key: cord-264300-6qp0ymi2
authors: Sutin, Angelina R.; Luchetti, Martina; Terracciano, Antonio
title: Has loneliness increased during COVID-19? Comment on “Loneliness: A signature mental health concern in the era of COVID-19”
date: 2020-07-13
journal: Psychiatry Res
DOI: 10.1016/j.psychres.2020.113295
sha: 
doc_id: 264300
cord_uid: 6qp0ymi2

nan

Has loneliness increased during COVID-19? Comment on "Loneliness: A signature mental health concern in the era of COVID-19" Angelina R. Sutin*, Martina Luchetti, and We read the recent Letter to the Editor by Killgore and colleagues (2020) in Psychiatry Research on loneliness during COVID-19 and found it to be a timely issue of broad interest. The authors reported that a national sample of adults aged 18-35 assessed during the pandemic scored significantly higher in loneliness (d=0.48) compared to a sample measured before 2003. There is certainly little doubt that the coronavirus pandemic has caused a great deal of distress that has alarming consequences for mental health. There has been a lot of concern about loneliness in particular because of the implementation of social distancing and stay-at-home orders that have been critical to slow the spread of the virus. While necessary, there have been significant fears about the impact of these measures on loneliness because, by design, they are meant to keep people apart. The Killgore findings seem to support these concerns. Other studies, however, have not been able to document a similar increase. In a longitudinal study in the United States, for example, participants measured just prior to and then twice during the pandemic found no change in loneliness (Luchetti et al., 2020) . That is, participants reported similar average levels of loneliness from before (January-February 2020) to during (mid-March and again in late April 2020) the pandemic. A second study that compared the prevalence of loneliness from 2018 to April 2020 in two national samples came to a similar conclusion: There was not a large increase in loneliness during the stay-at-home orders caused by the pandemic (McGinty et al., 2020) .

On the surface, these findings look contradictory. When examining means from different samples, however, the comparison sample is vitally important for what conclusions can be drawn from any differences/similarities found. In this case, Killgore and colleagues compared the mean from their national sample (N=1,013) aged 18-35 surveyed in April 2020 to the mean of a sample (N=277) of undergraduate students at a select private college that was published in 2003. There are many differences between the two samples that likely have nothing to do with the pandemic (e.g., age, education, socioeconomic status, setting, year of assessment).

In this letter, we compare the loneliness data of Killgore and colleagues to a more recent, nationally representative sample to re-evaluate their conclusion. Specifically, Bruce and colleagues (2019) used the UCLA Loneliness Scale-3, which is the exact same measure used by Killgore and colleagues, on a nationally representative sample in 2018. Bruce and colleagues reported mean loneliness by age group that allows for more direct comparisons with the sample surveyed during the pandemic than the comparison group used by Killgore and colleagues. Specifically, Killgore and colleagues reported a mean of 43.8 (SD=13.5) in their 18-35-year-old sample. The comparable age groups in Bruce and colleagues had a weighted mean of 47.87 (SD=13.76) and 44.92 (SD=13.95) for 18-25-year-olds and 26-34-year-olds, respectively. The means indicated a significant decline in loneliness between 2018 and April 2020 for both age groups (t=7.921, p<.01, d=-0.30 and t=2.231, p=.01, d=-0 .08 for the 18-25 and 26-34 age groups, respectively). This conclusion is in stark contrast to the conclusion in Killgore and colleagues. The decline may be due to differences in sampling (e.g., online recruitment versus nationally representative) rather than to an actual decline in loneliness, but overall, from this comparison, there is no evidence of an increase in loneliness during COVID-19.

We absolutely agree with Killgore and colleagues that loneliness is a critical public health concern. Loneliness increases risk of mental and physical health burden and decreases life expectancy (Hawkley & Cacioppo, 2010) . The social distancing and stay-at-home measures that literally keep people apart would seem ripe for tremendous increases in loneliness. But despite the physical distancing, most people may feel emotionally connected because we are all in this together. Indeed, there is evidence that people feel more emotional and social support from others than before the pandemic (Luchetti et al., 2020) . Such support may have helped buffer against the effect of the physical distancing on loneliness. There is little doubt that the pandemic has caused a great deal of distress and that there are pressing mental health problems that must be addressed (McGinty et al., 2020) . Resources should be directed at these most critical mental health needs. Further, even though there currently is no evidence of a surge in loneliness due to the pandemic, surveillance of loneliness needs to continue. There may be longer-term consequences of social distancing on loneliness that have yet to be detected.

The design of most studies of loneliness during the pandemic has relied on responses to online surveys. Such methodologies are useful for surveying large numbers of participants efficiently in a short period of time, especially during a pandemic. At the same time, however, these methods are likely to miss populations most vulnerable to the economic and health effects of the pandemic, including families who do not have internet access, rural communities, and individuals in assisted living facilities or nursing homes. More inclusive surveillance is clearly needed. And, yet, despite these caveats and the need for more surveillance, the emerging pattern from this re-analyses of the Killgore and colleagues data and others (Luchetti et al., 2020; McGinty et al., 2020) is one of resilience rather than harm, at least as far as loneliness is concerned.

Loneliness in the United States: A 2018 national panel survey of demographic, structural, cognitive, and behavioral characteristics

Loneliness matters: a theoretical and empirical review of consequences and mechanisms

Loneliness: A signature mental health concern in the era of COVID-19

The trajectory of loneliness in response to COVID-19

Psychological distress and loneliness reported by US Adults

Angelina R. Sutin, PhD* Martina Luchetti, PhD Antonio Terracciano, PhD *Address correspondence to: Angelina.sutin@med.fsu.edu