Abstract
BackgroundThe experience of loneliness can have drastic consequences for health and quality of life. Given that loneliness is highly prevalent in persons with physical disabilities and that loneliness more profoundly affects persons of low socioeconomic status, more evidence is required in order to understand the mechanisms determining loneliness in this population. The objective of this study is therefore to investigate the potential pathways through which socioeconomic status influences loneliness in persons with spinal cord injury.MethodsParallel and serial mediation analysis utilising structural equation models and bias corrected and accelerated confidence intervals were used in order to test the mediation effects of health status, functioning, participation, social support and self-efficacy on the association between socioeconomic status and loneliness in persons with spinal cord injury. A latent construct was created for socioeconomic status with the indicators education, household income, financial hardship, subjective social status and engagement in paid work. ResultsThis study found evidence to support the mediating role of psychosocial resources and of secondary health conditions in the association between socioeconomic status and loneliness. The study demonstrated robust associations between socioeconomic status and all mediators, whereby higher socioeconomic status was associated with better health, participation and psychosocial resources. Results also suggested that the serial mediation model explained the interplay between socioeconomic status, mediators on different levels, and loneliness. For example, emotional support and self-efficacy were both positively associated with fewer restrictions to participation (0.12 (CI: 0.05, 0.17); 0.29 (CI: 0.23, 0.35) respectively), and frequency of participation increased as a result of improved functional independence and fewer secondary health conditions (0.31 (CI: 0.23, 0.36); -0.18 (CI: -0.24, -0.10) respectively). ConclusionsThis study has emphasized the social gradient of loneliness in persons with spinal cord injury and has identified several potential mediating factors, such as health status and psychosocial resources, in the association between socioeconomic status and loneliness. This population-based evidence suggests potential targets of interventions on the pathway to loneliness, and has identified potential underlying mechanisms, through which socioeconomic status influences loneliness.
Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland
