This article adopts the phenomenological approach of Merleau-Ponty to explore how the body is both a source of hope and betrayal for the protagonists' aspirations in Philip Roth's last four novels: ...Everyman, Indignation, The Humbling, and Nemesis. When the characters accept the reality of their bodies, it leads them to a sense of responsibility in their communities; when they reject the truth of their bodies, it leads them to social isolation and existential despair. From these novels, Roth's characters point toward an understanding of community that is corporeal and, for it to be healthy, demands its members recognize the realities of it.
Purpose
Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review ...evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation.
Methods
Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary.
Results
In total, 30 RCTs met the review’s inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants’ characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies.
Conclusion
The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.
Abstract
Loneliness may be related to psychotic symptoms but a comprehensive synthesis of the literature in this area is lacking. The primary aim of the current study is to provide a systematic ...review and meta-analysis of the association between loneliness and psychotic symptoms in people with psychosis. A search of electronic databases was conducted (PsychINFO, MEDLINE, EMBASE, and Web of Science). A random effects meta-analysis was used to compute a pooled estimate of the correlation between loneliness and psychotic symptoms. Study and outcome quality were assessed using adapted versions of the Agency for Healthcare Research and Quality (AHRQ) tool and GRADE approach, respectively. Thirteen studies were included, providing data from 15 647 participants. A moderate association between psychosis and loneliness was observed (k = 13, N = 15 647, r = .32, 95% CI 0.20, 0.44; I2 = 97.56%; moderate quality evidence). Whether loneliness was assessed by a single-item or a more comprehensive measure had no moderating effect on the estimate. Results indicate that there is a significant positive relationship between loneliness and psychosis. Further studies are needed to determine the causal status of this relationship, but this robust finding should be considered in clinical practice and treatment provision for those with psychotic disorders.
•Social isolation is strongly associated with suicidal outcomes.•The subjective feeling of loneliness has a major impact, even transculturally.•Objective and subjective social isolation should be ...added in suicide risk assessment.
Social isolation is one of the main risk factors associated with suicidal outcomes. The aim of this narrative review was to provide an overview on the link between social isolation and suicidal thoughts and behaviors.
We used the PubMed database to identify relevant articles published until April 13, 2018. We focused on: (a) systematic reviews, meta-analyses, and narrative reviews; (b) original observational studies with large samples (N ≥ 500); and (c) qualitative studies. We included all relevant suicidal outcomes: suicidal ideation (SI), suicidal planning, non-suicidal self-injury, deliberate self-harm, suicide attempt (SA), and suicide.
The main social constructs associated with suicidal outcomes were marital status (being single, separated, divorced, or widowed) and living alone, social isolation, loneliness, alienation, and belongingness. We included 40 original observational studies, the majority of them performed on adolescents and/or young adults (k = 23, 57.5%). Both the objective condition (e.g., living alone) and the subjective feeling of being alone (i.e., loneliness) were strongly associated with suicidal outcomes, in particular with SA and SI. However, loneliness, which was investigated in most studies (k = 24, 60%), had a major impact on both SI and SA. These associations were transculturally consistent.
Confounding factors can limit the weight of the results obtained in observational studies.
Data from the observational studies suggest that both objective social isolation and the subjective feeling of loneliness should be incorporated in the risk assessment of suicide. Interventional studies targeting social isolation for suicide prevention are needed.
Researchers have shown great interest in the antecedents and outcomes of workplace ostracism, which has led to an expansive body of research. In light of this work, the current article fulfills the ...need for a comprehensive review and meta-analysis of the antecedents and outcomes associated with workplace ostracism. We begin our review by adapting a victimization perspective to understand ostracism as a triadic social process between the victim, perpetrator, and the environment. The meta-analytic results then support that leadership characteristics are the strongest related antecedents of workplace ostracism, followed by certain aspects of personality (e.g., Big Five) and contextual characteristics (e.g., social support). The results also show that workplace ostracism very strongly relates to deviance, and it strongly relates to other performance outcomes (e.g., core-performance, helping, voice), well-being outcomes (e.g., psychological well-being, emotions, self-perceptions), and organizational perceptions (e.g., job satisfaction, commitment, justice). We also show that the relationship of performance, well-being, emotions, and self-perceptions when measured after ostracism was comparable to their relationship when measured before ostracism. These results suggest that the outcomes of ostracism are less certain than previously thought, as they may instead be antecedents of ostracism. Finally, we call for future research to investigate this notion, along with further integration of the victimization perspective as well as the study of contextual predictors and moderators.
This study aimed to examine the moderating effect of coping flexibility on the relationship between objective and subjective social isolation and depression in older adults. This study involved the ...analysis of data collected through a self-report survey administered to 243 participants aged 65 years or older. Participants were given the option to complete the survey online or offline, with most surveys conducted online (209 participants). A total of 234 participants (109 men and 125 women) were included in the final analysis, after excluding nine participants who did not meet the recruitment criteria. The Korean version of the Lubben Social Network Scale-18 and UCLA Loneliness Scale were used to measure objective and subjective social isolation, respectively. In this study, the moderating effects were examined using the PROCESS macro in SPSS 4.0. The results are as follows. First, we found that women had higher levels of depression than men, depression increased as age increased, and lower education as well as being single were associated with increased levels of depression. Second, objective as well as subjective social isolation had significant positive influences on depression. Furthermore, coping flexibility had a significant moderating effect on the relationship between subjective social isolation and depression. However, coping flexibility had no moderating effect on the relationship between objective social isolation and depression. This study provides theoretical evidence of the factors necessary to prevent social isolation and mental health problems in old age.
BACKGROUND/OBJECTIVES
Physical distancing during the COVID‐19 pandemic may have unintended, detrimental effects on social isolation and loneliness among older adults. Our objectives were to ...investigate (1) experiences of social isolation and loneliness during shelter‐in‐place orders, and (2) unmet health needs related to changes in social interactions.
DESIGN
Mixed‐methods longitudinal phone‐based survey administered every 2 weeks.
SETTING
Two community sites and an academic geriatrics outpatient clinical practice.
PARTICIPANTS
A total of 151 community‐dwelling older adults.
MEASUREMENTS
We measured social isolation using a six‐item modified Duke Social Support Index, social interaction subscale, that included assessments of video‐based and Internet‐based socializing. Measures of loneliness included self‐reported worsened loneliness due to the COVID‐19 pandemic and loneliness severity based on the three‐item University of California, Los Angeles (UCLA) Loneliness Scale. Participants were invited to share open‐ended comments about their social experiences.
RESULTS
Participants were on average aged 75 years (standard deviation = 10), 50% had hearing or vision impairment, 64% lived alone, and 26% had difficulty bathing. Participants reported social isolation in 40% of interviews, 76% reported minimal video‐based socializing, and 42% minimal Internet‐based socializing. Socially isolated participants reported difficulty finding help with functional needs including bathing (20% vs 55%; P = .04). More than half (54%) of the participants reported worsened loneliness due to COVID‐19 that was associated with worsened depression (62% vs 9%; P < .001) and anxiety (57% vs 9%; P < .001). Rates of loneliness improved on average by time since shelter‐in‐place orders (4–6 weeks: 46% vs 13–15 weeks: 27%; P = .009), however, loneliness persisted or worsened for a subgroup of participants. Open‐ended responses revealed challenges faced by the subgroup experiencing persistent loneliness including poor emotional coping and discomfort with new technologies.
CONCLUSION
Many older adults are adjusting to COVID‐19 restrictions since the start of shelter‐in‐place orders. Additional steps are critically needed to address the psychological suffering and unmet medical needs of those with persistent loneliness or barriers to technology‐based social interaction.
•Overall, social isolation was not clearly related to ADL disability in older people.•Subgroup analysis showed that in Asian regions, social isolation was related to ADL disability.•Not participating ...in social clubs or religious groups consistently showed an association with ADL disability.
We assessed the relationship between social isolation and functional disability in older people.
Comparison of longitudinal cohort studies.
Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong.
Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models.
Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI 0.97–1.14, n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI 1.02, 1.16, but not in Western regions (pooled RR = 1.01, 95 % CI 0.96, 1.07). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI 1.04, 1.21).
Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.
This study investigates students' social networks and mental health before and at the time of the COVID-19 pandemic in April 2020, using longitudinal data collected since 2018. We analyze change on ...multiple dimensions of social networks (interaction, friendship, social support, co-studying) and mental health indicators (depression, anxiety, stress, loneliness) within two cohorts of Swiss undergraduate students experiencing the crisis (N = 212), and make additional comparisons to an earlier cohort which did not experience the crisis (N = 54). In within-person comparisons we find that interaction and co-studying networks had become sparser, and more students were studying alone. Furthermore, students' levels of stress, anxiety, loneliness, and depressive symptoms got worse, compared to measures before the crisis. Stressors shifted from fears of missing out on social life to worries about health, family, friends, and their future. Exploratory analyses suggest that COVID-19 specific worries, isolation in social networks, lack of interaction and emotional support, and physical isolation were associated with negative mental health trajectories. Female students appeared to have worse mental health trajectories when controlling for different levels of social integration and COVID-19 related stressors. As universities and researchers discuss future strategies on how to combine on-site teaching with online courses, our results indicate the importance of considering social contacts in students' mental health and offer starting points to identify and support students at higher risk of social isolation and negative psychological effects during the COVID-19 pandemic.
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