Studies of the psychological well-being of elderly living alone have yielded inconsistent results. Few investigators have distinguished living alone from loneliness in the same study. Thus, the present study examined the independent and interactive effects of living alone and loneliness on depressive symptoms (GDS score) and quality of life (SF-12 MCS score) in a prospective 2-year follow-up cohort study of 2808 community-dwelling older adults (aged ≥55 years) in Singapore, controlling for baseline covariates. In cross-sectional analysis, loneliness was a more robust predictor of GDS score than living arrangements; living alone, when controlled for loneliness, was not associated with GDS score. GDS score associated with living alone was worse for those who felt lonely than for those who did not feel lonely. Similar patterns of association were found in longitudinal analyses and for SF-12 MCS score, although not all were significant. Thus, though living alone predicted lower psychological well-being, its predictive ability was reduced when loneliness was taken into account and loneliness, a stronger predictor, worsened the psychological effects of living alone.
Population aging generates an array of social and health concerns, among which are the special concerns of the psychological well-being of elderly who live alone. Much research on the association between living arrangements and subjective well-being of the elderly has yielded inconsistent findings. Studies of various older populations in the United States, Hong Kong, Japan, and The Netherlands have reported that elderly living alone were more likely to be depressed [
However, some authors reported that living alone was not associated with higher levels of depressive symptoms and lower quality of life [
Loneliness can be viewed as a subjective measure of one’s state of mind and the negative feelings about one’s level of social contact [
In much of the earlier literature, the concepts of living alone and loneliness were often used interchangeably [
It has been suggested that the relationship between living alone and psychological well-being may be more salient in Chinese populations [
Under the influence of the traditional values such as filial piety which still dominates the family support system of modern collectivist societies including Singapore, adult children are expected to support their parents financially, physically, and emotionally. This traditional cultural practice and attitude enable most elderly to have high level of social engagement and thereby reduce feeling of loneliness. Yang and Victor [
The present study seeks to examine the unique effects of living arrangements (living alone versus living with others) and loneliness and their interactions on depression and quality of life in a 2-year followup study of community-dwelling elderly in Singapore. We postulated that while living alone might possibly be negatively associated with these measures of psychological well-being, the associated feeling of loneliness might possibly be a stronger contributing factor. Furthermore, the effect of living alone on the psychological well-being might possibly be amplified by the experience of loneliness. These relationships are examined by controlling for the effects of other variables known to influence well-being in the elderly: age, gender, race, marital status, educational level, social contact frequency, number of medical problems, number of social/productive/fitness/health activities, functional disabilities (activities of daily living, ADL), and cognitive status.
The present study used data drawn from 2808 participants in the Singapore Longitudinal Aging Study (SLAS), a prospective cohort study of aging and health among community-dwelling elderly Singaporeans. All older adults who were citizens or permanent residents aged 55 years or above were identified by door-to-door census and invited to participate voluntarily in the study. The study was approved by National University of Singapore Institutional Review Board. The estimated response rate was 78.5%.
Compared to those who dropped out, those who were followed up in the present study included more women, (65.3% versus 58.9%,
Participants underwent an extensive series of health interviews and assessments. Structured interviews, physical performance, and clinical assessments were conducted by trained nurses and clinical psychologists. Interviews were conducted by a multiethnic and multilanguage team in the language or dialect with which the subjects were most conversant with.
Participants were asked whether they were currently (1) living alone or with (0) others (spouse, adult children, other relatives, or friends).
Participants were asked “Do you feel that at the present moment you are: not at all lonely (= 1), fairly lonely (= 2), very lonely (= 3)?” As there were small numbers of participants who were “very lonely” (and only three participants who were “very lonely” and lived alone), the loneliness variable was dichotomized into “not lonely” and “lonely” (fairly lonely and very lonely).
The 15-item Geriatric Depression Scale [
The generic health-related quality of life (QOL) was measured with the 12-item Short-Form Health Survey [
Potential confounders collected at baseline included (1) sociodemographic variables; (2) number of chronic medical problems: participants were asked whether they had been diagnosed and treated by a doctor for a list of medical problem(s) including high blood pressure, high cholesterol, diabetes, stroke, heart attack, atrial fibrillation, heart failure, cataract/major eye problem, kidney failure, asthma, chronic obstructive lung disease, arthritis, hip fracture, and mental illness; the number of chronic medical problems was added for each participant; (3) social contact frequency: frequency of social contract was measured based on the reported frequency of participants’ visits and calls by children/relatives/friends, ranging from 3 = at least once a week, 2 = at least once a month, 1 = at least once a year, 0 = none; (4) social activities: participants were asked the number of social activities (in six classes: “Attend church, temple, or mosque,” “Visit cinemas, restaurants, sport events,” “Day or excursive trips,” “play cards, games, bingos, mahjong,” “join a senior citizen club activities,” “Participate in social group activities e.g., karaoke, line dancing”) that they engaged in at least once a month; (5) productive activities: participants were asked the number of productive activities (in six classes: “hobbies, e.g., gardening, painting,” “Preparing meals,” “Shopping,” “Unpaid community work,” “Paid community work,” and “Other paid employment or business”) that they engage in at least once a month; (6) fitness activities: participants were asked the number of fitness activities (“Physical exercises,” “Walking,” “Active sports or swimming,” and “Taiji”) that they engaged in at least once a month; (7) health activities: participants were asked the number of health activities (“Watch what you eat”, “Exercise regularly (i.e., 2-3 times a week),” “Good sleep,” and “Have time for leisure and relaxation”) that they engage in at least once a month; (8) functional status: assessed by the participants’ level of dependency in performing 10-item Basic Activities of Daily Living (ADL) found in the Barthel Index [
Analysis of covariance (ANCOVA) was used in cross-sectional and longitudinal analyses to examine the relations between baseline values of living alone and loneliness on baseline and followup levels of GDS and SF-12_MCS scores as dependent variables, controlling for covariates including age, gender, race, marital status, educational level, social contact frequency, number of medical problems, number of social/productive/fitness/health activities, baseline levels of depression, activities of daily living (ADL), cognitive function, and mental components of quality of life. Longitudinal analyses included additionally as covariates baseline levels of GDS and SF-12_MCS.
In this population of older adults (mean age 66 years), 211 (7.5%) reported living alone and 344 (11.9%) reported feeling lonely (Table
Baseline characteristics and well-being of older adults by living arrangement (
Living alone ( | Living with others ( | ||||||||||
Mean | % | SD | Mean | % | SD | ||||||
Age, years | 67.5 | 7.47 | 65.9 | 7.67 | 2.90 | 0.004 | |||||
Gender | |||||||||||
Male | 21.3 | 45 | 38.0 | 976 | 23.3 | <0.001 | |||||
Female | 78.7 | 166 | 62.0 | 1592 | |||||||
Race | |||||||||||
Chinese | 91.0 | 192 | 93.5 | 2401 | 6.60 | 0.04 | |||||
Non-Chinese | 9.0 | 19 | 6.50 | 167 | |||||||
Marital status | |||||||||||
Single | 28.0 | 59 | 4.00 | 104 | 455.2 | <0.001 | |||||
Married | 16.1 | 34 | 78.5 | 2017 | |||||||
Divorced/Separated | 13.7 | 29 | 2.50 | 61 | |||||||
Widowed | 42.2 | 89 | 15.0 | 385 | |||||||
Education | |||||||||||
None | 28.0 | 59 | 18.3 | 470 | 14.0 | 0.007 | |||||
Primary (1–6 years) | 27.5 | 58 | 33.6 | 864 | |||||||
Secondary (7–10 years) | 32.2 | 68 | 31.7 | 814 | |||||||
Postsecondary | 6.60 | 14 | 9.70 | 250 | |||||||
University | 5.70 | 12 | 6.70 | 170 | |||||||
Loneliness status | |||||||||||
Lonely | 24.2 | 51 | 10.9 | 279 | 36.5 | <0.001 | |||||
Not lonely | 75.8 | 160 | 89.1 | 2309 | |||||||
Social contact score | 1.60 | 0.89 | 1.36 | 0.68 | 4.87 | <0.001 | |||||
Social activities score | 3.10 | 2.29 | 2.99 | 2.21 | 0.68 | 0.50 | |||||
Production activities score | 4.00 | 1.78 | 3.82 | 1.92 | 1.34 | 0.18 | |||||
Fitness activities score | 2.29 | 1.91 | 2.52 | 1.99 | −1.60 | 0.11 | |||||
Health activities score | 5.74 | 1.81 | 5.73 | 1.83 | 0.03 | 0.98 | |||||
No. of medical problems | 2.05 | 1.45 | 1.98 | 1.78 | 0.61 | 0.54 | |||||
Baseline ADL | 19.9 | 0.51 | 19.7 | 1.48 | 1.33 | 0.18 | |||||
Baseline GDS | 2.45 | 3.39 | 1.85 | 2.67 | 3.07 | 0.002 | |||||
Baseline MMSE | 26.5 | 3.53 | 26.9 | 3.58 | −1.41 | 0.16 | |||||
Baseline SF-12_MCS | 54.2 | 7.73 | 53.7 | 8.18 | 0.88 | 0.38 | |||||
Lonely ( | Not lonely ( | ||||||||||
Mean | % | SD | Mean | % | SD | ||||||
Age, years | 67.5 | 8.64 | 65.9 | 7.49 | 3.40 | 0.001 | |||||
Gender | |||||||||||
Male | 38.3 | 128 | 36.9 | 830 | 0.25 | 0.62 | |||||
Female | 61.7 | 206 | 63.1 | 1419 | |||||||
Race | |||||||||||
Chinese | 90.4 | 302 | 93.7 | 830 | 5.57 | 0.06 | |||||
Non-Chinese | 9.60 | 32 | 6.30 | 142 | |||||||
Marital status | |||||||||||
Single | 10.5 | 35 | 5.10 | 115 | 64.5 | <0.001 | |||||
Married | 57.5 | 192 | 76.4 | 1719 | |||||||
Divorced/Separated | 7.50 | 25 | 2.40 | 55 | |||||||
Widowed | 24.5 | 81 | 15.9 | 357 | |||||||
Education | |||||||||||
None | 17.7 | 59 | 19.8 | 445 | 2.86 | 0.58 | |||||
Primary (1–6 years) | 35.3 | 118 | 32.2 | 725 | |||||||
Secondary (7–10 years) | 31.7 | 106 | 31.5 | 709 | |||||||
Postsecondary | 8.10 | 27 | 9.90 | 222 | |||||||
University | 7.20 | 24 | 6.60 | 148 | |||||||
Social contact score | 1.61 | 0.87 | 1.32 | 0.65 | 7.35 | <0.001 | |||||
Social activities score | 2.53 | 1.94 | 3.10 | 2.25 | −4.39 | <0.001 | |||||
Production activities score | 3.30 | 1.94 | 3.93 | 1.89 | −5.70 | <0.001 | |||||
Fitness activities score | 2.17 | 1.96 | 2.57 | 1.99 | −3.44 | 0.001 | |||||
Health activities score | 5.14 | 1.98 | 5.84 | 1.80 | −6.55 | <0.001 | |||||
No. of medical problems | 2.20 | 1.46 | 1.94 | 1.80 | 2.60 | 0.01 | |||||
Baseline ADL | 19.6 | 1.73 | 19.8 | 1.40 | −2.08 | 0.04 | |||||
Baseline GDS | 4.57 | 3.99 | 1.28 | 1.91 | 24.5 | <0.001 | |||||
Baseline MMSE | 26.2 | 4.30 | 27.0 | 3.41 | −3.56 | <0.001 | |||||
Baseline SF-12_MCS | 48.6 | 10.1 | 54.9 | 7.09 | −7.81 | <0.001 |
Seniors who were living alone were more likely to be older, women, non-Chinese, single, divorced or widowed, and without formal education. Notably, they were twice more likely to report feeling lonely (24.2% versus 10.9%). Interestingly, they reported higher frequency of social contact. There were no significant differences in leisure, health and fitness activities scores, number of medical problems, and cognitive and functional disability; but those who lived alone reported significantly higher number of depressive symptoms (2.45 versus 1.85).
Seniors who were lonely were also more likely to be older, single, divorced or widowed, but did not differ on other socioeconomic characteristics. Similarly, they also reported higher frequency of social contact, but, in contrast, they reported significantly fewer leisure, health and fitness activities, more medical problems, cognitive and functional disability, and depressive symptoms, as well as poorer SF-12_MCS scores.
The results of the main effects of living arrangements and loneliness and their interactions for depressive symptoms in cross-sectional and longitudinal analyses are shown in Tables
Cross-sectional analysis: associations of living arrangement and loneliness with baseline GDS and SF-12_MCS scores.
Source of variation | Depressive symptoms scores ( | SF-12_MCS scores ( | ||||||||
df | Mean square | df | Mean square | |||||||
Base model: | ||||||||||
Age | 1 | 63.19 | 9.06 | 0.003 | 1 | 364.17 | 5.63 | 0.02 | ||
Gender (0 = male, 1 = female) | 1 | 3.50 | 0.50 | 0.48 | 1 | 20.46 | 0.32 | 0.54 | ||
Race | 1 | 5.71 | 0.82 | 0.37 | 1 | 58.43 | 0.90 | 0.34 | ||
Education | 1 | 0.15 | 0.02 | 0.88 | 1 | 7.16 | 0.11 | 0.74 | ||
Marital status | 1 | 13.50 | 1.94 | 0.16 | 1 | 79.10 | 1.22 | 0.27 | ||
Number of medical problems | 1 | 202.57 | 29.06 | <0.001 | 1 | 861.44 | 13.32 | <0.001 | ||
Baseline ADL | 1 | 24.06 | 3.45 | 0.06 | 1 | 156.18 | 2.42 | 0.12 | ||
Baseline MMSE | 1 | 191.21 | 27.43 | <0.001 | 1 | 317.57 | 4.91 | 0.03 | ||
Social contact frequency score | 1 | 175.08 | 25.11 | <0.001 | 1 | 514.34 | 7.95 | 0.005 | ||
Social activities score | 1 | 31.12 | 4.46 | 0.04 | 1 | 86.30 | 1.33 | 0.25 | ||
Production activities score | 1 | 92.58 | 13.28 | <0.001 | 1 | 847.28 | 13.10 | <0.001 | ||
Fitness activities score | 1 | 1.45 | 0.21 | 0.65 | 1 | 198.54 | 3.07 | 0.08 | ||
Health activities score | 1 | 313.76 | 45.00 | <0.001 | 0.081 | 1 | 1721.80 | 26.62 | <0.001 | 0.034 |
Model 1a: plus living alone versus with others (1,0) only | 1 | 51.85 | 7.45 | 0.006 | 0.083 | 1 | 79.03 | 1.22 | 0.27 | 0.034 |
Model 1b: plus Lonely versus not lonely (1,0) only | 1 | 2414.76 | 486.86 | <0.001 | 0.231 | 1 | 9170.17 | 165.16 | <0.001 | 0.095 |
Model 2: plus living alone and loneliness (main effects) | ||||||||||
Living alone versus with others (1,0) | 1 | 2.25 | 0.45 | 0.50 | 1 | 345.37 | 6.23 | 0.01 | ||
Lonely versus not lonely (1,0) | 1 | 2349.77 | 473.56 | <0.001 | 0.231 | 1 | 9294.44 | 167.59 | <0.001 | 0.096 |
Model 3: Main effects and interaction | ||||||||||
Living alone versus with others (1,0) | 1 | 19.55 | 3.95 | 0.047 | 1 | 388.59 | 7.01 | 0.01 | ||
Lonely versus not lonely (1,0) | 1 | 1445.06 | 292.07 | <0.001 | 1 | 3753.97 | 67.69 | <0.001 | ||
Living arrangements*Loneliness | 1 | 40.85 | 8.26 | 0.004 | 0.232 | 1 | 51.08 | 0.92 | 0.34 | 0.096 |
Longitudinal analysis: living arrangement and loneliness on psychological well-being at followup.
Source of variation | Depressive symptoms scores at followup ( | SF-12_MCS scores at followup ( | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
df | Mean square | df | Mean square | |||||||
Base model: | ||||||||||
Age | 1 | 25.85 | 9.34 | 0.02 | 1 | 388.21 | 11.02 | 0.001 | ||
Gender (0 = male, 1 = female) | 1 | 13.46 | 4.86 | 0.03 | 1 | 9.74 | 0.28 | 0.60 | ||
Race | 1 | 0.44 | 0.16 | 0.69 | 1 | 1.25 | 0.04 | 0.85 | ||
Education | 1 | 2.38 | 0.86 | 0.35 | 1 | 1.41 | 0.04 | 0.84 | ||
Marital status | 1 | 4.40 | 1.59 | 0.21 | 1 | 9.08 | 0.26 | 0.61 | ||
Number of medical problems | 1 | 35.39 | 12.78 | <0.001 | 1 | 702.45 | 19.95 | <0.001 | ||
Baseline GDS | 1 | 788.88 | 284.87 | <0.001 | ||||||
Baseline ADL | 1 | 39.76 | 14.36 | <0.001 | 1 | 340.17 | 99.66 | 0.002 | ||
Baseline MMSE | 1 | 0.89 | 0.32 | 0.57 | 1 | 107.09 | 3.04 | 0.08 | ||
Social contact frequency score | 1 | 8.40 | 3.03 | 0.08 | 1 | 121.46 | 3.45 | 0.06 | ||
Social activities score | 1 | 21.10 | 7.62 | 0.01 | 1 | 447.60 | 12.71 | <0.001 | ||
Production activities score | 1 | 35.32 | 12.75 | <0.001 | 1 | 156.46 | 4.44 | 0.04 | ||
Fitness activities score | 1 | 4.70 | 1.70 | 0.19 | 1 | 0.06 | 0.02 | 0.97 | ||
Health activities score | 1 | 8.74 | 3.16 | 0.08 | 0.220 | 1 | 169.03 | 4.80 | 0.03 | |
Baseline SF-12_MCS well-being | — | — | — | — | — | 1 | 4179.08 | 118.67 | <0.001 | 0.140 |
Model 1a: plus living alone versus with others (1,0) only | 1 | 5.30 | 1.91 | 0.17 | 0.220 | 1 | 130.54 | 3.71 | 0.05 | 0.143 |
Model 1b: plus Lonely versus not lonely (1,0) only | 1 | 37.67 | 14.93 | <0.001 | 0.223 | 1 | 578.94 | 17.14 | <0.001 | 0.145 |
Model 2: plus living alone and loneliness (main effects) | ||||||||||
Living alone versus with others (1,0) | 1 | 4.63 | 1.84 | 0.18 | 1 | 65.10 | 1.93 | 0.17 | ||
Lonely versus not lonely (1,0) | 1 | 35.07 | 13.91 | <0.001 | 0.221 | 1 | 526.48 | 15.58 | <0.001 | 0.146 |
Model 3: Main effects and interaction | ||||||||||
Living alone versus with others (1,0) | 1 | 8.56 | 3.40 | 0.07 | 1 | 152.81 | 4.53 | 0.03 | ||
Lonely versus not lonely (1,0) | 1 | 32.57 | 12.92 | <0.001 | 1 | 560.42 | 16.61 | <0.001 | ||
Living arrangements*Loneliness | 1 | 4.39 | 1.74 | 0.19 | 0.242 | 1 | 110.65 | 3.28 | 0.07 | 0.158 |
Between living alone and loneliness, their respective
In the cross-sectional analysis, there was a significant interaction between living arrangements and loneliness, F (1, 2536) = 8.28,
Logistic regression predicting depression at baseline and followup.
Source of variation | Depression at baseline ( | Depression at followup ( | ||||||
B | S.E | Odds ratio | B | S.E | Odds ratio | |||
Base model: | ||||||||
Age | 0.03 | 0.01 | 1.03 | 0.004 | 0.02 | 0.02 | 1.03 | 0.25 |
Gender (0 = male, 1 = female) | −0.14 | 0.17 | 0.87 | 0.44 | −0.33 | 0.36 | 0.72 | 0.35 |
Race | ||||||||
Chinese | 0.50 | 0.81 | 1.64 | 0.54 | −0.58 | 1.13 | 0.56 | 0.61 |
Malay | −0.51 | 0.92 | 0.60 | 0.58 | −0.32 | 1.28 | 0.73 | 0.81 |
Indian | 0.39 | 0.92 | 1.48 | 0.67 | −0.85 | 1.43 | 0.43 | 0.55 |
Education | −0.10 | 0.08 | 0.90 | 0.22 | −0.02 | 0.17 | 0.98 | 0.90 |
Marital status | ||||||||
Single | 0.45 | 0.33 | 1.57 | 0.17 | 0.86 | 0.61 | 2.35 | 0.16 |
Married | 0.26 | 0.21 | 1.29 | 0.24 | 0.45 | 0.40 | 1.57 | 0.26 |
Divorced, separated | 0.46 | 0.39 | 1.58 | 0.28 | 0.64 | 0.74 | 1.89 | 0.39 |
Number of medical problems | 0.17 | 0.05 | 1.18 | 0.001 | 0.17 | 0.09 | 1.18 | 0.06 |
Baseline ADL | −0.04 | 0.04 | 0.97 | 0.08 | −0.14 | 0.06 | 0.87 | 0.01 |
Baseline MMSE | −0.09 | 0.02 | 0.92 | <0.001 | −0.002 | 0.04 | 1.00 | 0.96 |
Social contact frequency score | 0.17 | 0.09 | 1.18 | 0.08 | 0.10 | 0.18 | 1.11 | 0.57 |
Social activities score | −0.04 | 0.04 | 0.96 | 0.25 | −0.11 | 0.08 | 0.89 | 0.16 |
Production activities score | −0.08 | 0.05 | 0.93 | 0.08 | −0.07 | 0.09 | 0.97 | 0.40 |
Fitness activities score | 0.07 | 0.04 | 1.07 | 0.12 | −0.04 | 0.09 | 0.79 | 0.70 |
Health activities score | −0.11 | 0.04 | 0.90 | 0.008 | −0.24 | 0.08 | 0.93 | 0.004 |
Baseline GDS | — | — | — | — | 0.29 | 0.04 | 1.33 | <0.001 |
Living alone versus with others (1,0) | 0.21 | 0.34 | 1.23 | 0.05 | 0.11 | 0.71 | 1.11 | 0.10 |
Lonely versus not lonely (1,0) | 0.44 | 0.16 | 1.55 | 0.001 | 0.33 | 0.36 | 1.39 | 0.03 |
Living arrangements*Loneliness | 0.31 | 0.52 | 1.36 | 0.04 | 0.16 | 0.33 | 1.17 | 0.4 |
In agreement with previous studies, we found that loneliness was by far a stronger contributor to mental health and functioning. Our study suggests that while living alone contributed to poorer psychological well-being, it was mostly attributed to loneliness. Whether living alone or with others, elderly persons who were not lonely showed similarly fewest numbers of depressive symptoms. However, lonely elderly persons showed higher number of depressive symptoms if they were living alone than if they were living with others. These results from an Asian Singaporean sample are similar to findings from some large surveys in UK and US such as the Health and Retirement Survey, the English Longitudinal Survey, and the Chicago Health and Aging Survey which also used a single-item measure of loneliness.
These findings help to explain the inconsistent findings reported in previous research on the effects of living alone on depression. Populations of older persons who live alone in different studies may vary in their proportions of those who felt lonely, depending on the ecological context of social support and cohesions. In our study population, this proportion was about a quarter. For example, Mui [
Living alone may predispose to more depression by engendering social isolation especially when social contacts are not maintained [
It is thus interesting to note that, given the traditional preference for Chinese elderly people to live with their adult children especially sons, living alone did not appear to have a profound effect on mental health and functioning as expected. Most probably, the case is that given the same collectivist culture that emphases family togetherness, living alone may not greatly diminish the close knit of family members and their moral obligations for psychosocial support, even though nuclearization of families is on the increase. In Singapore, public policy emphasis and tangible incentives to encourage nuclear families to live in close proximity to elderly parents living alone also help to alleviate the detrimental effects on their psychological and subjective well-being.
On the other hand, loneliness was found to have a much stronger impact on the psychological well-being of the elderly. The intrinsic emotional bonding between elderly parents and their adult children is more central than physical togetherness in determining mental well-being. We further postulate that the differential effects between living alone and loneliness may lie in the subjective perception of their children as being filial in fulfilling the responsibilities of caring for their parents. Even with children living apart, some elderly may not perceive their needs as unmet by their children, and, hence, there is no negative impact on their well-being. However, those elderly who felt that their children had failed to provide the desired and expected level of support, albeit living with them under the same roof, may be more likely to report poorer mental health and psychological well-being.
The study has both strengths and limitations. The population-based approach makes the results more widely generalizable. However, special high-risk groups of frail elderly living alone need a separate and more detailed study. In the longitudinal analyses, because the selection characteristics of the participants in the followup interview was clearly biased towards better functioning individuals, the relationships of primary interest were likely to have been attenuated as a result. Self-reported data are subjected to possible social desirability and recall bias, and solely relying on such responses might possibly exaggerate the relationships. The construct of loneliness in this study is simple, and further studies may examine the multiple dimensions of loneliness and their effects on the mental health and functioning of elderly persons.