1. Bibliographic Information

• Title: Review: Interventions addressing loneliness amongst university students: a systematic review
• Authors: Olivia Betty Ellard, Christina Dennison, & Helena Tuomainen
• Affiliations: Warwick Medical School, University of Warwick, Coventry, UK.
• Journal/Conference: Journal of Further and Higher Education. This is a peer-reviewed academic journal focused on educational theory and practice in post-compulsory, tertiary, and higher education. It is a reputable venue for research in this field.
• Publication Year: The provided text does not explicitly state the final publication year, but the search update was conducted in March 2022, suggesting a publication date of 2022 or later.
• Abstract: The review systematically identifies and evaluates interventions aimed at reducing loneliness in university students. Searching four major databases, the authors included 28 articles (25 quantitative, 3 qualitative) covering 37 interventions, primarily from the United States. Interventions were categorized as psychoeducation, social support groups, increasing social interaction, or reflective exercises. The analysis of 2,339 participants (mean age 20.63) found that while most interventions showed some effect, the benefit's magnitude was unclear. Interventions based on social support, social interaction, or reflection were more consistently effective (80%) than psychoeducation-based ones (50%). Group-based interventions were generally successful. The authors conclude that universities have various effective options, especially those promoting social connectedness, and call for more high-quality, international research focusing on vulnerable student groups.
• Original Source Link: /files/papers/68e7994f8bf05fa320b49b06/paper.pdf. This appears to be a local file path. The paper is formally published and can be found through academic search engines.

2. Executive Summary

• Background & Motivation (Why):

  • Core Problem: University students are at a higher risk of loneliness compared to the general population. Loneliness is detrimental to mental health, being associated with depression, anxiety, stress, and even suicidal ideation.
  • Importance & Gaps: Despite rising mental health issues among students and increasing demand for university support services, there is a lack of consolidated research on what specifically works to reduce loneliness in this unique population. Previous systematic reviews on loneliness either focused on the general adult population or broad age ranges of young people, failing to address the specific transitional challenges (academic, social, financial pressures) faced by university students. This review fills the gap by focusing exclusively on interventions within the higher education setting.
  • Innovation: The paper's fresh angle is its specific focus on university students and its inclusive approach of considering studies where loneliness was either a primary or secondary outcome. This provides a broader picture of interventions that can impact student wellbeing.

• Main Contributions / Findings (What):

  • Comprehensive Synthesis: The paper provides the first systematic review of interventions targeting loneliness specifically within the university student population.
  • Categorization of Interventions: It categorizes 37 distinct interventions into four practical types: psychoeducation, social support groups, increasing social interaction, and reflective exercises.
  • Key Finding on Effectiveness: The most significant finding is that interventions promoting social connectedness (social support, social interaction, reflective exercises) were more consistently effective (80% success rate in quantitative studies) than those based solely on psychoeducation (50% success rate).
  • Effectiveness of Group Settings: Two-thirds of interventions delivered in a group setting were found to be effective, highlighting the importance of shared experience and peer connection in combating loneliness.
  • Call for Better Research: The review highlights the moderate to high risk of bias in existing studies and the geographical concentration of research in the U.S., calling for more rigorous, international, and longitudinal studies, particularly for vulnerable student populations (e.g., BAME, disabled, and international students).

3. Prerequisite Knowledge & Related Work

• Foundational Concepts:

  • Loneliness: The paper defines loneliness as a subjective, negative experience stemming from a perceived deficit in the quantity or quality of one's social relationships. It is distinct from social isolation, which is an objective state of having few social contacts.
  • Systematic Review: A research method that collects and critically analyzes multiple research studies or papers. The goal is to provide an exhaustive summary of current evidence relevant to a research question. This review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement, a widely accepted standard.
  • Psychoeducation: An intervention approach that focuses on educating individuals about a specific condition (like loneliness or depression) and teaching them skills to cope with it. This can include cognitive restructuring (changing negative thought patterns) and social skills training.
  • Randomised Controlled Trial (RCT): A type of scientific experiment considered the gold standard for evaluating an intervention's effectiveness. Participants are randomly assigned to either an experimental group (receiving the intervention) or a control group (not receiving the intervention or receiving a placebo/standard treatment).
  • Risk of Bias: The potential for a study's results to be skewed by systematic errors in its design, conduct, or analysis. The review uses established tools like ROB2 (for RCTs) and ROBINS-I (for non-randomised studies) to assess this.

• Previous Works: The authors situate their review by discussing several prior ones:

  • Masi et al. (2011): A foundational review on loneliness interventions in adults. It identified four categories of interventions (improving social skills, enhancing social support, increasing social contact, and addressing maladaptive social cognition) and found the last to be most effective. However, it did not focus on students.
  • Bessaha et al. (2020): Found that technology-based interventions and support groups were effective for non-elderly adults, but again, did not single out students.
  • Eccles & Qualter (2021) and Osborn et al. (2021): These reviews targeted young people but covered a very wide age range (e.g., 3-25 years) and multiple settings, lacking a specific focus on the university context.
  • Williams et al. (2021): This review did recognize students as a specific group but was limited to interventions compatible with COVID-19 social distancing, identifying only five studies with a psychological or cognitive focus.

• Differentiation: This paper distinguishes itself from previous work in two key ways:

  1. Specific Population Focus: It is the first systematic review to exclusively synthesize evidence on loneliness interventions for university/college students, a group facing unique transitional stressors.
  2. Broad Outcome Inclusion: Unlike reviews that only include studies explicitly targeting loneliness, this paper includes research where loneliness was a secondary outcome of a broader wellbeing intervention. This allows for the identification of a wider range of potentially effective strategies.

4. Methodology (Core Technology & Implementation)

The methodology of this paper is the systematic review process itself, which was rigorously designed and executed.

• Principles: The review adheres to the PRISMA guidelines for transparent and complete reporting. The core idea is to systematically identify all relevant studies, assess their quality, and synthesize their findings to answer the research questions about the characteristics and effectiveness of loneliness interventions for students.

• Steps & Procedures:

  1. Protocol and Registration: The review's plan was pre-registered with PROSPERO (CRD42020180867), an international database of systematic reviews. This promotes transparency and prevents selective reporting.
  2. Search Strategy: A comprehensive search was conducted on four major academic databases (PsycINFO, Medline, Web of Science, ASSIA) from their inception until March 22, 2022. The search used a combination of keywords related to three concepts: 'loneliness', 'intervention', and 'students'.
  3. Eligibility and Study Selection:
     • Inclusion Criteria: Peer-reviewed articles and doctoral dissertations in English, implementing an intervention for undergraduate or postgraduate students in higher education, with loneliness measured as an outcome.
     • Screening Process: Two reviewers (OE and CD) independently screened titles and abstracts, followed by a full-text review. Disagreements were resolved through discussion or by a third reviewer (HT). The inter-rater reliability was high (78.14% at abstract screen, 94.5% at full-text screen).
  4. Quality Assessment:
     • The risk of bias for each included study was assessed at both the study and outcome levels.
     • Randomised trials were evaluated using the ROB2 (Revised Cochrane risk-of-bias tool for randomised trials).
     • Non-randomised studies were evaluated using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool.
     • Studies with a 'critical' risk of bias were excluded from the final synthesis.
  5. Data Extraction and Synthesis:
     • Two reviewers independently extracted key data from each study, including study design, participant characteristics, intervention details, control conditions, outcome measures, and results.
     • Due to the high degree of variation (heterogeneity) in study designs, interventions, and outcome measures, a statistical meta-analysis was not feasible.
     • Instead, a narrative synthesis was performed, where findings are grouped and summarized thematically. This approach was guided by the SWiM (Synthesis Without Meta-analysis) reporting guidelines.

5. Experimental Setup

In this systematic review, the "experimental setup" refers to the body of literature that was analyzed.

• Datasets (Included Studies): The final analysis included 28 articles, comprising 25 quantitative studies and 3 qualitative studies. These articles covered a total of 37 distinct interventions.

  • Origin: The vast majority of studies were conducted in the United States ($n = 14$), with a few from China, Canada, and one each from Iran, Ireland, Japan, the UK, and Turkey.
  • Size & Characteristics: The total number of participants across all studies was 2,339, with a mean age of 20.63 years (ranging from 17.62 to 25). Some studies targeted specific subgroups, such as first-year students, medical students, students with autism, or those with elevated baseline loneliness.
  • Study Designs: The quantitative studies included 16 RCTs, 3 controlled pre-post designs, and 6 pre-post designs without a control group.

• Evaluation Metrics (Loneliness Measures): The primary studies used various scales to measure loneliness.

  1. Conceptual Definition: These are self-report questionnaires where participants rate their agreement with statements about their social connections and feelings of isolation. Higher scores typically indicate greater loneliness.
  2. Most Common Tool: The Revised UCLA Loneliness Scale (UCLA3) was the most frequently used measure ($n = 12$). It is a 20-item scale assessing subjective feelings of loneliness and social isolation. Participants rate items like "How often do you feel close to people?" on a 4-point scale from 'Never' to 'Often'. Shorter versions of the UCLA scale were also used.
  3. Other Tools: Other measures included:
     • A three-item loneliness Likert scale.
     • The University of the Philippines Loneliness Assessment Scale (UPLAS).
     • The Chinese College Student Loneliness Scale (CCSLS).
     • The Social and Emotional Loneliness Scale for Adults (SELSA-S).
  • Note on Formulas: These metrics are based on summed scores from Likert-type items, so there isn't a complex mathematical formula to present, but rather a scoring algorithm (e.g., sum of scores on 20 items, each rated 1-4).

• Baselines (Control Conditions): Among the 19 studies that included a control condition, the setups varied:

  • No-Intervention Control: The most common approach ($n = 12$) was a waitlist or no-treatment control group, where participants simply completed the outcome measures at the same time points as the intervention group.
  • Active Control: Seven studies used an "active" control, providing an alternative activity or information that was not expected to reduce loneliness. Examples include receiving general information, taking an unrelated educational course, or participating in a self-help discussion.

6. Results & Analysis

This section synthesizes the findings from the 28 included studies.

• Core Results (Quantitative Studies): The review found that most interventions influenced loneliness outcomes, but the strength of the effect was often unclear. The effectiveness varied significantly by intervention type.

  Effectiveness by Intervention Category: The following is a summary table constructed from the percentages reported in the "Results" section of the paper. This is a transcribed summary based on the paper's text, not a direct reproduction of a table from the original publication.

  Intervention Category	Number of Interventions	Number Effective	Percentage Effective
  Psychoeducation	14	7	50%
  Social Support Groups	4	3	75%
  Increasing Social Interaction	7	6	86%
  Reflective Exercises	9	7	78%
  Combined (Non-Psychoeducation)	20	16	80%

  • Key Insight: Interventions based on social support groups, increasing social interaction, and reflective exercises were collectively deemed effective 80% of the time. In contrast, psychoeducation interventions were only effective 50% of the time.
  • Group vs. Individual Interventions: The majority of interventions ($n=28$) were delivered in a group setting. Of these, two-thirds were effective in reducing loneliness. Only three of the six individual interventions were effective.
  • Online Interventions: Three online/digital interventions were found to be effective, including two involving online chat and one involving journaling. This suggests virtual platforms can be a viable medium.

• Qualitative Study Findings: The three qualitative studies reinforced the importance of social connection.

  • Shared Experience: A program for Black male students (Clark & Brooms, 2018) reduced feelings of alienation by bringing together students with a shared cultural background.
  • Peer Support: An online forum for students with depressive symptoms (Horgan et al., 2013) helped participants feel less lonely because they could share their problems with others in a similar situation. One participant noted, "It's about empathy and the realisation that you're not alone."
  • Belongingness: Support groups for medical students (Goetzel et al., 1983) fulfilled social affiliation needs and helped develop a sense of belonging.
  • Overarching Theme: Across these studies, a key theme was that participants felt "less alone" by connecting with peers, sharing experiences, and realizing others faced similar struggles.

• Study Quality Analysis:

  • Three quantitative studies were excluded due to a "critical" risk of bias.
  • Of the remaining 25, 7 had a high or serious risk of bias, and 10 had a moderate risk. A common issue was the lack of blinding of participants, which is difficult to avoid in such interventions but means that self-reported outcomes could be influenced by participant expectations (placebo effect). The findings from these studies were interpreted with caution.

7. Conclusion & Reflections

• Conclusion Summary: The review concludes that universities have a variety of effective interventions to choose from to reduce student loneliness, deliverable both on-campus and virtually. The most successful strategies are those that actively foster social connectedness, such as support groups, activities promoting social interaction, and group-based reflective exercises. While psychoeducation can be effective, it appears less reliable on its own for this population. The authors stress the need for more high-quality research, particularly outside the U.S. and with a focus on vulnerable student groups.

• Limitations & Future Work (as stated by authors):

  • Limitations:
    • Publication Bias: The review may be biased towards positive results, as studies with non-significant findings are less likely to be published. Grey literature was not searched.
    • Heterogeneity: The diversity of interventions and measures prevented a meta-analysis, limiting the ability to make strong quantitative comparisons.
    • Risk of Bias: Many included studies had a moderate to high risk of bias, primarily due to the inability to blind participants to the intervention.
    • Subjective Categorization: The classification of interventions into four groups involved some subjectivity.
  • Future Work:
    • Conduct more rigorous RCTs, especially with students who have elevated loneliness or existing mental health issues.
    • Perform longitudinal studies to see if the effects of interventions are long-lasting.
    • Focus research on vulnerable subgroups like BAME students and those with autism or disabilities.
    • Explore the mechanisms of successful interventions (i.e., why they work).
    • Investigate digital interventions further, as they offer promising, scalable solutions.
    • Use loneliness measures that differentiate between social and emotional loneliness to allow for more tailored interventions.

• Personal Insights & Critique:

  • This is a timely and important review, especially in the post-COVID era where student social connection has been severely disrupted. The findings provide clear, actionable guidance for university administrators and student support services.
  • The distinction between the effectiveness of "social connection" interventions (80%) versus "psychoeducation" (50%) is a powerful insight. It suggests that for many students, the primary issue may not be a lack of knowledge or skills, but a lack of opportunity and environment to form meaningful connections. Universities should prioritize creating these spaces and opportunities.
  • The call to consider different dimensions of loneliness (social vs. emotional) is critical. A student may feel socially connected within a club but emotionally lonely due to a lack of deep, intimate friendships. Future interventions could be more effective if they are tailored to address the specific type of loneliness a student is experiencing.
  • The paper rightly points out the potential of virtual platforms. However, it also acknowledges the mixed literature on technology's impact. Future research should not just ask if digital interventions work, but what kind of digital interactions (e.g., anonymous forums, structured group video calls, shared online activities) are most beneficial and which are detrimental.
  • The review provides a strong foundation, but the next step should be implementation research: studying how to best integrate these evidence-based interventions into the complex ecosystem of a university, considering factors like cost, scalability, and student uptake.