Loneliness before and during the COVID-19 pandemic: A systematic review with meta-analysis

Abstract

The COVID-19 pandemic and measures aimed at its mitigation, such as physical distancing, have been discussed as risk factors for loneliness, which increases the risk of premature mortality and mental and physical health conditions. To ascertain whether loneliness has increased since the start of the pandemic, this study aimed to narratively and statistically synthesize relevant high-quality primary studies. This systematic review with meta-analysis was registered at PROSPERO (ID CRD42021246771). Searched databases were PubMed, PsycINFO, Cochrane Library/Central Register of Controlled Trials/EMBASE/CINAHL, Web of Science, the World Health Organization (WHO) COVID-19 database, supplemented by Google Scholar and citation searching (cutoff date of the systematic search December 5, 2021). Summary data from prospective research including loneliness assessments before and during the pandemic were extracted. Of 6,850 retrieved records, 34 studies (23 longitudinal, 9 pseudolongitudinal, 2 reporting both designs) on 215,026 participants were included. Risk of bias (RoB) was estimated using the risk of bias in non-randomised studies-of interventions (ROBINS-I) tool. Standardized mean differences (SMD, Hedges' g) for continuous loneliness values and logOR for loneliness prevalence rates were calculated as pooled effect size estimators in random-effects meta-analyses. Pooling studies with longitudinal designs only (overall N = 45,734), loneliness scores (19 studies, SMD = 0.27 [95% confidence interval = 0.14-0.40], Z = 4.02, p < .001, I 2 = 98%) and prevalence rates (8 studies, logOR = 0.33 [0.04-0.62], Z = 2.25, p = .02, I 2 = 96%) increased relative to prepandemic times with small effect sizes. Results were robust with respect to studies' overall RoB, pseudolongitudinal designs, timing of prepandemic assessments, and clinical populations. The heterogeneity of effects indicates a need to further investigate risk and protective factors as the pandemic progresses to inform targeted interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Figure 1

Study Selection: PRISMA 2020 Flow Diagram for Systematic Reviews Including Searches of Databases, Registers and Other Sources for the Present Study

Figure 2

Forest Plot for Reports of Continuous Loneliness Values Based on Longitudinal Original Studies Note. The plot depicts model fit, individual study and pooled effect size estimates (standardized mean differences and corresponding 95% confidence intervals). The size of the boxes corresponds to the respective studies’ (inverse variance) weighting. SMD: standardized mean differences; CI: confidence interval.

Figure 3

Forest Plot for Reports of Prevalence Rates of Loneliness Based on Longitudinal Original Studies Note. The plot depicts model fit, pooled effect size estimates (log odds ratios), and the corresponding study results and IDs. The size of the boxes corresponds to the respective studies’ weighting. Log OR: log odds ratio; CI: confidence interval.

Figure 4

Funnel Plots of the Effect Size Estimators for Loneliness Note. The dots represent the individual studies. Standardized mean differences are plotted against standard errors.