Longitudinal Investigation of Social Isolation, Loneliness, and Health Outcomes Among Refugees in a Low-Resource Setting

Background Social isolation and loneliness are global public health concerns, adversely impacting mental and physical health. There is an urgent need to expand the evidence base with studies focused on at-risk populations in low-resource contexts. This study aimed to examine the longitudinal association of social isolation and loneliness and health outcomes (probable depression and post-traumatic stress disorder (PTSD), and general health), and to identify individual and social determinants of social isolation and loneliness among refugees in a low-resource context.

A longitudinal study involving 1,235 culturally and linguistically diverse refugees was conducted over a two-year period across four time points. Social isolation and loneliness, probable depression and PTSD, and general health were measured using self-report instruments across four time points over two years (six-month intervals). Generalised Linear Mixed Models were used to examine the association between social disconnection and health outcomes over time. Linear regression was used to identify individual, social, and contextual factors associated with social isolation and loneliness.

Social isolation and loneliness were associated with increased risk of probable depression, PTSD, and poor health over two years. Younger age, higher education, family separation, traumatic experiences, longer time in the protracted displacement setting, and post-displacement stressors significantly predicted higher social isolation and loneliness at baseline.

The present findings indicate a dose-response relationship between social isolation and loneliness and mental health outcomes among refugees in a low-resource setting. Multilevel interventions addressing individual, social, and contextual factors are needed to tackle social disconnection and improve health among refugees. Competing Interest Statement The authors have declared no competing interest. Funding Statement The current study was supported by an Australian Research Council Linkage Grant (LP170100852), MQ: Transforming Mental Health Postdoctoral Scholarship (MPSIP\15), and Australian National Health and Medical Research Council Investigator Leadership Grant (2018104). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study was approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC190494) and Atma Jaya University, Jakarta (0792/III/LPPM-PM.10.05/07/2019). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data availability Data is not publicly available due to its sensitive nature. Anonymized data may be shared upon reasonable request to the corresponding author.