Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, Ontario M5S 1V4, Canada; Department of Social and Behavioural Sciences, City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong SAR, China.
J Affect Disord. 2023 Jan 1;320:7-17. doi: 10.1016/j.jad.2022.08.131. Epub 2022 Sep 2.
Pandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada.
A population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7).
The estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26-1.85), those who were younger (OR's range 1.42-3.00), women without college degree (OR = 1.44, 99 % CI: 1.01-2.04), those living alone (OR = 1.56, 99 % CI: 1.09-2.23), immigrant men (OR = 1.79, 99 % CI: 1.23-2.60), those with small network (OR's range: 1.73-3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04-4.28), past-month binge drinkers (OR's range: 1.39-1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12-1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness. Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21-2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17-1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29-2.49).
Cross-sectional data prohibits causal inferences.
The COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.
大流行期间实施的社交隔离和居家令虽然成功减少了 COVID-19 的传播，但可能会加剧孤独感。很少有研究探讨与大流行相关的社会决定因素如何相互作用，从而塑造加拿大的大流行孤独感及其与精神卫生保健的关系。
使用加拿大观点调查系列（CPSS-6；2021 年 1 月 25 日至 31 日）的具有代表性的 3772 名成年人的人群代表性样本。使用性别特异性逻辑回归来研究三项目孤独量表（UCLA-3）与社会人口统计学、工作不稳定、健康行为、社会隔离指标和寻求精神卫生帮助之间的关联。分类和回归树（CART）模型用于确定相互交织的风险因素和严重孤独（UCLA-3 评分≥7）的最重要预测因素。
加拿大严重孤独的估计患病率为 34.7%，女性明显高于男性（38.1%比 31.3%，p<0.001）。大流行孤独在女性中更为普遍（OR=1.53，99%CI：1.26-1.85），年轻人（OR 范围 1.42-3.00），没有大学学历的女性（OR=1.44，99%CI：1.01-2.04），独居者（OR=1.56，99%CI：1.09-2.23），移民男性（OR=1.79，99%CI：1.23-2.60），网络较小的人（OR 范围：1.73-3.26），因 COVID-19 相关原因缺勤的人（OR=2.11，99%CI：1.04-4.28），过去一个月狂饮者（OR 范围：1.39-1.70）和大麻使用者（OR=1.47，99%CI：1.12-1.93）。CART 算法确定，经历大流行引发的工作不稳定的移民是最容易孤独的群体。大流行孤独与向精神卫生专业人员寻求正式帮助（OR=1.71，99%CI：1.21-2.41）、向社交圈寻求非正式帮助（OR=1.51，99%CI：1.17-1.95）和未满足的精神卫生需求（OR=1.78，99%CI：1.29-2.49）呈正相关。
横断面数据禁止因果推断。
COVID-19 大流行与加拿大的孤独流行相吻合。预防和干预计划应针对心理健康的上游社会决定因素，特别是移民身份和 COVID-19 相关工作不稳定之间的交叉点，以消除大流行期间的孤独感。
