Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study

Abstract

ObjectiveLoneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.Design, setting and participantsThis cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.MeasuresLoneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.ResultsThe average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.ConclusionA 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.Trial registration numberClinicalTrials.gov NCT03593889

Using a Loneliness Measure to Screen for Risk of Mental Health Problems: A Replication in Two Nationally Representative Cohorts

“…Statistically, a cut-off score of 5 on the scale (ranging from 3 to 9) was supported by the ROC curve analyses. This is similar to the findings of a recent study among older adults [7], which showed that a cut-off of 3 (on a scale from 0 to 9) using a modified Cantonese translation of the UCLA Scale showed good accuracy at classifying cases of depression. However, the trade-off between sensitivity and specificity can be informed by other priorities besides accuracy alone, such as the cost of committing a false negative versus a false positive [28].…”

“…Societal perceptions of loneliness and mental health problems may differ across cultural contexts, and hence the association between these phenomena may similarly vary in strength or be mediated by different processes. The study by Liu and colleagues [7] found similar results to the present study in a sample of older Hong Kong residents; however, further research is merited to attempt replication in other populations. Furthermore, while the findings were replicated in two different age brackets, it is unclear to what extent they hold true in older age, when the experience of loneliness and the reasons for it may differ from earlier stages of the lifespan.…”

“…The cohort is primarily white (93%), matching South Island demographics [18]. Assessments were carried out at birth and ages 3,5,7,9,11,13,15,18,21,26,32,38 and most recently (completed April 2019) 45 years, when 94.1% (n = 938) of the 997 participants still alive took part. At each assessment, participants were brought to the research unit for interviews and examinations.…”

“…Loneliness may also be of interest to clinicians as a valuable individual risk indicator for psychopathology, as it is analogous to sleep problems or difficulties with concentration, which are present in a number of disorders and are included in widely used screening checklists such as the Patient Health Questionnaire and the Center for Epidemiological Studies Depression Scale [4][5][6]. Though not all individuals who experience loneliness will have co-occurring mental health problems, there is potential scope to utilise a loneliness measure alongside other information as part of a screening tool [7].…”

Mental Distress and Its Contributing Factors Among Young People During the First Wave of COVID-19: A Belgian Survey Study

“…Social support was measured using the 3-item Oslo Social Support Scale (OSSS-3) and sum scores were operationalized into three categories: poor support (3-8), moderate support (9)(10)(11), and strong support (12-14) (33). Loneliness was measured using an adapted version of the UCLA 3-item Loneliness scale with a four-point Likert scale ("never, " "once in a while, " "fairly often, " and "very often"), yielding a score from 0 to 9 (34,35). Respondents with a score ≥6 were categorized as experiencing a high level of loneliness.…”