1. Loneliness across the life course First steps
COMPASS Colloquium
Wellington
10 August 2017
Roy Lay-Yee & Colleagues (Barry Milne, Ngaire Kerse et al.) 1

2. Acknowledgements Dr Jeanette Crossley (Fellowship)
Dr Allison Oosterman, Jamie Thompson
Data providers, study participants, community partners, and funders
Dunedin Study (Health Research Council)
LiLACS NZ (HRC, Ministry of Health, Rotorua Energy Charitable Trust, Ngā Pae o te Māramatanga, Oakley Mental Health Research Foundation, Heart Foundation)
ISSP (Jeanette Crossley Fellowship) 2

3. Outline Overview Background Our objectives & research questions
Data sources (3 studies)
Introduction; loneliness measures; risk factors & consequences
Summary
Questions 3

4. Background
Loneliness – the subjective feeling of lacking companionship; perceived social isolation (socially isolated may have higher risk of loneliness)
Loneliness is associated with negative consequences
Poor mental & physical health, suicide, cognitive decline, premature mortality, lower quality of life, and social & economic outcomes
Of policy concern, e.g. ‘Campaign To End Loneliness’ – UK coalition
Loneliness affects all ages from children to older people
Longitudinal studies are rare, but important to understand the development of loneliness

5. Our objectives To investigate
the development of loneliness longitudinally and across the life-course
its risk factors and consequences in relation to different life stages – are they the same? - do negative effects accumulate?
To achieve this, we utilise data from 3 studies focusing on different life stages:
2 longitudinal studies (childhood to mid-adulthood, and older people, respectively) and a cross-sectional survey (adulthood) 5

6. Data sources (A tale of 3 studies … more later)
‘The Dunedin Study’
(Dunedin Multidisciplinary Health & Development Study)
data access in progress
‘LiLACS NZ’
( Life and Living in Advanced Age: a Cohort Study in NZ)
‘The ISSP Survey’
(International Social Survey Programme 2017)
- data collection near completion 6

7. Research question 1
Is loneliness across the life-course similarly expressed and are correlates similar?
To what extent do lonely children become lonely adults? Are there distinct ‘child onset’ and adult-onset’ loneliness groups?
Are the risk factors for loneliness in childhood the same or different than those observed in adults and the elderly?
How does the trajectory in cognitive function among the lonely (both in mid-life using Dunedin data and in older age using LiLACS NZ data) differ from those without loneliness? 7

8. Research question 2
What are the consequences of loneliness across the life course?
How does loneliness affect functioning across various health and wellbeing domains (physical health, mental health, cognition, economics)
Does experience of loneliness at different life stages have different effects on functioning in any of these domains?
Does adult and elder loneliness have an effect on functioning over and above that of childhood loneliness (and vice versa)? 8

9. Outline Overview Background Our objectives & research questions
Data sources (3 studies)
Introduction; loneliness measures; risk factors & consequences
Summary
Questions 9

10. The Dunedin Study: Introduction
Ongoing longitudinal investigation of health and behaviour of a complete birth cohort of consecutive births between April and March in Dunedin (n=1037)
Half-day long assessments conducted at ages 3, 5, 7, 9 & 11
Day-long assessments conducted at ages 13, 15, 18, 21, 26, 32 & 38 10

11. The Dunedin Study: Loneliness measures
Loneliness has been assessed in childhood: a collection of measures from ages 5 to 11, and again at every assessment since age 21
Most recent assessment at age 38 used the UCLA loneliness scale
Next assessment phase, at age 45 (in ) will include UCLA loneliness scale and items on social support
UCLA Loneliness Scale (UCLA-LS-3, Russell, 1996) is most widely used self-report measure of loneliness:
20 items rated as 1=Never, 2=Rarely, 3=Sometimes, 4=Always
Score calculated by summing responses to each item
Higher scores indicate higher level of loneliness 11

12. Four questions from UCLA-LS-3, +1
How often do you feel that you lack companionship?
How often do you feel left out?
How often do you feel isolated from others?
How often do you feel alone?
How often have you felt lonely in the past week?
1=Never, 2=Rarely, 3=Sometimes, 4=Always 12

13. The Dunedin Study: Risk factors
Birth and infant factors (birthweight, breastfeeding, smoking in pregnancy, early [teen] parenting
Family factors (socio-economic status, residence changes, family functioning)
Child psychosocial factors (maltreatment, self control, IQ, literacy
Child health factors (asthma, overweight, dental caries, chronic illness)
Child mental health (problem behaviours) 13

14. The Dunedin Study: Consequences
Economics (education, occupational socio-economic status, time on benefit, income, wealth)
Mental health and substance abuse (adult mental health disorders, smoking, alcohol and drug abuse, health costs for mental health and substance abuse treatment)
Health (Obesity, cardiovascular risk factors, oral health, chronic conditions, costs for health treatment)
Cognition (IQ, neuropsychological tests)
Premature aging 14

15. Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu
Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand LiLACS NZ: Introduction
To learn about issues related to wellbeing in advanced age: cultural, family, whānau and hapū, environmental, social, and health
Bicultural cohort of older people starting in 2010 with 5 years of completed follow up (6 waves)
All Māori aged & non-Māori aged 85, living in Bay of Plenty & Lakes DHB areas invited to participate
Wave 1 enrolled 937 people: 421 Māori & 516 non-Māori
Annual routine assessments matching domains of the Dunedin Study, plus questions focussed on situation of older people 15

16. LiLACS NZ: Loneliness measures
JA14. How much time do you spend by yourself? Always / often / seldom / never alone
[Social Isolation]
JA14a. Would you say that you:
Always / often / sometimes / never feel lonely [Loneliness] 16

17. LiLACS NZ: Domains Personal history Housing and environment
Physical health
Everyday interests and activities
Medical history
Nutrition *
Financial situation
Mental health
Respect *
Life skills *
Overall views about growing older
Support needs
Physical performance measures
Physical assessments 17

18. Loneliness
in advanced age
Source: Ngaire Kerse 18

19. The ISSP Survey: Introduction
An annual survey run in more than 40 countries which assesses a different social science topic each year (
COMPASS Research Centre has administered the ISSP since 2013
Administered to random sample of adults (age 18+) selected from NZ electoral roll (target sample size =1200) – stratified to improve response rate
Sample of n=3874 mailed
n=1338 returned so far… still dribbling in
n=1266 data entered, for prelim. unweighted analysis 19

20. The ISSP Survey: Loneliness measures
The Social Networks survey for 2017:
Lacking companionship, feeling isolated or left out, having little contact with others
Systematically asks about the range of people with whom respondents have contact, and in what contexts
Added questions on mental health (e.g. Kessler 10, Kessler et al., 2003), and health status (e.g. SF-12, Jenkinson et al., 1997) to compare associations between loneliness and health/mental health across ages
Previous ISSP modules have not assessed loneliness, so cross-time comparisons will not be possible 20

21. The ISSP Survey: Loneliness measures
Q8. How often in the past 4 weeks have you felt that …
you lack companionship?
you are isolated from others?
you are left out?
you feel alone?
1=Never / 2=Rarely / 3=Sometimes / 4=Often / 5=Very often 21

22. The ISSP Survey: Loneliness
Define ‘lonely’ group as the top 10% of total scores summed across items 22

23. Loneliness: Demographics23

24. Loneliness: Health correlates24

25. Outline Overview Background Our objectives & research questions
Data sources (3 studies)
Introduction; loneliness measures; risk factors & consequences
Summary
Questions 25

26. Summary
Investigation of loneliness, its risk factors and consequences … first steps
Standing on the shoulders of 3 NZ studies: 2 longitudinal, 1 cross-sectional – covering life stages: child, adult, older age
Will contribute to evidence base necessary to underpin prevention and intervention initiatives 26

27. Questions? 27