Experiences of loneliness in lower- and middle-income countries: A systematic review of qualitative studies.

Loneliness is understood as a subjective experience resulting from unmet social relationship expectations. As most loneliness research has been conducted in higher-income-countries, there is limited understanding of loneliness in relation to diverse cultural, economic, and socio-political factors. To address this gap, the present review systematically synthesises existing qualitative studies on the experience of loneliness and social relationship expectations in lower- and middle-income countries (LMICs). Between June and July 2022, six online databases (Embase, Ovid Medline, APA PsycINFO, Global Health, Web of Science, Google Scholar) were searched for peer-reviewed studies from LMICs on loneliness using qualitative methods. There were no restrictions on publication date, language, or study setting. Studies that solely focused on social isolation or were conducted with children (<16 years) were excluded. Risk of bias was assessed with the Critical Appraisal Skills Programme. After deduplication, a total of 7866 records were identified and screened for inclusion, resulting in 24 studies published between 2002 and 2022. The included studies represent data from 728 participants in 15 countries across West Africa (Ghana, Nigeria, Niger, Mali), East Africa (Uganda, Kenya), North Africa (Egypt), West Asia (Iran), South Asia (India, Pakistan, Sri Lanka) and Southeast Asia (Myanmar, Cambodia, Indonesia, Philippines). Data were analysed combining inductive and deductive coding, summarised using narrative synthesis, and examined by geographical region. Common features of loneliness included rejection, overthinking, and pain. Loneliness was related to depression across regions. Whereas loneliness tended to be distinguished from social isolation in studies from Africa, it tended to be related with being alone in studies from Asia. Poverty and stigma were common barriers to fulfilling social relationship expectations. This review illustrates how loneliness and expectations are contextually embedded, with some expectations possibly being specific to a certain culture or life stage, having implications for assessment of and interventions for loneliness worldwide.

Love Culturally: How Does Culture Affect Intimacy, Commitment & Love.

This paper, relying on a thematic review of the literature, aimed to explore the influence of culture on human relations, particularly on love. We highlighted the innate need of humans to belong and be part of a community and, moreover, partake in an intimate relationship. Most humans yearn for intimacy, and thus it was defined and described. In our Western culture, intimacy is often found in marriage, usually built on love. Love, if not nurtured, may fade, and so we described what happens when it does. Romantic relationships, where love is usually expressed and actualized, were examined, including how it is shown, how time affects love, and what causes love relationships to be marred by loneliness. The main part of the paper is devoted to examining the effect of culture on love, its expression, and on romantic relationships. While love may be universal, its development, expression, and importance in intimate relationships differ depending on the culture and era in which it occurs.

The Consequences of Child Abuse.

This review provides an overview of the consequences of early adverse experiences across various domains of life. Drawing on the Adverse Childhood Experiences (ACEs) conceptual framework, we discuss the ACE pyramid and the varying degrees of consequences that ACE exposure may elicit. Using online search engines such as Google Scholar, the authors sifted through empirical research to locate relevant articles and research to help prepare this review. This article sheds light on the implications of ACEs for health, socio-emotional and psychosocial well-being, relationships, personality, and cognitive functioning.

Love and Infidelity: Causes and Consequences.

This is a narrative review addressing the topic of romantic infidelity, its causes and its consequences. Love is commonly a source of much pleasure and fulfillment. However, as this review points out, it can also cause stress, heartache and may even be traumatic in some circumstances. Infidelity, which is relatively common in Western culture, can damage a loving, romantic relationship to the point of its demise. However, by highlighting this phenomenon, its causes and its consequences, we hope to provide useful insight for both researchers and clinicians who may be assisting couples facing these issues. We begin by defining infidelity and illustrating the various ways in which one may become unfaithful to their partner. We explore the personal and relational factors that enhance an individual's tendency to betray their partner, the various reactions related to a discovered affair and the challenges related to the nosological categorization of infidelity-based trauma, and conclude by reviewing the effects of COVID-19 on unfaithful behavior, as well as clinical implications related to infidelity-based treatment. Ultimately, we hope to provide a road map, for academicians and clinicians alike, of what some couples may experience in their relationships and how can they be helped.

Loneliness in Intimate Relationships Scale (LIRS): Development and Validation.

Intimate relationships have been shown to be loneliness positively related to self-esteem. Happiness and well-being and have also been regarded as a buffer against loneliness. Nevertheless, substantive research indicates that intimate relationships and marriage can produce or result in loneliness and thus seriously affect the person's physical, emotional and spiritual well-being. Loneliness in intimate relationships may damage the relationship if it goes on, and thus, this newly developed scale has been introduced to aid clinicians and researchers in discovering loneliness in an intimate union so it can be addressed before it negatively affects the union. Since none of the measures of loneliness tap loneliness as experienced in intimate relationships, a new rating scale, the Loneliness in Intimate Relationships Scale (LIRS), was developed and tested psychometrically. The generation of items followed a qualitative approach based on a semi-structured questionnaire administered to 108 volunteers from the general Israeli population, theoretical and empirical literature, and assessments of expert psychologists. In a second study (N = 215), a self-report scale assessing loneliness in intimate relationships was developed. This was followed by psychometric and construct validity evaluations with a new sample of 306 participants. Analyses revealed that loneliness in intimate relationships is experienced mainly in terms of three aspects: detachment, hurt, and guilt. Exploratory and confirmatory factor analyses and validity tests indicate that the final 14-item Loneliness in Intimate Relationship Scale is a well-structured, reliable, and valid scale tapping emotional, behavioral, and cognitive manifestations of loneliness in intimate relationships.

Different loneliness types, cognitive function, and brain structure in midlife: Findings from the Framingham Heart Study.

Background: It remains unclear whether persistent loneliness is related to brain structures that are associated with cognitive decline and development of Alzheimer's disease (AD). This study aimed to investigate the relationships between different loneliness types, cognitive functioning, and regional brain volumes. Methods: Loneliness was measured longitudinally, using the item from the Center for Epidemiologic Studies Depression Scale in the Framingham Heart Study, Generation 3, with participants' average age of 46·3 ± 8·6 years. Robust regression models tested the association between different loneliness types with longitudinal neuropsychological performance (n = 2,609) and regional magnetic resonance imaging brain data (n = 1,829) (2002-2019). Results were stratified for sex, depression, and Apolipoprotein E4 (ApoE4). Findings: Persistent loneliness, but not transient loneliness, was strongly associated with cognitive decline, especially memory and executive function. Persistent loneliness was negatively associated with temporal lobe volume (ß = -0.18, 95%CI [-0.32, -0.04], P = 0·01). Among women, persistent loneliness was associated with smaller frontal lobe (ß = -0.19, 95%CI [-0.38, -0.01], P = 0·04), temporal lobe (ß = -0.20, 95%CI [-0.37, -0.03], P = 0·02), and hippocampus volumes (ß = -0.23, 95%CI [-0.40, -0.06], P = 0·007), and larger lateral ventricle volume (ß = 0.15, 95%CI [0.02, 0.28], P = 0·03). The higher cumulative loneliness scores across three exams, the smaller parietal, temporal, and hippocampus volumes and larger lateral ventricle were evident, especially in the presence of ApoE4. Interpretation: Persistent loneliness in midlife was associated with atrophy in brain regions responsible for memory and executive dysfunction. Interventions to reduce the chronicity of loneliness may mitigate the risk of age-related cognitive decline and AD. Funding: US National Institute on Aging.

The COVID-19 era: How therapists can diminish burnout symptoms through self-care.

COVID-19 is a frightening, stress-inducing, and unchartered territory for all. It is suggested that stress, loneliness, and the emotional toll of the pandemic will result in increased numbers of those who will seek psychological intervention, need support, and guidance on how to cope with a time period that none of us were prepared for. Psychologists, in general, are trained in and know how to help others. They are less effective in taking care of themselves, so that they can be their best in helping others. The article, which aims to heighten clinicians' awareness of the need for self-care, especially now in the post-pandemic era, describes the demanding nature of psychotherapy and the initial resistance by therapists to engage in self-care, and outlines the consequences of neglecting to care for themselves. We covered the demanding nature of psychotherapy and its grinding trajectory, the loneliness and isolation felt by clinicians in private practice, the professional hazards faced by those caring for others, and the creative and insightful ways that mental health practitioners can care for themselves for the good of their clients, their families, and obviously, themselves.

Loneliness of the Blind and the Visually Impaired.

Loneliness has been termed a social epidemic, especially when experienced by people with disabilities. In order to better understand how loneliness is experienced in vulnerable populations, the present study compared the qualitative dimensions of loneliness of the blind and visually impaired with the general population not on the frequency or intensity of their loneliness, but on its qualitative aspects. One hundred and eighty-seven participants responded to a questionnaire which measured the qualitative aspects of loneliness on five subscales: Emotional distress, social inadequacy, Growth and discovery, social isolation, and emotional alienation. Results indicated that as expected, the two populations differed significantly in their scores on four of the five subscales (except emotional alienation), but in the opposite direction of what was expected. That may indicate that the visually impaired person's ability to transcend their blindness, and connect with those around them, and the larger society, in different-and not necessarily less meaningful-manner than the seeing general population. As expected, the visually impaired scored significantly higher than the general population on the Growth and development subscale.

The Lonely, Isolating, and Alienating Implications of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

This article provides a narrative review on myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) through a psychosocial lens and examines how this impairment affects its sufferers during adolescence and adulthood, as well as how it impacts family caregivers and healthcare professionals' mental health. Since there has been a lack of investigation in the literature, the primary psychosocial stressor that this review focuses on is loneliness. As such, and in an attempt to help establish a theoretical framework regarding how loneliness may impact ME/CFS, loneliness is comprehensively reviewed, and its relation to chronic illness is described. We conclude by discussing a variety of coping strategies that may be employed by ME/CFS individuals to address their loneliness. Future directions and ways with which the literature may investigate loneliness and ME/CFS are discussed.

The Road to Becoming a Psychologist: Indicators of Success and Hardship during the University Years.

In order to become a full-fledged psychologist, one must undertake a long, demanding, and quite difficult journey in academia. The academic journey holds a promise of delivering knowledge, interesting theories, and strategies on helping those who need psychological assessment and/or treatment. However, the constant expectation of keeping up with the material, of succeeding in tests and exams, and of preparing to proceed to the next educational level can be daunting and exhausting. In line with the topic of this special issue, this paper addresses factors contributing to academic success at the undergraduate, graduate, and post-graduate levels of psychology. Utilizing the available literature on the Big Five personality classification scheme, high conscientiousness was found to be the most consistent predictor of success, although curiously, this relationship was only found to be reliable at the undergraduate level. Less robust findings included high agreeableness and low neuroticism as predictors of general academic success in all tertiary levels of education. The importance of mentorship figures in psychology, and a highlight of its lack of widespread implementation at the undergraduate level, are also addressed. Additionally, we discuss the negative implications of the impostor phenomenon and of loneliness, which students at all levels may experience as common barriers to scholastic success in psychology. Following a discussion of each factor as outlined above, there is a brief literature review regarding ways that its constraining effects may be limited or its positive effects possibly enhanced.

Senseless Violence: An Overview.

In this epilogue I review some of the existing literature on senseless violence, highlighting the phenomenon, examining the factors that cause people to commit such horrific deeds, and the complex thoughts, feelings, and acts that precede such senseless violence. The article ends with some reflections on what we should do as a profession and as a society to help curb this life shattering violence.

Cancer patients, their caregivers and coping with loneliness.

Four hundred and twenty-six participants volunteered to participate in this study. A total of 159 men and 281 women comprised the sample. The sample was composed of 99 cancer stricken patients, 97 caregivers, 124 participants from the general population, and 126 people who were related to them in a similar manner that caregivers were related to patients (i.e. spouse, intimate partner, child, family member, etc.). Utilizing the Loneliness Questionnaire, the Multidimensional Scale of Perceived Social Support (MPSS), and the Sense of Coherence (SOC) questionnaires, it was found that significant differences among the four groups were found on Reflection and Acceptance, Self-development and Understanding, Social Support Network, Distancing and Denial, and on the Increased Activity subscales. Significant differences were not found on the Religion and Faith subscale. The findings are interpreted in light of the analyses of the other two measures which address the social support that patients and caregivers received and their SOC.