The Loneliness Epidemic, Intersecting Risk Factors and Relations to Mental Health Help-Seeking: A Population-Based Study during COVID-19 Lockdown in Canada

Background and Purpose: Pandemic-induced social distancing and stay-at-home orders, while successful in decreasing the transmission of COVID-19, could exacerbate loneliness. Few studies have examined how pandemic-related social determinants intersect to shape pandemic loneliness and its relations to mental health care in Canada. The present study aims to examine the following three research questions: (1) What are pandemic-specific risk and resilience factors of loneliness symptoms and how do these factors differ between men and women in the general population? (2) How do risk factors intersect to affect loneliness symptoms and which is the most important social determinant of loneliness during the pandemic? (3) Is loneliness a robust indicator associated with greater likelihood of mental health help-seeking behaviours after controlling for other mental health conditions?

Methods: A population-representative sample of 3772 adults from the Canadian Perspective Survey Series (CPSS-6; January 25 to 31, 2021) was analyzed. Gender-specific logistic regression was employed to investigate the association between three-item loneliness scale (UCLA-3) with socio-demographics, job precarity, health behaviours, social isolation indicators, and mental health help-seeking. Classification and Regression Tree (CART) modelling, a machine learning approach, was used to identify intersecting risk factors and the most important predictor of severe loneliness (UCLA-3 score ≥ 7).

Results: The estimated prevalence of severe loneliness was 34.7 % in Canada, with women significantly higher than men (38.1 % vs 31.3 %, p < 0.001). Pandemic loneliness were more prevalent in female (OR = 1.53, 99 % CI: 1.26–1.85), those who were younger (OR's range 1.42–3.00), women without college degree (OR = 1.44, 99 % CI: 1.01–2.04), those living alone (OR = 1.56, 99 % CI: 1.09–2.23), immigrant men (OR = 1.79, 99 % CI: 1.23–2.60), those with small network (OR's range: 1.73–3.26), those who were absent from work due to COVID-19 related reasons (OR = 2.11, 99 % CI: 1.04–4.28), past-month binge drinkers (OR's range: 1.39–1.70) and cannabis user (OR = 1.47, 99 % CI: 1.12–1.93). The CART algorithm identifies that immigrants who experienced pandemic-triggered job insecurity were the most-at-risk group of severely loneliness, compared to Canadian-born residents (86.2 % vs. 48.7 %). The CART tree also elucidates how risk profiles intersect in more complex way to shape loneliness: the absence of five risk factors sequentially were the most protective from developing loneliness (19.7%), that is when respondents did not experience pandemic-related job insecurity, have larger social circle (> 2 persons), being adults (> 24 years), no past-month binge drinking and with higher educational attainment (≥ college degree). Pandemic loneliness was positively associated with formal help-seeking from mental health professionals (OR = 1.71, 99 % CI: 1.21–2.41), informal help-seeking from social circle (OR = 1.51, 99 % CI: 1.17–1.95), and unmet mental health needs (OR = 1.78, 99 % CI: 1.29–2.49).

Conclusion: The COVID-19 pandemic converges with loneliness epidemic in Canada. Prevention and intervention programs should target upstream social determinants of mental health, especially the intersection of migration status and COVID-19-related job precarity, to eliminate loneliness during the pandemic.