key: cord-0911163-zt3amlhx authors: Surkalim, Daniel L; Luo, Mengyun; Eres, Robert; Gebel, Klaus; van Buskirk, Joseph; Bauman, Adrian; Ding, Ding title: The prevalence of loneliness across 113 countries: systematic review and meta-analysis date: 2022-02-09 journal: BMJ DOI: 10.1136/bmj-2021-067068 sha: 432eaa25ccdda0d9c51f4251910617e94e04e5bb doc_id: 911163 cord_uid: zt3amlhx OBJECTIVES: To identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine temporal trends of loneliness in countries where data exist. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Embase, Medline, PsycINFO, and Scopus for peer reviewed literature, and Google Scholar and Open Grey for grey literature, supplemented by backward reference searching (to 1 September 2021) ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies based on nationally representative samples (n≥292), validated instruments, and prevalence data for 2000-19. Two researchers independently extracted data and assessed the risk of bias using the Joanna Briggs Institute checklist. Random effects meta-analysis was conducted in the subset of studies with relatively homogeneous research methods by measurement instrument, age group, and WHO region. RESULTS: Prevalence data were available for 113 countries or territories, according to official WHO nomenclature for regions, from 57 studies. Data were available for adolescents (12-17 years) in 77 countries or territories, young adults (18-29 years) in 30 countries, middle aged adults (30-59 years) in 32 countries, and older adults (≥60 years) in 40 countries. Data for all age groups except adolescents were lacking outside of Europe. Overall, 212 estimates for 106 countries from 24 studies were included in meta-analyses. The pooled prevalence of loneliness for adolescents ranged from 9.2% (95% confidence interval 6.8% to 12.4%) in South-East Asia to 14.4% (12.2% to 17.1%) in the Eastern Mediterranean region. For adults, meta-analysis was conducted for the European region only, and a consistent geographical pattern was shown for all adult age groups. The lowest prevalence of loneliness was consistently observed in northern European countries (2.9%, 1.8% to 4.5% for young adults; 2.7%, 2.4% to 3.0% for middle aged adults; and 5.2%, 4.2% to 6.5% for older adults) and the highest in eastern European countries (7.5%, 5.9% to 9.4% for young adults; 9.6%, 7.7% to 12.0% for middle aged adults; and 21.3%, 18.7% to 24.2% for older adults). CONCLUSION: Problematic levels of loneliness are experienced by a substantial proportion of the population in many countries. The substantial difference in data coverage between high income countries (particularly Europe) and low and middle income countries raised an important equity issue. Evidence on the temporal trends of loneliness is insufficient. The findings of this meta-analysis are limited by data scarcity and methodological heterogeneity. Loneliness should be incorporated into general health surveillance with broader geographical and age coverage, using standardised and validated measurement tools. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019131448. : Example search strategy for EMBASE, MEDLINE, and PsycINFO 3 Figure S1 : PRISMA flowchart for study selection 4 References for included studies cited in Tables 1 and 2 28 L: Low; LM: Lower Middle; UM: Upper Middle; H: High-income countries based on the World Bank country income group classification. original study. † Prevalence estimates in young adults References: 12 Vancampfort Understanding loneliness in adolescence and young adulthood Late-Life Loneliness in 11 European countries: results from the Generations and Gender Survey Loneliness does (not) have cardiometabolic effects: A longitudinal study of older adults in two countries Association between musculoskeletal pain with social isolation and loneliness: analysis of the English Longitudinal Study of Ageing Lonely places or lonely people? Investigating the relationship between loneliness and place of residence The association between socioeconomic status and depression among older adults in Finland, Poland and Spain: a comparative cross-sectional study of distinct measures and pathways Loneliness and depression in the elderly: The role of social network Mental health symptoms and verbal fluency in elderly people: Evidence from the Spanish longitudinal study of aging Loneliness among Older Adults: A National Survey of Adults 45+ Loneliness and the Workplace Associations of Loneliness and Social Isolation with Healthspan and Lifespan in the US Health and Retirement Study Leisure-time sedentary behavior and loneliness among 148,045 adolescents aged 12-15 years from 52 low-and middle-income countries Physical activity and loneliness among adults aged 50 years or older in six low-and middle-income countries Bullying victimization as a predictor of suicidal ideation and suicide attempt among senior high school students in Ghana: Results from the 2012 Ghana Global School-Based Health Survey Bullying Victimization among in-school adolescents in Ghana: Analysis of prevalence and correlates from the Global School-Based Health Survey Loneliness among in-school adolescents in Ghana: evidence from the 2012 Global School-based Student Health Survey Single and Multiple Suicide Attempts: Prevalence and Correlates in School-Going Adolescents in Liberia in 2017 Is hunger associated with truancy among in-school adolescents in Tanzania? Evidence from the 2015 Global School-based Health Survey Loneliness and its associated risk factors among in-school adolescents in Tanzania: Cross-sectional analyses of the Global School-based Health Survey data Loneliness and friendlessness among adolescents in 25 countries in Latin America and the Caribbean Association of macro-level determinants with adolescent overweight and suicidal ideation with planning: A cross-sectional study of 21 Latin American and Caribbean Countries Loneliness and associated factors among Brazilian adolescents: Results of National Adolescent School-based Health Survey Factors associated with perceived quality of life in older adults: ELSI-Brazil The role of family and computer-mediated communication in adolescent loneliness Examining individual and geographic factors associated with social isolation and loneliness using Canadian Longitudinal Study on Aging (CLSA) data Prevalence and correlates of past 12-month suicide attempt among in-school adolescents in Guatemala Jamaican youth health status 2005 Prevalence of suicidal behaviors and associated factors among Peruvian adolescent students: an analysis of a 2010 survey Sociodemographic and health-related risks for loneliness and outcome differences by loneliness status in a sample of older U.S. adults Predictors of loneliness in U.S. adults over age sixty-five Trends in the prevalence of twenty health indicators among adolescents in United Arab Emirates: Crosssectional national school surveys from Loneliness: its correlates and association with health behaviours and outcomes in nine countries of the former Soviet Union Age and loneliness in 25 European nations Does household help prevent loneliness among the elderly? An evaluation of a policy reform in the Netherlands Loneliness among older Europeans Trends in social inequality in loneliness among adolescents 1991-2014 The association between loneliness, mental well-being, and self-esteem among adolescents in four Nordic countries Loneliness and subjective health complaints among school-aged children Perceived poverty, perceived income adequacy and loneliness in Israeli young adults: Are social capital and neighbourhood capital resilience factors? Who are lonely? Loneliness in different age groups (18-81 years old), using two measures of loneliness Trends in Socioeconomic Inequalities in Norwegian Adolescents' Mental Health From Lonelier than ever? Loneliness of older people over two decades Predictors of loneliness among older women and men in Swede n: A national longitudinal study The prevalence of loneliness among adults: a case study of the United Kingdom The prevalence of, and risk factors for, loneliness in later life: A survey of older people in Great Britain Suicidal behavior among school-going adolescents in Bangladesh: Findings of the Global School-based Student Health Survey Psychosocial and socio-environmental factors associated with adolescents' tobacco and other substance use in Bangladesh Suicidal ideation and attempt among school going adolescents in Bhutan -a secondary analysis of a global school-based student health survey in Bhutan Correlates of sedentary behaviour among Bhutanese adolescents: Findings from the 2016 Global School-based Health Survey Associations of loneliness with poor physical health, poor mental health and health risk behaviours among a nationally representative community-dwelling sample of middle-aged and older adults in India Suicide attempt and associated factors among adolescents in five Southeast Asian countries in 2015 Factors associated with suicidal ideation and suicidal attempts among adolescent students in Nepal: Findings from Global School-based Students Health Survey High prevalence of unintentional injuries and socio-psychological correlates among school-going adolescents in Timor-Leste Global School-based Student Health Survey reveals correlates of suicidal behaviors in Brunei Darussalam: a nationwide cross-sectional study The prevalence of and risk factors for loneliness among older people in China Association of depressive symptoms with incident cardiovascular diseases in middle-aged and older Chinese adults Bullying victimization among school-going adolescents in Malaysia: prevalence and associated factors