Different kinds of loneliness – Having poor quality relationships is associated with greater distress than having too few

According to a new study, there are 4 different types of loneliness.

Different kinds of loneliness – Having poor quality relationships is associated with greater distress than having too few

Loneliness not only feels bad, experts have characterised it as a disease that increases the risk of a range of physical and psychological disorders. Some national prevalence estimates for loneliness are alarming. Although they can be as low as 4.4 per cent (in Azerbaijan), in other countries (such as Denmark) as many as 20 per cent of adults report being either moderately or severely lonely.


However, there's no established way of identifying loneliness. Most diagnostic methods treat it as a one-dimensional construct: though it can vary in degrees, someone is either "lonely", or they're not. A new approach, outlined in a paper published recently in Social Psychiatry and Psychiatric Epidemiology, suggests that loneliness should in fact be divided into three sub-types, two of which are associated with poor mental health.

Philip Hyland at Trinity College Dublin and colleagues studied a nationally representative sample of 1,839 US adults aged between 18 and 70, all of whom had experienced at least one traumatic event in their lifetime. (This allowed the team to also look for associations between childhood or adult trauma and loneliness.) Most were married or living with a partner.

Participants completed a six-item scale that measured feelings of "social loneliness" (focusing on perceptions of the quantity of one's social relationships) and "emotional loneliness" (which focused on perceptions of the quality of one's relationships). They also completed questionnaires assessing levels of childhood and adult trauma, depression and anxiety, and their psychological wellbeing.

Following convention, the 17.1 per cent of participants who scored a certain amount above the average loneliness score for the sample (by more than one standard deviation) were classified as "lonely" – a figure comparable to that found previously in many other countries.

However, the researchers also used a statistical technique to look for qualitative differences between the participants' loneliness responses, and this revealed four distinct classes.

The first class – which they called "low loneliness" – was characterised by low scores on both types of loneliness, social and emotional. Just over half the participants fell into this category. The second class – "social loneliness" – making up 8.2 per cent of the sample, comprised people low on emotional loneliness, but high on social loneliness. The third class – "emotional loneliness" – made up just over a quarter of the total sample and was characterised by the opposite pattern of high emotional loneliness but low levels of social loneliness. People in the fourth and final "social and emotional loneliness" class, accounting for 12.4 per cent of the sample, scored high for both types of loneliness.

The researchers found a clear gradient of psychological distress across the classes. People in the low loneliness class were, predictably, least distressed, followed by people in the "social loneliness" class, then the "emotional loneliness" class, and finally the "social and emotional loneliness" class. In fact, people in both these last two classes had levels of symptoms of depression, anxiety and negative psychological wellbeing that were reflective of a psychiatric disorder.

In other words, quality of relationships appears more important to mental health than the sheer number of them."These results indicate that while the experience of social loneliness is associated with slight diminutions in overall mental health, relative to the low loneliness class, the experience of emotional loneliness has a substantially greater, and more negative impact on overall mental health status," the researchers write. "The combination of social and emotional loneliness is associated with the poorest mental health status," they note.

People who belonged to the emotional loneliness class were more likely to be female, younger than average for the group, not in a relationship and to have suffered an increased number of childhood traumas. (Every childhood traumatic experience increased the odds of belonging to the emotional loneliness class by 28 per cent.) The same associations were true for the "social and emotional" loneliness class – except they were also characterised by a greater number of adult traumas.

At 39.0 per cent, the total percentage of participants who fell into the two loneliness classes characterised by clinically relevant levels of psychological distress was much higher than the 17.1 per cent loneliness figure obtained using the conventional one-dimensional approach. "This finding indicates that by recognising naturally occurring subtypes of loneliness, the number of people experiencing a form… that is likely to be of clinical relevance is more than double the number identified when loneliness is conceptualised as a unidimensional construct," the researchers note.

The work suggests that in assessing loneliness, whether in an individual or at a national level, it's important to recognise there are various subtypes. It also supports findings from some other studies that it's the quality, not quantity, of your relationships that really matters. As the researchers conclude: "From a societal perspective, and in the interests of reducing the burden of psychological distress, efforts should be made to enhance the quality of social connections as opposed to promoting the virtues of larger social networks."

Quality not quantity: loneliness subtypes, psychological trauma, and mental health in the US adult population

Emma Young (@EmmaELYoung) is Staff Writer at BPS Research Digest

--This article was originally published on BPS Research Digest. Read the original article.

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For the first time, researchers appear to have effectively treated a genetic disorder by directly injecting a CRISPR therapy into patients' bloodstreams — overcoming one of the biggest hurdles to curing diseases with the gene editing technology.

The therapy appears to be astonishingly effective, editing nearly every cell in the liver to stop a disease-causing mutation.

The challenge: CRISPR gives us the ability to correct genetic mutations, and given that such mutations are responsible for more than 6,000 human diseases, the tech has the potential to dramatically improve human health.

One way to use CRISPR to treat diseases is to remove affected cells from a patient, edit out the mutation in the lab, and place the cells back in the body to replicate — that's how one team functionally cured people with the blood disorder sickle cell anemia, editing and then infusing bone marrow cells.

Bone marrow is a special case, though, and many mutations cause disease in organs that are harder to fix.

Another option is to insert the CRISPR system itself into the body so that it can make edits directly in the affected organs (that's only been attempted once, in an ongoing study in which people had a CRISPR therapy injected into their eyes to treat a rare vision disorder).

Injecting a CRISPR therapy right into the bloodstream has been a problem, though, because the therapy has to find the right cells to edit. An inherited mutation will be in the DNA of every cell of your body, but if it only causes disease in the liver, you don't want your therapy being used up in the pancreas or kidneys.

A new CRISPR therapy: Now, researchers from Intellia Therapeutics and Regeneron Pharmaceuticals have demonstrated for the first time that a CRISPR therapy delivered into the bloodstream can travel to desired tissues to make edits.

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"This is a major milestone for patients," Jennifer Doudna, co-developer of CRISPR, who wasn't involved in the trial, told NPR.

"While these are early data, they show us that we can overcome one of the biggest challenges with applying CRISPR clinically so far, which is being able to deliver it systemically and get it to the right place," she continued.

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A better option: The CRISPR therapy produced only mild adverse effects and did lower the protein levels, but we don't know yet if the effect will be permanent. It'll also be a few months before we know if the therapy can alleviate the symptoms of transthyretin amyloidosis.

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If everything goes as hoped, though, NTLA-2001 could one day offer a better treatment option for transthyretin amyloidosis than a currently approved medication, patisiran, which only reduces toxic protein levels by 81% and must be injected regularly.

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