Using a Loneliness Measure to Screen for Risk of Mental Health Problems: A Replication in Two Nationally Representative Cohorts.

BACKGROUND: Loneliness co-occurs alongside many mental health problems and is associated with poorer treatment outcomes. It could therefore be a phenomenon of interest to clinicians as an indicator of generalised risk for psychopathology. The present study tested whether a short measure of loneliness can accurately classify individuals who are at increased risk of common mental health problems. METHODS: Data were drawn from two nationally representative cohorts: the age-18 wave of the UK-based Environmental Risk (E-Risk) Longitudinal Twin Study and the age-38 wave of the New Zealand-based Dunedin Multidisciplinary Health and Development Study. In both cohorts, loneliness was assessed using the three-item UCLA Loneliness Scale, plus two stand-alone items about feeling alone and feeling lonely. Outcome measures consisted of diagnoses of depression and anxiety and self-reports of self-harm/suicide attempts, assessed via a structured interview. RESULTS: ROC curve analysis showed that the Loneliness Scale had fair accuracy in classifying individuals meeting criteria for all three outcomes, with a cut-off score of 5 (on a scale from 3 to 9) having the strongest empirical support. Both of the stand-alone items showed modest sensitivity and specificity but were more limited in their flexibility. The findings were replicated across the two cohorts, indicating that they are applicable both to younger and older adults. In addition, the accuracy of the loneliness scale in detecting mental health problems was comparable to a measure of poor sleep quality, a phenomenon which is often included in screening tools for depression and anxiety. CONCLUSIONS: These findings indicate that a loneliness measure could have utility in mental health screening contexts, as well as in research.

Debate: Recognising and responding to the mental health needs of young people in the era of COVID-19.

The COVID-19 pandemic is a 'perfect storm' for the mental health of young people, because of exposure to known risk factors for psychopathology and lack of support from the infrastructures that are normally in place to ensure safety and provide support. However, it is yet unclear if this 'perfect storm' will flood the Child & Adolescent Mental Health Services. The early, normative emotional responses observed may not lead to enduring psychopathology in most young people. Nevertheless, a minority of young people may show complex presentations, particularly in relation to bereavement. As epidemiology and clinical practice will reveal the actual needs of young people, the hope is that we will find the focus and determination to build new solutions to promote young people's mental health.