PDF 3
PDF 3
PDF 3
Viewpoint
Corresponding Author:
Mowafa Househ, PhD
Hamad bin Khalifa University
Education City - Gate 8
Ar Rayyan
Doha
Qatar
Phone: 974 44547278
Email: mhouseh@hbku.edu.qa
Abstract
Loneliness affects the quality of life of people all around the world. Loneliness is also shown to be directly associated with mental
health issues and is often the cause of mental health problems. It is also shown to increase the risk of heart diseases and other
physical illnesses. Loneliness is studied both from the social and medical sciences perspectives. There are also interventions on
the basis of health informatics, information and communication technologies (ICTs), social media, and other technological
solutions. In the literature, loneliness is studied from various angles and perspectives ranging from biological to socioeconomical
and through anthropological understandings of technology. From the ICT and technological sides, there are multiple reviews
studying the effectiveness of intervention strategies and solutions. However, there is a lack of a comprehensive review on loneliness
that engulfs the psychological, social, and technological studies of loneliness. From the perspective of loneliness informatics (ie,
the application of health informatics practices and tools), it is important to understand the psychological and biological basis of
loneliness. When it comes to technological interventions to fight off loneliness, the majority of interventions focus on older
people. While loneliness is highest among older people, theoretical and demographical studies of loneliness give a U-shaped
distribution age-wise to loneliness; that is, younger people and older people are the demographics most affected by loneliness.
But the strategies and interventions designed for older people cannot be directly applied to younger people. We present the
dynamics of loneliness in younger people and also provide an overview of the technological interventions for loneliness in younger
people. This paper presents an approach wherein the studies carried out from the perspectives of digital health and informatics
are discussed in detail. A comprehensive overview of the understanding of loneliness and the study of the overall field of tools
and strategies of loneliness informatics was carried out. The need to study loneliness in younger people is addressed and particular
digital solutions and interventions developed for younger people are presented. This paper can be used to overcome the challenges
of technological gaps in the studies and strategies developed for loneliness. The findings of this study show that the majority of
interventions and reviews are focused on older people, with ICT-based and social media–based interventions showing promise
for countering the effects of loneliness. There are new technologies, such as conversational agents and robots, which are tailored
to the particular needs of younger people. This literature review suggests that the digital solutions developed to overcome loneliness
can benefit people, and younger people in particular, more if they are made interactive in order to retain users.
KEYWORDS
health informatics; loneliness informatics; loneliness theory; health effects; loneliness interventions; information and communication
technology; ICT-based interventions; social-media–based interventions; social media; ICT; lonely; loneliness; social isolation;
mental health; psychological
in productivity is estimated to be US$3.14 billion per year for and consuming alcohol [17]. Studies have also shown that young
employees in the United Kingdom. Loneliness is also linked to people are particularly prone to mental health problems, with
a 30% increase in heart disease, stroke, dementia, depression, 1 in every 8 young people aged 5 to 19 years having a mental
and anxiety [2-4]. Loneliness and isolation are interlinked yet health issue [18]. Because loneliness and mental health problems
separate concepts. Loneliness is defined as the subjective are related in adults and 75% of all mental health problems
difference between a person’s desired and actual social contact emerge before the age of 24 years, it is important to study
and relations [5]. Loneliness can be subjective, while isolation, loneliness in younger people and overcome the condition earlier
on the other hand, is a social phenomenon in which there is to avoid consequent mental health problems.
actual absence of social engagement and contact both with the
Finally, the COVID-19 pandemic has had a greater impact on
immediate family and larger community [6]. This can be acutely
the feeling of loneliness among younger people than the general
the case for older adults, where one-third and one-quarter of
population, with 50.8% of people aged 16 to 24 years reporting
them will experience feelings of loneliness and isolation,
feeling lonely as compared to the general population ratio of
respectively [7,8].
30.9% [17]. Other research has shown an increase in feelings
Social isolation results in the loss of self-esteem and of anger and perceived stress during the COVID-19 pandemic
self-confidence and hence the ability to form meaningful social as compared to prepandemic levels [19].
relationships. Stigma may be particularly significant for certain
These factors make studying loneliness in young people urgent.
age groups, such as young people [9]. Studies have linked
A review is important to find out what technology-based
loneliness and social isolation to numerous determinants, such
interventions are available for loneliness among young people
as possible psychological, social, neurocognitive, and genetic
and what kind of interventions will be more effective than others
mechanisms, as well as relationships with community and social
in reducing loneliness among young people. This paper was
factors [9]. What makes loneliness hard to study as a category
written after consulting a wide range of resources on loneliness,
is that it can be viewed as a transdiagnostic construct that can
from theoretical understandings of loneliness to technological
occur alongside, as well as cause and predict, a variety of mental
interventions for overcoming loneliness. The resources and
health conditions [10]. Transient loneliness results in emotional
papers were found using Google Scholar. No particular inclusion
distress, which can be caused by social disconnection but can
methodology was used to review or study papers other than to
be coped with. The problem arises if loneliness persists in the
find papers that gave an introduction to both loneliness on a
long-term, at which point it can result in the altering of
theoretical level and for technological interventions. The
neurobiological and behavioral patterns. Cacioppo and Hawkley
available literature was further studied to identify different
[11] theorize about a self-enforcing loop of chronic loneliness,
categories of technological interventions to overcome loneliness.
leading to an increase in hypervigilance and cognitive bias
The survey of available literature revealed that a relatively
toward social threat, hence eliciting hostile behavior toward
smaller number of technological interventions focus on
social interaction.
overcoming loneliness in younger people than in older people.
There have been several systematic and scoping reviews done Summarily, there are 3 types of technology-based interventions
to understand loneliness. Similarly, from a health informatics in the literature on loneliness in young people. The first type
perspective, there have been multiple systematic reviews of the deals with social media–based intervention strategies for fighting
connection between loneliness and mental health [6,8,12-14]. loneliness in young people. The second type deals with broader
From the health informatics side, there also have been studies applications of information and communication technology
that deal with the application of technology-based interventions (ICT) ranging from videoconferencing, psychotherapy, and
to cope with loneliness. There are also scoping reviews to find remote counselling. The third type of literature available in
the effectiveness of technology-based intervention strategies loneliness informatics is about exploring the effects of the
for loneliness [14]. However, there are limitations to the scoping prevalent use of social media in young people and its
reviews done on loneliness, both theoretical (ie, psychological relationship with loneliness.
aspect) and technical (ie, from a health informatics perspective).
The major contributions of this literature review are as follows:
The first limitation is that almost all of them focus on
intervention strategies for older people. Second, from a health • Situating the literature on loneliness in young people in
informatics perspective, a comprehensive study of loneliness informatics through a short overview of the
technology-based interventions has not been carried such that literature on loneliness across all age groups.
a general overview of different technologies used to cope with • Comprehensively reviewing technology-based intervention
loneliness can be drawn. strategies for reducing loneliness in younger people.
• Highlighting gaps in the current literature on loneliness in
Young people are particularly prone to being lonely. The reasons
young people.
for this are multifaceted. The first context is a developmental
• Exploring and proposing methods and technology tools that
one, wherein adolescent social interaction is key to identity
can be used to build more effective tools for reducing
formation and individuation from family [15,16]. Any negative
loneliness in younger people.
experience as to social interaction can result in self-imposed
isolation, and thus loneliness. The other context is that of
increased risky behavior, which can be exacerbated by the
feeling of loneliness. Studies have shown that loneliness in
young people results in increased risks of smoking, taking drugs,
https://www.i-jmr.org/2023/1/e45197 Interact J Med Res 2023 | vol. 12 | e45197 | p. 2
(page number not for citation purposes)
XSL• FO
RenderX
INTERACTIVE JOURNAL OF MEDICAL RESEARCH Shah & Househ
disconnection from their social context [28]. It was also noted interaction and interpersonal skills [31]. Technology-based
by the UK Office of National Statistics that people aged 16 to interventions for loneliness focus on one or more of these target
24 years were the loneliest of all age groups [28]. It was shown areas. Technology can engulf different modes of interventions,
by Qualter et al [29] that chronic loneliness predicts adolescent such as individual psychotherapy with cognitive behavioral
depression. Loneliness affects the quality of life particularly therapy, mindfulness therapies, and social support groups
because of the stigma associated with seeking formal or informal [32-34]. Because of the COVID-19 pandemic, remote
help [30]. The loneliness reported by younger people is even psychotherapies and support groups have been used.
higher than that reported by older people, as reported by some Internet-based cognitive behavioral therapy and skills training
studies. A web-based survey found that out of 55,000 people, to access internet and web-based support have been used for
40% of people aged 16 to 24 years reported loneliness as remote therapies [35,36].
compared to 27% of people older than 75 years [28]. Behavioral
Figure 1 presents the particular dynamics of loneliness in
genetic analysis indicates that loneliness and depression are
younger people and shows that the causes of loneliness in
influenced by the same genes, while the effects of these genes
younger people are distinct; therefore, the solutions for
can be higher in younger people. In view of the high prevalence
overcoming loneliness in younger people should address these
of loneliness in younger people and its potential lifelong
distinct causes. These distinct causes include processes of
consequences, it is paramount to gain a better understanding of
identity formation, individuation from family, as well as
loneliness and its relation to depression in younger people and
experiencing new environments, such as that of college and a
to design age-appropriate treatments.
new city [15,16]. Figure 1 has presented these parameters in
Psychological interventions for overcoming loneliness have graphical form with the consequences of increased loneliness.
proven to work if the target areas are changing maladaptive The increased risk of mental health issues, isolation, and
social perception, increasing social contact, increasing substance abuse are presented [18,37].
opportunities for social interaction, and improving social
Figure 1. Dynamics of loneliness in young people.
found that there was a lack of evidence and limited insight into
innovative technologies, such as extended reality frameworks.
Loneliness Informatics for Younger
In work by Shah et al [1], a systematic review and meta-analysis People
was carried out for digital technology–based interventions to
reduce loneliness in older adults. The study analyzed 6 articles This section presents in detail the literature on loneliness
including a total of 646 participants. The study showed no informatics for younger people. This section aims to present
statistical difference between the effectiveness of digital focused technological interventions for younger people in order
intervention, but it self-reported the lack of enough studies and to build upon them. The following subsections discuss each in
small sample size of participants as the cause for the lack of detail.
validating effectiveness. ICT-Based Interventions
However, there are studies (eg, [38]) that establish the While ICT-based interventions are used extensively for
relationship between communication-based technologies and overcoming loneliness in older people in the literature, it can
reduction in the feeling of loneliness. A cross-sectional study also be applied to younger people. ICT-based interventions for
of 4315 adults older than 50 years reported that rural older adults loneliness in older people suit their needs of communication
who used technology less frequently felt loneliness more than and connection as their loneliness is often born out of social
urban older adults. The study also explored the relationship isolation. Pitman et al [9] presented a scoping review of reviews
between race, urbanity, and age, and recommended that of ICT-based interventions for older people; however, such
technology-based intervention be consider a social technology reports do not exist for younger people.
to address rural and racial disparities. Nevertheless, the
Studies on the effectiveness of ICT-based interventions for
connection or direct correlation between social media technology
young people are rare. Internet, videoconferencing, email,
use and reduction in the feeling of loneliness is not strongly
telephone, video game consoles, tablets, and smartphones are
established. Wiwatkunupakarn et al [12] performed a study of
the mediums for implementing ICT-based loneliness
the effectiveness of social networking site usage in older people
intervention strategies. The use of these mediums and tools is
for reducing loneliness. The study analyzed 10 observational
prevalent in younger people, and intervention strategies for
studies and 5 experimental studies, of which 5 studies focused
loneliness for younger people can be designed around them. In
on loneliness and social isolation. Among the observational
work by Stephens-Reicher et al [43], an evidence base was built
studies, some evidence was found that the use of social
to see the efficacy of ICT interventions for youths facing social
networking sites was associated with reductions in the feelings
isolation and ensuing mental health problems. It has to be noted
of loneliness and depression; however, the study was lacking
that social isolation is not totally specific to young people, and
on the experimental side. The conclusion here, too, required
other groups, such as transgender people, may feel it and may
more studies to establish unambiguously the relationship
rely upon the internet to find safety and connection. Similarly,
between technology use and loneliness.
for young people experiencing limited career opportunities as
As can be seen from the reviews presented in this section, work well as limited social and educational opportunities, ICT tools
in technology-based intervention to reduce loneliness has been may be the gateway to building friendships and connection and
focused on older people. There is a protocol design study for seeking ways for growth. It was also reported by Yeo and
carrying out technology-based interventions for older people, Sawyer [44] that young people with chronic illnesses may have
which details the parameters on which such a scoping review limited opportunities for social interaction, which can be
can be done [6]. There is also a survey study about designing overcome by the use of ICT for continual social and educational
a digital psychoeducation tool for reducing loneliness in older participation [45].
people [39]. The study highlighted how the older adults’
The social isolation born out of geographical location and
concerns about technology could be incorporated through an
socioeconomic parameters, such as race, class, and religious
iterative process in a co-design approach to designing a
identity, can reduce access to face-to-face services for loneliness
technological approach. Budak et al [40] studied a
and other mental health–related services. ICT-based
technology-based intervention for dementia and loneliness with
interventions for loneliness and related mental health problems,
a particular focus on the role of assistive technologies. It was
if delivered strategically, can overcome geographic and
concluded that assistive technologies meant to fight dementia
socioeconomic discriminations. The developmental challenges
have a positive effect in reducing loneliness in older people.
faced by youths that lead to social isolation, such as growth and
Many studies meant to analyze loneliness in young people also consolidation of identity, maturation of identity, and transition
consider older people. For example, Loveys et al [31] found into formal schooling, can well be addressed by ICT-based
that technology-based interventions for both older and younger interventions. The specific importance of social and digital
people were acceptable to both groups. Other studies also media in web-based spaces for providing support during the
focused on surveying and designing feasibility cases for COVID-19 pandemic has been reported [46]. The ability to
technology-based intervention in older people [41,42]. The connect with others is also reported to be associated with
common denominator in these technology-based studies is that well-being achieved through using communication technologies
both older and younger people are considered. [47]. The positive effects of technology intervention were
reported to be 44% [29]. A scoping review of interventions
specifically for youths suggested that technology may be an
effective alternative to face-to-face interventions as 90% of a positive correlation between the self-esteem of college students
younger adults use the internet at least occasionally [48]. The and the use of social media sites. Individuals who are socially
current literature is mostly focused on exploring anxious, introverted, or less likely to self-disclose may find
technology-based interventions to overcome loneliness for older social media particularly helpful in establishing contacts, thus
adults. This calls for the need to explore ICT and other reducing the feelings of social isolation and loneliness. The
technology-based interventions to overcome loneliness in self-disclosure hypothesis has also been supported in the
younger people. literature [57]. It was showed that, because of reduced visual,
auditory, and contextual signals, the users may become more
Social Media–Based Interventions confident to share their feelings, vulnerabilities, and emotions
Like ICT-based interventions for loneliness, social networking as they perceive the medium and the interaction to be less
sites (SNSs) and social media–based interventions for loneliness judgmental, hence leading to more self-disclosure and deeper
have been considered for older adults in the literature. Because relationships.
of the wide appeal and use of social media and SNSs, there are
a few studies of these mediums for loneliness interventions in In a report by Vincent [58], the use of social media to develop
younger people as well. The main distinction between social a sense of belonging was studied. Belonging and loneliness are
media and SNSs is that SNSs allow users to share content with associated—a sense of belonging to a community brings down
limited users to see responses from friends, family members, the feeling of loneliness. The study explored the role of social
or followers [12,49]. This makes popular social media sites, media as a therapeutic model used by college counsellors. The
such as Twitter, Facebook, and Instagram, SNSs but not the results showed that such use of social media increased the sense
other way around. SNSs with limited circles of interaction were of belonging. This study suggests that social media can be used
found to be effective in social support and be a source of health by college counselors as a potential tool to overcome loneliness
information [50]. Loneliness is reported to be reduced through in college students. Similar results were reported by Liu et al
the use of SNS-based interventions for older people [51]. [59] for minority youths to identify more with web-based friends
and to report more support on the internet than in real life. When
Social media–based interventions for loneliness can address the belonging and overcoming loneliness is the central motivating
needs of younger people to connect and create bonds. The factor behind the use of social media, it was found that the sense
displacement of identity and social relations, which result in of community is likely to increase, resulting in a reduction in
loneliness in younger people, can be overcome through loneliness [60].
SNS-based interventions. Studies show that social media
technology enables personal relationships inside and outside of Robots, Conversational Agents, and Digital Humans:
one’s social circle. The use of social media is also shown to Application to Loneliness in Younger People
result in a deepened sense of identity and purpose [52,53]. When Robots are another area of technology-based interventions for
considering the use of social media–based interventions for loneliness. Robots are particularly useful for older adults [31,61].
youths, the following questions should be addressed: Does social Studies have suggested different robots for companionship and
media help in forming social relationships among youths or the reported a general reduction in loneliness and an increase in the
opposite? Do some youths, on the basis of their socioeconomic sense of companionship [46,62-64]. Social robots are also
or geographical realities, become more prone to using social reported to improve loneliness in younger adults [65]. Similarly,
media as their primary source of socialization? Finally, is social conversational agents (CAs), where robots or interactive mobile
media use associated with problematic internet use (PIU), and or software applications conversate, have been effective in older
at what point do the benefits of social media use change into people, especially if they are human-like embodied and use
PIU? proactive communications.
A study in 2018 explored the relationship of social media use CAs can be employed for all age groups as they respond to the
over time in youths and frequent face-to-face communication needs of people with loneliness. Digital humans (DHs) can be
with close social circles, such as family and friends, and their classified as a type of CA, with the difference that the agent
associated subjective well-being [54]. The research provided who is interacting with the user has a human-like appearance
little support for the social displacement model theory, which and uses artificial intelligence to build real-time social and
states that social media displaces or replaces real-life social emotional engagement with users [66]. Interacting with such
relationships, which have depth with remote social media an agent can reduce the feeling of loneliness, as the appearance
connections. In fact, the study found a positive association of DHs is human-like because they are based on real-life
between social media use and well-being changes. Similarly, characters. Some DHs are designed to include a complex
there is little support for the assertion that increased social media cognitive architecture modelled on human behavior, which is
use can result in loneliness and depression [55]. If social media able to show attachment and separation toward users to influence
and the internet are better integrated into the lives of the their behavior. DHs can be useful in delivering remote loneliness
participants, such as when they are used to interact with friends intervention as they are scalable and require access to the
and family, the result is the feeling of loneliness fades over time. internet and a device, be it a computer, tablet, or mobile device.
The social compensation model, contrary to the social The features of DHs that can be useful for countering loneliness
displacement model, asserts that social media may reduce the are the real-life tasks that can be recommended by the
feeling of loneliness because it may be seen by users as a safer human-like CA to the user. In a study by Loveys et al [31], a
space for exploring social connections. Ellison et al [56] found DH was designed by the name of “Bella”. Bella was modelled
https://www.i-jmr.org/2023/1/e45197 Interact J Med Res 2023 | vol. 12 | e45197 | p. 6
(page number not for citation purposes)
XSL• FO
RenderX
INTERACTIVE JOURNAL OF MEDICAL RESEARCH Shah & Househ
to be a woman of Maori and New Zealand European decent, digital media use is that it is often asserted that they are
and the program was accessible through the web. The responsible for increased loneliness in younger people. The
conversation facilitator (ie, Bella), responded to users’ input reported studies in this paper suggested that this may not be the
through speech, text, or a prompt to press a button on a screen. case. However, there still is the possibility of PIU. There are
Bella engaged in human-like facial gestures, and her face factors that may affect addiction possibilities, such as low social
portrayed joy and concern. Bella also had linguistic variation capital, which can carry over to social media and bullying, which
of her own such that the user did not feel mechanical repetition can happen in social media and web-based spaces. Some
of the same phrases. The relationship-building strategies students and younger people who have social anxiety issues use
employed by Bella were taken from psychology and social media for socialization. Overall, social media was found
human-computer interaction research [67]. These included tasks to be an effective intervention tool and strategy for countering
such as positive self-affirmation, reaching out to a friend, and loneliness. CAs and DHs, forms of digital technology with the
complimenting someone you know. Participants who took part added features of human-like language processing or human-like
in interactions with Bella reported that Bella was useful in appearance, were also found to be helpful as coping mechanisms
improving the feeling of loneliness and that they would like to for loneliness. Because of the requirement of technology
interact with Bella again in the future. The study also reported competency, the study found that they are more helpful to
that it was easy to train younger people to use the service either younger people.
in a clinic room at the university or through video calling, and
Understanding loneliness from a health informatics perspective
technical support requests were low for younger people during
is an open field. There are issues, gaps, and challenges that
the training. DHs are used for a variety of purposes. DHs play
should be addressed in future works. A comprehensive review
a key role in augmenting reality and in other forms of extended
of different aspects of the application of technology to
reality. These are not limited to mental health applications, or
understand loneliness and to design intervention programs for
in the case of this paper, to loneliness informatics.
overcoming loneliness can be undertaken. Examples of such
reviews can be the application of virtual reality– and extended
Conclusion and Future Directions reality–based interventions for loneliness, machine
This paper presented a comprehensive review of loneliness learning–based applications in serious games for loneliness,
informatics. While there has been significant work done on and comparative analysis of these technologies for younger and
countering loneliness in older adults, the same is not true for older people. There are also other aspects of loneliness and its
younger people, who have the highest loneliness numbers. This intersection with technology that need to be explored, such as
paper discussed in detail the particular dynamics of loneliness whether the use of technology, especially social media, leads
in younger people, which range from developmental changes to loneliness and how to use social media effectively for
to transitioning into new social contexts to cultural and countering loneliness. Other than analysis of the literature,
psychological dynamics that begin to form at adolescence, such loneliness informatics can use data to understand loneliness in
as the search for personal identity, meaning, and purpose. This different geographical regions as well as different contexts. One
paper presented an overview of loneliness informatics for older challenge to loneliness informatics is the availability of data,
people, which included the use of digital media, social media, which needs to be approximated from different sources, such
and robotics for interventions to cope with loneliness. as social media and news analyses. Another challenge is that
the intervention strategies have to consider the social and
The focus of loneliness informatics is not on the younger economic contexts of loneliness, which need policymaking at
population. However, in terms of social media, there have been multiple levels of government and organizations.
some studies carried out. One downside of social media and
Authors' Contributions
HAS designed the study, selected sources to review, and wrote the manuscript. MH supervised the study and reviewed the draft
of the paper.
Conflicts of Interest
None declared.
References
1. Shah SGS, Nogueras D, van Woerden HC, Kiparoglou V. Evaluation of the effectiveness of digital technology interventions
to reduce loneliness in older adults: systematic review and meta-analysis. J Med Internet Res 2021 Jun 04;23(6):e24712
[FREE Full text] [doi: 10.2196/24712] [Medline: 34085942]
2. Schrempft S, Jackowska M, Hamer M, Steptoe A. Associations between social isolation, loneliness, and objective physical
activity in older men and women. BMC Public Health 2019 Jan 16;19(1):74 [FREE Full text] [doi:
10.1186/s12889-019-6424-y] [Medline: 30651092]
3. Okwaraji FE, Obiechina KI, Onyebueke GC, Udegbunam ON, Nnadum GS. Loneliness, life satisfaction and psychological
distress among out-of-school adolescents in a Nigerian urban city. Psychol Health Med 2018 Oct;23(9):1106-1112 [doi:
10.1080/13548506.2018.1476726] [Medline: 29792068]
https://www.i-jmr.org/2023/1/e45197 Interact J Med Res 2023 | vol. 12 | e45197 | p. 7
(page number not for citation purposes)
XSL• FO
RenderX
INTERACTIVE JOURNAL OF MEDICAL RESEARCH Shah & Househ
4. van den Broek T. Gender differences in the correlates of loneliness among Japanese persons aged 50-70. Australas J Ageing
2017 Sep;36(3):234-237 [doi: 10.1111/ajag.12448] [Medline: 28685951]
5. Holt-Lunstad J. The potential public health relevance of social isolation and loneliness: prevalence, epidemiology, and risk
factors. Public Policy Aging Rep 2017;27(4):127-130 [doi: 10.1093/ppar/prx030]
6. Wister A, Fyffe I, O'Dea E. Technological interventions for loneliness and social isolation among older adults: a scoping
review protocol. Syst Rev 2021 Aug 07;10(1):217 [FREE Full text] [doi: 10.1186/s13643-021-01775-6] [Medline: 34362447]
7. Grenade L, Boldy D. Social isolation and loneliness among older people: issues and future challenges in community and
residential settings. Aust Health Rev 2008 Aug;32(3):468-478 [doi: 10.1071/ah080468] [Medline: 18666874]
8. Wister A, Menec V, Mugford G. Loneliness, social isolation, and social engagement. The Canadian Longitudinal Study
on Aging (CLSA) Report on Health and Aging in Canada. 2018. URL: https://www.clsa-elcv.ca/doc/2639 [accessed
2023-10-12]
9. Pitman A, Mann F, Johnson S. Advancing our understanding of loneliness and mental health problems in young people.
Lancet Psychiatry 2018 Dec;5(12):955-956 [doi: 10.1016/s2215-0366(18)30436-x]
10. Hickin N, Käll A, Shafran R, Sutcliffe S, Manzotti G, Langan D. The effectiveness of psychological interventions for
loneliness: a systematic review and meta-analysis. Clin Psychol Rev 2021 Aug;88:102066 [doi: 10.1016/j.cpr.2021.102066]
[Medline: 34339939]
11. Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci 2009 Oct;13(10):447-454 [FREE
Full text] [doi: 10.1016/j.tics.2009.06.005] [Medline: 19726219]
12. Wiwatkunupakarn N, Pateekhum C, Aramrat C, Jirapornchaoren W, Pinyopornpanish K, Angkurawaranon C. Social
networking site usage: a systematic review of its relationship with social isolation, loneliness, and depression among older
adults. Aging Ment Health 2022 Jul;26(7):1318-1326 [doi: 10.1080/13607863.2021.1966745] [Medline: 34427132]
13. Choi HK, Lee SH. Trends and effectiveness of ICT interventions for the elderly to reduce loneliness: a systematic review.
Healthcare (Basel) 2021 Mar 07;9(3):293 [FREE Full text] [doi: 10.3390/healthcare9030293] [Medline: 33800099]
14. Döring N, Conde M, Brandenburg K, Broll W, Gross H, Werner S, et al. Can communication technologies reduce loneliness
and social isolation in older people? A scoping review of reviews. Int J Environ Res Public Health 2022 Sep 08;19(18):11310
[FREE Full text] [doi: 10.3390/ijerph191811310] [Medline: 36141581]
15. Hards E, Loades ME, Higson-Sweeney N, Shafran R, Serafimova T, Brigden A, et al. Loneliness and mental health in
children and adolescents with pre-existing mental health problems: a rapid systematic review. Br J Clin Psychol 2022
Jun;61(2):313-334 [doi: 10.1111/bjc.12331] [Medline: 34529837]
16. Blakemore S, Mills KL. Is adolescence a sensitive period for sociocultural processing? Annu Rev Psychol 2014;65:187-207
[doi: 10.1146/annurev-psych-010213-115202] [Medline: 24016274]
17. Stickley A, Koyanagi A, Koposov R, Schwab-Stone M, Ruchkin V. Loneliness and health risk behaviours among Russian
and U.S. adolescents: a cross-sectional study. BMC Public Health 2014 Apr 16;14:366 [FREE Full text] [doi:
10.1186/1471-2458-14-366] [Medline: 24735570]
18. Study Quality Assessment Tools. National Heart, Lung, and Blood Institute. URL: https://www.nhlbi.nih.gov/health-topics/
study-quality-assessment-tools [accessed 2023-10-12]
19. Shanahan L, Steinhoff A, Bechtiger L, Murray AL, Nivette A, Hepp U, et al. Emotional distress in young adults during the
COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study. Psychol Med 2020 Jun
23;52(5):824-833 [doi: 10.1017/s003329172000241x]
20. Peplau LA, Perlman D, editors. Loneliness: A Sourcebook of Current Theory, Research and Therapy. New York: Wiley;
1982.
21. Gierveld JDJ. A review of loneliness: concept and definitions, determinants and consequences. Rev Clin Gerontol 1998
Feb 01;8(1):73-80 [doi: 10.1017/s0959259898008090]
22. Spithoven AWM, Cacioppo S, Goossens L, Cacioppo JT. Genetic contributions to loneliness and their relevance to the
evolutionary theory of loneliness. Perspect Psychol Sci 2019 May;14(3):376-396 [doi: 10.1177/1745691618812684]
[Medline: 30844327]
23. Maes M, Qualter P, Vanhalst J, Van den Noortgate W, Goossens L. Gender differences in loneliness across the lifespan: a
meta–analysis. Eur J Pers 2019 Nov 01;33(6):642-654 [doi: 10.1002/per.2220]
24. Achterbergh L, Pitman A, Birken M, Pearce E, Sno H, Johnson S. The experience of loneliness among young people with
depression: a qualitative meta-synthesis of the literature. BMC Psychiatry 2020 Aug 24;20(1):415 [FREE Full text] [doi:
10.1186/s12888-020-02818-3] [Medline: 32831064]
25. Stessman J, Rottenberg Y, Shimshilashvili I, Ein-Mor E, Jacobs JM. Loneliness, health, and longevity. J Gerontol A Biol
Sci Med Sci 2014 Jun;69(6):744-750 [doi: 10.1093/gerona/glt147] [Medline: 24077598]
26. Vanhalst J, Goossens L, Luyckx K, Scholte RH, Engels RC. The development of loneliness from mid- to late adolescence:
trajectory classes, personality traits, and psychosocial functioning. J Adolesc 2013 Dec;36(6):1305-1312 [doi:
10.1016/j.adolescence.2012.04.002] [Medline: 22560517]
27. Weiss RS, editor. Loneliness: The Experience of Emotional and Social Isolation. Cambridge: The MIT Press; 1975.
28. Children’s and young people’s experiences of loneliness: 2018. Office for National Statistics. URL: https://www.ons.gov.uk/
peoplepopulationandcommunity/wellbeing/articles/childrensandyoungpeoplesexperiencesofloneliness/2018 [accessed
2023-10-12]
29. Qualter P, Brown SL, Munn P, Rotenberg KJ. Childhood loneliness as a predictor of adolescent depressive symptoms: an
8-year longitudinal study. Eur Child Adolesc Psychiatry 2010 Jun;19(6):493-501 [doi: 10.1007/s00787-009-0059-y]
[Medline: 19777287]
30. Salaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: a cross-sectional
survey. Br J Gen Pract 2016 Sep 29;66(651):e686-e692 [doi: 10.3399/bjgp16x687313]
31. Loveys K, Sagar M, Pickering I, Broadbent E. A digital human for delivering a remote loneliness and stress intervention
to at-risk younger and older adults during the COVID-19 pandemic: randomized pilot trial. JMIR Ment Health 2021 Nov
08;8(11):e31586 [FREE Full text] [doi: 10.2196/31586] [Medline: 34596572]
32. Chiang K, Chu H, Chang H, Chung M, Chen C, Chiou H, et al. The effects of reminiscence therapy on psychological
well-being, depression, and loneliness among the institutionalized aged. Int J Geriatr Psychiatry 2010 Apr;25(4):380-388
[doi: 10.1002/gps.2350] [Medline: 19697299]
33. Creswell JD, Irwin MR, Burklund LJ, Lieberman MD, Arevalo JM, Ma J, et al. Mindfulness-based stress reduction training
reduces loneliness and pro-inflammatory gene expression in older adults: a small randomized controlled trial. Brain Behav
Immun 2012 Oct;26(7):1095-1101 [FREE Full text] [doi: 10.1016/j.bbi.2012.07.006] [Medline: 22820409]
34. Collins CC, Benedict J. Evaluation of a community-based health promotion program for the elderly: lessons from Seniors
CAN. Am J Health Promot 2006 Sep;21(1):45-48 [doi: 10.4278/0890-1171-21.1.45]
35. Käll A, Jägholm S, Hesser H, Andersson F, Mathaldi A, Norkvist BT, et al. Internet-based cognitive behavior therapy for
loneliness: a pilot randomized controlled trial. Behav Ther 2020 Jan;51(1):54-68 [doi: 10.1016/j.beth.2019.05.001] [Medline:
32005340]
36. Jones RB, Ashurst EJ, Atkey J, Duffy B. Older people going online: its value and before-after evaluation of volunteer
support. J Med Internet Res 2015 May 18;17(5):e122 [FREE Full text] [doi: 10.2196/jmir.3943] [Medline: 25986724]
37. Kessler R, Angermeyer M, Anthony JC, DE Graaf R, Demyttenaere K, Gasquet I, et al. Lifetime prevalence and age-of-onset
distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative. World Psychiatry
2007 Oct;6(3):168-176 [FREE Full text] [Medline: 18188442]
38. Byrne KA, Anaraky RG, Dye C, Ross LA, Chalil Madathil K, Knijnenburg B, et al. Examining rural and racial disparities
in the relationship between loneliness and social technology use among older adults. Front Public Health 2021;9:723925
[FREE Full text] [doi: 10.3389/fpubh.2021.723925] [Medline: 34532308]
39. Al Mahmud A, Long KM, Harrington KD, Casey K, Bhar S, Curran S, et al. Developing a digital psychoeducational tool
to reduce loneliness in older adults: a design case study. Int J Hum-Comput Int 2021 Aug 04;38(6):499-528 [doi:
10.1080/10447318.2021.1949854]
40. Budak KB, Atefi G, Hoel V, Laporte Uribe F, Meiland F, Teupen S, et al. Can technology impact loneliness in dementia?
A scoping review on the role of assistive technologies in delivering psychosocial interventions in long-term care. Disabil
Rehabil Assist Technol 2021 Nov 09:1-13 [doi: 10.1080/17483107.2021.1984594] [Medline: 34752177]
41. Amundsen D. Digital technologies as a panacea for social isolation and loneliness among older adults: an intervention
model for flourishing and wellbeing. Video J Educ Pedagog 2021 Jan 11;5(1):1-14 [doi: 10.1163/23644583-00501008]
42. Hoang P, Whaley C, Thompson K, Ho V, Rehman U, Boluk K, et al. Evaluation of an intergenerational and technological
intervention for loneliness: protocol for a feasibility randomized controlled trial. JMIR Res Protoc 2021 Feb 17;10(2):e23767
[FREE Full text] [doi: 10.2196/23767] [Medline: 33595443]
43. Stephens-Reicher J, Metcalf A, Blanchard M, Mangan C, Burns J. Reaching the hard-to-reach: how information
communication technologies can reach young people at greater risk of mental health difficulties. Australas Psychiatry 2011
Jul:S58-S61 [doi: 10.3109/10398562.2011.583077] [Medline: 21878021]
44. Yeo M, Sawyer S. Chronic illness and disability. BMJ 2005 Mar 26;330(7493):721-723 [FREE Full text] [doi:
10.1136/bmj.330.7493.721] [Medline: 15790645]
45. Third A, Richardson I. Analysing the impacts of social networking for young people living with chronic illness, a serious
condition or a disability: an evaluation of the livewire online community. Murdoch Univeristy. 2009. URL: https:/
/researchportal.murdoch.edu.au/esploro/outputs/report/Analysing-the-impacts-of-social-networking/991005543794107891
[accessed 2023-10-12]
46. Robinson H, Macdonald B, Kerse N, Broadbent E. The psychosocial effects of a companion robot: a randomized controlled
trial. J Am Med Dir Assoc 2013 Sep;14(9):661-667 [doi: 10.1016/j.jamda.2013.02.007] [Medline: 23545466]
47. Laranjo L, Dunn AG, Tong HL, Kocaballi AB, Chen J, Bashir R, et al. Conversational agents in healthcare: a systematic
review. J Am Med Inform Assoc 2018 Sep 01;25(9):1248-1258 [FREE Full text] [doi: 10.1093/jamia/ocy072] [Medline:
30010941]
48. Eccles AM, Qualter P. Alleviating loneliness in young people - a meta-analysis of interventions. Child Adolesc Ment Health
2021 Feb;26(1):17-33 [doi: 10.1111/camh.12389] [Medline: 32406165]
49. Casanova G, Zaccaria D, Rolandi E, Guaita A. The effect of information and communication technology and social
networking site use on older people's well-being in relation to loneliness: review of experimental studies. J Med Internet
Res 2021 Mar 01;23(3):e23588 [FREE Full text] [doi: 10.2196/23588] [Medline: 33439127]
50. Teng C, Joo TM. Analyzing the usage of social media: A study on elderly in Malaysia. Int J Humanit Soc Sci
2017;11(3):737-743
51. Goswami S, Köbler F, Leimeister JM, Krcmar H. Using online social networking to enhance social connectedness and
social support for the elderly. In: ICIS 2010 PROCEEDINGS. 2010 Presented at: ICIS 2010; December 12-15, 2010; St.
Louis
52. Smith D, Leonis T, Anandavalli S. Belonging and loneliness in cyberspace: impacts of social media on adolescents’
well-being. Aust J Psychol 2021 Mar 31;73(1):12-23 [doi: 10.1080/00049530.2021.1898914]
53. Verduyn P, Ybarra O, Résibois M, Jonides J, Kross E. Do social network sites enhance or undermine subjective well‐being?
A critical review. Soc Issues Policy Rev 2017 Jan 13;11(1):274-302 [doi: 10.1111/sipr.12033]
54. Hall JA, Kearney MW, Xing C. Two tests of social displacement through social media use. Inf Commun Soc 2018 Feb
02;22(10):1396-1413 [doi: 10.1080/1369118x.2018.1430162]
55. Houghton S, Lawrence D, Hunter SC, Rosenberg M, Zadow C, Wood L, et al. Reciprocal relationships between trajectories
of depressive symptoms and screen media use during adolescence. J Youth Adolesc 2018 Nov;47(11):2453-2467 [FREE
Full text] [doi: 10.1007/s10964-018-0901-y] [Medline: 30046970]
56. Ellison N, Steinfield C, Lampe C. The benefits of Facebook "friends:" social capital and college students' use of online
social network sites. J Comput-Mediat Comm 2007;12(4):1143-1168 [doi: 10.1111/j.1083-6101.2007.00367.x]
57. Valkenburg PM, Peter J. Online communication among adolescents: an integrated model of its attraction, opportunities,
and risks. J Adolesc Health 2011 Feb;48(2):121-127 [doi: 10.1016/j.jadohealth.2010.08.020] [Medline: 21257109]
58. Vincent EA. Social media as an avenue to achieving sense of belonging among college students.Vistas Online,36. Vistas
ONLINE. 2016. URL: https://www.counseling.org/docs/default-source/vistas/social-media-as-an-avenue.pdf [accessed
2023-10-12]
59. Liu D, Baumeister RF, Yang CC, Hu B. Digital communication media use and psychological well-being: a meta-analysis.
J Comput-Mediat Comm 2019;24(5):259-273 [doi: 10.1093/jcmc/zmz013]
60. Liu Q, Shao Z, Fan W. The impact of users’ sense of belonging on social media habit formation: empirical evidence from
social networking and microblogging websites in China. Int J Inf Manage 2018 Dec;43:209-223 [doi:
10.1016/j.ijinfomgt.2018.08.005]
61. Gasteiger N, Loveys K, Law M, Broadbent E. Friends from the future: a scoping review of research into robots and computer
agents to combat loneliness in older people. Clin Interv Aging 2021 May;16:941-971 [doi: 10.2147/cia.s282709]
62. Niemelä M, van Aerschot L, Tammela A, Aaltonen I, Lammi H. Towards ethical guidelines of using telepresence robots
in residential care. Int J of Soc Robotics 2019 Feb 22;13(3):431-439 [doi: 10.1007/s12369-019-00529-8]
63. Barrett E, Burke M, Whelan S, Santorelli A, Oliveira BL, Cavallo F, et al. Evaluation of a companion robot for individuals
with dementia: quantitative findings of the MARIO project in an Irish residential care setting. J Gerontol Nurs 2019 Jul
01;45(7):36-45 [doi: 10.3928/00989134-20190531-01] [Medline: 31237660]
64. Gross HM, Scheidig A, Müller S, Schütz B, Fricke C, Meyer S. Living with a mobile companion robot in your own
apartment-final implementation and results of a 20-weeks field study with 20 seniors. 2019 Presented at: 2019 IEEE
International Conference on Robotics and Automation; May 20-24, 2019; Montreal p. 2253-2259 [doi:
10.1109/icra.2019.8793693]
65. Jeong K, Sung J, Lee HS, Kim A, Kim H, Park C, et al. Fribo: a social networking robot for increasing social connectedness
through sharing daily home activities from living noise data. In: Proceedings of the 2018 ACM/IEEE International Conference
on Human-Robot Interaction. 2018 Presented at: HRI '18; March 5-8, 2018; Chicago p. 114-122 [doi:
10.1145/3171221.3171254]
66. Sagar M, Bullivant D, Robertson P, Efimov O, Jawed K, Kalarot R, et al. A neurobehavioural framework for autonomous
animation of virtual human faces. In: SIGGRAPH Asia 2014 Autonomous Virtual Humans and Social Robot for Telepresence.
2014 Presented at: SA '14; December 3-6, 2014; Shenzhen p. 1-10 [doi: 10.1145/2668956.2668960]
67. Loveys K, Sebaratnam G, Sagar M, Broadbent E. The effect of design features on relationship quality with embodied
conversational agents: a systematic review. Int J of Soc Robotics 2020 Sep 24;12(6):1293-1312 [doi:
10.1007/s12369-020-00680-7]
Abbreviations
CA: conversational agent
DH: digital human
ETL: evolutionary theory of loneliness
ICT: information and communication technology
PIU: problematic internet use
SNS: social networking site
Edited by A Mavragani; submitted 20.12.22; peer-reviewed by A Molinard-Chenu, J Taylor; comments to author 02.02.23; revised
version received 20.03.23; accepted 30.04.23; published 02.11.23
Please cite as:
Shah HA, Househ M
Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions
Interact J Med Res 2023;12:e45197
URL: https://www.i-jmr.org/2023/1/e45197
doi: 10.2196/45197
PMID: 37917125
©Hurmat Ali Shah, Mowafa Househ. Originally published in the Interactive Journal of Medical Research (https://www.i-jmr.org/),
02.11.2023. This is an open-access article distributed under the terms of the Creative Commons Attribution License
(https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original work, first published in the Interactive Journal of Medical Research, is properly cited. The complete
bibliographic information, a link to the original publication on https://www.i-jmr.org/, as well as this copyright and license
information must be included.