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<front>
<journal-meta>
<journal-id journal-id-type="publisher-id">Front. Public Health</journal-id>
<journal-title>Frontiers in Public Health</journal-title>
<abbrev-journal-title abbrev-type="pubmed">Front. Public Health</abbrev-journal-title>
<issn pub-type="epub">2296-2565</issn>
<publisher>
<publisher-name>Frontiers Media S.A.</publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id pub-id-type="doi">10.3389/fpubh.2022.1067038</article-id>
<article-categories>
<subj-group subj-group-type="heading">
<subject>Public Health</subject>
<subj-group>
<subject>Original Research</subject>
</subj-group>
</subj-group>
</article-categories>
<title-group>
<article-title>Positive and negative experiences with the COVID-19 pandemic among lonely and non-lonely populations in Germany</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author" corresp="yes">
<name><surname>Wegner</surname> <given-names>Luisa</given-names></name>
<xref ref-type="aff" rid="aff1"><sup>1</sup></xref>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c001"><sup>&#x0002A;</sup></xref>
<uri xlink:href="http://loop.frontiersin.org/people/2032436/overview"/>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name><surname>Liu</surname> <given-names>Shuyan</given-names></name>
<xref ref-type="aff" rid="aff2"><sup>2</sup></xref>
<xref ref-type="corresp" rid="c002"><sup>&#x0002A;</sup></xref>
</contrib>
</contrib-group>
<aff id="aff1"><sup>1</sup><institution>Department of Education and Psychology, Freie Universit&#x000E4;t Berlin</institution>, <addr-line>Berlin</addr-line>, <country>Germany</country></aff>
<aff id="aff2"><sup>2</sup><institution>Department of Psychiatry and Psychotherapy, Charit&#x000E9; &#x02013; Universit&#x000E4;tsmedizin Berlin (Campus Charit&#x000E9; Mitte)</institution>, <addr-line>Berlin</addr-line>, <country>Germany</country></aff>
<author-notes>
<fn fn-type="edited-by"><p>Edited by: Mohammadreza Shalbafan, Iran University of Medical Sciences, Iran</p></fn>
<fn fn-type="edited-by"><p>Reviewed by: Rajib Kumar Dey, Indira Gandhi Memorial Hospital, Maldives; Mohsen Saffari, Baqiyatallah University of Medical Sciences, Iran; Lily Podder, All India Institute of Medical Sciences Bhopal, India; Ravi Philip Rajkumar, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), India</p></fn>
<corresp id="c001">&#x0002A;Correspondence: Luisa Wegner <email>luisa.wegner&#x00040;fu-berlin.de</email>; <email>luisa.wegner&#x00040;charite.de</email></corresp>
<corresp id="c002">Shuyan Liu <email>siyan908&#x00040;hotmail.com</email>; <email>shuyan.liu&#x00040;charite.de</email></corresp>
<fn fn-type="other" id="fn001"><p>This article was submitted to Public Mental Health, a section of the journal Frontiers in Public Health</p></fn></author-notes>
<pub-date pub-type="epub">
<day>02</day>
<month>03</month>
<year>2023</year>
</pub-date>
<pub-date pub-type="collection">
<year>2022</year>
</pub-date>
<volume>10</volume>
<elocation-id>1067038</elocation-id>
<history>
<date date-type="received">
<day>11</day>
<month>10</month>
<year>2022</year>
</date>
<date date-type="accepted">
<day>19</day>
<month>12</month>
<year>2022</year>
</date>
</history>
<permissions>
<copyright-statement>Copyright &#x000A9; 2023 Wegner and Liu.</copyright-statement>
<copyright-year>2023</copyright-year>
<copyright-holder>Wegner and Liu</copyright-holder>
<license xlink:href="http://creativecommons.org/licenses/by/4.0/"><p>This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.</p></license> </permissions>
<abstract>
<p>The COVID-19 pandemic is causing an epidemic of loneliness. Previous studies have shown the differences in positive and negative experiences of lonely and non-lonely people in a non-pandemic setting. However, it is unclear how the drastic alteration of the COVID-19 pandemic may influence peoples&#x00027; reactions and beliefs, especially among those who feel lonely. Our study aims to examine the positive and negative experiences among lonely and non-lonely people. We undertook a cross-sectional online survey of the general population in Germany (<italic>N</italic> = 1,758) from May 2020 to May 2022. We assessed their feelings of loneliness with the short eight-item UCLA Loneliness Scale (ULS-8), their positive and negative experience of living in the COVID-19 pandemic as well as their psychological distress regarding the pandemic with the COVID-19 Peritraumatic Distress Index (CPDI). We found lonely individuals (ULS-8 score &#x02265; 16) reported fewer positive experiences of living in the COVID-19 pandemic, for example, less time with loved ones [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;2.5, <italic>p</italic> = 0.012] and less sense of togetherness [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;2.39, <italic>p</italic> = 0.017] as compared to non-lonely individuals. Meanwhile, they experienced more negative experiences, for example, worry and fear [<italic>z</italic><sub>(1, 756)</sub> = 6.31, <italic>p</italic> &#x0003C; 0.001] compared with non-lonely individuals. Interestingly, lonely people were less likely to view the pandemic as a conspiracy than non-lonely people were [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;3.35, <italic>p</italic> &#x0003C; 0.001]. Our results may give insight into attribution bias and the negative affect of lonely people during the COVID-19 pandemic as well as highlight the experience of non-lonely people and raise the question of differences in conspiracy beliefs. For pandemic preparedness and response, decision-makers may focus on interventions to foster social cohesion, empower people, build resilience, and most importantly provide timely social care.</p></abstract>
<kwd-group>
<kwd>social isolation</kwd>
<kwd>epidemic</kwd>
<kwd>environmentally friendly</kwd>
<kwd>perception</kwd>
<kwd>positive psychology</kwd>
<kwd>attribution bias</kwd>
<kwd>conspiracy beliefs</kwd>
</kwd-group>
<counts>
<fig-count count="2"/>
<table-count count="2"/>
<equation-count count="0"/>
<ref-count count="85"/>
<page-count count="11"/>
<word-count count="7359"/>
</counts>
</article-meta>
</front>
<body>
<sec id="s1">
<title>1. Introduction</title>
<p>With the start of lockdown during the beginning of COVID-19, it was uncertain how long the significant changes that governments made would last. Those changes brought grand challenges to life, such as preventing the virus from spreading around the world (e.g., wearing a mask) (<xref ref-type="bibr" rid="B1">1</xref>), staying at home to protect children and vulnerable adults (<xref ref-type="bibr" rid="B2">2</xref>&#x02013;<xref ref-type="bibr" rid="B4">4</xref>), and staying connected when physically apart (<xref ref-type="bibr" rid="B5">5</xref>&#x02013;<xref ref-type="bibr" rid="B7">7</xref>). The World Health Organization reported that the global prevalence of anxiety and depression increased by a massive 25% in the first year of COVID-19 (<xref ref-type="bibr" rid="B8">8</xref>). Beyond health challenges, COVID-19 has also exacerbated social challenges (<xref ref-type="bibr" rid="B9">9</xref>&#x02013;<xref ref-type="bibr" rid="B14">14</xref>), including attitudes toward social roles (e.g., gender roles) (<xref ref-type="bibr" rid="B15">15</xref>). However, dealing with this adversity is a chance to bring forward positive aspects as well. Wong&#x00027;s Existential Positive Psychology theory states that the great adversity that exists in life is a chance to bring forward positive experiences, indicating that suffering can promote strength and wellbeing (<xref ref-type="bibr" rid="B16">16</xref>). Wong et al. proposed that faith, courage, creativity, and the meaning of life are essential to transform suffering into flourishing (<xref ref-type="bibr" rid="B17">17</xref>). Existential positive psychology seeks to integrate various ways that help people experience positive states in times of suffering (<xref ref-type="bibr" rid="B17">17</xref>). To prepare for and respond to future pandemics, it is crucial to reflect on both positive and negative experiences that we had during the ongoing COVID-19 pandemic. When looking back, the COVID-19 movement restrictions did have a positive impact on the living environment (i.e., reduction in air pollution and emission of greenhouse gases) (<xref ref-type="bibr" rid="B7">7</xref>). In addition to making life more environmentally friendly compared to before COVID-19, the adaption to the new way of living (e.g., spending more time at home) provided opportunities for introspection (<xref ref-type="bibr" rid="B18">18</xref>). For example, people can for once rethink what is really important in their life, how they truly want to spend their time, and what they value most (<xref ref-type="bibr" rid="B18">18</xref>). This is a unique opportunity to generate ideas as well as to evaluate one&#x00027;s life. Moreover, staying at home during the lockdown enabled people to spend more time with loved ones (i.e., family members that live together in lockdown) (<xref ref-type="bibr" rid="B19">19</xref>). Another positive outcome of the unexpected COVID-19 lockdown was more time for hobbies (<xref ref-type="bibr" rid="B20">20</xref>). People chose hobbies that can be done in solidarity like spending time in nature and engaging in creative activities (<xref ref-type="bibr" rid="B20">20</xref>). Finally, working from home has advantages, such as greater work control and an improved work&#x02013;life balance (<xref ref-type="bibr" rid="B21">21</xref>), which may lead to less work-related stress.</p>
<p>Despite the potential positive experiences of COVID-19, it is important to understand perceived negative experiences as well (<xref ref-type="bibr" rid="B22">22</xref>). Existential positive psychology suggests that negative experiences can add meaning to life by striving to overcome them (<xref ref-type="bibr" rid="B23">23</xref>). Considerable studies across countries reported negative effects of COVID-19 on mental health, including feeling worried, anxious, restricted, lonely, angry, depressed, and having sleep problems (<xref ref-type="bibr" rid="B24">24</xref>&#x02013;<xref ref-type="bibr" rid="B29">29</xref>). People experience negative cognitive states, such as COVID-19-related worry, which can be an indicator of negative mood (<xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B30">30</xref>). Moreover, such negative feelings or experiences are most common among vulnerable populations (e.g., the elderly, pregnant women and their children, people with disabilities, and chronic long-term health conditions) (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B31">31</xref>). In addition, perceiving COVID-19 as more dangerous than seasonal influenza (<xref ref-type="bibr" rid="B32">32</xref>) was associated with a heightened perception of worry and fear (<xref ref-type="bibr" rid="B33">33</xref>). Interestingly, many people even believed the whole pandemic was a hoax and made up of secret organizations, possibly to change the &#x0201C;world order,&#x0201D; which is a narrative deeply rooted in antisemitism (<xref ref-type="bibr" rid="B34">34</xref>).</p>
<p>Strikingly, loneliness played a key role in triggering stress-related behaviors and cognition during lockdown (<xref ref-type="bibr" rid="B35">35</xref>). Even before COVID-19, loneliness was described as a &#x0201C;behavioral epidemic&#x0201D; in the population (<xref ref-type="bibr" rid="B36">36</xref>). During COVID-19, physical distancing can worsen this situation, as positive social contact is a key factor in battling loneliness (<xref ref-type="bibr" rid="B37">37</xref>). Other factors that can increase feelings of loneliness and may have been intensified under COVID-19 are living alone, infrequent contact with family or friends, dissatisfaction with living circumstances, chronic work and/or social stress, small social network as well as a poor quality social network, and marital or family conflict (<xref ref-type="bibr" rid="B38">38</xref>). A representative study from Germany showed that the prevalence of loneliness increased from 11% before COVID-19 to 27% during COVID-19 (<xref ref-type="bibr" rid="B37">37</xref>). Our recent study showed that up to 66% of people in Germany sometimes or always felt lonely amid COVID-19 (<xref ref-type="bibr" rid="B39">39</xref>). Furthermore, loneliness increased with a small effect size in the population that reinforces a &#x0201C;loneliness epidemic&#x0201D; (<xref ref-type="bibr" rid="B40">40</xref>). Similar results have been reported in the association between increased prevalence of loneliness, depression, and anxiety (<xref ref-type="bibr" rid="B41">41</xref>, <xref ref-type="bibr" rid="B42">42</xref>).</p>
<p>The Evolutionary Theory of Loneliness (ETLs) conceptualizes that loneliness has an adaptive and non-conscious function of a person perceiving the world as more threatening (<xref ref-type="bibr" rid="B43">43</xref>). Furthermore, if people feel no sense of solidarity, it leads to them operating in a &#x0201C;selfish&#x0201D; mode, which can help them protect themselves in a potentially dangerous situation (<xref ref-type="bibr" rid="B43">43</xref>). This state is extremely aversive and thus is conceptualized to bring people to renew their social connections (<xref ref-type="bibr" rid="B38">38</xref>) and to protect themselves from being alone in a hostile environment (<xref ref-type="bibr" rid="B43">43</xref>). Considering these points, it highlights that lonely individuals may perceive an objectively neutral situation as more hostile than non-lonely individuals may. That raises an interesting question of whether lonely and non-lonely people react differently in the ongoing COVID-19 pandemic. Spithoven et al. highlighted that lonely people process information differently from non-lonely individuals (<xref ref-type="bibr" rid="B44">44</xref>). Lonely individuals interpret information with more negative expectations and have a hostile attribution bias and negative evaluation of self and others (<xref ref-type="bibr" rid="B44">44</xref>). They also tend to have a higher sensibility for socially threatening and socially negative stimuli (<xref ref-type="bibr" rid="B44">44</xref>). These cognitive biases tend to reinforce and strengthen counterproductive social behaviors (<xref ref-type="bibr" rid="B44">44</xref>, <xref ref-type="bibr" rid="B45">45</xref>). These findings undermine the fact that in a socially shifting situation like a lockdown, lonely people may perceive the world differently from non-lonely people. One of the popular beliefs amid COVID-19 was conspiracy theories. There were mixed results on loneliness relating to belief in conspiracy theories. On the one hand, the induction of loneliness increases paranoid ideation (<xref ref-type="bibr" rid="B46">46</xref>) that correlated with COVID-19 conspiracy beliefs (<xref ref-type="bibr" rid="B47">47</xref>). On the other hand, instead of loneliness, people who endorse conspiracy theories are influenced by their personal willingness to conspire (<xref ref-type="bibr" rid="B48">48</xref>) and by social contagion through conventional and social media (<xref ref-type="bibr" rid="B49">49</xref>). The inconsistent results are encouraging a better understanding of the role of loneliness in conspiracy endorsement.</p>
<p>While there is a surfeit of studies measuring the negative experiences among lonely people amid COVID-19 (<xref ref-type="bibr" rid="B2">2</xref>, <xref ref-type="bibr" rid="B8">8</xref>&#x02013;<xref ref-type="bibr" rid="B14">14</xref>, <xref ref-type="bibr" rid="B26">26</xref>, <xref ref-type="bibr" rid="B31">31</xref>, <xref ref-type="bibr" rid="B35">35</xref>), there is a lack of studies on positive outcomes. To better prepare for and respond to the future pandemic, it is crucial to understand both positive and negative lessons we have learned during the COVID-19 pandemic. In this study, we aim to examine the positive and negative experiences during COVID-19 among lonely and non-lonely individuals in Germany. We expect that there will be different positive and negative experiences of living in COVID-19 among lonely and non-lonely people. Specifically, we hypothesize that lonely individuals will report less positive and more negative experiences than non-lonely individuals will. Finally, we assume the belief in conspiracy theories will be independent of individuals&#x00027; feelings of loneliness.</p></sec>
<sec id="s2">
<title>2. Methods</title>
<sec>
<title>2.1. Participants and procedure</title>
<p>We conducted an anonymous online survey using the Siuvo platform (<ext-link ext-link-type="uri" xlink:href="https://www.siuvo.com">https://www.siuvo.com</ext-link>) for psychological assessments in healthcare settings between May 2020 and May 2022 in Germany. The survey was distributed using a QR code shared primarily through social media, advertisements, and newsletters. We recruited participants who were aged 18 years and above and gave informed consent. We collected our data conveniently by recruiting populations who had access to the Internet. We used G<sup>&#x0002A;</sup>Power Version 3.1.9.6 to determine sample size. According to a previous study in Germany (<xref ref-type="bibr" rid="B50">50</xref>), 32% of people reported being lonely in Germany under the first nationwide lockdown in March 2020. We calculated a sample size of 1,434, which gives an &#x003B1; error rate of 5%, power of 90%, a &#x0201C;small&#x0201D; effect size (<italic>d</italic> = 0.2), and an allocation ratio of 0.32. Considering a 20% dropout rate, 1,721 participants were set as the target sample size. We collected socio-demographic data (i.e., sex, age, and years of education), used a short form of the UCLA Loneliness Scale (ULS-8) to assess feelings of loneliness, as well as the COVID-19 Peritraumatic Distress Instrument (CPDI) and asked individuals&#x00027; positive and negative experiences of living in the COVID-19 pandemic. We also asked our participants if they have less contact with their family amid COVID-19 and if they have been diagnosed with a mental illness in the past 3 months. The Ethics Committee of Charit&#x000E9;&#x02014;Universit&#x000E4;tsmedizin Berlin (EA2/143/20) approved the study.</p>
</sec>
<sec>
<title>2.2. Measurement of loneliness and perceived positive and negative experiences amid COVID-19 and COVID-19-related distress</title>
<p>Loneliness was assessed by using the well-established short eight-item UCLA Loneliness Scale (ULS-8) in a validated German version (<xref ref-type="bibr" rid="B39">39</xref>, <xref ref-type="bibr" rid="B51">51</xref>, <xref ref-type="bibr" rid="B52">52</xref>). Each item was answered on a 4-point Likert scale with total scores ranging from 8 to 32, with higher scores suggesting a higher degree of loneliness. Participants who reported at least sometimes (a cut-off score &#x02265;16) to always feeling lonely were considered &#x0201C;lonely people&#x0201D; (<xref ref-type="bibr" rid="B53">53</xref>). We used the 24-item COVID-19 Peritraumatic Distress Index (CPDI) questionnaire to capture peritraumatic psychological distress in the general population amid COVID-19 (<xref ref-type="bibr" rid="B54">54</xref>). Each item was answered on a 5-point Likert scale, with higher scores suggesting a higher psychological distress level (a score between 28 and 51 indicates mild-to-moderate distress). Perceived positive experiences during COVID-19 were assessed with a nominal scale by asking, &#x0201C;Do you perceive any positive experiences of the COVID-19 pandemic?&#x0201D; Participants had to choose one of the nine following categorical statements compared to before COVID-19: (1) &#x0201C;No positive effects at all,&#x0201D; (2) &#x0201C;A more environmentally friendly world,&#x0201D; (3) &#x0201C;Time to think about life,&#x0201D; (4) &#x0201C;More time for loved ones,&#x0201D; (5) &#x0201C;More time for hobbies,&#x0201D; (6) &#x0201C;Less work-related stress,&#x0201D; (7) &#x0201C;Less social pressure,&#x0201D; (8) &#x0201C;An increased sense of togetherness,&#x0201D; and (9) &#x0201C;Other positive experiences.&#x0201D; Perceived negative experiences during the pandemic were assessed with a nominal scale by asking, &#x0201C;Did you perceive any negative experiences of the COVID-19 pandemic?&#x0201D; Participants had to choose one of the five following categorical statements that made them feel the most psychological distressed in times of COVID-19: (1) &#x0201C;Corona <italic>per se</italic> is a dangerous infectious disease,&#x0201D; (2) &#x0201C;The epidemic was deliberately manufactured to serve the interest of powerful forces,&#x0201D; (3) &#x0201C;A feeling of imminent threat,&#x0201D; (4) &#x0201C;An edge and worries in general,&#x0201D; and (5) &#x0201C;Other negative experiences.&#x0201D; The items on positive and negative experiences were based on previous studies on life-changing experiences before COVID-19 (e.g., the outbreak of Ebola virus disease, the 2003 SARS epidemic) (<xref ref-type="bibr" rid="B55">55</xref>&#x02013;<xref ref-type="bibr" rid="B57">57</xref>) and public views about COVID-19 in Germany (<xref ref-type="bibr" rid="B58">58</xref>&#x02013;<xref ref-type="bibr" rid="B61">61</xref>).</p>
</sec>
<sec>
<title>2.3. Data analysis</title>
<p>We performed statistical analysis by using R Statistical Software (version 4.1.2; R Foundation for Statistical Computing, Vienna, Austria). Differences were considered statistically significant at <italic>p</italic> &#x0003C; 0.05 and highly statistically significant at <italic>p</italic> &#x0003C; 0.01. To check the influences of socio-demographic factors (i.e., sex, age, and years of education) on the loneliness scores, we conducted a multiple linear regression analysis. We used the chi-square test to evaluate if there are differences between non-lonely and lonely people in reporting their contact with families and having been diagnosed with a mental illness in the past 3 months. We used independent sample <italic>t</italic>-tests to examine differences in CPDI scores in non-lonely and lonely people as well as in men and women. We used logistic regression analysis to examine whether there was a significant difference between non-lonely and lonely people in choosing each category of positive and negative experiences. We used the chi-square test to compare men and women and investigate the effects of gender. Finally, we performed logistical regression analyses to understand whether gender, age, and loneliness played a role in conspiracy beliefs.</p></sec></sec>
<sec id="s3">
<title>3. Results</title>
<sec>
<title>3.1. Group description</title>
<p>A total of 4,226 participants got access to our survey, 2,466 participants responded to it, 1,858 participants completed it, and 100 participants did not meet the data quality control. Our final sample consists of 1,758 participants (1,304 women (74.2%), age range: 18&#x02013;75, M = 33.37, SD = 12.24), as shown in <xref ref-type="table" rid="T1">Table 1</xref>. Each participant completed the survey only once. Of note, 1,354 (77.02%) participants were categorized as &#x0201C;lonely,&#x0201D; as they reported feeling lonely at least sometimes. Our regression analysis revealed that people with less years of education [<italic>t</italic><sub>(3, 1, 754)</sub> = &#x02212;2.16, <italic>p</italic> = 0.03] reported higher loneliness scores. Younger age [<italic>t</italic><sub>(3, 1, 754)</sub> = &#x02212;1.73, <italic>p</italic> = 0.08] and gender did not play a role in the feeling of loneliness [<italic>t</italic><sub>(3, 1, 754)</sub> = 1.63, <italic>p</italic> = 0.1]. The the chi-square tests showed that lonely people responded to having less family contact amid COVID-19 as compared to non-lonely people [<inline-formula><mml:math id="M1"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>4</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 177.9, <italic>p</italic> = &#x0003C; 0.001], and there was no significantly higher proportion of lonely people who were diagnosed with a mental illness as compared to non-lonely people [<inline-formula><mml:math id="M2"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 3.84, <italic>p</italic> = 0.0501]. There were gender differences in reporting psychological distress: CPDI scores were significantly higher in women than men (<italic>p</italic> &#x0003C; 0.001), indicating that women had higher COVID-19-related distress than men.</p>
<table-wrap position="float" id="T1">
<label>Table 1</label>
<caption><p>Descriptive differences between non-lonely and lonely individuals.</p></caption>
<table frame="box" rules="all">
<thead>
<tr style="background-color:#8f9496">
<th/>
<th valign="top" align="center"><bold>All</bold></th>
<th valign="top" align="center"><bold>Non-lonely</bold></th>
<th valign="top" align="center"><bold>Lonely</bold></th>
<th valign="top" align="center"><bold><italic>p</italic></bold></th>
</tr>
<tr style="background-color:#8f9496">
<th/>
<th valign="top" align="center"><bold><italic>N</italic> = 1,758</bold></th>
<th valign="top" align="center"><bold><italic>N</italic> = 404</bold></th>
<th valign="top" align="center"><bold><italic>N</italic> = 1,354</bold></th>
<th/>
</tr>
</thead>
<tbody>
<tr style="background-color:#dfdfdf">
<td valign="top" align="left" colspan="5"><bold>Gender</bold>, <italic><bold>n</bold></italic> <bold>(%)</bold></td>
</tr> <tr>
<td valign="top" align="left">Women</td>
<td valign="top" align="center">1,304 (74.2)</td>
<td valign="top" align="center">282 (69.8)</td>
<td valign="top" align="center">1,022 (75.5)</td>
<td valign="top" align="center">0.026</td>
</tr> <tr>
<td valign="top" align="left">Men</td>
<td valign="top" align="center">454 (25.8)</td>
<td valign="top" align="center">122 (30.2)</td>
<td valign="top" align="center">332 (24.5)</td>
<td/>
</tr> <tr>
<td valign="top" align="left"><bold>Age, mean (SD)</bold></td>
<td valign="top" align="center">33.4 (12.2)</td>
<td valign="top" align="center">35.3 (12.9)</td>
<td valign="top" align="center">32.8 (12.0)</td>
<td valign="top" align="center">0.001</td>
</tr> <tr>
<td valign="top" align="left"><bold>Years of education, mean (SD)</bold></td>
<td valign="top" align="center">15.8 (3.68)</td>
<td valign="top" align="center">16.0 (3.84)</td>
<td valign="top" align="center">15.8 (3.64)</td>
<td valign="top" align="center">0.439</td>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left" colspan="5"><bold>Less family contact</bold>, <italic><bold>n</bold></italic> <bold>(%)</bold></td>
</tr> <tr>
<td valign="top" align="left">No</td>
<td valign="top" align="center">893 (50.8)</td>
<td valign="top" align="center">321 (79.5)</td>
<td valign="top" align="center">572 (42.2)</td>
<td valign="top" align="center">&#x0003C; 0.001</td>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left" colspan="5"><bold>Prior diagnosis</bold>, <italic><bold>n</bold></italic> <bold>(%)</bold></td>
</tr> <tr>
<td valign="top" align="left">Yes</td>
<td valign="top" align="center">251 (14.3)</td>
<td valign="top" align="center">46 (11.4)</td>
<td valign="top" align="center">205 (15.1)</td>
<td valign="top" align="center">0.0501</td>
</tr> <tr>
<td valign="top" align="left"><bold>CPDI score, mean (SD)</bold></td>
<td valign="top" align="center">35.9 (18.7)</td>
<td valign="top" align="center">19.1 (13.2)</td>
<td valign="top" align="center">40.9 (17.1)</td>
<td valign="top" align="center">&#x0003C; 0.001</td>
</tr> <tr>
<td valign="top" align="left"><bold>ULS-8 score, mean (SD)</bold></td>
<td valign="top" align="center">20.0 (5.83)</td>
<td valign="top" align="center">12.0 (2.34)</td>
<td valign="top" align="center">22.4 (4.16)</td>
<td valign="top" align="center">0.000</td>
</tr></tbody>
</table>
</table-wrap>
</sec>
<sec>
<title>3.2. Less positive experiences of living in COVID-19 among lonely individuals</title>
<p>We found that lonely people were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely people [<italic>z</italic><sub>(1, 756)</sub> = 2.92, <italic>p</italic> = 0.004], as shown in <xref ref-type="fig" rid="F1">Figure 1</xref>. In our sample, due to a higher proportion of women, we also conducted additional analyses of men and women separately. In general, we did not find a significant difference between men and women in perceiving no positive experiences during the pandemic [<inline-formula><mml:math id="M3"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 1.4, <italic>p</italic> = 0.24]. However, we found lonely women were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely women (<italic>p</italic> = 0.007). In lonely men, we did not find that they were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely men (<italic>p</italic> = 0.85). Furthermore, lonely people experienced significantly less time with loved ones [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;2.5, <italic>p</italic> = 0.012] and less sense of togetherness [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;2.39, <italic>p</italic> = 0.017] than non-lonely people. There was no significant difference between lonely and non-lonely individuals in experiencing a more &#x0201C;eco-friendly world&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;0.009, <italic>p</italic> = 0.99], &#x0201C;more time to think about life&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = 1.12, <italic>p</italic> = 0.295], &#x0201C;more time for hobbies&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;1.44, <italic>p</italic> = 0.15], &#x0201C;less work-related stress&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = 0.181, <italic>p</italic> = 0.857], and &#x0201C;less social pressure&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = 0.846, <italic>p</italic> = 0.398] as positive outcomes of COVID-19.</p>
<fig id="F1" position="float">
<label>Figure 1</label>
<caption><p>Differences in positive experiences of living in the COVID-19 pandemic among lonely and non-lonely individuals. <sup>&#x0002A;</sup><italic>p</italic> &#x0003C; 0.05; <sup>&#x0002A;&#x0002A;</sup><italic>p</italic> &#x0003C; 0.01.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fpubh-10-1067038-g0001.tif"/>
</fig>
</sec>
<sec>
<title>3.3. More negative experiences of living in COVID-19 among lonely individuals</title>
<p>Lonely participants reported &#x0201C;worry&#x0201D; significantly more often than non-lonely participants [<italic>z</italic><sub>(1, 756)</sub> = 6.31, <italic>p</italic> &#x0003C; 0.001], as shown in <xref ref-type="fig" rid="F2">Figure 2</xref>. There was no significant difference between lonely and non-lonely individuals in experiencing &#x0201C;danger&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;0.19, <italic>p</italic> = 0.85], as well as &#x0201C;threat&#x0201D; [<italic>z</italic><sub>(1, 756)</sub> = 1.51, <italic>p</italic> = 0.13]. Non-lonely participants experienced &#x0201C;other&#x0201D; negative outcomes of COVID-19 [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;8.54, <italic>p</italic> &#x0003C; 0.001] significantly more often than lonely participants. The detailed logistical regression results are reported in <xref ref-type="table" rid="T2">Table 2</xref>. When comparing men with women, we found that women reported worry as a negative experience more often [<inline-formula><mml:math id="M4"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 7.29, <italic>p</italic> = 0.007] than men. Conversely, men reported perceiving the pandemic as dangerous more often as a negative outcome [<inline-formula><mml:math id="M5"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 5.29, <italic>p</italic> = 0.007] than women. We did not find a significant difference between men and women in having conspiracy beliefs [<inline-formula><mml:math id="M6"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 3.68, <italic>p</italic> = 0.055] and perceiving the pandemic as threatening [<inline-formula><mml:math id="M7"><mml:msubsup><mml:mrow><mml:mi>&#x003C7;</mml:mi></mml:mrow><mml:mrow><mml:mrow><mml:mo stretchy="false">(</mml:mo><mml:mrow><mml:mn>1</mml:mn></mml:mrow><mml:mo stretchy="false">)</mml:mo></mml:mrow></mml:mrow><mml:mrow><mml:mn>2</mml:mn></mml:mrow></mml:msubsup></mml:math></inline-formula> = 0.11, <italic>p</italic> = 0.74]. Overall, our logistic regression showed that age [<italic>z</italic><sub>(1, 756)</sub> = 0.15, <italic>p</italic> = 0.88] and gender [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;1.9, <italic>p</italic> = 0.057] were not associated with conspiracy belief, whereas loneliness score was associated with conspiracy belief [<italic>z</italic><sub>(1, 756)</sub> = &#x02212;3.35, <italic>p</italic> &#x0003C; 0.001].</p>
<fig id="F2" position="float">
<label>Figure 2</label>
<caption><p>Differences in negative experiences of living in the COVID-19 pandemic among lonely and non-lonely individuals. <sup>&#x0002A;&#x0002A;</sup><italic>p</italic> &#x0003C; 0.01.</p></caption>
<graphic mimetype="image" mime-subtype="tiff" xlink:href="fpubh-10-1067038-g0002.tif"/>
</fig>
<table-wrap position="float" id="T2">
<label>Table 2</label>
<caption><p>Differences in positive and negative experiences of living in the COVID-19 pandemic among lonely and non-lonely individuals.</p></caption>
<table frame="box" rules="all">
<thead>
<tr style="background-color:#8f9496">
<th/>
<th valign="top" align="center"><bold>All</bold></th>
<th valign="top" align="center"><bold>Non-lonely</bold></th>
<th valign="top" align="center"><bold>Lonely</bold></th>
<th valign="top" align="center"><bold><italic>p</italic></bold></th>
</tr>
<tr>
<th/>
<th valign="top" align="center"><bold><italic>N</italic> = 1,758</bold></th>
<th valign="top" align="center"><bold><italic>N</italic> = 404</bold></th>
<th valign="top" align="center"><bold><italic>N</italic> = 1,354</bold></th>
<th/>
</tr>
</thead>
<tbody>
<tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>No positives</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.004</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,560 (88.7%)</td>
<td valign="top" align="center">375 (92.8%)</td>
<td valign="top" align="center">1,185 (87.5%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">198 (11.3%)</td>
<td valign="top" align="center">29 (7.18%)</td>
<td valign="top" align="center">169 (12.5%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Eco-friendly world</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">1.000</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,284 (73.0%)</td>
<td valign="top" align="center">295 (73.0%)</td>
<td valign="top" align="center">989 (73.0%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">474 (27.0%)</td>
<td valign="top" align="center">109 (27.0%)</td>
<td valign="top" align="center">365 (27.0%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Thinking about life</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.295</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,406 (80.0%)</td>
<td valign="top" align="center">331 (81.9%)</td>
<td valign="top" align="center">1,075 (79.4%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">352 (20.0%)</td>
<td valign="top" align="center">73 (18.1%)</td>
<td valign="top" align="center">279 (20.6%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Time loved ones</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.016</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,600 (91.0%)</td>
<td valign="top" align="center">355 (87.9%)</td>
<td valign="top" align="center">1,245 (91.9%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">158 (8.99%)</td>
<td valign="top" align="center">49 (12.1%)</td>
<td valign="top" align="center">109 (8.05%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Time hobbies</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.183</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,638 (93.2%)</td>
<td valign="top" align="center">370 (91.6%)</td>
<td valign="top" align="center">1,268 (93.6%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">120 (6.83%)</td>
<td valign="top" align="center">34 (8.42%)</td>
<td valign="top" align="center">86 (6.35%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Less work-stress</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.945</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,637 (93.1%)</td>
<td valign="top" align="center">377 (93.3%)</td>
<td valign="top" align="center">1,260 (93.1%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">121 (6.88%)</td>
<td valign="top" align="center">27 (6.68%)</td>
<td valign="top" align="center">94 (6.94%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Less social pressure</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.453</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,591 (90.5%)</td>
<td valign="top" align="center">370 (91.6%)</td>
<td valign="top" align="center">1,221 (90.2%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">167 (9.50%)</td>
<td valign="top" align="center">34 (8.42%)</td>
<td valign="top" align="center">133 (9.82%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Sense of togetherness</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.022</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,679 (95.5%)</td>
<td valign="top" align="center">377 (93.3%)</td>
<td valign="top" align="center">1,302 (96.2%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">79 (4.49%)</td>
<td valign="top" align="center">27 (6.68%)</td>
<td valign="top" align="center">52 (3.84%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Other positives</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.787</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,669 (94.9%)</td>
<td valign="top" align="center">382 (94.6%)</td>
<td valign="top" align="center">1,287 (95.1%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">89 (5.06%)</td>
<td valign="top" align="center">22 (5.45%)</td>
<td valign="top" align="center">67 (4.95%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Danger</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.914</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,502 (85.4%)</td>
<td valign="top" align="center">344 (85.1%)</td>
<td valign="top" align="center">1,158 (85.5%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">256 (14.6%)</td>
<td valign="top" align="center">60 (14.9%)</td>
<td valign="top" align="center">196 (14.5%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Conspiracy</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.001</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,678 (95.4%)</td>
<td valign="top" align="center">373 (92.3%)</td>
<td valign="top" align="center">1,305 (96.4%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">80 (4.55%)</td>
<td valign="top" align="center">31 (7.67%)</td>
<td valign="top" align="center">49 (3.62%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Threat</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">0.152</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,490 (84.8%)</td>
<td valign="top" align="center">352 (87.1%)</td>
<td valign="top" align="center">1,138 (84.0%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">268 (15.2%)</td>
<td valign="top" align="center">52 (12.9%)</td>
<td valign="top" align="center">216 (16.0%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Worry</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">&#x0003C; 0.001</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">822 (46.8%)</td>
<td valign="top" align="center">245 (60.6%)</td>
<td valign="top" align="center">577 (42.6%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">936 (53.2%)</td>
<td valign="top" align="center">159 (39.4%)</td>
<td valign="top" align="center">777 (57.4%)</td>
<td/>
</tr> <tr style="background-color:#dfdfdf">
<td valign="top" align="left"><bold>Other negatives</bold></td>
<td/>
<td/>
<td/>
<td valign="top" align="center">&#x0003C; 0.001</td>
</tr> <tr>
<td valign="top" align="left">Not chosen</td>
<td valign="top" align="center">1,540 (87.6%)</td>
<td valign="top" align="center">302 (74.8%)</td>
<td valign="top" align="center">1,238 (91.4%)</td>
<td/>
</tr> <tr>
<td valign="top" align="left">Chosen</td>
<td valign="top" align="center">218 (12.4%)</td>
<td valign="top" align="center">102 (25.2%)</td>
<td valign="top" align="center">116 (8.57%)</td>
<td/>
</tr></tbody>
</table>
</table-wrap>
</sec></sec>
<sec id="s4">
<title>4. Discussion</title>
<p>We conducted a cross-sectional study from May 2020 to May 2022 to discover whether there are different positive and negative experiences of living during the COVID-19 pandemic among lonely and non-lonely people. We found less positive and more negative experiences among lonely people as compared with non-lonely people.</p>
<p>Regarding positive experiences, lonely people reported perceiving no positive experiences of living during the pandemic more than non-lonely people. In line with previous studies, lonely people tend to have negative feelings more often (<xref ref-type="bibr" rid="B62">62</xref>). Negative feelings and thinking can hint at a generally depressed mood in lonely people, as loneliness can be a sign of depression (<xref ref-type="bibr" rid="B63">63</xref>). The negative effect of a depressed state can lead people to withdraw from social life even more (<xref ref-type="bibr" rid="B64">64</xref>, <xref ref-type="bibr" rid="B65">65</xref>), which can be an alarming situation during an already-implemented lockdown. In line with Wong&#x00027;s Existential Positive Psychology theory (<xref ref-type="bibr" rid="B17">17</xref>), positives cannot exist apart from negatives. Wong conceptualizes wellbeing not only as pursuing positive goals but also as overcoming and mastering negative experiences (<xref ref-type="bibr" rid="B17">17</xref>). The absence of positive experiences being especially prominent in lonely people may reflect that they desire ways to deal with negativity and savor positive experiences. In addition to the positive experiences among non-lonely and lonely people, we found that lonely women were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely women. There was no such a significant difference between non-lonely and lonely men. Further research is needed to examine different positive and negative experiences among non-lonely and lonely men and women.</p>
<p>Furthermore, we found that lonely people perceived &#x0201C;spending more time with loved ones&#x0201D; significantly less than non-lonely people did. It is unclear whether such a perception plays a role in developing and maintaining a desired social relationship that is associated with defying loneliness: Did people not spend enough time with their loved ones and then became lonely, or were they lonely and withdrew themselves even more from social contacts? Another interesting aspect would be to exhibit if lonely people actually spend less time with loved ones than non-lonely people or if they just perceive it as such, as lonely people tend to have more negative and less satisfying social interactions, which contribute to negative moods and interactions (<xref ref-type="bibr" rid="B66">66</xref>). In this context, we found that lonely people reported less sense of togetherness than non-lonely people. A sense of togetherness reflects solidarity that comes hand in hand with achieving a common goal (<xref ref-type="bibr" rid="B67">67</xref>). Interestingly, loneliness as &#x0201C;selfish&#x0201D; mode can inhibit our sense of solidarity (<xref ref-type="bibr" rid="B43">43</xref>, <xref ref-type="bibr" rid="B68">68</xref>, <xref ref-type="bibr" rid="B69">69</xref>). The ETL suggests this &#x0201C;selfish&#x0201D; mode as a response to avoid a dangerous situation (<xref ref-type="bibr" rid="B43">43</xref>). However, people may be at risk of developing chronic loneliness, if they continue with this mode over time (<xref ref-type="bibr" rid="B70">70</xref>). Loss of sense of togetherness may reinforce this vicious circle. Laitinen and Pessi suggested that chaos and conflict in societies can oppose solidarity, along with the maximization of self-interest (<xref ref-type="bibr" rid="B71">71</xref>). Furthermore, our findings uncovered various aspects of what it feels like to be lonely amid COVID-19. Although closer friendships seem to remain intact in the pandemic (<xref ref-type="bibr" rid="B72">72</xref>), it is associated with less general peer-to-peer contact (<xref ref-type="bibr" rid="B73">73</xref>) and worse recognition of one&#x00027;s own and others&#x00027; emotions (<xref ref-type="bibr" rid="B74">74</xref>), which can lead to more distress and loneliness (<xref ref-type="bibr" rid="B73">73</xref>). When looking back at the possible evolutionary functions of loneliness, solidarity and spending time with a peer group help increase social skills for battling loneliness, which in turn lessens their risk for mortality (<xref ref-type="bibr" rid="B43">43</xref>). The absence of those social experiences and their effects on the mind and body can be a particular danger for lonely people.</p>
<p>Regarding the negative experiences of living during the pandemic, our results were consistent with the previous studies showing an association between loneliness and worry (<xref ref-type="bibr" rid="B75">75</xref>). In our study, lonely people worried significantly more than non-lonely people did. Strikingly, nearly two times as many of the non-lonely individuals believed that the whole pandemic was a hoax and made up of secret powers compared to lonely people. Recent research explains what draws people to conspiracy beliefs. Reasons to believe in conspiracy theories are that they give self-contained explanations for insecure situations, make people feel special, and give them a positive self-image for knowing information that nobody else knows and/or satisfy people&#x00027;s needs for safety and security (<xref ref-type="bibr" rid="B76">76</xref>). Other important socio-demographic data related to conspiracy beliefs are socio-economic status, education and political positions (<xref ref-type="bibr" rid="B76">76</xref>). Finally, our results showed that non-lonely individuals experienced more &#x0201C;other&#x0201D; negative outcomes of COVID-19 than lonely participants did. Negative experiences that were not mentioned before may include, among other factors, prolonged grievances for loved ones who died (<xref ref-type="bibr" rid="B77">77</xref>&#x02013;<xref ref-type="bibr" rid="B79">79</xref>), financial hardships (<xref ref-type="bibr" rid="B80">80</xref>, <xref ref-type="bibr" rid="B81">81</xref>), and family problems (<xref ref-type="bibr" rid="B82">82</xref>, <xref ref-type="bibr" rid="B83">83</xref>).</p>
<p>Generalizability and representativeness are limited in our study populations (e.g., people 18 &#x000B1; 75 years old), although our socio-demographic characteristics are consistent with other published surveys during COVID-19 (<xref ref-type="bibr" rid="B84">84</xref>, <xref ref-type="bibr" rid="B85">85</xref>). To reduce sampling bias, respondents were from Germany&#x00027;s 16 federal states and worked in various fields, such as office administration, healthcare, education, civil service, sales, agriculture, arts, sports, and media. Moreover, our sample consists of a high rate of women, which is consistent with other published surveys during COVID-19 (<xref ref-type="bibr" rid="B84">84</xref>, <xref ref-type="bibr" rid="B85">85</xref>). Our findings cannot establish a cause-and-effect relationship or analyze momentary experiences and daily behavior over a period. We cannot rule out the varying influences of COVID-19 and its related measures (e.g., lockdowns, public health, social, and economic measures) on our observed results. Future studies may also consider different socio-demographic factors (e.g., marital status, migration background, and household) that may have influences on the observed effects. A depth quality assessment is needed to uncover other potential positive and negative experiences with the COVID-19 pandemic.</p></sec>
<sec id="s5">
<title>5. Conclusion</title>
<p>The COVID-19 crisis may be a chance to reconsider personal and social priorities. Our study showed that lonely people reported more negative and less positive experiences during the COVID-19 pandemic than non-lonely people. To prepare for and respond to future pandemics, decision-makers may seek to spread positive energy among vulnerable populations (e.g., people who feel lonely), build trust and confidence in dealing with negative experiences (e.g., worry and fear), and improve communication. Future studies may focus on effective, adaptive, and scalable interventions to foster social cohesion, empower people helps build resilience, and, most importantly, provide timely social care.</p></sec>
<sec sec-type="data-availability" id="s6">
<title>Data availability statement</title>
<p>The datasets are available, with restrictions, due to confidentiality in line with Berlin Data Protection Act (Berliner Datenschutzgesetz - BlnDSG). Interested individuals can contact <email>stresshealth&#x00040;charite.de</email>.</p></sec>
<sec sec-type="ethics-statement" id="s7">
<title>Ethics statement</title>
<p>The studies involving human participants were reviewed and approved by Ethics Committee of Charit&#x000E9; &#x02013; Universit&#x000E4;tsmedizin Berlin. The participants provided their written informed consent to participate in this study.</p></sec>
<sec sec-type="author-contributions" id="s8">
<title>Author contributions</title>
<p>Conceptualization, writing&#x02014;review and editing, and supervision: SL. Methodology, data collection, and data curation: LW and SL. Data analysis and writing&#x02014;original draft preparation: LW. Both authors have read and agreed to the published version of the manuscript.</p></sec>
</body>
<back>
<sec sec-type="funding-information" id="s9">
<title>Funding</title>
<p>This study was supported by internal research funds from the Charit&#x000E9; &#x02013; Universit&#x000E4;tsmedizin Berlin (SL). We acknowledge support by the Open Access Publication Fund of the Freie Universit&#x000E4;t Berlin.</p>
</sec>
<ack><p>The authors thank Bin Shen, Cecilia Shen, and the team at Siuvo Inc. for setting up the survey on the Siuvo platform (<ext-link ext-link-type="uri" xlink:href="https://www.siuvo.com">https://www.siuvo.com</ext-link>, accessed on 30 September 2022). The authors also thank all the participants.</p>
</ack>
<sec sec-type="COI-statement" id="conf1">
<title>Conflict of interest</title>
<p>The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.</p>
</sec>
<sec sec-type="disclaimer" id="s10">
<title>Publisher&#x00027;s note</title>
<p>All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.</p>
</sec>

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