{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T14:39:24Z","timestamp":1781361564918,"version":"3.54.1"},"reference-count":51,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,5,1]],"date-time":"2025-05-01T00:00:00Z","timestamp":1746057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000913","name":"James S McDonnell Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000913","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Public Health"],"published-print":{"date-parts":[[2025,5]]},"DOI":"10.1016\/j.puhe.2025.02.037","type":"journal-article","created":{"date-parts":[[2025,4,1]],"date-time":"2025-04-01T16:26:07Z","timestamp":1743524767000},"page":"272-277","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":10,"special_numbering":"C","title":["Associations amongst poverty, loneliness, and a defensive symptom cluster characterised by pain, fatigue, and low mood"],"prefix":"10.1016","volume":"242","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-7768","authenticated-orcid":false,"given":"Arran J.","family":"Davis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Nettle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.puhe.2025.02.037_bib1","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1086\/668207","article-title":"Two key steps in the evolution of human cooperation: the interdependence hypothesis","volume":"53","author":"Tomasello","year":"2012","journal-title":"Curr Anthropol"},{"key":"10.1016\/j.puhe.2025.02.037_bib2","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1111\/j.1751-9004.2011.00400.x","article-title":"Social baseline theory: the role of social proximity in emotion and economy of action","volume":"5","author":"Beckes","year":"2011","journal-title":"Soc. Pers. Psychol. Compass"},{"key":"10.1016\/j.puhe.2025.02.037_bib3","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1146\/annurev-clinpsy-032816-045159","article-title":"Social safety theory: a biologically based evolutionary perspective on life stress, health, and behavior","volume":"16","author":"Slavich","year":"2020","journal-title":"Annu Rev Clin Psychol"},{"key":"10.1016\/j.puhe.2025.02.037_bib4","doi-asserted-by":"crossref","first-page":"eaax9553","DOI":"10.1126\/science.aax9553","article-title":"Social determinants of health and survival in humans and other animals","volume":"368","author":"Snyder-Mackler","year":"2020","journal-title":"Science"},{"key":"10.1016\/j.puhe.2025.02.037_bib5","series-title":"Health Behavior and Health Education: Theory, Research, and Practice","article-title":"Social support and health","author":"Holt-Lunstad","year":"2015"},{"key":"10.1016\/j.puhe.2025.02.037_bib6","series-title":"Placebo Effects in Sport and Exercise","first-page":"45","article-title":"Are placebo effects special?","author":"Cohen","year":"2023"},{"key":"10.1016\/j.puhe.2025.02.037_bib7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1080\/17437199.2023.2171900","article-title":"Social Safety Theory: conceptual foundation, underlying mechanisms, and future directions","volume":"17","author":"Slavich","year":"2023","journal-title":"Health Psychol Rev"},{"key":"10.1016\/j.puhe.2025.02.037_bib8","doi-asserted-by":"crossref","first-page":"948","DOI":"10.1037\/a0034012","article-title":"Pain, depression, and fatigue: loneliness as a longitudinal risk factor","volume":"33","author":"Jaremka","year":"2014","journal-title":"Health Psychol"},{"key":"10.1016\/j.puhe.2025.02.037_bib9","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1177\/0956797612464059","article-title":"Loneliness promotes inflammation during acute stress","volume":"24","author":"Jaremka","year":"2013","journal-title":"Psychol Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib10","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1037\/a0017216","article-title":"Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study","volume":"25","author":"Cacioppo","year":"2010","journal-title":"Psychol Aging"},{"key":"10.1016\/j.puhe.2025.02.037_bib11","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1037\/a0035302","article-title":"From stress to inflammation and major depressive disorder: a social signal transduction theory of depression","volume":"140","author":"Slavich","year":"2014","journal-title":"Psychol Bull"},{"key":"10.1016\/j.puhe.2025.02.037_bib12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fphys.2012.00082","article-title":"Fatigue is a brain-derived emotion that regulates the exercise behavior to ensure the protection of whole body homeostasis","volume":"3","author":"Noakes","year":"2012","journal-title":"Front Physiol"},{"key":"10.1016\/j.puhe.2025.02.037_bib13","doi-asserted-by":"crossref","DOI":"10.3389\/fnins.2013.00046","article-title":"Pain, decisions, and actions: a motivational perspective","volume":"7","author":"Wiech","year":"2013","journal-title":"Front Neurosci"},{"key":"10.1016\/j.puhe.2025.02.037_bib14","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.bbi.2015.05.008","article-title":"Depression as sickness behavior? A test of the host defense hypothesis in a high pathogen population","volume":"49","author":"Stieglitz","year":"2015","journal-title":"Brain Behav Immun"},{"key":"10.1016\/j.puhe.2025.02.037_bib15","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1016\/j.genhosppsych.2009.04.002","article-title":"The longitudinal effects of depression on physical activity","volume":"31","author":"Roshanaei-Moghaddam","year":"2009","journal-title":"Gen Hosp Psychiatry"},{"key":"10.1016\/j.puhe.2025.02.037_bib16","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/02699931.2013.837379","article-title":"Evolutionary mechanisms for loneliness","volume":"28","author":"Cacioppo","year":"2014","journal-title":"Cognit Emot"},{"key":"10.1016\/j.puhe.2025.02.037_bib17","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.appet.2017.01.016","article-title":"Eating moderates the link between body mass index and perceived social connection","volume":"112","author":"Jaremka","year":"2017","journal-title":"Appetite"},{"key":"10.1016\/j.puhe.2025.02.037_bib18","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.psyneuen.2013.12.016","article-title":"Social support predicts inflammation, pain, and depressive symptoms: longitudinal relationships among breast cancer survivors","volume":"42","author":"Hughes","year":"2014","journal-title":"Psychoneuroendocrinology"},{"key":"10.1016\/j.puhe.2025.02.037_bib19","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1177\/0956797615625640","article-title":"Economic insecurity increases physical pain","volume":"27","author":"Chou","year":"2016","journal-title":"Psychol Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib20","series-title":"Deaths of Despair and the Future of Capitalism","author":"Case","year":"2020"},{"key":"10.1016\/j.puhe.2025.02.037_bib21","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1002\/ejp.1409","article-title":"The European epidemic: pain prevalence and socioeconomic inequalities in pain across 19 European countries","volume":"23","author":"Todd","year":"2019","journal-title":"Eur J Pain"},{"key":"10.1016\/j.puhe.2025.02.037_bib22","first-page":"1","article-title":"Short\u2010term changes in financial situation have immediate mental health consequences: implications for social policy","author":"Nettle","year":"2024","journal-title":"Soc Pol Adm"},{"key":"10.1016\/j.puhe.2025.02.037_bib23","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s11205-014-0858-5","article-title":"For whom money matters less: social connectedness as a resilience resource in the UK","volume":"125","author":"Richards","year":"2016","journal-title":"Soc Indic Res"},{"key":"10.1016\/j.puhe.2025.02.037_bib24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s11524-012-9757-8","article-title":"Reconsidering the effects of poverty and social support on health: a 5-year longitudinal test of the stress-buffering hypothesis","volume":"90","author":"Moskowitz","year":"2013","journal-title":"J Urban Health"},{"key":"10.1016\/j.puhe.2025.02.037_bib25","doi-asserted-by":"crossref","first-page":"17149","DOI":"10.1073\/pnas.1315458110","article-title":"Childhood Abuse, Parental Warmth, and Adult Multisystem Biological Risk in the Coronary Artery Risk Development in Young Adults Study","volume":"110","author":"Carroll","year":"2013","journal-title":"Proc Natl Acad Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib26","series-title":"Handbook of adult resilience","first-page":"213","article-title":"Resilience over the lifespan: Developmental perspectives on resistance, recovery, and transformation","author":"Masten","year":"2010"},{"key":"10.1016\/j.puhe.2025.02.037_bib27","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.1086\/663574","article-title":"Disposable ties and the urban poor","volume":"117","author":"Desmond","year":"2012","journal-title":"Am J Sociol"},{"key":"10.1016\/j.puhe.2025.02.037_bib28","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1177\/0002716220911913","article-title":"Relationships stretched thin: social support mobilization in poverty","volume":"689","author":"Lubbers","year":"2020","journal-title":"Ann Am Acad Polit Soc Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib29","unstructured":"Berlingieri F., Colagrossi M., Mauri C. Loneliness and Social Connectedness: Insights from a New EU-wide Survey. European Commission. 2023:JRC133351. https:\/\/publications.jrc.ec.europa.eu\/repository\/handle\/JRC133351."},{"key":"10.1016\/j.puhe.2025.02.037_bib30","doi-asserted-by":"crossref","first-page":"20140114","DOI":"10.1098\/rstb.2014.0114","article-title":"Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach","volume":"370","author":"Hawkley","year":"2015","journal-title":"Phil Trans R Soc B"},{"key":"10.1016\/j.puhe.2025.02.037_bib31","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1097\/00006842-200205000-00005","article-title":"Loneliness and health: potential mechanisms","volume":"64","author":"Cacioppo","year":"2002","journal-title":"Psychosom Med"},{"key":"10.1016\/j.puhe.2025.02.037_bib32","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1037\/0022-3514.85.1.105","article-title":"Loneliness in everyday life: cardiovascular activity, psychosocial context, and health behaviors","volume":"85","author":"Hawkley","year":"2003","journal-title":"J Pers Soc Psychol"},{"key":"10.1016\/j.puhe.2025.02.037_bib33","author":"European Social Survey European Research Infrastructure"},{"key":"10.1016\/j.puhe.2025.02.037_bib34","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.puhe.2018.09.003","article-title":"Loneliness in the city\u2019: examining socio-economics, loneliness and poor health in the North East of England","volume":"165","author":"Macdonald","year":"2018","journal-title":"Public Health"},{"key":"10.1016\/j.puhe.2025.02.037_bib35","unstructured":"Bates D., Maechler M., Bolker B., Walker S. lme4: linear mixed-effects models using Eigen and S4. R package. 2014 https:\/\/cran.r-project.org\/package=lme4."},{"key":"10.1016\/j.puhe.2025.02.037_bib36","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1177\/1403494820987466","article-title":"The Gender Pain Gap: gender inequalities in pain across 19 European countries","volume":"50","author":"Bimpong","year":"2022","journal-title":"Scand J Publ Health"},{"key":"10.1016\/j.puhe.2025.02.037_bib37","doi-asserted-by":"crossref","unstructured":"Masur P.K., Scharkow M. Specr: Conducting and Visualizing Specification Curve Analyses. R package.2020. https:\/\/cran.r-project.org\/package=specr.","DOI":"10.32614\/CRAN.package.specr"},{"key":"10.1016\/j.puhe.2025.02.037_bib38","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1038\/s41562-020-0912-z","article-title":"Specification curve analysis","volume":"4","author":"Simonsohn","year":"2020","journal-title":"Nat Hum Behav"},{"key":"10.1016\/j.puhe.2025.02.037_bib39","series-title":"Tyneside Neighbourhoods: Deprivation, Social Life and Social Behaviour in One British City","author":"Nettle","year":"2015"},{"key":"10.1016\/j.puhe.2025.02.037_bib40","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1086\/229572","article-title":"Different strokes from different folks: community ties and social support","volume":"96","author":"Wellman","year":"1990","journal-title":"Am J Sociol"},{"key":"10.1016\/j.puhe.2025.02.037_bib41","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/0022146510395592","article-title":"Mechanisms linking social ties and support to physical and mental health","volume":"52","author":"Thoits","year":"2011","journal-title":"J Health Soc Behav"},{"key":"10.1016\/j.puhe.2025.02.037_bib42","series-title":"Handbook of the Sociology of Mental Health","first-page":"379","article-title":"The sense of personal control: social structural causes and emotional consequences","author":"Ross","year":"2013"},{"key":"10.1016\/j.puhe.2025.02.037_bib43","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/0002764298042001005","article-title":"Are all associations alike? Member diversity, associational type, and the creation of social capital","volume":"42","author":"Stolle","year":"1998","journal-title":"Am Behav Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib44","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1080\/17461391.2019.1635212","article-title":"You don\u2019t need to administer a placebo to elicit a placebo effect: social factors trigger neurobiological pathways to enhance sports performance","author":"Davis","year":"2020","journal-title":"Eur J Sport Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib45","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1353\/hpu.0.0255","article-title":"Race, ethnicity, and pain among the US adult population","volume":"21","author":"Shavers","year":"2010","journal-title":"J Health Care Poor Underserved"},{"key":"10.1016\/j.puhe.2025.02.037_bib46","series-title":"Weathering: The Extraordinary Stress of Ordinary Life in an Unjust Society","author":"Geronimus","year":"2023"},{"key":"10.1016\/j.puhe.2025.02.037_bib47","doi-asserted-by":"crossref","first-page":"eadd3715","DOI":"10.1126\/sciadv.add3715","article-title":"Social bonds are related to health behaviors and positive well-being globally","volume":"9","author":"Tun\u00e7gen\u00e7","year":"2023","journal-title":"Sci Adv"},{"key":"10.1016\/j.puhe.2025.02.037_bib48","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1177\/09567976231156413","article-title":"Homeostatic regulation of energetic arousal during acute social isolation: evidence from the lab and the field","volume":"34","author":"Stijovic","year":"2023","journal-title":"Psychol Sci"},{"key":"10.1016\/j.puhe.2025.02.037_bib49","doi-asserted-by":"crossref","first-page":"11721","DOI":"10.1073\/pnas.1108239108","article-title":"Attachment figures activate a safety signal-related neural region and reduce pain experience","volume":"108","author":"Eisenberger","year":"2011","journal-title":"Proc Natl Acad Sci U S A."},{"key":"10.1016\/j.puhe.2025.02.037_bib50","doi-asserted-by":"crossref","first-page":"113490","DOI":"10.1016\/j.physbeh.2021.113490","article-title":"Effects of social support on performance outputs and perceived difficulty during physical exercise","volume":"239","author":"Davis","year":"2021","journal-title":"Physiol Behav"},{"key":"10.1016\/j.puhe.2025.02.037_bib51","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1037\/a0014400","article-title":"Loneliness predicts reduced physical activity: cross-sectional & longitudinal analyses","volume":"28","author":"Hawkley","year":"2009","journal-title":"Health Psychol"}],"container-title":["Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0033350625001209?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0033350625001209?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T02:49:14Z","timestamp":1757645354000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0033350625001209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5]]},"references-count":51,"alternative-id":["S0033350625001209"],"URL":"https:\/\/doi.org\/10.1016\/j.puhe.2025.02.037","relation":{},"ISSN":["0033-3506"],"issn-type":[{"value":"0033-3506","type":"print"}],"subject":[],"published":{"date-parts":[[2025,5]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Associations amongst poverty, loneliness, and a defensive symptom cluster characterised by pain, fatigue, and low mood","name":"articletitle","label":"Article Title"},{"value":"Public Health","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.puhe.2025.02.037","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health.","name":"copyright","label":"Copyright"}]}}