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Loneliness: a concept relevant to the care of dying persons.

Loneliness, whether conceptualized as a basic "fact" of human existence or as a painful, subjective experience in response to changes or deficiencies in the quality or quantity of a person's social relationships, has been recognized as an experience feared or felt by human beings since antiquity. As health care professionals, nurses have observed and responded to loneliness as an actual or potential problem amenable to nursing intervention. Being a subjective experience and one which may or may not be connected to the more objective condition of social isolation or aloneness, loneliness has puzzled scholars and researchers across disciplines. Although the nature of loneliness as a relational deficit is beginning to be explicated, particularly through the efforts of social psychologists, there are still major questions to be answered with regard to antecedents, manifestations, and interventions. Dying persons may represent a particularly vulnerable group, especially those dying in an acute care/cure-oriented setting. Since the limited knowledge about the nature of loneliness has been acquired primarily through studying college students or young adults, the question of whether or not their experience is comparable to that of other groups remains to be answered. Nurses continue to make clinical judgments about the loneliness of their patients. They basically are guided by a knowledge of affiliative functioning, and their interventions reflect a goal of optimal, social functioning for individuals experiencing or at-risk for loneliness.

Emotions↗

Three loneliness scales: an assessment of their measurement properties.

In loneliness research, there has not been a consensus concerning either the factorial structure of most loneliness scales or the factorial structure of each of the proposed dimensions of loneliness. We investigated theoretical and operational definitions, as well as the factorial structure, based on gender of three loneliness scales: the University of California at Los Angeles (UCLA) Loneliness Scale, the Loneliness Deprivation Scale, and the Emotional/Social Loneliness Inventory. Unidimensional, best-fit models of the structures of these scales are presented.

Journal Article↗

Social and demographic correlates of loneliness in late life.

Although loneliness is often viewed as a serious problem of old age, few studies have addressed either its measurement or prevalence among older populations. The present study analyzed survey data from newspaper questionnaires circulated in three North American cities (N = 2,026) in order to examine the prevalence of loneliness across the life-span and some of its correlates in late life. Loneliness decreased across the adult life-span, with respondents age 65 and older the least lonely; elders were also more satisfied with their social relationships. Neither gender nor living alone was related to loneliness for older people. The data also partially confirm the desolation hypothesis, suggesting that desolation, or the loss of an intimate attachment, rather than isolation per se is a major correlate of loneliness in late life. Further, recency of loss was strongly related to increased loneliness. Directions for future research and intervention are discussed.

Adolescent↗

Genetic and environmental contributions to loneliness in adults: the Netherlands twin register study.

Heritability estimates based on two small studies in children indicate that the genetic contribution to individual differences in loneliness is approximately 50%. Heritability estimates of complex traits such as loneliness may change across the lifespan, however, as the frequency, duration, and range of exposure to environmental influences accrues, or as the expression of genetic factors changes. We examined data on loneliness from 8,387 young adult and adult Dutch twins who had participated in longitudinal survey studies. A measure of loneliness was developed based on factor analyses of items of the YASR (The Young Adult Self Report). Variation in loneliness was analyzed with genetic structural equation models. The estimate of genetic contributions to variation in loneliness in adults was 48%, which is similar to the heritability estimates found previously in children. There was no evidence for sex or age differences in genetic architecture. Sex differences in prevalence were significant, but we did not see an association with age or birth cohort. All resemblance between twin relatives was explained by shared genes, without any suggestion of a contribution of shared environmental factors.

Adult↗

Psychological correlates of loneliness in the older adult.

Loneliness is the emotional response to the discrepancy between desired and available relationships. As people grow old, the likelihood of experiencing age-related losses increases. Such losses may impede the maintenance or acquisition of desired relationships, resulting in a higher incidence of loneliness. This pilot study examines how loneliness relates to age-related losses, hopelessness, self-transcendence, and spiritual well-being in a convenience sample of 107 adults aged 65 years or older. The collective utility of the independent variables in predicting loneliness was investigated by means of a regression decision tree with an automatic random subset crossvalidation procedure. This procedure explained 46% of the variance. Higher scores for age-related losses and hopelessness were associated with higher loneliness scores. Higher scores for self-transcendence and existential spiritual well-being were associated with lower loneliness scores.

Aged↗

Predictors and subjective causes of loneliness in an aged population.

The aim of the study was to examine the prevalence and self-reported causes of loneliness among Finnish older population. The data were collected with a postal questionnaire from a random sample of 6,786 elderly people (>or=75 years of age). The response rate was 71.8% from community-dwelling sample. Of the respondents, 39% suffered from loneliness, 5% often or always. Loneliness was more common among rural elderly people than those living in cities. It was associated with advancing age, living alone or in a residential home, widowhood, low level of education and poor income. In addition, poor health status, poor functional status, poor vision and loss of hearing increased the prevalence of loneliness. The most common subjective causes for loneliness were illnesses, death of a spouse and lack of friends. Loneliness seems to derive from societal life changes as well as from natural life events and hardships originating from aging.

Aged↗

The clinical significance of loneliness: a literature review.

Satisfying social relationships are vital for good mental and physical health. Accordingly, we recommend that the alleviation and prevention of social relationship deficits be a key focus of clinicians. In this review, we focus on loneliness as a crucial marker of social relationship deficits and contend that loneliness should command clinicians' attention in its own right--not just as an adjunct to the treatment of other problems such as depression. With a particular focus on the adolescent developmental period, this review is organized into five sections: Drawing on developmental and evolutionary psychology theories, the nature of social relationships and the function they serve is first discussed. In the second section, loneliness is introduced as an exemplar of social relationship deficits. Here a definition of loneliness is provided, as well as an explanation of why it may pose a situation of concern. This is followed by a review of the prototypic features of loneliness through examination of its affective, cognitive, and behavioral correlates. The fourth section includes a review of theories related to the antecedent and maintenance factors involved in loneliness. Finally, methodological and theoretical considerations are addressed, and conclusions and proposals for future research directions are put forth.

Adolescent↗

Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women.

Loneliness is a psychological experience related to social isolation and perceived lack of companionship, and may be relevant to health risk. The revised UCLA loneliness scale was completed by 240 working men and women aged 47-59 years, and related to affective state and neuroendocrine, cardiovascular, and inflammatory responses. Loneliness scores were not associated with gender, age or socioeconomic position, but were lower in married than single or divorced participants, and were positively related to social isolation, low emotional support, ratings of depression, hopelessness and low self-esteem, and to reported sleep problems. Diastolic blood pressure reactions to acute mental stress were positively correlated with loneliness in women but not men, independently of age, socioeconomic status, smoking, body mass and marital status (p = 0.014). Lonely individuals also displayed significantly greater fibrinogen (p = 0.038) and natural killer cell responses (p = 0.042) to stress, independently of covariates. The cortisol response over the first 30 min following waking was positively associated with loneliness after adjusting for waking cortisol value, sex, socioeconomic status, smoking, time of waking, and body mass (p = 0.046). We conclude that loneliness is a psychological experience with potentially adverse effects on biological stress processes that may be relevant to health.

Adult↗

Peer interaction and loneliness in high-functioning children with autism.

Social interaction with peers and the understanding and feelings of loneliness were examined in 18 high-functioning children with autism and 17 typically developing children matched for IQ, chronological age, gender, and maternal education. Observations were conducted on children's spontaneous social initiations and responses to their peers in natural settings such as recess and snack time, and children reported on their understanding and feelings of loneliness and social interaction. Overall, children with autism revealed a good understanding of both social interaction and loneliness, and they demonstrated a high level of social initiation. However, they spent only half the time in social interactions with peers compared with their matched counterparts, and they interacted more often with a typically developing child than with another special education child. Despite the intergroup differences in frequency of interaction, a similar distribution of interactions emerged for both groups, who presented mostly positive social behaviors, fewer low-level behaviors, and very infrequent negative behaviors. Children with autism reported higher degrees of loneliness than their typical age-mates, as well as a lower association between social interaction and loneliness, suggesting their poorer understanding of the relations between loneliness and social interaction. Research and practice implications of these findings are discussed.

Adolescent↗

Loneliness in everyday life: cardiovascular activity, psychosocial context, and health behaviors.

Prior lab research revealed higher basal total peripheral resistance (TPR) and lower cardiac output (CO) in lonely than in nonlonely young adults. In this study, experience sampling was used to obtain ambulatory blood pressure; impedance cardiography: and reports of activities, appraisals, interactions, and health behaviors. Results confirmed that loneliness predicted higher TPR and lower CO during a normal day. Loneliness did not predict differences in time spent alone, daily activities, or health behaviors but did predict higher stress appraisals and poorer social interactions. Independent of loneliness, interaction quality contributed to TPR. Loneliness differences were not mediated by depressed affect or neuroticism. Social support mediated loneliness differences in stress and threat. Concomitants of loneliness were comparable for men and women.

Adult↗

Predictors of loneliness in elderly Korean immigrant women living in the United States of America.

The purpose of this study was to examine the predictors of loneliness in elderly Korean immigrant women. The sample was derived from a larger study designed to examine loneliness in elderly Korean immigrants. Subjects were 110 elderly Korean immigrant women who were at least 60 years of age and lived in a large metropolitan city area in the United States of America. Data were collected by telephone interview using the Revised University of California Los Angeles (UCLA) Loneliness Scale (RULS), Social Support Questionnaire, Ethnic Attachment Questionnaire and Instrumental Activities of Daily Living (ADL) Scale. Measures were prepared using translation and back-translation procedures. Results indicate that elderly Korean immigrant women were more lonely than those found in other studies. Satisfaction with social support, social network size, ethnic attachment and functional status were predictive variables of loneliness. Satisfaction with social support was the largest predictor of loneliness in elderly Korean women. Marital status was not a predictor of loneliness.

Aged↗

A phenomenological exploration of loneliness in the older adult.

Loneliness is an important phenomenon of concern for psychiatric mental health nursing. Research findings have related loneliness in older adults to mental health problems especially depression. However, little is known about loneliness from the perspective of older adults living in the community. A phenomenological inquiry using Giorgi's research methodology was undertaken to explore and describe the meaning of loneliness for older adults. Twenty participants, most who are over the age of 75, were interviewed and 1385 naïve meaning units were extrapolated from tape-recorded verbatim transcripts. These units were clustered into five major themes describing the loneliness experience. The findings are described and discussed relative to the literature on loneliness. Implications for mental health nursing are presented.

Activities of Daily Living↗

The relationship between coping style and loneliness in adolescents: can "sad passivity" be adaptive?

The authors' purpose in this paper was to examine how the use of the "sad passive" coping style may be related to adolescent self-reported loneliness. Subjects were asked to complete the revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980) to determine self-reported loneliness and the Coping with Loneliness Questionnaire (CLQ; Rubenstein & Shaver, 1980) in order to examine coping styles. We hypothesized that those adolescents whose coping strategies fell into the category of sad passivity described by Rubenstein and Shaver would indicate greater loneliness than those adolescents whose coping strategies fell into other categories. Results indicated that sad passivity was used by both lonely and nonlonely adolescents, but that nonlonely youngsters resorted to this method only temporarily and in preparation for a more active coping style. Lonely teens, on the other hand, appeared to remain in the sad-passive mode to a maladaptive degree. These results were discussed in terms of their importance for theories of adolescent loneliness and for possible intervention strategies.

Adaptation, Psychological↗

Loneliness and life satisfaction in Japan and Australia.

We examined the relationship between loneliness and life satisfaction in 121 residents of Fukoku, Japan, and 139 residents of Melbourne, Australia, using the Satisfaction With Life Scale (Diener, Emmons, Larsen, & Griffin, 1983) and the Revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980). Australian subjects reported significantly less loneliness and significantly greater life satisfaction than Japanese subjects. A high inverse correlation was found between loneliness and life satisfaction in Australian subjects, with a much smaller inverse relationship observed among the Japanese, suggesting that loneliness in Japanese subjects did not emotionally translate into life dissatisfaction as it did in Australian subjects. Instead, the experience of loneliness in Japanese individuals may remain largely independent of general life satisfaction.

Adolescent↗

Loneliness and depression in caregivers of persons with Alzheimer's disease or related disorders.

Secondary analysis of data from a sample of 242 husbands, wives, and daughters providing care for Alzheimer's disease family members was conducted to examine the relationships among loneliness and depression and the following variables: quality of the past relationship, relational deprivation, quality of the current relationship, and distance felt due to caregiving. Loneliness was significantly related to depression (r = .66, p < .001), relational deprivation (r = .36, p < .001), and quality of the current relationship (r = .34, p < .001), indicating that the more loneliness reported by the caregivers, the more the caregiver experienced depression, relational deprivation, and a poorer quality of the current relationship. Significant gender differences were found with the caregiving wives and daughters reporting higher mean scores than caregiving husbands on relational deprivation, loneliness, and depression. Loneliness was the only variable significant for predicting depression in caregiving husbands, wives, and daughters. In order for loneliness and depression to be addressed in the Alzheimer's disease caregiver, they must first be recognized by nurses.

Adult↗

Loneliness in older women: a review of the literature.

Older women report more loneliness than male peers. Loneliness is an area of concern related to the well being of older women because it is a cause of emotional distress and is linked to a variety of health problems in older individuals. Life changes, including widowhood and relocation, are associated with increased vulnerability to loneliness. Gender, social, and cultural factors influence the experience of loneliness in older women. Cognitive and interactionist theoretical approaches to loneliness have utility for nursing practice and research with older women who experience loneliness.

Age Factors↗

A model of loneliness in older adults.

Loneliness and physical health status in older adults have been correlated strongly but the predictive direction is unclear. This study examined the relationship between personality, cognition, social network, and age modeled as predictors of loneliness in older Americans. Self-assessed health mediated the relationship. The sample consisted of 208 independently living individuals 60 to 106 years of age from the southern region of the United States. Model comparison revealed health did not mediate the relationship significantly but that self-reported loneliness itself mediated between personal characteristics and perceived health. Results indicate anxiety, frequency of telephone contact, and age, but not frequency of face-to-face contact with others or cognitive functioning, affect perceived loneliness. Perceived loneliness mediates the effects of anxiety, frequency of telephone contact, and age on self-assessed health. Feelings of loneliness decrease one's evaluation of physical well-being.

Activities of Daily Living↗

Urinary cortisol levels, cellular immunocompetency, and loneliness in psychiatric inpatients.

This study examined the associations among loneliness, stressful life events, urinary cortisol levels, and immunocompetency. Blood and urine were obtained from 33 psychiatric inpatients on the day after admission, at which time the patients completed the UCLA Loneliness Scale, the Psychiatric Epidemiology Research Interview Life Events Scale (PERI), and the MMPI. Patients who scored above the median on loneliness had significantly higher urinary cortisol levels. The high loneliness group also had significantly lower levels of natural killer cell activity, as well as a poorer T-lymphocyte response to phytohemagglutinin. The high loneliness subjects described themselves as more distressed than the low loneliness group on the MMPI. There were no consistent significant effects on either the immunologic measures or the MMPI associated with the PERI.

Adolescent↗