Social Isolation and Loneliness Definitions and Measures

Stephanie Veazie; Jennifer Gilbert; Kara Winchell; Robin Paynter; Jeanne-Marie Guise

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Veazie S, Gilbert J, Winchell K, et al. Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Feb.

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Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review [Internet].

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Appendix FSocial Isolation and Loneliness Definitions and Measures

Table F-1Definitions of social isolation and loneliness

Institution	Definitions
National Health Service – Centre for Reviews and Dissemination¹	Social isolation: The lack of social contact or support¹ Loneliness: The feeling of being alone or isolated¹
Review	Definitions
Gardiner et al, 2018²	Social isolation: The objective absence or paucity of_contacts and interactions between a person and a social network.³ Loneliness: A subjective feeling state of being alone, separated or apart from others, and has been conceptualized as an imbalance between desired social contacts and actual social contacts.⁴^,⁵
Poscia et al, 2018⁶	Social isolation: An objective lack of meaningful and sustained communication.⁶ Loneliness: The way people perceive and experience the lack of interaction.⁶
Shvedko et al, 2018⁷	Social isolation: A state in which the individual lacks a sense of belonging socially, lacks engagement with others, has a minimal number of social contacts, and they are deficient in fulfilling and quality relationships.⁸ Loneliness: A discrepancy between a person’s desired and actual social relationships.⁹
Ronzi et al, 2018¹⁰	(Social isolation and loneliness not measured) Social inclusion: Has explicit links with concepts such as equality, human rights and social cohesion, and it has focused on barriers that prevent people from participating meaningfully in society.¹¹

Table F-2Measures of social isolation and loneliness

Study	Construct: Measure	Measure Explanation/Questions
Seino, 2017¹²	Structural social capital: Check List for Vivid Social Activities¹³ – “social participation and voluntary activities” domain	Check List for Vivid Social Activities¹³ Unable to find original checklist and unable to find full-text of the study which validated the measure.
Chan, 2017¹⁴	Social network: Lubben Social Network Scale-6¹⁵ Loneliness: De Jong Gierveld Loneliness Scale¹⁶ Social support: Revised Social Support Questionnaire (also known as the SSQ6)¹⁷	Lubben Social Network Scale-6¹⁵ Measures social isolation by measuring frequency, size, and closeness of contacts of the respondent’s social network by assessing the perceived level of support they get from friends and families. Scoring is as follows: 0=none; 1-one; 2=two; 3=three or four; 4=five thru eight; 5=nine or more. Total scores from 0-30 with higher scores indicating larger social networks Three questions on family, and 3 on friends. Questions are framed the same way across family/friends. Scale questions: How many relatives/friends do you see or hear from at least once a month? How many relatives/friends do you feel at ease with that you can talk about private matters? How many relatives/friends do you feel close to such that you could call on them for help? De Jong Gierveld Loneliness Scale¹⁶ Measures emotional and social loneliness. Six statements, three measuring emotional loneliness and three measuring social loneliness, each with three choices including yes, more or less, and no. Scores range from 0-6, with 6 indicating higher loneliness. Emotional loneliness statements: “I experience a general sense of emptiness”; “I miss having people around me”; and “I often feel rejected” Social loneliness statements: “There are plenty of people I can rely on when I have problems”; “There are many people I can trust completely”; and “There are enough people I feel close to.” Revised Social Support Questionnaire (SSQ6)¹⁷ Six-item measure of social support wherein respondents indicate the number of people they feel they have available to provide support in six areas: “Who can you count on when you need help?” “Whom can you really count on to help you feel more relaxed when you are under pressure or tense?” “Who accepts you totally, including both your worse and best points?” “Who can you really count on to care about you, regardless of what is happening to you?” “Who can you really count on to help you feel better when you are feeling generally down in the dumps?” “Who can you count on to console you when you are very upset?” Each question has a follow up scale regarding how satisfied the respondent is with support given in each area.
Pynnonen, 2018¹⁸	Loneliness: developed their own measure Perceived togetherness: Social Provisions Scale¹⁹	Measure for loneliness Participants were asked “Do you feel lonely?’ Answer options were: very rarely or never, sometimes, and often or almost always Social Provisions Scale¹⁹ 24-statement scale, split into six dimensions: attachment, social integration, reliable alliance, guidance, opportunity for nurturance, and reassurance of worth Scale from 1 (strongly disagree) to 4 (strongly agree). Larger final score indicates greater degree of perceived support. Examples of statements include: “There are people I know will help me if I really need it”; “I have close relationships that make me feel good”; and “I feel a strong emotional tie with at least one other person.”
Tarazona-Santabalbina, 2016²⁰	Social support: Duke Social Support Index. (NOTE: The study was non-specific. They state they used “Duke Social Support” with no associated reference. There is no tool by this name. There is the Duke Social Support Index,²¹ and an abbreviated version of this tool. We provide information on the most current version when the study came out: the DSSI-10.²²)	Duke Social Support Index-10²² Originally 35 items long, this index was reworked in 2013, and the current 10-item assessment, which measures social support, has two subscales: social interaction and subjective social satisfaction. Higher scores indicate more social support Example questions in the social interaction subscale include: “What is the number of times in the past week spent with someone not living with you?” and “What is the number of times in the past week you talked with friends/relatives on the telephone?” Example questions in the social support subscale include: “Do you feel useful to your family and friends?” and “Can you talk about your deepest problems?”
Kamegaya, 2014²³	Social support: Lubben Social Network Scale Revised¹⁵	Lubben Social Network Scale-6¹⁵ See “Lubben Social Network Scale-6” under Chan, 2017
Mountain, 2017²⁴	Loneliness: De Jong Gierveld Loneliness Scale¹⁶	De Jong Gierveld Loneliness Scale¹⁶ See “De Jong Gierveld Loneliness Scale” under Chan, 2017
Gonyea, 2013²⁵	Loneliness: UCLA Loneliness Scale Version 3²⁶	UCLA Loneliness Scale Version 3²⁶ 20-question tool used to assess subjective feelings of loneliness or social isolation. All questions are framed using “how often do you feel…” and choices include never, rarely, sometimes, and often. Scores range from 20 to 80, with a higher score indicating greater loneliness. Examples of questions include: “How often do you feel a lack on companionship?”; “How often do you feel left out?”; and “How often do you feel isolated from others?”
Coll-Planas, 2017²⁷	Loneliness: De Jong Gierveld Loneliness Scale¹⁶ Social support (as cognitive aspect of social capital): Social Resources Inventory in Older Adults Social participation (as structural aspect of social capital): Subjective Social Participation Index²⁸	De Jong Gierveld Loneliness Scale¹⁶ See “De Jong Gierveld Loneliness Scale” under Chan, 2017 Social Resources Inventory in Older Adults Unable to find inventory and unable to find full-text of the study which validated the measure. Subjective Social Participation Index²⁸ Of note, we could only find this scale in Spanish. We used Google Translate to translate the scale into English, so some questions may not translate perfectly. This 15-question scale is broken into three “Factors” – perception of social support, use of new technologies, and index of subjective social participation. This study used to the four questions asked in the social participation factor: During the week and on weekends do you call other people to go outside? Do you find it easy to make friends? Do you go to any park, association, home of the pensioner (retirement home) where you relate to other elders? Do you like to participate in leisure activities that are organized in your neighborhood/town? Answers to these four questions are always=0, sometimes=1, or never=2. Low scores indicate increased social participation.
Gaggioli, 2014²⁹	Loneliness: Italian Loneliness Scale³⁰	Italian Loneliness Scale³⁰ This 18-item scale is broken into three subscales: emotional loneliness, social loneliness, and general loneliness. Questions are answered on a 4-point Likert-type scale (ranging from 1=never to 4=always). The emotional loneliness subscale has six negative statements, including “Often I feel rejected,” and “I miss having people around.” The social loneliness subscale has five positive statements such as “There are enough people that I feel close to,” and “I can call on my friends whenever I need them.” The general loneliness subscale has seven negative statements such as “I feel left out,” and “People are around me but not with me.”
Yap, 2017³¹	Social network: Lubben Social Network Scale-6¹⁵	Lubben Social Network Scale-6¹⁵ See “Lubben Social Network Scale-6” under Chan, 2017
Phinney, 2014³²	Social support: Multidimensional Scale of Perceived Social Support³³	Multidimensional Scale of Perceived Social Support³³ This 12-item scale is broken into three factor groups (source of social support): family, friends, and significant other. This scale is scored on a 1 (very strongly disagree) to 7 (very strongly agree) Likert-type scale. Four is neutral. Higher scores indicate high levels of social support. Statements in the family factor group include: “My family really tries to help me”; “I get the emotional help and support I need from my family”; “I can talk about my problems with my family”; and “My family is willing to help me make decisions.” Statements in the friend factor group include: “My friends really try to help me”; “I can count on my friends when things go wrong”; “I have friends with whom I can share my joys and sorrows”; “I can talk about my problems with my friends.” Statements in the significant other factor group include: “There is a special person who is around when I am in need”; “There is a special person with whom I can share my joys and sorrows”; “I have a special person who is a real source of comfort to me”; and “There is a special person in my life who cares about my feelings.”
Davidson, 2014³⁴	Loneliness: UCLA Loneliness Scale Version 3²⁶	UCLA Loneliness Scale Version 3²⁶ See “UCLA Loneliness Scale Version 3” under Gonyea, 2013
Bartsch, 2013³⁵	Social isolation: developed own survey, called the “Care Manager Survey”	Care Manager Survey This survey was given at intake and discharge for all clients. The survey measured five potential isolators: emotional disturbance, cognitive impairment, social isolation, physical impairment, and economic disadvantage. The scoring for each isolator is as follows: 0 for no problem with the isolator to 4 for a major problem with the isolator.

Studies that did not measure social isolation or loneliness: Murayama, 2014; Vogelpoel, 2014; Kim, 2018.

References for Appendix F

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Veazie S, Gilbert J, Winchell K, et al. Addressing Social Isolation To Improve the Health of Older Adults: A Rapid Review [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2019 Feb. Appendix F, Social Isolation and Loneliness Definitions and Measures.
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