As loneliness and social isolation emerge as pressing public health concerns, identifying effective interventions is essential. Digital solutions offer flexible, scalable, and cost-effective approaches, yet their effectiveness remains uncertain. This systematic review and meta-analysis assess the impact of randomized controlled trials (RCTs) on digital interventions to reduce loneliness and social isolation. Following PRISMA 2020 guidelines, we searched seven databases and grey literature (2022-) and applied random-effects models to pool effect sizes by intervention type. A total of 40 RCTs involving 6062 participants were included, with one-third focusing on younger individuals. Loneliness was assessed in 36 studies, while eight examined social isolation. Interventions were classified as psychological (k = 25), social (k = 4), activity-based (k = 4), robot-based (k = 4), and social media reduction (k = 5). Psychological interventions-especially those with group or social components-along with group-based activities and robotic pets, were effective in reducing loneliness. In contrast, social contact interventions, self-guided individual activities, and conversational robots showed limited impact. Social media reduction interventions suggested potential benefits, though results were not statistically significant. The evidence base exhibited moderate to high risk of bias, heterogeneity, and limited long-term follow-up. We provide specific recommendations for future interventions and research, including leveraging digital technologies for enhanced personalization, using digital tools for signposting non-digital interventions, systematically comparing digital and non-digital versions of the same intervention, and, most critically, examining the impact of increasingly popular AI-driven and humanlike social chatbots.

Background: Universities worldwide are witnessing a surge in mental health problems among students, particularly in anxiety and depression. The Hopkins Symptom Checklist (HSCL) is a popular screening tool, but its reliability in identifying mental disorders remains debated. The aim of this study was to evaluate the criterion validity of the HSCL-25, HSCL-10, and HSCL-5 using 30-day prevalence of major depressive episode (MDE) and generalized anxiety disorder (GAD) from a self-administered electronic version of the Composite International Diagnostic Interview, fifth version (CIDI 5.0), as the benchmark. Method: Data stem from a national survey targeting students in higher education in Norway. In a 2023 follow-up study on mental disorders, 5,568 participants completed both the HSCL-25 and the CIDI. Sex-specific optimal thresholds for all HSCL versions in relation to MDE and GAD (from CIDI) were determined using the Youden Index maximization. Results: The optimal cut-off values for detecting MDE or GAD with the HSCL-25 were 1.96 for males and 2.20 for females, displaying a good balance between sensitivity and specificity. Similar high and balanced sensitivity and specificity patterns were found for both the HSCL-10 and HSCL-5. However, all HSCL versions overestimated prevalence rates compared to the self-administered CIDI. Conclusions: All three HSCL versions showed high criterion validity. The data indicate that HSCL may be better as a screening tool than for precise estimation of MDE and GAD prevalence. For improved diagnostic accuracy, future HSCL versions should incorporate functional impairment assessment. This update would bring the HSCL into closer alignment with clinical diagnostic standards.

Background: Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway. Methods: In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire. Results: A positive screening result did not increase participants’ level of anxiety or depression, or decrease participants’ level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance. Conclusion: The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.

Background Participants’ experience with a screening test can influence adherence, and therefore the efficacy of screening programs. We compared screening with unsedated flexible sigmoidoscopy and fecal immunochemical testing (FIT) for participants’ satisfaction with the decision and for willingness to repeat colorectal cancer screening. Methods In a prospective, randomized trial 3257 individuals (50 – 74 years) were invited to either flexible sigmoidoscopy or FIT (1:1), of whom 1650 took up the offer (52.6 %). In total, 1497 screening participants completed at least one questionnaire, either before screening, and/or at three time points in the following year, that measured willingness to repeat screening, willingness to recommend screening, and satisfaction with decision to attend. There were 769 and 728 responders in the flexible sigmoidoscopy and FIT group, respectively. Additionally, 581 flexible sigmoidoscopy participants also completed a pain questionnaire. Results 1 year later, 10 % of the flexible sigmoidoscopy participants were not willing to repeat screening, compared to 5 % of FIT participants. A higher percentage of women compared to men would not repeat flexible sigmoidoscopy screening (adjusted odds ratio [OR] 2.52, 95 % confidence interval [95 %CI] 1.48 to 4.28). Notably, 22 % of women reported pain during flexible sigmoidoscopy compared to 5 % of men. When we added pain to the statistical model, pain was significantly associated with unwillingness to repeat flexible sigmoidoscopy (OR 3.15, 95 %CI 1.68 to 5.87), while gender was no longer associated (OR 1.53, 95 %CI 0.82 to 2.88). Conclusion Acceptability for flexible sigmoidoscopy and for FIT was high among Norwegian screening participants, though FIT participants were more willing to repeat screening. Women were less willing to repeat screening with flexible sigmoidoscopy compared to men. This gender difference seemed partly due to pain, and therefore preventable. This study is registered at ClinicalTrials.gov: NCT01538550.

The effectiveness of colorectal cancer screening programs depends on the participation rate. This study examined the association between type and severity of mental illness and colorectal cancer screening participation. Between 2012 and 2017, a total of 46,919 individuals were invited to sigmoidoscopy screening in Norway, and 70,019 were invited to fecal immunochemical testing. In 2022, logistic regression was used to evaluate the association between the use of antipsychotics, anxiolytics, hypnotics, and antidepressants in the year preceding the screening invitation and screening participation, adjusted for demographic and socioeconomic factors. Defined daily doses of individual drugs were used to assess dose‒response relationships. Overall, 19.2% (24.8% of women, 13.4% of men) of all invitees used at least 1 psychotropic medication. Nonparticipation in the 2 arms combined was associated with the use of anxiolytics (60.7% in users vs 43.2% in nonusers; OR=1.53; 95% CI=1.45, 1.62) and antipsychotics (64.3% vs 43.8%; OR=1.41; 95% CI=1.30, 1.53) and increased with higher doses for both drugs. Hypnotics and antidepressants were only weakly associated with nonparticipation in higher doses. Participation rates were 57.3%, 52.3%, 42.9%, and 35.4% in those prescribed 0, 1, 2, and 3-4 classes of psychotropic medications, respectively. The associations between the use of psychotropic medications and nonparticipation were similar for the 2 screening tests. These findings show significant disparities in colorectal cancer screening participation for individuals with mental illness, independent of the screening method. Moreover, screening participation varied depending on the type and severity of mental illness. Targeted interventions are warranted to ensure that people with mental illness are supported to access the benefits of colorectal cancer screening.

Public health systems should guarantee universal access to health care services, including cancer screening. We assessed whether certain population subgroups were underrepresented among participants in colorectal cancer screening with sigmoidoscopy and faecal immunochemical testing (FIT). Between 2012 and 2019, about 140 000 individuals aged 50 to 74 years were randomly invited to once‐only sigmoidoscopy or first round of FIT screening. Our study included 46 919 individuals invited to sigmoidoscopy and 70 019 to FIT between 2012 and 2017. We used logistic regression models to evaluate if demographic and socioeconomic factors and use of certain drugs were associated with participation. Twenty‐four thousand one hundred and fifty‐nine (51.5%) individuals attended sigmoidoscopy and 40 931 (58.5%) FIT screening. Male gender, young age, low education and income, being retired or unemployed, living alone, being an immigrant, long driving time to screening centre, and use of antidiabetic and psychotropic drugs were associated with low participation in both screening groups. Many of these factors also predicted low acceptance of colonoscopy after positive FIT. While male gender, young age and living alone were more strongly associated with nonparticipation in FIT than sigmoidoscopy, low education and income, being retired or immigrant and long driving time were more strongly associated with nonparticipation in sigmoidoscopy than FIT. In conclusion, participation was lower in sigmoidoscopy than FIT. Predictors of nonparticipation were similar between arms. However, low socioeconomic status, being an immigrant and long driving time affected participation more in sigmoidoscopy screening, suggesting that FIT may guarantee more equal access to screening services than sigmoidoscopy.