Adverse Adolescence Experiences, Feeling Lonely Across Life Stages & Loneliness in Adulthood (PDF)

+Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS International Journal of Clinical and Health Psychology (2020) xxx, xxx---xxx International Journal of Clinical and Health Psychology...

+Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS International Journal of Clinical and Health Psychology (2020) xxx, xxx---xxx International Journal of Clinical and Health Psychology www.elsevier.es/ijchp ORIGINAL ARTICLE Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood Wen-Hsu Lin, Chi Chiao ∗ Institute of Health and Welfare Policy, College of Medicine, National Yang-Ming University, Taiwan Received 28 March 2020; accepted 23 July 2020 KEYWORDS Abstract Loneliness; Background/Objective: Loneliness is a mental health issue emerging over the life course. This Adverse adolescence study examines the latent structure of adult loneliness in a non-Western society and its associa- experiences (AAEs); tion with adverse adolescence experiences (AAEs) as well as feeling lonely during middle school, Life course; high school, and college. Method: A cohort sample living in Northern Taiwan (N = 2,289) was ana- Taiwan; lyzed from adolescence to adulthood. The de Jong Gierveld Loneliness Scale operationalized Ex post fact study loneliness by a three-cluster model to present the latent structure of loneliness: emotional, serious emotional, and severe emotional/social loners. AAEs (e.g., abuse, neglect, and dys- functional family) were measured by seven items. Multivariate multinomial logistic regression models were used to explore the longitudinal effects of AAEs and feeling lonely reported during middle school, high school, and college on adult loneliness. Results: AAEs and feeling lonely during adolescence were significantly associated with serious emotional loneliness and severe emotional/social loneliness during adulthood, even after adjusting for the individual’s char- acteristics. Attendance at a 4-year college was associated with decreased odds of serious emotional loneliness and severe emotional/social loneliness. Conclusions: Adults with AAEs and feelings of loneliness over life stages are more likely to report loneliness in the emotional and social domains. © 2020 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Psicologı́a Con- ductual. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/). ∗ Corresponding author at: Institute of Health and Welfare Policy, College of Medicine, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan. E-mail address: [email protected] (C. Chiao). https://doi.org/10.1016/j.ijchp.2020.07.006 1697-2600/© 2020 Published by Elsevier España, S.L.U. on behalf of Asociación Española de Psicologı́a Conductual. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS 2 W.-H. Lin, C. Chiao PALABRAS CLAVE Experiencias adversas en la adolescencia, sentirse solo en las etapas de la vida y Soledad; soledad en la edad adulta Experiencias adversas Resumen en la adolescencia Antecedentes/Objetivo: La soledad es un problema de salud mental que emerge a lo largo de (EAA); la vida. Se examina la estructura latente de la soledad de adultos en una sociedad no occidental Transcurso de vida; y su asociación con experiencias adversas en la adolescencia (EAAs), además de sentirse solo Taiwán; durante la Secundaria y la Universidad. Estudios Ex post facto Método: Se analizó una muestra de cohorte de Taiwán (N = 2.289) desde la adolescencia hasta la edad adulta. La Jong Gierveld Loneliness Scale operacionalizó la soledad mediante un modelo de tres grupos para presentar la estructura latente de la soledad: emocional, emocional grave y soledad emocional/social severa. Las EAAs (e.g., abuso, negligencia y familia disfuncional) se midieron con siete ítems. Se utilizaron modelos de regresión logística multinomial multivariante para explorar los efectos longitudinales de EAAs y sentirse solo informado durante la Secundaria y la Universidad sobre la soledad adulta. Resultados: Las EAAs y sentirse solo durante la adolescencia se asociaron significativamente con soledad emocional grave y emocional/social severa durante la adultez, incluso después de ajustarse a las características del individuo. Asistir a la Universidad durante cuatro años se asoció con una disminución de las probabilidades de soledad emocional grave y emocional/social severa. Conclusiones: Adultos con EAAs y sentimientos de soledad durante las etapas de la vida tienen más probabilidades de informar soledad en ámbitos emocional y social. © 2020 Publicado por Elsevier España, S.L.U. en nombre de Asociación Española de Psi- cologı́a Conductual. Este es un artı́culo Open Access bajo la licencia CC BY-NC-ND (http:// creativecommons.org/licenses/by-nc-nd/4.0/). Loneliness refers to a condition wherein a person suffers contributing to early-life experiences (Cacioppo, Hawkley from emotional distress due to a feeling of being rejected et al., 2006). Similarly, some studies suggest that adverse by or isolated from other individuals, and/or is lacking experiences, including exposures to abuse, violence, and a social partner for desired activities (McWhirter, 1990; neglect in both family and school environments, may render Perlman & Peplau, 1981). Recent research has underscored some individuals particularly vulnerable to emotional loneli- the importance of loneliness as one of the most commonly ness during emerging adulthood (Belsky, 1993; Hyland et al., encountered mental health problems during young adult- 2019). However, to our knowledge, there has been no empir- hood (Pitman, Mann, & Johnson, 2018) and it has been shown ical research that has explored adverse experiences during to often seriously affect other mental health problems, the adolescence and their association with subsequent loneli- quality of life of individuals and their families (Cacioppo ness during adulthood, including both social and emotional & Cacioppo, 2018; Johnson, Dupuis, Clayborne, & Colman, loneliness. 2018). Yet, only a handful of studies have paid attention to The Belsky developmental model (1993) posits that early- loneliness in emerging adulthood (Arnett, Žukauskienė, & life adversities are more likely than other events to be Sugimura, 2014), and such studies remain even rarer in an associated with poor mental health because this particu- East Asian society such as Taiwan. lar group continues to disproportionately experience a wide Traumatic experiences before age 18 have been demon- range of adversities, perceived stressors, throughout their strated to have significant and profound effects on a wide lives. Accordingly, negative emotional during early life and is range of mental health measures (Kim, Kim, Chartier, Wike, accumulation may be another important source of adversity. & McDonald, 2019; Racine, Madigan, Plamondon, McDonald, Prior studies had found that early memories or experience of & Tough, 2018). For example, most previous studies have negative emotions were associated with psychiatric illnesses shown that early traumatic or adverse experience is strongly in community populations (Doering et al., 2019; Lempinen, related to depression or psychiatric problems (e.g., suicidal- Junttila, & Sourander, 2018). Hence, feelings of loneliness at ity) (Merrick, Ports, Ford, Afifi, Gershoff, & Grogan-Kaylor, important life stage (e.g., middle and high school), accom- 2017; Rytila-Manninen, Haravuori, Frojd, Marttunen, & panied by other adversities, may play an influential, albeit a Lindberg, 2018). Belsky’s developmental hypothesis (Belsky, different role, in the experience of loneliness during emerg- 1993) provided a theoretical background for this relation and ing adulthood. Chen and Qin (2019) analyzed a sample of 569 argued that the accumulation of various personal adversi- Chinese adolescents with the 16-item Children’s Loneliness ties throughout an individual’s life will synergistically create Scale (Asher, Hymel, & Reshaw, 1984) and found an associa- poor health consequences in later years. In regard to loneli- tion between feelings of loneliness social anxiety in addition ness, some have attributed the rise in emotional loneliness to the early experience of emotional abuse. However, this among young people to a developmental process and as study did not include measures that assessed feelings of Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS Adverse adolescence experiences 3 loneliness at different life stages and the measure of abuse dataset is publicly available for research with the approval was limited to emotional abuse. of Academia Sinica in Taiwan (www.typ.sinica.edu.tw). All As a result of the knowledge gaps in the literature, inves- TYP participants gave informed written consent at the start tigations of the effects of feelings of loneliness over life of their interviews. The present study protocol was approved stages have not clearly distinguished these emotional feel- by the Research Ethics Committee of National Yang-Ming ings from other adverse experiences. Furthermore, there University (Taipei, Taiwan) (IRB Number: YM106103E-2). has been scant research on the relationships between adverse adolescence experiences (AAEs) and adulthood loneliness in non-Western societies. Using a cohort sam- Measures ple in Northern Taiwan, this paper examined whether AAEs contribute to the structure of loneliness during adulthood, Loneliness in emerging adulthood was measured by the six- and assessed whether their effect is independent of impor- item de Jong Gierveld Short Scale (DJGS; de Jong Gierveld & tant confounders. Furthermore, an additional gap in the Van Tiburg, 2010). This scale included two distinct domains literature is whether feelings of loneliness over life stages of loneliness: Social and Emotional loneliness (Weiss, 1973). are related to a longitudinal association between AAEs and Each item was recoded into two categories: not lonely loneliness during adulthood once confounders are included. (coded 0) or lonely/extremely lonely (coded 1). Latent class Thus, we have conceptually separated a single-item measure analysis (LCA) is used to assess the underlying structure of of a feeling of loneliness during middle school, high school, loneliness. Based on the model fit indices (AIC and BIC) along and college by testing its association with the results of the with interpretability, the LCA analysis yields three mutually 6-item de Jong Gierveld Loneliness Scale (DJGS) (de Jong exclusive categories (Chiao, Chen & Yi, 2019; Hyland et al., Gierveld & Van Tiburg, 2010) to determine whether or not a 2019): emotional loners (the reference group), serious emo- single item, a feeling of loneliness, captures some aspects tional loners, and severe emotional/social loners. The use of the latent structure of loneliness. of this 6-item DJGS as a measure of loneliness has been val- idated for Chinese version, but this validation involved an older population from Hong Kong (Leung, de Jong Gierveld, Method & Lam, 2008). The total score on social domain ranged from 0 to 3 and yielded very good internal consistency and relia- Participants and procedure bility (␣ =.77). The other three DJGS items in the emotional domain had a total score ranging from 0 to 3 with Cronbach The dataset was drawn from the Taiwan Youth Project (TYP), ␣ of.51. conducted by the Institute of Sociology, Academia Sinica, Adverse adolescence experiences (AAEs), our major Taiwan. The TYP surveys were designed to collect longitu- predictor, is based on Centers for Disease Control and dinal information over two phases. The first phase began Prevention Research and Related Studies (CDC; Clements- in 2000 and included annual interviews for 9 years. The sec- Nolle & Waddington, 2019). AAEs include abuse, neglect ond phase then recruited participants who had responded to and household dysfunction. Abuse includes both physical the last surveys of the first phase in 2011, 2014, and 2017. abuse (1 question) and verbal abuse (1 question). We took The TYP did not apply the 6-item DJGS until 2014. Partici- an average of responses regarding paternal and mater- pants were approaching 30 years old and older in 2017, at nal behavior and converted this into the closest integer; which time Taiwanese participants will have been complet- then, we dichotomized each item into either experienc- ing their education. The response rate for the 2017 survey ing abuse (1) if the computed score fell into almost always was 79% and the attrition rate was 6.10% compared to the and always; while all other results were coded as no (0). 2014 survey. The adult sample flow is shown in Figure 1. Household dysfunction includes parental divorce or separa- Attrition is of particular importance to longitudinal tion (1 question), parental addiction (1 question), parental research because adolescents with AAEs are typically in mental illness (3 questions), and criminal justice system poorer mental health than their counterparts, making involvement in the household (1 question). Respondents them the most difficult to retain over the complete study were deemed to have experienced parental mental illness, period. We assessed differences in individual background if the one parent suffered from any of three SCL-90-R and socioeconomic status between continuing participants (Derogatis, 2000) symptoms. The remaining household dys- and dropouts across waves (the results not tabled). The anal- functionality item was also dichotomized and those who yses indicated that AAEs were the major cause of the decline experiencing such events received a score of 1 (yes). Finally, in sample size. emotional neglect (1 question) was based on adolescents’ We restricted our analysis to participants with complete self-reporting of family social support as ‘‘no support’’ and responses in both phases for the major measures, yielding ‘‘not enough.’’ The total score for AAEs ranged from 0 to 7. a final sample of 1,092 females (47.71%) and 1,197 males The measures used to assess feelings of being lonely when (52.29%) (see Figure 1). A logistic regression of missing data attending middle school (age 15), high school (age 17-18) status was used to assess whether missing responses were and college (age 20-22) were identical, using the same cod- random by considering individual background characteristics ing scheme, assessed emotional loneliness at each stage. as independent variables. The non-significant results indi- Adolescents were asked whether or not they had felt lonely cated no apparent systematic origins of missing responses. during the past two weeks and was dichotomized based on Most of the variables used in the present study emerged from the suggestions from prior studies (de John-Gierveld & van the participants via self-reporting, though some adverse Tilburg, 1999; Holi, 2003): ‘‘feelings of being lonely (coded experiences were derived from parental reports. The TYP as 1)’’, including slightly serious, serious, and very serious Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS 4 W.-H. Lin, C. Chiao Figure 1 Participants in the serial surveys that form the Taiwan Youth Project (TYP) from 2009 to 2017. Note: ‘‘LFU’’ indicates lost-to-follow-up, which was mainly due to moving and thus being unable to be interviewed. feelings of loneliness, while ‘‘no feelings of being lonely reported sleep hours and was dichotomized into a lack of (coded as 0).’’ sleep (daily sleep hours < 6 hours) and adequate sleep (Lin Individual and socio-demographic characteristics were & Yi, 2015). The socio-demographic characteristics of age, assessed at age 15 and controlled for. Among these individ- gender, residential location (Taipei County, Yilan County, and ual characteristics were early sexual maturation and lack of Taipei City) and parental education were measured by the sleep. Early sexual maturation was assessed using a pubertal standard procedures used in survey research. College atten- developmental scale that summed three items for females dance and number of siblings (only child or not) reflect the and four items for males (Petersen, Crockett, Richards, expansion of education that occurred in Taiwan during the & Boxer, 1988). The summed score across all items was 1970s. standardized and it was gender and age specific. Those indi- viduals who were one standard deviation above the mean were grouped into the ‘‘early maturation’’ group, while Data analysis the others were grouped into the reference group (Chiao & Ksobiech, 2015; Sun, Mensah, Azzopardi, Patton, & Wake, We aimed to examine whether AAEs are longitudinally 2017). Lack of sleep was based on the individual’s self- associated with the latent structure of loneliness during Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS Adverse adolescence experiences 5 adulthood. Multinomial logistic regression modeling with Table 1 Descriptive characteristics of the sample of young progressive adjustments was applied. Model 1 explored the adults used in this study [percent or mean (SD)]. effects of AAEs together with feeling lonely during middle school, while controlling for all the covariates. Feelings of Variable Percent or mean (SD) loneliness during late adolescence (middle school and high Age (range: 30-35) 31.32 (1.15) school) were added to Model 2, and Model 3 was adjusted Male (%) 52.29 to include feeling lonely during emerging adulthood (in col- Being only child (%) 3.89 lege). All regression analyses adjusted for sample clustering Attendance in 4-year college (%) 82.61 and used STATA 15.0. Given the effect of multiple com- Parental education (range: 1-6) 3.03 (1.23) parison on possible spurious positive results, we set the significant level of ␣ up to.001. Individual characteristics in early We conducted two approaches to evaluate this rela- adolescence (at aged 15) tionship (see Appendix 1). Firstly we adopted exploratory Adverse adolescence experience 0.81 (0.95) factor analyses (EFA) along with parallel analysis (Fabrigar (AAE) (range: 0-6) & Wegener, 2012) and screet plot to determine the factor Abuse structure. The results supported a two-factor solution: emo- Physical abuse (including hitting, 10.70 tional loneliness, specifically feeling lonely and the three beating and spanking with an emotional loneliness items from DJGS, and social loneliness. object by a parent) These two latent factors explained about 58% of the vari- Verbal abuse (including yelling 5.40 ance. The second part of the analysis involved carrying out with intense anger by a parent) a confirmatory factor analysis (CFA) based on the EFA find- Household dysfunction ings. For this analysis, we used three indices with specified Parental divorce or separation 6.70 cut-offs (Hu & Bentler, 1999) as benchmarks to evaluate the Parental alcohol or gambling 8.80 model. The CFA results showed acceptable fit, and confirm problems the EFA model. These two sets of results were able to provide Parental severe depressive 18.30 evidence that supports the hypothesis that the single item symptomatology identified above is able to capture an individual’s loneliness Household member imprisoned 1.90 or at least that that person’s emotional loneliness domain. for a crime Neglect Emotional aspect 29.70 Results No adverse experience 46.31 Early maturation with regard to 10.48 Table 1 presents the descriptive characteristics of the study pubertal timing (%) sample. Seven per cent of the participants were identified as Lack of sleep: average sleep hours 37.70 severe emotional/social loners while 40% were serious emo- are less than 6 hours (%) tional loners and 53% were slight emotional loners. Over the Residence (%) subjects’ life course, about 46% of the adolescents reported Taipei City 37.27 feeling lonely in middle school, 49% in high school, and about Taipei county 36.87 64% during college. On the other hand, the mean score for Yilan county 25.86 AAE was less than 1 (M = 0.81; SD = 0.95); and 46% of the participants had not experienced any of the assessed AAEs. Feelings of loneliness (%) The ages of the subjects ranged 30---35 years, and more than During middle school 45.78 three-quarters (83%) had attended a 4-year college. During high school 48.71 The multivariate multinomial logistic regression models During college 63.95 with progressive adjustments were shown in Table 2. Model 1 Loneliness clustering among young demonstrated that adults who reported experiencing adver- adult (%) sity during adolescence were more likely to be severe Emotional loners 52.51 emotional/social loners rather than emotional loners (the Serious emotional loners 40.24 reference group) (RRR = 1.42, 95% CI: 1.23---1.63). Feelings of Severe emotional/social loners 7.25 loneliness during middle school were found to be important even 15 years later because this feeling lonely increased the N 2,289 odds of being either a serious emotional loner (RRR = 1.66, Note: SD = Standard deviation. Percentages may not sum to 100 95% CI: 1.39---1.98) or a severe emotional/social loner during owing to rounding. young adulthood (RRR = 2.27, 95% CI: 1.72---3.00) compared to the reference group. In contrast to the AAE impact on adulthood loneliness, the fact that the subject had attended change, although the magnitude slightly decreased. Like a 4-year college reduced the odds of being a serious emo- feeling loneliness during middle school, feeling lonely during tional loner (RRR = 0.69, 95% CI: 0.54---0.87) or a severe high school was also more likely to result in the sub- emotional/social loner (RRR = 0.64, 95% CI: 0.41---1). ject becoming either a serious emotional loner (RRR = 1.91, Model 2 added feeling lonely during high school to Model 95% CI: 1.61---2.27) or a severe emotional/social loner 1. The association of AAEs and feeling lonely during mid- (RRR = 1.98, 95% CI: 1.40---2.81), as compared to the refe- dle school with adulthood loneliness showed no significant rence group. Model 3 showed that feeling lonely during Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006  6 IJCHP-195; No. of Pages 10 +Model https://doi.org/10.1016/j.ijchp.2020.07.006 across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely Table 2 Multivariate multinomial logistic regression results for loneliness cluster among young adults, TYP 2000-2017 (N = 2,289). Loneliness Cluster/Class Contrast RRR (95%)/Ref = Emotional Loners Model 1 Model 2 Model 3 Serious Severe Serious Severe Serious Severe Emotional Emotional & Emotional Emotional & Emotional Emotional & Loners Social Loners Loners Social Loners Loners Social Loners Individual ARTICLE IN PRESS characteristics in early adolescence (at aged 15) Adverse adolescence 1.07 (0.98, 1.17) 1.42 (1.23, 1.63)*** 1.05 (0.95, 1.15) 1.38 (1.20, 1.60)*** 1.04 (0.94, 1.15) 1.36 (1.18, 1.57)** experience (AAE) Early maturation 1.27 (0.96, 1.68)§ 1.19 (0.79, 1.79) 1.27 (0.97, 1.66)§ 1.19 (0.79, 1.79) 1.22 (0.94, 1.60) 1.12 (0.73, 1.71) (ref = Others) § Short sleep (ref = Others) 1.06 (0.84, 1.34) 0.77 (0.55, 1.09) 1.03 (0.82, 1.29) 0.75 (0.53, 1.06) 1.04 (0.82, 1.32) 0.77 (0.54, 1.09) Feeling of loneliness During middle school 1.66 (1.38, 1.98)*** 2.27 (1.72, 3.00)*** 1.41 (1.18, 1.68)*** 1.91 (1.41, 2.60)*** 1.32 (1.10, 1.57)** 1.72 (1.26, 2.36)*** During high school 1.91 (1.61, 2.27)*** 1.98 (1.40, 2.81)*** 1.69 (1.42, 2.02)*** 1.62 (1.11, 2.37)* During college 1.67 (1.37, 2.02)*** 2.45 (1.63, 3.67)*** Covariates Age 0.99 (0.89, 1.09) 1.04 (0.90, 1.21) 1.02 (0.92, 1.13) 1.08 (0.93, 1.24) 1.01 (0.91, 1.11) 1.06 (0.93, 1.22) Male 0.99 (0.85, 1.15) 0.98 (0.71, 1.37) 1.04 (0.89, 1.23) 1.04 (0.75, 1.44) 1.06 (0.90, 1.26) 1.07 (0.77, 1.47) Attendance at a 4-year 0.69 (0.54, 0.87)*** 0.64 (0.41, 1.00)* 0.66 (0.52, 0.83)*** 0.62 (0.39, 0.96)* 0.63 (0.50, 0.81)** 0.58 (0.37, 0.91)* college Being an only child 0.82 (0.53, 1.26) 0.47 (0.20, 1.14)§ 0.78 (0.50, 1.22) 0.45 (0.19, 1.10)§ 0.72 (0.46, 1.16) 0.42 (0.17, 1)* Parental educational 1.05 (0.98, 1.14)§ 1.15 (1.00, 1.32)* 1.04 (0.96, 1.13) 1.14 (0.99, 1.30)§ 1.05 (0.96, 1.14) 1.14 (0.99, 1.32)§ level Residence during early adolescence (ref = Taipei City) W.-H. Lin, C. Chiao Taipei county 0.89 (0.70, 1.13) 0.92 (0.71, 1.18) 0.89 (0.70, 1.14) 0.92 (0.72, 1.18) 0.89 (0.70, 1.13) 0.92 (0.72, 1.18) Yilan county 0.90 (0.66, 1.22) 0.84 (0.61, 1.16) 0.89 (0.66, 1.20) 0.83 (0.61, 1.14) 0.89 (0.65, 1.22) 0.85 (0.60, 1.20) Note: RRR = relative risk ratio; CI = confidence interval; All models adjust for sample clusters; § p <.10; *p <.05; **p <.01; ***p <.001. +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS Adverse adolescence experiences 7 Table 3 Multivariate logistic regression results for the likelihood of feeling lonely among young adults, TYP 2000-2017 (N = 2,289). AOR (95% CI) Basic Model Model 1 Model 2 Model 3 Individual characteristics in early adolescence (at aged 15) Adverse adolescence 1.17 (1.07, 1.26)*** 1.11 (1.03, 1.19)** 1.08 (1.00, 1.16)* 1.07 (0.99, 1.15) experience (AAE) Early maturation (ref = Others) 1.17 (0.88, 1.55) 1.15 (0.89, 1.48) 1.14 (0.89, 1.46) 1.07 (0.84, 1.37) Short sleep (ref = Others) 0.98 (0.78, 1.24) 0.93 (0.73, 1.17) 0.90 (0.70, 1.15) 0.91 (0.71, 1.18) Feelings of loneliness During middle school 2.05 (1.67, 2.53)*** 1.72 (1.40, 2.12)*** 1.56 (1.26, 1.93)*** During high school 2.03 (1.71, 2.41)*** 1.68 (1.41, 2.01)*** During college 2.38 (1.98, 2.85)*** Covariates Age 1.02 (0.96, 1.10) 1.00 (0.94, 1.07) 1.04 (0.97, 1.11) 1.02 (0.96, 1.09) Male 0.71 (0.56, 0.92)** 0.77 (0.60, 0.98)* 0.81 (0.64, 1.03)§ 0.82 (0.64, 1.05) Attendance at 4-year college 0.97 (0.76, 1.24) 0.96 (0.74, 1.24) 0.92 (0.71, 1.20) 0.88 (0.66, 1.17) Being an only child 0.87 (0.53, 1.43) 0.90 (0.54, 1.53) 0.87 (0.53, 1.43) 0.80 (0.47, 1.35) Parental educational level 1.04 (0.93, 1.16) 1.03 (0.91, 1.16) 1.01 (0.90, 1.14) 1.02 (0.90, 1.15) Residence in early adolescence (ref = Taipei City) Taipei county 1.03 (0.81, 1.32) 1.02 (0.80, 1.29) 1.02 (0.81, 1.29) 1.03 (0.82, 1.30) Yilan county 0.60 (0.44, 0.83)** 0.60 (0.43, 0.82)** 0.59 (0.43, 0.81)** 0.59 (0.43, 0.81)** Abbreviations: AOR = adjusted odds ratio; CI = confidence interval; All models adjust for sample clusters; § p <.10; *p <.05; **p <.01; ***p <.001. college also increased the odds of being either a serious between these two groups would be about 8.50% smaller emotional loner (RRR = 1.67, 95% CI: 1.37---2.02) or a severe than the observed difference, net of the individual’s char- emotional/social loner (RRR = 2.45, 95% CI: 1.63---3.67), even acteristics. The measures of feeling lonely across life stages after adjusting for individual and demographic characteris- consistently produced significant effects and it would seem tics. Finally, as compared to the reference group, the odds of that a more recent feeling of being lonely had a stronger being a serious emotional loner or a severe emotional/social effect than an earlier feeling of being lonely. loner significantly decreased if the adult attended a 4-year college. In order to further validate the application of the sin- gle item of loneliness, we used this single item loneliness Discussion as an outcome variable together with the same explana- tory variables that examined the AAE effect with progressive The main purpose of this study was to explore AAEs and adjustments as shown in Table 3. Basic Model demonstrated their longitudinal association with loneliness during young that adults who reported experiencing adversity during ado- adulthood using a large community cohort sample from a lescence were more likely to report feeling of loneliness in non-Western society. Consistent with the Belsky develop- emerging adulthood (AOR = 1.17, 95% CI: 1.07---1.26). Results mental model, our analysis found that AAEs had a profound were similar to those in Table 2: people who reported impact on severe emotional/social loneliness during emerg- adversities during adolescence were also more likely to ing adulthood, and this adversity effect was only reduced experience emotional loneliness (AOR = 1.11, 95% CI 1.03- slightly after adjusting for other important individual risk 1.19) (Model 1). This significant result was observed even factors and feeling lonely at various life stages. In addition, after controlling for various covariates, as well as feel- feelings of loneliness across important life stages resulted ings of being lonely during middle school and high school in a greater risk of becoming a serious emotional loners or (AOR = 1.08, 95% CI 1.00-1.16) (Model 2) but not college severe emotional/social loners. The risk factors during early (AOR = 1.07, 95% CI 0.99-1.15) (Model 3). Feelings of being life consistently showed a significant longitudinal influence lonely when attending middle school, high school and col- across each life stage. We also found that AAEs and feelings lege reduced the association between AAE and feeling of of loneliness across life stages ‘‘work’’ together additively, loneliness in emerging adulthood by 8.50%. That is, if those which may in turn shape the vulnerabilities of individuals, with AAEs experienced the same level of emotional lone- resulting in severe mental health problems later, such as liness as others, the difference in feeling of loneliness loneliness during emerging adulthood. Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS 8 W.-H. Lin, C. Chiao Our results further extend the available current litera- people. In addition to the effect of attending a 4-year col- ture on the negative effects of adverse experiences during lege, our analysis showed that parental education also had a early life on an individual’s health later in life by showing marginal effect. Parents with higher levels of education had how these affect loneliness during adulthood and its rela- reduced risks of their children becoming emotional/social tionship with adolescence adversities (Merrick et al., 2017; loner. Furthermore, as suggested by earlier studies, parental Sheikh, 2017). Given that loneliness has negative effects on control has a negative effect on loneliness, which may act both physical (Leigh-Hunt et al., 2017) and mental health as the mechanism whereby the level of parental education (Cacioppo & Cacioppo, 2018), preventing children and ado- affects long-term mental health in this non-Western society lescents from having such adverse experiences is warranted. (Chiao et al., 2019). It can be seen from the many and varied adverse experiences The present study provides significant new insights on described in the original CDC-Kaiser ACE study (Felitti et al., AAEs and their longitudinal association with loneliness dur- 1998) and by WHO (World Health Organization, 2012) that a ing adulthood. However, the results need to be interpreted significant number of such experiences are family related. with care because of the limitations of this study. First, the Thus reducing family adversity is crucial to promoting the TYP data is based on self-reported recall of AAEs and loneli- mental health of children, adolescents and adults. Parent- ness, raising the issue of recall bias. In addition, self-report ing skill training, for example, should help to reduce conflict measures of AAEs and loneliness may also suffer from shared and abuse in the home, and when this is employed it poten- method variance rather than the constructs the measures tially ought to prevent the occurrence of such adversities in are hypothesized to represent. The measure of AAEs is not a family context (Center for Disease Control and Preventing, comprehensive; however, given that the significant effects 2019a, 2019b). of the AAEs we identified are consistent with prior studies Furthermore, our findings indicate that the effects of of adverse childhood experiences (ACEs) (Kim et al., 2019; early negative experience can be profound and complex. Suglia et al., 2018), we are confident more comprehen- External negative experiences, such as AAEs, appear to sive measures of AAEs would not yield appreciably different work in an additive manner with internal negative expe- results. Moreover, several AAE items were adopted from the riences such as feeling lonely, increasing the likelihood of reports of parents rather than adolescent children. The bias the individual developing severe emotional and social lone- of social desirability is possibly limited. When the 6-item liness. On the other hand, there may be a cascade effect, DJGS was measured by asking young adults to identify with whereby external AAEs trigger internal negative emotions their loneliness status, it may have had a stigma attached. that together might lead to serious mental health prob- However, the 6-item DJGS was validated in both Western lems during adulthood. We conducted an additional analysis and non-Western participants (Chiao et al., 2019; de Jong showing that AAEs were significantly associated with both Gierveld, & Van Tiburg, 2010; Leung et al., 2008). Second, feelings of loneliness in middle and high school (results not to present our results more concisely, we limited our anal- shown), which in turn were related to serious loneliness ysis to feelings of loneliness across various life stages and during emerging adulthood. its effects on adult loneliness by adjusting for individual In addition, this study also showed that the one-item and demographic characteristics as covariates. However, the measure of feelings of loneliness is a significant predictor Belsky developmental model proposes that it should be pos- of the loneliness construct. The results of the EFA suggest sible to distinguish the cumulative effects of feeling lonely that the 1-item loneliness feeling loads on the latent struc- across all life stages. Future research is needed to specif- ture of ‘‘emotional loneliness’’ along with the original three ically identify the complex effects of cumulative negative items of the emotional domain from the DJGS (Appendix emotions and how adverse experiences during early life may 1), which CFA corroborated. These findings, along with our influence the development of loneliness during later life. findings from the regression models, suggest that this single Third, while prior studies have suggested that the influ- item of feeling lonely may be a valid measure for emotional ence of family dynamics and friendship are important in loneliness. To further support this conclusion, we conducted relation to loneliness (Rico-Uribe, Caballero, Olaya, Tobiasz- additional series of analyses to valid this possibility. Sug- Adamczyk, & Koskinen, 2016), such information was not gested by prior studies (Davey, Barratt, Butow, & Deeks, available in the present investigation. Fourth, attrition is 2007), our analysis showed that this single item of feeling always a matter of great concern when using a panel sam- lonely was positively associated with alcohol use and low ple. In the present context, the participants with missing self-esteem (results not shown).Therefore, our results not data are more likely to be suffering from mental health only suggest that this single item may be a valid indicator of problems. emotional loneliness, but that it also echoes the suspicions Nevertheless, to our knowledge this is the first report of Cacioppo, Hughes, Waite, Hawkley, & Thisted, 2006 that exploring AAEs and their longitudinal association with the loneliness and depressive symptomatology are often con- latent structure of loneliness during emerging adulthood in flated together because this single item is derived from the a non-Western society. This study extends the existing lit- depressive symptoms scale (Derogatis, 2000). erature by showing that AAE is associated with loneliness Our results further confirm previous research showing during adulthood. In addition, we employed a life-course the benefit of education by the decreased risk of Taiwanese perspective to examine feeling lonely across various life adults becoming severe emotional/social loners when they stage (middle school, high school, and college) and found had a 4-year college degree. Prior research largely explored them to be related additively to the development of both the effect of educational disparities on mental health, emotional and social loneliness during emerging adulthood. mostly depression (Shen, 2020; Todd & Teitler, 2019), and Furthermore, the validation analysis of the use of a single our study extends these results to loneliness among young item as an outcome afforded us a better insight into the con- Please cite this article in press as: Lin, W. -H., & Chiao, C. Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006 +Model IJCHP-195; No. of Pages 10 ARTICLE IN PRESS Adverse adolescence experiences 9 ceptual separation when using the single item for loneliness Cacioppo, J. T., & Cacioppo, S. (2018). The growing prob- versus the 6-item DJGS. lem of loneliness. Lancet, 3, 426. http://dx.doi.org/ 10.1016/S0140-6736(18)30142-9 Cacioppo, J. T., Hawkley, L. C., Ernst, J. M., Burleson, M., Berntson, G. G., Nouriani, B., & Spiegel, D. (2006). Funding Loneliness within a nomological net: An evolutionary per- spective. Journal of Research in Personality, 40, 1054---1085. This study was funded by Ministry of Science and Technology http://dx.doi.org/10.1016/j.jrp.2005.11.007 in Taiwan under grants 108-2410-H-010-014, 107-2511-H- Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., 010-001-MY2 and 109-2410-H-010-006-MY2. The conclusions & Thisted, R. A. (2006). Loneliness as a specific risk fac- herein are those of the authors and do not represent the tor for depressive symptoms: Cross-sectional and longitudinal viewpoint of the Ministry. analyses. 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Adverse adolescence experiences, feeling lonely across life stages and loneliness in adulthood. International Journal of Clinical and Health Psychology (2020), https://doi.org/10.1016/j.ijchp.2020.07.006