Are loneliness interventions effective in reducing loneliness? A meta-analytic review of 128 studies

Abstract   Loneliness is widely acknowledged as a growing public health concern, accelerated by the onset of the COVID-19 pandemic. However, our knowledge about the effectiveness of interventions to reduce loneliness across the lifespan, including knowledge of different intervention strategies, is limited. This preregistered systematic review and meta-analysis aimed to evaluate the effect of interventions to reduce loneliness. The systematic review identified 136 studies. The meta-analysis included 128 studies comprising 54 randomised controlled trials (RCTs) (n = 6,379), 23 multi-cohort studies (n = 2,882) and 48 single-cohort studies (n = 3,009). A small to moderate statistically significant effect was detected (RCTs; SMD = -0.47, multi-cohort studies; SMD = -0.24, single cohort-studies; SMD = -0.42). Using the GRADE system, confidence in the estimates was assessed as low or very low, implying that the estimates may potentially be higher or lower. No statistically significant differences were found between age groups. Psychological treatment, social support interventions, and social and emotional skills training appeared to be the most effective intervention strategies in reducing loneliness but there is currently no strong reason to prefer one intervention strategy over another. Further analyses demonstrated that the long-term effects (i.e., one to six months after the intervention) were comparable to the short-term effects (i.e., up to four weeks after the intervention). Findings from the current meta-analyses provide overall evidence of the effectiveness of loneliness interventions. Given methodological limitations, including the heterogeneity of the reviewed studies, it remains unclear who the interventions would help the most. Overall, there is a need for rigorous and high-quality development and evaluations of interventions for loneliness. Key messages • The findings of this meta-analytic review suggest that interventions designed to reduce loneliness are effective. • Psychological treatment, social support interventions, and social and emotional skills training are the most promising interventions, albeit the magnitude of the effects is moderate.


Background:
Data comparing the populations' mental health from before, during and after the pandemic is needed. We aim to assess the risk factors for the first-onset and persistence of major depressive disorder (MDD) and suicidal thoughts and behaviours (STB) during the first year of the pandemic among the Spanish general population.

Methods:
Cohort study through two online surveys from before the pandemic (N = 2,005, October/November 2019) and 12months later (N = 1,357) on an adult Spanish, nationally representative, population-based sample. Multiple logistic regression models were used to assess the association between socio-demographic, COVID-19 related variables and healthcare received during the pandemic with the onset and persistence of MDD and STB.

Conclusions:
During the COVID-19 pandemic, women were consistently more at risk of having worse mental health than men. Direct and indirect consequences caused or aggravated by the pandemic are common risk factors for the increased risk for the onset and persistence of both MDD and STB. Identification of high-risk subgroups and risk factors for MDD and STB among the Spanish general population will allow the developing and implementing of evidence-driven strategies for reducing the long-term impact of the pandemic in populations' mental health. Key messages: The pandemic consequences, whether due to having had COVID-19, having close people affected or who have died from the infection and the social consequences increase the risk for worse mental health. Evidence-driven strategies for reducing the long-term impact of the pandemic in populations' mental health should be a public health priority.
Loneliness is widely acknowledged as a growing public health concern, accelerated by the onset of the COVID-19 pandemic. However, our knowledge about the effectiveness of interventions to reduce loneliness across the lifespan, including knowledge of different intervention strategies, is limited. This preregistered systematic review and meta-analysis aimed to evaluate the effect of interventions to reduce loneliness. The systematic review identified 136 studies. The meta-analysis included 128 studies comprising 54 randomised controlled trials (RCTs) (n = 6,379), 23 multi-cohort studies (n = 2,882) and 48 single-cohort studies (n = 3,009). A small to moderate statistically significant effect was detected (RCTs; SMD = -0.47, multi-cohort studies; SMD = -0.24, single cohortstudies; SMD = -0.42). Using the GRADE system, confidence in the estimates was assessed as low or very low, implying that the estimates may potentially be higher or lower. No statistically significant differences were found between age groups. Psychological treatment, social support interventions, and social and emotional skills training appeared to be the most effective intervention strategies in reducing loneliness but there is currently no strong reason to prefer one intervention strategy over another. Further analyses demonstrated that the long-term effects (i.e., one to six months after the intervention) were comparable to the short-term effects (i.e., up to four weeks after the intervention). Findings from the current metaanalyses provide overall evidence of the effectiveness of loneliness interventions. Given methodological limitations, including the heterogeneity of the reviewed studies, it remains unclear who the interventions would help the most. Overall, there is a need for rigorous and high-quality development and evaluations of interventions for loneliness.

Background:
Public policies can enhance opportunities for the whole populations to be more health promoting. They are important tools as they tackle the upstream component of health promotion behaviours to influence the environment and opportunities for the general population. Research has focused on policy development and content, but less on its implementation process and s evaluation. These latter steps are necessary for policy accountability, would serve policy-making process and strengthen policy impact for real change. Objectives: The objectives of the workshop are to present different methods and toolkits allowing the evaluation of policy implementation at national level.

Workshop format:
The workshop will include 4 presentations, with two systematic reviews and two tool presentation, to offer opportunities to the audience to understand both theoretical and methodological perspective and applied process in regard to health promotion policy evaluation and implementation evaluation. First, a systematic literature review considering the fitting framework for implementation of policies promoting health nutrition and physically active lifestyle will describe the components and scope of 18 policy implementation frameworks. Second, a systematic literature review on methods of physical activity policy monitoring will help us to learn from the analysis of 112 studies on research-driven, governmentdriven or co-production approaches, their strengths and weaknesses. The third presentation will introduce the Physical Activity Environment Policy Index, a tool to monitor and benchmark policies to improve the healthiness of physical activity policy environment, as well as provide guidance on how to use it. The fourth presentation will present the health promoting sports clubs national audit tool, aimed at reviewing policy supporting sports clubs to promote health, and present preliminary results from its use in Ireland. During the presentation we will pose questions to the audience, encouraging them to apply the theory/tools to their own context, and to spark conversation and interaction as part of the workshop. After the presentations, questions from the audience will be discussed with each presenter, and a discussion will be open in terms of future challenges for health promotion policies implementation evaluation.

Key messages:
Guidance is needed to evaluate health promotion policies implementation to improve practice, as well as development of framework and methods to build toolkits. Policy implementation evaluation is key for improving policy making process.
Abstract citation ID: ckac129.268 Finding the fitting framework for the implementation of policies promoting healthy nutrition and physically active lifestyle: Results from a systematic review