Search Results (118)

Loneliness and social isolation are related but distinct experiences, and their relative contributions to mental health among men who have sex with men (MSM) remain insufficiently studied in Portugal. This cross-sectional online survey of 641 cisgender MSM (age 18–74 years; M = 38.51, SD = 12.83) examined associations among loneliness, objective connectivity, interpersonal belonging, LGBTQIA+ community belonging, social-network composition, negative affect, and psychological distress, using the UCLA Loneliness Scale, the Social Isolation Scale, the Depression Anxiety Stress Scales-21, and a short Portuguese Positive and Negative Affect Schedule. LGBTQIA+ community belonging and LGBTQIA+ network representation were assessed with single items. Correlations, multiple regressions, and two moderation models were estimated with heteroscedasticity-consistent standard errors and sensitivity analyses. Loneliness was the strongest independent correlate of psychological distress (β = 0.509, p < 0.001, R² = 0.353) and negative affect (β = 0.398, p < 0.001, R² = 0.193). Interpersonal belonging showed a small, borderline inverse association with distress (β = −0.10, p = 0.050) that did not survive covariate adjustment. Neither LGBTQIA+ community belonging nor LGBTQIA+ network representation moderated the loneliness–distress association. Subjective loneliness was more closely tied to distress than objective connectivity or broad community integration. These cross-sectional findings are consistent with the value of examining interventions that address the quality and reciprocity of close relationships alongside affirming community resources. Full article

Social disconnection has become a public-health concern, but it remains unclear whether mental-health symptoms are more closely related to limited social contact or to the subjective experience of loneliness. This cross-sectional study examined 632 self-selected adults living in Portugal, recruited online, and explored whether loneliness helps explain the association between social isolation and psychological distress across small, medium, and large cities. Participants completed self-report measures of loneliness, social isolation, depression, anxiety, stress, and positive and negative affect. Loneliness was a salient experience: the mean score was close to the scale midpoint, and 36.2% of participants scored above it. Higher loneliness was associated with greater psychological distress, greater social isolation, lower positive affect, and higher negative affect. When loneliness was considered together with social isolation, the direct link between isolation and distress became minimal, suggesting that distress was more closely connected to how social disconnection was experienced than to contact frequency alone. This pattern was similar across city sizes, and average levels of loneliness, isolation, distress, and affect did not meaningfully differ between small, medium, and large cities. Overall, the findings are consistent with loneliness as a candidate target for mental-health promotion in this sample of Portuguese adults, although longitudinal studies are needed to clarify causal pathways. Full article

Background: Problematic school attendance in adolescence is a heterogeneous phenomenon with academic, emotional, and developmental consequences. Although relational factors are increasingly recognised, the literature remains conceptually fragmented, with overlapping constructs such as social isolation, loneliness, social withdrawal, and peer difficulties examined under partially distinct frameworks. Objective: This systematic review aimed to synthesize empirical evidence on the association between social isolation, related constructs, and problematic school attendance during adolescence. Methods: Following PRISMA 2020 guidelines, searches were conducted in PubMed, Scopus, and Embase (final search: 20 January 2026). Eligible studies were observational or qualitative empirical investigations involving adolescents aged 11–18 years and examining at least one relational construct (objective/subjective social isolation, loneliness, social withdrawal, peer rejection) together with at least one school attendance outcome (school refusal, withdrawal, truancy, avoidance, dropout). Risk of bias was assessed with design-specific JBI tools and findings were synthesized narratively. Results: Eleven studies met the inclusion criteria: six cross-sectional, four longitudinal/cohort, and one qualitative. Loneliness, bullying, school alienation, and social isolation at school were most consistently associated with school refusal and absenteeism, whereas peer acceptance, reciprocal friendships, teacher emotional support, and school belonging were associated with reduced dropout intentions, higher graduation rates, and better school transition. Longitudinally, loneliness and low teacher support preceded increases in intention to quit, while supportive relationships appeared to protect against later disengagement. Conclusions: Social isolation and related constructs are meaningfully associated with problematic school attendance in adolescence. Social isolation and related constructs appear to be meaningfully associated with problematic school attendance in adolescence, although the evidence base remains limited and heterogeneous. These findings suggest that a relational perspective may usefully complement existing approaches to attendance difficulties, and point to the need for longitudinal, multi-informant studies disentangling subjective, interpersonal, and institutional disconnection across distinct attendance profiles. Full article

Objective: Against the background of rapid population aging, this study examined the associations between social participation and physical and mental health among middle-aged and older adults in China and explored potential psychosocial pathways involving loneliness and subjective well-being. Methods: Data were drawn from the 2023 Chinese General Social Survey (CGSS). A total of 3823 respondents aged 45 years and older were included in the analysis. Ordinary least squares regression models were used to examine the associations between social participation and physical and mental health. Sensitivity analyses, robustness checks, ordered logit models, and supplementary instrumental variable analyses were conducted to assess the consistency of the findings. Serial mediation analysis was used to explore the potential indirect associations involving loneliness and subjective well-being. Results: Higher levels of social participation were positively associated with better physical health and mental health among middle-aged and older adults (p < 0.001). Sensitivity and robustness analyses generally supported the consistency of these findings. Supplementary instrumental variable analyses showed a significant positive association with mental health, while the positive estimate for physical health was not statistically significant. Exploratory mediation analyses suggested that loneliness and subjective well-being may represent potential psychosocial pathways linking social participation to health outcomes. The total indirect association accounted for 22.40% of the total association with physical health and 33.24% of the total association with mental health. Conclusions: Social participation was positively associated with health among middle-aged and older adults in China, with more consistent evidence for mental health. Loneliness and subjective well-being may represent potential psychosocial pathways linking social participation to health outcomes. Full article

Background/Objectives: Norway’s ageing population includes many older adults living alone who receive home care and are at increased risk of loneliness. Loneliness is the subjective sense of unmet or imbalanced social needs, shaped by culture and living conditions, and can be social (lack of contact) or emotional (absence of close, trusting relationships). In older people, it often follows partner or role loss or reduced mobility or participation and is associated with emotional pain, lowered self-worth and poorer health and quality of life. This study aimed to explore patients’ experiences of loneliness while living alone and receiving home care. Methods: Twelve older patients (aged 74–98 years) participated in in-depth interviews, which were analysed using phenomenological-hermeneutical analysis in line with Lindseth and Norberg’s recommendations. Results: The results are presented under the following themes: (I) An overwhelming and painful feeling, (II) A presence without connection, and (III) Experiencing a sense of alienation. Conclusions: This study describes complex feelings of loneliness for the majority of participants, often worsened by poor mobility and shrinking social networks. From the patient perspective, good home care goes beyond practical and medical tasks: patients need to be treated as whole persons, with respect and understanding, to alleviate loneliness. Staffing stability, predictable visiting times, time for conversation, and small acts of kindness are central to well-being and the prevention of loneliness. Municipal healthcare should prioritize relationship-building, communication skills, and organizational solutions that enable continuity and flexibility. Focusing on the patient perspective in planning and evaluation will create better targeted interventions and support dignified ageing. Full article

Background/Objectives: Population ageing and the increasing prevalence of loneliness and social isolation represent major public health challenges. Digital health technologies, including conversational agents, have emerged as potential tools to support emotional well-being and daily functioning in older adults. This study presents the design and exploratory pilot evaluation of UjaBienestar, a multimodal conversational chatbot aimed at providing accessible emotional and practical support. Methods: A web-based multimodal system integrating text and voice interaction was developed using a Django backend and a Rasa-based conversational engine. The system was designed following user-centred and accessibility-oriented principles for older adults. A pilot usability and feasibility study was conducted with 10 participants using task-based interaction, observational data and pre/post-questionnaires. The exploratory evaluation focused on preliminary user perception, accessibility, and interaction feasibility rather than on statistically generalizable or clinically validated outcomes. Results: Participants reported high levels of perceived usability, accessibility, and acceptability. Multimodal interaction, particularly voice support, was positively valued. Users reported subjective perceptions of companionship during interaction within this pilot context. Initial barriers were mainly related to onboarding and first-time use. Conclusions: The findings suggest that the proposed system is a feasible and acceptable digital health support tool for older adults. While the results are preliminary, they highlight the potential of multimodal conversational technologies for supporting perceived emotional well-being, accessibility, and daily assistance in ageing populations. These findings are based on perceived user responses and do not represent clinically validated outcomes. Further large-scale and longitudinal studies are required to assess clinical and psychosocial impact. Full article

The verbal working memory training proposed by Borella and co-authors found specific and transfer effects among older adults. However, the effective training lengths needed to maximize transfer effects are not yet clear. Also, far-transfer effects related to psychological well-being and subjective health are still under debate. The present study aimed to assess gains and transfer effects of a modified version of the WM training protocol by Borella and co-authors by comparing the original three-session (1 h each) version to a modified eighteen-session (1 h each) version. Our results confirmed the already demonstrated specific cognitive effects that seem to increase as the number of sessions increases. Regarding psychological well-being and subjective health, we found that while even three sessions of training can diminish reported loneliness and negative affective states, the longer training significantly improves the subjective perception of general health, suggesting that longer working memory training may be particularly fruitful in promoting well-being and successful aging. Full article

As the global population continues to age, mental health issues such as depression, anxiety, stress, loneliness, and social isolation among older adults are receiving increasing attention. The built environment is closely associated with older adults’ daily mobility, environmental perception, social participation, and mental health and well-being, but the evidence remains heterogeneous across spatial contexts, environmental indicators, and study designs. Previous umbrella reviews have summarized broad links between the built environment and healthy aging, but less attention has been paid to recent original empirical studies published after the COVID-19 pandemic, the distinction between objective environmental exposure and subjective environmental perception, and the role of social participation as a pathway linking environmental conditions to mental health and well-being. This study employs a systematic literature review approach, searching and screening peer-reviewed empirical studies published between 2015 and January 2026 that focus on the associations between the built environment and older adults’ mental health and well-being. PubMed, Scopus, and Web of Science databases were used for searching, supplemented by manual searching. After title and abstract screening and full-text evaluation, a total of 60 studies were included. Subsequently, a comprehensive analysis was conducted on aspects such as research design, spatial scale, environmental indicators, types of mental health outcomes, and potential pathways of action. In this review, core mental health and well-being outcomes included negative outcomes, such as depression, anxiety, stress, psychological distress, loneliness, and social isolation, and positive outcomes, such as life satisfaction, subjective well-being, psychological well-being, and mental well-being. Social participation was examined as a behavioral and psychosocial pathway rather than as a core outcome. Emerging methods, including street-view image analysis, FCN-based semantic segmentation, and XGBoost-SHAP, were examined because they can refine environmental exposure measurement and support variable-importance interpretation, rather than because they provide causal evidence. The main synthesis suggests that several built environment factors are associated with older adults’ mental health and well-being, although the strength and consistency of evidence vary across outcome types, spatial contexts, and study designs. (1) Exposure to green and blue spaces, quality of public open spaces, walkability and accessibility, accessibility of neighborhood facilities and services, housing and living conditions, and positive environmental perception are mostly associated with lower levels of depression, anxiety, stress, and loneliness, as well as higher levels of life satisfaction, subjective well-being, and psychological well-being. (2) Conversely, adverse environmental exposures such as proximity to roads, pollution, non-vegetated spaces, and high-intensity urbanization are more likely to exacerbate negative psychological outcomes. Existing evidence also suggests that social participation is one of the important behavioral pathways through which the built environment is linked to the mental health of older adults, but it is not the only mechanism. (3) In addition, the direction and intensity of environmental associations remain heterogeneous under different spatial scales, indicator types, and research methods. Overall, this review contributes by organizing recent empirical evidence into a built environment–social participation–mental health and well-being framework, while emphasizing that most findings should be interpreted primarily as evidence of association rather than as stable or uniform causal effects. Full article

Social disconnection, encompassing both loneliness and social isolation, is increasingly recognised as an important public health concern. While employment provides opportunities for social participation and role engagement, less is known about how different forms of labour market detachment relate to subjective and objective dimensions of social connection in later working life. This study examined the association between labour force attachment and both loneliness and social isolation among Australians aged 50–64 years using cross-sectional data from Wave 22 (2022) of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (n = 3362). Participants were classified into labour force attachment groups including in work, underemployed hidden workers, unemployed hidden workers, discouraged workers, those not wanting work, and other. Survey-weighted logistic regression models were used to estimate adjusted predicted probabilities of loneliness and social isolation across labour force groups. After adjustment for sociodemographic and health characteristics, predicted probabilities of loneliness were elevated across hidden worker subtypes relative to those in paid employment, with point estimates 10–13 percentage points higher across categories. Differences in social isolation between hidden worker subtypes and those in paid work were small in magnitude. The highest adjusted predicted probability of social isolation was observed among individuals who reported not wanting work. These findings suggest that, in later working life, labour market marginalisation is associated more strongly with subjective experiences of social disconnection than with the structural availability of social contact. Interventions to reduce loneliness among older working-age adults may benefit from recognising the institutional functions of paid work alongside approaches targeting social contact. Full article

This article examines experiences of loneliness among older adults from a life course perspective, fostering a dialogue grounded in Social Work. The aim is to understand how loneliness is constructed, expressed and reinterpreted as a subjective, relational and dynamic experience embedded in diverse life trajectories and shaped by structural factors. A qualitative, descriptive and interpretative approach was adopted, involving 30 individual interviews and 4 focus groups with 74 participants (older adults, social workers and other social-sector professionals) in Barcelona (Spain). The analysis was structured around the three core concepts of life course theory and its five key principles. The findings show that loneliness, understood as distinct from social isolation, is linked to biographical processes marked by expected and unexpected life changes. Its intensity and meaning vary according to timing, historical context, social position and life decisions. Employment, family, institutional, migratory, and sexual orientation and gender identity trajectories significantly shape experiences of loneliness. The study highlights the role of agency and underscores the importance of an intersectional approach to understanding accumulated inequalities. From a Social Work perspective, the article advocates a biographical, situated and relational approach to loneliness, promoting interventions that recognise individual trajectories and support meaningful social relationships. Full article

Loneliness describes a complex experience, the subjective incongruence between one’s desired and perceived social connections. The study of loneliness has increased but mostly through quantitative methods, leaving a gap in the personal experience and understanding of what it means to be lonely. The everyday language used to articulate the personal experience of loneliness remains underexamined. To address this gap, we conducted 18 semi-structured life story interviews with older adult mental health service users. Interviews were conducted via telephone and lasted on average 45 min. Participants were included on the basis of being objectively classified as lonely and ranged in age from 66 to 84. This paper provides a thematic analysis of responses to the question “What does loneliness mean to you?” Responses include subjective and objective aspects, as well as frequency, duration, and intensity, and social, emotional, and existential loneliness. Loneliness is a multidimensional, personal experience, rather than a single construct. Participants discussed loneliness alongside social isolation, depression, grief, feelings of emptiness, purpose, meaning, boredom and hopelessness. These insights are important for informing how we frame loneliness in research, policy, and practice, and for highlighting that our language needs to be sufficiently inclusive to capture the complexity of loneliness, not only for work with mental health service users but in public health. Full article

Chronic obstructive pulmonary disease (COPD) imposes a substantial physical and psychosocial burden, yet the role of loneliness remains under-recognised in clinical practice. Loneliness, defined as a subjective discrepancy between desired and actual social relationships, has emerged as a clinically relevant determinant of patient outcomes. This narrative review synthesises current evidence on the epidemiology, mechanisms, and clinical consequences of loneliness in COPD, and evaluates its implications for disease management. Available evidence indicates that loneliness affects a considerable proportion of individuals with COPD, with prevalence estimates ranging from approximately 18% to over 30%, particularly among patients with greater symptom burden, functional limitation, and oxygen dependence. Dyspnoea and advancing disease severity reduce social participation and increase vulnerability to perceived social disconnection. Loneliness influences COPD outcomes through interconnected behavioural, biological, and healthcare engagement pathways, including systemic inflammation, neuroendocrine stress responses, physical inactivity, impaired self-management, and reduced engagement with healthcare services. These mechanisms contribute to poorer clinical trajectories, as loneliness is consistently associated with reduced health-related quality of life, increased exacerbations, higher healthcare utilisation, greater risk of hospitalisation, and elevated mortality, independent of depression and anxiety. Despite this, loneliness is rarely assessed in routine respiratory care, and targeted interventions remain limited. Emerging strategies, including pulmonary rehabilitation, peer support, and digital health interventions, show promise in reducing loneliness and improving outcomes. Loneliness represents a modifiable and clinically actionable risk factor in COPD, and its integration into routine assessment and management may enhance patient engagement, optimise treatment effectiveness, and reduce healthcare burden. Addressing loneliness represents a critical opportunity to advance more effective and comprehensive COPD care. Full article

Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers. Full article

Community social capital (CSC) and the community-built environment (CBE) are key resources associated with residents’ health, yet their combined associations with multidimensional health and well-being remain insufficiently understood. Drawing on large-scale data from the 2018 China Labor-force Dynamics Survey, this study analyzed a filtered sample of 14,127 respondents nested within 326 communities and employed multilevel models to examine the direct, interactive, and combined associations of CSC and CBE on four outcomes: residents’ self-rated health, subjective well-being, loneliness, and mental health. The results identified two CSC indicators: neighborhood mutual support and resident relationship quality, and two CBE indicators: community type and residential density, as key factors associated with multidimensional health, each showing significant associations with multiple health outcomes, with CSC indicators demonstrating relatively stronger and more consistent effect sizes than CBE indicators. The study further identified a dual mechanism involving key indicators of CSC (relationship quality and neighborhood mutual support) and CBE (community type and residential density). When one dimension was constrained, the other was associated with compensatory patterns in residents’ health, whereas high levels of both social and physical resources were associated with synergistic advantages. Stratified analyses revealed that individuals with low external social engagement appeared more sensitive to these environmental associations. This study emphasizes that sustainable community planning and governance should consider key social and physical indicators to support both social sustainability and built-environment sustainability. Depending on the level of community resources, it may be beneficial to leverage the compensatory and synergistic patterns among different community attributes to support improvements in residents’ health benefits. Particular attention may be warranted for individuals with low social engagement to build healthier and more sustainable communities. This research advances an integrated resource configuration framework that contributes to a shift in urban health governance from isolated environmental interventions toward an adaptive, balanced approach. Full article

Background/Objectives: Loneliness is highly prevalent in Japan and has become a major public health concern. Although primary health care professionals are often the first to encounter lonely patients, loneliness is subjective and difficult to detect in routine clinical practice. This study aims to examine how family physicians and nurses assess patient loneliness, and whether their approaches differ. Methods: This mixed-methods study comprised two surveys administered in Japanese family medicine clinics. Survey 1 (August 2020) was a cross-sectional questionnaire involving patients aged ≥ 50 years (n = 470), six family physicians, and seven nurses, of whom one responded on behalf of the group. Patient loneliness was measured using the UCLA (University of California, Los Angeles) Loneliness Scale (Version 3) and served as the reference standard. Physicians and nurses independently assessed patient loneliness based on medical records. Sensitivity, specificity, and predictive values were calculated. Survey 2 (August–September 2023) used an open-ended questionnaire completed by the same physicians and nurses, with responses analyzed using quantitative text mining to explore assessment perspectives. Results: Based on the UCLA scale, 38% of patients were classified as lonely. Compared to each other, family physicians demonstrated a higher sensitivity (45.3%) but lower specificity (67.4%), whereas nurses showed a lower sensitivity (21.8%) but higher specificity (84.5%). Text mining revealed that family physicians emphasized relational quality and psychological context, sometimes identifying loneliness even when there is no apparent lack of social connections. In contrast, nurses tended to define loneliness in terms of clearly observable social circumstances and emphasized patients’ subjective acknowledgment. Conclusions: Family physicians and nurses employ distinct yet complementary approaches to identifying loneliness in primary health care. Collaborative, role-based strategies may enhance the accurate detection of loneliness and support more effective patient care. Full article