Changes in Loneliness and Mental Health during the Pandemic

From the Anderson Group, Public Health Sciences Division

Before the present global COVID-19 pandemic, loneliness was prevalent among older adults; over 40% of Americans (aged 60 and above) were lonely.  In recent years, the stigma surrounding mental health has decreased and the population has become more open about expressing their feelings. Loneliness has now started to be appreciated as a public health concern among older adults, it is associated with long-term negative physical, cognitive, and mental health consequences, and premature all-cause mortality.  During the pandemic, physical distancing and stay-at home measures were mandated for certain areas. This in turn, intensified feelings of loneliness among older adults. There are few studies about loneliness that include older cohorts. Also, these studies have yielded mixed results. One study concluded that younger individuals were lonelier than their older counterparts during the pandemic,  older women reported more loneliness than older men. Currently, we don’t know how the measurement of loneliness changed in older women before and during the pandemic. Throughout the pandemic, significant precautions have been taken to protect older women from the virus because they are more susceptible to COVID-19, and other illnesses.  This separation interrupted their daily social connections and potentially adversely affected mental health outcomes.  Therefore, the Anderson Group utilized data from the Women’s Health Initiative (WHI) participants (aged 71-104 years) who completed surveys pre pandemic (2014-2016) and during the early months of the pandemic (Feb – Oct. 2020) to examine (1) the changes in loneliness scores from the pre-pandemic to intra-pandemic period; (2) factors associated with changes in loneliness from pre-to-intra pandemic period and loneliness severity during the pandemic; and 3) the associations between changes in loneliness and social connections from the pre-to  intra-pandemic period and mental health outcomes during the pandemic. The study is published in The Journals of Gerontology: Series A.

In 2005, women in the observation study and clinical trial of WHI agreed to participate in extension studies that collected health updates and outcomes annually in active participants. Women who completed the three-item UCLA Loneliness scale surveys, two surveys during the pandemic, and a COVID-19 Impact Survey were included in this study. The women completed the following psychological and mental health assessments during the pandemic: four-item perceived stress scale, six-item Center for Epidemiologic Studies Depression Scale (CES-D short form), the PROMIS Anxiety Short Form questionnaire, in addition to reporting living arrangements and changes in social connection. A paired t-test was used to evaluate the changes in the loneliness score (before and during the pandemic), linear regression was utilized to examine changes in the loneliness scores (before the pandemic), and multivariable linear regression analyses examined the associations of living along (during the pandemic), changes in loneliness and social connection (before and during the pandemic), and each mental health outcome, separately. 

Loneliness among older women increased during the COVID-19 pandemic
Loneliness among older women increased during the COVID-19 pandemic Image from

The Anderson Group summarized the results of the paper by stating, “significant increases in loneliness were observed during the earlier pandemic months, relative to pre-pandemic levels; this increase was more pronounced in those 70 years of age and older. Factors associated with increasing loneliness scores included older age, experiencing a greater number of life stressors (especially death of a spouse/partner) during the past year, having a history of CVD [cardiovascular disease], a history of depression, and reporting social connection disruptions during the pandemic. The factors associated with decrease in loneliness over time included being Black/African American, being Asian/Pacific Islander, engaging in more frequent physical activity, being more optimistic, and having a higher purpose in life. Increasing feelings of loneliness were associated with higher perceived stress, and depressive and anxiety symptoms during the pandemic. In contrast, living alone during the pandemic was not associated with mental health, and changes in objective social connection measures showed modest or no associations with these measures during the pandemic.”

This study provided new insight into loneliness among older women and its association with mental health during the pandemic and shows that it is necessary to prevent, monitor, and manage this silent epidemic. The findings provide data to develop strategies to minimize loneliness. The Anderson Group’s findings can contribute to future interventions that focus on physical activity, decreasing alcohol intake, and cultivating positive attributes to combat the feeling of loneliness in older women. 

This research was supported by the National Heart, Lung, and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services.

Fred Hutch/UW Cancer Consortium member Garnet L. Anderson contributed to this work.

Goveas JS, Ray RM, Woods NF, Manson JA, Kroenke CH, Michael YL, Shadyab AH, Meliker JR, Chen JC, Johnson L, Mouton C. Associations between changes in loneliness and social connections, and mental health during the COVID-19 Pandemic: The Women’s Health Initiative. The Journals of Gerontology: Series A. 2021 Dec 16.