Associations amongst poverty, loneliness, and a defensive symptom cluster characterised by pain, fatigue, and low mood

Objective

Perceived social isolation is associated with increased pain, fatigue, and depression. Other research has shown that pain and depression are more common in individuals experiencing low socio-economic status, and that social relationships are especially important for buffering the negative health effects of low socio-economic status.

Study design

Cross-sectional.

Methods

We used a 20-country, cross-sectional sample of 24,504 respondents to the European Social Survey 7. Multilevel linear regression was used to test for the effects of loneliness, income decile, and their interaction on a symptom cluster variable that was the average of respondent z-scores on self-reported pain, fatigue, and low mood. We hypothesised that loneliness and low income would be interactively associated with higher symptom cluster scores.

Results

Those from lower income deciles were much more likely to feel lonely (48.7 % in the lowest income decile; 15.2 % in the highest income decile), despite no differences in reported time spent socialising. Multilevel linear regression indicated statistically significant associations consistent with our hypotheses: (1) lonely individuals score 0.447 SD higher on the symptom cluster, (2) for every increase in income decile, symptom cluster scores decrease by 0.022 SD, and (3) a loneliness by income interaction on the symptom cluster (b = −0.018), with the association between loneliness and the symptom cluster being strongest amongst those in lower income deciles.

Conclusions

Both loneliness and low income were associated with higher scores on the symptom cluster, and social relationships were especially strong buffers of the symptom cluster for individuals experiencing poverty. Results inform understandings of social and economic gradients in health.