The prospective association of adolescent loneliness and low resilience with anxiety and depression in young adulthood: The HUNT study

May combine two claims.

The burden of mental illness in young adulthood often stems from factors experienced during adolescence, with loneliness being a significant, yet understudied factor.

“The burden of mental illness in young adulthood often stems from factors experienced during adolescence, with loneliness being a significant, yet understudied factor [9, 10].”

• cites [9] Solmi M, Radua J, Olivola M et al (2022) Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry 27(1):281–295. https://doi.org/10.1038/s41380-021-01161-7 sourcePartly supported

  The Discussion (page unavailable) reports that many adult mental disorders originate early and that pooled onset peaks in mid-to-late adolescence. This supports an adolescent origin for some later mental illness, but the paper does not establish that the burden in young adulthood stems from factors experienced during adolescence, or identify loneliness as a significant, understudied factor. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [10] Beutel ME, Klein EM, Brähler E et al (2017) Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 17:1–7 sourcePartly supported

  The Results and Discussion associate loneliness with depression, anxiety and suicidal ideation, and the Discussion calls for more research on its mental-health impact in people under 35. The paper does not establish that mental illness in young adulthood often stems from experiences during adolescence; it explicitly says its cross-sectional study cannot support causal conclusions. The indexed passages provide section labels but no page numbers. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

There remains a gap in understanding the long-term effects of loneliness on mental health into adulthood.

“While previous research has established the link between loneliness and mental health problems [16–18], there remains a gap in understanding the long-term effects of loneliness on mental health into adulthood [19].”

• cites [19] Kehusmaa J, Ruotsalainen H, Männikkö N et al (2022) The association between the social environment of childhood and adolescence and depression in young adulthood - A prospective cohort study. J Affect Disord 305:37–46. https://doi.org/10.1016/j.jad.2022.02.067 sourcePartly supported

  Section 4.2 says there has been a lack of studies on childhood loneliness and depression in young adulthood, particularly regarding gender differences. That supports a gap in knowledge about a long-term association, but the cited passage concerns depression specifically, not mental health outcomes broadly. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Loneliness can lead to a lack of social support and meaningful connections, further exacerbating feelings of distress and contributing to the onset of anxiety and depression.

“Research shows that loneliness can lead to a lack of social support and meaningful connections, further exacerbating feelings of distress and contributing to the onset of anxiety and depression [15].”

• cites [15] Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S (2018) Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry 18(1):1–16 sourcePartly supported

  The Discussion (Main findings; page not provided) reports that greater loneliness is associated with more severe depression and anxiety symptoms, and the Background links missing close relationships with distress. The review examines outcomes among people with existing mental health problems; it does not establish that loneliness causes a lack of social support or contributes to the onset of anxiety or depression. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

May combine two claims.

Resilience is negatively correlated with anxiety and depression, suggesting it may protect against these conditions by buffering risk factors.

“Research shows resilience is negatively correlated with anxiety and depression,, suggesting it may protect against these conditions by buffering risk factors [37–43].”

• cites [37] Wingo AP, Wrenn G, Pelletier T, Gutman AR, Bradley B, Ressler KJ (2010) Moderating effects of resilience on depression in individuals with a history of childhood abuse or trauma exposure. J Affect Disord 126(3):411–414 sourcePartly supported

  The Results report that higher resilience was associated with lower depressive symptom severity and moderated the association between other trauma exposure and depression. The study examined depression in a highly traumatized population; it does not report a resilience–anxiety correlation or show that resilience buffers risk factors for anxiety. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [38] Ding H, Han J, Zhang M, Wang K, Gong J, Yang S (2017) Moderating and mediating effects of resilience between childhood trauma and depressive symptoms in Chinese children. J Affect Disord 211:130–135. https://doi.org/10.1016/j.jad.2016.12.056 sourceNot checked — no full text of the source
• cites [39] Poole JC, Dobson KS, Pusch D (2017) Childhood adversity and adult depression: the protective role of psychological resilience. Child Abuse Negl 64:89–100. https://doi.org/10.1016/j.chiabu.2016.12.012 sourceNot checked — no full text of the source
• cites [40] Hu T, Zhang D, Wang J (2015) A meta-analysis of the trait resilience and mental health. Pers Indiv Differ 76:18–27 sourceNot checked — no full text of the source
• cites [41] Shapero BG, Farabaugh A, Terechina O et al (2019) Understanding the effects of emotional reactivity on depression and suicidal thoughts and behaviors: moderating effects of childhood adversity and resilience. J Affect Disord 245:419–427 sourceNot checked — no full text of the source
• cites [42] Navrady L, Adams M, Chan S, Ritchie S, McIntosh A (2018) Genetic risk of major depressive disorder: the moderating and mediating effects of neuroticism and psychological resilience on clinical and self-reported depression. Psychol Med 48(11):1890–1899 sourcePartly supported

  The Results (Moderation; page not provided) report an inverse association between resilience and clinical and self-reported depression. The paper does not establish the claimed association with anxiety. It also found no resilience-by-genetic-risk interaction for depression, although its Discussion suggests resilience may mitigate genetic risk through mediation. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites [43] Schulz A, Becker M, Van der Auwera S et al (2014) The impact of childhood trauma on depression: does resilience matter? Population-based results from the study of health in Pomerania. J Psychosom Res 77(2):97–103. https://doi.org/10.1016/j.jpsychores.2014.06.008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The READ can be used during all of adolescence, from 14 to 15 years of age up to 18 to 20 years of age.

“Furthermore, several studies support the use of the scale during all of adolescence, from 14 to 15 years of age up to 18 to 20 years of age.”

• cites [54] von Soest T, Mossige S, Stefansen K, Hjemdal O (2010) A validation study of the resilience scale for adolescents (READ). J Psychopathol Behav Assess 32:215–225 sourceNot checked — no full text of the source
• cites [55] Kelly Y, Fitzgerald A, Dooley B (2017) Validation of the resilience scale for adolescents (READ) in Ireland: a multi-group analysis. Int J Methods Psychiatr Res 26(2):e1506 sourceSupported
• cites [56] Moksnes UK, Haugan G (2018) Validation of the resilience scale for adolescents in Norwegian adolescents 13–18 years. Scand J Caring Sci 32(1):430–440 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A failure to form intimate relationships during adolescence can heighten the risk of experiencing loneliness.

“A failure to form such intimate relationships during this developmental stage can heighten the risk of experiencing loneliness [24, 25].”

• cites [24] Sundqvist A, Hemberg J (2021) Adolescents’ and young adults’ experiences of loneliness and their thoughts about its alleviation. Int J Adolescence Youth 26(1):238–255 sourceSupported
• cites [25] Hemberg J, Östman L, Korzhina Y, Groundstroem H, Nyström L, Nyman-Kurkiala P (2022) Loneliness as experienced by adolescents and young adults: an explorative qualitative study. Int J Adolescence Youth 27(1):362–384 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Adolescence is a phase of major biological, psychological, social, and cognitive transitions, making adolescents more vulnerable to loneliness than those in later life stages.

“Adolescence is a phase of major biological, psychological, social, and cognitive transitions, making adolescents more vulnerable to loneliness than those in later life stages [22, 23]”

• cites [22] Franssen T, Stijnen M, Hamers F, Schneider F (2020) Age differences in demographic, social and health-related factors associated with loneliness across the adult life span (19–65 years): a cross-sectional study in the Netherlands. BMC Public Health 20(1):1–12 sourcePartly supported

  The Background (page not specified) links loneliness to age-specific life goals and transitions, which supports the general life-stage framing. But the study examines adults aged 19–65, not adolescents, and does not establish that biological, psychological, social and cognitive transitions make adolescents lonelier than people in later life stages. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [23] Balážová M, Gallová I, Praško J, Šlepecký M, Kotianová A (2017) Family environment as predictor of adolescents’ loneliness. Eur Psychiatry 41(S1):S82–S sourcePartly supported

  The Introduction in the Abstract says adolescents are particularly vulnerable to loneliness as they become more independent of family and form peer relationships. It does not describe biological, psychological, and cognitive transitions or compare adolescents’ vulnerability with people in later life stages. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Our findings align with studies by Kehusmaa et al. and Xerxa et al., linking childhood and adolescent loneliness with anxiety and depression in young adulthood.

“Our findings align with studies by Kehusmaa et al. [29] and Xerxa et al. [30], linking childhood and adolescent loneliness with anxiety and depression in young adulthood.”

• cites [29] Kehusmaa J, Ruotsalainen H, Männikkö N et al (2022) The association between the social environment of childhood and adolescence and depression in young adulthood-A prospective cohort study. J Affect Disord 305:37–46 sourcePartly supported

  Section 4.2 reports that childhood loneliness was associated with depression in young adulthood only among boys, while adolescent loneliness was associated with depression in both genders. It does not report an association with anxiety in young adulthood; it mentions anxiety only as a possible mechanism that may increase depression risk. Page numbers were not provided in our copy. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites [30] Xerxa Y, Rescorla LA, Shanahan L, Tiemeier H, Copeland WE (2023) Childhood loneliness as a specific risk factor for adult psychiatric disorders. Psychol Med 53(1):227–235 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Several cross-sectional studies across different age groups have highlighted resilience's protective role.

“Several cross-sectional studies across different age groups have highlighted resilience’s protective role.”

• cites [92] Zhang X, Brown AM, Rhubart DC (2023) Can resilience buffer the effects of loneliness on mental distress among working-age adults in the united States during the COVID-19 pandemic? A latent moderated structural modeling analysis. Int J Behav Med 30(6):790–800 sourcePartly supported

  The Results and Discussion report that psychological resilience was associated with less mental distress and weakened the relationship between loneliness and distress. The Discussion identifies this as a cross-sectional study of U.S. working-age adults. Although the paper discusses other studies, it does not establish that several cross-sectional studies across different age groups found this protective role. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [93] Skrove M, Romundstad P, Indredavik MS (2013) Resilience, lifestyle and symptoms of anxiety and depression in adolescence: the Young-HUNT study. Soc Psychiatry Psychiatr Epidemiol 48:407–416 sourceNot checked — no full text of the source
• cites [94] Zhao X, Zhang D, Wu M et al (2018) Loneliness and depression symptoms among the elderly in nursing homes: A moderated mediation model of resilience and social support. Psychiatry Res 268:143–151 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Individuals with low psychological resilience seem to have compromised control of brain circuits involved in emotion and fear and poor cortico-limbic inhibition, representing a dysregulated emotional response to stress that may result in elevated cortisol exposure.

“Moreover, individuals with low psychological resilience seem to have compromised control of brain circuits involved in emotion and fear [97] and poor cortico-limbic inhibition, representing a dysregulated emotional response to stress that may result in elevated cortisol exposure [98].”

• cites [97] Southwick SM, Charney DS (2012) The science of resilience: implications for the prevention and treatment of depression. Science 338(6103):79–82 sourceNot checked — no full text of the source
• cites [98] Gupta A, Love A, Kilpatrick LA et al (2017) Morphological brain measures of cortico-limbic Inhibition related to resilience. J Neurosci Res 95(9):1760–1775 sourcePartly supported

  Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Junker et al. showed that loneliness, often accompanied by anxiety and depression, increased self-harm hospitalization risk among Norwegian adolescents.

“Similarly, Junker et al. [75] showed that loneliness, often accompanied by anxiety and depression, increased self-harm hospitalization risk among Norwegian adolescents.”

• cites [75] Junker A, Bjørngaard JH, Bjerkeset O (2017) Adolescent health and subsequent risk of self-harm hospitalisation: a 15-year follow-up of the Young-HUNT cohort. Child Adolesc Psychiatry Mental Health 11(1):1–14 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Beutel et al. highlighted a strong association between loneliness and generalized anxiety and depression, especially among middle and late adulthood individuals.

“Additionally, Beutel et al. [12] highlighted a strong association between loneliness and generalized anxiety and depression, especially among middle and late adulthood individuals.”

• cites [12] Beutel ME, Klein EM, Brähler E et al (2017) Loneliness in the general population: prevalence, determinants and relations to mental health. BMC Psychiatry 17(1):1–7 sourcePartly supported

  The Results report associations of loneliness with depression (OR = 1.91) and generalized anxiety (OR = 1.21). They do not establish that these associations are especially strong in middle or late adulthood; the Discussion instead says younger age groups were more affected by loneliness. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

Loneliness affects youth's diurnal cortisol, potentially causing chronic increases in cortisol in young adulthood, leading to higher risks of depression, anxiety, inflammation, and other adverse health outcomes.

“Loneliness affects youth’s diurnal cortisol, a key stress hormone [83, 84], potentially causing chronic increases in cortisol in young adulthood, leading to higher risks of depression, anxiety, inflammation, and other adverse health outcomes [85–87].”

• cites [83] Adam EK, Quinn ME, Tavernier R, McQuillan MT, Dahlke KA, Gilbert KE (2017) Diurnal cortisol slopes and mental and physical health outcomes: A systematic review and meta-analysis. Psychoneuroendocrinology 83:25–41 sourcePartly supported

  The Discussion (§4.1; page unavailable) reports that flatter diurnal cortisol slopes are associated with depression, immune/inflammatory outcomes, and other poorer health outcomes. The Results (§3.3; page unavailable) find no significant association with anxiety and note a trend in the opposite direction. The paper does not establish that loneliness in youth causes chronically elevated cortisol in young adulthood or that such an increase leads to those outcomes. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [84] Doane LD, Adam EK (2010) Loneliness and cortisol: momentary, day-to-day, and trait associations. Psychoneuroendocrinology 35(3):430–441 sourceSupported
• cites [85] Nederhof E, Marceau K, Shirtcliff EA, Hastings PD, Oldehinkel AJ (2015) Autonomic and adrenocortical interactions predict mental health in late adolescence: the TRAILS study. J Abnorm Child Psychol 43:847–861 sourceNot checked — no full text of the source
• cites [86] Ruttle PL, Javaras KN, Klein MH, Armstrong JM, Burk LR, Essex MJ (2013) Concurrent and longitudinal associations between diurnal cortisol and body mass index across adolescence. J Adolesc Health 52(6):731–737 sourceCould not verify

  The Methods and Discussion describe diurnal cortisol measurements in adolescents and their association with BMI, not loneliness. Searches for loneliness, chronic cortisol increases in young adulthood, and the stated depression, anxiety, and inflammation risks found no passage establishing the claimed chain of effects. The reported lower cortisol levels associated with higher BMI do not, by themselves, contradict a claim about loneliness. (LLM, conf=0.76)

  Experimental — accuracy not yet measured
• cites [87] Jopling E, Rnic K, Tracy A, LeMoult J (2021) Impact of loneliness on diurnal cortisol in youth. Psychoneuroendocrinology 132:105345 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Lonelier individuals may exhibit disrupted emotional regulation, leading to increased negative emotions and a higher propensity for risky health behaviors, which could impact future mental health outcomes.

“Lonelier individuals may exhibit disrupted emotional regulation, leading to increased negative emotions and a higher propensity for risky health behaviors, which could impact future mental health outcomes [90].”

• cites [90] Matthews T, Danese A, Caspi A et al (2019) Lonely young adults in modern Britain: findings from an epidemiological cohort study. Psychol Med 49(2):268–277 sourcePartly supported

  The Results (Correlates of loneliness in young adulthood; page unavailable) associate loneliness with negative coping strategies, depression and anxiety, less physical activity, and daily smoking. The paper does not establish disrupted emotional regulation as the mechanism or show that these behaviours lead to future mental health outcomes; its Discussion raises concern about later physical health outcomes instead. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Stickley et al. reported higher odds of headaches, anxiety, and depressive symptoms among lonely adolescents.

“For instance, Stickley et al. [26] reported higher odds of headaches, anxiety, and depressive symptoms among lonely adolescents.”

• cites [26] Stickley A, Koyanagi A, Koposov R et al (2016) Loneliness and its association with psychological and somatic health problems among Czech, Russian and US adolescents. BMC Psychiatry 16(1):1–11 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

The pathway between loneliness and anxiety and depression involves psychological, biological, and social factors.

“The pathway between loneliness and anxiety and depression involves psychological, biological, and social factors [77, 78].”

• cites [77] Lim MH, Eres R, Vasan S (2020) Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions. Soc Psychiatry Psychiatr Epidemiol 55:793–810 sourceNot checked — no full text of the source
• cites [78] Umberson D, Karas Montez J (2010) Social relationships and health: A flashpoint for health policy. J Health Soc Behav 51(1suppl):S54–S66 sourcePartly supported

  The Psychosocial and Physiological Explanations sections describe social, psychological, and physiological mechanisms linking social ties to health. But Future Research says the causal mechanisms linking social isolation to poor health remain poorly understood; the paper does not establish this three-part pathway specifically between loneliness and anxiety or depression. Page numbers were not available in our copy. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Lonelier individuals experience poorer sleep quality in young adulthood, potentially worsening their long-term mental health.

“Additionally, lonelier individuals experience poorer sleep quality in young adulthood, potentially worsening their long-term mental health [91].”

• cites [91] Matthews T, Danese A, Gregory AM, Caspi A, Moffitt TE, Arseneault L (2017) Sleeping with one eye open: loneliness and sleep quality in young adults. Psychol Med 47(12):2177–2186 sourcePartly supported

  The Discussion reports a modest but robust association between loneliness and poorer sleep quality in young adults. The Conclusions suggest possible physical health problems in later life, but do not say that poorer sleep may worsen long-term mental health; the Discussion says longitudinal research is needed to test long-term effects. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Zhao et al. found resilience mediated the link between loneliness and depression in the elderly, while studies on working-age adults and Norwegian adolescents showed resilience moderated this relationship.

“For instance, Zhao et al. found resilience mediated the link between loneliness and depression in the elderly, while studies on working-age adults and Norwegian adolescents showed resilience moderated this relationship [92–94].”

• cites [92] Zhang X, Brown AM, Rhubart DC (2023) Can resilience buffer the effects of loneliness on mental distress among working-age adults in the united States during the COVID-19 pandemic? A latent moderated structural modeling analysis. Int J Behav Med 30(6):790–800 sourcePartly supported

  The Results section (‘The Buffering Effects of Psychological Resilience and Perceived Social Support’; page unavailable) reports that psychological resilience moderated the association between loneliness and mental distress in working-age adults. The Measures section defines mental distress as a combined depression-and-anxiety symptom measure, so this paper does not establish moderation of a depression-specific outcome. The elderly and Norwegian adolescent findings are attributed to other studies in the citation group. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites [93] Skrove M, Romundstad P, Indredavik MS (2013) Resilience, lifestyle and symptoms of anxiety and depression in adolescence: the Young-HUNT study. Soc Psychiatry Psychiatr Epidemiol 48:407–416 sourceNot checked — no full text of the source
• cites [94] Zhao X, Zhang D, Wu M et al (2018) Loneliness and depression symptoms among the elderly in nursing homes: A moderated mediation model of resilience and social support. Psychiatry Res 268:143–151 sourceNot checked — no full text of the source

May combine two claims.

Chronic stress associated with loneliness dysregulates biological systems, including the HPA axis and immune system, which are crucial in the onset and persistence of anxiety and depression.

“Moreover, the chronic stress associated with loneliness dysregulates biological systems, including the hypothalamic-pituitary-adrenal (HPA) axis and the immune system, which are crucial in the onset and persistence of anxiety and depression [80–82].”

• cites [80] Yanguas J, Pinazo-Henandis S, Tarazona-Santabalbina FJ (2018) The complexity of loneliness. Acta Biomed 89(2):302–314. https://doi.org/10.23750/abm.v89i2.7404 sourcePartly supported

  In “Loneliness and health” (page not provided), the paper links loneliness and chronic social isolation to increased HPA-axis activity, immune and inflammatory changes, and symptoms of anxiety and depression. It does not establish that dysregulation of those systems is crucial to the onset and persistence of both disorders; that causal claim is stronger than the paper’s account. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites [81] Hawkley LC, Hughes ME, Waite LJ, Masi CM, Thisted RA, Cacioppo JT (2008) From social structural factors to perceptions of relationship quality and loneliness: the Chicago health, aging, and social relations study. Journals Gerontol Ser B: Psychol Sci Social Sci 63(6):S375–S84 sourcePartly supported

  The Discussion (page unavailable) reports prior findings linking loneliness to a greater morning rise in cortisol and to gene-transcription changes favoring inflammation. The Results section on stress exposure associates chronic stress with loneliness, but the paper does not establish that loneliness-related chronic stress dysregulates those systems or that this pathway causes the onset or persistence of anxiety and depression. (LLM, conf=0.85)

  Experimental — accuracy not yet measured
• cites [82] Hawkley LC, Cole SW, Capitanio JP, Norman GJ, Cacioppo JT (2012) Effects of social isolation on glucocorticoid regulation in social mammals. Horm Behav 62(3):314–323 sourcePartly supported

  The Discussion (page not specified) says persistent isolation can lead to HPA dysregulation and changes that heighten the risk of inflammatory processes and reduced immune responses. The Humans section also reports associations between loneliness and impaired immunity. The paper does not establish that these changes are crucial to the onset or persistence of anxiety and depression. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

Loneliness can lead to negative cognitive patterns, such as rumination and self-criticism, which are linked to anxiety and depression.

“Loneliness can lead to negative cognitive patterns, such as rumination and self-criticism, which are linked to anxiety and depression [14, 79].”

• cites [14] Muyan M, Chang EC, Jilani Z, Yu T, Lin J, Hirsch JK (2016) Loneliness and negative affective conditions in adults: is there any room for hope in predicting anxiety and depressive symptoms? J Psychol 150(3):333–341 sourceNot checked — no full text of the source
• cites [79] Mushtaq R, Shoib S, Shah T, Mushtaq S (2014) Relationship between loneliness, psychiatric disorders and physical health? A review on the psychological aspects of loneliness. J Clin Diagn Res 8(9):We01–4. https://doi.org/10.7860/jcdr/2014/10077.4828 sourcePartly supported

  The Introduction (page not provided) links loneliness in people who are also depressed with negative feelings and negative judgments of personality attributes. The Psychiatric Disorders and Loneliness section also reports more depressive symptoms among lonely people. The copy does not describe rumination, establish that loneliness leads to these cognitive patterns, or link them to anxiety. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Maes et al. found a positive association between loneliness and social anxiety symptoms across childhood and adolescence.

“Moreover, a multilevel meta-analysis by Maes et al. [74] found a positive association between loneliness and social anxiety symptoms across childhood and adolescence.”

• cites [74] Maes M, Nelemans SA, Danneel S et al (2019) Loneliness and social anxiety across childhood and adolescence: multilevel meta-analyses of cross-sectional and longitudinal associations. Dev Psychol 55(7):1548 sourceSupported

May combine two claims.

Loneliness and social isolation during adolescence precipitate a state of vulnerability or social frailty, rendering individuals more susceptible to adverse outcomes.

“Likewise, loneliness and social isolation during adolescence precipitate a state of vulnerability or social frailty [80], rendering individuals more susceptible to adverse outcomes.”

• cites [80] Yanguas J, Pinazo-Henandis S, Tarazona-Santabalbina FJ (2018) The complexity of loneliness. Acta Biomed 89(2):302–314. https://doi.org/10.23750/abm.v89i2.7404 sourcePartly supported

  The 'Loneliness and health' section links loneliness and social isolation to frailty and adverse health outcomes. But its discussion of frailty concerns older adults, not adolescence, and describes associations or risk factors rather than establishing that isolation precipitates social frailty in adolescents. Page numbers are unavailable in our copy. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Mental health may have played a role in attrition, with those experiencing anxiety or depression being less likely to participate.

“Mental health may have played a role, with those experiencing anxiety or depression being less likely to participate [110].”

• cites [110] Langhammer A, Krokstad S, Romundstad P, Heggland J, Holmen J (2012) The HUNT study: participation is associated with survival and depends on socioeconomic status, diseases and symptoms. BMC Med Res Methodol 12:1–14 sourcePartly supported

  The Discussion section (‘Influence on incidence and prevalence estimates’; page unavailable) says depression appears to restrict participation more than anxiety. It reports higher anxiety-symptom prevalence among participants than the prevalence of anxiety diagnoses in the background population, while cautioning that these measures cannot be directly compared. Thus it supports a possible role for depression, but not the claim that people experiencing anxiety were also less likely to participate. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Self-reported measures of loneliness have been shown to be equally reliable and valid as other forms of assessment.

“Nevertheless, self-reported measures of loneliness have been shown to be equally reliable and valid as other forms of assessment [101].”

• cites [101] Mund M, Maes M, Drewke PM, Gutzeit A, Jaki I, Qualter P (2023) Would the real loneliness please stand up? The validity of loneliness scores and the reliability of single-item scores. Assessment 30(4):1226–1248 sourcePartly supported

  Study 1’s Results and Discussion report high agreement between self-ratings and informant-ratings and conclude that the instruments studied can assess loneliness from either perspective. Study 2 also describes the included measures as valid and reliable in adults, but the paper does not establish that self-reports are equally reliable and valid as all other forms of assessment; it notes an exception for one measure’s partner-ratings. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

MI assumes data are missing at random (MAR), but missingness in loneliness and anxiety/depression was likely due to participants experiencing these conditions, making MI unreliable.

“MI assumes data are missing at random (MAR), but missingness in loneliness and anxiety/depression was likely due to participants experiencing these conditions, making MI unreliable [111].”

• cites [111] Carpenter JR, Smuk M (2021) Missing data: A statistical framework for practice. Biom J 63(5):915–947. https://doi.org/10.1002/bimj.202000196 sourcePartly supported

  The Multiple imputation section (page unavailable) says standard MI draws missing values from a distribution estimated under MAR. The Beyond Mar: Sensitivity Analysis section (page unavailable) also describes MI approaches for departures from MAR. The paper does not assess loneliness or anxiety/depression missingness, or establish that MI was unreliable for those variables. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

HUNT's voluntary nature challenges retention, and a lower response rate to the second questionnaire (Q2) in HUNT4 led to missing data on anxiety and depression (HADS).

“HUNT’s voluntary nature further challenges retention, and a lower response rate to the second questionnaire (Q2) in HUNT4 led to missing data on anxiety and depression (HADS) [49].”

• cites [49] Åsvold BO, Langhammer A, Rehn TA et al (2023) Cohort profile update: the HUNT study, Norway. Int J Epidemiol 52(1):e80–e91 sourcePartly supported

  The ‘Who is in the cohort?’ and ‘What are the main strengths and weaknesses?’ sections report attrition between HUNT3 and HUNT4, including higher attrition among participants with ill health. They do not establish that voluntary participation caused retention problems, or that a lower Q2 response rate caused missing HADS data; searches for Q2, HADS, and the Hospital Anxiety and Depression Scale did not locate that link. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Attrition is a common issue in longitudinal studies.

“However, this is a common issue in longitudinal studies [105, 106].”

• cites [105] Schaffer HR (1996) Social development. Blackwell PublishingNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [106] Tambs K, Rønning T, Prescott C et al (2009) The Norwegian Institute of public health twin study of mental health: examining recruitment and attrition bias. Twin Res Hum Genet 12(2):158–168 sourceSupported

May combine two claims.

The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).

“The combined effect of loneliness and low resilience exhibited a synergistic interaction on the additive scale, although it was not statistically significant (RERI 0.13, 95% CI -2.39-2.65).”

• Also stated in: § Joint associations of adolescent loneliness and low resilience with anxiety and depression in young adulthood · hedged

  “We found a positive interaction on the additive scale for loneliness and resilience at baseline with the subsequent risk of anxiety and depression (HADS-T), with a RERI of 0.13 (95% CI -2.39-2.65), indicating the combined effect was greater than the sum of their individual effects, though not statistically significant.”

• AssumptionThe authors state this as an assumption: The ‘Very lonely’ category captures the most severe and high-risk cases of loneliness, and the ‘Rarely lonely’ category captures less severe and temporary forms or a complete absence of loneliness.

May combine two claims.

During the 11-year follow-up, anxiety prevalence was 16.6% (N = 380) and depression prevalence was 6.1% (N = 141).

“During the 11-year follow-up, anxiety prevalence was 16.6% (N = 380) and depression prevalence was 6.1% (N = 141) (Table 1).”

May combine two claims.

For depression (HADS-D), lonely individuals with high resilience had an OR of 2.36 (95% CI: 0.87-6.39), low resilience without loneliness had an OR of 1.81 (95% CI: 1.11-2.93), and those with both had an OR of 2.31 (95% CI: 1.17-4.55).

“For depression (HADS-D), lonely individuals with high resilience had an OR of 2.36 (95% CI: 0.87–6.39), low resilience without loneliness had an OR of 1.81 (95% CI: 1.11–2.93), and those with both had an OR of 2.31 (95% CI: 1.17–4.55).”

• AssumptionThe authors state this as an assumption: The ‘Very lonely’ category captures the most severe and high-risk cases of loneliness, and the ‘Rarely lonely’ category captures less severe and temporary forms or a complete absence of loneliness.

The quote only partly states this claim.

Additional adjustment for loneliness (Model III) reduced the OR for low resilience and anxiety even more.

“Additional adjustment for loneliness (Model III) reduced the OR even more.”

May combine two claims.

For the total score (HADS-T), lonely individuals with high resilience had an OR of 1.87 (95% CI: 0.59-5.90), low resilience without loneliness had an OR of 1.57 (95% CI: 0.92-2.67), and those with both had an OR of 2.57 (95% CI: 1.26-5.23).

“For the total score (HADS-T), lonely individuals with high resilience had an OR of 1.87 (95% CI: 0.59–5.90), low resilience without loneliness had an OR of 1.57 (95% CI: 0.92–2.67), and those with both had an OR of 2.57 (95% CI: 1.26–5.23).”

• AssumptionThe authors state this as an assumption: The ‘Very lonely’ category captures the most severe and high-risk cases of loneliness, and the ‘Rarely lonely’ category captures less severe and temporary forms or a complete absence of loneliness.

Probably not a substantial claim: may not pass S3 (load-bearing).

Among the 2293 participants, the prevalence of loneliness was 8.2% (N = 189).

“Among the 2293 participants, the prevalence of loneliness was 8.2% (N = 189).”

May combine two claims.

Adolescent loneliness and low resilience were both associated with an increased risk of anxiety and depression in adulthood.

“While we found that adolescent loneliness and low resilience were both associated with an increased risk of anxiety and depression in adulthood, the evidence for a synergistic effect was weak.”

May combine two claims.

For anxiety (HADS-A), lonely individuals with high resilience had an OR of 2.05 (95% CI: 0.96-4.35), low resilience without loneliness had an OR of 1.13 (95% CI: 0.81-1.58), and those with both had an OR of 2.11 (95% CI: 1.28-3.47).

“For anxiety (HADS-A), lonely individuals with high resilience had an OR of 2.05 (95% CI: 0.96–4.35), low resilience without loneliness had an OR of 1.13 (95% CI: 0.81–1.58), and those with both had an OR of 2.11 (95% CI: 1.28–3.47).”

• AssumptionThe authors state this as an assumption: The ‘Very lonely’ category captures the most severe and high-risk cases of loneliness, and the ‘Rarely lonely’ category captures less severe and temporary forms or a complete absence of loneliness.

The quote only partly states this claim.

Similar associations were noted for both depression (HADS-D) and the total measures of anxiety and depression (HADS-T) for loneliness.

“Similar associations were noted for both depression (HADS-D) and the total measures of anxiety and depression (HADS-T).”

May combine two claims.

Anxiety and depression at follow-up were higher in women, 23-25-year-olds, the mentally distressed, those with low resilience, poor family relationships, low self-esteem, low school satisfaction, and low SES.

“Anxiety and depression at follow-up were higher in women, 23–25-year-olds, the mentally distressed, those with low resilience, poor family relationships, low self-esteem, low school satisfaction, and low SES.”

May combine two claims.

Loneliness was more prevalent among girls, 16-19-year-olds, the mentally distressed (HSCL ≥ 2), those with low resilience, poor family relationships, low self-esteem, low school satisfaction, and low SES.

“Loneliness was more prevalent among girls, 16–19-year-olds, the mentally distressed (HSCL ≥ 2), those with low resilience, poor family relationships, low self-esteem, low school satisfaction, and low SES.”

Classified as probably not a substantial claim. May combine two claims.

The regression models adjusted for age and gender (Model I), additionally for SES, family relationship, school satisfaction, and self-esteem (Model II), and additionally for resilience and loneliness as continuous variables (Model III).

“In Model I, we adjusted for age and gender. Model II was adjusted for age, gender, SES, quality of relationship with family members, school satisfaction, and self-esteem as potential confounding factors. In Model III, we additionally adjusted for resilience and loneliness as continuous variables.”

Classified as probably not a substantial claim.

The impact of loneliness varies based on individual vulnerabilities, protective factors, and resources.

“The impact of loneliness varies based on individual vulnerabilities, protective factors, and resources [31].”

• cites [31] Park C, Majeed A, Gill H et al (2020) The effect of loneliness on distinct health outcomes: a comprehensive review and meta-analysis. Psychiatry Res 294:113514 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Directed Acyclic Graphs were used to select covariates that could be associated with loneliness and anxiety and depression.

“We reviewed the literature and created Directed Acyclic Graphs (DAGs) to select covariates that could be associated with loneliness (exposure) and anxiety and depression (outcome) in the regression analyses.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Of the 8199 adolescents included in YH3, 2293 (29%) attended HUNT4.

“Of the 8199 adolescents who were included in YH3, 2293 (29%) attended HUNT4.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The short-form 5-item HSCL has acceptable validity compared with the HSCL-25.

“Compared with the HSCL-25, the short-form 5-item HSCL has acceptable validity [58].”

• cites [58] Schmalbach B, Zenger M, Tibubos AN, Kliem S, Petrowski K, Brähler E (2021) Psychometric properties of two brief versions of the Hopkins symptom checklist: HSCL-5 and HSCL-10. Assessment 28(2):617–631 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Low resilience makes coping with stress harder, increasing vulnerability to mental health issues.

“Low resilience, however, makes coping with stress harder, increasing vulnerability to mental health issues [40].”

• cites [40] Hu T, Zhang D, Wang J (2015) A meta-analysis of the trait resilience and mental health. Pers Indiv Differ 76:18–27 sourceNot checked — no full text of the source

The quote only partly states this claim.

Low resilience interacting with loneliness can heighten the risk of anxiety and depression in young adulthood.

“Low resilience interacting with loneliness can heighten this risk, reflecting the interconnectedness of the biological stress response.”

May combine two claims.

Adolescent loneliness and low resilience independently contribute to anxiety and depression in young adulthood.

“In conclusion, our extensive cohort study indicates that adolescent loneliness and low resilience independently contribute to anxiety and depression in young adulthood.”

Probably not a substantial claim: may not pass S3 (load-bearing).

These findings align with previous research linking adolescent loneliness to higher anxiety and depression risk across all ages.

“These findings align with previous research linking adolescent loneliness to higher anxiety and depression risk across all ages.”

Classified as probably not a substantial claim.

To address reverse causality, the sensitivity analysis included only adolescents who scored <2 on HSCL-5 in YH3 (free from anxiety and depression at baseline).

“To address reverse causality, we included only those adolescents who scored < 2 on the HSCL-5 in YH3 (free from anxiety and depression at baseline) in another sensitivity analysis.”

Classified as probably not a substantial claim.

The small RERI value with wide confidence intervals suggests uncertainty in the estimate.

“The interaction analyses yielded a small RERI value (0.13) with wide confidence intervals, suggesting uncertainty in the estimate.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Chronic loneliness during adolescence can hinder social skill development, leading to low self-esteem and vulnerability and thus exacerbating anxiety and depression.

“Chronic loneliness during adolescence can hinder social skill development, leading to low self-esteem and vulnerability and thus exacerbating anxiety and depression [88].”

• cites [88] Qualter P, Vanhalst J, Harris R et al (2015) Loneliness across the life span. Perspect Psychol Sci 10(2):250–264 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Loneliness disrupts cognitive processes, increasing susceptibility to anxiety and depression.

“Moreover, loneliness disrupts cognitive processes, increasing susceptibility to anxiety and depression [89].”

• cites [89] Shankar A, Hamer M, McMunn A, Steptoe A (2013) Social isolation and loneliness: relationships with cognitive function during 4 years of follow-up in the english longitudinal study of ageing. Psychosom Med 75(2):161–170 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Higher loneliness correlated with increased depression among young adults with low resilience.

“They compared depression levels among young adults with high and low resilience, showing that higher loneliness correlated with increased depression among those with low resilience, likely due to stress hormones like cortisol, which can lead to long-term neurological and physiological issues [96].”

• cites [96] Kalisch R, Müller MB, Tüscher O (2015) A conceptual framework for the Neurobiological study of resilience. Behav Brain Sci 38:e92 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Sensitivity analyses were conducted to ensure robustness, using an alternative definition of anxiety and depression that included those on antidepressant medication and those with recent healthcare visits, which increased precision and avoided misclassification.

“We conducted sensitivity analyses to ensure robustness, using an alternative definition of anxiety and depression that included those on antidepressant medication and those with recent healthcare visits, which increased precision and avoided misclassification.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Self-reported loneliness is prone to underreporting due to social stigma.

“Self-reported loneliness is also prone to underreporting due to social stigma [100].”

• cites [100] Marcoen A, Goossens L, Caes P (1987) Lonelines in pre-through late adolescence: exploring the contributions of a multidimensional approach. J Youth Adolesc 16(6):561–577 sourceNot checked — no full text of the source

May combine two claims.

The study had a large sample size at over an 11-year follow-up.

“Our study’s strengths include a prospective design that establishes a clear temporal sequence, a large sample size at over an 11-year follow-up, and the ability to assess the interaction between adolescent loneliness and low resilience on young adult anxiety and depression.”

Classified as probably not a substantial claim.

The comprehensive dataset allowed control for various potential confounders.

“Additionally, the comprehensive dataset al.lowed control for various potential confounders.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Some level of bias might still be present.

“But some level of bias might still be present.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All analyses were repeated after excluding adolescents who reported anxiety and depression at baseline.

“Additionally, we repeated all analyses after excluding adolescents who reported anxiety and depression at baseline.”

May combine two claims.

Non-responders were more likely to be older, male, or from vocational schools, suggesting socioeconomic differences.

“Non-responders were more likely to be older, male, or from vocational schools, suggesting socioeconomic differences [47], but these were already adjusted for in our models.”

• cites [47] Holmen TL, Bratberg G, Krokstad S et al (2014) Cohort profile of the Young-HUNT study, Norway: a population-based study of adolescents. Int J Epidemiol 43(2):536–544 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The HADS was used as a screening tool to capture symptoms of anxiety or depression and not a clinical diagnosis.

“In the current study, the HADS was used as a screening tool to capture symptoms of anxiety or depression and not a clinical diagnosis [104].”

• cites [104] Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A (2010) The hospital anxiety and depression scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res 69(4):371–378 sourceNot checked — no full text of the source

May combine two claims.

Strong baseline participation, consistent response patterns, and linkage to national registries support the study's validity.

“Despite this, strong baseline participation, consistent response patterns, and linkage to national registries support the study’s validity.”

Probably not a substantial claim: may not pass S3 (load-bearing).

We adjusted for major confounders to account for potential bias due to missing data.

“Lastly, we adjusted for major confounders to account for potential bias due to missing data.”

Probably not a substantial claim: may not pass S3 (load-bearing).

It is uncertain if loneliness, low resilience, anxiety, and depression at baseline mutually influenced each other and thus increased the risk of anxiety and depression prospectively.

“Furthermore, it is uncertain if loneliness, low resilience, anxiety, and depression at baseline mutually influenced each other and thus increased the risk of anxiety and depression prospectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The broad ranking and categorization of loneliness in this study fails to distinguish between adolescents who are rarely lonely and those who are never lonely.

“Moreover, despite the broad ranking and categorization of loneliness in this study, it fails to distinguish between adolescents who are rarely lonely and those who are never lonely.”

Probably not a substantial claim: may not pass S3 (load-bearing).

There is residual confounding despite controlling for relevant factors.

“Another limitation is residual confounding despite controlling for relevant factors.”