Theo G van TilburgpersName (2020date). “Social, Emotional, and Existential Loneliness: A Test of the Multidimensional Concept.” The Gerontologisttitle·j.
Object of study — instruments measuring social, emotional and existential lonelinessterm·dom among older Dutch adults
Research question — whether social, emotional and existential lonelinessterm·dom are related but distinctive dimensions of lonelinessterm·dom
Contribution — evidence for dimensions of lonelinessterm·dom beyond social and emotional lonelinessterm·dom, and a proposal of 18 questions measuring three types
phenomenon · claim-type · cross-domain-transfer · mechanism · claim-relation · replication-status · limitation — grounded in the full text| phenomenon | the multidimensional structure of loneliness in older adults — “Loneliness is multifaceted and means that one is not embedded in a personal network, misses closeness and intimacy, and lacks meaning in life.” | |
| claim-type | existence — “By applying the translated ELQ among older Dutch adults, we found evidence for multiple dimensions of loneliness in addition to social and emotional loneliness.” | |
| method — evidence | — “The 2019 observation of the Longitudinal Aging Study Amsterdam ( N = 1,316; aged 61–101 years; 52% women) included five direct questions about loneliness, the 11-item de Jong Gierveld social and emotional loneliness scale, and 14 items from the translated Existential Loneliness Questionnaire. Confirmatory factor analysis was conducted in Mplus.” | |
| object of study — evidence | — “This article examines whether instruments to measure these conceptualizations indicate a multidimensional concept.” | |
| research question — evidence | — “It tests whether social, emotional, and existential loneliness are related but distinctive dimensions of loneliness that are associated with direct measurements of loneliness.” | |
| contribution — evidence | — “By applying the translated ELQ among older Dutch adults, we found evidence for multiple dimensions of loneliness in addition to social and emotional loneliness.” | |
| mechanism | network deficit When the social network is too small or its relationships of too little quality, the person often feels lonely. — “If the social network is too small or the relationships are of insufficient quality, the person often feels lonely ( de Jong Gierveld, 1978 ; Perlman & Peplau, 1981 ).” | mechanisms[0] |
| sense | existential loneliness - in this article a negative experience only; the positive side is called solitude instead — “In this article, we focus on existential loneliness as a negative experience, and we aim to use the concept of solitude for when people want to be alone with positive purposes ( Lay et al., 2020 ).” | senses[0] |
| sense | existential loneliness - for Moustakas, inherent in human existence, such that everyone can identify as a solitary individual — “For Moustakas (1961) , existential loneliness is inherent in human existence, such that everyone can identify as a solitary individual.” | senses[1] |
| relation | ELQ —same-as→ Existential Loneliness Questionnaire — (ELQ) — “Mayers et al. (2002) developed the Existential Loneliness Questionnaire (ELQ).” | concept_edges[0] |
| weight | ELQ —same-as→ Existential Loneliness Questionnaire — 0.95 — “Mayers et al. (2002) developed the Existential Loneliness Questionnaire (ELQ).” | concept_edges[0] |
| relation | CFI —same-as→ comparative fit index — (CFI) — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concept_edges[1] |
| weight | CFI —same-as→ comparative fit index — 0.95 — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concept_edges[1] |
| relation | RMSEA —same-as→ root mean square error of approximation — (RMSEA) — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concept_edges[2] |
| weight | RMSEA —same-as→ root mean square error of approximation — 0.95 — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concept_edges[2] |
| relation | existential loneliness —distinct-from→ emotional loneliness — differs from — “Existential loneliness differs from social and emotional loneliness in two ways.” | concept_edges[3] |
| weight | existential loneliness —distinct-from→ emotional loneliness — 0.85 — “Existential loneliness differs from social and emotional loneliness in two ways.” | concept_edges[3] |
| relation | emotional loneliness —is-a→ loneliness — Two basic types of loneliness — “Two basic types of loneliness are social and emotional loneliness ( Weiss, 1973 ).” | concept_edges[4] |
| weight | emotional loneliness —is-a→ loneliness — 0.85 — “Two basic types of loneliness are social and emotional loneliness ( Weiss, 1973 ).” | concept_edges[4] |
| relation | existential loneliness —operationalised-as→ ELQ — was measured by — “Existential loneliness was measured by 14 ELQ items.” | concept_edges[5] |
| weight | existential loneliness —operationalised-as→ ELQ — 0.9 — “Existential loneliness was measured by 14 ELQ items.” | concept_edges[5] |
| replication | original | |
| limitation | The sample includes few older people in severe illness or at the end of life, where existential loneliness is most studied. — “The sample does not include many older people who are in a serious situation, such as severe illness or the end of life, which is the focus of a number of studies on existential loneliness.” | limitations[0] |
| limitation | The respondent's situation may have changed between the two interviews, lowering the DJG-ELQ correlation. — “At the same time, the respondent’s situation may have changed between the two interviews, which may have contributed to the relatively low correlation between the DJG scores (assessed in the first interview) and the ELQ scores (assessed in the second interview).” | limitations[1] |
| limitation | The quality of the scales was not examined in detail, nor whether removing items would make them more homogeneous. — “Finally, we did not look in detail at the quality of the scales and did not investigate whether removing items leads to more homogeneous scales.” | limitations[2] |
finding · quantity · variable · definition · key-term — grounded in the full text| finding | Five factors fit: direct questions, social loneliness, emotional loneliness, loneliness in relationships and meaninglessness in life. — “Five factors were observed: direct questions, social and emotional loneliness, and loneliness in relationships and meaninglessness in life.” | content_tags.findings[0] |
| finding | Emotional loneliness correlated most strongly with the direct questions. — “The highest correlation was found between the direct questions and emotional loneliness.” | content_tags.findings[1] |
| finding | Loneliness did not correlate with frequency of church attendance. — “Loneliness did not correlate with the frequency of church attendance.” | content_tags.findings[2] |
| finding | The two existential loneliness scales are weakly homogeneous and of low reliability. — “The two existential loneliness scales are weakly homogeneous (0.30 and 0.34) and have low reliability (Cronbach’s alpha = 0.69 and 0.73).” | content_tags.findings[3] |
| finding | The ELQ subscale on relationships does not add enough to the conceptualization of loneliness. — “We conclude that the ELQ subscale on relationships does not contribute sufficiently to the conceptualization of loneliness.” | content_tags.findings[4] |
| quantity | 1,316 — — “Thus, data from 1,316 respondents were analyzed.” | content_tags.quantities[0] |
| quantity | 0.32 and 0.82 — — “Attenuation-corrected correlations between the five loneliness scale scores varied between 0.32 and 0.82 ( Table 3 ).” | content_tags.quantities[1] |
| quantity | 18 — — “In future research, we propose using 18 questions that measure three types of loneliness.” | content_tags.quantities[2] |
| definition | social loneliness — “Social loneliness originates from the absence of a broader group of contacts or an engaging social network.” | content_tags.definitions[0] |
| definition | emotional loneliness — “Emotional loneliness originates from the absence of an intimate figure or a close emotional attachment.” | content_tags.definitions[1] |
| definition | existential loneliness — “Existential loneliness is the result of a broader separation related to the nature of existence and, in particular, a lack of meaning in life.” | content_tags.definitions[2] |
| key-terms | loneliness, social loneliness, emotional loneliness, existential loneliness, solitude, confirmatory factor analysis, homogeneity, reliability, direct questions |
| concept | loneliness — Loneliness is a negative feeling related to loss and disappointment. It is the outcome of a process in which a person weighs up his or her existing personal relationships against his or her own wishes and social expectations with regard to relationships. — “Loneliness is a negative feeling related to loss and disappointment. It is the outcome of a process in which a person weighs up his or her existing personal relationships against his or her own wishes and social expectations with regard to relationships.” | concepts[0] |
| concept | social loneliness — Social loneliness originates from the absence of a broader group of contacts or an engaging social network. — “Social loneliness originates from the absence of a broader group of contacts or an engaging social network.” | concepts[1] |
| concept | emotional loneliness — Emotional loneliness originates from the absence of an intimate figure or a close emotional attachment. — “Emotional loneliness originates from the absence of an intimate figure or a close emotional attachment.” | concepts[2] |
| concept | existential loneliness — Existential loneliness is the result of a broader separation related to the nature of existence and, in particular, a lack of meaning in life. — “Existential loneliness is the result of a broader separation related to the nature of existence and, in particular, a lack of meaning in life.” | concepts[3] |
| concept | solitude — for when people want to be alone with positive purposes ( Lay et al., 2020 ) — “In this article, we focus on existential loneliness as a negative experience, and we aim to use the concept of solitude for when people want to be alone with positive purposes ( Lay et al., 2020 ).” | concepts[4] |
| concept | Existential Loneliness Questionnaire — This is the only scale we found that focuses on existential loneliness in survey research — “Mayers et al. (2002) developed the Existential Loneliness Questionnaire (ELQ).” | concepts[5] |
| concept | ELQ — Existential Loneliness Questionnaire — “Mayers et al. (2002) developed the Existential Loneliness Questionnaire (ELQ).” | concepts[6] |
| concept | homogeneity — Homogeneity ( H ), computed by Mokken scale analysis, was indicated by the correlation between the item scores — “Homogeneity ( H ), computed by Mokken scale analysis, was indicated by the correlation between the item scores (scale lower limit is 0.30, indicating weak homogeneity; 0.40–0.50 indicates medium homogeneity; 0.50 or higher shows strong homogeneity; Sijtsma & van der Ark, 2017 ).” | concepts[7] |
| concept | reliability — Reliability describes the interrelationship in terms of the number of items — “Reliability describes the interrelationship in terms of the number of items (lower limit 0.80; Nunnally & Bernstein, 1994 ).” | concepts[8] |
| concept | comparative fit index — not defined in this paper's own words; CFI of 0.95 or more indicates an acceptable model fit — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concepts[9] |
| concept | CFI — comparative fit index — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concepts[10] |
| concept | root mean square error of approximation — not defined in this paper's own words; RMSEA of 0.07 or less indicates an acceptable model fit — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concepts[11] |
| concept | RMSEA — root mean square error of approximation — “To test the model fit, we used χ 2 / df , the comparative fit index (CFI), the Tucker–Lewis index (TLI), and the root mean square error of approximation (RMSEA): χ 2 / df <3, CFI and TLI ≥0.95, and RMSEA ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ).” | concepts[12] |
| concept | meaninglessness in life — not defined in this paper's own words; the name the paper gives to an existential loneliness factor derived from Gökdemir-Bulut and Bozo — “The third factor distinguished by Gökdemir-Bulut and Bozo relates to a differential conceptualization that we have labeled “meaninglessness in life.”” | concepts[13] |
| Kuder-Richardson 20 KR-20 | as written: KR-20] = 0.86 — “The homogeneity of loneliness as measured by direct questions was strong (0.75; Table 1 ), and the reliability was sufficient (Kuder-Richardson 20 [KR-20] = 0.86).” | content_tags.statistics[0] |
| Cronbach's alpha α | as written: Cronbach’s alpha = 0.69 and 0.73 — “The two existential loneliness scales are weakly homogeneous (0.30 and 0.34) and have low reliability (Cronbach’s alpha = 0.69 and 0.73).” | content_tags.statistics[1] |
Full text — tagged
Social, Emotional, and Existential Lonelinessterm·dom: A Test of the Multidimensional Concept Abstract Since the 1980s, most researchers have agreed on the concept of social and emotional lonelinessterm·dom as an unacceptable and negatively experienced discrepancy between realized and desired interpersonal relationships. For other researchers, existential lonelinessterm·dom stems from the realization that a human being is fundamentally alone, with the accompanying emptiness, sadness, and longing. This article examines whether instruments to measure these conceptualizations indicate a multidimensional concept.
The 2019 observation of the Longitudinal Aging Study Amsterdam ( N = 1,316; aged 61–101 years; 52% women) included five direct questionsterm·key about lonelinessterm·dom, the 11-item de Jong Gierveld social and emotional lonelinessterm·dom scale, and 14 items from the translated Existential Loneliness Questionnaireterm·mth. Confirmatory factor analysisterm·key was conducted in Mplus.
Five factors were observed: direct questionsterm·key, social and emotional lonelinessterm·dom, and lonelinessterm·dom in relationships and meaninglessness in lifeterm·dom. The intercorrelations among all five factors were positive. Emotional lonelinessterm·dom correlated most strongly with direct questionsterm·key.
Lonelinessterm·dom is multifaceted and means that one is not embedded in a personal network, misses closeness and intimacy, and lacks meaning in life. The emotional lonelinessterm·dom items most closely represent what people mean when they report lonelinessterm·dom.
Keywords: Analysis, Factor analysis, Measurement, Social isolation Since the 1980s, most researchers have agreed on the concept of lonelinessterm·dom as a feeling of deprivation related to interpersonal relationships. Perlman and Peplau (1981 , p. 31) defined lonelinessterm·dom as “the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively.” Other researchers have defined existential lonelinessterm·dom “as an intolerable emptiness, sadness, and longing, that results from the awareness of one’s fundamental separateness as a human being” ( Ettema et al., 2010 , p. 142). The two definitions and, as will be shown, their measuring instruments not only use similar terms, but also highlight a lack of social connection, albeit in a very different way. This article examines whether the instruments for measuring these conceptualizations indicate a multidimensional concept.
The Concepts of Social, Emotional, and Existential Lonelinessterm·dom Lonelinessterm·dom is a negative feeling related to loss and disappointment. It is the outcome of a process in which a person weighs up his or her existing personal relationships against his or her own wishes and social expectations with regard to relationships. If the social network is too small or the relationships are of insufficient quality, the person often feels lonely ( de Jong Gierveld, 1978 ; Perlman & Peplau, 1981 ). This has been the most widely used conceptualization of lonelinessterm·dom in research. Two basic types of lonelinessterm·dom are social and emotional lonelinessterm·dom ( Weiss, 1973 ). Social lonelinessterm·dom originates from the absence of a broader group of contacts or an engaging social network. Emotional lonelinessterm·dom originates from the absence of an intimate figure or a close emotional attachment. Social and emotional lonelinessterm·dom often occur due to reduced social activities ( Aartsen & Jylhä, 2011 ) or loss of the partner ( Utz et al., 2014 ), among other situations.
In a literature review, Bolmsjö et al. (2019) distinguished several key aspects of existential lonelinessterm·dom: not connecting with others and the world outside, alienation, feelings of isolation, emptiness, and abandonment. Additionally, mortality-related fears were identified to be associated with this type of lonelinessterm·dom, including the fear of disappearing from the earth, the fear of being forgotten, and the fear of dying. A further examination of this concept leads to two considerations.
First, the concept of existential lonelinessterm·dom needs to be sharpened and more clearly distinguished from social and emotional lonelinessterm·dom. For example, a negative evaluation of not connecting with others overlaps with social lonelinessterm·dom. Feelings of isolation, emptiness, and abandonment are aspects of emotional lonelinessterm·dom.
Second, social and emotional lonelinessterm·dom happen to somebody; people do not seek lonelinessterm·dom voluntarily. These types of lonelinessterm·dom are felt as social pain ( Cacioppo et al., 2006 ). In contrast, some scholars see existential lonelinessterm·dom as something that can be appreciated positively; one finds strength in being solitary, although it takes effort to realize this situation. For Moustakas (1961) , existential lonelinessterm·dom is inherent in human existence, such that everyone can identify as a solitary individual. People retreat from the social world to create a self-identity and to live a genuine life. Thus, in life’s most intimate and important moments, someone is an individual and is always alone. Lonelinessterm·dom can be a creative force among people who create music or inventions on their own. Ellison (1978) has described the separation by which humans give meaning to life and to their relationship with God. For Ettema et al. (2010) , existential lonelinessterm·dom consists of negative feelings of nothingness that alternate and amalgamate with being in a process of inner growth. In this article, we focus on existential lonelinessterm·dom as a negative experience, and we aim to use the concept of solitudeterm·dom for when people want to be alone with positive purposes ( Lay et al., 2020 ).
Existential lonelinessterm·dom is often studied in patients with severe illness ( Tarbi & Meghani, 2019 ) and end-of-life situations ( Boston et al., 2011 ). Casey and Holmes (1995) studied older people residing in nursing homes. After living a fulfilling and often busy life, these people are left without meaningful roles ( Hupkens et al., 2018 ). Rosedale (2007) studied people with severe illnesses who realize their own mortality. Cherry and Smith (1993) examined lonelinessterm·dom in AIDS patients and observed that patients experienced inescapable separateness from others.
Existential lonelinessterm·dom differs from social and emotional lonelinessterm·dom in two ways. First, social and emotional lonelinessterm·dom are associated with a lack of meaningful social relationships and a lack of social companionship. Existential lonelinessterm·dom is the result of a broader separation related to the nature of existence and, in particular, a lack of meaning in life. An individual may be in the company of others but experience existential lonelinessterm·dom ( Larsson et al., 2019 ). Second, social and emotional lonelinessterm·dom can be overcome by improving the quality of the network of relationships or by adjusting the level of aspiration ( Rook & Peplau, 1982 ). Existential lonelinessterm·dom, on the other hand, has no permanent remedy according to the phenomenological approach ( Mayers & Svartberg, 2001 ).
The Measurement of Lonelinessterm·dom Lonelinessterm·dom is often measured with a single, direct questionterm·key. Such a question, for example, “Do you feel lonely?,” is simple to use, appears to be acceptable to respondents, reflects lonelinessterm·dom as understood by the respondent, and provides an easy way to assess the prevalence of lonelinessterm·dom ( Jylhä & Saarenheimo, 2010 ; van TilburgpersName & de Jong Gierveld, 1999 ; Victor et al., 2005 ). However, the use of a direct questionterm·key presupposes that the respondents have a common understanding of the term “lonelinessterm·dom” and that their understanding encompasses the whole theoretical concept. A single item does not provide information on the relevance of social, emotional, and existential aspects of lonelinessterm·dom. Because of the social stigma of lonelinessterm·dom ( Lau & Gruen, 1992 ), people who are not seen as lonely by others may find it difficult to admit their lonelinessterm·dom as an answer to a direct questionterm·key. Finally, the psychometric quality of a single question cannot be determined.
Alternatively, lonelinessterm·dom can be measured with a scale including statements that relate to lonelinessterm·dom but avoid the term “lonelinessterm·dom” or similar wording. The UCLA scale ( Russell, 1996 ) and the de Jong Gierveld (DJG) scale ( de Jong Gierveld & Kamphuis, 1985 ) are based on a conceptual framework of lonelinessterm·dom, in which different relational aspects and emotions relevant to the experience of lonelinessterm·dom are distinguished. Solano (1980) concluded that the UCLA scale appeared to identify a subjective lack of social companionship and is less sensitive to philosophically determined types of lonelinessterm·dom, such as existential lonelinessterm·dom. McWhirter (1990) and Hawkley et al. (2005) found various dimensions in the UCLA scale, but it is often considered a unidimensional measure. The DJG scale was developed as a unidimensional lonelinessterm·dom scale with both the social and emotional aspects of lonelinessterm·dom in mind. The homogeneityterm·mth of the unidimensional scale proved to be modest at best. When searching for more homogeneous subscales, social and emotional lonelinessterm·dom factors emerged ( de Jong Gierveld & van TilburgpersName, 1992 ; van Baarsen et al., 2001 ). The UCLA and DJG scales have rarely been studied in one sample. In a Dutch study, de Jong Gierveld and van TilburgpersName (1992) observed that the measurement of social lonelinessterm·dom was similar to that of the core dimension of the UCLA scale, which includes seven items. Another study ( Penning et al., 2014 ) indicated that both scales were multidimensional, but the correlation between the scale scores was not reported.
While scales for social and emotional lonelinessterm·dom are widely used, there has been limited research into existential lonelinessterm·dom. Mayers et al. (2002) developed the Existential Loneliness Questionnaireterm·mth (ELQterm·mth). This is the only scale we found that focuses on existential lonelinessterm·dom in surveyterm·mth research, with the exception of one studied among students in the 1970s ( Belcher, 1973 ). The ELQterm·mth consists of 22 items and was found to be sufficiently internally consistent. Three items were specific to HIV, three were formulated conditionally, and two included a direct reference to lonelinessterm·dom. Gökdemir-Bulut and Bozo (2018) conducted two studies on the ELQterm·mth. They found three factors, that is, lonelinessterm·dom in social ties, lonelinessterm·dom in close relationships, and finding meaning in life; it appears that the first and second factors relate to social and emotional lonelinessterm·dom.
The Current Study As far as we know, no research has examined whether existential lonelinessterm·dom should be distinguished from social and emotional lonelinessterm·dom. The current research analyzes data from older respondents who answered items from the DJG and ELQterm·mth scales, along with direct lonelinessterm·dom questions. It tests whether social, emotional, and existential lonelinessterm·dom are related but distinctive dimensions of lonelinessterm·dom that are associated with direct measurements of lonelinessterm·dom. We also aim to determine whether existential lonelinessterm·dom is indeed a negative feeling.
To support the validity of the lonelinessterm·dom scales, we look for the association of various characteristics with the three types of lonelinessterm·dom. We expect to find that men and women have similar levels of lonelinessterm·dom scales scores ( Maes et al., 2019 ) but that women will report more lonelinessterm·dom on the direct questionsterm·key ( Borys & Perlman, 1985 ). We also expect that age will correlate positively with all instruments ( Luhmann & Hawkley, 2016 ), as will being without a partner, having a smaller network, not having daily network contact, and having poor health because unhealthy people have little social participation ( de Jong Gierveld et al., 2018 ). Religiosity is linked to lower levels of lonelinessterm·dom ( Lauder et al., 2006 ). Religious people are more involved than others in church-based social contacts and organizations in the community ( Rote et al., 2013 ). In the current study, validity testing can go both ways. When there is a strong core in the concept of lonelinessterm·dom, we can establish that measurements of social, emotional, and existential lonelinessterm·dom are similarly associated with a number of antecedents. When multiple dimensions in lonelinessterm·dom need to be distinguished, we can establish that the measurements are differently associated with the antecedents.
Design and Methods Respondents Data were taken from the Longitudinal Aging Study Amsterdam ( Huisman et al., 2011 ). This program employed samples of men and women born between 1908 and 1957 taken from the population registers of the cities of Amsterdam, Zwolle, and Oss, and six surrounding small municipalities in 1992, with additions in 2002 and 2012. The response rate at baseline was 63%. Follow-up interviews were conducted every 3 or 4 years. For each follow-up, an average of 82% of respondents were reinterviewed.
Data collection on 1,701 men and women was completed in 2019. We excluded 110 participants for whom data were collected from an interview with a proxy and 198 respondents interviewed by phone with a short questionnaire including only six social and emotional lonelinessterm·dom items. The DJG scale and three direct questionsterm·key were part of the first, general face-to-face interview. One respondent was unable to participate in a full interview due to incapacity and did not answer the lonelinessterm·dom questions. The ELQterm·mth was part of a subsequent medical interview, which was conducted by another interviewer an average of 32 days after the initial interview. A total of 76 respondents from the first interview did not participate in the second interview. Thus, data from 1,316 respondents were analyzed. Their age varied between 61 and 101 years ( M = 73.0), and 52% were women. Migrants were underrepresented. Most respondents were of Dutch origin; 3% were born in another Western country, and 2% were born in a non-Western country. Almost all respondents lived independently; 1% lived in a nursing home.
Measures Table 1 displays all lonelinessterm·dom questions and response options. Three direct lonelinessterm·dom questions were asked: a self-rating; an item assessing whether respondents “sometimes feel lonely” ( de Jong Gierveld, 1984 ); and “During the past week I felt lonely,” which is adapted from the Center for Epidemiologic Studies Depression scale ( Radloff, 1977 ). Two ELQterm·mth items that asked respondents whether they feel “lonely” and “alone” were also treated as direct questionsterm·key.
Lonelinessterm·dom Items, Mean and Lonelinessterm·dom Scores, Homogeneityterm·mth, and Factor Loadings in the Five-Factor Model From the DJG scale, five positively phrased items and six negatively phrased items measure the intensity of deprivation, which is considered to be the essence of lonelinessterm·dom. The subscales reflect social lonelinessterm·dom and emotional lonelinessterm·dom, respectively.
Existential lonelinessterm·dom was measured by 14 ELQterm·mth items. We excluded three HIV items and three conditionally formulated items. We performed a translation from English into Dutch, followed by back translation, using two translators in both steps ( Beaton et al., 2000 ).
Marital and partner status was assessed by three questions. Network members with whom there was regular contact and who were important to the respondent were identified by name across seven domains ( van TilburgpersName, 1998 ). We derived two characteristics: personal network size (not counting the partner) and being in daily contact with someone in the network. Self-rated health was measured using the question “How is your health in general?” (poor to very good). The frequency of church attendance was assessed on a six-point scale from “never” to “once a week or more.”
Procedure The scores on the five direct questionsterm·key were recoded so that the answers “not lonely,” “rarely or never,” “no,” and “no!” indicate the absence of lonelinessterm·dom and the other answers indicate lonelinessterm·dom; it was assumed that the middle category “more or less” indicates lonelinessterm·dom ( de Jong Gierveld & Kamphuis, 1985 ). We investigated the psychometric properties of the scales. Homogeneityterm·mth ( H ), computed by Mokken scale analysis, was indicated by the correlation between the item scores (scale lower limit is 0.30, indicating weak homogeneityterm·mth; 0.40–0.50 indicates medium homogeneityterm·mth; 0.50 or higher shows strong homogeneityterm·mth; Sijtsma & van der Ark, 2017 ). Reliabilityterm·mth describes the interrelationship in terms of the number of items (lower limit 0.80; Nunnally & Bernstein, 1994 ).
We applied confirmatory factor analysisterm·key in Mplus ( Muthén & Muthen, 2017 ). Item scores were treated as having categorical (direct questionsterm·key) and ordinal (all other) measurement levels; latent variables were continuous. First, we tested whether there are five factors underlying the 30 items. The five factors are direct measurements, social lonelinessterm·dom, emotional lonelinessterm·dom, and the existential aspects “lonelinessterm·dom in relationships” and “meaninglessness in lifeterm·dom,” which are derived from the work of Gökdemir-Bulut and Bozo (2018) . Next, to investigate the commonality of the five factors, we tested a unidimensional, second-order, and bifactor model ( Canivez, 2016 ). To test the model fit, we used χ 2 / df , the comparative fit indexterm·mth (CFIterm·mth), the Tucker–Lewis index (TLI), and the root mean square error of approximationterm·mth (RMSEAterm·mth): χ 2 / df <3, CFIterm·mth and TLI ≥0.95, and RMSEAterm·mth ≤0.07 indicate an acceptable model fit ( Hooper et al., 2008 ). The model was estimated using the full information maximum likelihood method. We present unstandardized factor loadings herein. Correlations between factors were corrected for attenuation. Estimated factor scores were derived to create individual lonelinessterm·dom scale scores. We also computed Pearson correlations between lonelinessterm·dom scale scores and the antecedents of lonelinessterm·dom. Differences in strength between lonelinessterm·dom scores were tested with the z -statistic ( Lee & Preacher, 2013 ).
Results There were few missing data. One respondent did not answer five items, and 16 respondents did not answer ELQterm·mth item 16. The frequency of lonelinessterm·dom as indicated by the 30 items varied considerably ( Table 1 ). Of the three direct questionsterm·key in the first interview, between 19% and 25% of the respondents reported being lonely. Only approximately 10% reported lonelinessterm·dom using the two direct ELQterm·mth questions. For the social lonelinessterm·dom items, an average of 17% of respondents answered affirmatively to indicate lonelinessterm·dom (including answers in the middle category). Many respondents answered negatively to the item “There are many people I can trust completely” (DJG 7). On average 15% reported emotional lonelinessterm·dom. Few respondents answered affirmatively to the item “I often feel rejected.” On average 20% reported existential lonelinessterm·dom in relationships. Compared to other items, respondents answered more affirmatively on ELQterm·mth item 12, that is, “can trust and rely,” indicating low levels of lonelinessterm·dom; however, a differently worded item on trust from the DJG scale (item 7) indicated higher levels of lonelinessterm·dom. There were a high number of affirmative responses to the item “Important relationships have ended or become weaker.” Finally, the average for meaninglessness in lifeterm·dom was 19%. There were few affirmative answers to the item “I feel dead.” Many respondents disagreed with the statement “There is a purpose in my life.”
The homogeneityterm·mth of lonelinessterm·dom as measured by direct questionsterm·key was strong (0.75; Table 1 ), and the reliabilityterm·mth was sufficient (Kuder-Richardson 20 [KR-20] = 0.86). For social and emotional lonelinessterm·dom, the homogeneityterm·mth was strong (0.51 and 0.53, respectively), and the reliabilityterm·mth was (almost) sufficient (KR-20 = 0.79 and 0.84, respectively). The two existential lonelinessterm·dom scales are weakly homogeneous (0.30 and 0.34) and have low reliabilityterm·mth (Cronbach’s alphaterm·stat = 0.69 and 0.73).
The five-factor model had the best fit and three of the four indices indicated that the model fit the data ( Table 2 ). For each factor, one item served as a reference with a factor loading of 1; for the direct questionsterm·key factor, the reference item was the self-rated item ( Table 1 ). The lower estimated factor loadings for three items (“sometimes lonely,” “last week lonely,” and “feel alone”) indicate a weaker correlation between the item and the latent factor compared to the other two items. The R 2 represents these correlations. The high item–factor correlations for direct questionsterm·key and social and emotional lonelinessterm·dom factors and the lower correlations for the two existential lonelinessterm·dom factors are congruent with the differences in homogeneityterm·mth and reliabilityterm·mth reported previously.
Fit of Four Models in Confirmatory Factor Analysisterm·key Attenuation-corrected correlations between the five lonelinessterm·dom scale scores varied between 0.32 and 0.82 ( Table 3 ). The highest correlation was found between the direct questionsterm·key and emotional lonelinessterm·dom. Correlations among the two existential lonelinessterm·dom scales and the other factors were relatively low.
Observed Correlations and Correlations Corrected for Attenuation a Between Lonelinessterm·dom Scale Scores b Most respondents (63%) lived with their spouse; fewer than 1% lived independently while their spouse lived in a nursing home; 3% were not married and lived with a partner; 5% had a partner who lived outside of the household; and 29% did not have a partner. Most respondents had extensive personal networks: fewer than 1% had no or only one tie, and 91% had six or more ties; the average network size was 16.5 ties. In addition to daily contact with the partner with whom one lived (66%), 18% had daily contact with someone else, and 15% had no daily network contact. Health was rated as good or very good by 68%. The frequency of church attendance was monthly or more frequently for 23% of the respondents. Correlations between the lonelinessterm·dom scales and gender (with the exception of emotional lonelinessterm·dom), age, network characteristics, and health were in the direction similar to the directions reported in the literature ( Table 4 ). The correlations were generally modest and there were few differences between the five scales. Most striking was that the correlation with living with spouse or partner was relatively high for the direct questionsterm·key and emotional lonelinessterm·dom. Lonelinessterm·dom did not correlate with the frequency of church attendance.
Correlations Between Lonelinessterm·dom Scale Scores and Antecedents of Lonelinessterm·dom Discussion and Implications By applying the translated ELQterm·mth among older Dutch adults, we found evidence for multiple dimensions of lonelinessterm·dom in addition to social and emotional lonelinessterm·dom. Gökdemir-Bulut and Bozo (2018) tested the ELQterm·mth and assumed three factors. Because we excluded a number of items for different reasons, we combined two factors into one dimension, namely, “existential lonelinessterm·dom in relationships.” This ELQterm·mth dimension focuses on social bonding in relationships and has similarities with social lonelinessterm·dom (e.g., item 12 with DJG item 7). However, this ELQterm·mth dimension was only modestly related to social lonelinessterm·dom. This modest association may be due to addressing different aspects of lonelinessterm·dom in the other items and due to different wordings and mode effects, such as the use of two different interviews and different numbers of response options. The congruence of “existential lonelinessterm·dom in relationships” and social and emotional lonelinessterm·dom needs to be further investigated. We conclude that the ELQterm·mth subscale on relationships does not contribute sufficiently to the conceptualization of lonelinessterm·dom. In addition, the subscale is weakly homogeneous and insufficiently reliable. The third factor distinguished by Gökdemir-Bulut and Bozo relates to a differential conceptualization that we have labeled “meaninglessness in lifeterm·dom.” The positive correlations among existential lonelinessterm·dom scale scores, the direct questionterm·key scores, and social and emotional lonelinessterm·dom show that existential lonelinessterm·dom as measured with the ELQterm·mth is not a positive and rewarding experience. However, we did not address the fact that individuals sometimes seek solitudeterm·dom ( Lay et al., 2020 ) or think they are better off alone ( Birditt et al., 2019 ), and we did not measure the “desire for aloneness” ( Leung, 2015 ).
The lack of fit of the unidimensional, second-order, and bifactor models and the modest correlations between the five factors, especially between social and emotional lonelinessterm·dom on the one hand and existential lonelinessterm·dom on the other, suggest that the various instruments address many different aspects. We can see the collection of these aspects as representative for one broad multidimensional theoretical concept, or, alternatively, these aspects do not have enough in common to be seen as dimensions of one sharply defined concept of lonelinessterm·dom and represent two concepts, namely, “lonelinessterm·dom” and “meaning in life” ( Brandstätter et al., 2012 ), each with their own definition. The three dimensions can also be interpreted to cover three aspects of the life experience ( Steptoe et al., 2015 ): how satisfied people are with their lives (evaluative), feelings and moods (hedonistic), and assessing giving meaning to life (eudemonic). However, unlike Steptoe et al.’s findings, we did not find clearly distinct antecedents associated with the lonelinessterm·dom dimensions. This may indicate a commonality: social, emotional, and existential aspects are all negative lonelinessterm·dom feelings pointing to a lack of connectedness with people and life, which are associated in the same way to a number of lonelinessterm·dom antecedents. On the basis of the antecedents, the three dimensions cannot therefore be sufficiently distinguished from each other to be treated as a standalone phenomenon. In future research, we propose using 18 questions that measure three types of lonelinessterm·dom. The existential scale could be improved.
We also included direct questionsterm·key on lonelinessterm·dom in our analyses. The strong homogeneityterm·mth of the factor with direct questionsterm·key may be related to the repetition of the word “lonelinessterm·dom” (or variants) in four of the five items. Balancing the advantages and disadvantages of direct questionsterm·key compared to scales, many researchers prefer the use of scales. The use of a direct questionterm·key can be of additional value when a strong correlation is observed with a lonelinessterm·dom scale score to confirm the validity of the scale ( Victor et al., 2005 ). The high correlation we observed between the scores for the direct questionsterm·key and the emotional lonelinessterm·dom scale scores suggests that the evaluations and feelings included in the six emotional lonelinessterm·dom items most closely represent what people mean when they report lonelinessterm·dom. A researcher who prefers to use only one direct questionterm·key does not know which type of lonelinessterm·dom the question measures, or in the best case, it most likely measures emotional lonelinessterm·dom in an unreliable way.
It is now widely recognized that lonelinessterm·dom is related to public health, for example, due to increased premature mortality among lonely people ( Holt-Lunstad et al., 2015 ). Therefore, policy makers are interested in the prevalence of lonelinessterm·dom, and practitioners treating clients who may be lonely need to assess whether lonelinessterm·dom is the problem. Scale ratings of lonelinessterm·dom indicate the severity of lonelinessterm·dom but do not indicate the prevalence of lonelinessterm·dom or whether a person is lonely. Providing a cutoff score of a lonelinessterm·dom scale may solve this problem but also needs a reference that can be found in answers on direct lonelinessterm·dom questions ( van TilburgpersName & de Jong Gierveld, 1999 ). We found that the frequency of signs of lonelinessterm·dom varies greatly between items. This may have to do with the period covered in the items (e.g., last week or undefined), the wording of the items (e.g., trusting many people completely or having a trustee), the different number of response options (three to five), and the context of the interview (i.e., general or medical). This suggests that both the basis for determining lonelinessterm·dom prevalence and the likelihood of an individual being assessed as lonely vary based on the design of the research. However, we observed strong homogeneityterm·mth among the answers to the five direct questionsterm·key. This offers opportunities for an improved way to estimate the prevalence of lonelinessterm·dom and to assess individuals. Answers to various questions can be averaged, and this average can be used to determine appropriate cutoff scores.
We want to draw attention to some design issues in addition to those addressed previously. First, respondents participated in two long interviews. The sample does not include many older people who are in a serious situation, such as severe illness or the end of life, which is the focus of a number of studies on existential lonelinessterm·dom. Second, there was a time between the two interviews, which contributed to participants avoiding response sets and other ways in which offering many questions on one topic can affect the outcome of the research. At the same time, the respondent’s situation may have changed between the two interviews, which may have contributed to the relatively low correlation between the DJG scores (assessed in the first interview) and the ELQterm·mth scores (assessed in the second interview). However, we also note that the factor of direct questionsterm·key, of which three were asked in the first interview and two were asked in the second interview, had very good psychometric properties. This suggests that the interval between the two interviews did not strongly influence our results. Finally, we did not look in detail at the quality of the scales and did not investigate whether removing items leads to more homogeneous scales.
To conclude, we explored the dimensions of lonelinessterm·dom and found that social, emotional, and existential aspects were relevant. These were equally related to the antecedents of lonelinessterm·dom. Direct questionsterm·key may be of additional value in assessing lonelinessterm·dom among older adults.
Funding The Longitudinal Aging Study Amsterdam is supported by a grant from the Netherlands Ministry of Health, Welfare and Sport, Directorate of Long-Term Care.
Conflict of Interest None declared.
References