Review: Interventions addressing loneliness amongst university students: a systematic review

Background

Loneliness is detrimental to mental health, with university students at higher risk of feeling lonely than other population groups. However, little research has explored interventions to reduce loneliness among students. This review identifies the characteristics and effectiveness of interventions targeting university/college students.

Methods

PsycINFO, Medline, ASSIA and Web of Science were searched from inception using keywords linked to ‘loneliness’, ‘intervention’ and ‘students’. Relevant peer and nonpeer-reviewed English-language articles on studies implementing an intervention with loneliness as an outcome and investigating undergraduate or postgraduate students at a higher education institution were included for quality analysis and narrative synthesis. Risk of bias was assessed at both study level and at outcome level.

Results

Twenty-eight articles were included, comprising 25 quantitative and three qualitative studies, covering 37 interventions, most implemented in the United States. Interventions were based on psychoeducation, social support groups, increasing social interaction or reflective exercises. The age of the participants (n = 2339) ranged from 17.62 to 25 (mean age 20.63) years. Evidence from the RCTs suggests that most interventions influenced loneliness outcomes, but the magnitude of the benefit is unclear. Across quantitative studies, 80% (16/20) of interventions based on either social support groups, increasing social interaction or reflective exercises, and 50% (7/14) of interventions based on psychoeducation were deemed effective in reducing loneliness. Most interventions measured quantitatively were delivered in a group setting, of which two thirds were considered effective in reducing loneliness scores, regardless of intervention.

Conclusions

Universities have a choice of interventions to help reduce loneliness among students either on campus or virtually. Ones promoting social connectedness appear to be more successful. More high-quality studies in a larger number of countries are needed, taking vulnerable student groups into consideration.     

Loneliness and cardiovascular disease and the role of late‐life depression

Objective

Loneliness and depression have a strong reciprocal influence, and both predict adverse health outcomes at old age. Therefore, this study examines whether loneliness is associated with the presence of cardiovascular diseases taking into account the role of late‐life depression.

Methods

Cross‐sectional data of 477 older adults in the Netherlands Study of Depressed Older Persons were used. Logistic regression analysis was performed to examine the relation between loneliness and cardiovascular disease. Depression was added to the regression model to examine whether depression is an explanatory factor in the association between loneliness and cardiovascular disease. Interaction terms between loneliness and depression and between loneliness and sex were introduced in the regression model to investigate whether depressed and non‐depressed participants, and men and women differed in their association between loneliness and cardiovascular disease.

Results

Of the overall group, 61% were lonely, 28% had a history of cardiovascular disease and 74% were depressed. Loneliness and cardiovascular disease were not associated in the overall group after adjustment for confounders (continuous: odds ratio [OR] = 1.04, 95% confidence interval [CI] = 0.98–1.10), p = 0.25; dichotomous: OR = 1.27, 95% CI = 0.80–2.03, p = 0.32). For women, there was an association between loneliness and cardiovascular diseases (continuous: OR = 1.13, 95% CI = 1.06–1.21, p < 0.001; dichotomous: OR = 2.64, 95% CI = 1.50–4.65, p = 0.001), but this association was not present in men (OR = 0.96, 95% CI = 0.88–1.05, p = 0.38). This association remained significant after adjustment for confounders, but it lost significance after adding depression to the model.

Conclusion

For women only, there was an association between loneliness and cardiovascular disease. However, this association was explained by depression, indicating that loneliness in its own right seems not related with cardiovascular disease. Copyright © 2017 John Wiley & Sons, Ltd.     

Psychiatric disorders in students in six French universities: 12-month prevalence, comorbidity, impairment and help-seeking

Purpose  

Few studies have explored the prevalence of psychiatric disorders (PD) among university students. This article aims to study 12-month prevalence of PD in university students, their socio-economic correlates, impairment in daily life and help-seeking behaviours.     

Risk factors for mental disorder among university students in Australia: findings from a web-based cross-sectional survey

Purpose

To identify variables associated with common mental disorders in an Australian university population.

Methods

We invited all Australia-based students from a large public university (N = 24,209) to participate in a web-based student mental health survey. Outcome measures included the patient health questionnaire depression, anxiety, and eating disorders modules, and the alcohol use disorders identification test. Explanatory variables of interest included gender, age, year of study, degree type, financial means, parental education, domestic/international status, and sexual orientation. Multiple logistic regression analysis was used to estimate independent associations with the four outcomes.

Results

Complete responses were received from 6,044 students (25 %). Proportions reporting depression, anxiety, eating disorders, and harmful drinking were 8, 13, 14, and 8 %, respectively, while 30 % had at least one of these disorders. The groups with the highest rates of disorder were women, 25–34-year-olds, students on low income, and homosexual or bisexual students. Parental education was not associated with disorder, nor was international/domestic status.

Conclusion

This is the first study examining mental disorders in a population-based sample of university students in Australia. Given increasing student numbers and participation of students from lower socio-economic backgrounds, policy is urgently needed to promote better mental health in this population, to routinely identify vulnerable students, and to intervene early. Groups in particular need are women, students on low incomes, and homosexual or bisexual students.     

Psychological distress in first year university students: socioeconomic and academic stressors,mastery and social support in young men and women

Purpose  

Little is known about the role of stressors associated with university life on psychological distress (PD). The aims of this article are to: (1) assess the prevalence of PD among students during their first year of university; (2) study its associations with stressors (socioeconomic and university-related) and protective factors (mastery, social support); and (3) to compare these factors according to gender.     

Alcohol use prevalence and sociodemographic correlates of alcohol use in a university student sample in Turkey

Background  

This study is a survey to determine prevalence and sociodemographic correlates of drinking problems among students from five university centres in Turkey.     

Mental,physical and sexual health in sexual minority third-level students: Findings from My World Survey 2

Aims

Sexual minority youth experience health disparities across mental, physical and sexual domains. However, little is known about the extent to which mental health overlaps with sexual and physical health to compound health problems among sexual minority youth. This study examined risky health behaviours, adverse health outcomes, and their overlap across mental, physical and sexual domains, in lesbian, gay, bisexual, questioning (LGBQ) and heterosexual third-level students in Ireland.

Method

Cross-sectional data from the My World Survey 2-Post Second Level (MWS2-PSL) were used. Analyses were conducted on data from N = 7950 18–25-year-old students, of which 6204 (78%) identified as heterosexual, 910 (11.4%) bisexual, 412 (5.2%) lesbian/gay and 424 (5.3%) questioning. Risky health behaviours (e.g., self-harm), adverse outcomes (e.g., mental health difficulties, physical health conditions) and their overlap across mental, physical and sexual domains were compared across heterosexual and LGBQ students using Chi-square tests. Clustering of health behaviours/outcomes within and between domains were examined.

Results

LGBQ students were more likely to exhibit a greater number of risky mental and sexual health behaviours and outcomes. Sexual, physical and mental health behaviours and outcomes overlapped to a greater extent in LGBQ versus heterosexual students. Distinct health outcomes were observed across sexual minority subgroups (e.g., bisexual women reported greater mental health difficulties).

Conclusion

Findings demonstrate health inequalities experienced by LGBQ students, particularly across mental and sexual domains. Holistic integrated approaches that consider multiple health domains simultaneously and the distinct health needs of sexual minority subgroups are needed to promote greater health equity.     

Potentially traumatic events have negative and positive effects on loneliness,depending on PTSD-symptom levels: evidence from a population-based prospective comparative study

Purpose

Examine to what extent adults affected by recent potentially traumatic events (PTE) with different PTSD-symptom levels are more at risk for post-event loneliness than non-affected adults are in the same study period.

Methods

We extracted data from the Dutch longitudinal LISS panel to measure pre-event loneliness (2011) and post-event loneliness (2013 and 2014), pre-event mental health problems (2011), PTE and PTSD symptoms (2012). This panel is based on a traditional random sample drawn from the population register by Statistics Netherlands.

Results

Results of the multinomial logistic regression analyses showed that affected adults with high levels of PTSD symptoms were more at risk for high levels of post-event loneliness than affected adults with very low PTSD-symptom levels and non-affected adults, while controlling for pre-event loneliness, pre-event mental health problems and demographics. However, affected adults with very low levels of PTSD symptoms compared to non-affected adults were less at risk for medium and high levels of post-event loneliness while controlling for the same variables. Yet, pre-event loneliness appeared to be the strongest independent predictor of loneliness at later stages: more than 80% with high pre-event levels had high post-event levels at both follow-ups.

Conclusions

Remarkably, potentially traumatic events have depending on PTSD-symptom levels both negative and positive effects on post-event loneliness in favor of affected adults with very low PTSD symptoms levels. However, post-event levels at later stages are predominantly determined by pre-event loneliness levels.

     

The role of socio-economic status and neighborhood social capital on loneliness among older adults: evidence from the Sant Boi Aging Study

Purpose

The aim of the present study is to analyze the role of age in the association between socio-economic status (SES) and loneliness as well as the role of neighborhood social capital (NSC) in the association between individual social capital and loneliness.

Methods

Data include a representative population-based sample from Sant Boi de Llobregat (a suburb of Barcelona) of 1124 adults aged 50 and over. Logistic regression models were used to analyze the survey data. Interactions between SES and age, and NSC and individual social capital were explored.

Results

Among the poorest older adults, older individuals showed a lower likelihood of loneliness (OR 0.09, 95% CI 0.02, 0.30, p < 0.05) compared with the youngest cohort after adjusting for covariates, while among the richest individuals there were no significant differences among age cohorts. Individuals living in an area with high NSC and high individual social capital showed a lower likelihood of loneliness (OR 0.36, 95% CI 0.17, 0.73, p < 0.05) compared with those with low individual social capital after adjusting for covariates. The effect of individual social capital was not significant among individuals living in an area with low NSC.

Conclusion

Interventions focusing on low SES middle-aged (50–59 years old) individuals and those aiming to increase NSC could be effective strategies to reduce the prevalence of loneliness in older people.

     

Childhood abuse and late‐life depression: Mediating effects of psychosocial factors for early‐ and late‐onset depression

Objective

Childhood abuse makes people vulnerable to developing depression, even in late life. Psychosocial factors that are common in late life, such as loneliness or lack of a partner, may explain this association. Our aim was to investigate whether the association between childhood abuse and depression in older adults can be explained by psychosocial factors.

Methods

Cross‐sectional data were derived from the Netherlands Study of Depression in Older Persons (aged 60‐93), including 132 without lifetime depression, 242 persons with an early‐onset depression (<60 years), and 125 with a late‐onset (≥60 years) depression. Childhood abuse (yes/no) and a frequency‐based childhood abuse index were included. Multinomial regression and multivariable mediation analyses were used to examine the association between childhood abuse and the onset of depression, and the influence of loneliness, social network, and partner status.

Results

Multinomial regression analyses showed a significant association between childhood abuse and the childhood abuse index with early‐ and late‐onset depression. Multivariable mediation analyses showed that the association between childhood abuse and early‐onset depression was partly mediated by social network size and loneliness. This was particularly present for emotional neglect and psychological abuse, but not for physical and sexual abuse. No psychosocial mediators were found for the association between childhood abuse and late‐onset depression.

Conclusions

A smaller social network and feelings of loneliness mediate the association between childhood abuse and early‐onset depression in older adults. Our findings show the importance of detecting childhood abuse as well as the age at depression onset and mapping of relevant psychosocial factors in the treatment of late‐life depression.     

Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety

Purpose

To investigate social support and network features in people with first-episode psychosis, and to examine anxiety as a possible mediator between loneliness and a rating of paranoia.

Method

Thirty-eight people with first-episode psychosis were recruited for a cross-sectional study. Self-report questionnaires and structured interviews assessed symptoms, functioning, and qualitative social network and support features. A mood-induction task involved watching anxiety-inducing pictures on a computer screen. Visual analogue scales assessed changes in paranoia, anxiety and loneliness and a mediation analysis was conducted.

Results

One-third of the sample (34 %) had no confidant [95 % CI (18.4, 50.0 %)]. The average number of weekly contacts was 3.9, with 2.6 lonely days. Poor perceived social support, loneliness and the absence of a confidant were strongly associated with psychosis and depressive symptoms (0.35 < rs < 0.60). The association between loneliness and paranoia was mediated through anxiety (ab = 0.43, z = 3.5; p < 0.001).

Conclusions

Even at first episode, a large proportion of people with psychosis have poor perceived support, no confidant and report several lonely days a week. Patients without a confidant appear to be more susceptible to feeling lonely and anxious. Anxiety may be one pathway through which loneliness affects psychosis. Interventions which focus on this are indicated.     

Stigmatising attitude of medical students towards a psychiatry label

Background  

The aim of this study is to evaluate the effect of a psychiatric label attached to an apparently normal person on the attitude of final year medical students at a Nigerian university.     

Socioeconomic status and the risk of depression among UK higher education students

Background

Many university students experience some symptoms of depression during the course of their studies but there is evidence that students from less advantaged backgrounds may be more vulnerable.

Methods

The study was a cross-sectional online survey of 923 undergraduate students attending 6 UK Universities in the academic year 2009–2010 who completed a modified version of the Zagazig Depression Scale (ZDS).

Results

Overall, 58.1 % of female and 59.9 % of male study participants screened positive for depression (ZDS score >10). In the fully adjusted model, final year students (OR = 1.8) who lived in a more deprived area (OR = 2.3) were more likely to report higher rates of depressive symptoms. Additionally, students with high perceived control (OR = 1.6) whose mothers were highly educated (OR = 0.5) and from a family of a high affluence (OR = 0.3) were less likely to suffer from higher rates of depressive symptoms. The relationship between lower social economic status and depression was partly mediated by low sense of control.

Conclusion

Students from less advantaged backgrounds are more at risk of depression but a strong sense of control over one’s life may be protective.

Application

Since depression has strong impact on students’ learning and quality of life universities should consider confidential screening for mental health problems and provide additional support for students.     

Investigating the roles of loneliness and clinician- and self-rated depressive symptoms in predicting the subjective quality of life among people with psychosis

Purpose

To examine the roles of loneliness and clinician- and self-rated depressive symptoms as predictors of the subjective quality of life (QoL) in psychosis.

Methods

This cross-sectional study was conducted on a sample of 207 patients diagnosed with psychotic disorders. They were assessed with self-reported measures of QoL, loneliness and depression and with clinician-rated measures of depression and overall psychopathology. Multiple indicators multiple causes (MIMIC) modeling was used to analyze the data.

Results

Both loneliness and depression turned out to be independent predictors of impaired QoL. However, once loneliness was accounted for, the effect of depression on QoL was markedly reduced and the effect of loneliness proved to be visibly larger. Self-rated depression was found to be more strongly associated with QoL than clinician-rated depression. Each type of depression measure explained a unique amount of variance in QoL. Depression moderated the relationship between loneliness and QoL in such a way that the negative effect of loneliness on QoL weakened with the increasing intensity of depressive symptoms.

Conclusions

Therapeutic programs aiming to enhance the QoL of people with psychotic disorders should incorporate interventions targeting both loneliness and depression and need to be tailored to the clinical status of patients. The emphasis on alleviating loneliness should be placed first of all in the case of those with low levels of depression, among whom the negative impact of loneliness on QoL is especially strong. Researchers should be aware that the method chosen for assessing depressive symptoms in models predicting QoL in psychosis matters.

     

Suicide and deliberate self-harm in Oxford University students over a 30-year period

Purpose  

To determine whether rates of suicide and self-harm in university students differ from those in other young people.     

The prevalence and correlates of neurotic disorders among undergraduates at a mainland Chinese university

Objectives

To study the prevalence and risk factors of neurotic disorders (NDs) among Chinese university students.

Methods

Stratified random sampling was used to select students who were interviewed using the World Health Organization Composite International Diagnostic Interview Version 3.0 to diagnose psychiatric disorder and collected socio-demographic, and family structure and environment data. The response rate was 90?% (N?=?1,843). The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) criteria were used to diagnose NDs. We used logistical regression to evaluate the links between NDs and selected correlates.

Results

The prevalence of NDs was 25.6?% (lifetime), 15.7?% (12-month), and 6.8?% (30-day) among the university students with no significant gender differences in these rates. No family structure characteristics were related to 12-month prevalence of NDs (P?>?0.05). In contrast, family environment factors including a history of family disputes (OR 1.562, CI 1.108–2.203), parental mental health problems (OR 1.800, CI 1.379–2.349), and absence of care in childhood (OR 1.916, 95?% CI 1.331–2.759) were associated with higher prevalence rates of NDs.

Conclusions

Our findings show a high prevalence of NDs in this sample of Chinese undergraduates. Social environment factors, in the student’s family of orientation, were significantly associated with the prevalence of NDs. These findings support the importance of negative family experiences during childhood and adolescence and increasing vulnerability to NDs.     

Predictors of loneliness in caregivers of persons with Parkinson's disease

This study examined loneliness among caregivers of individuals with Parkinson's disease (PD). The sample included 70 caregivers (74% female; 96% spouses) who were currently living with the patient. A postal survey was sent to caregivers of persons with PD on the mailing list of a regional Parkinson association; response rate was 39%. Assessment instruments included the UCLA Loneliness Scale, Social Provisions Scale, Hoehn and Yahr (caregiver version), a perceived Self-Efficacy Scale developed previously for use with PD caregivers, and questions related to both patient and caregiver characteristics. Caregivers reported more loneliness than all similar normative groups except Alzheimer caregivers (P < 0.001 to P = 0.011). Hierarchical regression analyses were used to determine whether patient or caregiver characteristics were more predictive of loneliness. Results indicated that patient variables accounted for only 12% of the variance in loneliness, whereas caregiver variables accounted for an additional 46% of the variance (P < 0.01). Among the significant individual caregiver predictors of greater loneliness were less education, lower perceived self-efficacy (both P < 0.05) and poorer physical health (P < 0.01). It was also found that persons attending caregiver support groups reported less loneliness (P < 0.05) and more perceived support (P < 0.05) than those not attending support groups. Because loneliness was significantly predicted by caregiver rather than patient variables, it is possible that strategic interventions for caregivers could ameliorate loneliness.     

A systematic review of studies of depression prevalence in university students

Background

Depression is a common health problem, ranking third after cardiac and respiratory diseases as a major cause of disability. There is evidence to suggest that university students are at higher risk of depression, despite being a socially advantaged population, but the reported rates have shown wide variability across settings.

Purpose

To explore the prevalence of depression in university students.

Method

PubMed, PsycINFO, BioMed Central and Medline were searched to identify studies published between 1990 and 2010 reporting on depression prevalence among university students. Searches used a combination of the terms depression, depressive symptoms, depressive disorders, prevalence, university students, college students, undergraduate students, adolescents and/or young adults. Studies were evaluated with a quality rating.

Results

Twenty-four articles were identified that met the inclusion and exclusion criteria. Reported prevalence rates ranged from 10% to 85% with a weighted mean prevalence of 30.6%.

Conclusions

The results suggest that university students experience rates of depression that are substantially higher than those found in the general population. Study quality has not improved since 1990.     

Cognitive and Psychosocial Health Risk Factors of Social Networking Addiction

The aim of this study was to examine the effects of the two cognitive factors proposed by social cognitive theory to be highly influential on behavior (i.e., outcome expectancies and self-efficacy), in addition to optimism and loneliness, on social networking addiction among university students. In the study, 395 Chinese students (145 males, M _age = 19.05, age range = 17–27 years) voluntarily completed an online, anonymous questionnaire regarding their Internet use. Almost all of the participants (99 %) were found to be using online social networking sites, and findings showed that social networking addiction was strongly correlated with Internet addiction. As hypothesized, more negative outcome expectancies and lower self-efficacy with regard to reducing Internet use were associated with higher social networking addictive tendencies. The results of the path analysis showed that low optimism was an indirect risk factor of social networking addiction through outcome expectancies and self-efficacy, while loneliness was a direct risk factor. The findings provide practical implications to preventive intervention for social networking addiction among youth.