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Loneliness in 2019

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Rehabil Nurs. 2019 Jan/Feb;44(1):52-59. doi: 10.1097/rnj.0000000000000128.

Loneliness in Multiple Sclerosis: Possible Antecedents and Correlates.

Balto JM, Pilutti LA, Motl RW.



The prevalence and possible antecedents and correlates of loneliness in multiple sclerosis (MS) was examined.


Cross-sectional, comparative study of MS (n = 63) and healthy adults (n = 21).


Data were collected using self-reports of loneliness and antecedents and correlates and analyzed using inferential statistics.


Those with MS had significantly higher loneliness scores than healthy adults (p < .05), and this was explained by employment status. Possible antecedents included marital status (p < .05), upper extremity function (r= -.28, p < .03), social disability frequency (r= -.49, p < .00), social disability limitations (r= -.38, p < .00), and personal disability limitations (r= -.29, p < .03). Social disability frequency (beta = -.41, p < .001) and marital status (beta = -.23, p < .046) accounted for 25% of the variance in loneliness scores. Possible correlates included depression (r= .49, p < .00), cognitive fatigue (r= .34, p < .01), psychosocial fatigue (r= .30, p < .02), and psychological quality of life (r= .44, p < .00).


We provide evidence of loneliness in persons with MS, and this is associated with possible antecedents (e.g., marital status and disability limitations) and correlates (e.g., depression and fatigue).


Loneliness should be recognized clinically as an important concomitant of MS.


'Maybe happiness too is a metaphor invented
on a day of boredom' - Gustav Flaubert, novelist

Loneliness is an epidemic within humanity that must be taken seriously. It has been linked to both physical illness, as well as functional and cognitive decline (Researchers confront an Epidemic of Loneliness; The New York Times). And not surprisingly, it has its very own ICD-10 (International Statistical Classification of Diseases and Health Related Problems) diagnosis code:


The loss related to MS, be it the disability, loss of employment, quality of life or restricted community or social participation, makes MS an insidious condition that impacts on nearly every aspect of life. Those affected don't realize that they're in the thick of it often until its too late. 

Surveying loneliness is always tricky one, as a majority of people do not want to openly dissect what they personally attribute as failure in accomplishment. It is difficult to conceptualize loneliness, but in psychosocial terms it is defined as 'the unpleasant experience that occurs when a person's network of social relationships is significantly deficient in either quality or quantity' (Perlman and Peplau's social psychological theory). Here, the authors have used a predefined scale and invited those with MS and those without MS to participate.

The findings are informative and will help PwMS to be cognizant of them much earlier on:

Loneliness is
  • Based on employment status
  • Marital status, functional and disability frequency and limitations were potential antecedents of loneliness
  • depression, fatigue and quality of life (QOL) correlated with loneliness

Why is employment status important? Lack of employment marginalizes or chronically cuts you off from social contacts, placing you at risk of loneliness. 

Why is marital status important? Those who are single with MS are lonelier than their married counterparts and this is due to an importance of fulfilling relationships. A diagnosis of MS can result in separation and divorce, thereby increasing the likelihood of loneliness. 

Why is depression, fatigue and psychological QOL important? These factors are not unique to MS and have been documented as correlates of loneliness in other populations. It can also become a circular argument. For example, cancer survivors that reported being lonelier also experienced more concurrent pain, depression, fatigue and larger increases in symptom cluster. 

We now live in a global society and loneliness now needs to be considered at a population level. I came across this interesting dissection of loneliness while researching this topic, entitled cross-national differences in loneliness:

Figure: Explanations for cross-national differences in loneliness (1. The inhabitants of the different countries have different individual characteristics, and thus that the differences might be attributable to differences in population composition. 2. The countries as a whole are different. In this kind of an explanation references might be made to differences in cultural systems, economic organization, policy arrangements, and so forth. 3. There is an interaction between individual and country characteristics, implying that the importance of a particular individual-level predictor might vary between countries. One should note that these explanations are not mutually exclusive.)

View the full article on Barts MS Blog

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