Kristen Ngai, Livingston High School, Livingston, New Jersey, USA
Introduction: Numerous Americans suffer from loneliness and lack of social support. In October of 2020, 36% out of 950 Americans reported “serious loneliness.” Having a lack of close friendships is strongly related to loneliness, which is a crucial factor for health and well-being. The present study aimed to examine the impact of loneliness on the overall health and well-being of women with multiple sclerosis (MS).
Methods: 160 women with MS were enrolled in a prospective, longitudinal study examining the factors associated with unemployment. As part the study survey, participants were asked whether or not they have a best friend or someone they can confide in. Group comparisons were made between those who said “yes” and those who said “no” on social support, health, well-being, life and marital satisfaction measures.
Results: Thirty (19%) respondents reported that they did not have a best friend or confidant. These individuals reported lower levels of social support, psychological well-being, and life satisfaction. They also reported worse perceived health, greater medical comorbidities, depression, anxiety, fatigue, and pain.
Conclusions: The simple question of “Do you have someone to confide with?” becomes an important indicator, not only of an individual’s level of social support and marital gratification, but their health, mental well-being, and overall life satisfaction. Practitioners are hence encouraged to attend to an individual's support network. This is even more important in light of the COVID-19 pandemic, which is further affecting friendships and social activity.
Numerous Americans suffer from loneliness and a lack of social support from their peers. In October of 2020, a study of 950 Americans showed that 36% reported “serious loneliness”, meaning that they frequently feel lonely in the last four weeks (Alphonsus et. al. 2020). Loneliness is the state of being remote and isolated from others, which may worsen an individual's overall well-being. Having a lack of close friendships is strongly related to loneliness. In fact, 1 in 4 Americans do not feel that they have a best friend to confide in (Nicholas et. al 2016). More importantly, not having a good friend to share one’s feelings with can cause anxiety disorder, trouble sleeping, bad focus, a short temper, and poor eating habits (Hosseinbor et. al. 2014).
To illustrate this point, Vivek Murthy, a nominated US Surgeon General, indicated that “loneliness is an epidemic” (Scheimer and Chakrabarti, 2020). Furthermore, the loneliness epidemic is so serious that the World Health Organization (WHO) now lists “social support networks” as a predictor of health.
Figure 1: The prevalence of social and health conditions among adults in the United States (Holt-Lunstad et al., 2017).
Evidence also suggests that individuals who are socially connected experience longevity, specifically a 50% increased chance of survival (Holt-Lunstad et al., 2010). When compared to other health conditions in the US population, loneliness is the most prevalent health indicator in decreasing mortality, and the percentage is even higher than inactivity, obesity, and smoking (Holt-Lunstad et al., 2017). Therefore, it is important to address the epidemic of loneliness in the United States and to find out the underlying causes of the phenomenon. It is even more essential to address isolation in patients with multiple sclerosis because their mental well-being is greatly linked to the physical symptoms that they experience.
Multiple Sclerosis (MS) is a disease that affects roughly 2.8 million people worldwide but with no definitive cure. It is predicted that 50% to 70% of multiple sclerosis patients experience loneliness. During the course of the disease, a patient's immune system attacks the body’s tissues, which destroys a coating of nerve fibers in the central nervous system called the myelin sheath. Some symptoms of multiple sclerosis include muscle weakness, tremors, loss of vision, pain, and even paralysis (Figure 1).
In a recent seminal study investigating the impact of loneliness in MS, nearly 1 in 2 female MS patients felt lonely (Taylor et al., 2021). Another study done in the UK had even more alarming findings; 70% of multiple sclerosis patients reported feeling lonely and 72% reported feeling socially isolated. Therefore, considering how widespread these feelings are and their impact, it is important for clinicians and psychologists to be more aware of whether each patient with MS is experiencing loneliness or isolation.
Starting in March 2020, the COVID-19 pandemic caused many public health measures such as isolation and social distancing which resulted in many people experiencing a reduction in social support and mental well-being. Furthermore, people with MS experience a disadvantage in social participation, as some may face physical disabilities. Therefore, a higher level of isolation and loneliness may be present among individuals with MS during this time.
The majority of studies done in the past emphasized on the effects of loneliness on general health in older patients. However, little is known about the impact of loneliness on individuals with Multiple Sclerosis. This study aims to examine the impact of loneliness on the overall well-being of patients with multiple sclerosis. Our hypothesis is that people without confidants will experience higher rates of depression, loneliness, anxiety, pain, and fatigue. We also sought to quantify the impact of confidants among people with MS’s social well-being, depression, anxiety, and personality. Moreover, we looked into the question of whether or not patients with MS have confidants can help clinicians gather information about the overall mental well-being of MS patients Materials and Methods
All participants were diagnosed with clinically definite MS and enrolled in a longitudinal investigation examining employment status in MS. They completed their assessment between January 2014 and March 2017. Eligibility criteria included age ranging from 20 to 64, absence of other neurological disorders, and presently employed. Individuals were recruited on a national level through the National Multiple Sclerosis Society website and local MS clinics. All participants completed an online survey, approved by the Institutional Review Board. Informed consent was obtained from all participants.
Measures used for assessment
State Trait Anxiety Inventory (STAI) - a commonly used measure of trait and state anxiety (Spielberger et. al. 1983).
MOS Pain Effect Scale - provides an assessment of the ways in which pain interferes with mood, ability to walk or move, sleep, work, recreation, and enjoyment of life (Melzack and Targerson 1971).
Modified Fatigue Impact Scale - Questions based on items derived from interviews with MS patients concerning how fatigue impacts their lives (Fisk et al 1994)
CDMI Score - Complaint Directed Mini-Interventions (CDMI) for depressive symptoms in patients with MS (Wijnen et. al. 2018).
Modified Social Support Scale - a survey to analyze the amount of social support patients with MS are getting (Sherbourne and Stewart 1991).
Statistical analysis SPSS version 26.0 was used to conduct statistical analysis. A t-test was conducted to determine the relationship between the Cognitive Behavioral therapy and the level of anxiety in patients. Bivariate Correlation analyses were also done to determine if COVID-19 impacted the overall health and well-being of people with MS.
The study consisted of 160 individuals with MS, with 130 (81%) having a confidant and 30 (19%) not having a confidant (Table 1).
Total number of participants
Table 1: Participant Demographics
Patients who do not have a confidant do not get adequate social support
Lower levels of social support were related to not having a confidant (F=6.669, p=0.021). 19% (n=31) of people with MS who do not have a confidant reported lower levels of social support. This matches with the 19% of patients who do not have a friend to confide with.
The MOS Pain effect scale and the Modified Fatigue Impact Scale was used to determine the effects of having a confidant on pain and fatigue in MS patients. The mean pain score for patients without a confidant is 16.16 ± 6.18 while the mean pain score for patients with a confidant is 12.35 ± 5.25. The mean fatigue score for patients without a confidant is 44.74± 21.19, while the mean fatigue score for patients with a confidant is 35.01 ±18.24. These results indicate that there is a significant relationship between fatigue, pain, and whether participants have a friend to confide in. On a measure of anxiety and depression among people with MS, there is a consistent trend of anxiety and depression scores being higher when people with MS do not have a confidant.
The physical composite scale was used to determine the effects on overall health in MS patients. The mean general health score for patients with a confidant is 16.45 ± 3.69 while the mean score for patients without a confidant is 14.77 ± 3.70. The mean physical health score for patients without a confidant is 44.74± 21.19 while the physical health score for patients with a confidant is 35.01 ±18.24. The mean mental health score for patients without a confidant is 37.49 ± 11.23 while the mental health score for patients with a confidant is 47.28 ±10.66.. These results indicate that there is a significant relationship between overall health, mental health, and physical health and whether participants have a friend to confide in.
There is an overall rise in anxiety and depression during the COVID-19 Pandemic when compared to pre-pandemic. In addition, having a confidant decreases the social loneliness of people with MS by 75%. For individuals with MS during the pandemic, having a confidant also significantly lowers their level of anxiety. The results point towards a significant effect of having a confidant on lowering anxiety, depression, and social loneliness in individuals with MS during COVID-19. The decrease in anxiety, depression, and social loneliness may be due to the social isolation imposed on patients with MS, particularly those who are immunosuppressed, during the COVID-19 pandemic.
Having a confidant correlates with higher levels of social support, although not statistically significant (M=1.32, SD= 6.18). The results point towards a higher level for COVID resiliency, and a lower level of COVID disruption and distress for individuals with a confidant. This may be due to a stronger social support structure for those with a confidant which also strengthens their ability to persevere through difficult times.
Through this study, the relationship between friendship, physical well-being, and emotional well-being was found. The study also contributes to a clearer understanding of the importance of having a strong social support network, which proves the hypothesis of friendship being a contributing factor to overall well-being. Mainly, it was found that loneliness impacts a patient’s overall well-being, social support, anxiety, personality, and couple satisfaction. Social connectedness is a crucial indicator of health and helps prevent premature mortality.
In short, there is adequate evidence to support the idea that social support and connectedness play a role in improving the level of physical functioning, health, and overall well-being in patients with MS. The control of gender and marital status was taken into account when investigating the relationship between social support and MS patients’ well-being. This accounts for any error when analyzing the effects of friendship and well-being when patients with MS have a partner to talk to.
When looking into the effect of the COVID-19 pandemic on the overall health and well-being of individuals with and without a confidant, a significantly greater amount of social loneliness was felt by individuals without a confidant. Furthermore, the percentage of individuals without a confidant is 18%, which is similar to the amount pre-pandemic. When comparing the anxiety and depression levels of patients with MS before and during the pandemic, a 30% and 40% increase was found respectively. Therefore, the COVID-19 pandemic further worsened the loneliness epidemic in the United States and caused more people to be socially lonely.
As shown in this study, the simple question of “Do you have someone to confide with?” becomes an important indicator of a person’s mental well-being and social support level. The loneliness epidemic is a worldwide systematic problem that needs to be addressed. With the COVID-19 pandemic further affecting friendships, it is important that clinicians present MS patients with this simple question that can help determine if they are suffering from a lack of social support. This simple question also addresses the loneliness epidemic and can help determine if the patient with MS is in poor mental health or needs to receive therapy.
Limitations in this research may include the subjectivity of each participant when rating the pain, fatigue, depression, or anxiety scale. Another limitation is also the small sample size utilized in this survey study. Some sources of error include sampling errors between groups and processing errors when transferring the data from the actual survey to the SPSS analysis tool. Therefore, future work can focus on the mechanisms of social support that help alleviate the symptoms that individuals with MS are experiencing. Other works can also examine the long-term effects of isolation on patients with MS.