Effect of Layperson-Delivered, Empathy-Focused Program of Telephone Calls on Loneliness, Depression, and Anxiety Among Adults During the COVID-19 Pandemic: A Randomized Clinical Trial
Open accessAbstract
Importance: Loneliness is a risk factor for many clinical conditions, but there are few effective interventions deployable at scale. Objective: To determine whether a layperson-delivered, empathy-focused program of telephone calls could rapidly improve loneliness, depression, and anxiety in at-risk adults. Design, Setting, and Participants: From July 6 to September 24, 2020, we recruited and followed up 240 adults who were assigned to receive calls (intervention group) or no calls (control group) via block randomization. Loneliness, depression, and anxiety were measured using validated scales at enrollment and after 4 weeks. Intention-to-treat analyses were conducted. Meals on Wheels Central Texas (MOWCTX) clients received calls in their homes or wherever they might have been when the call was received. The study included MOWCTX clients who fit their service criteria, including being homebound and expressing a need for food. A total of 296 participants were screened, of whom 240 were randomized to intervention or control. Interventions: Sixteen callers, aged 17 to 23 years, were briefly trained in empathetic conversational techniques. Each called 6 to 9 participants over 4 weeks daily for the first 5 days, after which clients could choose to drop down to fewer calls but no less than 2 calls a week. Main Outcomes and Measures: Primary outcome was loneliness (3-item UCLA Loneliness Scale, range 3-9; and 6-item De Jong Giervald Loneliness [De Jong] Scale, range 0-6). Secondary outcomes were depression (Personal Health Questionnaire for Depression), anxiety (Generalized Anxiety Disorder scale), and self-rated health (Short Form Health Survey Questionnaire). Results: The 240 participants were aged 27 to 101 years, with 63% aged at least 65 years (n = 149 of 232), 56% living alone (n = 135 of 240), 79% women (n = 190 of 240), 39% Black or African American (n = 94 of 240), and 22% Hispanic or Latino (n = 52 of 240), and all reported at least 1 chronic condition. Of 240 participants enrolled, 13 were lost to follow-up in the intervention arm and 1 in the control arm. Postassessment differences between intervention and control after 4 weeks showed an improvement of 1.1 on the UCLA Loneliness Scale (95% CI, 0.5-1.7; P < .001; Cohen d of 0.48), and improvement of 0.32 on De Jong (95% CI, -0.20 to 0.81; P = .06; Cohen d, 0.17) for loneliness; an improvement of 1.5 on the Personal Health Questionnaire for Depression (95% CI, 0.22-2.7; P < .001; Cohen d, 0.31) for depression; and an improvement of 1.8 on the Generalized Anxiety Disorder scale (95% CI, 0.44 to 3.2; P < .001; Cohen d, 0.35) for anxiety. General physical health on the Short Form Health Questionnaire Survey showed no change, but mental health improved by 2.6 (95% CI, 0.81 to 4.4; P = .003; Cohen d of 0.46). Conclusions and Relevance: A layperson-delivered, empathy-oriented telephone call program reduced loneliness, depression, and anxiety compared with the control group and improved the general mental health of participants within 4 weeks. Future research can determine whether effects on depression and anxiety can be extended to maximize clinical relevance. Trial Registration: ClinicalTrials.gov Identifier: NCT04595708.
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A four-week program of empathetic telephone calls decreased feelings of loneliness.
“Similarly, another study found that a four-week program of empathetic telephone calls decreased feelings of loneliness (Kahlon et al. 2021).”
From AI Companions Reduce Loneliness (2024) · cites this paper as Kahlon et al. 2021
Other interventions delivered through phone calls or videoconferencing often focus on peer support or empathy-based approaches without consistently employing structured, evidence-based frameworks.
“Others emphasize interventions delivered through phone calls or videoconferencing, often focusing on peer support or empathy-based approaches without consistently employing structured, evidence-based frameworks [e.g., (69–71)].”
From Telephone-based group mental health support for older adults in central Canada: pilot acceptability and effectiveness findings of The CONNECT Program (2025) · cites this paper as [70]
A systematic review by Bonardi et al found 3 high-quality studies that decreased different COVID-19-related symptoms like anxiety and depressive symptoms in adults postintervention or at least 6 weeks after the intervention.
“the systematic review by Bonardi et al [38] found 3 high-quality studies that were able to decrease different COVID-19–related symptoms like anxiety and depressive symptoms in adults postintervention [71] or at least 6 weeks after the intervention [72,73]”
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Cites
A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.10.1092 · Cited by 31,765 · see citing works
WARE, J. E., KOSINSKI, M., & KELLER, S. D. (1996) · Medical Care · doi:10.1097/00005650-199603000-00003 · Cited by 17,392 · cited 1× · see citing works
“Logistic mixed-effect regressions were run in addition to linear mixed-effect regressions when instruments had well-established clinical cutoffs for mild (5-9), moderate (10-19), or severe (>20) depression (PHQ-8)18 or anxiety (GAD-7)19 to gauge clinical significance.”
MethodCONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371 · see citing works
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group (2010) · BMJ · doi:10.1136/bmj.c332 · Cited by 9,329 · see citing works
A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004) · Research on Aging · doi:10.1177/0164027504268574 · Cited by 4,781 · see citing works
Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006) · Psychology and Aging · doi:10.1037/0882-7974.21.1.140 · Cited by 2,380 · see citing works
A Meta-Analysis of Interventions to Reduce Loneliness
Masi, C. M., Chen, H.-Y., Hawkley, L. C., & Cacioppo, J. T. (2011) · Personality and Social Psychology Review · doi:10.1177/1088868310377394 · Cited by 1,995 · cited 1× · see citing works
“Logistic mixed-effect regressions were run in addition to linear mixed-effect regressions when instruments had well-established clinical cutoffs for mild (5-9), moderate (10-19), or severe (>20) depression (PHQ-8)18 or anxiety (GAD-7)19 to gauge clinical significance.”
MethodA 6-Item Scale for Overall, Emotional, and Social Loneliness: Confirmatory Tests on Survey Data
Gierveld, J. D. J., & Tilburg, T. V. (2006) · Research on Aging · doi:10.1177/0164027506289723 · Cited by 1,467 · see citing works
Psychological distress and loneliness reported by US adults in 2018 and April 2020
McGinty, E. E., Presskreischer, R., Han, H., & Barry, C. L. (2020) · JAMA · doi:10.1001/jama.2020.9740 · Cited by 978 · see citing works
Loneliness: A signature mental health concern in the era of COVID-19
Killgore, W. D. S., Cloonan, S. A., Taylor, E. C., & Dailey, N. S. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113117 · Cited by 915 · see citing works
The trajectory of loneliness in response to COVID-19
Luchetti, M., Lee, J. H., Aschwanden, D., Sesker, A., Strickhouser, J. E., Terracciano, A., & Sutin, A. R. (2020) · American Psychologist · doi:10.1037/amp0000690 · Cited by 903 · see citing works
De Jong Gierveld, J., & Van Tilburg, T. (2010) · European Journal of Ageing · doi:10.1007/s10433-010-0144-6 · Cited by 791 · see citing works
Loneliness and Mental Health During the COVID-19 Pandemic: A Study Among Dutch Older Adults
van Tilburg, T. G., Steinmetz, S., Stolte, E., van der Roest, H., & de Vries, D. H. (2021) · The Journals of Gerontology: Series B · doi:10.1093/geronb/gbaa111 · Cited by 690 · see citing works
Older Adults and the Mental Health Effects of COVID-19
Vahia, I. V., Jeste, D. V., & Reynolds, C. F. (2020) · JAMA · doi:10.1001/jama.2020.21753 · Cited by 520 · see citing works
Social Isolation and Loneliness in Older Adults
Board on Health Sciences Policy, Board on Behavioral, C., Division, H. A. M., Education, D. O. B. A. S. S. A., & National Academies of Sciences, E. (2020) · National Academies Press eBooks · doi:10.17226/25663 · Cited by 487 · see citing works
Bu, F., Steptoe, A., & Fancourt, D. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113521 · Cited by 462 · see citing works
Chiang, K., Chu, H., Chang, H., Chung, M., Chen, C., Chiou, H., & Chou, K. (2009) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2350 · Cited by 320 · see citing works
Shin, C., Lee, S., Han, K., Yoon, H.-K., & Han, C. (2019) · Psychiatry Investigation · doi:10.30773/pi.2019.02.01 · Cited by 265 · see citing works
McGinty, E. E., Presskreischer, R., Anderson, K. E., Han, H. C., & Barry, C. L. (2020) · JAMA · doi:10.1001/jama.2020.21231 · Cited by 216 · see citing works
Penning, M., Liu, G.-P., & Chou, P. H. B. (2014) · Social Indicators Research · doi:10.1007/s11205-013-0461-1 · Cited by 160 · see citing works
Choi, N. G., Pepin, R. L., Marti, C. N., Stevens, C. J., & BRUCE, M. L. (2020) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2020.02.008 · Cited by 148 · see citing works
Bruce, M. L., Pepin, R., Marti, C. N., Stevens, C. J., & Choi, N. G. (2021) · The American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2021.05.005 · Cited by 82 · see citing works
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Taylor, S. (2022) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-072720-020131 · Cited by 164 · see citing works
AI Companions Reduce Loneliness
De Freitas, J., Oğuz-Uğuralp, Z., Uğuralp, A. K., & Puntoni, S. (2026) · Journal of Consumer Research · doi:10.1093/jcr/ucaf040 · Cited by 165 · see citing works
Bonardi, O., Wang, Y., Li, K., Jiang, X., Krishnan, A., He, C., Sun, Y., Wu, Y., Boruff, J. T., Markham, S., et al. (2022) · The Canadian Journal of Psychiatry · doi:10.1177/07067437211070648 · Cited by 43 · see citing works
Fischer-Grote, L., Fössing, V., Aigner, M., Fehrmann, E., & Boeckle, M. (2024) · JMIR Mental Health · doi:10.2196/46637 · Cited by 42 · see citing works
“…studies that were able to decrease different COVID-19–related symptoms like anxiety and depressive symptoms in adults postintervention [71] or at least 6 weeks after the intervention [72,73]; this shows that there seems to be some online or remote interventions available for adult participants.”
BackgroundAI Companions Reduce Loneliness
De Freitas, J., Uguralp, A. K., Uguralp, Z. O., & Stefano, P. (2024) · arXiv · doi:10.48550/arxiv.2407.19096 · Cited by 12 · see citing works
Godara, M., Hecht, M., & Singer, T. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.03.037 · Cited by 12 · see citing works
Tan, X. R., Wilson, I. M., Tay, P. K. C., Win, P. P. S., Song, C. F., & Wee, S.-L. (2024) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2024.105478 · Cited by 10 · see citing works
A proactive phone intervention for older adults to address loneliness identified by a health plan
Hough, K. A., Tha, S. H., Perissinotto, C. M., Burnes, P., & Kotwal, A. A. (2024) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.15223 · Cited by 4 · see citing works
Reynolds, K. A. A., Kudar, K., Joshi, J., Christianson, I., Davidson, D., Gopinath, G., Koven, L., Mackenzie, C., Miller, S., & Newall, N. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1541583 · Cited by 2 · see citing works
- Authors
- Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., Mundhenk, R., Sebastian, K. R., & Tomlinson, S.
- Affiliations
- The University of Texas at Austin (US)
- Maine Medical Center Research Institute (US)
- Lone Star Circle of Care, Georgetown, Texas
- Seminary of the Southwest (US)
- Corresponding author
- Kahlon, Maninder K.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2021-06-01
- Volume
- 78
- Issue
- 6
- Pages
- 616
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC7903319
- OpenAlex
- W3132202418
- Cited by
- 184
- References
- 22
- Citations by year
- 2026: 16 · 2025: 32 · 2024: 37 · 2023: 38 · 2022: 41 · 2021: 20
- FWCI
- 23.18
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- loneliness, depression, anxiety, telephone-delivered intervention, COVID-19 pandemic, Meals on Wheels, social isolation, self-rated health, older adults, living alone, chronic disease, community-based mental health interventions, depression intervention, anxiety intervention
- MeSH terms
- COVID-19, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety, Chronic Disease, Community Health Workers, Depression, Empathy, Female, Humans, Loneliness, Male, Mental Health, Middle Aged, Social Work, Telephone, Texas, Program Development, Outcome Assessment, Health Care, Telemedicine, Young Adult
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