studies, it is worth reaching more
varied samples, testing if the relationships between attachment styles, EI, and loneliness,
discussed above, are the same or similar in males, older adults, and people from countries
more ethnically diverse than Poland. Finally, both studies included only trait EI; in future
Int. J. Environ. Res. Public Health 2022,19, 14831 16 of 18
research, the mediating and moderating roles of EI abilities should also be investigated
(e.g., using performance-based measures of EI).
5. Conclusions
Previous research revealed that both anxious and avoidant attachment styles were
positively related to loneliness. Little is known, however, about the mediators and modera-
tors of these relationships. The aim of the presented research was to examine if emotional
intelligence (EI) could be regarded as a mechanism mediating the relationship between
attachment and loneliness. The authors also tested the moderating role of this variable,
investigating whether EI was a protective factor against loneliness in insecurely attached
individuals. The two studies presented in this article yielded a consistent pattern of results,
indicating a dual role of EI in the relationships between attachment styles and loneliness.
Firstly, they showed the mediating role of this variable, explaining why insecure attach-
ment styles were linked with a risk of increased loneliness. The results suggest that both
anxiously and avoidantly attached individuals are characterized by a low level of ability to
regulate their emotions, which, in the interpersonal context, is associated with an increased
sense of social isolation. Thus, low EI appears to be an intermediary link in the intensifica-
tion of loneliness as a result of insecure social experiences in childhood. Furthermore, the
present research is the first to find the mediating role of EI while controlling for another
mediator of the relationships between attachment styles and loneliness, well documented
by now, namely internal representations of self and others.
Secondly, in the current research, it was found for the first time that EI buffered the
effect of anxious attachment on loneliness, which means that the strength of the relationship
between anxious attachment and loneliness decreased with an increase in EI. Moreover,
when EI is high, anxious attachment—a well-documented predictor of loneliness—is no
longer related to this variable. This novel finding has important practical implications.
Given that EI can be developed throughout the life span [
49
], these data suggest that
anxiously attached persons can effectively protect themselves from loneliness by training
their emotional regulation skills. In other words, highly developed EI can prevent early
childhood anxious interpersonal experiences from translating into problems linked with a
sense of isolation in adult life.
Supplementary Materials:
The following supporting information can be downloaded at: https:
//www.mdpi.com/article/10.3390/ijerph192214831/s1, Table S1: Alternative Mediation Analysis
for Study 2 (with EI Measurement Excluding Two TEIque Items Corresponding in Terms of Content
to the Self-Worth Subscale of the WAS); Table S2: Alternative mediation analysis for Study 1 (with
participants’ Gender and Age as covariates); Table S3: Alternative mediation analysis for Study 2
(with participants’ Gender and Age as covariates); Table S4: Alternative moderation analyses for
Study 1 (with participants’ Gender and Age as covariates); Table S5: Alternative moderation analyses
for Study 2 (with participants’ Gender and Age as covariates).
Author Contributions:
Conceptualization, D.B., M.S. and K.R.; methodology, D.B.; formal analysis,
D.B.; investigation, M.S. and K.R.; data curation, D.B.; writing—original draft preparation, D.B., M.S.
and T.W.; writing—review and editing, D.B. and T.W.; visualization, D.B.; project administration, D.B.;
funding acquisition, D.B. All authors have read and agreed to the published version of the manuscript.
Funding:
This research was financed from funds allocated to the statutory activity of Jan Kochanowski
University (SUPS.RN.22.043).
Institutional Review Board Statement:
The study was conducted in accordance with the Declara-
tion of Helsinki and was approved by the Faculty Bioethics Committee at the author’s institution
(Resolution no. 11/2019).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
The anonymized data are available from the corresponding author
upon reasonable request.
Conflicts of Interest: The authors declare no actual or potential conflict of interest.
Int. J. Environ. Res. Public Health 2022,19, 14831 17 of 18
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