Loneliness is a significant public health issue. The COVID-19 pandemic has resulted in lockdown measures limiting social contact. The UK public are worried about the impact of these measures on mental health outcomes. Understanding the prevalence and predictors of loneliness at this time is a priority issue for research. The study employed a cross-sectional online survey design. Baseline data collected between March 23rd and April 24th 2020 from UK adults in the COVID-19 Psychological Wellbeing Study were analysed (N = 1964, 18–87 years, M = 37.11, SD = 12.86, 70% female). Logistic regression analysis examined the influence of sociodemographic, social, health and COVID-19 specific factors on loneliness. The prevalence of loneliness was 27% (530/1964). Risk factors for loneliness were younger age group (OR: 4.67–5.31), being separated or divorced (OR: 2.29), scores meeting clinical criteria for depression (OR: 1.74), greater emotion regulation difficulties (OR: 1.04), and poor quality sleep due to the COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being married/co-habiting (OR: 0.35) and living with a greater number of adults (OR: 0.87) were protective factors. Rates of loneliness during the initial phase of lockdown were high. Risk factors were not specific to the COVID-19 crisis. Findings suggest that supportive interventions to reduce loneliness should prioritise younger people and those with mental health symptoms. Improving emotion regulation and sleep quality, and increasing social support may be optimal initial targets to reduce the impact of COVID-19 regulations on mental health outcomes.

Objectives: Loneliness is a significant public health issue. The COVID-19 pandemic has resulted in lockdown measures limiting social contact. The UK public are worried about the impact of these measures on mental health outcomes. Understanding the prevalence and predictors of loneliness at this time is a priority issue for research. Design: The study employed a cross-sectional online survey design. Method: Baseline data collected between March 23rd and April 24th 2020 from UK adults in the COVID-19 Psychological Wellbeing Study were analysed (N = 1963, 18-87 years, M = 37.11, SD = 12.86, 70% female). Logistic regression analysis was used to look at the influence of sociodemographic, social, health and COVID-19 specific factors on loneliness. Results: The prevalence of loneliness was 27% (530/1963). Risk factors for loneliness were younger age group (OR: 4.67 – 5.31), being separated or divorced (OR: 2.29), meeting clinical criteria for major depression (OR: 1.74), greater emotion regulation difficulties (OR: 1.04), and poor quality sleep due to the COVID-19 crisis (OR: 1.30). Higher levels of social support (OR: 0.92), being married/co-habiting (OR: 0.35) and living with a great number of adults (OR: 0.87) were protective factors. Conclusions: Rates of loneliness during the initial phase of lockdown were high. Risk factors were not specific to the COVID-19 crisis. Findings suggest that supportive interventions to reduce loneliness should prioritise younger people and those with mental health symptoms. Improving emotion regulation and sleep quality may be optimal initial targets to reduce the impact of COVID-19 regulations on mental health outcomes.

Background: Death literacy includes the knowledge and skills that people need to gain access to, understand, and make informed choices about end of life and death care options. The Death Literacy Index (DLI) can be used to determine levels of death literacy across multiple contexts, including at a community/national level, and to evaluate the outcome of public health interventions. As the first measure of death literacy, the DLI has potential to significantly advance public health approaches to palliative care. The current study aimed to provide the first assessment of the psychometric properties of the DLI in the UK, alongside population-level benchmarks.Methods: A large nationally representative sample of 399 participants, stratified by age, gender and ethnicity, were prospectively recruited via an online panel. The factor structure of the 29-item DLI was investigated using confirmatory factor analysis. Internal consistency of subscales was assessed alongside interpretability. Hypothesised associations with theoretically related/unrelated constructs were examined to assess convergent and discriminant validity. Descriptive statistics were used to provide scaled mean scores on the DLI.Results: Confirmatory factor analysis supported the original higher-order 8 factor structure, with the best fitting model including one substituted item developed specifically for UK respondents. The subscales reported high internal consistency. Good convergent and discriminant validity was evidenced in relation to objective knowledge of the death system, death competency, actions relating to death and dying in the community and loneliness. Good known-groups validity was achieved with respondents with professional/lived experience of end-of-life care reporting higher levels of death literacy. There was little socio-demographic variability in DLI scores. Scaled population-level mean scores were near the mid-point of DLI subscale/total, with comparatively high levels of experiential knowledge and the ability to talk about death and dying.Conclusions: Psychometric evaluations suggest the DLI is a reliable and valid measure of death literacy for use in the UK, with population level benchmarks suggesting the UK population could strengthen capacity in factual knowledge and accessing help. International validation of the DLI represents a significant advancement in outcome measurement for public health approaches to palliative care.Pre-registration: https://osf.io/fwxkh/

Music therapy is increasingly used as an adjunct therapy to support symptom management in palliative care. However, studies to date have paid little attention to the processes that lead to changes in patient outcomes. To fill this gap, we examined the processes and experiences involved in the introduction of music therapy as an adjunct complementary therapy to palliative care in a hospice setting in the United Kingdom (UK). Using a realistic evaluation approach, we conducted a qualitative study using a variety of approaches. These consisted of open text answers from patients (n = 16) on how music therapy helped meet their needs within one hospice in Northern Ireland, UK. We also conducted three focus groups with a range of palliative care practitioners (seven physicians, seven nursing staff, two social workers and three allied health professionals) to help understand their perspectives on music therapy’s impact on their work setting, and what influences its successful implementation. This was supplemented with an interview with the music therapist delivering the intervention. Music therapy contains multiple mechanisms that can provide physical, psychological, emotional, expressive, existential and social support. There is also evidence that the hospice context, animated by a holistic approach to healthcare, is an important facilitator of the effects of music therapy. Examination of patients’ responses helped identify specific benefits for different types of patients. There is a synergy between the therapeutic aims of music therapy and those of palliative care, which appealed to a significant proportion of participants, who perceived it as effective.

Background: Ongoing assessment of psychological reaction to illness in palliative and end of life care settings is recommended, yet validated tools are not routinely used in clinical practice. The Distress Thermometer is a short screening tool developed for use in oncology, to detect individuals who would benefit from further psychological assessment. However the optimal cut-off to detect indicative psychological morbidity in patients with advanced cancer receiving specialist palliative care is unclear. Aim: To provide the first validation of the Distress Thermometer in an advanced cancer population receiving specialist palliative care in a UK hospice setting. Design: Receiver Operating Characteristics analysis was used to compare the sensitivity and specificity of cut-offs indicative of psychological morbidity on the Distress Thermometer in comparison to the Hospital Anxiety and Depression Scale. Setting/Participants: Data were derived from 202 patients with advanced cancer who were approached on admission to inpatient or day hospice care, with 139 patients providing complete data on both measures. Results: The area under the curve was optimal using a Distress Thermometer cut-off score of ⩾6 for total distress and for anxiety, and a cut-off score of ⩾4 optimal when screening for depression. Conclusions: The Distress Thermometer is a valid, accurate screening tool to be used in advanced cancer but with caution in relation to the lack of specificity. With little variation between the area under the curve scores, arguably a Distress Thermometer cut-off score of ⩾5 is most appropriate in screening for all types of psychological morbidity if sensitivity is to be prioritised.