Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy.
XIV Corso di Formazione Specifica in Medicina Generale, Scuola di Sanità Pubblica (SSP), Veneto Region, Venice, Italy.
Health Soc Care Community. 2021 Sep;29(5):e89-e96. doi: 10.1111/hsc.13248. Epub 2020 Dec 5.
Loneliness is a common phenomenon associated with several negative health outcomes. Current knowledge regarding interventions for reducing loneliness in randomised controlled trials (RCTs) is conflicting. The aim of the present work is to provide an overview of interventions to reduce loneliness, using an umbrella review of previously published systematic reviews and meta-analyses. We searched major databases from database inception to 31 March 2020 for RCTs comparing active versus non-active interventions for reducing loneliness. For each intervention, random-effects summary effect size and 95% confidence intervals (CIs) were calculated. For significant outcomes (p-value < 0.05), the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool was used, grading the evidence from very low to high. From 211 studies initially evaluated, seven meta-analyses for seven different types of interventions were included (median number of RCTs: 8; median number of participants: 600). Three interventions were statistically significant for reducing loneliness, that is, meditation/mindfulness, social cognitive training and social support. When applying GRADE criteria, meditation/mindfulness (mean difference, MD = -6.03; 95% CI: -9.33 to -2.73; very low strength of the evidence), social cognitive training (8 RCTs; SMD = -0.49; 95% CI: -0.84 to -0.13; very low strength of the evidence) and social support (9 RCTs; SMD = -0.13; 95% CI: -0.25 to -0.01; low strength of the evidence) significantly decreased the perception of loneliness. In conclusion, three intervention types may be utilised for reducing loneliness, but they are supported by a low/very low certainty of evidence indicating the need for future large-scale RCTs to further investigate the efficacy of interventions for reducing loneliness.
孤独是一种与多种负面健康结果相关的常见现象。目前关于随机对照试验(RCT)中减少孤独感的干预措施的知识存在冲突。本研究的目的是通过对先前发表的系统评价和荟萃分析进行伞式综述,提供减少孤独感的干预措施概述。我们从数据库成立到 2020 年 3 月 31 日,检索了主要数据库,以比较主动干预与非主动干预减少孤独感的 RCT。对于每种干预措施,计算了随机效应汇总效应大小和 95%置信区间(CI)。对于有统计学意义的结局(p 值<0.05),使用 GRADE(推荐评估、制定与评价)工具进行评估,将证据质量从极低到高进行分级。在最初评估的 211 项研究中,纳入了 7 项针对 7 种不同类型干预措施的荟萃分析(RCT 中位数:8;参与者中位数:600)。3 种干预措施在降低孤独感方面具有统计学意义,即冥想/正念、社会认知训练和社会支持。当应用 GRADE 标准时,冥想/正念(MD=-6.03;95%CI:-9.33 至-2.73;证据强度极低)、社会认知训练(8 项 RCT;SMD=-0.49;95%CI:-0.84 至-0.13;证据强度极低)和社会支持(9 项 RCT;SMD=-0.13;95%CI:-0.25 至-0.01;证据强度低)显著降低了孤独感。总之,三种干预类型可能用于降低孤独感,但证据的确定性低/极低,表明需要进一步开展大规模 RCT 来进一步研究干预措施降低孤独感的疗效。