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4 h1bh1bnn * V V 8 l A < &$ & L) b) b) b) Q* Q* Q* ? ? ? ? ? ? ? $ @C E n ? Q* Q* Q* Q* Q* ? b) b) @ 0 0 0 Q* > b) b) ? 0 Q* ? 0 0 V 7 8 b) _}e , y8 ? @ 0 A 8 0 dF %. h dF 8 8 dF 9 Q* Q* 0 Q* Q* Q* Q* Q* ? ? 0 Q* Q* Q* A Q* Q* Q* Q* dF Q* Q* Q* Q* Q* Q* Q* Q* Q* V B : Published article available at: Primack BA, Shensa A, Sidani JE, Whaite EO, Lin L, Rosen D, Colditz JB, Radovic A, Miller E. Social media use and perceived social isolation among young adults in the U.S. American Journal of Preventive Medicine. 2017;53(1):1-8. DOI: 10.1016/j.amepre.2017.01.010
Social Media Use and Perceived Social Isolation Among Young Adults in the U.S.
Brian A. Primack, MD, PhD,1,2,3 Ariel Shensa, MA,1,2 Jaime E. Sidani, PhD, MPH,1,2 Erin O. Whaite, BS,1,4 Liu yi Lin, MD,1,5 Daniel Rosen, PhD,1,6 Jason B. Colditz, MEd,1,2 Ana M. Radovic, MD, MSc,1,3 Elizabeth Miller, MD, PhD1,3
From the 1Center for Research on Media, Technology, and Health, University of Pittsburgh, Pittsburgh, Pennsylvania; 2Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 3Division of Adolescent Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 4University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; 5UPMC McKeesport Family Medicine and Psychiatry Residency Program, Pittsburgh, Pennsylvania; and 6School of Social Work, University of Pittsburgh, Pittsburgh, Pennsylvania
Address correspondence to: Brian A. Primack, MD, PhD, 230 McKee Place, Suite 600, Pittsburgh PA 15213. E-mail: bprimack@pitt.edu.
Introduction: Perceived social isolation (PSI) is associated with substantial morbidity and mortality. Social media platforms, commonly used by young adults, may offer an opportunity to ameliorate social isolation. This study assessed associations between social media use (SMU) and PSI among U.S. young adults.
Methods: Participants were a nationally representative sample of 1787 U.S. adults aged 1932 years. They were recruited in OctoberNovember 2014 for a cross-sectional survey using a sampling frame that represented 97% of the U.S. population. SMU was assessed using both time and frequency of using 11 social media platforms, including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit. PSI was measured using the Patient-Reported Outcomes Measurement Information System scale. In 2015, ordered logistic regression was used to assess associations between SMU and SI while controlling for eight covariates.
Results: In fully adjusted multivariable models that included survey weights, compared with those in the lowest quartile for SMU time, participants in the highest quartile had twice the odds of having greater PSI (AOR=2.0, 95% CI=1.4, 2.8). Similarly, compared with those in the lowest quartile, those in the highest quartile of SMU frequency had more than three times the odds of having greater PSI (AOR=3.4, 95% CI=2.3, 5.1). Associations were linear (p<0.001 for all), and results were robust to all sensitivity analyses.
Conclusions: Young adults with high SMU seem to feel more socially isolated than their counterparts with lower SMU. Future research should focus on determining directionality and elucidating reasons for these associations.
INTRODUCTION
Social isolation, a state in which an individual lacks a sense of social belonging, true engagement with others, and fulfilling relationships,ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "abstract" : "Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to numerous detrimental health conditions. With a high prevalence, and an increasing number of older persons, social isolation will impact the health, well-being, and quality of life of numerous older adults now and in the foreseeable future. For this review, a series of literature searches of the CINAHL, PsycINFO, and Medline databases were conducted, using the key words \"social isolation,\" \"social networks,\" \"older adults,\" \"elderly,\" \"belonging,\" \"perceived isolation,\" \"social engagement,\" \"social contacts,\" and \"social integration,\" for the period of 1995-2010. The results show that there is an overabundance of evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation. However, there is scarce evidence that public health professionals are assessing social isolation in older persons, despite their unique access to very socially isolated, homebound older adults. Additionally, few viable interventions were found; therefore, it is advisable to focus on the prevention of social isolation in older adults. Public health professionals can take steps toward increasing the early assessment of social isolation and referring at-risk individuals to available community resources in order to prevent social isolation or further isolation, which would serve to reduce the numerous negative health outcomes associated with this condition.", "author" : [ { "dropping-particle" : "", "family" : "Nicholson", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Primary Prevention", "id" : "ITEM-1", "issue" : "2-3", "issued" : { "date-parts" : [ [ "2012" ] ] }, "page" : "137-152", "title" : "A review of social isolation: An important but underassessed condition in older adults", "type" : "article", "volume" : "33" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=428a0014-d2c9-4c50-8c08-d415029d9b38" ] } ], "mendeley" : { "formattedCitation" : "1", "plainTextFormattedCitation" : "1", "previouslyFormattedCitation" : "1" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1 is associated with increased morbidity and mortality.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.2105/AJPH.2013.301261", "ISSN" : "1541-0048", "PMID" : "24028260", "abstract" : "OBJECTIVES We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors. METHODS We used data on 16,849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan-Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality. RESULTS Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in religious activities, and lacking club or organization affiliations; among women, significant predictors were being unmarried, infrequent social contact, and participating infrequently in religious activities. CONCLUSIONS The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors. Our results suggest the importance of assessing patients' level of social isolation.", "author" : [ { "dropping-particle" : "", "family" : "Pantell", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rehkopf", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jutte", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Syme", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balmes", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adler", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Public Health", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "2056-2062", "title" : "Social isolation: a predictor of mortality comparable to traditional clinical risk factors.", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7c631058-2409-453a-bf1a-55251c913443" ] } ], "mendeley" : { "formattedCitation" : "2", "plainTextFormattedCitation" : "2", "previouslyFormattedCitation" : "2" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }2 For example, social isolation has been compared to obesity in terms of potential association with negative health effects.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1745691614568352", "abstract" : "Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.", "author" : [ { "dropping-particle" : "", "family" : "Holt-Lunstad", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "T B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephenson", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Perspectives on Psychological Science", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "227-237", "title" : "Loneliness and social isolation as risk factors for mortality a meta-analytic review", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a2d78fde-f690-4dad-bee9-7dc1ff2f7849" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }3 Social isolation also is known to be associated with unnatural increases in cortisol patterns, and these aberrant patterns can disrupt sleep, immune function, and cognition.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.tics.2009.06.005", "ISSN" : "1364-6613", "PMID" : "19726219", "abstract" : "Social species, from Drosophila melanogaster to Homo sapiens, fare poorly when isolated. Homo sapiens, an irrepressibly meaning-making species, are, in normal circumstances, dramatically affected by perceived social isolation. Research indicates that perceived social isolation (i.e. loneliness) is a risk factor for, and may contribute to, poorer overall cognitive performance, faster cognitive decline, poorer executive functioning, increased negativity and depressive cognition, heightened sensitivity to social threats, a confirmatory bias in social cognition that is self-protective and paradoxically self-defeating, heightened anthropomorphism and contagion that threatens social cohesion. These differences in attention and cognition impact on emotions, decisions, behaviors and interpersonal interactions that can contribute to the association between loneliness and cognitive decline and between loneliness and morbidity more generally.", "author" : [ { "dropping-particle" : "", "family" : "Cacioppo", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hawkley", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Trends in Cognitive Sciences", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2009", "10" ] ] }, "page" : "447-454", "title" : "Perceived social isolation and cognition", "type" : "article-journal", "volume" : "13" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a9746e35-cc19-4d27-84df-9aaea3a46461" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.2105/AJPH.2013.301261", "ISSN" : "1541-0048", "PMID" : "24028260", "abstract" : "OBJECTIVES We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors. METHODS We used data on 16,849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan-Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality. RESULTS Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in religious activities, and lacking club or organization affiliations; among women, significant predictors were being unmarried, infrequent social contact, and participating infrequently in religious activities. CONCLUSIONS The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors. Our results suggest the importance of assessing patients' level of social isolation.", "author" : [ { "dropping-particle" : "", "family" : "Pantell", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rehkopf", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jutte", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Syme", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balmes", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adler", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Public Health", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "2056-2062", "title" : "Social isolation: a predictor of mortality comparable to traditional clinical risk factors.", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7c631058-2409-453a-bf1a-55251c913443" ] } ], "mendeley" : { "formattedCitation" : "2,4", "plainTextFormattedCitation" : "2,4", "previouslyFormattedCitation" : "2,4" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }2,4 Social isolation also affects gene expression, negatively impacting vascular and mental health.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.expneurol.2011.01.016", "ISSN" : "1090-2430", "PMID" : "21281636", "abstract" : "Stress is a universal experience for living organisms. Under many circumstances activation of the hypothalamic-pituitary adrenal (HPA) axis is an adaptive response to stress. However, when stress or HPA activation is prolonged or its timing immediately precedes or coincides with an ongoing neurodegenerative process, the results can be deleterious. A causal relationship among stress, HPA axis activity, and stroke outcome exists. Stress is one of many potential triggers of ischemic stroke and sustained elevations in glucocorticoids compromise neuronal survival following an ischemic attack. Indeed, glucocorticoid exposure is a critical determinant of stroke outcome; prior exposure to stress and elevated peri-ischemic glucocorticoid concentrations are associated with poor outcome among stroke patients and in rodent models of cerebral ischemia. Likely, stress and glucocorticoid exposure exacerbate stroke by sensitizing the neuroimmune response to ischemia; stroke induces an upregulation of pro-inflammatory cytokines which contributes to migration of leukocytes into cerebral tissue and neuronal death. Social isolation also appears to compromise stroke outcome through priming of the neuroimmune system. Among individuals who survive the stroke, residual inflammation is apt to further compromise quality of life via its effect on cognitive function and affect. A better understanding of the mechanisms through which stress and social environment modulate neuroimmune function could lead to improved treatment of stroke and other neurodegenerative diseases.", "author" : [ { "dropping-particle" : "", "family" : "Stuller", "given" : "K A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jarrett", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeVries", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Experimental Neurology", "id" : "ITEM-1", "issue" : "1", "issued" : { "date-parts" : [ [ "2012", "1" ] ] }, "page" : "33-39", "title" : "Stress and social isolation increase vulnerability to stroke", "type" : "article-journal", "volume" : "233" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e38553d6-db41-4789-90d0-004c4282a65d" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1016/j.neulet.2015.08.026", "ISSN" : "18727972", "PMID" : "26300541", "abstract" : "Social isolation (SI) rearing has been demonstrated to induce behavioral abnormalities like anxiety, impulsivity, aggression, and learning and memory deficits which are relevant to core symptoms in patients with some certain neuropsychiatric disorders. But the underlying pathophysiological mechanisms remain unclear. Recent studies have revealed HINT1 has close relation with diverse neuropsychiatric diseases. In this present study, the SI rearing mice exhibited depression-like and aggressive behavior. Besides, HINT1 protein levels decreased in PFC but increased in HIP. Based on the data obtained, we concluded that HINT1 is involved in the behavioral abnormalities induced by social isolation and exerts distinct roles in different encephalic regions.", "author" : [ { "dropping-particle" : "", "family" : "Dang", "given" : "Y H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ma", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chu", "given" : "Z", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Liu", "given" : "Y P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wang", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ma", "given" : "X C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gao", "given" : "C G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Neuroscience Letters", "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "40-45", "title" : "HINT1 is involved in the behavioral abnormalities induced by social isolation rearing", "type" : "article-journal", "volume" : "607" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=1e2ab986-808e-4c29-be46-9b44cf8b349e" ] } ], "mendeley" : { "formattedCitation" : "5,6", "plainTextFormattedCitation" : "5,6", "previouslyFormattedCitation" : "5,6" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }5,6 In view of these underlying mechanisms, it is not surprising that social isolation can substantially increase the risk for all-cause mortality.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1073/pnas.1219686110", "ISBN" : "1091-6490 (Electronic)\\r0027-8424 (Linking)", "ISSN" : "1091-6490", "PMID" : "23530191", "abstract" : "Both social isolation and loneliness are associated with increased mortality, but it is uncertain whether their effects are independent or whether loneliness represents the emotional pathway through which social isolation impairs health. We therefore assessed the extent to which the association between social isolation and mortality is mediated by loneliness. We assessed social isolation in terms of contact with family and friends and participation in civic organizations in 6,500 men and women aged 52 and older who took part in the English Longitudinal Study of Ageing in 2004-2005. A standard questionnaire measure of loneliness was administered also. We monitored all-cause mortality up to March 2012 (mean follow-up 7.25 y) and analyzed results using Cox proportional hazards regression. We found that mortality was higher among more socially isolated and more lonely participants. However, after adjusting statistically for demographic factors and baseline health, social isolation remained significantly associated with mortality (hazard ratio 1.26, 95% confidence interval, 1.08-1.48 for the top quintile of isolation), but loneliness did not (hazard ratio 0.92, 95% confidence interval, 0.78-1.09). The association of social isolation with mortality was unchanged when loneliness was included in the model. Both social isolation and loneliness were associated with increased mortality. However, the effect of loneliness was not independent of demographic characteristics or health problems and did not contribute to the risk associated with social isolation. Although both isolation and loneliness impair quality of life and well-being, efforts to reduce isolation are likely to be more relevant to mortality.", "author" : [ { "dropping-particle" : "", "family" : "Steptoe", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shankar", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Demakakos", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wardle", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Proceedings of the National Academy of Sciences of the United States of America", "id" : "ITEM-1", "issue" : "15", "issued" : { "date-parts" : [ [ "2013" ] ] }, "page" : "5797-5801", "title" : "Social isolation, loneliness, and all-cause mortality in older men and women", "type" : "article-journal", "volume" : "110" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=cb6151a0-1584-4a81-b3af-d2f6284699ea" ] } ], "mendeley" : { "formattedCitation" : "7", "plainTextFormattedCitation" : "7", "previouslyFormattedCitation" : "7" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }7
The construct of social isolation includes both objective social isolationthe actual lack of social tiesand subjective social isolationthe feeling of a lack of engagement with others.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1745691614568352", "abstract" : "Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.", "author" : [ { "dropping-particle" : "", "family" : "Holt-Lunstad", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "T B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephenson", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Perspectives on Psychological Science", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "227-237", "title" : "Loneliness and social isolation as risk factors for mortality a meta-analytic review", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a2d78fde-f690-4dad-bee9-7dc1ff2f7849" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }3 These facets of social isolation are related but not the same: One may be objectively isolated but not feel a sense of loneliness, and one may be objectively connected to others but still feel lonely.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1177/1745691614568352", "abstract" : "Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.", "author" : [ { "dropping-particle" : "", "family" : "Holt-Lunstad", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "T B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Harris", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stephenson", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Perspectives on Psychological Science", "id" : "ITEM-1", "issue" : "2", "issued" : { "date-parts" : [ [ "2015" ] ] }, "page" : "227-237", "title" : "Loneliness and social isolation as risk factors for mortality a meta-analytic review", "type" : "article-journal", "volume" : "10" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a2d78fde-f690-4dad-bee9-7dc1ff2f7849" ] } ], "mendeley" : { "formattedCitation" : "3", "plainTextFormattedCitation" : "3", "previouslyFormattedCitation" : "3" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }3 This study focused on subjective social isolation, or perceived social isolation (PSI). This is because the perception of being socially isolated and lonelyand not merely the objective lack of social connectionhas been particularly linked to both mental and physical conditions.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.tics.2009.06.005", "ISSN" : "1364-6613", "PMID" : "19726219", "abstract" : "Social species, from Drosophila melanogaster to Homo sapiens, fare poorly when isolated. Homo sapiens, an irrepressibly meaning-making species, are, in normal circumstances, dramatically affected by perceived social isolation. Research indicates that perceived social isolation (i.e. loneliness) is a risk factor for, and may contribute to, poorer overall cognitive performance, faster cognitive decline, poorer executive functioning, increased negativity and depressive cognition, heightened sensitivity to social threats, a confirmatory bias in social cognition that is self-protective and paradoxically self-defeating, heightened anthropomorphism and contagion that threatens social cohesion. These differences in attention and cognition impact on emotions, decisions, behaviors and interpersonal interactions that can contribute to the association between loneliness and cognitive decline and between loneliness and morbidity more generally.", "author" : [ { "dropping-particle" : "", "family" : "Cacioppo", "given" : "J T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hawkley", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Trends in Cognitive Sciences", "id" : "ITEM-1", "issue" : "10", "issued" : { "date-parts" : [ [ "2009", "10" ] ] }, "page" : "447-454", "title" : "Perceived social isolation and cognition", "type" : "article-journal", "volume" : "13" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a9746e35-cc19-4d27-84df-9aaea3a46461" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.2105/AJPH.2013.301261", "ISSN" : "1541-0048", "PMID" : "24028260", "abstract" : "OBJECTIVES We explored the relationship between social isolation and mortality in a nationally representative US sample and compared the predictive power of social isolation with that of traditional clinical risk factors. METHODS We used data on 16,849 adults from the Third National Health and Nutrition Examination Survey and the National Death Index. Predictor variables were 4 social isolation factors and a composite index. Comparison predictors included smoking, obesity, elevated blood pressure, and high cholesterol. Unadjusted Kaplan-Meier tables and Cox proportional hazards regression models controlling for sociodemographic characteristics were used to predict mortality. RESULTS Socially isolated men and women had worse unadjusted survival curves than less socially isolated individuals. Cox models revealed that social isolation predicted mortality for both genders, as did smoking and high blood pressure. Among men, individual social predictors included being unmarried, participating infrequently in religious activities, and lacking club or organization affiliations; among women, significant predictors were being unmarried, infrequent social contact, and participating infrequently in religious activities. CONCLUSIONS The strength of social isolation as a predictor of mortality is similar to that of well-documented clinical risk factors. Our results suggest the importance of assessing patients' level of social isolation.", "author" : [ { "dropping-particle" : "", "family" : "Pantell", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rehkopf", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jutte", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Syme", "given" : "S L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Balmes", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Adler", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "American Journal of Public Health", "id" : "ITEM-2", "issue" : "11", "issued" : { "date-parts" : [ [ "2013", "11" ] ] }, "page" : "2056-2062", "title" : "Social isolation: a predictor of mortality comparable to traditional clinical risk factors.", "type" : "article-journal", "volume" : "103" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7c631058-2409-453a-bf1a-55251c913443" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1017/S0033291711001772", "ISSN" : "1469-8978 (Electronic)", "PMID" : "21896239", "abstract" : "BACKGROUND: Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors. METHOD: In our prospective cohort study of 4004 older persons aged 65-84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors. RESULTS: At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04-1.63] in men and 1.04 (95% CI 0.90-1.24) in women. No higher risk of mortality was found for social isolation. CONCLUSIONS: Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.", "author" : [ { "dropping-particle" : "", "family" : "Holwerda", "given" : "T J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beekman", "given" : "A T F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deeg", "given" : "D J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stek", "given" : "M L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tilburg", "given" : "T G", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Visser", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schmand", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jonker", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schoevers", "given" : "R A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Psychological medicine", "id" : "ITEM-3", "issue" : "4", "issued" : { "date-parts" : [ [ "2012", "4" ] ] }, "language" : "ENG", "page" : "843-853", "publisher-place" : "England", "title" : "Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL).", "type" : "article-journal", "volume" : "42" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=99b80d50-cfd0-4548-abd4-1f302cf6699a" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1136/jnnp-2012-302755", "ISSN" : "1468-330X (Electronic)", "PMID" : "23232034", "abstract" : "BACKGROUND: Known risk factors for Alzheimer's disease and other dementias include medical conditions, genetic vulnerability, depression, demographic factors and mild cognitive impairment. The role of feelings of loneliness and social isolation in dementia is less well understood, and prospective studies including these risk factors are scarce. METHODS: We tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort study among 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed (Geriatric Mental State (GMS) Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT)). Logistic regression analysis was used to examine the association between social isolation and feelings of loneliness and the risk of dementia, controlling for sociodemographic factors, medical conditions, depression, cognitive functioning and functional status. RESULTS: After adjustment for other risk factors, older persons with feelings of loneliness were more likely to develop dementia (OR 1.64, 95% CI 1.05 to 2.56) than people without such feelings. Social isolation was not associated with a higher dementia risk in multivariate analysis. CONCLUSIONS: Feeling lonely rather than being alone is associated with an increased risk of clinical dementia in later life and can be considered a major risk factor that, independently of vascular disease, depression and other confounding factors, deserves clinical attention. Feelings of loneliness may signal a prodromal stage of dementia. A better understanding of the background of feeling lonely may help us to identify vulnerable persons and develop interventions to improve outcome in older persons at risk of dementia.", "author" : [ { "dropping-particle" : "", "family" : "Holwerda", "given" : "Tjalling Jan", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Deeg", "given" : "Dorly J H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Beekman", "given" : "Aartjan T F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tilburg", "given" : "Theo G", "non-dropping-particle" : "van", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stek", "given" : "Max L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jonker", "given" : "Cees", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Schoevers", "given" : "Robert A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of neurology, neurosurgery, and psychiatry", "id" : "ITEM-4", "issue" : "2", "issued" : { "date-parts" : [ [ "2014", "2" ] ] }, "language" : "ENG", "page" : "135-142", "publisher-place" : "England", "title" : "Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL).", "type" : "article-journal", "volume" : "85" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=692e2168-97e6-4a3b-a678-fdf6cad0ef0f" ] } ], "mendeley" : { "formattedCitation" : "2,4,8,9", "plainTextFormattedCitation" : "2,4,8,9", "previouslyFormattedCitation" : "2,4,8,9" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }2,4,8,9 The perception of loneliness seems to be linked to poor health outcomes based on both genetic predisposition and epigenetic factors.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s00127-016-1178-7", "ISSN" : "1433-9285 (Electronic)", "PMID" : "26843197", "abstract" : "PURPOSE: To investigate the association between social isolation and loneliness, how they relate to depression, and whether these associations are explained by genetic influences. METHODS: We used data from the age-18 wave of the Environmental Risk Longitudinal Twin Study, a birth cohort of 1116 same-sex twin pairs born in England and Wales in 1994 and 1995. Participants reported on their levels of social isolation, loneliness and depressive symptoms. We conducted regression analyses to test the differential associations of isolation and loneliness with depression. Using the twin study design, we estimated the proportion of variance in each construct and their covariance that was accounted for by genetic and environmental factors. RESULTS: Social isolation and loneliness were moderately correlated (r = 0.39), reflecting the separateness of these constructs, and both were associated with depression. When entered simultaneously in a regression analysis, loneliness was more robustly associated with depression. We observed similar degrees of genetic influence on social isolation (40 %) and loneliness (38 %), and a smaller genetic influence on depressive symptoms (29 %), with the remaining variance accounted for by the non-shared environment. Genetic correlations of 0.65 between isolation and loneliness and 0.63 between loneliness and depression indicated a strong role of genetic influences in the co-occurrence of these phenotypes. CONCLUSIONS: Socially isolated young adults do not necessarily experience loneliness. However, those who are lonely are often depressed, partly because the same genes influence loneliness and depression. Interventions should not only aim at increasing social connections but also focus on subjective feelings of loneliness.", "author" : [ { "dropping-particle" : "", "family" : "Matthews", "given" : "Timothy", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Danese", "given" : "Andrea", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wertz", "given" : "Jasmin", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Odgers", "given" : "Candice L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ambler", "given" : "Antony", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Moffitt", "given" : "Terrie E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Arseneault", "given" : "Louise", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Social psychiatry and psychiatric epidemiology", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2016", "3" ] ] }, "language" : "ENG", "page" : "339-348", "publisher-place" : "Germany", "title" : "Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis.", "type" : "article-journal", "volume" : "51" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=67606872-15cb-428b-a2c8-1cc87eeb62da" ] } ], "mendeley" : { "formattedCitation" : "10", "plainTextFormattedCitation" : "10" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }10
Recent increases in social media use (SMU) via platforms such as Facebook may provide opportunities for alleviation of PSI. For example, if people feel isolated because of their physical environment, they may be able to access supportive networks online. Similarly, SMU may facilitate forming connections among people by increasing social support.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.appdev.2008.07.002", "ISSN" : "01933973", "abstract" : "A longitudinal analysis of panel data from users of a popular online social network site, Facebook, investigated the relationship between intensity of Facebook use, measures of psychological well-being, and bridging social capital. Two surveys conducted a year apart at a large U.S. university, complemented with in-depth interviews with 18 Facebook users, provide the study data. Intensity of Facebook use in year one strongly predicted bridging social capital outcomes in year two, even after controlling for measures of self-esteem and satisfaction with life. These latter psychological variables were also strongly associated with social capital outcomes. Self-esteem served to moderate the relationship between Facebook usage intensity and bridging social capital: those with lower self-esteem gained more from their use of Facebook in terms of bridging social capital than higher self-esteem participants. We suggest that Facebook affordances help reduce barriers that lower self-esteem students might experience in forming the kinds of large, heterogeneous networks that are sources of bridging social capital.", "author" : [ { "dropping-particle" : "", "family" : "Steinfield", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ellison", "given" : "N B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lampe", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Applied Developmental Psychology", "id" : "ITEM-1", "issue" : "6", "issued" : { "date-parts" : [ [ "2008", "11" ] ] }, "page" : "434-445", "title" : "Social capital, self-esteem, and use of online social network sites: A longitudinal analysis", "type" : "article-journal", "volume" : "29" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=b41368d9-2625-4554-99cd-9e931a8b054d" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1111/j.1083-6101.2007.00367.x", "ISBN" : "0521832969", "ISSN" : "10836101", "PMID" : "10540012", "abstract" : "This study examines the relationship between use of Facebook, a popular online social network site, and the formation and maintenance of social capital. In addition to assessing bonding and bridging social capital, we explore a dimension of social capital that assesses one\u2019s ability to stay connected with members of a previously inhabited community, which we call maintained social capital. Regression analyses conducted on results from a survey of undergraduate students (N = 286) suggest a strong association between use of Facebook and the three types of social capital, with the strongest relationship being to bridging social capital. In addition, Facebook usage was found to interact with measures of psychological well-being, suggesting that it might provide greater", "author" : [ { "dropping-particle" : "", "family" : "Ellison", "given" : "N. B.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Steinfield", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lampe", "given" : "C.", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Computer-Mediated Communication", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2007", "7" ] ] }, "page" : "1143-1168", "title" : "The benefits of facebook \"friends:\" Social capital and college students' use of online social network sites", "type" : "article-journal", "volume" : "12" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=d10402a2-8c33-48d0-af9c-3467e92a39cf" ] } ], "mendeley" : { "formattedCitation" : "11,12", "plainTextFormattedCitation" : "11,12", "previouslyFormattedCitation" : "10,11" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }11,12 For example, they may help individuals with rare or stigmatizing conditions form support systems otherwise be difficult to establish. SMU has increased in particular among young adults, who are navigating critical stages of social identity formation.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1111/j.1467-8624.2004.00658.x", "ISBN" : "ISSN-0009-3920", "ISSN" : "00093920", "PMID" : "15015679", "abstract" : "Drawing on data from a normative sample of 205 children tracked into adulthood, this study examined the predictive links from 3 salient (friendship, academic, conduct) and 2 emerging (work, romantic) developmental tasks during the transition years around age 20 to adult adaptation 10 years later. Results (a) confirm the utility of salient developmental tasks for predicting adult success, (b) suggest that emerging domains have limited long-term predictive significance, and (c) more generally support a view that developmental tasks follow a course through life of waxing and waning salience and organization that has implications for future adaptation.", "author" : [ { "dropping-particle" : "", "family" : "Roisman", "given" : "G I", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Masten", "given" : "A S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Coatsworth", "given" : "J D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Tellegen", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Child Development", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2004" ] ] }, "page" : "123-133", "title" : "Salient and emerging developmental tasks in the transition to adulthood", "type" : "article-journal", "volume" : "75" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6a5d255e-e45a-42e2-a2e4-238835142f02" ] } ], "mendeley" : { "formattedCitation" : "13", "plainTextFormattedCitation" : "13", "previouslyFormattedCitation" : "12" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }13 As many as 90% of young adults in the U.S. use social media, and the majority of users visit these sites at least once a day.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEhvS11", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Pew Research Center", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Washington DC", "title" : "Social media update 2015", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=df0f6d13-93d3-4769-83ea-683475cc9ef4" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14
However, it may be that SMU in this population may counterintuitively increase PSI. For example, frequent users may substitute SMU for face-to-face social interactions. Similarly, frequent exposure to highly distilled, unrealistic portrayals on social media may give people the impression that others are living happier, more connected lives, and this may make users feel more socially isolated in comparison.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10900-015-0128-8", "ISSN" : "0094-5145", "PMID" : "26613936", "abstract" : "Low emotional support is associated with poor health outcomes. Engagement with face-to-face social networks is one way of increasing emotional support. However, it is not yet known whether engagement with proliferating electronic social networks is similarly associated with increased emotional support. Thus, the purpose of this study was to assess associations between social media use and perceived emotional support in a large, nationally-representative sample. In October 2014, we collected data from 1796 U.S. adults ages 19\u201332. We assessed social media use using both total time spent and frequency of visits to each of the 11 most popular social media platforms. Our dependent variable was perceived emotional support as measured by the brief Patient-Reported Outcomes Measurement Information System (PROMIS) emotional support scale. A multivariable model including all sociodemographic covariates and accounting for survey weights demonstrated that, compared with the lowest quartile of time on social media, being in the highest quartile (spending two or more hours per day) was significantly associated with decreased odds of having higher perceived emotional support (AOR 0.62, 95 % CI 0.40, 0.94). However, compared with those in the lowest quartile, being in the highest quartile regarding frequency of social media use was not significantly associated with perceived emotional support (AOR 0.70, 95 % CI 0.45, 1.09). In conclusion, while the cross-sectional nature of these data hinder inference regarding directionality, it seems that heavy users of social media may actually feel less and not more emotional support.", "author" : [ { "dropping-particle" : "", "family" : "Shensa", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sidani", "given" : "J E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bowman", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Primack", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Community Health", "id" : "ITEM-1", "issue" : "3", "issued" : { "date-parts" : [ [ "2016", "6", "27" ] ] }, "page" : "541-549", "title" : "Social media use and perceived emotional support among US young adults", "type" : "article-journal", "volume" : "41" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5792898b-9eca-43b9-b221-3940205d79b4" ] } ], "mendeley" : { "formattedCitation" : "15", "plainTextFormattedCitation" : "15", "previouslyFormattedCitation" : "14" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }15 In empirical studies, SMU has been associated with constructs such as depression.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1371/journal.pone.0069841", "ISSN" : "1932-6203", "PMID" : "23967061", "abstract" : "Over 500 million people interact daily with Facebook. Yet, whether Facebook use influences subjective well-being over time is unknown. We addressed this issue using experience-sampling, the most reliable method for measuring in-vivo behavior and psychological experience. We text-messaged people five times per day for two-weeks to examine how Facebook use influences the two components of subjective well-being: how people feel moment-to-moment and how satisfied they are with their lives. Our results indicate that Facebook use predicts negative shifts on both of these variables over time. The more people used Facebook at one time point, the worse they felt the next time we text-messaged them; the more they used Facebook over two-weeks, the more their life satisfaction levels declined over time. Interacting with other people \"directly\" did not predict these negative outcomes. They were also not moderated by the size of people's Facebook networks, their perceived supportiveness, motivation for using Facebook, gender, loneliness, self-esteem, or depression. On the surface, Facebook provides an invaluable resource for fulfilling the basic human need for social connection. Rather than enhancing well-being, however, these findings suggest that Facebook may undermine it.", "author" : [ { "dropping-particle" : "", "family" : "Kross", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Verduyn", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Demiralp", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Park", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "D S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lin", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shablack", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Jonides", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Ybarra", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "PLOS ONE", "id" : "ITEM-1", "issue" : "8", "issued" : { "date-parts" : [ [ "2013", "1" ] ] }, "page" : "e69841", "title" : "Facebook use predicts declines in subjective well-being in young adults", "type" : "article-journal", "volume" : "8" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=873515fa-d7e2-4b35-87c7-268dadc4db77" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1089/cyber.2011.0324", "ISSN" : "2152-2723", "PMID" : "22165917", "abstract" : "Facebook, as one of the most popular social networking sites among college students, provides a platform for people to manage others' impressions of them. People tend to present themselves in a favorable way on their Facebook profile. This research examines the impact of using Facebook on people's perceptions of others' lives. It is argued that those with deeper involvement with Facebook will have different perceptions of others than those less involved due to two reasons. First, Facebook users tend to base judgment on examples easily recalled (the availability heuristic). Second, Facebook users tend to attribute the positive content presented on Facebook to others' personality, rather than situational factors (correspondence bias), especially for those they do not know personally. Questionnaires, including items measuring years of using Facebook, time spent on Facebook each week, number of people listed as their Facebook \"friends,\" and perceptions about others' lives, were completed by 425 undergraduate students taking classes across various academic disciplines at a state university in Utah. Surveys were collected during regular class period, except for two online classes where surveys were submitted online. The multivariate analysis indicated that those who have used Facebook longer agreed more that others were happier, and agreed less that life is fair, and those spending more time on Facebook each week agreed more that others were happier and had better lives. Furthermore, those that included more people whom they did not personally know as their Facebook \"friends\" agreed more that others had better lives.", "author" : [ { "dropping-particle" : "", "family" : "Chou", "given" : "H T G", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Edge", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Cyberpsychology, Behavior and Social Networking", "id" : "ITEM-2", "issue" : "2", "issued" : { "date-parts" : [ [ "2012", "2" ] ] }, "page" : "117-21", "title" : "\"They are happier and having better lives than I am\": The impact of using Facebook on perceptions of others' lives.", "type" : "article-journal", "volume" : "15" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=08282e10-493a-44d6-aaef-9dafcf34fe60" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1016/j.chb.2014.03.003", "ISSN" : "07475632", "abstract" : "Facebook is the world's most popular online social network and used by more than one billion people. In three studies, we explored the hypothesis that Facebook activity negatively affects people's emotional state. A first study shows that the longer people are active on Facebook, the more negative is their mood afterwards. The second study provides causal evidence for this effect by showing that Facebook activity leads to a deterioration of mood compared to two different control conditions. Furthermore, it was demonstrated that this effect is mediated by a feeling of not having done anything meaningful. With such negative outcomes for its users, the question arises as to why so many people continue to use Facebook on a daily basis. A third study suggests that this may be because people commit an affective forecasting error in that they expect to feel better after using Facebook, whereas, in fact, they feel worse. ?? 2014 Elsevier Ltd. All rights reserved.", "author" : [ { "dropping-particle" : "", "family" : "Sagioglou", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Greitemeyer", "given" : "T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Computers in Human Behavior", "id" : "ITEM-3", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "359-363", "title" : "Facebook's emotional consequences: Why Facebook causes a decrease in mood and why people still use it", "type" : "article-journal", "volume" : "35" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ae944b7a-8a43-444c-a983-dd70da5165c4" ] }, { "id" : "ITEM-4", "itemData" : { "DOI" : "10.1002/da.22466", "ISSN" : "10914269", "abstract" : "Background Social media (SM) use is increasing among U.S. young adults, and its association with mental well-being remains unclear. This study assessed the association between SM use and depression in a nationally representative sample of young adults. Methods We surveyed 1,787 adults ages 19 to 32 about SM use and depression. Participants were recruited via random digit dialing and address-based sampling. SM use was assessed by self-reported total time per day spent on SM, visits per week, and a global frequency score based on the Pew Internet Research Questionnaire. Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression Scale Short Form. Chi-squared tests and ordered logistic regressions were performed with sample weights. Results The weighted sample was 50.3% female and 57.5% White. Compared to those in the lowest quartile of total time per day spent on SM, participants in the highest quartile had significantly increased odds of depression (AOR = 1.66, 95% CI = 1.14\u20132.42) after controlling for all covariates. Compared with those in the lowest quartile, individuals in the highest quartile of SM site visits per week and those with a higher global frequency score had significantly increased odds of depression (AOR = 2.74, 95% CI = 1.86\u20134.04; AOR = 3.05, 95% CI = 2.03\u20134.59, respectively). All associations between independent variables and depression had strong, linear, dose\u2013response trends. Results were robust to all sensitivity analyses. Conclusions SM use was significantly associated with increased depression. Given the proliferation of SM, identifying the mechanisms and direction of this association is critical for informing interventions that address SM use and depression.", "author" : [ { "dropping-particle" : "", "family" : "Lin", "given" : "L Y", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sidani", "given" : "J E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Shensa", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Radovic", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Miller", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Colditz", "given" : "J B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hoffman", "given" : "B H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Giles", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Primack", "given" : "B A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Depression and Anxiety", "id" : "ITEM-4", "issue" : "4", "issued" : { "date-parts" : [ [ "2016", "1" ] ] }, "page" : "323\u2013331", "title" : "Association between social media use and depression among U.S. young adults", "type" : "article-journal", "volume" : "33" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=7a3bfbe4-9ba6-4699-a631-8c6c80a4f4aa" ] } ], "mendeley" : { "formattedCitation" : "16\u201319", "plainTextFormattedCitation" : "16\u201319", "previouslyFormattedCitation" : "15\u201318" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }1619 To the authors knowledge, however, the association between SMU and PSI has not been assessed in a large-scale study.
Therefore, the aim of this study was to assess associations between SMU and PSI in a nationally representative sample of U.S. young adults. The focus on young adults was appropriate because of the particular increase in SMU in this population.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEhvS11", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Pew Research Center", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Washington DC", "title" : "Social media update 2015", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=df0f6d13-93d3-4769-83ea-683475cc9ef4" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14 Additionally, PSI often begins during emerging adulthood, when people leave structured environments such as school or home of origin.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/S2215-0366(14)00080-7", "ISSN" : "2215-0374 (Electronic)", "PMID" : "26361316", "abstract" : "Since 1960 demographic trends towards longer time in education and late age to enter into marriage and of parenthood have led to the rise of a new life stage at ages 18-29 years, now widely known as emerging adulthood in developmental psychology. In this review we present some of the demographics of emerging adulthood in high-income countries with respect to the prevalence of tertiary education and the timing of parenthood. We examine the characteristics of emerging adulthood in several regions (with a focus on mental health implications) including distinctive features of emerging adulthood in the USA, unemployment in Europe, and a shift towards greater individualism in Japan.", "author" : [ { "dropping-particle" : "", "family" : "Arnett", "given" : "J J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zukauskiene", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Sugimura", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "The Lancet Psychiatry", "id" : "ITEM-1", "issue" : "7", "issued" : { "date-parts" : [ [ "2014", "12" ] ] }, "language" : "eng", "page" : "569-576", "publisher-place" : "England", "title" : "The new life stage of emerging adulthood at ages 18-29 years: Implications for mental health", "type" : "article-journal", "volume" : "1" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=e007dfb5-0bc7-4a15-bbde-2b99482ec680" ] } ], "mendeley" : { "formattedCitation" : "20", "plainTextFormattedCitation" : "20", "previouslyFormattedCitation" : "19" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }20 Because of the seeming strength of SMU to provide social support, the hypothesis was that increased SMU would be associated with lower PSI.
METHODS
Study Sample
A nationally representative sample of U.S. adults aged 1932 years was surveyed regarding SMU and PSI. The sample was drawn from a research panel maintained by Growth from Knowledge (GfK), which recruited participants via random-digit dialing and address-based sampling.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEWO5mb", "author" : [ { "dropping-particle" : "", "family" : "GfK KnowledgePanel\u00ae", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "title" : "KnowledgePanel Design Summary", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a3719d9e-7fd4-4387-8f03-39ad46ef7189" ] } ], "mendeley" : { "formattedCitation" : "21", "plainTextFormattedCitation" : "21", "previouslyFormattedCitation" : "20" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }21 Using this process, they maintained a sampling frame including >97% of the U.S. population.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEWO5mb", "author" : [ { "dropping-particle" : "", "family" : "GfK KnowledgePanel\u00ae", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2013" ] ] }, "title" : "KnowledgePanel Design Summary", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=a3719d9e-7fd4-4387-8f03-39ad46ef7189" ] } ], "mendeley" : { "formattedCitation" : "21", "plainTextFormattedCitation" : "21", "previouslyFormattedCitation" : "20" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }21 GfKs sampling strategy has been shown to be a statistically valid method for assessing a nationally representative sample.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1093/poq/nfq048", "ISSN" : "0033362X", "abstract" : "In September 2008, the AAPOR Executive Council established an Opt-In Online Panel Task Force and charged it with \u201creviewing the current empirical findings related to opt-in online panels utilized for data collection and developing recommendations for AAPOR members.\u201d The council further specified that the charge did not include development of best practices, but rather would \u201cprovide key information and recommendations about whether and when opt-in panels might be best utilized and how best to judge their quality.\u201d The task force was formed in October 2008. This is its report.", "author" : [ { "dropping-particle" : "", "family" : "Baker", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Blumberg", "given" : "S J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Brick", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Couper", "given" : "M P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Courtright", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dennis", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dillman", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Frankel", "given" : "M R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garland", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Groves", "given" : "R M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Kennedy", "given" : "C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Krosnick", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lavrakas", "given" : "P J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lee", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Link", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Piekarski", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rao", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Thomas", "given" : "R K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Zahs", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Public Opinion Quarterly", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2010", "10", "20" ] ] }, "page" : "711-781", "title" : "Research Synthesis", "type" : "article-journal", "volume" : "74" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=2f427604-1408-4988-9d81-813e7060221b" ] }, { "id" : "ITEM-2", "itemData" : { "ISBN" : "1545-1151", "ISSN" : "1545-1151", "PMID" : "15670445", "abstract" : "INTRODUCTION: Chronic conditions are among the leading causes of death and disability in the United States. The Internet is a source of health information and advice for individuals with chronic conditions and shows promise for helping individuals manage their conditions and improve their quality of life. METHODS: We assessed Internet use for health information by people who had one or more of five common chronic conditions. We conducted a national survey of adults aged 21 and older, then analyzed data from 1980 respondents who had Internet access and who reported that they had hypertension, diabetes, cancer, heart problems, and/or depression. RESULTS: Adjusted rates for any Internet use for health information ranged from 33.8% (heart problems only) to 52.0% (diabetes only). A sizable minority of respondents - particularly individuals with diabetes - reported that the Internet helped them to manage their condition themselves, and 7.9% said information on the Internet led them to seek care from a different doctor. CONCLUSION: Use of the Internet for health information by chronically ill patients is moderate. Self-reported effects on choice of treatment or provider are small but noteworthy.", "author" : [ { "dropping-particle" : "", "family" : "Wagner", "given" : "T H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Baker", "given" : "L C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bundorf", "given" : "M K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Singer", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Preventing Chronic Disease", "id" : "ITEM-2", "issue" : "4", "issued" : { "date-parts" : [ [ "2004", "10" ] ] }, "page" : "A13", "title" : "Use of the Internet for health information by the chronically ill", "type" : "article-journal", "volume" : "1" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6501171c-7ac2-4509-8ecf-1c41f5c9b818" ] } ], "mendeley" : { "formattedCitation" : "22,23", "plainTextFormattedCitation" : "22,23", "previouslyFormattedCitation" : "21,22" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }22,23
From October 2014 to November 2014, the web-based survey was sent via e-mail to a random sample of 3,048 non-institutionalized adults aged 1932 years who had consented to participate in a previous study wave that held no criteria except that participants had to be aged 1830 years at baseline. The current data were collected during the 18-month follow-up of the prior study; only the 18-month follow-up data were used because the social media items were not asked at baseline. Responses were received from 1,787 participants (59%). This represented a strong response rate, because many of the baseline respondents were likely no longer in the GfK panel, which turns over participants every 2 years to prevent cohorts from becoming fatigued by surveys. Additionally, survey weights accounted for non-response and there were no demographic differences between responders and non-responders, both of which attest to external generalizability of the results.
Multiple strategies were instituted by GfK to improve data quality, such as minimizing survey length, reducing the need for scrolling, and avoiding the use of long grids. If individuals did not answer a question, they were prompted once to answer with the statement your answer is important to us. Please put your best guess. However, participants were not forced to answer any items.
The median time for survey completion was 20 minutes and participants received $15 for their participation. This study was approved by the University of Pittsburgh IRB and was granted a Certificate of Confidentiality from NIH.
Measures
Participants completed online survey items including measures of PSI (dependent variable), SMU (independent variable), and covariates.
PSI was assessed using a four-item scale developed by the Patient-Reported Outcomes Measurement Information System (PROMIS). PROMIS is an NIH Roadmap initiative that aims to provide precise, valid, reliable, and standardized questionnaires measuring patient-reported outcomes across the domains of physical, mental, and social health.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1016/j.jclinepi.2010.04.011", "ISSN" : "1878-5921", "PMID" : "20685078", "abstract" : "OBJECTIVES: Patient-reported outcomes (PROs) are essential when evaluating many new treatments in health care; yet, current measures have been limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The Patient-Reported Outcomes Measurement Information System (PROMIS) provides item banks that offer the potential for efficient (minimizes item number without compromising reliability), flexible (enables optional use of interchangeable items), and precise (has minimal error in estimate) measurement of commonly studied PROs. We report results from the first large-scale testing of PROMIS items. STUDY DESIGN AND SETTING: Fourteen item pools were tested in the U.S. general population and clinical groups using an online panel and clinic recruitment. A scale-setting subsample was created reflecting demographics proportional to the 2000 U.S. census. RESULTS: Using item-response theory (graded response model), 11 item banks were calibrated on a sample of 21,133, measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Short forms from each bank were developed and compared with the overall bank and with other well-validated and widely accepted (\"legacy\") measures. All item banks demonstrated good reliability across most of the score distributions. Construct validity was supported by moderate to strong correlations with legacy measures. CONCLUSION: PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. Further testing will continue to validate and test PROMIS items and banks in diverse clinical populations.", "author" : [ { "dropping-particle" : "", "family" : "Cella", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riley", "given" : "W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Stone", "given" : "A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rothrock", "given" : "N", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Reeve", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yount", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Amtmann", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bode", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Buysse", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Choi", "given" : "S", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cook", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Devellis", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeWalt", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Fries", "given" : "J", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gershon", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hahn", "given" : "E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lai", "given" : "Ji", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilkonis", "given" : "P", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Revicki", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Rose", "given" : "M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Weinfurt", "given" : "K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hays", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Journal of Clinical Epidemiology", "id" : "ITEM-1", "issue" : "11", "issued" : { "date-parts" : [ [ "2010", "11" ] ] }, "page" : "1179-1194", "title" : "The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008", "type" : "article-journal", "volume" : "63" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5f295e92-6556-4b05-92d3-37fa2991bf3b" ] } ], "mendeley" : { "formattedCitation" : "24", "plainTextFormattedCitation" : "24", "previouslyFormattedCitation" : "23" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }24 The PROMIS social isolation scale was developed using item response theory to promote precision and decrease respondent burden.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s11136-007-9204-6", "ISSN" : "0962-9343", "PMID" : "17401637", "abstract" : "The use of item banks and computerized adaptive testing (CAT) begins with clear definitions of important outcomes, and references those definitions to specific questions gathered into large and well-studied pools, or \"banks\" of items. Items can be selected from the bank to form customized short scales, or can be administered in a sequence and length determined by a computer programmed for precision and clinical relevance. Although far from perfect, such item banks can form a common definition and understanding of human symptoms and functional problems such as fatigue, pain, depression, mobility, social function, sensory function, and many other health concepts that we can only measure by asking people directly. The support of the National Institutes of Health (NIH), as witnessed by its cooperative agreement with measurement experts through the NIH Roadmap Initiative known as PROMIS (www.nihpromis.org), is a big step in that direction. Our approach to item banking and CAT is practical; as focused on application as it is on science or theory. From a practical perspective, we frequently must decide whether to re-write and retest an item, add more items to fill gaps (often at the ceiling of the measure), re-test a bank after some modifications, or split up a bank into units that are more unidimensional, yet less clinically relevant or complete. These decisions are not easy, and yet they are rarely unforgiving. We encourage people to build practical tools that are capable of producing multiple short form measures and CAT administrations from common banks, and to further our understanding of these banks with various clinical populations and ages, so that with time the scores that emerge from these many activities begin to have not only a common metric and range, but a shared meaning and understanding across users. In this paper, we provide an overview of item banking and CAT, discuss our approach to item banking and its byproducts, describe testing options, discuss an example of CAT for fatigue, and discuss models for long term sustainability of an entity such as PROMIS. Some barriers to success include limitations in the methods themselves, controversies and disagreements across approaches, and end-user reluctance to move away from the familiar.", "author" : [ { "dropping-particle" : "", "family" : "Cella", "given" : "David", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Gershon", "given" : "Richard", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lai", "given" : "Jin-Shei", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Choi", "given" : "Seung", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation", "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2007", "1" ] ] }, "page" : "133-41", "title" : "The future of outcomes measurement: item banking, tailored short-forms, and computerized adaptive assessment", "type" : "article-journal", "volume" : "16 Suppl 1" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=f31360a7-d53d-4170-8b7c-442f401e7c7c" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1037/hea0000055", "ISSN" : "1930-7810", "abstract" : "OBJECTIVE: To develop psychometrically sound, culturally relevant, and linguistically equivalent English and Spanish self-report measures of social health guided by a comprehensive conceptual model and applicable across chronic illnesses. METHODS: The Patient-Reported Outcomes Measurement Information System (PROMIS) Social Health Workgroup implemented a mixed methods approach to evaluate earlier results (v1.0); expand and refine domain definitions and items; translate items into Spanish; and obtain qualitative feedback. Computer-based and paper/pencil questionnaire administration was conducted with a variety of U.S. respondent samples during 2009-2012. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter logistic item response theory (IRT) modeling, evaluation of differential item functioning (DIF), and evaluation of criterion and construct validity. RESULTS: Qualitative feedback supported the conceptualization of the Social Health domain framework (Social Function and Social Relationships subcomponents). Validation testing participants (n = 2,208 English; n = 644 Spanish) were diverse in terms of gender, age, education, and ethnicity/race. EFA, CFA, and IRT identified 7 unidimensional factors with good model fit. There was no DIF by language, and good evidence of criterion and construct validity. CONCLUSIONS: PROMIS English and Spanish language instruments (v2.0), including computer-adaptive tests and fixed-length short forms, are publicly available for assessment of Social Function (Ability to Participate in Social Roles and Activities, and Satisfaction with Social Roles and Activities) and Social Relationships (Companionship; Emotional, Informational and Instrumental Support; and Social Isolation). Measures of social health will play a key role in applications that use ecologic (or determinants of health) models that emphasize how patients' social environments influence their health.", "author" : [ { "dropping-particle" : "", "family" : "Hahn", "given" : "E A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeWalt", "given" : "D A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Bode", "given" : "R K", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garcia", "given" : "S F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "DeVellis", "given" : "R F", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Correia", "given" : "H", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cella", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Health Psychology", "id" : "ITEM-2", "issue" : "5", "issued" : { "date-parts" : [ [ "2014" ] ] }, "page" : "490-499", "title" : "New English and Spanish social health measures will facilitate evaluating health determinants", "type" : "article-journal", "volume" : "33" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6ddafd86-97ad-49ab-9539-3244016f0c5c" ] }, { "id" : "ITEM-3", "itemData" : { "DOI" : "10.1097/MLR.0000000000000413", "ISSN" : "0025-7079", "PMID" : "26366521", "abstract" : "BACKGROUND: To guide measure development, National Institutes of Health-supported Patient reported Outcomes Measurement Information System (PROMIS) investigators developed a hierarchical domain framework. The framework specifies health domains at multiple levels. The initial PROMIS domain framework specified that physical function and symptoms such as Pain and Fatigue indicate Physical Health (PH); Depression, Anxiety, and Anger indicate Mental Health (MH); and Social Role Performance and Social Satisfaction indicate Social Health (SH). We used confirmatory factor analyses to evaluate the fit of the hypothesized framework to data collected from a large sample. METHODS: We used data (n=14,098) from PROMIS's wave 1 field test and estimated domain scores using the PROMIS item response theory parameters. We then used confirmatory factor analyses to test whether the domains corresponded to the PROMIS domain framework as expected. RESULTS: A model corresponding to the domain framework did not provide ideal fit [root mean square error of approximation (RMSEA)=0.13; comparative fit index (CFI)=0.92; Tucker Lewis Index (TLI)=0.88; standardized root mean square residual (SRMR)=0.09]. On the basis of modification indices and exploratory factor analyses, we allowed Fatigue to load on both PH and MH. This model fit the data acceptably (RMSEA=0.08; CFI=0.97; TLI=0.96; SRMR=0.03). DISCUSSION: Our findings generally support the PROMIS domain framework. Allowing Fatigue to load on both PH and MH improved fit considerably.", "author" : [ { "dropping-particle" : "", "family" : "Carle", "given" : "A C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Riley", "given" : "Wi", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Hays", "given" : "R D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cella", "given" : "D", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Medical Care", "id" : "ITEM-3", "issue" : "10", "issued" : { "date-parts" : [ [ "2015", "10" ] ] }, "page" : "894-900", "title" : "Confirmatory factor analysis of the patient reported outcomes measurement information system (PROMIS) adult domain framework using item response theory scores", "type" : "article-journal", "volume" : "53" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ed7ab088-c0d2-46eb-913c-50809a48b225" ] } ], "mendeley" : { "formattedCitation" : "25\u201327", "plainTextFormattedCitation" : "25\u201327", "previouslyFormattedCitation" : "24\u201326" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }2527 Additionally, the PROMIS social isolation scale has been correlated with and validated against other commonly used social isolation measures.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "DOI" : "10.1007/s10597-014-9774-z", "ISSN" : "0010-3853", "abstract" : "Upon immigration to the rural areas in the US, Latino families may experience cultural, geographic, linguistic and social isolation, which can detrimentally affect their wellbeing by acting as chronic stressors. Using a community engagement approach, this is a pilot mixed-method study with an embedded design using concurrent qualitative and quantitative data. The purpose of this study is to evaluate family and social environments in terms of protective factors and modifiable risks associated with mental well-being in Latino immigrants living in rural areas of Florida. Latino immigrant mother and adolescent dyads were interviewed by using in-depth ethnographic semistructured interviews and subsequent quantitative assessments, including a demographic questionnaire and three structured instruments: the Family Environment Scale Real Form, the SF-12v2\u2122 Health Survey and the short version (eight items) of PROMIS Health Organization Social Isolation. This mixed-method pilot study highlighted how family, rural, and social environments can protect or impair wellbeing in rural Latino immigrant mother and adolescent dyads.", "author" : [ { "dropping-particle" : "", "family" : "Stacciarini", "given" : "J M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Smith", "given" : "R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Garvan", "given" : "C W", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Wiens", "given" : "B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Cottler", "given" : "L B", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Community Mental Health Journal", "id" : "ITEM-1", "issue" : "4", "issued" : { "date-parts" : [ [ "2015", "5", "4" ] ] }, "page" : "404-413", "title" : "Rural Latinos\u2019 mental wellbeing: A mixed-methods pilot study of family, environment and social isolation factors", "type" : "article-journal", "volume" : "51" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=bf69b8e3-baaf-4ccc-b915-74b8a53a1db1" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1007/s11136-015-1131-3", "ISSN" : "0962-9343", "abstract" : "PURPOSE: Our work as a primary research site of the Patient-Reported Outcomes Measurement Information System (PROMIS(\u00ae)), combined with support from the Patient-Centered Outcomes Research Institute, allowed us to evaluate the real-world applicability and acceptability of PROMIS measures in an addiction medicine setting. METHODS: As part of a 3-month prospective observational study, 225 outpatients at a substance abuse treatment clinic completed PROMIS item banks for alcohol use (as well as 15 additional item banks from 8 other PROMIS domains, including emotional distress, sleep, and pain), with assessments at intake, 1-month follow-up, and 3-month follow-up. A subsample of therapists and their patients completed health domain importance ratings and qualitative interviews to elicit feedback regarding the content and format of the patients' assessment results. RESULTS: The importance ratings revealed that depression, anxiety, and lack of emotional support were rated highest of the non-alcohol-related domains among both patients and clinicians. General alcohol use was considered most important by both patients and clinicians. Based on their suggestions, changes were made to item response feedback to facilitate comprehension and communication. CONCLUSIONS: Both therapists and patients agreed that their review of the graphical display of scores, as well as individual item responses, helped them to identify areas of greatest concern and was useful for treatment planning. The results of our pilot work demonstrated the value and practicality of incorporating a comprehensive health assessment within a substance abuse treatment setting.", "author" : [ { "dropping-particle" : "", "family" : "Johnston", "given" : "K L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Lawrence", "given" : "S M", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Dodds", "given" : "N E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Yu", "given" : "L", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Daley", "given" : "D C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Pilkonis", "given" : "P A", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Quality of Life Research", "id" : "ITEM-2", "issue" : "3", "issued" : { "date-parts" : [ [ "2016", "3", "9" ] ] }, "page" : "615-624", "title" : "Evaluating PROMIS\u00ae instruments and methods for patient-centered outcomes research: Patient and provider voices in a substance use treatment setting", "type" : "article-journal", "volume" : "25" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=5fc33fcc-ba19-4938-a5d0-88a26e45a299" ] } ], "mendeley" : { "formattedCitation" : "28,29", "plainTextFormattedCitation" : "28,29", "previouslyFormattedCitation" : "27,28" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }28,29 The social isolation scale assesses perceptions of being avoided, excluded, detached, disconnected from, or unknown by others. The specific items ask participants how frequently in the past 7 days they had felt: I feel left out; I feel that people barely know me; I feel isolated from others; and I feel that people are around me but not with me. These items were scored on a 5-point Likert scale ranging from 1 to 5, corresponding to responses of never, rarely, sometimes, often, and always. Thus, with four items, each scored from 1 to 5, raw scores for PSI ranged from 4 to 20. Though PROMIS refers to the scale as assessing overall social isolation, it is clear from the structure of the items and their openings I feel that the primary construct assessed by the scale is perceived (i.e., not objective) social isolation.
The continuous PSI data were non-normal and not amenable to transformation into normally distributed data. Therefore, raw scores were collapsed into tertiles of low, medium, and high for analysis. This was appropriate because one of the specific aims of the PROMIS social isolation scale is to grade its severity instead of merely providing a dichotomous cut off. Similarly, because there is no established clinical cut off for social isolation, groups were divided into approximate tertiles using the appropriate function in Stata, version 13.1 rather than basing the categories on specific numbers. Thus, all participants were categorized as having low, medium, or high social isolation, which represented 39%, 31%, and 30% of the sample, respectively. Low, medium, and high social isolation corresponded to raw scores of 46, 710, and e"1 1 , r e s p e c t i v e l y . T h e s c a l e e x h i b i t e d e x c e l l e n t i n t e r n a l c o n s i s t e n c y r e l i a b i l i t y ( C r o n b a c h s ( , 0 . 9 2 ) .
P a r t i c i p a n t s S M U w a s a s s e s s e d i n t w o c o m p l e m e n t a r y w a y s : t i m e a n d f r e q u e n c y o f u s e . F i r s t , p a r t i c i p a n t s w e r e a s k e d t o e s t i m a t e t i m e s p e n t o n s o c i a l m e dia for personal use. This item specifically instructed participants not to count any time spent on social media for work. Participants provided estimates in numerical fields for hours and minutes on an average day. Second, participants were asked to report frequency of their use of each of 11 widely used social media platforms, including Facebook, Twitter, Google+, YouTube, LinkedIn, Instagram, Pinterest, Tumblr, Vine, Snapchat, and Reddit.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEhvS11", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Pew Research Center", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Washington DC", "title" : "Social media update 2015", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=df0f6d13-93d3-4769-83ea-683475cc9ef4" ] }, { "id" : "ITEM-2", "itemData" : { "URL" : "http://www.webcitation.org/6bXTvRwTJ", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Nielsen", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-2", "issued" : { "date-parts" : [ [ "2012" ] ] }, "title" : "State of the media: The social media report 2012", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=6c70943a-0d96-42a7-80bf-4891c149a036" ] } ], "mendeley" : { "formattedCitation" : "14,30", "plainTextFormattedCitation" : "14,30", "previouslyFormattedCitation" : "13,29" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14,30 Seven response choices ranged from I do not use this platform to I use this platform 5 or more times a day. These items were based on the measures used by Pew Internet Research.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEhvS11", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Pew Research Center", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Washington DC", "title" : "Social media update 2015", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=df0f6d13-93d3-4769-83ea-683475cc9ef4" ] } ], "mendeley" : { "formattedCitation" : "14", "plainTextFormattedCitation" : "14", "previouslyFormattedCitation" : "13" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14 Using weighted averages based on the frequency responses, social media site visits per week were computed. To improve interpretability of results, all independent variables were collapsed into quartiles for primary analyses. To ensure robustness of results, all analyses were also conducted with independent variables as continuous.
For analysis, the sample was divided into three age groups based on the distribution of data. Race/ethnicity were grouped into five mutually exclusive categories. Other environmental and personal factors that may affect SMU and PSI were also assessed; these factors included relationship status, living situation, household income, and education level.ADDIN CSL_CITATION { "citationItems" : [ { "id" : "ITEM-1", "itemData" : { "URL" : "http://www.webcitation.org/6ajEhvS11", "accessed" : { "date-parts" : [ [ "2016", "6", "8" ] ] }, "author" : [ { "dropping-particle" : "", "family" : "Pew Research Center", "given" : "", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "id" : "ITEM-1", "issued" : { "date-parts" : [ [ "2015" ] ] }, "publisher-place" : "Washington DC", "title" : "Social media update 2015", "type" : "webpage" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=df0f6d13-93d3-4769-83ea-683475cc9ef4" ] }, { "id" : "ITEM-2", "itemData" : { "DOI" : "10.1001/archpsyc.62.6.617", "ISBN" : "0003-990X", "ISSN" : "0003-990X", "PMID" : "15939839", "abstract" : "Little is known about the general population prevalence or severity of DSM-IV mental disorders.", "author" : [ { "dropping-particle" : "", "family" : "Kessler", "given" : "R C", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Chiu", "given" : "W T", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Demler", "given" : "O", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Merikangas", "given" : "K R", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" }, { "dropping-particle" : "", "family" : "Walters", "given" : "E E", "non-dropping-particle" : "", "parse-names" : false, "suffix" : "" } ], "container-title" : "Archives of General Psychiatry", "id" : "ITEM-2", "issue" : "6", "issued" : { "date-parts" : [ [ "2005" ] ] }, "page" : "617-627", "title" : "Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication", "type" : "article-journal", "volume" : "62" }, "uris" : [ "http://www.mendeley.com/documents/?uuid=ec1ff2b1-e2d0-4174-9115-b5701c6c610f" ] } ], "mendeley" : { "formattedCitation" : "14,31", "plainTextFormattedCitation" : "14,31", "previouslyFormattedCitation" : "13,30" }, "properties" : { "noteIndex" : 0 }, "schema" : "https://github.com/citation-style-language/schema/raw/master/csl-citation.json" }14,31
Statistical Analysis
All participants who had complete data on the PROMIS social isolation scale and the social media items were included. Because only about 1% of participants had missing data for these variables, this did not affect results. Percentages were computed for the dependent variable, the two independent variables (time and frequency of SMU), and the seven covariates. Next, chi-square tests were used to determine bivariable associations between each of the independent variables and covariates and PSI.
After confirming that the proportional odds assumption was met, ordered logistic regression was used to examine associations between each social media variable and PSI. All covariates were included in primary multivariable models. To take advantage of the nationally representative data, all primary analyses were conducted using survey weights that took into account sex, age, race/ethnicity, education, household income, Census region, metropolitan area, and Internet access. Similar regression analyses examined whether there was an overall linear trend between each ordered categorical independent variable and the dependent variable.
Three sets of sensitivity analyses were also conducted to examine the robustness of results. First, all analyses were repeated with independent variables as continuous instead of ordered categorical. Second, all analyses were conducted using only covariates that had a bivariable association of p<0.15 with the outcome. Third, all analyses were conducted without survey weights. Results from all sensitivity analyses showed similar levels of significance and magnitude to the primary analyses described here.
Statistical analyses were performed in 2015 with Stata, version 13.1, and two-tailed p-values <0.05 were considered significant.
RESULTS
A total of 1,787 participants completed the questionnaire. The weighted sample was 50.3% female, 57.5% white, 13.0% African American, 20.6% Hispanic, and 8.9% biracial/multiracial or other. Of these, slightly more than half (55.6%) were in a committed relationship and approximately a third (35.6%) reported living with a significant other. In terms of household income, 22.9% were in the low category (<$30,000) and 38.7% were in the high category ( e"$ 7 5 , 0 0 0 ) . A b o u t o n e t h i r d ( 3 6 . 0 % ) o f p a r t i c i p a n t s h a d n o t a t t e n d e d a n y c o l l e g e , w h e r e a s a q u a r t e r ( 2 5 . 7 % ) h a d a B A o r h i g h e r ( T a b l e 1 ) . T h e r e w e r e n o d i f f e r e n c e s b e t w e e n r e s p o n d e r s a n d n o n - r e s p o n d e r s i n t e r m s o f a g e ( p = 0 . 1 2 ) , s e x ( p = 0 . 0 7 ) , o r r a c e ( p = 0 . 2 1 ).
Accounting for survey weights, PSI was classified as low, medium, and high among 42%, 31%, and 27% of participants, respectively. Median total time on social media was 61 minutes per day (interquartile range, 30135). Median social media site visits per week across all platforms was 30 (interquartile range, 957). Only 58 individuals (3.2%) reported zero site visits per week.
There were significant bivariable associations between PSI and each of the primary SMU variables. Compared with those who used so c i a l m e d i a <