Being without connection, felt and structural.
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451 to 475 of 969Social connection and mortality in UK Biobank: a prospective cohort analysis.
Background: Components of social connection are associated with mortality, but research examining their independent and combined effects in the same dataset is lacking. This study aimed to examine the independent and combined associations between functional and structural components of social connection and mortality.
Methods: Analysis of 458,146 participants with full data from the UK Biobank cohort linked to mortality registers. Social connection was assessed using two functional (frequency of ability to confide in someone close and often feeling lonely) and three structural (frequency of friends/family visits, weekly group activities, and living alone) component measures. Cox proportional hazard models were used to examine the associations with all-cause and cardiovascular disease (CVD) mortality.
Results: Over a median of 12.6 years (IQR 11.9-13.3) follow-up, 33,135 (7.2%) participan…
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Linking the exposome to frailty: pathways, mechanisms, clinical implications, and prevention.
Background: Frailty is a state of vulnerability that emerges from cumulative, non-genetic influences acting across the life course. This review applies an exposome lens, integrating general external exposures, specific external exposures, and internal biologic processes. We aimed to synthesize how social, environmental, behavioural, clinical, and biological exposures contribute to frailty and identify clinically actionable prevention targets.
Methods: This structured narrative review synthesized epidemiological, clinical, environmental, and mechanistic evidence linking exposome-related exposures to frailty in older adults. Literature was identified through targeted searches of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, supplemented by reference screening. Evidence was organized across exposome domains and narratively appraised according to study design, temporality, cons…
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Narrative Medicine: The Power of Shared Stories to Enhance Inclusive Clinical Care, Clinician Well-Being, and Medical Education.
The COVID-19 pandemic exacerbated the problem of secondary trauma and moral injury for health care workers. This reality, together with the epidemic of social isolation and loneliness, has brought the mental health of health care practitioners and patients to the forefront of the national conversation. Narrative medicine is an accessible, diversity-honoring, low-cost, underutilized pedagogical framework with potentially revolutionary benefits for enhancing patient care, supporting the underserved, mitigating clinician burnout, and improving team dynamics. Herein, the authors review the literature on these benefits and then discuss methods for integrating narrative medicine into clinical care and medical education at the undergraduate and graduate levels as well as continuing medical education.
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Palliative care considerations for the older adults with HIV/AIDS: a clinical practice review.
Human immunodeficiency virus (HIV) has historically been viewed as a terminal condition affecting younger populations, however, with advancements in antiretroviral therapy (ART) and better healthcare provisions, people with HIV are now living longer than ever before. This shift has highlighted the need to readdress the end-of-life care needs of patients aging with HIV. People aging with HIV face a double burden. Aging itself comes with an array of health challenges, including cognitive decline, frailty, and increased susceptibility to chronic illnesses. Despite effective management with ART, HIV is associated with ongoing inflammation, and may accelerate aging processes, increasing the risk of certain cancers and comorbidities, as well as an increased risk of cardiovascular disease. The stigma surrounding HIV, though diminished over the years, still lingers. People living with HIV have e…
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Whear R, Campbell F, Rogers M, Sutton A, Robinson-Carter E, Sharpe R, Cohen S, Fergy R, Garside R, Kneale D, Melendez-Torres GJ, Thompson-Coon J (2023)reviewMEDLINE-indexed journal, not yet read by usCampbell systematic reviews34 citations What is the effect of intergenerational activities on the wellbeing and mental health of older people?: A systematic review.
Background: Opportunities for social connection between generations have diminished over the last few decades around the world as a result of changes in the way that we live and work. The COVID-19 pandemic has exacerbated loneliness for many with young and old being kept apart for safety. The Public Health England prevention concordat for better mental health (Office for Health Improvement and Disparities) aims to bring a prevention-focused approach to improving public mental health. The concordat promotes evidence-based planning and commissioning to increase the impact on reducing health inequalities using sustainable and cost-effective interventions that impact on the wider determinants of mental health and wellbeing for children and young people and older people. Intergenerational activities could provide an opportunity to support both populations. In 2023, we produced an evidence and…
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How does the COVID-19 fuel insomnia?
One of the leading health consequences of the pandemic is the prevalence of sleep-related issues, such as insomnia. Hence, this study highlights the relationship between COVID-19 and insomnia and how insomnia is increasing due to the pandemic. The study's findings summarise that the COVID-19 pandemic has produced ubiquitous mental challenges, including loneliness, anxiety, fear, stress, extreme tiredness, and health concerns. It is also associated with physical issues such as social isolation, juggling work or study, parenting challenges, and significant behavior changes stemming from mass home confinement. There are also economic hardships, financial insecurity, risk, and infection. These factors lead to undoing routines and broken circadian rhythms amid the pandemic, affecting three sleep regulatory processes of the homeostatic sleep drive, the circadian rhythm, and the arousal system.…
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Knight JM, Taylor MR, Rentscher KE, Henley EC, Uttley HA, Nelson AM, Turcotte LM, McAndrew NS, Amonoo HL, Mohanraj L, Kelly DL, Costanzo ES (2022)reviewMEDLINE-indexed journal, not yet read by usFrontiers in immunology4 citations Biobehavioral Implications of Covid-19 for Transplantation and Cellular Therapy Recipients.
A growing body of literature has emphasized the importance of biobehavioral processes - defined as the interaction of behavior, psychology, socioenvironmental factors, and biological processes - for clinical outcomes among transplantation and cellular therapy (TCT) patients. TCT recipients are especially vulnerable to distress associated with pandemic conditions and represent a notably immunocompromised group at greater risk for SARS-CoV-2 infection with substantially worse outcomes. The summation of both the immunologic and psychologic vulnerability of TCT patients renders them particularly susceptible to adverse biobehavioral sequelae associated with the Covid-19 pandemic. Stress and adverse psychosocial factors alter neural and endocrine pathways through sympathetic nervous system and hypothalamic-pituitary-adrenal axis signaling that ultimately affect gene regulation in immune cells.…
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Sher L (2020)reviewMEDLINE-indexed journal, not yet read by usQJM : monthly journal of the Association of Physicians530 citations The impact of the COVID-19 pandemic on suicide rates.
Multiple lines of evidence indicate that the coronavirus disease 2019 (COVID-19) pandemic has profound psychological and social effects. The psychological sequelae of the pandemic will probably persist for months and years to come. Studies indicate that the COVID-19 pandemic is associated with distress, anxiety, fear of contagion, depression and insomnia in the general population and among healthcare professionals. Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use and other psychiatric disorders in vulnerable populations including individuals with pre-existing psychiatric disorders and people who reside in high COVID-19 prevalence areas. Stress-related psychiatric conditions including mood and substance use disorders are associated with suicidal behavior. CO…
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Bret R.; Rutherford; Katharine Brewster and 6 others (2017)reviewMEDLINE-indexed journal, not yet read by usAmerican Journal of Psychiatry444 citations
Sensation and Psychiatry: Linking Age-Related Hearing Loss to Late-Life Depression and Cognitive Decline
Recent research has linked age-related hearing loss to impaired performance across cognitive domains and increased risk for dementia diagnosis. The data linking hearing impairment to incident late-life depression are more mixed but suggest that diminished hearing does increase risk for depression. Behavioral mechanisms may explain these associations, such as the withdrawal of older adults from situations in which they may have difficulty hearing and communicating, which may contribute to the development of social isolation, loneliness, and consequent cognitive decline and depression. At a neural level, chronic hearing loss leads to reduced activation in central auditory pathways, resulting in compensatory increased activation in the cognitive control network, dysfunctional auditory-limbic connectivity, and deafferentation-induced atrophy in frontal brain regions. These pathologic changes…
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Age-related hearing impairment-a risk factor and frailty marker for dementia and AD.
Age-related hearing impairment (ARHI, also known as presbycusis) is potentially a reversible risk factor for dementia and Alzheimer disease (AD). Social isolation, loneliness, poor verbal communication, and cognitive reserve depletion might causally link ARHI with cognitive impairment. ARHI is an important frailty marker, and several factors related to physical frailty could be associated with cognitive impairment. Such factors include inflammatory markers and vascular factors, which might also directly contribute to ARHI. Randomized controlled trials of potential interventions, and larger population-based studies, could facilitate further understanding of the interplay between cognitive impairment, ARHI and frailty in older age. Deficits in both peripheral hearing and central auditory processing (CAP) can contribute to ARHI. Impairments in peripheral hearing and CAP have been linked to …
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Hidaka BH (2012)reviewMEDLINE-indexed journal, not yet read by usJournal of affective disorders355 citations Depression as a disease of modernity: explanations for increasing prevalence.
There has been much speculation about modern environments causing an epidemic of depression. This review aims to (1) determine whether depression rates have increased and (2) review evidence for possible explanations. While available data indicate rising prevalence and an increased lifetime risk for younger cohorts, strong conclusions cannot be drawn due to conflicting results and methodological flaws. There are numerous potential explanations for changing rates of depression. Cross-cultural studies can be useful for identifying likely culprits. General and specific characteristics of modernization correlate with higher risk. A positive correlation between a country's GDP per capita, as a quantitative measure of modernization, and lifetime risk of a mood disorder trended toward significance (p=0.06). Mental and physical well-being are intimately related. The growing burden of chronic dis…
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Does caring for a spouse with dementia promote cognitive decline? A hypothesis and proposed mechanisms.
Objective: To discuss why spouse caregivers (CGs) of people with dementia may be at higher risk for cognitive problems and decline than demographically similar people not caring for a spouse with dementia (noncaregivers; NCGs).
Design: Literature review.
Setting: Community.
Participants: Older adults caring for a family member (primarily spouses) with dementia.
Measurements: Cognitive, psychosocial, physiological, and behavioral.
Results: This article reports a review of the literature examining relationships between CG status and cognitive problems in the context of a theoretical model of chronic stress. The model suggests that spouse CGs may be at higher risk of cognitive impairment or dementia than NCG spouses in response to several mediators, including psychosocial (e.g., depression, loneliness, social isolation, sleep problems), behavioral (e.g., exercise, diet), and physiological (…
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Parental adjustment to the completion of their child's cancer treatment.
Childhood cancer treatment completion is a significant milestone. However, coming off treatment may be a time of psychological vulnerability for parents. This review assesses published research (1979-2009) on the psychosocial impact of treatment completion on parents. Fifteen articles met all inclusion criteria and demonstrated that while they celebrate treatment completion, parents (particularly mothers) can experience significant distress, including fear of recurrence, fatigue, and loneliness. Distress appears to ease with time, possibly as the perceived risk of relapse declines. Continued psychosocial support specifically targeting parents' risk perceptions, physical and emotional fatigue, social isolation, and parenting concerns post-treatment is warranted.
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Förster K, Kanske P (2022)reviewMEDLINE-indexed journal, not yet read by usInternational journal of psychophysiology : official journal of the International Organization of Psychophysiology17 citations Upregulating positive affect through compassion: Psychological and physiological evidence.
Positive emotion regulation, that is, upregulating, maintaining, and savoring positive emotions, also bears the potential to counteract and thus mitigate negative affect. In this narrative review, we report on the social emotion of compassion as a particularly efficient form of positive emotion regulation. Compassion emerges as an affiliative response to the suffering of others. It is characterized by feelings of warmth and kindness and an initiation of prosocial caring behavior towards others. The inherent positivity of compassion is also in line with its related neural correlates. Compassion is associated with activity in the ventral striatum, the (subgenual) anterior cingulate cortex, and the orbitofrontal cortex, brain regions related to strong positive emotions, such as romantic and maternal love. In addition to its long tradition in Eastern philosophy, the practice of compassion ha…
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de Figueiredo CS, Sandre PC, Portugal LCL, Mázala-de-Oliveira T, da Silva Chagas L, Raony Í, Ferreira ES, Giestal-de-Araujo E, Dos Santos AA, Bomfim PO (2021)reviewMEDLINE-indexed journal, not yet read by usProgress in neuro-psychopharmacology & biological psychiatry333 citations COVID-19 pandemic impact on children and adolescents' mental health: Biological, environmental, and social factors.
Since the Coronavirus disease 2019 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) was announced, we had an unprecedented change in the way we organize ourselves socially and in our daily routine. Children and adolescents were also greatly impacted by the abrupt withdrawal from school, social life and outdoor activities. Some of them also experienced domestic violence growing. The stress they are subjected to directly impacts their mental health on account of increased anxiety, changes in their diets and in school dynamics, fear or even failing to scale the problem. Our aim is to bring up a discussion under different aspects and to alert public health and government agents about the need for surveillance and care of these individuals. We hope that the damage to their mental health as a result of the side effect of this pandemic can be mitigated…
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Serotonin Regulation of the Prefrontal Cortex: Cognitive Relevance and the Impact of Developmental Perturbation.
The prefrontal cortex is essential for both executive function and emotional regulation. The interrelationships among these behavioral domains are increasingly recognized, as well as their sensitivity to serotonin (5-hydroxytryptamine, 5-HT). Prefrontal cortex receives serotonergic inputs from the dorsal and median raphe nuclei and is modulated by multiple subtypes of 5-HT receptor across its layers and cell types. Extremes of serotonergic modulation alter mood regulation in vulnerable individuals, yet the impact of serotonin under more typical physiological parameters remains unclear. In this regard, new tools are permitting a closer examination of the behavioral impact of the serotonin system. Optogenetic and chemogenetic manipulations of dorsal raphe 5-HT neurons reveal that serotonin has a greater impact on executive function than previously appreciated. Domains that appear sensitive…
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A review of social participation interventions for people with mental health problems.
Purpose: The association between social networks and improved mental and physical health is well documented in the literature, but mental health services rarely routinely intervene to improve an individual's social network. This review summarises social participation intervention models to illustrate different approaches which practitioners use, highlight gaps in the evidence base and suggest future directions for research.
Methods: A systematic search of electronic databases was conducted, and social participation interventions were grouped into six categories using a modified narrative synthesis approach.
Results: Nineteen interventions from 14 countries were identified, six of which were evaluated using a randomised controlled trial. They were grouped together as: individual social skills training; group skills training; supported community engagement; group-based community activities…
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Omega-3 supplementation reduces perceived social isolation in a sex-dependent manner: Secondary analysis of an RCT.
Background: Loneliness and chronic inflammation create a vicious cycle, and females may be especially vulnerable. In these secondary analyses of an RCT, we investigated whether omega-3 (n-3) supplementation decreased loneliness and perceived social isolation in a sex-dependent manner, and whether changes in n-3 in peripheral blood mononuclear cell (PBMC) membranes or inflammatory biomarkers predicted changes in social perception.
Methods: Healthy medical students (n = 38 males, n = 30 females) were randomized to 2.5 g/day of n-3 supplementation or placebo for 12 weeks. Perceived social isolation (Trier Inventory of Chronic Stressors), loneliness (UCLA Loneliness Scale), PBMC n-3 percentage, and serum and LPS-stimulated interleukin-6 and tumor necrosis factor-α were assessed multiple times throughout the trial.
Results: PBMC n-3 percentage increased in the supplementation group (p < .001)…
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Ko S, Anzai A, Liu X, Kinouchi K, Yamanoi K, Torimitsu T, Ichihara G, Kitakata H, Shirakawa K, Katsumata Y, Endo J, Hayashi K, Yoshida M, Nishimori K, Tanaka KF, Onaka T, Sano M, Ieda M (2025)MEDLINE-indexed journal, not yet read by usCirculation research2 citations Social Bonds Retain Oxytocin-Mediated Brain-Liver Axis to Retard Atherosclerosis.
Backgrounds: Social interaction with others is essential to life. Although social isolation and loneliness have been implicated as increased risks of cardiometabolic and cardiovascular diseases and all-cause mortality, the cellular and molecular mechanisms by which social connection maintains cardiometabolic and cardiovascular health remain largely unresolved.
Methods: To investigate how social connection protects against cardiometabolic and cardiovascular diseases, atherosclerosis-prone, high-fat diet-fed Apoe-/- mouse siblings were randomly assigned to either individual or grouped housing for 12 weeks. Histological, flow cytometric, biochemical, gene, and protein analyses were performed to assess atherosclerotic lesions, systemic metabolism, inflammation, and stress response. The effects of oxytocin on hepatocytes and subsequent cardiometabolic and cardiovascular function were investig…
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Kim B, Hu J (2025)MEDLINE-indexed journal, not yet read by usJournal of applied gerontology : the official journal of the Southern Gerontological Society A Multigroup Path Analysis of the Association Between Social Isolation, Loneliness, Physiological Mediators, and Cognitive Function: How Does It Vary With the Presence of Diabetes?
The study investigated the direct and indirect effects of social isolation and loneliness on cognitive function in older adults, with systemic inflammation and sleep disturbance as mediators and diabetes as a moderator. Data were drawn from 5,722 older adults who participated in the 10th and 12th waves of the Health and Retirement Study. Social isolation directly affected cognitive function, whereas loneliness did not. Sleep disturbance mediated the effects of both social isolation and loneliness on cognitive function. Systemic inflammation did not mediate the effects of social isolation or loneliness on cognitive function. Multigroup path analysis revealed no significant differences in the pathways linking social isolation, loneliness, physiological mediators, and cognitive function between the diabetes and non-diabetes groups. These findings suggest that sleep disturbance may serve as …
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Co-residence with children as a mediator between widowhood and loneliness in older adults.
Background: Loneliness in older adults, exacerbated by widowhood, is a significant public health concern. While widowhood can lead to changes in living arrangements, its impact on loneliness may vary across cultural contexts. In Western societies, widowhood often results in older adults living alone, which can intensify feelings of loneliness. However, in China, the cultural norm of filial piety and multigenerational households may lead to different outcomes. As few studies have explored this connection over time, this research seeks to bridge this gap using data from older Chinese adults.
Methods: Using 16 years of data from the Chinese Longitudinal Healthy Longevity Survey, which covers 21,986 individuals aged 65-104 years, we conducted causal mediation analysis to test if changes in living arrangements (i.e., living alone versus with children) serve as a mediator between widowhood and…
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Holt-Lunstad J (2024)MEDLINE-indexed journal, not yet read by usWorld psychiatry : official journal of the World Psychiatric Association (WPA)181 citations Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications.
Rising concerns about social isolation and loneliness globally have highlighted the need for a greater understanding of their mental and physical health implications. Robust evidence documents social connection factors as independent predictors of mental and physical health, with some of the strongest evidence on mortality. Although most data are observational, evidence points to directionality of effects, plausible pathways, and in some cases a causal link between social connection and later health outcomes. Societal trends across several indicators reveal increasing rates of those who lack social connection, and a significant portion of the population reporting loneliness. The scientific study on social isolation and loneliness has substantially extended over the past two decades, particularly since 2020; however, its relevance to health and mortality remains underappreciated by the pu…
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Social Isolation and Breast Cancer.
Although the role of life stressors in breast cancer remains unclear, social isolation is consistently associated with increased breast cancer risk and mortality. Social isolation can be defined as loneliness or an absence of perceived social connections. In female mice and rats, social isolation is mimicked by housing animals 1 per cage. Social isolation causes many biological changes, of which an increase in inflammatory markers and disruptions in mitochondrial and cellular metabolism are commonly reported. It is not clear how the 2 traditional stress-induced pathways, namely, the hypothalamic-pituitary-adrenocortical axis (HPA), resulting in a release of glucocorticoids from the adrenal cortex, and autonomic nervous system (ANS), resulting in a release of catecholamines from the adrenal medulla and postganglionic neurons, could explain the increased breast cancer risk in socially isol…
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Breaking the vicious cycle: The interplay between loneliness, metabolic illness, and mental health.
Loneliness, or perceived social isolation, is a leading predictor of all-cause mortality and is increasingly considered a public health epidemic afflicting significant portions of the general population. Chronic loneliness is itself associated with two of the most pressing public health epidemics currently facing the globe: the rise of mental illness and metabolic health disorders. Here, we highlight the epidemiological associations between loneliness and mental and metabolic health disorders and argue that loneliness contributes to the etiology of these conditions by acting as a chronic stressor that leads to neuroendocrine dysregulation and downstream immunometabolic consequences that manifest in disease. Specifically, we describe how loneliness can lead to overactivation of the hypothalamic-pituitary-adrenal axis and ultimately cause mitochondrial dysfunction, which is implicated in m…
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Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach.
The detrimental effects of loneliness and social isolation on health and well-being outcomes are well documented. In response, governments, corporations, and community-based organizations have begun leveraging tools to create interventions and policies aimed at reducing loneliness and social isolation at scale. However, these efforts are frequently hampered by a key knowledge gap: when attempting to improve specific health and well-being outcomes, decision-makers are often unsure whether to target loneliness, social isolation, or both. Filling this knowledge gap will inform the development and refinement of effective interventions. Using data from the Health and Retirement Study (13,752 participants (59% women and 41% men, mean [SD] age = 67 [10] years)), we examined how changes in loneliness and social isolation over a 4-year follow-up period (from t0:2008/2010 to t1:2012/2014) were ass…
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