Insatser för att motverka ofrivillig ensamhet

Publikationstyp: SBU:s upplysningstjänst Rapport ut202414Publicerad: 9 september 2024

Fråga och sammanfattning

Ofrivillig ensamhet är ett samhällsproblem som kan medföra allvarliga konsekvenser såsom psykiska och fysiska sjukdomar som kostar samhället stora vårdresurser. I Sverige lever ungefär var fjärde person i ofrivillig ensamhet och i social isolering. Störst är känslan av ofrivillig ensamhet bland barn, unga vuxna och de allra äldsta i befolkningen. Det behövs insatser i samhället som motverkar ofrivillig ensamhet och minskar dess konsekvenser.

Fråga

Vilken sammanställd forskning finns om insatser för att minska ofrivillig ensamhet?

Frågeställare: Utredare, Folkhälsomyndigheten

Sammanfattning

SBU:s upplysningstjänst har efter litteratursökning, relevansgranskning och bedömning av risk för snedvridning av resultaten, bias, redovisat tolv systematiska översikter i svaret.

Dessa tolv översikter har inkluderat populationerna äldre, personer som överlevt en cancersjukdom, personer med psykisk sjukdom och unga vuxna där en del har psykisk funktionsnedsättning. Samtliga översikter publicerades under perioden 2020–2024. Översikterna skilde sig åt med avseende på population, typ av intervention och uppföljningstid. Även studiedesignerna skiljde sig åt där både kvantitativa och kvalitativa studier inkluderades i några av översikterna. I majoriteten av översikterna drog författarna slutsatsen att deras resultat ska tolkas med försiktighet och att mer forskning behövs.

Nio översikter utvärderade interventioner som syftade till att motverka ofrivillig ensamhet hos äldre personer. Av dessa undersökte tre översikter digitala interventioner och tre sociala och psykosociala interventioner. I en översikt undersökte man djurassisterade interventioner och i två översikter undersökte man ett flertal olika typer av insatser. Dessa insatser rörde bland annat djur, digitala interventioner samt kognitiv beteendeterapi.

I de övriga tre översikterna utvärderades interventioner som syftade till att motverka ofrivillig ensamhet hos personer som drabbats av och överlevt en cancersjukdom, personer med psykisk sjukdom samt ungdomar och unga vuxna. Översikterna utvärderade bland annat stödgrupper och social färdighetsträning, socialt stöd som exempelvis medveten närvaro (engelska: mindfulness), digitalt stöd respektive psykoedukation och social färdighetsträning.

Svenska eller nordiska primärstudier ingår i sju av översikterna. Författarnas slutsatser i samtliga inkluderade översikter har inte analyserats utifrån svenska förhållanden.

Upplysningstjänsten har även identifierat 40 relevanta systematiska översikter som bedömdes ha hög risk för bias. Resultaten och författarnas slutsatser redovisas därför inte i svaret. Dessa undersökte även andra populationer, som allmänheten, personer med psykisk funktionsnedsättning samt barn.

På SBU:s upplysningstjänst identifierar och redovisar vi publicerade systematiska översikter* som svar på en avgränsad fråga.
Vi bedömer risken för bias (snedvridning eller systematiska fel) i systematiska översikter och presenterar författarnas slutsatser från översikter med låg eller måttlig risk för bias.
I Upplysningstjänstens svar väger vi inte samman resultat och bedömer heller inte grad av vetenskaplig tillförlitlighet.
Upplysningstjänsten identifierar publikationer från primärstudier** då det är relevant men gör ingen bedömning av risk för bias hos dessa och av den anledningen presenteras inga resultat.
Vid behov bedömer vi kvalitet och överförbarhet av resultat i hälsoekonomiska studier.

* Sammanställning av resultat från sådana studier som med systematiska och explicita metoder har identifierats, valts ut och bedömts kritiskt och som avser en specifikt formulerad fråga.

** En primärstudie är en vetenskaplig undersökning som innebär insamling och analys av originaldata. Primärstudier skiljer sig från sekundärstudier (t. ex. systematiska översikter), som innebär att tidigare insamlade data analyseras igen utifrån till exempel en ny forskningsfråga eller ett nytt perspektiv.

Bakgrund

Ofrivillig ensamhet är ett samhällsproblem som kan orsaka lidande för den enskilde och som kostar samhället stora vårdresurser eftersom ensamheten kan leda till såväl psykiska som fysiska sjukdomar. Ungefär var fjärde person lever i ensamhet och isolering. Störst är känslan av ofrivillig ensamhet bland barn, unga vuxna och de allra äldsta i befolkningen [1].

Världshälsoorganisationen (engelska: World Health Organization (WHO)) har år 2023 instiftat en internationell kommission med syfte att prioritera och öka synligheten av insatser som motverkar ofrivillig ensamhet och social isolering. Kommissionen understryker att ofrivillig ensamhet är ett globalt hälsoproblem. Sverige är det enda europeiska land som är representerat i kommissionen [2].

För att minska konsekvenserna av ofrivillig ensamhet behöver samhället insatser som motverkar detta problem [1]. Folkhälsomyndigheten har fått uppdraget att kartlägga och öka kunskapen om ofrivillig ensamhet och dess konsekvenser. De ska utifrån resultatet av kartläggningen föreslå en nationell strategi för hur man kan arbeta med att förebygga och minska ofrivillig ensamhet [3]. Socialstyrelsen har fått uppdraget att fördela statsbidrag till kommuner för insatser som ska bryta ofrivillig ensamhet hos äldre som bor på särskilda boenden eller har hemtjänst. Bidraget ska bland annat användas till att ordna aktiviteter som bidrar till gemenskap, skapa mötesplatser, aktiviteter som involverar olika former av teknologi eller kulturella aktiviteter [4].

Frågeställningar och avgränsningar

Upplysningstjänsten har tillsammans med frågeställaren formulerat frågan enligt följande PICO¹ :

Population: Personer (alla åldrar) ur allmänheten, personer med psykisk sjukdom, funktionsnedsättning eller somatisk sjukdom, som upplever ofrivillig ensamhet

Intervention: Interventioner som motverkar eller förebygger ofrivillig ensamhet

Control: Ingen eller annan insats

Outcome: Minskad ofrivillig ensamhet eller social isolering

^1.PICO är en förkortning för patient/population/problem, intervention (insats, behandling)/, comparison/control (jämförelseintervention (insats, behandling)) och outcome (utfallsmått).

Upplysningstjänsten har gjort sökningar (Bilaga 1) i databaserna Medline (Ovid), Scopus och PsycINFO.

Vi har även handsökt publikationer på webbsidor för regionala HTA² -organisationer och myndigheter. Svaret har begränsats till enbart systematiska översikter.

SBU:s Upplysningstjänst publicerade år 2022 svaret ”Insatser för att minska ensamhet hos äldre” [5]. Därför begränsades sökningen för populationen äldre som är ofrivilligt ensamma till artiklar publicerade från år 2021 och framåt.

^2.Utvärdering av hälso- och sjukvårdens (och i SBU:s fall socialtjänstens) metoder (engelska: Health Technology Assessment)

Bedömning av risk för bias

I en systematisk översikt finns det risk för bias, det vill säga att resultatet blir snedvridet på grund av brister i avgränsning, litteratursökning och hantering av resultatet. Det är därför viktigt att granska metoden i en systematisk översikt. Två utredare bedömde risken för bias i översikterna med stöd av SBU:s granskningsmall för att översiktligt bedöma risken för snedvridning/systematiska fel hos systematiska översikter (Bilaga 6). Granskningsmallen har sex steg och bygger på frågorna i AMSTAR granskningsmall [6]. Om översikten inte uppfyllde kraven listade i de tre första stegen bedömdes den ha hög risk för bias och granskades inte vidare. En systematisk översikt bedöms ha måttlig risk för bias om den uppfyller alla kraven till och med steg 4, och låg om den uppfyller samtliga steg i SBU:s mall (Bilaga 6 och Faktaruta 2).

Systematiska översikter med måttlig eller låg risk för bias beskrivs både i text och tabell. De översikter som bedöms ha hög risk för bias presenteras varken i text eller tabell eftersom risken för att resultaten är missvisande bedöms vara för hög.

Risken för bias avser den vetenskapliga kvaliteten hos en systematisk översikt och dess förmåga att besvara en viss fråga på ett tillförlitligt och transparent sätt. En översikt som bedömts ha låg till måttlig risk för bias uppfyller följande:

En tydligt definierad frågeställning
En välgjord litteratursökning som matchar frågeställningen och är dokumenterad så att den kan återskapas.
Studiernas relevans har granskats av minst två personer oberoende av varandra
De inkluderade studiernas resultat och karakteristika finns redovisade
De inkluderade studiernas risk för bias har granskats och dokumenterats
En sammanvägd beskrivning av resultatet finns gjord, antingen i form av metaanalys, metasyntes eller enbart beskrivning på det sätt som var lämpligast utifrån de inkluderade studierna.

Resultat från sökningen och bedömning av risk för bias

Upplysningstjänstens litteratursökning genererade totalt 2 301 artikelsammanfattningar (abstrakt) efter dubblettkontroll. Ett flödesschema för urvalsprocessen visas i Bilaga 2. Varje artikelsammanfattning lästes av två utredare på SBU och 145 översikter bedömdes kunna vara relevanta för frågan. Varje översikt lästes därefter i fulltext av två utredare och 93 artiklar som inte var relevanta för frågan exkluderades (Bilaga 3).

Två utredare på Upplysningstjänsten bedömde risken för bias i 52 systematiska översikter som var relevanta för frågan och tolv av dessa bedömdes ha måttlig eller låg risk för bias [7–18]. Resultat och slutsatser från dessa översikter redovisas nedan. Av de relevanta översikterna bedömdes 40 ha hög risk för bias [19–58]. Upplysningstjänstens bedömning av risk för bias redovisas i Bilaga 4.

Systematiska översikter

SBU:s upplysningstjänst inkluderade tolv systematiska översikter med låg eller måttlig risk för bias i svaret (Tabell 1 och Bilaga 5). Samtliga översikter publicerades mellan åren 2020 och 2024. Inkluderade studier i översikterna skilde sig med avseende på population, studiedesign, typ av intervention, och uppföljningstid. Bilaga 5 innehåller en översiktstabell där de inkluderade översikterna är grupperade efter population och interventionstyp. Det vanligaste utfallsmåttet i studierna var ensamhet och den skala som var mest använd för att mäta ensamhet var UCLA:s ensamhetsskala (UCLA loneliness scale). Interventionerna gavs individuellt eller i grupp, digitalt eller fysiskt i form av diskussionsforum. Svenska primärstudier ingår i sex översikter [7] [10] [12] [14] [16] [18] och studier från övriga Norden i fem översikter [8] [10] [12] [14] [18].

Nio av översikterna utvärderade effekten av metoder och insatser för äldre personer som upplevde ofrivillig ensamhet [7] [8] [9] [10] [11] [14] [16] [17] [18] varav fem utvärderade insatser till äldre som bodde i särskilt boende [9] [10] [11] [14] [16]. Tre översikter har undersökt digitala interventioner [9] [16] [17] tre har undersökt sociala- och psykosociala interventioner [7] [8] [11] en har undersökt djurassisterade interventioner [14] och två av studierna har undersökt ett flertal olika typer av insatser som bland annat rörde djur, digital intervention samt kognitiv beteendeterapi [10] [18].

I de övriga tre översikterna utvärderades interventioner för att motverka ofrivillig ensamhet hos personer som drabbats av och överlevt en cancersjukdom, ungdomar och unga vuxna respektive personer med psykisk sjukdom. I översikten om personer som drabbats av och överlevt en cancersjukdom utvärderades bland annat stödgrupper och social färdighetsträning som intervention för att motverka ensamhet [13]. I översikten om ungdomar och unga vuxna, där en del hade psykisk funktionsnedsättning eller psykisk sjukdom, utvärderades olika typer av socialt och digitalt stöd för att motverka ensamhet och social isolering [15]. I översikten om personer med psykisk sjukdom utvärderades bland annat psykoedukation och social färdighetsträning [12].

Sammanfattningsvis drog majoriteten av översiktsförfattarna slutsatsen att deras resultat ska tolkas med försiktighet och att mer forskning behövs för att styrka resultaten.

Notera att resultaten inte har analyserats utifrån svenska förhållanden.

SBU:s upplysningstjänst identifierade inga översikter med låg eller måttlig risk för bias som specifikt utvärderat interventioner för att motverka ensamhet till allmänheten, personer med fysisk eller psykisk funktionsnedsättning, barn och unga eller socialt utsatta personer.

Personer 50 år och äldre

Chua och medförfattare undersökte hembaserade interventioner som bestod av ”befriending”- program som ger sällskap och stöd, vanligtvis genom volontärarbete [7]. Övriga hembaserade interventioner var psykologiska terapier som exempelvis kognitiv beteendeterapi, insatser som involverade stöd till äldre personer (till exempel hemleverans av måltider, engelska: ”meals-on-wheels”) eller kompetensutvecklingsinsatser som inkluderade fritidsaktiviteter såsom trädgårdsprogram och dator- eller internetanvändning. Översikten visade statistiskt signifikanta positiva effekter på ensamhet (minskad ensamhet) för interventionerna ”befriending”, psykologisk terapi, kompetensutveckling och vård- och omsorgsstöd.

Foettinger och medförfattare undersökte interventioner där ideella lokala organisationer gav äldre män en lokal för hantverk och social interaktion (engelska: ”men’s sheds”) [8]. I denna systematiska översikt inkluderades alla resultat av kvantitativa mått på social isolering och kvalitativa resultat på social isolering med termer som "social interaktion", "känsla av tillhörighet" eller "ensamhet". En ofta använd skala är Lubben Social Network Scale där social isolering har undersökts under olika former (t.ex. "brist på socialt nätverk", "ensamhet"). Resultaten tyder på att äldre män skulle kunna dra nytta av delaktighet i ”men’s sheds”, dock är evidensen som stödjer detta begränsad och översiktsförfattarna understryker att longitudinella studier behövs för att utreda detta vidare.

Fu och medförfattare undersökte effekten av digitala interventioner som videosamtal, telefonsamtal eller dator- och internetbaserade interventioner för att minska ofrivillig ensamhet hos äldre människor [9]. Enligt översiktsförfattarna låg fokus på att skapa en social kontakt med hjälp av interventionen. Resultaten visade att digitala interventioner kan minska ensamhet hos äldre och att det sannolikt påverkas av medietyp, där man visat att videosamtal är den insatsen som har en statistiskt signifikant positiv effekt på ensamhet till skillnad från telefonsamtal eller dator- och internetbaserad intervention.

Hoang och medförfattare undersökte i en systematisk översikt effekten av flera olika interventioner som syftar till att minska ensamhet och social isolering hos äldre personer [10]. Översikten bestod av randomiserade kontrollerade studier där insatserna var djurassisterad terapi, psykoterapi eller kognitiv beteendeterapi, fysisk träning, musikrelaterad terapi, sociala samt digitala interventioner. Översiktsförfattarna kom fram till att de flesta interventionerna hade en liten positiv effekt på känslan av ensamhet. Djurassisterad terapi och digitala interventioner hade störst effekt på känslan av ensamhet vid långtidsvård jämfört med övriga interventioner som utvärderades. Dessa resultat bör dock enligt författarna tolkas med försiktighet.

Laermans och medförfattare undersökte effekten av ”friendly visitors” där besöken utfördes av volontärer och bestod av samtal, spel eller minnen, med syftet att minska ensamhet och social isolering hos äldre personer [11]. Ingen av studierna rapporterade om de långsiktiga effekterna (mer än sex månader efter besöken) på upplevd ensamhet eller social isolering. Primärstudierna var dessutom små och rapporterade ofta inte alla data på ett transparent sätt. De sammantagna resultaten visade ingen säker effekt av interventionen för att motverka ensamhet eller social isolering.

Orr och medförfattare rapporterade i en systematisk översikt de sammanställda resultaten från kvalitativa studier som studerat effekten av djurassisterade interventioner för äldre med och utan demens i särskilt boende [14]. Två studier inkluderade resultat för upplevd ensamhet. Båda studierna inkluderade två interventionsgrupper jämföda med sedvanlig vård. En studie jämförde levande hund med robothund, den andra jämförde besök av levande hund en gång i veckan med hundbesök tre gånger i veckan. Jämfört med sedvanlig vård fann man i båda studierna en statistiskt signifikant minskning av upplevd ensamhet hos de boende i interventionsgruppen. Däremot identifierade man inte någon statistiskt signifikant skillnad mellan interventionsgrupperna, det vill säga robothund jämfört med riktig hund, eller hundbesök en gång jämfört med tre gånger i veckan. I den kvalitativa delen av översikten fanns ingen särredovisning av hundassisterade studier, men översiktsförfattarna bedömer resultaten som positiva där de boende får möjlighet att minnas och samtala, delta i sensoriska och upplevt meningsfulla aktiviteter som ger respit från ensamhet.

Shah och medförfattare bedömde i sin systematiska översikt effekten av digitala interventioner såsom videosamtal för att minska upplevd ensamhet hos äldre människor [16]. Resultaten visade inte på någon statistiskt signifikant effekt av digitala interventioner jämfört med sedvanlig vård eller icke-digitala interventioner.

Yeo och medförfattare undersökte effekten av hjulförsedda robotar med trådlös internetuppkoppling på känslan av ensamhet hos äldre [17]. Robotarna kommunicerade med fjärrkommunikationsutrustning som kameror, mikrofoner och högtalare där en funktion med tvåvägskommunikation var möjlig. Det övergripande resultatet från de kvalitativa studierna var att användandet av mobila robotar ledde till att de äldre upplevde en minskad känsla av ensamhet och social isolering.

Yu och medförfattare undersökte i en systematisk översikt effekten av olika icke-farmakologiska interventioner på känslan av ensamhet hos äldre personer i eget boende [18]. Inkluderade interventioner var bland annat psykologiska insatser, sociala stödinsatser (med digitala och icke-digitala medel), beteendeaktivering med syfte att främja beteendeförändringar i samband med aktivt socialt engagemang, samt fysisk träning. Översiktsförfattarna kom fram till att psykologiska interventioner, digitala sociala stödinsatser samt multimodala interventioner hade positiva effekter på känslan av ensamhet, det vill säga minskad känsla av ensamhet.

Canceröverlevare

McElfresh och medförfattare undersökte i en systematisk översikt effekten av bland annat social färdighetsträning hos personer som drabbats av och överlevt en cancersjukdom [13]. Översikten bestod främst av randomiserade kontrollerade studier. De övergripande resultaten visar på positiva effekter av interventionerna när det gäller genomförbarhet och acceptans bland canceröverlevare. Översiktsförfattarna bedömer dock att det vetenskapliga stödet för att interventionerna minskar upplevd ensamhet hos canceröverlevare är svagt, trots en statistiskt signifikant minskning av upplevd ensamhet. Översikten belyser en brist på studier på vuxna canceröverlevare, särskilt större studier med en tillräcklig statistisk styrka. Författarna konstaterade att interventionerna i studierna varierade avsevärt gällande implementering, tillvägagångssätt, studiemiljöer, behandlingslängd samt antalet sessioner och drog slutsatsen att det endast finns mycket få studier där interventioner som ska minska upplevd ensamhet hos personer som överlevt cancer kan sammanvägas.

Ungdomar och unga vuxna

Osborn och medförfattare undersökte i en systematisk översikt effekten av social färdighetsträning hos ungdomar och unga vuxna som upplever ofrivillig ensamhet [15]. I många av de inkluderade studierna hade deltagarna psykisk funktionsnedsättning eller psykisk sjukdom. Olika typer av socialt stöd undersöktes som exempelvis medveten närvaro (engelska: mindfulness) och digitalt stöd i form av mobilappar som ska motverka upplevd ensamhet och social isolering. Studiernas design varierade (randomiserade kontrollerade studier, pre-post-studier, kvasi-experimentell studie, icke-randomiserade studier, kvalitativa studier). Resultaten visade en trend som talade för att interventionerna minskade upplevd ensamhet. De insatser som föreföll framgångsrika var inriktade på personernas specifika behov och genomfördes i mer institutionella miljöer. Interventionerna som innehöll social färdighetsträning var ofta dåligt beskrivna och gavs individuellt eller i små grupper. Författarna menar att med hänsyn till att ensamhet och social isolering är ett samhällsproblem är det osannolikt att dessa metoder skulle kunna skalas upp till den bredare befolkningen.

Personer med psykisk sjukdom

Ma och medförfattare undersökte i en systematisk översikt effekten av bland annat social färdighetsträning på social isolering hos personer med psykisk sjukdom [12]. Översikten bestod av randomiserade kontrollerade studier där insatserna var både individuella och gruppbaserade. Översiktsförfattarna kom bland annat fram till att evidensen för social färdighetsträning ännu inte är tillräckligt stark för att ge specifika rekommendationer för praxis. Författarna belyser behovet av en mer grundlig och teoridriven interventionsutveckling och av väl utformade randomiserade kontrollerade studier.

Tabell 1 Systematiska översikter med låg/måttlig risk för bias/Table 1 Systematic reviews with low/moderate risk of bias.
Included studies	Population, Intervention, Control	Outcome and Results
Chua et al, 2023 [7] Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis.
Included studies: 14 RCTs Setting: USA (7), Sweden (3), United Kingdom (1), Canada (2), Netherlands (1).	Population: Older people (over 50) living at home Intervention: Four different types of home-based interventions: befriending interventions, psychological therapies, skill development, and health and social care provision Control: Telephone support calls, friendly visits, standard care, or waitlist	Loneliness (continuous data) (8 studies, n=1356) SMD= −0.27 (95% CI, −0.51 to −0.03, p=0.03) It showed a statistically significant small effect size favoring the intervention group. Loneliness (dichotomous data) (2 studies, n=219)RR=0.60 (95% CI, 0.27 to 1.34) No significant difference compared to control group.
Authors' conclusion: “Overall, this review found that home-based interventions were able to significantly increase older adults’ social connectedness (social support and social engagement) and reduce their loneliness and depressive symptoms. […] Considering the low-quality rating by the GRADE approach, future research is needed to confirm current findings.”
Foettinger et al, 2022 [8] The Role of Community-Based Men's Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review. American journal of men's health.
Included studies: 52 studies (35 qualitative, 9 quantitative, 8 mixed-methods studies) Setting: Australia (28), United Kingdom (8), Ireland (5), New Zealand (3), Canada (3), Denmark (1), cross-country comparisons (4)	Population: Men aged 50 years and older Intervention: Men’s sheds (set up in communal spaces where men can get together to engage in joint activities and work on projects) Control (intervention)/Comparison/: Men who do not participate in Men’s Sheds or no control	Social isolation No separate analysis of quantitative results. Synthesis of the complete material found 4 themes, where social isolation was one. The code social isolation was described (with sub-codes in italics): The shed environment facilitates social interaction between the participating men which can counteract social isolation in retirement. Social interaction is characterized by communicating “shoulder to shoulder.” Thereby, men develop a sense of belonging. The companionship and new connections both expand and strengthen the social network.
Authors' conclusion: “The results indicate that older men can benefit from shed participation in regard to mental health, well-being, and social isolation. […] This mixed-methods systematic review provides a comprehensive overview of the evidence base concerning Men’s Sheds and highlights the needfor longitudinal studies investigating causal relationships and gathering sufficient information on how to successfully transfer and implement the concept of Men’s Sheds in other countries.”
Fu et al, 2022 [9] The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis.
Included studies: 13 RCTs Setting: USA (6), Israel (2), South Africa (1), Canada (1), Taiwan (1), United Kingdom (1), China (1)	Population: Older adults (above 65) Intervention: Remotely delivered (telephone call, video call, computer or internet-based) treatment of loneliness Control: Brief contact, social activity, usual care, or no intervention.	Loneliness All delivery types compared to all control groups: (13 studies, n=1045) SMD= –0.41 (95% CI, –0.70 to –0.13) Analyses based on specific interventions Video call compared to all control groups: (3 studies, n=211) SMD= –0.54 (95% CI, –0.83 to –0.25, p=0.0003) Media subgroup analysis supported the effectiveness of intervention delivered by video call. Telephone-based compared to all control groups: (6 studies, n=591) SMD= –0.20 (95% CI, –0.56 to 0.15, p=0.27) Computer and internet-based compared to all control groups: (4 studies, n=243) SMD= –0.85 (95% CI, –1.8 to 0.1, p=0.08) No evidence was found to support the effectiveness of telephone call and computer and internet- delivered intervention. Note: This is a selection of relevant results. For complete results, see reference in full.
Authors' conclusion: “In conclusion, we believe that remotely delivered intervention can provide superior loneliness relief than brief intervention, usual care, and no intervention. The effect on loneliness reduction appears to be affected by intervention technology, strategy, participants’ characteristic, group format, and effect measurement time point.”
Hoang et al, 2022 [10] Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis.
Included studies: 70 RCT (56 RCT included in meta-analysis) Setting: USA (25), China (7), United Kingdom (5), Netherlands (4), Taiwan (3), Australia (3), Sweden (3), Canada (3), Finland (3), Iran (2), Italy (2), New Zealand (1), South Africa (1), Norway (1), Austria (1), Russia (1), Singapore (1), Japan (1), Hong Kong (1), Israel (1), multi (1)	Population: Older adults (over 65), living in community or long-term care. Intervention: Interventions to prevent or reduce loneliness, for example animal therapy, cognitive behavioural therapy, exercise, or technological interventions. Control: Waitlist control, standard care, no intervention	Loneliness Combined or multicomponent interventions, long term care compared to control (3 studies, n=675) SMD= -0.53 (95% CI, –0.86 to –0.20) Animal therapy, long term care compared to control (one study comparing individual animal therapy to group animal therapy excluded) (3 studies, n=111) SMD= −1.86 (95% CI, −3.14 to −0.59) Note: This is a selection of results. For results of all interventions, see the reference in full.
Authors' conclusion: “In this study, animal therapy and technology in long-term care had large effect sizes, but also high heterogeneity, so the effect size’s magnitude should be interpreted with caution. The small number of studies per intervention limits conclusions on sources of heterogeneity. Overall quality of evidence was very low.”
Laermans et al, 2023 [11] Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review.
Included studies: 13 studies (9 RCTs, 4 non-RCTs) Setting: USA (9), Canada (2), Germany (1), Ireland (1)	Population: Community‐dwelling or institutionalized older adults (over 60) Intervention: Friendly visitors Control No friendly visitors	Loneliness (2 studies, n=123) No synthesis provided. Social isolation (2 studies, n=134) Synthesizing the results of two non‐randomized controlled trials by vote counting based on the direction of effect, three of the four effects (75%) favoured the friendly visiting intervention.
Authors' conclusion: “At the moment, the evidence is very uncertain about the effect of friendly face‐to‐face visiting by a volunteer on improving loneliness, social isolation, and wellbeing in older adults. Overall, the identified evidence is scarce and of very low certainty, which precludes any conclusions about the added value of friendly face to‐face visiting by a volunteer.”
Ma et al, 2020 [12] The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review.
Included studies: 30 RCTs; n=3080 Setting: USA (13), Europe including Sweden and Norway (11), Israel (3), China (2), Canada (1).	Population: People diagnosed with mental health conditions. Intervention: Interventions which were designed to alleviate subjective or/and objective social isolation for people with mental health problems. For example, psychoeducation and social skills programs. Control: Treatment as usual, no treatment, two or more active treatments	Subjective social isolation (15 studies) Active intervention vs control (10 studies) No significant differences between groupsStudies comparing two active interventions (5 studies)1 case of significant between-group difference Objective social isolation (11 studies) Active intervention vs control (6 studies) 4/6 studies suggest superior outcomes compared to control group. Studies comparing two active interventions (5 studies) 2 studies present positive findings. Interventions targeting subjective and objective social isolation (4 studies) Active intervention vs control (4 studies) 2 of 4 report significant between-group difference for both subjective and objective social isolation. 3 reported significant difference for only subjective social isolation.
Authors' conclusion: “The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. We highlight the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.”
McElfresh et al, 2021 [13] Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis.
Included studies: 8 studies (7 RCTs, 1 pre-post evaluation study design) Setting: USA (6), Iran (1), and Japan (1).	Population: Cancer survivors (lung cancer, breast cancer, and other cancers) Intervention: Interventions to reduce loneliness in cancer survivors. Interventions include for example social skills training and support discussion groups.Group-based (4), telephone-based (3) and web-based (1). Control: Standard care, waitlist, or other version of an education program.	Loneliness (6 studies, n=465) SMD= –0.32 (95% CI, –0.50 to –0.14, p<0.001) indicating interventions overall had a significant effect on reducing loneliness.
Authors' conclusion: “There are limited interventions addressing loneliness in cancer survivors. Development and testing of culturally-relevant programs are warranted.”
Orr et al, 2023 [14] What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence.
Included studies: 34 studies (18 qualitative and 16 quantitative) Setting: USA (17), United Kingdom (4), Canada (2), Norway (2), Spain (2), New Zealand (1), Japan (1), Sweden (1), Italy (1), South Africa (1), Australia (1), Denmark (1)	Population: Elderly in care homes or long-term care facilities. 5 qualitative and 9 quantitative studies included patients with dementia. Intervention: Animal assisted interventions, for example animal-assisted therapy with a dog or robotic animals Control: Usual care (no control in qualitative studies)	Loneliness Visits from a dog (real or robotic) compared to usual care Or Visits from a dog 1 or 3 times a week compared to usual care (2 studies, n=unclear) Significantly less loneliness in both dog intervention groups compared to control (2 studies). Respite from loneliness was identified (based on 14 studies) as an aspect of one of 7 themes in the qualitative synthesis.
Authors' conclusion: “There was, however, limited evidence of a positive effect of pet/animal interaction on outcomes of loneliness […]”
Osborn et al, 2021 [15] Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness.
Included studies: 16 studies (presented in 28 articles) 5 RCTs, 7 pre-post designs, 1 quasi-experimental, 1 non-randomised group comparison study, and 2 repeated measure design (qualitative). Setting: Portugal (1), USA (4), Canada (3), Israel (1), China (1), Australia (5)	Population: Teenagers and adolescents at risk of loneliness (for example with mental illness, autistic spectrum disorders or chronic health conditions) Intervention: Interventions seeking to prevent or reduce loneliness and/or social isolation in young people (16 different social and emotional learning programs) Comparison: Brief advice and other various comparisons.	Loneliness Meta-analysis or thematic synthesis were not possible due to the significant heterogeneity of the material. Narrative synthesis of the results shows 14 of the 16 programs found reduction in prevalence of loneliness (measured by 8 different scales) over the study period. For complete descriptions of interventions and results, see reference in full.
Authors' conclusion “Interventions that appeared successful were targeted at the specific needs of the population and the determinants of loneliness or social isolation specific to the context and implemented in more institutional settings. However, the interventions were mostly intensive, individual, or small group approaches that were often poorly described. Given loneliness and social isolation are common and pervasive issues it is unlikely these approaches could be scaled to the wider population”.
Shah et al, 2021 [16] Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis.
Included studies: 6 studies: 1 quasi-experimentalstudy, 1 beforeand afterstudy, 4 RCTs Setting: Taiwan (1), Netherlands (1), Sweden (1), USA (1), United Kingdom (1), South Africa (1).	Population: Older people, in nursing home or independent living Intervention: Digital technology interventions, for example videoconferencing Control: Regular care, no comparator, care as usual plus regular carervisits	Loneliness (Digital technology interventions compared to control, 3 studies, n=106) SMD=0.02 (95% CI, −0.36 to 0.40, p=0.92) Narrative synthesis showed that there was a reduction in loneliness in the intervention groups at the follow-ups compared with baseline.
Authors' conclusion: “Our meta-analysis showed no evidence supporting the effectiveness of DTIs in reducing loneliness in older adults. Therefore, there is a need for further research involving RCTs with larger sample sizes and longer duration of interventions and follow-up measurement periods.”
Yeo et al, 2023 [17] Unpacking older adults’ experiences using mobile telepresence robots: A systematic mixed-studies review.
Included studies: 43 studies, 13 qualitative, 17 quantitative and 13 mixed-methods studies Setting: Australia (2), Austria (2), Belgium (1), Canada (3), Finland (2), France (4), Germany (3), Greece (1), Hungary (2), Italy (8), Japan (2), Macedonia (1), Netherlands (1), New Zealand (5), Poland (1), Spain (1), Sweden (2), United Kingdom (2), USA (6)	Population: Older adults, with or without cognitive impairment Intervention: Mobile telepresence robots Control: Not clearly stated, or no control	Loneliness No separate reporting of quantitative data on loneliness. A mixed methods synthesis, pooling results from both the qualitative and quantitative findings, produced four themes:-Enjoyable experiences-Willingness and acceptance-Promoting social connectedness-Improved psychosocial and physiological well-being “Alleviated loneliness” was a component of the theme Enjoyable experience. “Promote social connectivity” was a component of the theme Promoting social connectedness.
Authors' conclusion: “[…] it recognised the value of increasing access to quality care as well as overcoming social isolation and loneliness through the engagement, enjoyment, and connection brought about by mobile telepresence robots”
Yu et al, 2023 [18] Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression.
Included studies: 60 studies (37 included in meta-analysis) RCT (49 studies) Non-randomized studies (11 studies) Setting: USA (13), United Kingdom (7), Netherlands (7), Finland (4), Sweden (4), Spain (3), Israel (3), China (3), Taiwan (2), India (2), Iran (2), Canada (2), Philippines (1), Japan (1), Singapore (1), Egypt (1), Brazil (1), Denmark (1), Italy (1), Portugal (1)	Population: Community-dwelling older adults (aged 60 years or above) Intervention: Non-pharmacological interventions to prevent loneliness (for example behavioural activation, individual-based or group-based exercise, health promotion) Control: Active control, usual care or no-treatment control.	Loneliness Psychological interventions vs control group (6 studies, n=1171) SMD= −2.33 (95% CI, −4.40 to −0.25, p=0.003) Non-digital social support interventions vs control group (14 studies, n=2439) SMD =−0.63 (95% CI, −1.16 to −0.10, p= 0.02) Multi-component interventions vs control group (7 studies, n=1317) SMD= −0.28 (95% CI, −0.54 to −0.03, p=0.03) Behavioural activation, digital social support, exercise with social engagement No significant differences
Authors' conclusion: “In conclusion, this is the first review to offer a comparison between different interventions to combat loneliness among community dwelling older adults. The findings reinforce the complexity of late-life loneliness and emphasize the need for integrative interventions to increase the emotional adaptation of older adults, optimize their social connection skills and enhance the accessibility to social networks. Gender and health-related risk factors loneliness also need to be considered in identifying the optimal intervention.”
SMD = standardized mean difference; RCT= randomised controlled trial

SBU har inte gjort någon syntes eller evidensgradering av resultaten, det vill säga bedömt deras tillförlitlighet. Det är möjligt att översiktsförfattarnas bedömning av de ingående primärstudierna och evidensgradering av resultaten kan avvika från de bedömningar som SBU skulle göra vid framtagandet av en systematisk översikt.

Lästips

Campbell collaboration har i två nyligen publicerade artiklar kartlagt evidens och kunskapsluckor för olika insatser som syftar till att minska social isolering och ensamhet. I den ena kartläggs insatser där personlig kontakt är en huvudkomponent och som vänder sig till personer i alla åldersgrupper [59]. I den andra kartläggs digitala insatser till äldre [60]. Författarna har bedömt risken för bias i de systematiska översikterna men inte i de identifierade primärstudierna.

Till bägge publikationerna finns en digital evidenskarta där relevanta översikter och primärstudier med olika interventioner, utfall och risk för bias, lätt kan filtreras fram.

Vetenskapliga kunskapsluckor

Enligt SBU:s modell innebär en vetenskaplig kunskapslucka att det saknas evidens för vilken sammanvägd effekt en metod eller insats har, det vill säga kunskap från en systematisk översikt (Faktaruta 3).

SBU:s upplysningstjänst har efter litteratursökning identifierat tolv systematiska översikter med låg eller måttlig risk för bias. Kunskapsluckan gäller för insatser till allmänheten (alla åldrar), populationer med psykisk eller fysisk funktionsnedsättning, barn och unga eller socialt utsatta personer.

Ingen litteratursökning efter primärstudier har gjorts så nya primärstudier kan ha tillkommit efter att respektive översikt publicerades.

En systematisk översikt behövs när vi inte vet vilka studier som finns och därmed inte den sammanvägda effekten. De primärstudier som eventuellt finns behöver identifieras, granskas och vägas samman i en systematisk översikt för att kunskapsläget ska kunna fastställas.

Fler primärstudier behövs när en tillförlitlig systematisk översikt visar att det är osäkert vilken den sammanvägda effekten är. Det kan bero på att det saknas studier, att studierna har bedömts ha hög risk för systematiska fel, är för få, för små eller visar motsägande resultat (tillförlitligheten hos den sammanvägda effekten är mycket låg, till exempel enligt GRADE. Läs mer om GRADE i SBU:s metodbok).

En uppdaterad systematisk översikt behövs när det tidigare gjorts en systematisk översikt som visar att primärstudier behövs, och det finns skäl att tro att nya studier har tillkommit som möjligen kan ändra kunskapsläget.

Vetenskapliga kunskapsluckor registreras i SBU:s databas

Projektgrupp

Detta svar är sammanställt av Shahrzad Kia Komujuni (utredare), Lisa Andersson (utredare), Maral Jolstedt (utredare), Sally Saad (utredare), Sara Fundell (projektadministratör), Irene Edebert (produktsamordnare), Gunilla Fahlström (intern sakkunnig) samt Pernilla Östlund (avdelningschef) vid SBU.

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Rapo E, Johansson E, Jonsson F, Hornsten A, Lundgren AS, Nilsson I. Critical components of social prescribing programmes with a focus on older adults - a systematic review. Scand J Prim Health Care. 2023;41(3):326-42. Available from: https://doi.org/10.1080/02813432.2023.2237078.
Reinhardt GY, Vidovic D, Hammerton C. Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness. Perspect Public Health. 2021;141(4):204-13. Available from: https://doi.org/10.1177/1757913920967040.
Siette J, Cassidy M, Priebe S. Effectiveness of befriending interventions: a systematic review and meta-analysis. BMJ open. 2017;7(4):e014304. Available from: https://doi.org/10.1136/bmjopen-2016-014304.
Suthershinii G, Tan WA, Lee ARYB, Chen MZ. Behavioral Interventions for the Patient-Caregiver Unit in Patients with Chronic Heart Failure: A Systematic Review of Caregiver Outcomes. J MultidiscipHealthc. 2022;15:921-39. Available from: https://doi.org/10.2147/JMDH.S357179.
Tobin MC, Drager KDR, Richardson LF. A systematic review of social participation for adults with autism spectrum disorders: Support, social functioning, and quality of life. Res Autism Spectr Disord. 2014;8(3):214-29. Available from: https://doi.org/10.1016/j.rasd.2013.12.002.
Tong F, Yu C, Wang L, Chi I, Fu F. Systematic Review of Efficacy of Interventions for Social Isolation of Older Adults. Front Psychol. 2021;12:554145. Available from: https://doi.org/10.3389/fpsyg.2021.554145.
Vidovic D, Reinhardt GY, Hammerton C. Can Social Prescribing Foster Individual and Community Well-Being? A Systematic Review of the Evidence. Int J Environ Res Public Health. 2021;18(10). Available from: https://doi.org/10.3390/ijerph18105276.
Wiwatkunupakarn N, Pateekhum C, Aramrat C, Jirapornchaoren W, Pinyopornpanish K, Angkurawaranon C. Social networking site usage: A systematic review of its relationship with social isolation, loneliness, and depression among older adults. Aging Ment Health. 2022;26(7):1318-26. Available from: https://doi.org/10.1080/13607863.2021.1966745.
Yu J, Han M, Miao F, Hua D. Using mindfulness-based stress reduction to relieve loneliness, anxiety, and depression in cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2023;102(37):e34917. Available from: https://doi.org/10.1097/MD.0000000000034917.
Zagic D, Wuthrich VM, Rapee RM, Wolters N. Interventions to improve social connections: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2022;57(5):885-906. Available from: https://doi.org/10.1007/s00127-021-02191-w.
Welch V, Ghogomu ET, Dowling S, Barbeau VI, Al‐Zubaidi AAA, Beveridge E, et al. In‐person interventions to reduce social isolation and loneliness: An evidence and gap map. Campbell Syst Rev. 2024;20(2):e1408. Available from: https://doi.org/10.1002/cl2.1408.
Welch V, Ghogomu ET, Barbeau VI, Dowling S, Doyle R, Beveridge E, et al. Digital interventions to reduce social isolation and loneliness in older adults: An evidence and gap map. Campbell Syst Rev. 2023;19(4):e1369. Available from: https://doi.org/10.1002/cl2.1369.

Bilaga 1 Dokumentation av sökstrategier

Medline via OvidSP 22 November 2023

Title: Interventions for reducing loneliness
Search terms		Items found
1.	exp Social Isolation/ or exp Loneliness/ or ("social* isolat" OR lonel OR "social* disconnect" OR "Social Exclu" OR "social depriv" OR "social estrange" OR "social alienat" OR "societal alienat" OR "societal isolat" OR "societal disconnect" OR "societal Exclu" OR "societal depriv" OR "societal estrange*").ab,bt,kf,ti	47 465
Intervention:
2.	exp Social Participation/ OR exp Social Interaction/ OR exp Exercise/ OR exp Social support/ OR Social capital/ OR exp Animal Assisted Therapy/ OR exp Community Networks/ OR (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri" OR Multicomponent OR intergeneration OR "Active aging" OR "Active ageing" OR "social* particip" OR "peer relationship" OR "social relationship" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot OR "social* interact" OR integr OR reduc* OR "community centre" OR "community center" OR "community hub" OR "meeting point" OR "open centre" OR "open center" OR "open meet" OR "open space" OR "health connector" OR "social connect" OR befriend OR "social capital").ab,bt,kf,ti	15 699 991
Study types: systematic reviews and meta-analysis
3.	((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys" or metaanalys).ti,bt,ab.) not (editorial/ or letter/ or case reports/))	45 8520
Combined sets:
4.	1 AND 2	31 280
5.	3 AND 4	1027
Final result
6.		1027
/ = Term from the MeSH controlled vocabulary.sh = Term from the MeSH controlled vocabulary; exp = Term from MeSH including terms found below this term in the MeSH hierarchy;.ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other; * or $ = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:

Scopus via scopus.com 22 November 23

Title: Interventions for reducing loneliness
Search terms		Items found
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords); ALL = All fields; W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter; “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1.	TITLE-ABS-KEY ("social* isolat" OR lonel OR "social* disconnect" OR "Social Exclu" OR "social depriv" OR "social estrange" OR "social alienat" OR "societal alienat" OR "societal isolat" OR "societal disconnect" OR "societal Exclu" OR "societal depriv" OR "societal estrange*")	91 674
Intervention:
2.	TITLE-ABS-KEY (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri" OR Multicomponent OR intergeneration OR "Active aging" OR "Active ageing" OR "social* particip" OR "peer relationship" OR "social relationship" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot OR "social* interact" OR integr OR reduc* OR "community centre" OR "community center" OR "community hub" OR "meeting point" OR "open centre" OR "open center" OR "open meet" OR "open space" OR "health connector" OR "social connect" OR befriend OR "social capital")	37 733 349
Study types: systematic reviews and meta-analysis / randomized controlled trials
3.	TITLE-ABS-KEY ((systematic W/2 review) OR "meta analy" OR metaanaly ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”))	672 655
Combined sets:
4.	1 AND 2	62 769
5.	3 AND 4	1938
Final result
6.		1938

PSYCINFO via EBSCO 22 November 2023

Title: Interventions for reducing loneliness
Search terms		Items found
TI = Title; AB = Abstract; SU = Keyword, exact or part (including all other fields for indexed and author keywords); DE = Exact keyword; TX = All text; MR = Methodology; Nn = Near. Proximity operator retrieving terms within n words from each other; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Population:
1.	SU ("social* isolat" OR lonel OR "social* disconnect" OR "Social Exclu" OR "social depriv" OR "social estrange" OR "social alienat" OR "societal alienat" OR "societal isolat" OR "societal disconnect" OR "societal Exclu" OR "societal depriv" OR "societal estrange") OR TI ("social isolat" OR lonel OR "social* disconnect" OR "Social Exclu" OR "social depriv" OR "social estrange" OR "social alienat" OR "societal alienat" OR "societal isolat" OR "societal disconnect" OR "societal Exclu" OR "societal depriv" OR "societal estrange") OR AB ("social isolat" OR lonel OR "social* disconnect" OR "Social Exclu" OR "social depriv" OR "social estrange" OR "social alienat" OR "societal alienat" OR "societal isolat" OR "societal disconnect" OR "societal Exclu" OR "societal depriv" OR "societal estrange*")	39 954
Intervention:
2.	SU (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri" OR Multicomponent OR intergeneration OR "Active aging" OR "Active ageing" OR "social* particip" OR "peer relationship" OR "social relationship" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot OR "social* interact" OR integr OR reduc* OR "community centre" OR "community center" OR "community hub" OR "meeting point" OR "open centre" OR "open center" OR "open meet" OR "open space" OR "health connector" OR "social connect" OR befriend OR "social capital") OR TI (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri" OR Multicomponent OR intergeneration OR "Active aging" OR "Active ageing" OR "social* particip" OR "peer relationship" OR "social relationship" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot OR "social* interact" OR integr OR reduc* OR "community centre" OR "community center" OR "community hub" OR "meeting point" OR "open centre" OR "open center" OR "open meet" OR "open space" OR "health connector" OR "social connect" OR befriend OR "social capital") OR AB (interv* OR support* OR program* OR treatment* OR prevent* OR therap* OR activation OR "Social access" OR "Neighbourhood identification" OR engage* OR "social* prescri" OR Multicomponent OR intergeneration OR "Active aging" OR "Active ageing" OR "social* particip" OR "peer relationship" OR "social relationship" OR "Physical activity" OR exercise OR "Animal assisted" OR "Animal Facilitated" OR "Pet assisted" OR "Pet Facilitated" OR promot OR "social* interact" OR integr OR reduc* OR "community centre" OR "community center" OR "community hub" OR "meeting point" OR "open centre" OR "open center" OR "open meet" OR "open space" OR "health connector" OR "social connect" OR befriend OR "social capital")	3 022 750
Study types: systematic reviews and meta-analysis
3.	TI((systematic n3 review) OR "meta analys" OR metaanalys) OR AB((systematic n3 review) OR "meta analys" OR metaanalys) OR SU((systematic n3 review) OR "meta analys" OR metaanalys) OR (MR "Systematic Review" OR MR "meta analysis")	96 133
Combined sets:
4.	1 AND 2	27 514
5.	3 AND 4	621
Final result
6.		621

Bilaga 2 Flödesschema för urval av artiklar

Av 145 fulltextartiklar inkluderades 52, varav 12 hade måttlig risk för bias och 40 hög risk.

Bilaga 3 Exkluderade studier

Artiklar som exkluderats efter fulltextläsning på grund av bristande relevans
Excluded articles	Reason for exclusion
Systematic reviews
Adib-Hajbaghery M, Maghsoud F, Batooli Z. Evaluating Effect of Social Support Programs Based on the Roy's Adaptation Model on Patients with Breast Cancer: A Systematic Review. J Res Dev Nurs Midw. 2021;18(2):14-7. Available from: https://doi.org/10.52547/jgbfnm.18.2.14.	No relevant synthesis
Anderson K, Laxhman N, Priebe S. Can mental health interventions change social networks? A systematic review. BMC Psychiatry. 2015;15:297. Available from: https://doi.org/10.1186/s12888-015-0684-6.	Wrong outcome
Anvari MS, Hampton T, Tong MP, Kahn G, Triemstra JD, Magidson JF, et al. Behavioral Activation Disseminated by Non-Mental Health Professionals, Paraprofessionals, and Peers: A Systematic Review. Behav Ther. 2023;54(3):524-38. Available from: https://doi.org/10.1016/j.beth.2022.12.007.	Wrong outcome
Astasio-Picado A, Cobos-Moreno P, Gomez-Martin B, Verdu-Garces L, Zabala-Banos MDC. Efficacy of Interventions Based on the Use of Information and Communication Technologies for the Promotion of Active Aging. Int J Environ Res Public Health. 2022;19(3). Available from: https://doi.org/10.3390/ijerph19031534.	No relevant synthesis
Balki E, Hayes N, Holland C. Effectiveness of Technology Interventions in Addressing Social Isolation, Connectedness, and Loneliness in Older Adults: Systematic Umbrella Review. JMIR Aging. 2022;5(4):e40125. Available from: https://doi.org/10.2196/40125.	Wrong study design
Banbury A, Nancarrow S, Dart J, Gray L, Parkinson L. Telehealth Interventions Delivering Home-based Support Group Videoconferencing: Systematic Review. J Med Internet Res. 2018;20(2):e25. Available from: https://doi.org/10.2196/jmir.8090.	Wrong outcome
Barlow JH, Ellard DR. Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base. Child Care Health Dev. 2004;30(6):637-45. Available from: https://doi.org/10.1111/j.1365-2214.2004.00474.x.	Wrong publication type
Bauer A, Stevens M, Purtscheller D, Knapp M, Fonagy P, Evans-Lacko S, et al. Mobilising social support to improve mental health for children and adolescents: A systematic review using principles of realist synthesis. PLoS One. 2021;16(5):e0251750. Available from: https://doi.org/10.1371/journal.pone.0251750.	Wrong outcome
Beckers T, Maassen N, Koekkoek B, Tiemens B, Hutschemaekers G. Can social support be improved in people with a severe mental illness? A systematic review and meta-analysis. Curr Psychol. 2022:1-11. Available from: https://doi.org/10.1007/s12144-021-02694-4.	Wrong outcome
Bee P, Bower P, Byford S, Churchill R, Calam R, Stallard P, et al. The clinical effectiveness, cost-effectiveness and acceptability of community-based interventions aimed at improving or maintaining quality of life in children of parents with serious mental illness: a systematic review. Health Technol Assess. 2014;18(8):1-250. Available from: https://doi.org/10.3310/hta18080.	Wrong outcome
Beogo I, Sia D, Collin S, Phaelle Gedeon A, Louisme MC, Ramde J, et al. Strengthening Social Capital to Address Isolation and Loneliness in Long-Term Care Facilities During the COVID-19 Pandemic: Systematic Review of Research on Information and Communication Technologies. JMIR Aging. 2023;6:e46753. Available from: https://doi.org/10.2196/46753.	No relevant synthesis
Berkanish P, Pan S, Viola A, Rademaker Q, Devine KA. Technology-Based Peer Support Interventions for Adolescents with Chronic Illness: A Systematic Review. J Clin Psychol Med Settings. 2022;29(4):911-42. Available from: https://doi.org/10.1007/s10880-022-09853-0.	Wrong outcome
Bertuzzi V, Semonella M, Bruno D, Manna C, Edbrook-Childs J, Giusti EM, et al. Psychological Support Interventions for Healthcare Providers and Informal Caregivers during the COVID-19 Pandemic: A Systematic Review of the Literature. Int J Environ Res Public Health. 2021;18(13). Available from: https://doi.org/10.3390/ijerph18136939.	Wrong outcome
Bochicchio L, Reeder K, Ivanoff A, Pope H, Stefancic A. Psychotherapeutic interventions for LGBTQ + youth: A systematic review. J LGBT Youth. 2022;19(2):152-79. Available from: https://doi.org/10.1080/19361653.2020.1766393.	Wrong outcome
Boldt K, Coenen M, Movsisyan A, Voss S, Rehfuess E, Kunzler AM, et al. Interventions to Ameliorate the Psychosocial Effects of the COVID-19 Pandemic on Children-A Systematic Review. Int J Environ Res Public Health. 2021;18(5):1-31. Available from: https://doi.org/10.3390/ijerph18052361.	Wrong publication type
Bourne P, Camic PM, Crutch SJ. Psychosocial outcomes of dyadic arts interventions for people with a dementia and their informal caregivers: A systematic review. Health Soc Care Community. 2021;29(6):1632-49. Available from: https://doi.org/10.1111/hsc.13267.	Wrong outcome
Brand F, Scior K, Loewenberger A. Psychological and social outcomes of befriending interventions for adults with intellectual disabilities: A systematic review. J Appl Res Intellect Disabil. 2023. Available from: https://doi.org/10.1111/jar.13168.	Wrong outcome
Brooks HL, Rushton K, Lovell K, Bee P, Walker L, Grant L, et al. The power of support from companion animals for people living with mental health problems: a systematic review and narrative synthesis of the evidence. BMC Psychiatry. 2018;18(1):31. Available from: https://doi.org/10.1186/s12888-018-1613-2.	Wrong study design
Buechner H, Toparlak SM, Ostinelli EG, Shokraneh F, Nicholls-Mindlin J, Cipriani A, et al. Community interventions for anxiety and depression in adults and young people: A systematic review. Aust N Z J Psychiatry. 2023;57(9):1223-42. Available from: https://doi.org/10.1177/00048674221150362.	Wrong outcome
Bunn M, Zolman N, Smith CP, Khanna D, Hanneke R, Betancourt TS, et al. Family-based mental health interventions for refugees across the migration continuum: A systematic review. SSM Ment Health. 2022;2. Available from: https://doi.org/10.1016/j.ssmmh.2022.100153.	Wrong outcome
Cai R, Zakaryan G, Zhang K, Finnerty R. Connecting through music: A systematic review of the use of music to reduce loneliness during the COVID-19 pandemic. Music Med. 2023;15(3):171-82. Available from: https://doi.org/10.47513/mmd.v15i3.916.	Wrong control group
Caton S, Koivunen E-R, Allison C. Internet use for family carers of people with intellectual disabilities: A literature review and thematic synthesis. J Intellect Disabil. 2019;23(3):446-68. Available from: https://doi.org/10.1177/1744629519874214.	Wrong intervention
Christiansen HL, Bingen K, Hoag JA, Karst JS, Velazquez-Martin B, Barakat LP. Providing Children and Adolescents Opportunities for Social Interaction as a Standard of Care in Pediatric Oncology. Pediatr Blood Cancer. 2015;62 Suppl 5:S724-49. Available from: https://doi.org/10.1002/pbc.25774.	Wrong publication type
Clements H, Valentin S, Jenkins N, Rankin J, Baker JS, Gee N, et al. The effects of interacting with fish in aquariums on human health and well-being: A systematic review. PLoS One. 2019;14(7):e0220524. Available from: https://doi.org/10.1371/journal.pone.0220524.	No relevant synthesis
Crowe CL, Liu L, Bagnarol N, Fried LP. Loneliness prevention and the role of the Public Health system. Perspect Public Health. 2024;144(1):31-8. Available from: https://doi.org/10.1177/17579139221106579.	Wrong publication type
Dahm KT, Landmark B, Reinar LM. The Importance of Personnel Competence to Achieve Social Participation and Activity Amongst Users of Municipal Home Care. 2009.	Wrong publication type
Darbyshire LV, Stenfert Kroese B. Psychological Well‐Being and Social Support for Parents With Intellectual Disabilities: Risk Factors and Interventions. J Policy Pract Intellect Disabil. 2012;9(1):40-52. Available from: https://doi.org/10.1111/j.1741-1130.2012.00326.x.	Wrong outcome
Domenicucci R, Ferrandes F, Sarlo M, Borella E, Belacchi C. Efficacy of ICT-based interventions in improving psychological outcomes among older adults with MCI and dementia: A systematic review and meta-analysis. Ageing Res Rev. 2022;82:101781. Available from: https://doi.org/10.1016/j.arr.2022.101781.	No relevant synthesis
Dworschak C, Heim E, Maercker A. Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis. Internet Interv. 2022;27:100498. Available from: https://doi.org/10.1016/j.invent.2022.100498.	Wrong outcome
Fischer R, Hartle L. Effective interventions to reduce loneliness in big cities. Curr Opin Psychiatry. 2023;36(3):206-12. Available from: https://doi.org/10.1097/YCO.0000000000000844.	Wrong publication type
Freitas C, Fernandez-Company JF, Pita MF, Garcia-Rodriguez M. Music therapy for adolescents with psychiatric disorders: An overview. Clin Child Psychol Psychiatry. 2022;27(3):895-910. Available from: https://doi.org/10.1177/13591045221079161.	Wrong outcome
Gerritzen EV, Lee AR, McDermott O, Coulson N, Orrell M. Online Peer Support for People With Multiple Sclerosis: A Narrative Synthesis Systematic Review. Int J MS Care. 2022;24(6):252-9. Available from: https://doi.org/10.7224/1537-2073.2022-040.	Wrong outcome
Gerritzen EV, Lee AR, McDermott O, Coulson N, Orrell M. Online Peer Support for People With Parkinson Disease: Narrative Synthesis Systematic Review. JMIR Aging. 2022;5(3):e35425. Available from: https://doi.org/10.2196/35425.	Wrong outcome
Gettings RD, Kirtley J, Wilson-Menzfeld G, Oxburgh GE, Farrell D, Kiernan MD. Exploring the Role of Social Connection in Interventions With Military Veterans Diagnosed With Post-traumatic Stress Disorder: Systematic Narrative Review. Front Psychol. 2022;13:873885. Available from: https://doi.org/10.3389/fpsyg.2022.873885.	Wrong study design
Gilmour J, Machin T, Brownlow C, Jeffries C. Facebook-based social support and health: A systematic review. Psychol Pop Media. 2020;9(3):328-46. Available from: https://doi.org/10.1037/ppm0000246.	Wrong population
Godwin KM, Mills WL, Anderson JA, Kunik ME. Technology-driven interventions for caregivers of persons with dementia: a systematic review. Am J Alzheimers Dis Other Demen. 2013;28(3):216-22. Available from: https://doi.org/10.1177/1533317513481091.	Wrong outcome
Grillich L, Titscher V, Klingenstein P, Kostial E, Emprechtinger R, Klerings I, et al. The effectiveness of interventions to prevent loneliness and social isolation in the community-dwelling and old population: an overview of systematic reviews and meta-analysis. Eur J Public Health. 2023;33(2):235-41. Available from: https://doi.org/10.1093/eurpub/ckad006.	Wrong study design
Hackett S, McWhirter PT, Lesher S. The Therapeutic Efficacy of Domestic Violence Victim Interventions. Trauma Violence Abuse. 2016;17(2):123-32. Available from: https://doi.org/10.1177/1524838014566720.	Wrong outcome
Heaperman A, Andrews F. Promoting the health of mothers of young children in Australia: A review of face-to-face and online support. Health Promot J Austr. 2020;31(3):402-10. Available from: https://doi.org/10.1002/hpja.334.	Wrong outcome
Highton-Williamson E, Priebe S, Giacco D. Online social networking in people with psychosis: A systematic review. Int J Soc Psychiatry. 2015;61(1):92-101. Available from: https://doi.org/10.1177/0020764014556392.	Wrong outcome
Howarth S, Morris D, Newlin M, Webber M. Health and social care interventions which promote social participation for adults with learning disabilities: a review. Br J Learn Disabil. 2014;44(1):3-15. Available from: https://doi.org/10.1111/bld.12100.	Wrong outcome
Hsieh CJ, Li PS, Wang CH, Lin SL, Hsu TC, Tsai CT. Socially Assistive Robots for People Living with Dementia in Long-Term Facilities: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Gerontology. 2023;69(8):1027-42. Available from: https://doi.org/10.1159/000529849.	Wrong outcome
Hunt X, Shakespeare T, Vilyte G, Melendez-Torres GJ, Henry J, Bradshaw M, et al. Effectiveness of Social Inclusion Interventions for Anxiety and Depression among Adolescents: A Systematic Review. Int J Environ Res Public Health. 2023;20(3). Available from: https://doi.org/10.3390/ijerph20031895.	Wrong outcome
Iacovou M, Pattieson DC, Truby H, Palermo C. Social health and nutrition impacts of community kitchens: a systematic review. Public Health Nutr. 2013;16(3):535-43. Available from: https://doi.org/10.1017/S1368980012002753.	No relevant synthesis
Ingram I, Kelly PJ, Deane FP, Baker AL, Goh MCW, Raftery DK, et al. Loneliness among people with substance use problems: A narrative systematic review. Drug Alcohol Rev. 2020;39(5):447-83. Available from: https://doi.org/10.1111/dar.13064.	Wrong study design
Jin W, Liu Y, Yuan S, Bai R, Li X, Bai Z. The Effectiveness of Technology-Based Interventions for Reducing Loneliness in Older Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Psychol. 2021;12:711030. Available from: https://doi.org/10.3389/fpsyg.2021.711030.	Wrong population
Kiely B, Croke A, O'Shea M, Boland F, O'Shea E, Connolly D, et al. Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. BMJ Open. 2022;12(10):e062951. Available from: https://doi.org/10.1136/bmjopen-2022-062951.	Wrong outcome
Kusumota L, Diniz MAA, Ribeiro RM, Silva I, Figueira ALG, Rodrigues FR, et al. Impact of digital social media on the perception of loneliness and social isolation in older adults. Rev Lat Am Enfermagem. 2022;30:e3573. Available from: https://doi.org/10.1590/1518-8345.5641.3573.	Wrong study design
Laugeson EA. Review: social skills groups may improve social competence in children and adolescents with autism spectrum disorder. Evid Based Ment Health. 2013;16(1):11. Available from: https://doi.org/10.1136/eb-2012-100985.	Wrong publication type
Lindsay S, Kolne K, Cagliostro E. Electronic Mentoring Programs and Interventions for Children and Youth With Disabilities: Systematic Review. JMIR Pediatr Parent. 2018;1(2):e11679. Available from: https://doi.org/10.2196/11679.	Wrong outcome
Maor D, Mitchem KJ. Can technologies make a difference for hospitalized youth: Findings from research. Journal of Computer Assisted Learning. 2015;31(6):690-705. Available from: https://doi.org/10.1111/jcal.12112.	Wrong publication type
Mois G, Leathers TA, Murphy A, Emerson KG, Washington TR, Beer JM. Understand the role of technology embodiment in facilitating social connectivity to address loneliness across the lifespan: A systematic review. Gerontech. 2023;22(1):1-13. Available from: https://doi.org/10.4017/gt.2023.22.1.819.06.	Wrong publication type
Mousavizadeh SN, Jandaghian Bidgoli MA. Recovery-Oriented Practices in Community-based Mental Health Services: A Systematic Review. Iran J Psychiatry. 2023;18(3):332-51. Available from: https://doi.org/10.18502/ijps.v18i3.13013.	Wrong outcome
Murray J, Wickramasekera N, Elings M, Bragg R, Brennan C, Richardson Z, et al. The impact of care farms on quality of life, depression and anxiety among different population groups: A systematic review. Campbell Syst Rev. 2019;15(4):e1061. Available from: https://doi.org/10.1002/cl2.1061.	Wrong outcome
Newlin M, Webber M, Morris D, Howarth S. Social Participation Interventions for Adults with Mental Health Problems: A Review and Narrative Synthesis. Soc Work Res. 2015;39(3):167-80. Available from: https://doi.org/10.1093/swr/svv015.	Wrong outcome
Nolan S, Hendricks J, Ferguson S, Towell A. Social networking site (SNS) use by adolescent mothers: Can social support and social capital be enhanced by online social networks? - A structured review of the literature. Midwifery. 2017;48:24-31. Available from: https://doi.org/10.1016/j.midw.2017.03.002.	Wrong outcome
Noone C, Yang K. Community-based responses to loneliness in older people: A systematic review of qualitative studies. Health Soc Care Community. 2022;30(4):e859-e73. Available from: https://doi.org/10.1111/hsc.13682.	No relevant synthesis
Norman A, Moss TP. Psychosocial interventions for adults with visible differences: a systematic review. PeerJ. 2015;3(4):e870. Available from: https://doi.org/10.7717/peerj.870.	Wrong outcome
Nunnemann S, Kurz A, Leucht S, Diehl-Schmid J. Caregivers of patients with frontotemporal lobar degeneration: a review of burden, problems, needs, and interventions. Int Psychogeriatr. 2012;24(9):1368-86. Available from: https://doi.org/10.1017/S104161021200035X.	Wrong outcome
Olano-Lizarraga M, Wallstrom S, Martin-Martin J, Wolf A. Interventions on the social dimension of people with chronic heart failure: a systematic review of randomized controlled trials. Eur J Cardiovasc Nurs. 2023;22(2):113-25. Available from: https://doi.org/10.1093/eurjcn/zvac051.	Wrong outcome
Parker Oliver D, Patil S, Benson JJ, Gage A, Washington K, Kruse RL, et al. The Effect of Internet Group Support for Caregivers on Social Support, Self-Efficacy, and Caregiver Burden: A Meta-Analysis. Telemed J E Health. 2017;23(8):621-9. Available from: https://doi.org/10.1089/tmj.2016.0183.	Wrong outcome
Peters R, Ee N, Ward SA, Kenning G, Radford K, Goldwater M, et al. Intergenerational Programmes bringing together community dwelling non-familial older adults and children: A Systematic Review. Arch Gerontol Geriatr. 2021;94:104356. Available from: https://doi.org/10.1016/j.archger.2021.104356.	Relevant results not analysed separately
Plattner L, Brandstotter C, Paal P. [Loneliness in nursing homes-Experience and measures for amelioration : A literature review]. Z Gerontol Geriatr. 2022;55(1):5-10. Available from: https://doi.org/10.1007/s00391-021-01881-z.	Foreign language
Pollak I, Mitic M, Birchwood J, Dörfler S, Krammer I, Rogers JC, et al. A Systematic Review of Intervention Programs Promoting Peer Relationships Among Children and Adolescents: Methods and Targets Used in Effective Programs. Adol Res Rev. 2022;8(3):297-321. Available from: https://doi.org/10.1007/s40894-022-00195-4.	Wrong outcome
Pollock A, Hazelton C, Henderson CA, Angilley J, Dhillon B, Langhorne P, et al. Interventions for disorders of eye movement in patients with stroke. Cochrane Database Syst Rev. 2011(10):CD008389. Available from: https://doi.org/10.1002/14651858.CD008389.pub2.	Wrong outcome
Pollock A, Hazelton C, Rowe FJ, Jonuscheit S, Kernohan A, Angilley J, et al. Interventions for visual field defects in people with stroke. Cochrane Database Syst Rev. 2019;5(5):CD008388. Available from: https://doi.org/10.1002/14651858.CD008388.pub3.	Wrong outcome
Poudel PG, Horan MR, Brinkman TM, Wang Z, Robison LL, Hudson MM, et al. Interventions with Social Integration Components Addressing Psychosocial Outcomes of Young- and Middle-Aged Adult Cancer Individuals: A Systematic Review. Cancers (Basel). 2023;15(19). Available from: https://doi.org/10.3390/cancers15194710.	Wrong outcome
Pritchard E, Soh SE, Morello R, Berkovic D, Blair A, Anderson K, et al. Volunteer Programs Supporting People With Dementia/Delirium in Hospital: Systematic Review and Meta-Analysis. Gerontologist. 2021;61(8):e421-e34. Available from: https://doi.org/10.1093/geront/gnaa058.	Wrong population
Rai HK, Kernaghan D, Schoonmade L, Egan KJ, Pot AM. Digital Technologies to Prevent Social Isolation and Loneliness in Dementia: A Systematic Review. J Alzheimers Dis. 2022;90(2):513-28. Available from: https://doi.org/10.3233/JAD-220438.	Relevant results not analysed separately
Reichow B, Steiner AM, Volkmar F. Cochrane review: social skills groups for people aged 6 to 21 with autism spectrum disorders (ASD). Evid Based Child Health. 2013;8(2):266-315. Available from: https://doi.org/10.1002/ebch.1903.	Wrong outcome
Rennick-Egglestone S, Morgan K, Llewellyn-Beardsley J, Ramsay A, McGranahan R, Gillard S, et al. Mental Health Recovery Narratives and Their Impact on Recipients: Systematic Review and Narrative Synthesis. Can J Psychiatry. 2019;64(10):669-79. Available from: https://doi.org/10.1177/0706743719846108.	Wrong outcome
Ruiz-Montero PJ, Chiva-Bartoll O, Salvador-Garcia C, Martin-Moya R. Service-Learning with College Students toward Health-Care of Older Adults: A Systematic Review. Int J Environ Res Public Health. 2019;16(22). Available from: https://doi.org/10.3390/ijerph16224497.	Wrong outcome
Sallnow L, Richardson H, Murray SA, Kellehear A. The impact of a new public health approach to end-of-life care: A systematic review. Palliat Med. 2016;30(3):200-11. Available from: https://doi.org/10.1177/0269216315599869.	Wrong outcome
Scoresby KJ, Strand EB, Ng Z, Brown KC, Stilz CR, Strobel K, et al. Pet Ownership and Quality of Life: A Systematic Review of the Literature. Vet Sci. 2021;8(12). Available from: https://doi.org/10.3390/vetsci8120332.	Wrong study design
Sen K, Prybutok G, Prybutok V. The use of digital technology for social wellbeing reduces social isolation in older adults: A systematic review. SSM Popul Health. 2022;17:101020. Available from: https://doi.org/10.1016/j.ssmph.2021.101020.	Wrong outcome
Son H, Son YJ, Kim H, Lee Y. Effect of psychosocial interventions on the quality of life of patients with colorectal cancer: a systematic review and meta-analysis. Health Qual Life Outcomes. 2018;16(1):119. Available from: https://doi.org/10.1186/s12955-018-0943-6.	Wrong outcome
Spain D, Blainey SH. Group social skills interventions for adults with high-functioning autism spectrum disorders: A systematic review. Autism. 2015;19(7):874-86. Available from: https://doi.org/10.1177/1362361315587659.	Wrong outcome
Storebo OJ, Stoffers-Winterling JM, Vollm BA, Kongerslev MT, Mattivi JT, Jorgensen MS, et al. Psychological therapies for people with borderline personality disorder. Cochrane Database Syst Rev. 2020;5(5):CD012955. Available from: https://doi.org/10.1002/14651858.CD012955.pub2.	Wrong outcome
Teoh SL, Letchumanan V, Lee LH. Can Mindfulness Help to Alleviate Loneliness? A Systematic Review and Meta-Analysis. Front Psychol. 2021;12:633319. Available from: https://doi.org/10.3389/fpsyg.2021.633319.	Wrong population
Toneti BF, Barbosa RFM, Mano LY, Sawada LO, Oliveira IG, Sawada NO. Benefits of Qigong as an integrative and complementary practice for health: a systematic review. Rev Lat Am Enfermagem. 2020;28:e3317. Available from: https://doi.org/10.1590/1518-8345.3718.3317.	Wrong outcome
Tricco AC, Thomas SM, Radhakrishnan A, Ramkissoon N, Mitchell G, Fortune J, et al. Interventions for social isolation in older adults who have experienced a fall: a systematic review. BMJ Open. 2022;12(3):e056540. Available from: https://doi.org/10.1136/bmjopen-2021-056540.	No relevant synthesis
Ulusoy Y, Sumbas E, Sertkaya B. Psychodrama as an intervention management instrument for internal/external adolescent problems: A systematic literature review. The Arts in Psychotherapy. 2023;83. Available from: https://doi.org/10.1016/j.aip.2023.102000.	Wrong population
van der Aa HP, Margrain TH, van Rens GH, Heymans MW, van Nispen RM. Psychosocial interventions to improve mental health in adults with vision impairment: systematic review and meta-analysis. Ophthalmic Physiol Opt. 2016;36(5):584-606. Available from: https://doi.org/10.1111/opo.12313.	Wrong outcome
van der Meulen K, Granizo L, Del Barrio C. Emotional Peer Support Interventions for Students With SEND: A Systematic Review. Front Psychol. 2021;12:797913. Available from: https://doi.org/10.3389/fpsyg.2021.797913.	Wrong outcome
Virués-Ortega J, Pastor-Barriuso R, Castellote JM, Población A, de Pedro-Cuesta J. Effect of animal-assisted therapy on the psychological and functional status of elderly populations and patients with psychiatric disorders: a meta-analysis. Health Psychology Review. 2011;6(2):197-221. Available from: https://doi.org/10.1080/17437199.2010.534965.	Wrong outcome
Wang Y, Chen Y, Deng H. Effectiveness of Family- and Individual-Led Peer Support for People With Serious Mental Illness: A Meta-Analysis. J Psychosoc Nurs Ment Health Serv. 2022;60(2):20-6. Available from: https://doi.org/10.3928/02793695-20210818-01.	Wrong publication type
Wendel F, Bender S, Breitinger E, Coenen M, Hummel J, Immich G, et al. Interventions to build resilience and to ameliorate negative psychosocial effects of the COVID-19 pandemic on children and adolescents: a systematic review and meta-analysis. Eur Child Adolesc Psychiatry. 2023. Available from: https://doi.org/10.1007/s00787-023-02280-y.	Wrong outcome
Whear R, Campbell F, Rogers M, Sutton A, Robinson-Carter E, Sharpe R, et al. What is the effect of intergenerational activities on the wellbeing and mental health of older people?: A systematic review. Campbell Syst Rev. 2023;19(4):e1355. Available from: https://doi.org/10.1002/cl2.1355.	Wrong outcome
Whelan S, Teahan A, Casey D. Fostering the Resilience of People With Dementia: A Narrative Literature Review. Front Med (Lausanne). 2020;7:45. Available from: https://doi.org/10.3389/fmed.2020.00045.	Wrong outcome
Wigham S, Kaner E, Bourne J, Ahmed K, Hackett S. Public mental health and wellbeing interventions delivered by allied health professionals (AHPs): mapping the evidence and identification of gaps. A systematic review. J Public Ment Health. 2023;22(4):216-29. Available from: https://doi.org/10.1108/jpmh-04-2023-0033.	Relevant results not analysed separately
Younker T, Radunovich HL. Farmer Mental Health Interventions: A Systematic Review. Int J Environ Res Public Health. 2021;19(1). Available from: https://doi.org/10.3390/ijerph19010244.	Wrong outcome
Zhang D, Lee EKP, Mak ECW, Ho CY, Wong SYS. Mindfulness-based interventions: an overall review. Br Med Bull. 2021;138(1):41-57. Available from: https://doi.org/10.1093/bmb/ldab005.	Wrong publication type
Zhang K, Lu X, Zhang X, Zhang J, Ren J, Guo H, et al. Effects of Psychological or Exercise Interventions on Problematic Mobile Phone Use: a Systematic Review and Meta-analysis. Current Addiction Reports. 2023;10(2):230-53. Available from: https://doi.org/10.1007/s40429-023-00471-w.	Wrong population

Bilaga 4 Risk för bias hos relevanta systematiska översikter

Publication	RoB*	Comment
Bessaha ML, Sabbath EL, Morris Z, Malik S, Scheinfeld L, Saragossi J. A Systematic Review of Loneliness Interventions Among Non-elderly Adults. Clin Soc Work J. 2019;48(1):110-25. Available from: https://doi.org/10.1007/s10615-019-00724-0.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Bild E, Pachana NA. Social prescribing: A narrative review of how community engagement can improve wellbeing in later life. J Community Appl Soc Psychol. 2022;32(6):1148-215. Available from: https://doi.org/10.1002/casp.2631.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Cherry MG, Bee P, et al. Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis. BMC Psychiatry. 2023;23(1):486. Available from: https://doi.org/10.1186/s12888-023-04881-y.	High	No/insufficient risk of bias assessment of included primary studies
Casanova G, Zaccaria D, Rolandi E, Guaita A. The Effect of Information and Communication Technology and Social Networking Site Use on Older People's Well-Being in Relation to Loneliness: Review of Experimental Studies. J Med Internet Res. 2021;23(3):e23588. Available from: https://doi.org/10.2196/23588.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Choi HK, Lee SH. Trends and Effectiveness of ICT Interventions for the Elderly to Reduce Loneliness: A Systematic Review. Healthcare (Basel). 2021;9(3). Available from: https://doi.org/10.3390/healthcare9030293.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Chua CMS, Chua JYX, Shorey S. Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis. Aging Ment Health. 2024;28(1):1-10. Available from: https://doi.org/10.1080/13607863.2023.2237919.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review. Inadequate investigation of publication bias
Cooper M, Avery L, Scott J, Ashley K, Jordan C, Errington L, et al. Effectiveness and active ingredients of social prescribing interventions targeting mental health: a systematic review. BMJ Open. 2022;12(7):e060214. Available from: https://doi.org/10.1136/bmjopen-2021-060214.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Di Perna G, Radford K, Barbery G, Fitzgerald JA. A Systematic Literature Review of Loneliness in Community Dwelling Older Adults. Soc Sci. 2022;12(1). Available from: https://doi.org/10.3390/socsci12010021.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Eccles AM, Qualter P. Review: Alleviating loneliness in young people - a meta-analysis of interventions. Child Adolesc Ment Health. 2021;26(1):17-33. Available from: https://doi.org/10.1111/camh.12389.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Ellard OB, Dennison C, Tuomainen H. Review: Interventions addressing loneliness amongst university students: a systematic review. Child Adolesc Ment Health. 2023;28(4):512-23. Available from: https://doi.org/10.1111/camh.12614.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Foettinger L, Albrecht BM, Altgeld T, Gansefort D, Recke C, Stalling I, et al. The Role of Community-Based Men's Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review. Am J Mens Health. 2022;16(2):15579883221084490. Available from: https://doi.org/10.1177/15579883221084490.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review.
Forgeron P, King S, Reszel J, Fournier K. Psychosocial interventions to improve social functioning of children and adolescents with chronic physical conditions: A systematic review. Child Health Care. 2017;47(3):326-55. Available from: https://doi.org/10.1080/02739615.2017.1328600.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Fu Z, Yan M, Meng C. The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis. Front Psychol. 2022;13:935544. Available from: https://doi.org/10.3389/fpsyg.2022.935544.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review
Gilbey A, Tani K. Companion Animals and Loneliness: A Systematic Review of Quantitative Studies. Anthrozoos. 2015;28(2):181-97. Available from: https://doi.org/10.1080/08927936.2015.11435396.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Gomez-Soria I, Iguacel I, Cuenca-Zaldivar JN, Aguilar-Latorre A, Peralta-Marrupe P, Latorre E, et al. Cognitive stimulation and psychosocial results in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2023;115:105114. Available from: https://doi.org/10.1016/j.archger.2023.105114.	High	No/insufficient risk of bias assessment of included primary studies
Handajani YS, Aryani A, Schroder-Butterfill E, Turana Y. Impact of trained volunteers' services in caring for older persons with dementia: a systematic review. Psychogeriatrics. 2023;23(3):535-46. Available from: https://doi.org/10.1111/psyg.12958.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Hao X, Qin Y, Lv M, Zhao X, Wu S, Li K. Effectiveness of telehealth interventions on psychological outcomes and quality of life in community adults during the COVID-19 pandemic: A systematic review and meta-analysis. Int J Ment Health Nurs. 2023;32(4):979-1007. Available from: https://doi.org/10.1111/inm.13126.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Heins P, Boots LMM, Koh WQ, Neven A, Verhey FRJ, de Vugt ME. The Effects of Technological Interventions on Social Participation of Community-Dwelling Older Adults with and without Dementia: A Systematic Review. J Clin Med. 2021;10(11). Available from: https://doi.org/10.3390/jcm10112308.	High	Insufficient reporting of characteristics/results of included primary studies No/insufficient risk of bias assessment of included primary studies
Hickin N, Kall A, Shafran R, Sutcliffe S, Manzotti G, Langan D. The effectiveness of psychological interventions for loneliness: A systematic review and meta-analysis. Clin Psychol Rev. 2021;88:102066. Available from: https://doi.org/10.1016/j.cpr.2021.102066.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Hoang P, King JA, Moore S, Moore K, Reich K, Sidhu H, et al. Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(10):e2236676. Available from: https://doi.org/10.1001/jamanetworkopen.2022.36676.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review
Hsueh YC, Batchelor R, Liebmann M, Dhanani A, Vaughan L, Fett AK, et al. A Systematic Review of Studies Describing the Effectiveness, Acceptability, and Potential Harms of Place-Based Interventions to Address Loneliness and Mental Health Problems. Int J Environ Res Public Health. 2022;19(8). Available from: https://doi.org/10.3390/ijerph19084766.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Hussain B, Mirza M, Baines R, Burns L, Stevens S, Asthana S, et al. Loneliness and social networks of older adults in rural communities: a narrative synthesis systematic review. Front Public Health. 2023;11:1113864. Available from: https://doi.org/10.3389/fpubh.2023.1113864.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Isabet B, Pino M, Lewis M, Benveniste S, Rigaud AS. Social Telepresence Robots: A Narrative Review of Experiments Involving Older Adults before and during the COVID-19 Pandemic. Int J Environ Res Public Health. 2021;18(7). Available from: https://doi.org/10.3390/ijerph18073597.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Krzeczkowska A, Spalding DM, McGeown WJ, Gow AJ, Carlson MC, Nicholls LAB. A systematic review of the impacts of intergenerational engagement on older adults' cognitive, social, and health outcomes. Ageing Res Rev. 2021;71:101400. Available from: https://doi.org/10.1016/j.arr.2021.101400.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Laermans J, Scheers H, Vandekerckhove P, De Buck E. Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review. Campbell Syst Rev. 2023;19(4):e1359. Available from: https://doi.org/10.1002/cl2.1359.	Low
Li M, Rao W, Su Y, Sul Y, Caron G, D'Arcy C, et al. Psychological interventions for loneliness and social isolation among older adults during medical pandemics: a systematic review and meta-analysis. Age Ageing. 2023;52(6). Available from: https://doi.org/10.1093/ageing/afad076.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Liebmann M, Pitman A, Hsueh YC, Bertotti M, Pearce E. Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature. BMC Health Serv Res. 2022;22(1):1264. Available from: https://doi.org/10.1186/s12913-022-08656-1.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Ma R, Mann F, Wang J, Lloyd-Evans B, Terhune J, Al-Shihabi A, et al. The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2020;55(7):839-76. Available from: https://doi.org/10.1007/s00127-019-01800-z.	Moderate	No metanalysis No / insufficient assessment of certainty of evidence
Manjunath J, Manoj N, Alchalabi T. Interventions against Social Isolation of Older Adults: A Systematic Review of Existing Literature and Interventions. Geriatrics (Basel). 2021;6(3). Available from: https://doi.org/10.3390/geriatrics6030082.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. 2011;15(3):219-66. Available from: https://doi.org/10.1177/1088868310377394.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Moore THM, Kesten JM, Lopez-Lopez JA, Ijaz S, McAleenan A, Richards A, et al. The effects of changes to the built environment on the mental health and well-being of adults: Systematic review. Health Place. 2018;53:237-57. Available from: https://doi.org/10.1016/j.healthplace.2018.07.012.	High	No/insufficient risk of bias assessment of included primary studies
Morrish N, Choudhury S, Medina-Lara A. What works in interventions targeting loneliness: a systematic review of intervention characteristics. BMC Public Health. 2023;23(1):2214. Available from: https://doi.org/10.1186/s12889-023-17097-2.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
McElfresh JJ, Skiba MB, Segrin CG, Badger TA, Crane TE, Crist JD, et al. Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis. J Psychosoc Oncol. 2021;39(4):509-33. Available from: https://doi.org/10.1080/07347332.2020.1867690.	Moderate	No / insufficient assessment of certainty of evidence
McQuade L, O'Sullivan R. Examining arts and creativity in later life and its impact on older people's health and wellbeing: a systematic review of the evidence. Perspect Public Health. 2023:17579139231157533. Available from: https://doi.org/10.1177/17579139231157533.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Naude B, Rigaud AS, Pino M. Video Calls for Older Adults: A Narrative Review of Experiments Involving Older Adults in Elderly Care Institutions. Front Public Health. 2021;9:751150. Available from: https://doi.org/10.3389/fpubh.2021.751150.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Orr N, Abbott R, Bethel A, Paviour S, Whear R, Garside R, et al. What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence. BMC Geriatr. 2023;23(1):170. Available from: https://doi.org/10.1186/s12877-023-03834-0.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review.
Osborn T, Weatherburn P, French RS. Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness. J Adolesc. 2021;93:53-79. Available from: https://doi.org/10.1016/j.adolescence.2021.09.007.	Moderate	No metanalysis No / insufficient assessment of certainty of evidence
Rapo E, Johansson E, Jonsson F, Hornsten A, Lundgren AS, Nilsson I. Critical components of social prescribing programmes with a focus on older adults - a systematic review. Scand J Prim Health Care. 2023;41(3):326-42. Available from: https://doi.org/10.1080/02813432.2023.2237078.	High	Insufficient/incomplete documentation of PICO No/insufficient risk of bias assessment of included primary studies
Pels F, Kleinert J. Loneliness and physical activity: A systematic review. Int RevSport Exerc Psychol. 2016;9(1):231-60. Available from: https://doi.org/10.1080/1750984X.2016.1177849.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Plackett R, Blyth A, Schartau P. The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review. J Med Internet Res. 2023;25:e44922. Available from: https://doi.org/10.2196/44922.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Reinhardt GY, Vidovic D, Hammerton C. Understanding loneliness: a systematic review of the impact of social prescribing initiatives on loneliness. Perspect Public Health. 2021;141(4):204-13. Available from: https://doi.org/10.1177/1757913920967040.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Shah SGS, Nogueras D, van Woerden HC, Kiparoglou V. Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis. J Med Internet Res. 2021;23(6):e24712. Available from: https://doi.org/10.2196/24712.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review. No / insufficient assessment of certainty of evidence
Siette J, Cassidy M, Priebe S. Effectiveness of befriending interventions: a systematic review and meta-analysis. BMJ Open. 2017;7(4):e014304. Available from: https://doi.org/10.1136/bmjopen-2016-014304.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Suthershinii G, Tan WA, Lee A, Chen MZ. Behavioral Interventions for the Patient-Caregiver Unit in Patients with Chronic Heart Failure: A Systematic Review of Caregiver Outcomes. J MultidiscipHealthc. 2022;15:921-39. Available from: https://doi.org/10.2147/JMDH.S357179.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Tobin MC, Drager KDR, Richardson LF. A systematic review of social participation for adults with autism spectrum disorders: Support, social functioning, and quality of life. Res Autism Spectr Disord. 2014;8(3):214-29. Available from: https://doi.org/10.1016/j.rasd.2013.12.002.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Tong F, Yu C, Wang L, Chi I, Fu F. Systematic Review of Efficacy of Interventions for Social Isolation of Older Adults. Front Psychol. 2021;12:554145. Available from: https://doi.org/10.3389/fpsyg.2021.554145.	High	No/insufficient independent double screening of abstracts/fulltexts – risk of biased study selection
Vidovic D, Reinhardt GY, Hammerton C. Can Social Prescribing Foster Individual and Community Well-Being? A Systematic Review of the Evidence. Int J Environ Res Public Health. 2021;18(10). Available from: https://doi.org/10.3390/ijerph18105276.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Wiwatkunupakarn N, Pateekhum C, Aramrat C, Jirapornchaoren W, Pinyopornpanish K, Angkurawaranon C. Social networking site usage: A systematic review of its relationship with social isolation, loneliness, and depression among older adults. Aging Ment Health. 2022;26(7):1318-26. Available from: https://doi.org/10.1080/13607863.2021.1966745.	High	No/insufficient risk of bias assessment of included primary studies
Yeo Y, Lau Y, Ang WW, Wong QF, Tam HL, Loh WL, et al. Unpacking older adults’ experiences using mobile telepresence robots: A systematic mixed-studies review. Geriatr Nurs. 2023;54:280-301. Available from: https://doi.org/10.1016/j.gerinurse.2023.10.012.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review. No / insufficient assessment of certainty of evidence
Yu DS, Li PW, Lin RS, Kee F, Chiu A, Wu W. Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression. Int J Nurs Stud. 2023;144:104524. Available from: https://doi.org/10.1016/j.ijnurstu.2023.104524.	Moderate	Insufficient/incomplete account for RoB in individual studies when discussing the results of the review. No / insufficient assessment of certainty of evidence
Yu J, Han M, Miao F, Hua D. Using mindfulness-based stress reduction to relieve loneliness, anxiety, and depression in cancer patients: A systematic review and meta-analysis. Medicine (Baltimore). 2023;102(37):e34917. Available from: https://doi.org/10.1097/MD.0000000000034917.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
Zagic D, Wuthrich VM, Rapee RM, Wolters N. Interventions to improve social connections: a systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol. 2022;57(5):885-906. Available from: https://doi.org/10.1007/s00127-021-02191-w.	High	Insufficient/incomplete documentation of literature search strategy – risk of biased study identification
*ROB = Risk of Bias. The assessment tool is comprised of six steps based on the items in AMSTAR. To be assessed as low risk of bias, a systematic review has to fulfil all requirements for step 1 to 6. A systematic review is of moderate risk of bias if it fulfils all the requirements up to step 4. Systematic reviews that do not meet the requirements in one of the steps 1-4 are not assessed further than that step and has a high risk of bias.

Bilaga 5 Systematiska översikter med låg eller måttlig risk för bias uppdelade efter population och interventionstyp

Population Intervention type	Associated references	Intervention Components
Elderly
Social and psychosocial interventions	Chua et al, 2023 Effectiveness of home-based interventions in improving loneliness and social connectedness among older adults: a systematic review and meta-analysis Foettinger et al, 2022 The Role of Community-Based Men's Sheds in Health Promotion for Older Men: A Mixed-Methods Systematic Review. American journal of men's health Laermans et al, 2023 Friendly visiting by a volunteer for reducing loneliness or social isolation in older adults: A systematic review	Four different types of home-based interventions: befriending interventions, psychological therapies, skill development, and health and social care provision Men’s sheds (set up in communal spaces where men can get together to engage in joint activities and work on projects) Friendly visitors
Social and psychosocial interventions / Digital technology interventions / Animal related intervention	Hoang et al, 2022 Interventions Associated With Reduced Loneliness and Social Isolation in Older Adults: A Systematic Review and Meta-analysis	Interventions to prevent or reduce loneliness, for example animal therapy, cognitive behavioural therapy, exercise, or technological interventions.
Animal related intervention	Orr et al, 2023 What are the effects of animals on the health and wellbeing of residents in care homes? A systematic review of the qualitative and quantitative evidence	Animal assisted interventions, for example animal-assisted therapy with a dog or robotic animals
Digital technology interventions	Fu et al, 2022 The effectiveness of remote delivered intervention for loneliness reduction in older adults: A systematic review and meta-analysis Shah et al, 2021 Evaluation of the Effectiveness of Digital Technology Interventions to Reduce Loneliness in Older Adults: Systematic Review and Meta-analysis Yeo et al, 2023 Unpacking older adults’ experiences using mobile telepresence robots: A systematic mixed-studies review	Remotely delivered interventions as for example telephone call, video call, computer, or internet-based contact Videoconferencing Mobile telepresence robots
Social and psychosocial interventions / Digital technology interventions	Yu et al, 2023 Effects of non-pharmacological interventions on loneliness among community-dwelling older adults: A systematic review, network meta-analysis, and meta-regression	Non-pharmacological interventions to prevent loneliness (for example behavioural activation, individual-based or group-based exercise, health promotion).
Adult cancer survivors
Social and psychosocial interventions /Digital technology interventions	McElfresh et al, 2021 Interventions for Loneliness Among Adult Cancer Survivors: A Systematic Review and Meta-Analysis	Social skills training and support discussion groups that are group-based, telephone-based or web-based.
Teenagers and adolescents at risk of loneliness
Social and psychosocial interventions / Digital technology interventions	Osborn et al, 2021 Interventions to address loneliness and social isolation in young people: A systematic review of the evidence on acceptability and effectiveness	Social and emotional learning programs. These programs included social skills learning by role play, online internet chat rooms for discussions, mindfulness exercises by using a smartphone app for example, daily tasks delivered by text messages to address loneliness, online social networking using peer-to-peer support.
Mental health condition
Social and psychosocial interventions	Ma et al, 2020 The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review	Interventions which were designed to alleviate subjective or/and objective social isolation, for example psychoeducation and social skills programs.

Bilaga 6 SNABBSTAR Granskningsmall för att översiktligt bedöma risken för snedvridning/ systematiska fel hos systematiska översikter

Bilaga 6 SNABBSTAR Granskningsmall för att översiktligt bedöma risken för snedvridning/ systematiska fel hos systematiska översikter (PDF)

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