Loneliness as a Mediator in the Association Between Social Isolation and Psychological Distress: A Cross-Sectional Study With Older Korean Immigrants in the United States

Abstract

The present study explored the role of loneliness in the association between social isolation and psychological distress, using a cross-sectional sample of older Korean immigrants in the U.S. Considering structural (unmarried and living alone) and relational (isolation from family and friends) social isolation, we hypothesized that (1) both types of social isolation would be associated with loneliness and psychological distress and (2) their effect on psychological distress would be mediated through loneliness. Data came from the Study of Older Korean Americans (SOKA), a multisite survey of Korean immigrants aged 60 and older (n = 2,150). The multivariate analyses demonstrated that older individuals with structural and relational isolation reported higher levels of loneliness and psychological distress. Loneliness was found to mediate the effect of both types of social isolation on psychological distress. The intervening role of loneliness suggests strategies to alleviate the mental health consequences of social isolation in older immigrants.

Keywords

social isolation loneliness psychological distress older Korean immigrants Lubben Social Network Scale-6(LSNS-6)

Get full access to this article

View all access options for this article.

References

Administration for Community Living (2021). 2020 Profile of older Americans. https://acl.gov/sites/default/files/AgingandDisabilityinAmerica/2020ProfileOlderAmericans.Final_.pdf

Budiman

Cilluffo

Ruiz

N. G.

(2019). Key facts about Asian origin groups in the US. The immigrant learning center. https://www.immigrationresearch.org/system/files/AsianAmericansandtheirorigins_Keyfacts_PewResearchCenter.pdf

Cacioppo

J. T.

Hawkley

L. C.

(2009). Loneliness. In Leary

M. R.

Hoyle

R. H.

(Eds.), Handbook of individual differences in social behavior (pp. 227–240). The Guilford Press.

Chatters

L. M.

Taylor

H. O.

Nicklett

E. J.

Taylor

R. J.

(2018). Correlates of objective social isolation from family and friends among older adults. Healthcare, 6(1), 1–14. https://doi.org/10.3390/healthcare6010024

Choi

Kim

Lee

(2016). Effects of nativity, length of residence, and county-level foreign-born density on mental health among older adults in the US. Psychiatric Quarterly, 87(4), 675–688. https://doi.org/10.1007/s11126-016-9418-2

Cohen

West

S. G.

Aiken

L. S.

(2014). Applied multiple regression/correlation analysis for the behavioral sciences. Psychology press.

Cornwell

E. Y.

Waite

L. J.

(2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48. https://doi.org/10.1177/002214650905000103

Corona

Campos

Chen

(2017). Familism is associated with psychological well-being and physical health: Main effects and stress-buffering effects. Hispanic Journal of Behavioral Sciences, 39(1), 46–65. https://doi.org/10.1177/0739986316671297

Coyle

C. E.

Dugan

(2012). Social isolation, loneliness and health among older adults. Journal of Aging and Health, 24(8), 1346–1363. https://doi:10.1177/0898264312460275

10.

Cudjoe

T. K. M.

Roth

D. L.

Szanton

S. L.

Wolff

J. L.

Boyd

C. M.

Thorpe

R. J.

(2020). The epidemiology of social isolation: National health and aging trends study. The Journals of Gerontology, Series B: Psychological Science and Social Sciences, 75(1), 107–113. https://doi.org/10.1093/geronb/gby037

11.

Czaja

S. J.

Moxley

J. H.

Rogers

W. A.

(2021). Social support, isolation, loneliness, and health among older adults in the PRISM randomized controlled trial. Frontiers in Psychology, 12: 728658. https://doi.org/10.3389/fpsyg.2021.728658

12.

Donovan

N. J.

Blazer

(2020). Social isolation and loneliness in older adults: Review and commentary of a national academies report. American Journal of Geriatric Psychiatry, 28(12), 1233–1244. https://doi.org/10.1016/j.jagp.2020.08.005

13.

Gierveld

J. D. J.

Van Tilburg

T. G.

Dykstra

P. A.

(2018). New ways of theorizing and conducting research in the field of loneliness and social isolation. In Vangelisti

A. L.

Perlman

(Eds.), The Cambridge handbook of personal relationships (pp. 391–404). Cambridge University Press. https://doi.org/10.1017/9781316417867.031

14.

Gorenko

J. A.

Moran

Flynn

Dobson

Konnert

(2021). Social isolation and psychological distress among older adults related to COVID-19: A narrative review of remotely-delivered interventions and recommendations. Journal of Applied Gerontology, 40(1), 3–13. https://doi.org/10.1177/0733464820958550

15.

Hawkley

L. C.

Hughes

M. E.

Waite

L. J.

Masi

C. M.

Thisted

R. A.

Cacioppo

J. T.

(2008). From social structural factors to perceptions of relationship quality and loneliness: The Chicago health, aging, and social relations study. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 63(6), S375–S384. https://doi.org/10.1093/geronb/63.6.S375

16.

Hayes

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.

17.

Holt-Lunstad

Smith

T. B.

Baker

Harris

Stephenson

(2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237. https://doi.org/10.1177/1745691614568352

18.

Hong

Casado

B. L.

Harrington

(2011). Validation of Korean versions of the lubben social network scales in Korean Americans. Clinical Gerontologist, 34(4), 319–334. https://doi.org/10.1080/07317115.2011.572534

19.

Hughes

M. E.

Waite

L. J.

Hawkley

L. C.

Cacioppo

J. T.

(2004). A short scale for measuring loneliness in large surveys: Results from two population-based studies. Research on Aging, 26(6), 655–672. https://doi.org/10.1177/0164027504268574

20.

Jang

Chiriboga

D. A.

(2010). Living in a different world: Acculturative stress among Korean American elders. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 65B(1), 14–21. https://doi.org/10.1093/geronb/gbp019

21.

Jang

Kim

Chiriboga

D. A.

Cho

(2008). Willingness to use a nursing home: A study of Korean American elders. Journal of Applied Gerontology, 27(1), 110–117. https://doi.org/10.1177/0733464807307313

22.

Jang

Powers

D. A.

Park

N. S.

Chiriboga

D. A.

Chi

Lubben

(2022). Performance of an abbreviated Lubben social network scale (LSNS-6) in three ethnic groups of older Asian Americans. The Gerontologist, 62(2), e73–e81. https://doi.org/10.1093/geront/gnaa156

23.

Jang

Yoon

Rhee

M. K.

Park

N. S.

Chiriboga

D. A.

Kim

M. T.

(2019). Factors associated with dental service use of older Korean Americans. Community dentistry and oral epidemiology, 47(4), 340-345. https://doi.org/10.1111/cdoe.12464.

24.

Kawachi

Berkman

L. F.

(2001). Social ties and mental health. Journal of Urban Health, 78(3), 458–467. https://doi.org/10.1093/jurban/78.3.458

25.

Kessler

R. C.

Andrews

Colpe

L. J.

Hiripi

Mroczek

D. K.

Normand

S. L.

Walters

E. E.

, & Zaslavsky

A. M.

(2002). Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychological Medicine, 32(6), 959–976. https://doi:10.1017/S0033291702006074

26.

Kim

O. S.

(1997). Korean version of the revised UCLA loneliness scale: Reliability and validity test. Journal of Korean Academy of Nursing, 27(4), 871–879. https://doi:10.4040/jnas.1997.27.4.871

27.

Kim

Chiriboga

D. A.

Jang

Lee

Huang

C. H.

Parmelee

(2010). Health status of older Asian Americans in California. Journal of the American Geriatrics Society, 58(10), 2003–2008. https://doi.org/10.1111/j.1532-5415.2010.03034.x

28.

Kim

J. H.

Silverstein

(2021). Are filial piety and ethnic community engagement associated with psychological wellbeing among older Chinese American immigrants? A cultural resource perspective. Research on Aging, 43(2), 63–73. https://doi.org/10.1177/0164027520937477

29.

Lazarus

R. S.

Folkman

(1984). Stress, appraisal, and coping. Springer Publishing Company, Inc.

30.

Lubben

Blozik

Gillmann

Iliffe

von Renteln Kruse

Beck

J. C.

Stuck

A. E.

(2006). Performance of an abbreviated version of the Lubben social network scale among three European community-dwelling older adult populations. The Gerontologist, 46(4), 503–513. https://doi.org/10.1093/geront/46.4.503

31.

Lubben

Gironda

(2003). Centrality of social ties to the health and well-being of older adults. In Berkman

Harootyan

(Eds.), Social work and health care in an aging world: Education, policy, practice and research (pp. 319–350). Springer Publishing Company, Inc.

32.

Min

J. W.

Lee

S. H.

(2015). Validation of the K6/K10 scales of psychological distress and their optimal cutoff scores for older Koreans. The International Journal of Aging and Human Development, 80(3), 264–282. https://doi.org/10.1177/0091415015590316

33.

Min

J. W.

Moon

Lubben

J. E.

(2005). Determinants of psychological distress over time among older Korean immigrants and non-Hispanic white elders: Evidence from a two-wave panel study. Aging and Mental Health, 9(3), 210–222. https://doi.org/10.1080/13607860500090011

34.

National Academies of Sciences, Engineering, and Medicine (2020). Social isolation and loneliness in older adults: Opportunities for the health care system. The National Academies Press. https://doi.org/10.17226/25663

35.

O’Rourke

H. M.

Collins

Sidani

(2018). Interventions to address social connectedness and loneliness for older adults: A scoping review. BMC Geriatrics, 18(1), 1–13. https://doi.org/10.1186/s12877-018-0897-x

36.

Park

N. S.

Jang

Lee

B. S.

Chiriboga

D. A.

(2017). The relation between living alone and depressive symptoms in older Korean Americans: Do feelings of loneliness mediate? Aging and Mental Health, 21(3), 304–312. https://doi.org/10.1080/13607863.2015.1099035

37.

Park

N. S.

Jang

Lee

B. S.

J. E.

Haley

W. E.

Chiriboga

D. A.

(2015). An empirical typology of social networks and its association with physical and mental health: A study with older Korean immigrants. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 70(1), 67–76. https://doi.org/10.1093/geronb/gbt065

38.

Park

N. S.

Lee

B. S.

Chiriboga

D. A.

Chung

(2019). Loneliness as a mediator in the relationship between social engagement and depressive symptoms: Age differences among community‐dwelling Korean adults. Health and Social Care in the Community, 27(3), 706–716. https://doi.org/10.1111/hsc.12687

39.

Perissinotto

C. M.

Stijacic Cenzer

Covinsky

K. E.

(2012). Loneliness in older persons: A predictor of functional decline and death. Archives of Internal Medicine, 172(14), 1078–1083. https://doi:10.1001/archinternmed.2012.1993

40.

Pew Research Center (2021). Koreans in the U.S. Fact sheet. https://www.pewresearch.org/social-trends/fact-sheet/asian-americans-koreans-in-the-u-s/

41.

Roh

Lee

K. H.

Yoon

D. P.

(2013). General well-being of Korean immigrant elders: The significance of religiousness/spirituality and social support. Journal of Social Service Research, 39(4), 483–497. https://doi.org/10.1080/01488376.2012.709451

42.

Rote

Markides

(2014). Aging, social relationships, and health among older immigrants. Generations: Journal of the American Society of Aging, 38(1), 51-57. https://www.jstor.org/stable/26556029.

43.

Russell

Peplau

Ferguson

(1978). Developing a measure of loneliness. Journal of Personality Assessment, 42(3), 290–294. https://doi.org/10.1207/s15327752jpa4203_11

44.

Santini

Z. I.

Fiori

K. L.

Feeney

Tyrovolas

Haro

J. M.

Koyanagi

(2016). Social relationships, loneliness, and mental health among older men and women in Ireland: A prospective community-based study. Journal of Affective Disorders, 204, 59–69. https://doi.org/10.1016/j.jad.2016.06.032

45.

Santini

Z. I.

Jose

P. E.

Cornwell

E. Y.

Koyanagi

Nielsen

Hinrichsen

Koushede

(2020). Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): A longitudinal mediation analysis. The Lancet Public Health, 5(1), e62–e70. https://doi.org/10.1016/S2468-2667(19)30230-0

46.

Sung

H. Y.

(2010). The influence of culture on parenting practices of East Asian families and emotional intelligence of older adolescents: A qualitative study. School Psychology International, 31(2), 199–214. https://doi.org/10.1177/0143034309352268

47.

Taylor

H. O.

(2020). Social isolation’s influence on loneliness among older adults. Clinical Social Work Journal, 48(1), 140–151. https://doi.org/10.1007/s10615-019-00737-9

48.

Taylor

R. J.

Chatters

L. M.

Taylor

H. O.

(2019). Race and objective social isolation: Older African Americans, black Caribbeans, and non-Hispanic whites. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 74(8), 1429–1440. https://doi.org/10.1093/geronb/gby114

49.

Tomitaka

Kawasaki

Ide

Akutagawa

Ono

Furukawa

T. A.

(2019). Distribution of psychological distress is stable in recent decades and follows an exponential pattern in the US population. Scientific Reports, 9(1), 1–10. https://doi.org/10.1038/s41598-019-47322-1

50.

Van Baarsen

Snijders

T. A.

Smit

J. H.

Van Duijn

M. A.

(2001). Lonely but not alone: Emotional isolation and social isolation as two distinct dimensions of loneliness in older people. Educational and Psychological Measurement, 61(1), 119–135. https://doi.org/10.1177/00131640121971103