{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:36:19Z","timestamp":1790404579362,"version":"4.1.0"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T00:00:00Z","timestamp":1657065600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003710","name":"korea health industry development institute","doi-asserted-by":"publisher","award":["HI18C1284"],"award-info":[{"award-number":["HI18C1284"]}],"id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Owing to the COVID-19 outbreak, older adults living alone, who can only connect socially outside their homes, are at risk of social isolation and poor mental health. This study aimed to identify the changes, before and after COVID-19, by sex and age, in social relationships (social activity, social network, and social support) and mental health (depression and suicide ideation) among older adults living alone.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a prospective cohort study of community-dwelling older adults who were at least 65 years old and living alone in South Korea. The study was conducted during 2018\u20132020 with 2,291 participants (795, 771, and 725 for the 1st to 3rd waves, respectively). The data were collected via face-to-face interviews. A generalized linear mixed modeling framework was used to test for changes over three years.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Social activity was reduced after the COVID-19, with an interaction effect of sex: older women (odds ratio [OR], 0.19; 95% confidence interval [CI], 0.15\u20130.23; <jats:italic>p<\/jats:italic> &lt; .001) showed greater reduction than older men (OR, 0.50; 95% CI, 0.34\u20130.75; <jats:italic>p<\/jats:italic> &lt; .001). Interaction with neighbors also reduced after the pandemic, but there was no significant evidence of interaction effects. Interaction with family members increased in both sexes during the pandemic, with the interaction effect of sex: older women (OR, 1.40; 95% CI, 1.11\u20131.76; <jats:italic>p<\/jats:italic> = .004) showed greater increase than men (OR, 1.55; 95% CI, 1.13\u20132.14; <jats:italic>p<\/jats:italic> = .007). Social support increased in both sexes during the pandemic, but there was no significant evidence of interaction effects. Depression and suicide ideation showed no significant differences before and after the pandemic.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>The findings provide health administrators and health providers with explorative insights into the impact of the COVID-19 on social relationships and mental health among older adults living alone and can guide further studies of interventions considering specific properties of social relationships.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0270260","type":"journal-article","created":{"date-parts":[[2022,7,6]],"date-time":"2022-07-06T17:40:53Z","timestamp":1657129253000},"page":"e0270260","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["Impact of COVID-19 on the social relationships and mental health of older adults living alone: A two-year prospective cohort 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Korea","year":"2019"},{"issue":"2","key":"pone.0270260.ref003","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/1745691614568352","article-title":"Loneliness and social isolation as risk factors for mortality: a meta-analytic review.","volume":"10","author":"J Holt-Lunstad","year":"2015","journal-title":"Perspect Psychol Sci"},{"key":"pone.0270260.ref004","volume-title":"Social isolation and loneliness in older adults: opportunities for the health care system.","author":"National Academies of Sciences, Engineering, and Medicine.","year":"2020"},{"issue":"13","key":"pone.0270260.ref005","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1136\/heartjnl-2015-308790","article-title":"Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies","volume":"102","author":"NK Valtorta","year":"2016","journal-title":"Heart"},{"issue":"s1","key":"pone.0270260.ref006","doi-asserted-by":"crossref","first-page":"S119","DOI":"10.3233\/JAD-180501","article-title":"Social isolation and cognitive function in later life: a systematic review and meta-analysis","volume":"70","author":"IEM Evans","year":"2019","journal-title":"J Alzheimers Dis"},{"issue":"8","key":"pone.0270260.ref007","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1017\/S0144686X18000132","article-title":"Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health","volume":"39","author":"KJ Smith","year":"2019","journal-title":"Ageing Soc"},{"issue":"1","key":"pone.0270260.ref008","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1111\/aswp.12193","article-title":"Social participation, health\u2010related behavior, and depression of older adults living alone in Korea.","volume":"14","author":"S Won","year":"2020","journal-title":"Asian Soc Work Policy Rev"},{"key":"pone.0270260.ref009","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/med:psych\/9780195126709.003.0001","volume-title":"Social support measurement and intervention: A guide for health and social scientist","author":"S Cohen","year":"2000"},{"key":"pone.0270260.ref010","first-page":"189","volume-title":"Health behavior and health education: theory, research, and practice","author":"CA Heaney","year":"2008"},{"issue":"1","key":"pone.0270260.ref011","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/BF01107897","article-title":"Social support and social structure","volume":"2","author":"JS House","year":"1987","journal-title":"Sociol Forum"},{"issue":"4","key":"pone.0270260.ref012","first-page":"1169","article-title":"Social relationships and cognitive decline: a systematic review and meta-analysis of longitudinal cohort studies.","volume":"45","author":"JS Kuiper","year":"2016","journal-title":"Int J Epidemiol"},{"key":"pone.0270260.ref013","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.jad.2014.12.049","article-title":"The association between social relationships and depression: a systematic review","volume":"175","author":"ZI Santini","year":"2015","journal-title":"J Affect Disord"},{"issue":"2","key":"pone.0270260.ref014","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1136\/jnnp-2012-302755","article-title":"Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL).","volume":"85","author":"TJ Holwerda","year":"2014","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"15","key":"pone.0270260.ref015","doi-asserted-by":"crossref","first-page":"5797","DOI":"10.1073\/pnas.1219686110","article-title":"Social isolation, loneliness, and all-cause mortality in older men and women","volume":"110","author":"A Steptoe","year":"2013","journal-title":"Proc Natl Acad Sci USA"},{"issue":"7","key":"pone.0270260.ref016","doi-asserted-by":"crossref","first-page":"e1000316","DOI":"10.1371\/journal.pmed.1000316","article-title":"Social relationships and mortality risk: a meta-analytic review.","volume":"7","author":"J Holt-Lunstad","year":"2010","journal-title":"PLoS Med"},{"issue":"11","key":"pone.0270260.ref017","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1016\/j.jamda.2019.02.021","article-title":"Poor social network, not living alone, is associated with incidence of adverse health outcomes in older adults","volume":"20","author":"R Sakurai","year":"2019","journal-title":"J Am Med Dir Assoc"},{"issue":"1","key":"pone.0270260.ref018","doi-asserted-by":"crossref","first-page":"e132","DOI":"10.1093\/cid\/ciaa672","article-title":"Impact of public health interventions on seasonal influenza activity during the COVID-19 outbreak in Korea","volume":"73","author":"H Lee","year":"2021","journal-title":"Clin Infect Dis"},{"key":"pone.0270260.ref019","author":"DS Reher","year":"2020","journal-title":"The COVID-19 pandemic in an aging world"},{"issue":"4","key":"pone.0270260.ref020","doi-asserted-by":"crossref","first-page":"229","DOI":"10.4235\/agmr.20.0096","article-title":"Care inequality among older adults during the COVID-19 pandemic.","volume":"24","author":"SN Jang","year":"2020","journal-title":"Ann Geriatr Med Res"},{"issue":"9","key":"pone.0270260.ref021","doi-asserted-by":"crossref","first-page":"e2019686","DOI":"10.1001\/jamanetworkopen.2020.19686","article-title":"Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic","volume":"3","author":"CK Ettman","year":"2020","journal-title":"JAMA Netw Open"},{"issue":"10","key":"pone.0270260.ref022","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1080\/13607863.2016.1191060","article-title":"Living alone and depression: the modifying role of the perceived neighborhood environment.","volume":"21","author":"ST Stahl","year":"2017","journal-title":"Aging Ment Health"},{"issue":"1","key":"pone.0270260.ref023","doi-asserted-by":"crossref","first-page":"19","DOI":"10.2190\/PM.43.1.b","article-title":"Living arrangements and risk for late life depression: a meta-analysis of published literature","volume":"43","author":"H Xiu-Ying","year":"2012","journal-title":"Int J Psychiatry Med"},{"issue":"6","key":"pone.0270260.ref024","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1192\/bjp.bp.112.110130","article-title":"Factors associated with suicidal thoughts in a large community study of older adults.","volume":"201","author":"OP Almeida","year":"2012","journal-title":"Br J Psychiatry"},{"issue":"7","key":"pone.0270260.ref025","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/S2215-0366(21)00091-2","article-title":"Suicide trends in the early months of the COVID-19 pandemic: an interrupted time-series analysis of preliminary data from 21 countries","volume":"8","author":"J Pirkis","year":"2021","journal-title":"Lancet Psychiatry"},{"issue":"10312","key":"pone.0270260.ref026","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/S0140-6736(21)02143-7","article-title":"Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic","volume":"398","author":"DF Santomauro","year":"2021","journal-title":"Lancet"},{"key":"pone.0270260.ref027","doi-asserted-by":"crossref","first-page":"691","DOI":"10.2147\/CIA.S130670","article-title":"Suicide in older adults: current perspectives","volume":"13","author":"I Conejero","year":"2018","journal-title":"Clin Interv Aging"},{"key":"pone.0270260.ref028","first-page":"65","volume-title":"A demographic perspective on gender, family and health in Europe","author":"Springer","year":"2018"},{"key":"pone.0270260.ref029","doi-asserted-by":"crossref","first-page":"742","DOI":"10.1016\/j.ijid.2021.02.004","article-title":"Comparison of the second and third waves of the COVID-19 pandemic in South Korea: importance of early public health intervention","volume":"104","author":"H Seong","year":"2021","journal-title":"Int J Infect Dis"},{"key":"pone.0270260.ref030","unstructured":"Ministry of Health and Welfare. IMS meeting for novel coronavirus presided over by the prime minister [internet]. Sejong (KR); 2020 Feb 13 [cited 2021 Nov 20]. Available from: https:\/\/www.mohw.go.kr\/eng\/nw\/nw0101vw.jsp?PAR_MENU_ID=1007&MENU_ID=100701&page=1&CONT_SEQ=352865."},{"key":"pone.0270260.ref031","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.archger.2019.05.009","article-title":"Gender differences in health status, quality of life, and community service needs of older adults living alone","volume":"83","author":"H Ko","year":"2019","journal-title":"Arch Gerontol Geriatr"},{"issue":"2","key":"pone.0270260.ref032","doi-asserted-by":"crossref","first-page":"825","DOI":"10.3390\/ijerph18020825","article-title":"Development of a Community-Based Integrated Service Model of health and social care for older adults living alone","volume":"18","author":"YM Yi","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0270260.ref033","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1016\/j.gerinurse.2021.10.006","article-title":"Effectiveness of a community-based integrated service model for older adults living alone: A nonrandomized prospective study","volume":"42","author":"EY Noh","year":"2021","journal-title":"Geriatr Nurs"},{"key":"pone.0270260.ref034","article-title":"2017 survey of living conditions and welfare needs of Korean older persons [internet]","year":"2018","journal-title":"Ministry of Health and Welfare of South Korea"},{"issue":"2","key":"pone.0270260.ref035","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1093\/geront\/gnp103","article-title":"Changes in social participation and volunteer activity among recently widowed older adults","volume":"50","author":"EA Donnelly","year":"2010","journal-title":"Gerontologist"},{"key":"pone.0270260.ref036","unstructured":"Ministry of Health Welfare [internet]. Care service for older adults. 2017 [cited 2021 Nov 20]. Available from: http:\/\/www.mohw.go.kr\/react\/jb\/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=338646."},{"issue":"4","key":"pone.0270260.ref037","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1037\/a0022826","article-title":"Loneliness, social isolation, and behavioral and biological health indicators in older adults","volume":"30","author":"A Shankar","year":"2011","journal-title":"Health Psychol"},{"issue":"2","key":"pone.0270260.ref038","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4235\/jkgs.2012.16.2.84","article-title":"Social support, social network, and frailty in Korean elderly","volume":"16","author":"GS Jeon","year":"2012","journal-title":"J Korean Geriatr Soc"},{"issue":"6","key":"pone.0270260.ref039","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1097\/00008483-200311000-00001","article-title":"A short social support measure for patients recovering from myocardial infarction: the ENRICHD social support 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