Association between changes in loneliness identified through screening and changes in depression or anxiety in older adults

John F Steiner; Colleen Ross; Matthew Stiefel; David Mosen; Matthew P Banegas; Alena E Wall; Cally Martin; Tammy S Kelly; Andrea R Paolino; Chan Zeng

doi:10.1111/jgs.18012

Association between changes in loneliness identified through screening and changes in depression or anxiety in older adults

J Am Geriatr Soc. 2022 Dec;70(12):3458-3468. doi: 10.1111/jgs.18012. Epub 2022 Aug 24.

Authors

Affiliations

¹ Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, USA.
² Social Health Practice, Kaiser Permanente, Oakland, California, USA.
³ Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, USA.
⁴ Department of Radiation Medicine and Applied Sciences, University of California, San Diego, California, USA.
⁵ Quality, Risk & Patient Safety Department, Kaiser Permanente Colorado, Denver, Colorado, USA.

PMID: 36053977
DOI: 10.1111/jgs.18012

Abstract

Background: Changes in loneliness are associated with corresponding changes in depression, anxiety, and general health in population surveys, but few studies have assessed these associations through repeated screening in clinical settings.

Methods: Retrospective cohort study among individuals ≥age 65 in an integrated health care system who completed loneliness screening before two annual wellness visits, separated by a mean of 12.9 (SD 2.0) months, between 2013 and 2018. Their responses identified four subgroups: individuals who were persistently lonely; not lonely; experienced an increase (recently lonely); or decrease (previously lonely) in loneliness. Loneliness was assessed with a single item. Depression was assessed with the Patient Health Questionnaire-2. Anxiety was assessed with the Generalized Anxiety Disorder-2. Fair/poor general health was assessed by a single item. Linear mixed effects models assessed changes in outcomes after covariate adjustment.

Results: The cohort comprised 24,666 individuals (19.2% of older adults in the system). Mean age was 73.7 years (SD 6.4); 54.6% were female, and 11.6% were members of racial and ethnic minority groups. Of these individuals, 1936 (7.8%) were persistently lonely, 1687 (6.8%) were recently lonely, 1551 (6.3%) were previously lonely, and 19,492 (79.0%) were not lonely at either time point. After adjustment for sociodemographic, clinical and social variables, recent loneliness was associated with increases in depression (adjusted odds ratio [aOR] 1.76, 95% confidence interval [CI] 1.41-2.19) and anxiety (aOR 1.67, 95% CI 1.32-2.10). Previous loneliness was associated with decreases in depression (aOR, 0.46, 95% CI 0.36-0.58) and anxiety (aOR 0.69, 95% CI 0.54-0.90). Changes in loneliness were not associated with changes in general health.

Conclusions: Changes in loneliness identified through screening were associated with corresponding changes in depression and anxiety. These findings support the potential value of identifying social risk factors in clinical settings among older adults.

Keywords: anxiety; clinical screening; cohort study; depression; geriatrics; loneliness.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Anxiety
Anxiety Disorders
Depression* / diagnosis
Ethnicity
Female
Humans
Loneliness*
Male
Minority Groups
Retrospective Studies