Objective Loneliness is a significant and independent risk factor for depression in later life. Particularly in Asian culture, older people may find it less stigmatising to express loneliness than depression. This study aimed to adapt a simple loneliness screen for use in older Chinese, and to ascertain its relevance in detecting depressive symptoms as a community screening tool.
Design, setting and participants This cross-sectional study was conducted among 1653 older adults aged 60 years or above living in the community in Hong Kong. This was a convenient sample recruited from four local non-governmental organisations providing community eldercare or mental healthcare services. All data was collected by trained social workers through face-to-face interviews.
Measures Loneliness was measured using an adapted Chinese version of UCLA 3-item Loneliness Scale, depression symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9), and social support with emotional and instrumental support proxies (number of people who can offer help). Basic demographics including age, gender, education and living arrangement were also recorded.
Results The average loneliness score was 3.9±3.0, and it had a moderate correlation with depressive symptoms (r=0.41, p<0.01). A loneliness score of 3 can distinguish those without depression from those with mild or more significant depressive symptoms, defined as a PHQ-9 score of ≥5 (sensitivity 76%, specificity 62%, area under the curve=0.73±0.01). Loneliness explained 18% unique variance of depressive symptoms, adding to age, living arrangement and emotional support as significant predictors.
Conclusion A 3-item loneliness scale can reasonably identify older Chinese who are experiencing depressive symptoms as a quick community screening tool. Its wider use may facilitate early detection of depression, especially in cultures with strong mental health stigma.
Trial registration number ClinicalTrials.gov NCT03593889
- geriatric medicine
- mental health
- preventive medicine
- old age psychiatry
- depression & mood disorders
- public health
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Contributors TL and GW conceived the study and obtained funding. TL and WWK implemented the cultural adaptation of the UCLA 3-item scale. DKYL and LS coordinated scale adaptation, data input and data preparation. TL analysed and interpreted the data, wrote the first draft, which was refined in discussion with JYMT and HL for statistical analyses, and with SL for interpretation. GHKW and SL revised the draft further for intellectual consent. All authors read and approved the final manuscript.
Funding This work is supported by the Hong Kong Jockey Club Charites Trust for The University of Hong Kong for the Project JC JoyAge: Jockey Club Holistic Support Project for Elderly Mental Wellness (HKU Project Code: AR160026).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval This study was approved by the Human Research Ethics Committee (HREC) of the University of Hong Kong (HREC’s reference number: EA1709021). Each participant provided written informed consent before participating in the study.
Provenance and peer review Not commissioned; externally peer-reviewed.
Data availability statement No data are available. The ethical approval and participant consent for this study do not allow sharing of data beyond the research team.
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