Loneliness Trajectories, Associated Factors and Subsequent Health in Children and Young People During the COVID-19 Pandemic: A National Matched Cohort Study

Abstract

Verena Schneider,1 Tom Norris,2 Manjula Nugawela,3 Emma Dalrymple,3 Dougal Hargreaves,4 Anton Käll,5,6 Kelsey McOwat,7 Roz Shafran,3 Terence Stephenson,3 Laila Xu,3 Snehal M Pinto Pereira2 On behalf of CLoCk Consortium members1Department of Epidemiology & Public Health, University College London, London, UK; 2Department of Targeted Intervention, University College London, London, UK; 3UCL Great Ormond Street Institute of Child Health, University College London, London, UK; 4Mohn Centre for Children’s Health & Wellbeing, School of Public Health, Imperial College London, London, UK; 5Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden; 6Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; 7Immunisation Department, UK Health Security Agency, London, UKCorrespondence: Verena Schneider, Department of Epidemiology and Public Health, University College London, 1– 19, Torrington Place, London, WC1E 7HB, UK, Tel [phone], Email [email protected]: Loneliness is common amongst children and young people (CYP) and is an independent risk factor for poor health. This study aimed to i) determine whether subgroups of CYP with different loneliness trajectories (during the second year of the pandemic) exist; ii) examine associations with socio-demographic characteristics and subsequent health; and iii) understand whether associations between loneliness and subsequent health were modified by SARS-CoV-2 infection.Methods: A total of 5851 CYP (N=3260 SARS-CoV-2 positive and 2591 SARS-CoV-2 negative) provided data on loneliness (via the validated 3-item version of the UCLA Loneliness Scale for Children) at least twice in a 12-month period post PCR index-testing (conducted October 2020-March 2021). Latent class growth analyses were used to identify distinct classes of loneliness trajectories. Multinomial logistic regression was used to identify socio-demographic characteristics associated with class membership. Logistic regression models assessed the odds of reporting impairing symptoms 12-months post index-test.Results: Four distinct loneliness trajectories were identified: three mostly stable (low, medium, high) and one low-increasing trajectory. Being older, female, living in more deprived areas and testing negative were associated with greater odds of being in the highest vs lowest loneliness trajectory; eg OR for female vs male: 5.6 (95% CI:4.1,7.8); OR for 15– 17 vs 11– 14 years: 4.5 (95% CI:3.4,6.0). Following higher loneliness trajectories was associated with higher odds of experiencing impairing symptoms 12-months post index-test: ORadjusted (compared to lowest loneliness trajectory) were 15.9 (95% CI:11.9,21.3) (high loneliness), 6.5 (5.3,7.9) (medium loneliness) and 2.3 (1.9,2.8) (low-increasing loneliness). There was no evidence that this association was modified by PCR index-test result.Conclusion: About 5.3% of CYP were classified into a group experiencing (chronically) high loneliness. Being female, older and from more deprived areas were risk factors of belonging to this group. Results suggest that even small increases from low loneliness levels may be associated with worse health outcomes.Plain Language Summary: Why was the study done?Multiple lockdowns and school closures during the COVID-19 pandemic may have led to a rise in loneliness in children and young people (CYP). Loneliness can harm health and loneliness research often examines adult populations. We wanted to know if feelings of loneliness in CYP changed during the pandemic and which factors were associated with different loneliness patterns. Furthermore, we wanted to know how different patterns of loneliness linked to later health.What did the researchers do and find?We used data on almost 6000 CYP from the CLoCk study who completed multiple surveys during the pandemic. CYP were asked about feelings of loneliness using questions like: “how often do you feel you have no one to talk to”. We also asked about their health.We identified four patterns of loneliness in CYP between April 2021 and April 2022: 1) stable low loneliness levels, 2) initial low loneliness levels which increased over time, 3) stable medium loneliness levels, and 4) stable high loneliness levels. 5.3% of CYP had stable high loneliness levels and they were also more likely to be older, female, living in more deprived areas and testing negative for COVID-19. Compared to those following the lowest loneliness pattern, those with higher levels of loneliness were at greater risk of impaired health.What do these result mean?We identify CYP who may experience high levels of loneliness and highlight that even small increases in loneliness may be associated with worse health outcomes.Keywords: Adolescence, Loneliness, Pandemic, Mental Health, Physical Health, Longitudinal Studies

Keywords

• adolescence
• loneliness
• pandemic
• mental health
• physical health
• longitudinal studies