{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:40:13Z","timestamp":1787236813039,"version":"build-2736575974"},"reference-count":75,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,18]],"date-time":"2021-09-18T00:00:00Z","timestamp":1631923200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003093","name":"Ministry of Higher Education, Malaysia","doi-asserted-by":"publisher","award":["Higher Institution Centre of Excellence (HICoE) grant"],"award-info":[{"award-number":["Higher Institution Centre of Excellence (HICoE) grant"]}],"id":[{"id":"10.13039\/501100003093","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Studies showed that introversion is the strongest personality trait related to perceived social isolation (loneliness), which can predict various complications beyond objective isolation such as living alone. Lonely individuals are more likely to resort to social media for instantaneous comfort, but it is not a perpetual solution. Largely negative implications including poorer interpersonal relationship and depression were reported due to excessive social media usage. Conversational task is an established intervention to improve verbal communication, cognitive and behavioral adaptation among lonely individuals. Despite that behavioral benefits have been reported, it is unclear if they are accompanied by objective benefits underlying physiological changes. Here, we investigate the physiological signals from 28 healthy individuals during a conversational task. Participants were ranked by trait extraversion, where greater introversion is associated with increased susceptibility to perceived social isolation as compared to participants with greater extraversion as controls. We found that introverts had a greater tendency to be neurotic, and these participants also exhibited significant differences in task-related electrodermal activity (EDA), heart rate (HR) and HR variability (HRV) as compared to controls. Notably, resting state HRV among individuals susceptible to perceived loneliness was below the healthy thresholds established in literature. Conversational task with a stranger significantly increased HRV among individuals susceptible to isolation up to levels as seen in controls. Since HRV is also elevated by physical exercise and administration of oxytocin hormone (one form of therapy for behavioral isolation), conversational therapy among introverts could potentially confer physiological benefits to ameliorate social isolation and loneliness. Our findings also suggest that although the recent pandemic has changed how people are interacting typically, we should maintain a healthy dose of social interaction innovatively.<\/jats:p>","DOI":"10.3390\/ijerph18189858","type":"journal-article","created":{"date-parts":[[2021,9,20]],"date-time":"2021-09-20T07:52:14Z","timestamp":1632124334000},"page":"9858","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Conversational Task Increases Heart Rate Variability of Individuals Susceptible to Perceived Social Isolation"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4206-442X","authenticated-orcid":false,"given":"Ying Xing","family":"Feng","sequence":"first","affiliation":[{"name":"Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"},{"name":"Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nur Syahirah","family":"Roslan","sequence":"additional","affiliation":[{"name":"Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"},{"name":"Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lila Iznita","family":"Izhar","sequence":"additional","affiliation":[{"name":"Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"},{"name":"Smart Assistive and Rehabilitative Technology (SMART) Research Group, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad","family":"Abdul Rahman","sequence":"additional","affiliation":[{"name":"UniKL Royal College of Medicine Perak, Ipoh 30450, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7777-1119","authenticated-orcid":false,"given":"Ibrahima","family":"Faye","sequence":"additional","affiliation":[{"name":"Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"},{"name":"Department of Fundamental and Applied Sciences, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7590-1028","authenticated-orcid":false,"given":"Eric Tatt Wei","family":"Ho","sequence":"additional","affiliation":[{"name":"Centre for Intelligent Signal and Imaging Research (CISIR), Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"},{"name":"Department of Electrical and Electronic Engineering, Universiti Teknologi PETRONAS, Bandar Seri Iskandar 32610, Perak, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1126\/science.3399889","article-title":"Social relationships and health","volume":"241","author":"House","year":"1988","journal-title":"Science"},{"key":"ref_2","first-page":"22","article-title":"The rewarding nature of social interactions","volume":"4","author":"Krach","year":"2010","journal-title":"Front. Behav. Neurosci."},{"key":"ref_3","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":"Steptoe","year":"2013","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_4","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":"Smith","year":"2015","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1045","DOI":"10.1007\/s10802-010-9426-x","article-title":"Early Adolescent Depressive Symptoms: Prediction from Clique Isolation, Loneliness, and Perceived Social Acceptance","volume":"38","author":"Witvliet","year":"2010","journal-title":"J. Abnorm. Child Psychol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1037\/0882-7974.21.1.140","article-title":"Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses","volume":"21","author":"Cacioppo","year":"2006","journal-title":"Psychol. Aging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/0191-8869(89)90011-1","article-title":"Personality predictors of loneliness","volume":"10","author":"Saklofske","year":"1989","journal-title":"Personal. Individ. Differ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/0191-8869(86)90091-7","article-title":"Personality and loneliness","volume":"7","author":"Saklofske","year":"1986","journal-title":"Personal. Individ. Differ."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1002\/per.2229","article-title":"Loneliness and the Big Five Personality Traits: A Meta-analysis","volume":"34","author":"Buecker","year":"2020","journal-title":"Eur. J. Personal."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1037\/a0034950","article-title":"Personality and self-insight in individuals with autism spectrum disorder","volume":"106","author":"Schriber","year":"2014","journal-title":"J. Personal. Soc. Psychol."},{"key":"ref_11","unstructured":"Grimes, J. (2010). Introversion and Autism: A Conceptual Exploration of the Placement of Introversion on the Autism Spectrum. [Master\u2019s Thesis, University of Central Florida]."},{"key":"ref_12","first-page":"59","article-title":"Social media and higher education: Introversion and collaborative learning from the student\u2019s perspective","volume":"1","author":"Voorn","year":"2013","journal-title":"Int. J. Soc. Media Interact. Learn. Environ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"109934","DOI":"10.1016\/j.paid.2020.109934","article-title":"Extraversion rather than neuroticism is the dominant trait predictor of forecasted affect in relation to social situations","volume":"160","author":"Spark","year":"2020","journal-title":"Personal. Individ. Differ."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.chb.2014.04.011","article-title":"Does Facebook make you lonely?: A meta analysis","volume":"36","author":"Song","year":"2014","journal-title":"Comput. Hum. Behav."},{"key":"ref_15","first-page":"237","article-title":"The relationship of Internet use to depression and social isolation among adolescents","volume":"35","author":"Sanders","year":"2000","journal-title":"Adolescence"},{"key":"ref_16","first-page":"203","article-title":"Association of Facebook Use With Compromised Well-Being: A Longitudinal Study","volume":"185","author":"Shakya","year":"2017","journal-title":"Am. J. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.tics.2009.06.005","article-title":"Perceived social isolation and cognition","volume":"13","author":"Cacioppo","year":"2009","journal-title":"Trends Cogn. Sci."},{"key":"ref_18","first-page":"2661","article-title":"Social vocalizations can release oxytocin in humans","volume":"277","author":"Seltzer","year":"2010","journal-title":"Proc. Biol. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.evolhumbehav.2011.05.004","article-title":"Instant messages vs. speech: Hormones and why we still need to hear each other","volume":"33","author":"Seltzer","year":"2012","journal-title":"Evol. Hum. Behav."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2466\/pr0.1982.51.1.103","article-title":"Treatment of Social Isolation and Loneliness in a Sample of Visually Impaired Elderly Persons","volume":"51","author":"Evans","year":"1982","journal-title":"Psychol. Rep."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1037\/0022-006X.46.2.239","article-title":"Multimodal evaluation of practice interactions as treatment for social isolation","volume":"46","author":"Royce","year":"1978","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"561609","DOI":"10.3389\/fpsyg.2020.561609","article-title":"Social Distancing and Lockdown\u2014An Introvert\u2019s Paradise? An Empirical Investigation on the Association Between Introversion and the Psychological Impact of COVID19-Related Circumstantial Changes","volume":"11","author":"Wei","year":"2020","journal-title":"Front. Psychol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1017\/S0144686X04002594","article-title":"Preventing social isolation and loneliness among older people: A systematic review of health promotion interventions","volume":"25","author":"Cattan","year":"2005","journal-title":"Ageing Soc."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.biopsycho.2014.12.012","article-title":"Heart rate variability during adolescent and adult social interactions: A meta-analysis","volume":"105","author":"Shahrestani","year":"2015","journal-title":"Biol. Psychol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1111\/hsc.12367","article-title":"Interventions to reduce social isolation and loneliness among older people: An integrative review","volume":"26","author":"Gardiner","year":"2018","journal-title":"Health Soc. Care Community"},{"key":"ref_26","first-page":"2331216516678706","article-title":"A Flexible Question-and-Answer Task for Measuring Speech Understanding","volume":"20","author":"Best","year":"2016","journal-title":"Trends Hear."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1109\/JPROC.2012.2236291","article-title":"Behavioral Signal Processing: Deriving Human Behavioral Informatics From Speech and Language: Computational techniques are presented to analyze and model expressed and perceived human behavior-variedly characterized as typical, atypical, distressed, and disordered-from speech and language cues and their applications in health, commerce, education, and beyond","volume":"101","author":"Narayanan","year":"2013","journal-title":"Proc. IEEE. Inst. Electr. Electron. Eng."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1088\/0967-3334\/32\/10\/002","article-title":"Comparison of blood volume pulse and skin conductance responses to mental and affective stimuli at different anatomical sites","volume":"32","author":"Kushki","year":"2011","journal-title":"Physiol. Meas."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fpubh.2017.00258","article-title":"An Overview of Heart Rate Variability Metrics and Norms","volume":"5","author":"Shaffer","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"816","DOI":"10.1097\/00005768-199906000-00009","article-title":"Exercise training and heart rate variability in older people","volume":"31","author":"Schuit","year":"1999","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1016\/0002-9149(87)90795-8","article-title":"Decreased heart rate variability and its association with increased mortality after acute myocardial infarction","volume":"59","author":"Kleiger","year":"1987","journal-title":"Am. J. Cardiol."},{"key":"ref_32","unstructured":"John, O.P., and Srivastava, S. (1999). The Big Five Trait taxonomy: History, measurement, and theoretical perspectives. Handbook of Personality: Theory and Research, Guilford Press. [2nd ed.]."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Eysenck, H.J., and Eysenck, S.B.G. (1976). Eysenck Personality Questionnaire, Educational and Industrial Testing Service.","DOI":"10.1037\/t05462-000"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Khazan, I.Z. (2013). The Clinical Handbook of Biofeedback: A Step-by-Step Guide for Training and Practice with Mindfulness, John Wiley & Sons.","DOI":"10.1002\/9781118485309"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"634","DOI":"10.3109\/03091900903150998","article-title":"A comparison of photoplethysmography and ECG recording to analyse heart rate variability in healthy subjects","volume":"33","author":"Lu","year":"2009","journal-title":"J. Med. Eng. Technol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1037\/a0024338","article-title":"Effect size estimates: Current use, calculations, and interpretation","volume":"141","author":"Fritz","year":"2012","journal-title":"J. Exp. Psychol. Gen."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.2044-8295.1981.tb02158.x","article-title":"Social desirability in the Eysenck Personality Inventory","volume":"72","author":"Dunnett","year":"1981","journal-title":"Br. J. Psychol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/s00221-014-4097-4","article-title":"Neuroticism and extraversion mediate the association between loneliness and the dorsolateral prefrontal cortex","volume":"233","author":"Kong","year":"2015","journal-title":"Exp. Brain Res."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"42","DOI":"10.7748\/ns.21.49.42.s51","article-title":"Detecting changes in the respiratory status of ward patients","volume":"21","author":"Kennedy","year":"2007","journal-title":"Nurs. Stand."},{"key":"ref_40","first-page":"193","article-title":"Quantifying driver stress: Developing a system for collecting and processing bio-metric signals in natural situations","volume":"35","author":"Healey","year":"1999","journal-title":"Biomed. Sci. Instrum."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1002\/evan.20032","article-title":"Increased breathing control: Another factor in the evolution of human language","volume":"13","author":"Maclarnon","year":"2004","journal-title":"Evol. Anthropol. Issues News Rev."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Dawson, M.E., Schell, A.M., and Filion, D.L. (2016). The electrodermal system. Handbook of Psychophysiology, Cambridge University Press. [4th ed.].","DOI":"10.1017\/9781107415782.010"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"3138","DOI":"10.1038\/s41598-018-21518-3","article-title":"Biosignals reflect pair-dynamics in collaborative work: EDA and ECG study of pair-programming in a classroom environment","volume":"8","author":"Ahonen","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1177\/001872088903100503","article-title":"A dynamic model of stress and sustained attention","volume":"31","author":"Hancock","year":"1989","journal-title":"Hum. Factors"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/0887-6185(89)90009-1","article-title":"Assessment of social phobia: Reliability of an impromptu speech task","volume":"3","author":"Beidel","year":"1989","journal-title":"J. Anxiety Disord."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.biopsych.2009.03.006","article-title":"Acute psychological stress reduces working memory-related activity in the dorsolateral prefrontal cortex","volume":"66","author":"Qin","year":"2009","journal-title":"Biol. Psychiatry"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1162\/089892902317361877","article-title":"The Psychophysiology of Real-Time Financial Risk Processing","volume":"14","author":"Lo","year":"2002","journal-title":"J. Cogn. Neurosci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/j.1365-2702.2011.03916.x","article-title":"Effects of music intervention with nursing presence and recorded music on psycho-physiological indices of cancer patient caregivers","volume":"21","author":"Lai","year":"2012","journal-title":"J. Clin. Nurs."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1162\/PRES_a_00226","article-title":"The Effects of Spatialized Sounds on the Sense of Presence in Auditory Virtual Environments: A Psychological and Physiological Study","volume":"24","author":"Kobayashi","year":"2015","journal-title":"Presence Teleoperators Virtual Environ."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/0301-0511(95)05161-9","article-title":"Psychophysiology and adaptive automation","volume":"42","author":"Byrne","year":"1996","journal-title":"Biol. Psychol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.jbi.2015.11.007","article-title":"Towards an automatic early stress recognition system for office environments based on multimodal measurements: A review","volume":"59","author":"Alberdi","year":"2016","journal-title":"J. Biomed. Inform."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1023\/A:1025062812374","article-title":"Paradoxical autonomic response to mental tasks in autism","volume":"33","author":"Toichi","year":"2003","journal-title":"J. Autism Dev. Disord."},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Brouwer, A.-M., van Schaik, M., van Erp, J., and Korteling, H. (2013, January 2\u20135). Neuroticism, extraversion and stress: Physiological correlates. Proceedings of the 2013 Humaine Association Conference on Affective Computing and Intelligent Interaction, Geneva, Switzerland.","DOI":"10.1109\/ACII.2013.77"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/0301-0511(95)05159-7","article-title":"Individual differences in cortisol responses to a laboratory speech task and their relationship to responses to stressful daily events","volume":"43","author":"Nicolson","year":"1996","journal-title":"Biol. Psychol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1161\/01.CIR.93.5.1043","article-title":"Heart rate variability: Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology","volume":"93","author":"Camm","year":"1996","journal-title":"Circulation"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.biopsycho.2010.11.006","article-title":"Oxytocin increases autonomic cardiac control: Moderation by loneliness","volume":"86","author":"Norman","year":"2011","journal-title":"Biol. Psychol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Kemp, A.H., Quintana, D.S., Kuhnert, R.-L., Griffiths, K., Hickie, I.B., and Guastella, A.J. (2012). Oxytocin increases heart rate variability in humans at rest: Implications for social approach-related motivation and capacity for social engagement. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0044014"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"517","DOI":"10.2165\/00007256-200333070-00004","article-title":"Heart rate monitoring","volume":"33","author":"Achten","year":"2003","journal-title":"Sport. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/0149-7634(94)00066-A","article-title":"Cardiac vagal tone: A physiological index of stress","volume":"19","author":"Porges","year":"1995","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1097\/01.psy.0000170341.88395.47","article-title":"Effects of partner support on resting oxytocin, cortisol, norepinephrine, and blood pressure before and after warm partner contact","volume":"67","author":"Grewen","year":"2005","journal-title":"Psychosom. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e15","DOI":"10.1016\/j.jveb.2014.09.050","article-title":"Intranasally administered oxytocin decreases heart rate and increases heart rate variability in dogs","volume":"9","author":"Kis","year":"2014","journal-title":"J. Vet. Behav. Clin. Appl. Res."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1023\/A:1024409732742","article-title":"Happiness in everyday life: The uses of experience sampling","volume":"4","author":"Csikszentmihalyi","year":"2003","journal-title":"J. Happiness Stud."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1462","DOI":"10.1016\/S0735-1097(00)00595-7","article-title":"Effects of controlled breathing, mental activity and mental stress with or without verbalization on heart rate variability","volume":"35","author":"Bernardi","year":"2000","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_64","first-page":"54","article-title":"Is There More to Blood Volume Pulse Than Heart Rate Variability, Respiratory Sinus Arrhythmia, and Cardiorespiratory Synchrony?","volume":"35","author":"Peper","year":"2007","journal-title":"Biofeedback"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"A412","DOI":"10.1289\/ehp.114-a412","article-title":"Tracing the origins of autism: A spectrum of new studies","volume":"114","author":"Szpir","year":"2006","journal-title":"Environ. Health Perspect."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1007\/s10803-006-0164-4","article-title":"Involvement or isolation? The social networks of children with autism in regular classrooms","volume":"37","author":"Chamberlain","year":"2007","journal-title":"J. Autism Dev. Disord."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"K\u00e4mpfen, F., Kohler, I.V., Ciancio, A., Bruine de Bruin, W., Maurer, J., and Kohler, H.-P. (2020). Predictors of mental health during the COVID-19 pandemic in the US: Role of economic concerns, health worries and social distancing. PLoS ONE, 15.","DOI":"10.1101\/2020.06.06.20124198"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1089\/cyber.2012.0553","article-title":"Lonely People Are No Longer Lonely on Social Networking Sites: The Mediating Role of Self-Disclosure and Social Support","volume":"16","author":"Lee","year":"2013","journal-title":"Cyberpsychol. Behav. Soc. Netw."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.amepre.2017.01.010","article-title":"Social Media Use and Perceived Social Isolation Among Young Adults in the U.S","volume":"53","author":"Primack","year":"2017","journal-title":"Am. J. Prev. Med."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1002\/da.22466","article-title":"Association between social media use and depression among U.S. young adults","volume":"33","author":"Lin","year":"2016","journal-title":"Depress. Anxiety"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1857","DOI":"10.1016\/j.chb.2011.04.008","article-title":"Internet use, happiness, social support and introversion: A more fine grained analysis of person variables and internet activity","volume":"27","author":"Mitchell","year":"2011","journal-title":"Comput. Hum. Behav."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1177\/1745691617713052","article-title":"Loneliness and social internet use: Pathways to reconnection in a digital world?","volume":"13","author":"Nowland","year":"2018","journal-title":"Perspect. Psychol. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1111\/j.1749-6632.2011.06028.x","article-title":"Social isolation","volume":"1231","author":"Cacioppo","year":"2011","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1053\/euhj.1998.1084","article-title":"Heart rate variability and heart rate in healthy volunteers. Is the female autonomic nervous system cardioprotective?","volume":"19","author":"Ramaekers","year":"1998","journal-title":"Eur. Heart J."},{"key":"ref_75","first-page":"146","article-title":"The effect of gender on heart rate variability in asthmatic and normal healthy adults","volume":"5","author":"Lutfi","year":"2011","journal-title":"Int. J. Health Sci."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9858\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:02:03Z","timestamp":1760166123000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,18]]},"references-count":75,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["ijerph18189858"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18189858","relation":{"has-preprint":[{"id-type":"doi","id":"10.20944\/preprints202105.0440.v1","asserted-by":"object"}]},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,18]]}}}