Article Text

Original research
Adapting the UCLA 3-item loneliness scale for community-based depressive symptoms screening interview among older Chinese: a cross-sectional study
  1. Tianyin Liu,
  2. Shiyu Lu,
  3. Dara K Y Leung,
  4. Lesley C Y Sze,
  5. Wai Wai Kwok,
  6. Jennifer Y M Tang,
  7. Hao Luo,
  8. Terry Y S Lum,
  9. Gloria H Y Wong
  1. Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
  1. Correspondence to Dr Gloria H Y Wong; ghywong{at}


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 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.