Loneliness, social isolation, depression and anxiety among the elderly in Shanghai: Findings from a longitudinal study

OBJECTIVES: To investigate the longitudinal associations between loneliness, social isolation, depression and anxiety in the elderly. METHODS: A longitudinal cohort study was conducted among 634 older adults from three districts of Shanghai. Data were collected at baseline and 6-month follow-up. Loneliness and social isolation were measured using the De Jong Gierveld Loneliness Scale and the Lubben Social Network Scale respectively. Depressive and anxiety symptoms were assessed using the subscales of Depression Anxiety Stress Scales. Logistic regression and negative binomial regression models were used to examine the associations. RESULTS: We found that moderate to severe loneliness at baseline predicted higher depression scores 6 months later (incidence rate ratio (IRR)=1.99, 95% confidence interval (CI) 1.12, 3.53, p=0.019), while higher depression scores at baseline predicted social isolation at follow-up (odds ratio (OR)=1.14, 95% CI 1.03, 1.27, p=0.012). We also observed that higher anxiety scores predicted lower risk of social isolation (OR=0.87, 95% CI 0.77, 0.98, p=0.021). Additionally, persistent loneliness at both timepoints was significantly associated with higher depression scores at follow-up, and persistent social isolation was associated with a greater likelihood of having moderate to severe loneliness and higher depression scores at follow-up. CONCLUSIONS: Loneliness was found to be a robust predictor of changes in depressive symptoms. Both persistent loneliness and social isolation were closely associated with depression. We should develop effective and feasible interventions for older adults who have depressive symptoms or who are at risk of long-term social relationship problems to avoid the vicious circle among depression, social isolation and loneliness.