LONELINESS AMONG A SAMPLE OF SWEDISH UNIVERSITY STUDENTS
DURING THE COVID-19 PANDEMIC
Antonia Sigfridsson & Herman Brandt
Master’s Thesis, 30 ECTS
Study Programme for University Diploma in Psychology, 300 ECTS
Abstract
The outbreak of the COVID-19 pandemic has had an enormous impact worldwide and is posing a threat to the physical and mental health of world citizens. The present study examines the extent to which a sample of Swedish university students have experienced loneliness during COVID-19. Furthermore, it also examines if there is a correlation between a high degree of loneliness and increased alcohol consumption. Participants consisted of Swedish university students recruited online using opportunity sampling (N=224). Loneliness was measured using the UCLA Loneliness Scale translated into Swedish. Results showed that the sample displayed higher levels of loneliness compared to normative scores but lower levels when compared to students elsewhere who have been quarantined. A logistic regression found no connection between high degrees of loneliness and increased alcohol consumption in the sample. The results and their implications are discussed. A pre-post measurement design and longitudinal studies are encouraged for future research to evaluate long term consequences of loneliness, along with an increased focus on ways to reduce loneliness. Finally, we suggest that loneliness should continue to be a priority in research in order to fully understand the psychological impact of COVID-19.
Keywords: perceived loneliness, UCLA Loneliness Scale, COVID-19 pandemic, alcohol Abstrakt
Utbrottet av COVID-19 pandemin har haft en enorm påverkan världen över och utgör ett hot mot den fysiska och mentala hälsan. Vår studie syftade till att undersöka i vilken utsträckning ett urval av svenska universitetsstudenter upplevt ensamhet under COVID-19. Vidare har studien undersökt om det fanns ett samband mellan en hög grad av upplevd ensamhet under COVID-19 och ökad alkoholkonsumtion. Deltagarna bestod av svenska universitetsstudenter vilka rekryterades online genom bekvämlighetsurval (N=224). Deltagarna fyllde i en enkät där subjektiv ensamhet mättes med hjälp av en översatt version av UCLA Loneliness Scale till svenska. Resultaten visade att studenterna i vårt urval uppvisade högre nivå av ensamhet jämfört med normvärden, men lägre jämfört med studenter i andra länder som suttit i karantän. En logistisk regression fann inget samband mellan upplevd ensamhet och ökad alkoholkonsumtion.
Resultaten och deras implikationer diskuteras. För framtida forskning uppmuntras en för- och eftermätningsdesign samt longitudinella studier att utvärdera långsiktiga konsekvenser av ensamhet, samt ett ökat fokus på sätt att minska ensamhet. Slutligen föreslås att ensamhet blir ett fortsatt fokus i forskningen för att fullt ut förstå psykologiska effekterna av COVID-19.
Nyckelord: upplevd ensamhet, UCLA Loneliness Scale, COVID-19 pandemic, alkohol
Loneliness among a Sample of Swedish University Students during the COVID-19 Pandemic The outbreak of the COVID-19 pandemic has had an enormous impact worldwide and is posing a threat to the physical and mental health of world citizens (Holmes et al., 2020). The spread of COVID-19 in Sweden accelerated rapidly in March 2020 (Public Health Agency of Sweden, 2021). As a consequence, several restrictions were put in place. Restrictions include a ban of public gatherings of more than eight people; restrictions on the amount of people allowed inside stores, gyms, sports facilities and public transport; a ban on serving alcohol after 8 p.m.; as well as travel restrictions. It is also recommended to work from home whenever possible (Public Health Agency of Sweden, 2021). Further, higher educational institutions have been recommended to adapt their educational format to distance learning (Public Health Agency of Sweden, 2021). As of 26th of February 2021, the number of confirmed COVID-19 cases in Sweden was 652,465 and the number of deaths had reached 12,798 (Public Health Agency of Sweden, 2021). Considering that Sweden has adapted a unique strategy to dealing with COVID-19, there is a need to evaluate whether this strategy has been beneficial to the mental health of Swedish citizens.
The restrictions put in place in Sweden have been light compared to those enforced in other countries. For example, Turkey has imposed a night and weekend curfew on all citizens, restrictions on intercity travel as well as more rigid restrictions for people above 65 years of age (U.S. Embassy & Consulates in Turkey, 2021). Similarly, Spain has imposed a night time curfew, limited gatherings to six people and limited non-essential movement (Boletín Oficial del Estado, 2021). South Africa imposed a national lockdown, restrictions on all outdoor movement including local and international traveling, banned social gatherings, as well as a shutdown of restaurants, shops, schools and universities (South African Government, 2021). Regardless of the different approaches to dealing with the virus, it is unquestionable that COVID-19 has had a huge impact on the lives of people globally. As a result, there has been an urge for mental health professionals worldwide to take immediate, collaborative action to investigate the consequences of this global pandemic on mental health (Holmes et al., 2020).
Conducting research during a global pandemic is crucial in order to understand and prevent its detrimental effects on mental and physical health. Previous pandemics have shown that people who were in quarantine suffered more than those who were not restricted by quarantine (Erzon, 2018). Further, it has been demonstrated that quarantine and social isolation can lead to mental health consequences such as anxiety, depression, frustration and boredom (Razai, 2020; Kato, 2020) as well as increased disagreements and violence in close relationships (Kato, 2020). A study with participants from Australia and India has shown a range of negative mental health consequences among students during the ongoing pandemic. These included anxiety, difficulty sleeping, difficulty concentrating and disordered eating (Kochuvilayil, 2020).
A study examining students in China showed that around 25% of the participants experienced anxiety to varying degrees (Cao et al., 2020). Moreover, a study conducted in Belgium and Italy
showed that 5% of participants experienced an increased need for mental health care during the pandemic (Marchini et al., 2020).
As a result of the ongoing pandemic, social distancing and social isolation have been encouraged in order to avoid spread of infection. A common consequence of social isolation is loneliness (Killgore et al., 2020). Loneliness can be conceptualized as “an individual’s subjective evaluation of feeling without companionship, feeling isolated, or feeling like they don’t belong”
(de Jong-Gierveld & Havens, 2004). Loneliness affects both physical and mental health and has a mortality rate similar to smoking and obesity (Razai, 2020). Research on loneliness has shown that loneliness and social isolation can increase the likelihood of mortality, especially among people younger than 65 years of age (Holt-Lundstadt et al., 2015). Loneliness can have a significant effect on depression (Erzen, 2018) and is also a risk factor for suicide (Brown &
Schuman, 2020). Circumstances of the pandemic comprise several risk factors for suicide, such as social isolation, an increase in mental health problems, increased unemployment rates and economic losses, loss of relationships and relationship problems as well as increased consumption of alcohol and other drugs (Brown & Schuman, 2020).
Research during earlier pandemics has shown that alcohol use can increase as a consequence of quarantines and similar restrictions (Esterwood, 2020). On the contrary, alcohol use may also decrease as a consequence of lower physical and financial availability (Rehm, 2020). Some sex differences have been reported where men can be at particular risk of increased alcohol consumption (Rehm et al., 2020). Studies conducted during the current pandemic have shown that young adults and people who drink outside of their home decreased their alcohol use during COVID-19 (Callinnan et al., 2020a; Callinnan et.al., 2020b). Further, the connection between loneliness and alcohol use can vary within and between age groups. In some cases, loneliness among adolescents has been associated with increased alcohol (Stickley et al., 2014).
However, a longitudinal study of alcohol use showed higher levels of social acceptance and social integration by adolescent alcohol users compared to non users (Pedersen & von Soest, 2015). There have also been studies showing no association between loneliness and at-risk or binge drinking (Canham et al., 2016). Similarly, alcohol use has also been found to reduce moderately among lonely middle aged and older adults (Canham et al., 2016). Despite these findings, Immonen et al. (2015) suggested that older adults who were considered to be ‘at risk’
used alcohol to cope with loneliness.
Loneliness during COVID-19 has been a global concern. As a result, researchers across the world have sought to evaluate the extent to which world citizens have experienced feelings of loneliness during the pandemic. A study conducted in Turkey showed that young people aged 12-18 experienced anxiety and loneliness as a result of school closings and quarantine (Kılınçel et al., 2020). Furthermore, a Canadian study has examined stressors related to COVID-19, finding that adolescents aged 14-18 experienced loneliness and depression (Ellis, Dumas &
Forbes, 2020). An american study found that being under an order to stay at home was associated with more health anxiety, financial anxiety and loneliness (Tull et al., 2020). German researchers found that there was a significant rise in psychological distress from 24% to 66% among their
German population between what they call the peak and off-peak transmission period of COVID-19 cases (Liu et al., 2021). Moreover, negative mental health outcomes were associated with unemployment and loneliness. Interestingly, scores of psychological distress rose the most in females, young and lonely people (Liu et al., 2021). Another study investigated the mental health of a Polish population during the pandemic showed that scores for depression, insomnia, everyday fatigue and loneliness were high during stay-at-home-orders. Sex differences were also observed, where females scored higher on scales for depression and loneliness compared to males (Bartoszek et al., 2020).
The UCLA Loneliness Scale is widely used globally and several studies have been conducted to assess loneliness during the pandemic. Studies from Poland, Turkey, Belgium and Italy have found mean loneliness scores ranging from 41.9-43.8 (Bartoszek et al., 2020; Kılınçel et al., 2020; Marchini et al., 2020). Other studies from the United States, South Africa and Egypt have reported higher numbers around 49-51 (Killgore, 2020; Horigian, Schmidt & Feaster, 2021;
Padmanabhanunni & Pretorius, 2021; El-Monshed et al., 2021). These numbers are higher than the normative results on the UCLA Loneliness Scale suggested by Russell, Peplau & Cutrona (1980), which were reported as 37.06 for females and 36.06 for males, indicating that people are experiencing high levels of loneliness during the pandemic.
It has been suggested that young people may experience loneliness to a greater extent compared to older people when in home confinement (Losada-Baltar et al., 2021). This emphasizes the importance of investigating loneliness among young people during the pandemic.
Marchini et al (2020) also suggested that young people may be at particular risk of experiencing detrimental effects on mental health as a result of the pandemic, which further highlights the importance of including young people in research. In a Swedish sample that was examined before the pandemic, 14% of men and 19% of women within ages 16-24 experienced loneliness based on a single item yes-no question asking whether they felt lonely or not. For the age group 25-34, this number was 14% for men and 17% for women (Thelander, 2020).
As a result of COVID-19, several Swedish universities switched to distance learning, which has resulted in many students spending more time alone. It is known from previous research that university students experience mental illness to a greater extent compared to the normal population (Ibrahim et al., 2012; Rotenstein et al., 2016), which highlights the importance of investigating the impact of COVID-19 on university students. Further, some researchers have noted the possibility that students may experience loneliness to a higher degree compared to the rest of the population because of the importance of connecting with friends in this stage of life (El-Monshed et al., 2021). This might make social isolation particularly difficult for this group and the drastic consequences on everyday life might make university students particularly vulnerable to experiencing high degrees of loneliness during COVID-19 (El-Monshed et al., 2021). A survey sent out by the Swedish Psychological Association's student council indicated that psychology students experience negative consequences concerning their mental health as a consequence of the pandemic. Results showed that 50% of respondents felt
more depressed since the start of the pandemic and 60% experienced loneliness to a higher degree (Jernberg, 2021).
The present study aims to examine the extent to which a sample of Swedish university students have experienced loneliness during COVID-19 compared to previous research and normative scores of loneliness. Considering the past research that emphasizes the possible consequences of social isolation on mental health, we hypothesize that Swedish university students will experience a higher degree of loneliness compared to normative scores on the UCLA Loneliness Scale. We also hypothesize that the Swedish university students in our sample will experience loneliness to a lower degree compared to a comparison study which has enforced lockdown during COVID-19. Further, this study wants to examine if there is a correlation between loneliness during COVID-19 and increased alcohol consumption. We hypothesize that a high level of loneliness will correlate with increased alcohol consumption.
Method Participants
A sample of 224 Swedish university students were recruited online during the pandemic using opportunity sampling. Data collection took place between the 24th of February and the 22nd of March 2021. Inclusion criteria included being over 18 years of age, being a full time student and having resided in Sweden during the pandemic. Participants were aged 19-55 years and mean age was 26 years (SD=5.29). The sample consisted of 70% females, 28% males, 1%
identified as ‘Other’ and 1% did not want to declare their sex. Students from at least 11 different universities in Sweden were represented in the sample: Umeå University (48%), Uppsala University (17%), Örebro University (14%), Karlstad University (7%), Linköping University (2%), Lund University (2%), Göteborg University (1%), Stockholm University (1%), Karolinska Institute (1%), Mid Sweden University (1%) and Swedish University of Agriculture (1%). An additional 5% had selected the category ‘Other’ to indicate their place of study. Areas of study covered Humanities/social sciences (60%), Medicine/science (15%), Technology/computer science (12%) and Others (13%). The percentage of the sample who reported living alone during the pandemic was 45%. No incentive was given for participation.
Instruments and Materials
UCLA Loneliness Scale. Subjective feelings of loneliness were measured using the UCLA Loneliness Scale (see Appendix A) - one of the most widely used scales for measuring subjective loneliness globally (Russell, 1996). The scale consists of 20 statements aimed at assessing subjective feelings of loneliness where each statement (for example, “I feel left out”) is rated on a scale of 1 (Never) to 4 (Often). A total score ranging from 20 to 80 is calculated, with higher scores indicating severe loneliness (Russell, 1996). Factor analysis of the UCLA Loneliness Scale suggests that the scale measures more than one construct of loneliness
(McWhirter, 1990). However, Russell (1996) notes that although factor analysis supports multidimensional measurements of loneliness, these multidimensional measurements reflect different relational deficits which together lead to the state we call loneliness, thereby supporting an unidimensional construct (Russell, 1996).
The English version of the scale has been recommended as a screening tool for subjective loneliness (Razai et al., 2020). The scale is highly reliable in terms of internal consistency with a Cronbach’s alpha between .89 and .94 between four samples. It also has a test-retest reliability over a one year period with a test-retest correlation of .73 (Russell, 1996). Convergent validity when compared to other measures of loneliness such as the NYU Loneliness Scale or the Differential Loneliness Scale has also been confirmed (Russell, 1996). Convergent validity was further supported by negative correlations between the UCLA Loneliness Scale and perceived social support and perceived quality of social relations (Russell, 1996). Moreover, translated versions of the UCLA Loneliness Scale into Turkish, Danish, Japanese and Farsi have displayed similar levels of validity when compared to other measures of loneliness such as the Social Provisions Scale, Social Network Index and the Peer Network and Dyadic Loneliness Scale; as well as similar levels of reliability, with a Cronbach’s alpha between .85 and .93 (Durak &
Senol-Durak, 2010; Lasgaard, 2007; Arimoto & Tadaka, 2019; Zarei, et al., 2016). Hence, using the UCLA Loneliness Scale as a valid and reliable instrument for measuring subjective loneliness is supported, even in translated forms. In the present study, the scale was translated to Swedish (see Appendix B) using back-to-back translation as recommended by the World Health Organization (WHO) to achieve a different language version of an English instrument (WHO, 2021). The Swedish translated version was found to be reliable (20 items; 𝛼=.89).
Single Item Questions. The questionnaire also included questions about whether or not participants had been living alone during COVID-19, whether or not they had experienced an increase in alcohol consumption during the pandemic and whether or not they had felt lonely during COVID-19. These questions could be answered with “Yes” or “No”. The single item question regarding whether the responder had felt lonely or not was included in order to more easily compare the results of the present study to those from Thelander (2020) as that study also examined loneliness using a single item question.
Comparison with other studies. The results on the UCLA Loneliness Scale were compared to scores from Russell (1996) and to normative scores for males and females (Russell et.al., 1980). Russell’s (1996) sample consisted of 489 American college students (203 males, 286 females) who took part in the study for partial course credit. Ages were not reported. The 1980 study (Russell et al., 1980) consisted of 237 American psychology students (107 males, 130 females) who participated for partial course credit. Results on the UCLA Loneliness Scale were also compared with a study examining loneliness among university students during COVID-19 in South Africa (Padmanabhanunni & Pretorius, 2021). Their sample consisted of 340 university students (77% females) and mean age was 22 years. This study was chosen as a comparison study because it matches the present study with regards to its sample of university students, most of which were female, the online study design and instrument used (UCLA
Loneliness Scale). It is also fitting in the context of COVID-19, with the purpose of comparing loneliness scores in the present study to those from a country which imposed a lockdown. South Africa enforced a national lockdown, restricted traveling, and closed all non essential services as well as banned social gatherings (South African Government, 2021).
Design and Procedure
Participants were invited to take part in a self-administered online questionnaire (Microsoft Office 365 Forms) via social media (Facebook) and e-mail invitations through university program administrators. The form was available via a link and could be administered using a laptop or smartphone with an internet connection. The questionnaire required participants to give demographic information as well as assessing their subjective feelings of loneliness using the Swedish translated version of the UCLA Loneliness Scale (Russell, 1996). The average time to complete the questionnaire was under 5 minutes.
Ethical Considerations
Participants were briefed about the study and gave informed consent before starting the procedure. The briefing included information about where to seek help if participation was to raise any thoughts or concerns regarding feelings of loneliness or alcohol use. Participants were required to tick a box indicating their consent to continued participation before answering the questionnaire. At the end of the form, participants were reminded of the help lines if their participation had raised any thoughts or concerns.
Statistical Analysis
Statistical analyses were performed in SPSS Statistics 24.0. The answers to the binary
“Yes/No” questions eg. “Do you feel that your alcohol consumption has increased during COVID-19?” were coded as No=0 and Yes=1. Sex was coded as Female=0 and Male=1. Due to the low number of participants (N=5) who identified as ‘Other’ or declined to answer, these participants were excluded from analysis, thereby reducing the N from 224 to 219. T-tests were performed to compare the mean score of the students in our sample to normative results and to the results of a study conducted during COVID-19 in South Africa (Padmanabhanunni &
Pretorius, 2021). Effect size was calculated using Cohen’s d and Cohen’s (1988) suggestions were used to determine the descriptors (small, medium, large) of the effect size. One multiple logistic regression was performed to explore the association between scores measured on the UCLA Loneliness Scale and increased alcohol use. The multiple logistic regression included increased alcohol use as the dependent variable with total score on the UCLA Loneliness Scale, living alone and sex were entered as covariates.
Results
Descriptive statistics can be found in Table 1. Of the female participants 47.10% reported that they felt lonely when responding to the single item question. Of the male participants 50.00% reported that they felt lonely. An independent sample t-test showed that sex had no significant effect on the total UCLA Loneliness Scale score, t(217)=-.887, p=0.752. A Spearman's correlation showed a significant association between sex and living alone (rs=.250, p=.001, N=219), indicating that more males in the present study sample lived alone. A significant correlation was also seen between feeling alone and total score on the UCLA loneliness scale (rs=.536, p<.001, N=219), which was expected considering both can be seen as measures of loneliness. The students in our sample had an average score of 42.44 (SD=9.89) on UCLA Loneliness Scale. This can be seen in comparison with scores from Russell (1996) in which the average UCLA Loneliness Scale score among American college students was 40.08 (SD=9.50). A 2-sample t-test showed that this difference in means was significant; t(704)=3.01, p=0.003, 95% CI [0.80, 3.92]. A small (Cohen, 1988) effect size was found, (d=0.24). This suggests that Swedish university students experienced a higher degree of loneliness during COVID-19 compared to the sample of American college students, but the small effect size indicated that the real life differences may not be substantial.
Table 1 Descriptive statistics
M SD SE Skewness Kurtosis
UCLA Loneliness Scale total score
42.44 9.89 0.67 .402 -.600
Males Females
43.39 42.07
9.58 9.02
1.21 0.8
.339 .440
-.789 -.512
Yes No
Do you feel that your alcohol
consumption has increased? 11.4% 88.6%
Do you live alone? 55.3% 44.7%
Note: M= mean, SD= standard deviation, SE= standard error.
The females in our sample had an average score of 42.07 (SD=9.02) on UCLA Loneliness Scale. This can be compared with normative results from Russell, Peplau & Cutrona (1980) in which the UCLA Loneliness Scale score for females was 36.06 (SD=10.11). A 2-sample t-test indicated that this difference was significant, t(283)=-5.016, p=0.001 95% CI [-8.370, -3.649], with a medium (Cohen, 1988) effect size (d=0.597). For males in our sample,
the average UCLA Loneliness Scale score was 43.387 (SD=9.58). This was significantly different compared with normative scores (Russell, Peplau & Cutrona, 1980) (M=37.06, SD=10.91), t(162)=-3.767, p=0.002, CI [-9.539, -3.114], also with a medium (Cohen, 1988) effect size (d=0.616). When comparing the South African sample of university students (Padmanabhanunni & Pretorius, 2021) who had a mean score of 49.1 (SD=1.6) with our sample (M=42.44, SD=9.89) using a 2 sample t-test, a significant difference was found, t(225)=-9.88, p=.0001, 95% CI [-7.98, -5.34], with a large (Cohen, 1988) effect size (d=.940). This means that the Swedish university students of our sample experienced significantly lower levels of loneliness compared to the South African students.
A logistic regression (Table 2) was performed to investigate the link between loneliness, represented by UCLA Loneliness Scale total score and increased alcohol use. Sex and living alone were entered as covariates in step 1, neither of which were significant. UCLA Loneliness Scale total score was entered in step 2 and showed no significant association with increased odds of increased alcohol consumption (OR 1.01, 95% CI .965-1.05). Nagelkerke’s R2of .015 showed a weak connection between the covariates and increased alcohol consumption. A second logistic regression with only the UCLA Loneliness Scale total score as an independent variable was performed, also showing no significant association between the UCLA-Loneliness Scale total score and increased alcohol consumption (OR 1.01, 95% CI .968-1.05). On the basis of the logistic regression it can be concluded that higher levels of experienced loneliness showed no association with increased alcohol consumption in the sample.
Table 2 Logistic regressions
R2* B Wald OR(95%CI) p
Step 1 .014
Sexa -.167 .116 .846 (.460-2.08) .733
Living aloneb .548 1.54 1.73 (.660-3.54) .214
Step 2 .015
UCLA Loneliness Scale total score
.007 .094 1.01 (.965-1.05) .760 Note: * Nagelkerke’s R2
a0=Female, 1=Male.b”Have you lived alone during COVID-19?” 0=No, 1=Yes.
Discussion
The purpose of this study was to examine the extent to which a sample of Swedish university students experienced loneliness during COVID-19. It was hypothesized that our sample would experience a higher degree of loneliness compared to normative scores on UCLA Loneliness Scale. It was also hypothesized that the Swedish university students in our sample would experience loneliness to a lower degree compared to a study conducted in a different country that enforced lockdown during COVID-19. Results indicated that Swedish students experienced loneliness during COVID-19 to a higher degree compared to normative scores (Russell, Peplau & Cutrona, 1980). This was true for both males and females. The medium effect sizes suggested that this difference could also be meaningful in a real life context. Thus, the first hypothesis was supported. However, it is worth noting that in addition to being conducted in a different country (USA), the study from which the normative scores were derived was conducted 40 years ago. Since then, several societal changes have occurred including the digital revolution which may influence feelings of loneliness. Furthermore, we have no knowledge of how levels of loneliness have changed in the large scale population, nor if there are any differences in loneliness between the USA and Sweden. This limits the conclusions that can be drawn from this comparison.
In response to the single item question ”Do you feel lonely?” 47.1% of females and 50.0% of males responded ”yes”. According to reports from a Swedish sample examined before the pandemic where the same question was asked, these numbers were 14% for men and 19% for women within ages 16-24 (Thelander, 2020). Among ages 25-34 this number was 14% for men and 17% for women (Thelander, 2020). Thus, the numbers reported by participants in the present study are strikingly higher.
Moreover, our results indicated that the Swedish university students of our sample experienced significantly lower levels of loneliness compared to the South African university students from Padmanabhanunni and Pretorius (2021). The large effect size indicated that this is likely to mean a considerable difference in a real life context. This is in line with our hypothesis and is supported by research indicating that those who have been in quarantine can suffer more than those who have not been restricted to that degree (Erzon, 2018). The comparison study was chosen based on a match of similarities in sample and method to the present study. The sample consisted of university students with a similar distribution of sex (77% female) and the data was collected online (Padmanabhanunni & Pretorius, 2021). However, the comparison study took place in a different part of the world, which implies that various factors are likely to influence the results, such as collectivistic versus individualistic values. One also has to take into consideration possible cultural differences in experiences of loneliness. Further, socioeconomic differences may influence results. The South African study stated that the majority of their students originated from working class backgrounds (Padmanabhanunni & Pretorius, 2021), whereas the present study is unaware of the socioeconomic background of the participants. Moreover, authors of the South African study noted that the loneliness scores found in their sample was higher than
those reported in other literature in the time of COVID-19 (Padmanabhanunni & Pretorius, 2021).
Interestingly though, average loneliness scores among Swedish students was similar to numbers found in many other countries during the pandemic (Bartoszek et al., 2020; Kılınçel et al., 2020; Marchini et al., 2020 & Killgore, 2020) although some higher scores have also been reported (Horigian, Schmidt & Feaster, 2021; Padmanabhanunni & Pretorius, 2021; El-Monshed, et al., 2021). With loneliness being a common consequence of social isolation (Killgore et al., 2020) one would expect social distancing to result in high degrees of loneliness. However, some paradoxical findings have emerged related to loneliness during lockdown. A Spanish study found that being in lockdown reduced feelings of loneliness; ratings of loneliness remained stable for a two year period before lockdown but decreased significantly during the early stages of lockdown (Bartrés-Faz et.al., 2021). The authors proposed that this result could be attributed to an appreciation for the efforts and working morale of medical staff, along with government campaigns designed to promote feelings of solidarity, inclusion and belonging (Bartrés-Faz et al., 2021).
Further, there is a possibility that students in our sample experienced loneliness to a higher degree compared to the rest of the population because of the importance of connectedness to their friends at this stage of their life, as suggested in previous research (El-Monshed et al., 2021). Therefore, social isolation may be particularly painful for this group. Further, students tend to be a young population and the mean age of our sample was 26 years. It has been suggested that young people may experience loneliness to a higher degree compared to older people (Losada-Baltar et al., 2021) and that they may be at particular risk of experiencing negative health consequences during COVID-19 (Marchini et al., 2020). Despite the possible reasons for high scores of loneliness, it is alarming considering the known connection between loneliness and other health consequences such as depression, anxiety, sleeping problems, concentration difficulties, disordered eating, suicide risk and mortality (Tull et al., 2020;
Holt-Lundstadt et al., 2015; Erzen, 2018; Brown & Schuman, 2020; Kochuvilayil, 2020; Cao et al., 2020; Razai, 2020; Kato, 2020).
In order to combat these possible health consequences, prevention and action programs are necessary. Public health campaigns focused on spreading knowledge about COVID-19 have shown to be effective in promoting self efficacy and resilience in relation to loneliness (Padmanabhanunni & Pretorius, 2021). Further, health campaigns can gain from promoting protective factors of loneliness, such as encouraging social support (Groarke et al., 2020), spending safe time with family (online or with social distancing), maintaining contact with friends and engaging in physical activity (Ellis et al., 2020). Doing new things at home and experiencing nature on a daily basis have also been negatively associated with loneliness (Hoffart et al., 2020). Educational institutions can also consider the value of social contacts in students’ mental health. One suggestion is to identify and support students who may be at risk of social isolation and take action to prevent a decline in their mental health (Elmer, Mepham &
Stadtfeld, 2020).
The second hypothesis stated that a high level of loneliness would correlate with increased alcohol consumption. This hypothesis was not supported by the results of a hierarchical logistic regression, as the total score on UCLA Loneliness Scale did not increase the odds of the respondents declaring increased alcohol consumption during COVID-19. Research on this topic points in different directions. Some findings suggest that loneliness among adolescents can be associated with increased alcohol use (Stickley et al., 2014), while other studies have found a decrease in alcohol use among young people who typically drank outside of their home (Callinnan et al., 2020a; Callinnan et.al., 2020b). The fact that most students in our sample did not report an increase in alcohol consumption could be affected by a limited availability of alcohol, or attributed to few occasions during which alcohol is consumed. Student drinking culture tends to revolve around social gatherings, which have been minimized during the pandemic. This is consistent with findings that the physical availability of alcohol can be a reason for decreased alcohol use during a pandemic (Rehm, 2020).
The present study possesses several strengths. The UCLA Loneliness Scale is one of the most widely used scales to measure loneliness globally. It is highly reliable in terms of internal consistency and has a test-retest reliability over a one year period (Russel, 1996). Convergent validity and construct validity have also been confirmed (Russel, 1996) and translated versions of the scale have also shown to be reliable and valid (Durak & Senol-Durak, 2010; Lasgaard, 2007; Arimoto & Ataka, 2019; Zarei et al., 2016). UCLA Loneliness Scale was translated to Swedish using back-to-back translation, which is the recommended way to achieve a different language version of an instrument by the World Health Organization (WHO, 2021). Further, a Chronbach’s alpha of .89 showed that the Swedish translation had a reliability similar to the original scale (Russell et.al., 1980). However, a full psychometric evaluation of the Swedish scale has not been conducted. Despite the fact that it cannot be inferred that COVID-19 has caused these high levels of loneliness, this potential relationship is in line with other research findings during the pandemic (Tull et al., 2020; Holt-Lundstadt et al., 2015; Erzen, 2018; Brown
& Schuman, 2020).
Despite the strengths of the present study, it has some limitations. Data collection took place online because of restrictions due to COVID-19, which limits control over who submitted the answers. Not all Swedish students had the same chance at taking part in the study. One should also consider the possibility that those who chose to participate may not be representative of the student population at large. Opportunity sampling was used and those who chose to participate may share characteristics such as being particularly lonely or not feeling very lonely at all. Participants were represented by more than 11 Swedish universities, though in some cases only by one or two participants and the majority of participants were represented by Umeå University (48%). Although there was an uneven sex split in the sample, no significant sex differences in loneliness were observed. However, one should keep in mind that the comparatively small number of male participants might affect the generalizability of the results of the male respondents. Further, factors apart from COVID-19 are likely to influence feelings of loneliness. For example, having a part time job can provide social interactions, which might
alleviate feelings of loneliness. Such factors were not controlled for. Moreover, a pre-post measurement design would have been preferable for the research question. This was not possible because of time restraints and the fact that COVID-19 had its outbreak one year earlier than this study was conducted. Due to the absence of a pre-measurement, the results were compared to results from another study. This affects the quality of the analysis due to the fact that two different samples from different populations, separated by both decades and culture, were compared. Finally, the measure of alcohol consumption relies on the individual’s subjective evaluation of their drinking habits, which may not be a reliable measurement. There is research to suggest that high risk drinkers tend to underestimate their own consumption compared to others (Andersson, Wiréhn, Ölvander, Ekman & Bendtsen, 2009). There is also a possibility that stigmatization of alcohol consumption and a stigmatization of loneliness has affected the willingness among participants to report these measures truthfully. A way to combat this would be to use a standardized scale to measure alcohol consumption, such as the Alcohol Use Disorders Identification Test (WHO, 2021), ideally with measures before and during the pandemic. The above limitations are all factors which limit the generalizability and validity of the findings. With that being said, this study adds to the growing body of literature of the psychological effects of COVID-19. Further, it gives an indication of the level of loneliness experienced among Swedish students, which is an important factor in mental health.
Considering the possible negative health consequences of loneliness, we encourage a continued focus in this area in future research during COVID-19. A pre-post measurement design is fitting and longitudinal studies are needed to evaluate long term consequences of loneliness. Moreover, an increased focus on ways to reduce loneliness can be beneficial to guide governments in creating public health campaigns. Finally, we suggest that loneliness should continue to be a priority in research in order to fully understand the psychological impact of COVID-19 on world citizens.
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Appendix A
UCLA Loneliness Scale Revised, English version
INSTRUCTIONS: Indicate how often each of the statements below is descriptive of you.
Statement Never Rarely Sometimes Often
1. I feel in tune with the people around me 1 2 3 4
2. I lack companionship 1 2 3 4
3. There is no one I can turn to 1 2 3 4
4. I do not feel alone 1 2 3 4
5. I feel part of a group of friends 1 2 3 4
6. I have a lot in common with the people around me 1 2 3 4
7. I am no longer close to anyone 1 2 3 4
8. My interests and ideas are not shared by those around me 1 2 3 4
9. I am an outgoing person 1 2 3 4
10. There are people I feel close to 1 2 3 4
11. I feel left out 1 2 3 4
12. My social relationships are superficial 1 2 3 4
13. No one really knows me well 1 2 3 4
14. I feel isolated from others 1 2 3 4
15. I can find companionship when I want it 1 2 3 4
16. There are people who really understand me 1 2 3 4
17. I am unhappy being so withdrawn 1 2 3 4
18. People are around me but not with me 1 2 3 4
19. There are people I can talk to 1 2 3 4
20. There are people I can turn to 1 2 3 4
Scoring:
Items 1, 5, 6, 9, 10, 15, 16, 19, 20 are all reverse scored.
Keep scoring continuous.
Appendix B
UCLA Loneliness Scale Revised, Swedish translated version
INSTRUKTIONER: Ange hur ofta vart och ett av påståendena nedan är beskrivande för dig.
Påstående Aldrig Sällan Ibland Ofta
1. Jag känner mig i samklang med människor omkring mig 1 2 3 4
2. Jag saknar sällskap 1 2 3 4
3. Det finns ingen jag kan vända mig till 1 2 3 4
4. Jag känner mig inte ensam 1 2 3 4
5. Jag känner mig som en del av en vänskapskrets 1 2 3 4
6. Jag har mycket gemensamt med människor omkring mig 1 2 3 4
7. Jag står inte längre någon nära 1 2 3 4
8. Mina intressen delas inte av människor omkring mig 1 2 3 4
9. Jag är en utåtriktad person 1 2 3 4
10. Det finns människor som står mig nära 1 2 3 4
11. Jag känner mig utanför 1 2 3 4
12. Mina relationer är ytliga 1 2 3 4
13. Ingen känner mig särskilt väl 1 2 3 4
14. Jag känner mig isolerad från andra 1 2 3 4
15. Jag kan få sällskap när jag vill ha det 1 2 3 4
16. Det finns människor som verkligen förstår mig 1 2 3 4
17. Jag tycker inte om att vara så tillbakadragen 1 2 3 4
18. Det finns andra människor omkring mig men inte med mig 1 2 3 4
19. Det finns människor jag kan prata med 1 2 3 4
20. Det finns människor jag kan vända mig till 1 2 3 4
Scoring:
Items 1, 5, 6, 9, 10, 15, 16, 19, 20 are all reverse scored.
Keep scoring continuous.
