UNDERSTANDING THE SUBJECTIVE IMPACT OF

SOCIAL ISOLATION AND LONELINESS: A MULTI-CASE STUDY

____________________

A Thesis Presented to the Panel of Examiners

Arriesgado College Foundation, Inc.

Tagum City, Davao del Norte

____________________

In Partial Fulfillment of the Requirements for the Degree

Bachelor of Science in Nursing

___________________

DONNA JANE P. SABENORIO, ET AL.

August 2024
 ACKNOWLEDGEMENT

This work would not be possible without the presence of these

people, and we would like to acknowledge their huge contribution and
support in the fulfillment of this research project.

First and foremost, I want to express my sincere gratitude to God

Almighty, whose direction and favor have been a constant source of
inspiration and strength for me during my study. I am incredibly
appreciative of His discernment, kindness, and steadfast assistance,
which have lighted my way and given me the persistence required to
finish this study.

We would also like to express my sincere appreciation to my

family, friends, and acquaintances for their continuous
encouragement and understanding. Their emotional, spiritual, and
financial support has been invaluable and has greatly contributed to
the successful completion of this work.

Additionally, I am grateful to our research professor, Zadrack B.

Fiel, LPT, MSc Psy, DBM, for his knowledge, shared experiences,
invaluable guidance, and support throughout our research study. His
expertise and assistance have greatly contributed to this study. His
dedication and commitment to advancing knowledge have been a
guiding force in my research journey.
 We would also like to extend our heartfelt gratitude to our
dedicated research adviser, Daren Rose E. Mariano, RN, for her
invaluable guidance and unwavering support throughout our research
journey. Thank you for your expertise and mentorship.

Special thanks to the respondents, who participated in this

study and shared their lived experiences. Your insights have been
crucial to the success of this research.

TABLE OF CONTENTS

TITLE PAGE
APPROVAL PAGE
ACKNOWLEDGEMENT

ABSTRACT
TABLE OF CONTENTS
LIST OF TABLES
LIST OF FIGURES
CHAPTER
1 Introduction
 Purpose of the Study
Research Question
Theoretical Lens
Importance of the Study
Delimitation and Limitation of the Study
Definition of Terms
Review of Related Literature
Organization of the Study
2 Methodology
Research Design
Research Participants
Data Sources
Data Collection
Data Analysis
Trustworthiness of the Study
Role of the Researcher
Ethical Consideration
3 Result
4 Discussion
Implications for Educational Practice
Recommendations for Future Research
Concluding Remarks (what have you learned from the study)
REFERENCES
APPENDICES
CURRICULUM VITAE
 Chapter 1

INTRODUCTION

Older persons are more likely to live alone and tend to be less socially

engaged. There has also been a decline in religious involvement. This has been

perceived to result in a “loneliness epidemic.” Declared as a global epidemic by

former U.S. Surgeon General Vivek Murthy, loneliness and social isolation are

reported to occur in approximately one-third or more of older adults with 5% of

those often or always feeling lonely. Recent U.S.-based research suggests the

range is 17% - 57% of persons experience loneliness, a figure that increases for

those who have mental and physical health concerns, particularly those with

heart disease, depression, anxiety, and dementia. Loneliness and social isolation

have been shown to significantly impact older adults, both physically and

emotionally. Areas of the older adult's life that can be negatively affected when

the individual is experiencing loneliness and/or social isolation. The long-term

(greater than four years) effects of loneliness and social isolation can be even

more devastating, including increased blood pressure, depression, weight gain,

smoking alcohol/drug use, and alone time and decreased physical activity,

cognition, heart health, and sleep, stroke and coronary heart disease, in

particular (Berg-Weger and Morley, 2020). One in three adults have experienced

an anxiety disorder in their lifetime, making anxiety disorders one of the most

prevalent psychiatric problems worldwide. Social anxiety disorder (SAD) is

especially ubiquitous with a 13% rate of lifetime prevalence, followed by

generalized anxiety disorder (GAD; 6.2% lifetime prevalence), panic disorder

(PD; 5.2% lifetime prevalence), post-traumatic stress disorder (PTSD; 3.4%

lifetime prevalence), and agoraphobia (AG; 2.6% lifetime prevalence). Anxiety

disorders can have debilitating effects on social, occupational, and other areas of

functioning and quality of life for the individuals living with these conditions and

can even create financial burden Diagnoses of anxiety disorders are often

comorbid with other psychiatric disorders, such as major depressive disorder,

alcohol use disorder, and substance use disorder. Anxiety disorders have an

economic cost to society as well. The financial burden of diseases and illnesses

can be direct (medical and non-medical expenses resulting from the disease) or

indirect (value of the loss of productivity caused by the disease), and anxiety is

costly in both capacities. Inclusive of costs for treatment, medical expenses, lost

productivity in the workforce, lost potential earnings, long-term opportunity costs,

and costs associated with comorbid conditions, anxiety disorders are estimated

to cost over $100 billion per year (Nguyen, Taylor, Taylor, Ambroise, Hamler, Qin,

and Chatters, 2024).

Due to the high prevalence of mental health illnesses, prevention and

treatment of mental health issues are priorities in the US and around the world.

According to estimates, one in five adults in the US and one in eight persons

worldwide suffer from a mental health illness (National Alliance on Mental Illness,

2023; World Health Organization, 2022). The US Department of Defense (DOD)

has committed substantial resources to preventive, early identification, and early

intervention programs to decrease mental health issues since psychological

health issues have a negative impact on military readiness. Programs to help

civilian communities in the US and abroad can be developed with inspiration from

the preventative initiatives of the US military. If these initiatives were expanded,

they probably would lessen the negative impacts that mental health issues have

on both individuals and society. If these initiatives were expanded, they might

lessen the negative impacts that mental health issues have on people's lives and

society. They also probably would have positive economic implications. It is

difficult to draw direct comparisons between the rates of mental diagnoses in the

US military and the civilian population because of variations in demographics,

stressor exposure, and availability to care. Furthermore, it is challenging to draw

firm conclusions regarding how well or badly DOD programs have prevented

mental health disorders due to variance in the methods used to assess

prevalence and incidence rates. Lessons from this community, however, may

have implications for preventing mental health problems in other communities,

given that military personnel and their families face several factors that may

serve to elevate risk for mental health problems (e.g., separation from sources of

social support, job-related stress and trauma exposure, combat). When thinking

about stress-related conditions such adjustment disorders, depression, anxiety,

and posttraumatic stress disorder, these lessons might be especially crucial. The

Department of Defense (DOD) devotes many resources to encouraging physical

and psychological health as well as preventing illnesses and injuries because it

recognizes that the demands of the military lifestyle can inflict physical and

mental strain on service personnel and their families. Although most of the work
is focused on enhancing mission readiness, it also serves to maintain and

advance health. Many initiatives aimed at primary and secondary prevention of

mental and behavioral health issues are carried out by the Military Health System

(MHS) and the US military in general. In order to delay the onset of mental health

illnesses, primary preventive programs work to improve peer and social support,

as well as individual and group resilience. Early identification and intervention are

key components of secondary prevention programs aimed at slowing the

advancement of an illness (Paxton Willing, Nevers, Nofziger, Rogers, and Riggs,

2024).

According to Joanne Michelle F. Ocampo et al., Prior to COVID-19, the

Philippines was already facing one of the highest rates of mental disorders in the

Western Pacific, with an estimated 15.4 million Filipinos experiencing depression,

1 million living with schizophrenia, 15.3 million facing substance use dis-orders,

and 877,000 losing their lives to suicide annually (Maravilla and Tan, 2021). Not

only did the pandemic exacerbate severe health disorders, mental health

outcomes such as anxiety and stress, and psychosocial health were also

negatively affected. National government underscored the importance of mental

health during the COVID-19 pandemic, but simultaneously noted the dearth of

relevant resources. As elsewhere, compromised policy and implementation focus

on mental health has led to less availability of data monitoring and research in-

country (Toquero, 2021). The Philippines passed the landmark Mental Health Act

legislation in2018 (Lally, Tully, and Samaniego, 2019. This includes underfunded
programs, limited health financing and lack of mental health professionals with

about 500 psychiatrists, 4,200 guidance counselors, 1,600 psychologists, and

516 psychiatric nurses registered, but not necessarily in practice, to serve

approximately 110 million people (Philippine Statistics Authority, 2021).

Additionally, stigma, notably self-stigma and social stigma, present as substantial

barriers to health-seeking behavior within mental health (Martinez et al., 2020).

Economic constraints have affected people’s access to mental healthcare (Lally,

et al., 2019). including historically low levels (5%) of healthcare expenditures

devoted to mental health (Maravilla and Tan, 2021). While national funding levels

devoted to mental health increased substantially following the pandemic (Senate

of the Philippines 19th Congress, 2023), barriers remain, including elevated

emigration rates of health professionals to other countries due to factors such as

burnout and stress (Alibudbud, 2023) affecting the demand for training and

recruitment of clinical, public health and social workers for local health needs

(Lally et al., 2019). Non-clinical aspects of psychosocial health are less

emphasized or left out of mental health policy discussions.

Specifically in Davao del Norte, Region XI, many future outcomes are

believed to be dependent on the learning and development of students. Students'

early experiences lay the foundation for the results they will achieve in life. From

birth to age five, children's brains develop and grow at a rapid rate, making this a

crucial time for potential vulnerability. Students' wellbeing deteriorates when they

grow up in abusive and neglectful households. It is becoming more and more

obvious that a student's long-term learning and development are greatly

influenced by the relationships, experiences, and environments they are exposed

to. In the Philippine context, social support can take many different forms. It could

be simply spending time together or it could be assistance that is only

tangentially related to the current circumstance. It helps someone deal with

difficult situations or obstacles pertaining to their education and growth.

Furthermore, it has been repeatedly shown that early learner progression

improves a child's long-term outcomes, including career plans, academic

performance, and even life quality (Reyes, Davis, Chua, Olaveria, Pamintuan,

Serrano, and Tan, 2020). An emotionally astute individual is more knowledgeable

about feelings, which facilitates everything for them. Emotionally intelligent

people have superior techniques that use emotional regulating processes and

are more appropriate and productive in a certain circumstance (Jaymar C.

Reponte and Saramie S. Belleza, 2023).

RESEARCH GAP

Existing research has extensively examined the general effects of social

isolation but often lacks detailed insights into the nuanced, subjective

experiences of individuals. By concentrating on personal perspectives, this study

aims to provide a richer, more comprehensive understanding of how isolation

affects psychological well-being, including stress, depression, and anxiety. This

strategy will help close the existing gaps in the literature where the subjective

impact may be overlooked by objective measurements.

DISSEMINATION PLAN

This dissemination plan outlines a strategic approach to sharing the

findings of our well-being research with various audiences. The goal is to

maximize the impact of our work by presenting it to the research congress and

defending it from the panelists.

Additionally, this research study will serve as a manual for future scholars.

A hardbound copy of this study will be added to the Arriesgado College

Foundation, Inc. school library.

PURPOSE OF THE STUDY

This study aims to investigate the complex impacts of social isolation on

mental and physical health, with a particular focus on the subjective experiences

of individuals. This study aims to understand how isolation affects psychological

well-being, including factors like stress, depression, and anxiety, by looking at

individual experiences and perspectives. Furthermore, it aims to comprehend the

implications for physical health from the viewpoint of individuals who are directly

impacted, including immunological response and general physical fitness.

 The purpose of this study is also to uncover resilience variables and

possible coping strategies that people use to lessen the harmful effects of social

isolation. Comprehending these subjective experiences will facilitate the

development of specific interventions and support systems, as well as offer

insightful information about the wider health effects of social isolation. This study

aims to promote measures to improve overall well-being and contribute to a more

thorough knowledge of the effects of social isolation by filling the gap between

subjective experiences and objective health outcomes.

RESEARCH QUESTIONS

The subject of this study is to determine the lived experiences and

challenges of older adults in handling social isolation which affects their mental

and physical health.

Specifically, is sought to answer the following questions:

1. What are the lived-experiences of individuals who deal with social isolation and

loneliness?

2. What are the challenges they faced being socially isolated and lonely?

3. How did they manage their social isolation and loneliness?

4. What are the perspectives of the individuals towards conquering the obstacles

caused by their personal experiences?

THEORETICAL LENS

Leonard I. Pearlin, et al.: The Stress Process (1981)

The Stress Process (Pearlin et al. 1981) introduced the field, which was

preoccupied at the time with acute life change events, to the concept of a chronic

stressor and, equally important, to the idea that stressors are not necessarily

isolated, independent occurrences (e.g., divorce and natural disaster) but often

are interconnected and dependent on people’s locations in status hierarchies

(e.g., divorce and economic hardship among people of low socioeconomic status

[SES]). The initial test of the stress process model substantiated these

connections by showing that disruptive job events lead to depressive symptoms

by precipitating income loss and generating economic strain.

The Stress Process (Pearlin et al. 1981) was innovative and influential for

yet other reasons, including the specification of a system of causal relationships

to explain how stressors exert their inimical effects on mental health and why

these effects are stronger for some people than others.

Prolonged stress has detrimental effects on one's physical and emotional

well-being, with potentially catastrophic cascades. In terms of the mind,

persistent stress has a significant role in the development of disorders like

anxiety and depression. It affects cognitive processes, making it harder to focus,

recall details, and make choices. Stress also throws off sleep cycles, which can

result in poor quality sleep or insomnia, exacerbating mood swings and

emotional instability.
 The effects of long-term stress on the body are also concerning. Heart

disease risk and hypertension are two cardiovascular issues that have been

connected to stress. Additionally, it may impair immunity, increasing a person's

susceptibility to infections and illnesses and possibly delaying the healing

process from medical conditions. Another common result is digestive difficulties,

which can be made worse by stress, especially if you have acid reflux or irritable

bowel syndrome (IBS). Furthermore, persistent stress frequently results in tense

muscles, which can cause persistent pain or discomfort, especially in the

shoulders, back, and neck.

Furthermore, stress can interfere with metabolic functions, influencing

hunger and raising the risk of diabetes or unhealthful weight changes. The

inflammatory response brought on by stress can also exacerbate skin disorders

like acne or eczema. The intricate relationship between mental and physical

symptoms emphasizes how crucial it is to properly manage stress in order to

protect general health and wellbeing. The negative impacts of stress can be

lessened, and a healthier, more balanced existence can be promoted by putting

measures like mindfulness practices, regular exercise, balanced nutrition, and

getting professional support into practice.

IMPORTANCE OF THE STUDY

 Despite of the complicated and wide-ranging effects of social isolation on

mental and physical health are becoming more and more obvious, more research

is still desperately needed, especially from the perspectives of people who are

directly affected. This study fills this knowledge vacuum by concentrating on the

subjective experiences of people who experience social isolation, which makes it

extremely important.

To the general population,

Recognizing the impact of social isolation on the mental and physical

health of adults, particularly the elderly, is crucial in order to create efficient

interventions and support mechanisms that enhance their standard of living and

mitigate the negative consequences of social isolation.

To the individuals experiencing social isolation,

identifying the effects of social isolation on the mental and physical health

of those who encounter it is essential for customizing focused assistance

and interventions that can successfully address their unique challenges

and improve their overall health.

To the individuals with specific mental health conditions,

 Determining how social isolation impacts the physical and mental well-

being of people with mental health issues is crucial to creating specific programs

that address their vulnerabilities and enhance their overall quality of life.

To the caregivers and family members,

Figuring out how caregivers' and family members' mental and physical

health is affected by being alone is important for creating strong support

networks that can ease their burdens and improve their overall well-being.

To the healthcare professionals,

Healthcare workers need to understand how social isolation affects

people's mental and physical health to provide more comprehensive and

compassionate care that meets the many needs of people who are isolated.

To the community,

It's important for the community to be aware of how social isolation affects

people's mental and physical health. This raises awareness and leads to

activities that promote social connection and general health.

DELIMITATION AND LIMITATION OF THE STUDY

Delimitations of the Study

The scope and delimitation of our study is finding effects of social isolation

and loneliness on mental and physical health. The study is limited only to adults

residing in Tagum City, Davao del Norte. The main purpose of our study is to

point out the effects of social isolation and loneliness and to determine if social

isolation and loneliness hinder the daily activities of adults. The study only

focuses on social isolation and loneliness and its effects on the mental and

physical health of the adults.

Limitations of the Study

The limitations of this study include its narrow focus on adults living in

Tagum City, which may limit the findings' generalizability to other areas or

demographic groups. Furthermore, because participants' perceptions of social

isolation and loneliness can be influenced by their own experiences and

emotional states, relying solely on self-reported data may introduce biases.

Additionally, a multi-case study's small sample size may not adequately reflect

the range of experiences among the larger population.

DEFINITION OF TERMS

The following terms are used in this study will be defined conceptually and

operationally.
Mental health. Mental health is a state of mental well-being that enables people

to cope with the stresses of life, realize their abilities, learn well and work well,

and contribute to their community (Adam Felman and Rachel Ann Tee-Melegrito,

2024).

Physical Health. Physical health is a metabolic and cognitive state that involves

the absence of any disease, and it is obtained via sports, nutrition, and/or

ergogenic aids that enable persons to have a suitable life with maximum

functionality (Alicia Garcia-Falgueras, 2019).

Social Isolation. A state in which the individual lacks a sense of belonging

socially, lacks engagement with others, has a minimal number of social contacts,

and they are deficient in fulfilling and quality relationships (Veazie, Gilbert, and

Winchell, 2019).

Adults. An adult is defined as a person aged 18 years or older, who has reached

maturity in terms of physical, emotional, and social development (WHO, 2022).

REVIEW OF THE RELATED LITERATURE

This study focuses on social isolation's subjective effects on mental and

physical health, which is a serious public health concern. This research aims to

focus on the complex relationship between isolation and health by examining

how negative physical health outcomes and mental health issues are influenced

by feelings of loneliness and perceived lack of social support. This study aims to

provide insights that can guide focused interventions and policies to improve
social connectedness and overall health outcomes through a synthesis of the

body of existing literature.

Mental Health Implications

It has been established that several factors are necessary for teenagers to

form positive peer relationships. It has been discovered that social competence—

which is the ability to adjust one's behavior to suit the needs of different and

changing contexts—is a critical component of healthy peer relationships. Teens

who lack social skills often struggle to change how they behave in different social

situations, which leaves them more open to being victimized by their peers

(bullying). Adolescents who suffer from a range of mental health disorders are

more likely to struggle with social competence (Mariam Ter-Stepanian, Alexa

Martin-Storey, Roxanne Bizier-Lacroix, Michèle Déry, Jean-Pascal Lemelin &

Caroline E. Temcheff, 2019). Mental and physical health are equally important

for leading an active lifestyle. It is difficult to characterize mental health in terms

of physical health because many mental illnesses rely on how a person interprets

their experiences. Good mental health is not just indicated by the lack of anxiety,

depression, or any other illness (Masud Akhtar, Muhammad Akram Riaz,

Muhammad Akbar, Ifraz Adeel, Humaira Hussain, and Saima Waqar, 2022).

People are prone to emotional disorders like anxiety, depression, stress,

insomnia, anger, emotional depletion, and even post-traumatic symptoms of

disorder, according to recent studies published in the Lancet that examine the

psychological effects of quarantine. The COVID-19 pandemic affects our mental

and emotional health in many ways. These include more intense and persistent
negative emotions such as depression and anxiety, as well as unresolved grief

related to both emotional and interpersonal alienation and the loss of a loved

one. We are also living in "collective pain" as a result of everything that has

happened recently; we are no longer able to travel freely, participate in

depressing activities, or enjoy happiness in our families and communities.

(Mioara Grigoras and Anamaria Ciubara, 2021). Social connectivity is a

fundamental component of what it means to be human. Although they are

related, the subjective and objective experiences of social isolation and

loneliness have different impacts on a person's physical, mental, and cognitive

health. Many older adults found themselves suddenly cut off from important

sources of social interaction, and the COVID-19 pandemic forced a large portion

of the world's population into a prolonged state of isolation (Eileen Graham,

Shevaun D Neupert, and Toni Antonucci, 2023). Due to a lack of resources and

access to healthcare, poor mental health is becoming more prevalent in low- and

middle-income countries than in high-income ones. The majority of people with

mental illnesses in these nations receive either no care at all or care that is

insufficient, resulting in a significant treatment gap. For example, depression is

one of the most prevalent mental illnesses that impacts older adults' quality of

life, social interactions, and physical health. Even though depression is a widely

researched mental illness, little is known about interventions for it that are carried

out in environments with limited resources Carandang, Shibanuma, Kiriya,

Vardeleon, Asis, Murayama, and Jimba, 2020).

Physical Health Consequences

Social isolation has been connected to an increasing number of health

issues, such as early mortality, dementia, stroke, cardiovascular disease, and

cognitive decline. Additionally, it affects mental and emotional health (Mengsha

Luo and Lydia Li, 2022). Social isolation among older adults is associated with

worse mental and cognitive functioning, a higher incidence of chronic illnesses, a

higher risk of those illnesses getting worse, and a higher death rate from all

causes (Delerue Matos, A., Barbosa, F., Cunha, C., Voss, G., and Correia, 2021).

South Korea's aging population has led to an increase in the number of older

adults living alone, raising concerns about the impact of this trend on mental

health, especially in light of the social isolation and loneliness that accompany

living alone. The current study explores how living arrangements affect older

Koreans' psychological well-being, focusing on the prevalence of depression and

the importance of social isolation in the context of shifting family dynamics and

the COVID-19 pandemic (Geon Lee and Chulwoo Kim, 2024). A person's

likelihood of having a high body function and process is greatly enhanced when

they are physically healthy. Maintaining a healthy lifestyle to lower the risk of

illness is part of being physically health (Briguglio, Vitale, Galentino, Banfi, Dina,

Bona, Panzica, Porta, Dell'Osso, and Glick, 2020). For example, maintaining

physical fitness will support and improve a person's muscular strength, flexibility,

body composition, and heart and lung support. Immobilization leads to muscle

atrophy, or the degeneration or vestigialization of muscles, which results in a loss

of muscle mass. Thus, as the metabolism slows down, a process of fat

accumulation begins (Tzankova-Kaloyanova, 2020). A large percentage of the

population is at risk for social isolation, which is the objective state of having few

social relationships or infrequent social contact with others, and loneliness, which

is the subjective feeling of being alone. These two conditions are serious but

underappreciated public health hazards. About 25% of Americans 65 and older

who live in the community are thought to be socially isolated, and a sizable

percentage of American adults’ report feeling lonely (35% of adults 45 and older

and 43% of adults 60 and older) (National Academies of Sciences, Engineering,

and Medicine, 2020).

Interconnectedness of Mental and Physical Health

Children and adolescents' healthy social development depends on having

positive peer relationships, which also act as a buffer against the emergence of

mental health issues (Rapee, Oar, Johnco, Forbes, Fardouly, Magson, and

Richardson, 2019). According to a 2020 Cigna survey, social isolation—a term

that describes the lack of social ties and the sense of loneliness—has been rising

in recent years. According to the Centers for Disease Control and Prevention,

this social disconnection can have a serious negative effect on a person's

mental, emotional, and physical health. Loneliness has become a major concern

for college students in the digital age. Due to their involvement in academic and

social settings, college students—who are still in a developmental stage—are

better suited to address these issues. On the other hand, overuse of social media

can harm mental health and cause social isolation. According to a 2020 Cigna
survey, the number of people who report feeling lonely has significantly increased

in recent years. A person's mental, emotional, and physical health may suffer as

a result of the complicated and varied phenomenon of feeling cut off from others

(Bryan Roy Bautista Milloria, Anna Mae Despi Marzon, and Reynaldo Moral,

2024). Increased anxiety, depressive symptoms, and sleep disorders are very

common, according to preliminary data. Another study of 18,147 people in Italy

revealed that 37% of them had post-traumatic stress disorder, and 21-23% had

severe anxiety, perceived stress, insomnia, and difficulties adjusting. People

typically get a lot of information about the virus from the media during a

pandemic, which could make those who are susceptible to these symptoms more

concerned about their health. People who had a lot of health issues prior to the

COVID-19 pandemic are especially at risk for poor mental health outcomes

because they are more likely to misinterpret bodily sensations (like coughing)

and become deeply concerned that the virus will spread (Ines Blix, Marianne

Skogbrott Birkeland, & Siri Thoresen, 2021). Physical activity has a big influence

on our physical health, but it also shapes our mental health. The connection

between exercise and mental health is gaining attention and a growing body of

research. Regular exercise has been shown to have a substantial impact on a

variety of mental health factors, including stress reduction, mood enhancement,

and cognitive function. We will examine the different ways that physical activity

may impact mental health throughout this conversation. The physiological and

psychological aspects of exercise will be examined, along with the potential

benefits of integrating it into our daily routines for a holistic enhancement of our
state of being (Charls, Akhil, and Bhujanga Rao, 2023). Our general well-being is

influenced by both our physical and mental health. Despite their apparent

separation, they have a significant influence on one another. While physical

health refers to the condition of our body in terms of its capabilities and functions,

mental health refers to our emotional, psychological, and social well-being. It is

important to realize that without taking care of our mental and physical health, we

cannot attain total wellness. It is crucial to understand the connection between

these two facets of our health and give priority to maintaining them in today's

fast-paced, high-stress environment where self-care is frequently neglected

(United Community Solutions, 20 social isolation and loneliness have been linked

to anxiety, depression, heart disease, obesity, a weakened immune system, high

blood pressure, Alzheimer's disease, cognitive decline, and even death) (National

Institute of Aging, 2019). The detrimental effects of loneliness on people, society,

and governments around the world have been brought to light by the notable

increase in research on social isolation and loneliness over the past ten years,

particularly after the start of the COVID-19 pandemic. Due to a lack of

relationships and companionship, the pandemic caused older adults to feel

lonely, which can have a detrimental effect on mental and cognitive health. Older

adults were further isolated, and the detrimental effects of loneliness were

intensified by the paradox of social distancing, which was meant to protect them.

According to a long-term study on teenagers, they also felt socially isolated from

their peers, which led to an increase in loneliness as a result of school closures

brought on by COVID. Research demonstrates the negative effects of social

isolation on one's physical and mental well-being, employment prospects, and

relationship to social inequalities (Goldman, Khanna, El Asmar, Qualter, and El-

Osta, 2024). According to epidemiological research, loneliness is linked to some

of the most important public health issues of our day, such as the rise in chronic

illnesses like mental illness and the metabolic syndrome (MetS), which includes

obesity, insulin resistance, dyslipidemia, and hypertension. Numerous

neuropsychiatric conditions, such as major depressive disorder, anxiety

disorders, and post-traumatic stress disorder, are linked to loneliness. Cacioppo

and colleagues, for instance, showed through cross-lagged analyses of

longitudinal data from middle-aged and older U.S. populations that loneliness

predicted increases in depressive symptoms later on, but not the other way

around. This suggests that loneliness may be a cause of depression rather than

a side effect. natural consequence. adverse reactions. byproduct. symptom.

logical consequence. consequence. symptoms. drug interactions. natural

occurrence. contraindication. normal part. potential adverse effects. physiological

effects. total dose. safety profile. underlying disease. drug. tolerability. indication.

toxic effect. treatment. dosage. therapeutic effects. Although the majority of

studies on MetS have concentrated on the role that nutrition and exercise play,

some epidemiological research has also found links between MetS conditions

and loneliness or other social integration metrics. Interestingly, a large

longitudinal study found that people who reported feeling more alone were more

likely to develop MetS, with depression acting as a partial mediating factor in this

relationship (Ahmed, Cerda, and Maloof, 2023).

Informing Interventions and Policies

Sport is the cornerstone of any public policy aimed at promoting physical

activity, which is one of the most significant determinants of health in

contemporary society. Additionally, other elements like social interaction and

inclusion are linked to involvement in sports and physical activities (Tzankova-

Kaloyanova, 2020). Early psychological intervention is necessary to address the

psychological costs of the pandemic, feelings of loneliness, and uncertainties that

can lead to anxiety and depression. In addition to encouraging adherence to

pandemic measures in the short term, addressing psychological issues has long-

term benefits by reducing the prevalence of post-traumatic stress disorder,

anxiety, depression, substance abuse, and other conditions (Mioara Grigoras and

Anamaria Ciubara, 2021). The development of strong social support networks,

such as telehealth services, virtual support networks, and community outreach

initiatives, for frail older adults should be a top priority in future pandemic

preparedness plans. Frail older adults' mental health needs should be met with

interventions that are specific to their situation, considering things like physical

limitations and cognitive impairment. This could entail educating medical staff

about geriatric mental health and incorporating psychological services into

primary care settings. Reducing systemic obstacles like transportation

constraints and healthcare inequities should be the main goal of initiatives to

increase frail older adults' access to healthcare. Home-based care services and

telemedicine programs can help close the gap in healthcare delivery, especially

in emergency situations. Targeted financial assistance programs should be put in

place by governments and neighborhood associations to lessen the financial

strain that pandemics place on vulnerable senior citizens. This could involve

financial aid for necessities like housing and prescription drugs, as well as job

support services for people looking to return to the workforce (George

Christopher, Fatma Magdi, and Adebis hertiage Samuel, 2024). Living

arrangements, physical mobility, and supportive social networks can all act as

mediators of loneliness in older adults. Numerous interventions, such as physical

exercise, reminiscence therapy, and technological interventions, have been

linked to decreased loneliness in older adults, according to prior systematic

reviews (SRs) on loneliness-targeting interventions. Social support was included

as an outcome in a number of reviews, indicating that a variety of mechanisms

might enhance older adults' social environments. Previous SRs were restricted to

a single intervention (such as technology or exercise), lacked meta-analyses,

and had an older search date, even though more recent studies have separated

interventions by subtype. Twenty randomized clinical trials that focused solely on

loneliness outcomes were included in the most recent meta-analysis, which

searched the literature up to 2009. Since then, researchers, clinicians, and

policymakers have become more conscious of social isolation and loneliness,

and they have called for the centralization of best practices and evidence

(Hoang, King, Moore, Reich, Sidhu, Tan, Whaley, and McMillan, 2022). The

majority of depression treatments were administered in primary care and at home

in developed nations. Due to a lack of care coordination and sustainable

infrastructures, the majority of older adults in the USA were screened for
depression and treated in primary care settings, but frequently did not receive the

recommended standard care for depression. Home-based interventions in the

community were evaluated in a few studies, and the results showed that older

adults accepted treatment better and had fewer in-patient care days and nursing

home admissions. However, in community-based settings, conflicting results

were found, indicating that while interventions did improve the desired outcomes

(such as increasing physical therapy or training in specific skills), they did not

reduce depression (Carandang, et al. 2020). Another crucial component of aging

is comprehending how older people manage their daily responsibilities and social

roles. The development of healthy, problem-focused, and constructive coping

mechanisms is encouraged by proactive approaches to aging. Coping

mechanisms can therefore be seen as a constructive way to deal with aging.

Positive coping techniques have been proposed as a way to enhance quality of

life. It is also true that even under stressful circumstances, QOL can be enhanced

by the appropriate application of positive coping mechanisms. These studies

suggest that humor appreciation, a desire for assistance, and a sufficient level of

education (information) can all enhance quality of life (QOL). Furthermore, the

study by Atal and Cheng demonstrated that regardless of their financial situation,

participants with higher coping tendencies had comparable levels of QOL. Their

study found that coping mechanisms were more significant in improving quality of

life (QOL) than a person's socioeconomic status (SES). Given that 12% of

families in the Western Philippines are below the poverty line, this finding is

particularly significant for older adults (Palmes, Trajera, and Ching, 2021).
ORGANIZATION OF THE STUDY

Chapter 1. It appears that it includes the study's background information to

provide context for the "Understanding the Subjective Impact of Social Isolation

and Loneliness: A Multi-Case Study" is the study's title concept. It comprises the

following sections: the introduction, the Review of related literature, the purpose

of the study, the theoretical lens, the definition of terms, the scope and

delimitation, the research questions, the guide questions and the organization of

the study.

Chapter 2. Seemingly it involves the methodology, which comprises the study

plan, research subjects, data sources, data gathering, data analysis, and

reliability or trustworthiness of the outcome, the researcher’s role, and moral

issues.

Chapter 3. The study's findings, wherever the information was collected, would

be examined and recorded to produce a topic using thematic analysis.

Chapter 4. The exchanges of discussion in which the implications were to be

acknowledged for: The study's outcome, recommendations, and educational

practice.
 Chapter 2

METHODOLOGY

This chapter discusses the various methods in this study. It contained the

following: research design, research participants, data sources, data collection,

data analysis, trustworthiness of the study, role of the researcher, and ethical

consideration.

Research design. This study used a descriptive-correlational design. Creswell

(2024) states that the goal of descriptive research is to accurately and

methodically describe a population, circumstance, or phenomenon. It describes

how data is used as an interference to examine the subject under study. In

addition, Creswell (2018) defines correlational research as a manner of

conducting research in which the researcher measures the relationship between

two variables without having any control over either of the variables.

Phenomenology research employs a qualitative methodology whereby

researchers examine real-world data from one or more sources, including

interviews, observations, audio-visual materials, documents, and reports, to

produce a description of the phenomenon and related themes. This study was

conducted as qualitative phenomenological research because it offers adults a

chance to comprehend these phenomena—these perspectives of lived-

experiences in a new way (Bliss, 2016).

Research participants. The participants in this study were chosen using a

purposive sampling technique. Crossman (2020) defines a purposive sample as

a non-probability sample chosen based on the population's characteristics and

the study's goal. of the research. Purposive sampling involves selecting

participants for a study based on predetermined criteria, with the aim of gathering

data to address research concerns. The sample resident in Tagum City is used in

the current investigation. Participants in this study are randomly selected citizens

who have encountered social isolation in this context. This study would maintain

the anonymity and confidentiality of the participants, keeping the participants

information confidential, allowing the participant to remain anonymous and giving

participants codes instead of using their names will be performed to avoid

disclosure of personal information.

Data sources. In this study, with just thirteen research participants, we used

focus group discussions (FGD) with eight individuals and in-depth interviews (IDI)

with five people as our main methods of data collection. We drafted and

produced an interview guide questions that has been verified by experts.

Individual conversations that can reveal and illustrate more about people's

opinions, personalities, and feelings regarding important issues are made

feasible by the qualitative research methods known as focus group discussions

and in-depth interviews (IDI and FGD). Conducting in-depth interviews enables

the collection of perspectives and insights from students regarding their

encounters with patients, healthcare providers, clinical instructors, and their

respective areas of duty. On the other hand, focus group discussions bring

individuals together to talk about a particular topic of interest while sharing

comparable experiences or backgrounds. Typically, it entails conducting group

interviews with a small group of five to thirteen persons. It is a loosely structured

conversation about a variety of interesting topics that is facilitated by a moderator

(interviewer). Moreover, as a second source of data to bolster the conclusions of

the related review of literature, this study gathered information from the

previously mentioned books, journals, and articles. Information that has already

been gathered and is being evaluated for use in addressing new questions for

which it was not initially intended is known as secondary data.

Data collection. Interviews are very helpful for learning the backstory of a

person. Usually, researchers provide confidentiality agreements at the start of the

process of gathering data. Talking about confidentiality and it's crucial to discuss

participants' privacy concerns before data gathering starts enabling the

participants to understand how their information would be utilized, kept, and

safeguarded during the entire research process.

First, researchers must clearly define the objectives of the interview. What

specific data are they looking for? Setting definite objectives facilitates the

creation of pertinent questions that support the aim of the study. It is crucial to

create a list of open-ended questions after the objectives have been established.

To gain a deeper knowledge of participants' perspectives, these questions ought

to encourage them to communicate their ideas in detail.

Second, finding and enlisting the appropriate participants is also essential.

To ensure a varied range of perspectives, researchers should consider

demographics and experiences that are relevant to the study's emphasis. An

effective interview setting also includes choosing a calm and comfortable venue,
whether the interview is conducted in person or virtually, and scheduling the

sessions at times that work best for the participants.

Third, establishing a rapport before the interview starts is essential.

Starting off with some light talk will help release any tension and encourage

people to communicate more freely. More ways to build trust include outlining the

goal of the interview, how their answers will be used, and providing a guarantee

of secrecy.

Fourth, active listening is essential as the interview progresses. It is

imperative for researchers to pay close attention to the words and non-verbal

cues used by participants to indicate their participation. This focus invites people

to elaborate on their ideas while also demonstrating respect.

Fifth, summarizing important points at the end of the interview can be

helpful. This gives participants the chance to elaborate or explain their ideas

while also ensuring that the researcher fully comprehends their points of view.

Expressing gratitude to participants for their time and contributions helps to build

goodwill and emphasizes the value of their participation. It's critical to quickly

evaluate any notes or recordings made during the interview.

Lastly, this enables researchers to record further observations and

thoughts while the discussion is still fresh in their minds. After the interviews,

researchers move on to the analysis phase, where they search for themes,

patterns, and noteworthy revelations.

DATA ANALYSIS. Phenomenological analysis will be used to examine the data

from our study, which consists of focus group discussions and in-depth

interviews. This approach seeks to discover the essence of people's lived-

experiences by comprehending and interpreting them.

TRUSTWORTHINESS OF THE STUDY. The most important factor influencing

the rigor of qualitative research investigations is trustworthiness (Amankwaa,

2016; Eryilmaz, 2022). The degree of trustworthiness of qualitative research can

be measured by ensuring the credibility, transferability, dependability, and

conformability of research design, and neutrality.

Credibility. Credibility is like internal validity in quantitative analysis and

provides the actual data about the phenomenon.

Transferability. Transferability shows the degree of application of the research

finding in other exact natures of context, people, groups, and settings.

Dependability. If the findings of one study are replicated in a similar population,

condition, or context, then the findings are dependable.

Conformability. Conformability in research design ensures the validity of

findings, ensuring they can be confirmed by others, promoting objectivity and

tracing results back to collected data.

Neutrality. Neutrality is the degree of fairness of results consisting of purity of

initial responses and bias-free.

ROLE OF THE RESEARCHER. The researchers will establish rapport with

participants, demonstrating empathy and respect, using various methods for data

collection and handling, ensuring participant experiences are shared effectively

for the study's success. Part of the role, there is a facilitator which ensures a

comfortable environment for participants during interviews, fostering, attentive to

details and from the findings. Then a research secretary that manages

schedules, meetings, records, communication, documentation, participant

correspondence, and data collection activities, supporting the team's success by

maintaining organization and efficiency in the research process. Then a data

collector who gathers relevant information for a research study through methods

like surveys, interviews, or observations, adhering to research protocols,

maintaining participant confidentiality, and accurately recording responses for

analysis. Then a moderator that facilitates in-depth interviews and focus group

discussions, ensuring all voices are heard and creating a comfortable

environment for open dialogue. They must remain neutral and attentive for

analysis. Then a data encoder which is responsible for accurately inputting and

organizing qualitative data from research activities, ensuring consistency,

integrity, and efficiency in analysis. Attention to detail and familiarity with data

management software are essential.

ETHICAL CONSIDERATIONS

Researchers must obtain approval from the Arriesgado College

Foundation Inc. research program head and ethics committee before starting a

study. A letter of authorization is provided to participants, outlining the study's

nature, goals, privacy, and withdrawal options. Participants will receive written

information in three stages: a letter, oral communication, and outcomes upon

request. The aim is to ensure participants participate freely and benefit from the

information they contribute. The research is conducted for educational purposes,

with no financial benefits.

Social Value. The ethical principle of respect for persons justifies including

individuals in research projects based on the social value of the hypotheses or

questions. This study aims to address challenges nursing students face in clinical

duty, serve as a reference for future researchers, and recommend ways for

school administrators and clinical instructors to improve these challenges.

Informed Consent. Human studies must respect individuals' autonomy and

provide informed consent for participants from covered populations. Participants

must acknowledge their involvement and keep their identities private. Results are

provided based on the group's implied response, avoiding character responses.

Participants are made aware of their privacy and are encouraged to respond to

items they feel uncomfortable with, especially when arranging their assessment.

Vulnerability of the Research Participants. The study involved Tagum City

residents who were relaxed and stress-free due to the researcher's precautions.

Participants were given respect and safety, assistance, and freedom to leave at

any time. Extra caution was used, especially with sensitive topics.

Safety, Benefits and Risks. Researchers emphasize the importance of

participant agreement and safety in the study. They ensure participants are
aware of the study's goals and receive guarantees for their safety. IDI and FGD

are conducted at a suitable time to minimize hazards. Validators verify the guide

questions' effectiveness and double-check them for negative effects. Participants

are aware of potential hazards and are assured of their safety during the

research process.

Privacy and Confidentiality of Information. The research prioritizes privacy

and confidentiality, handling all data confidentially with unique codes for each

participant. Only authorized team members have access, and identifiable

information is removed before analysis. Findings are reported in aggregate form.

Transparency. Transparency in research involves transparently communicating

all aspects of the study's purpose, methods, data collection, and findings,

fostering trust and accountability. Research transparency aims to build

confidence among readers (scholars and practitioners), reviewers, and

administrators that the findings are reliable, useful, and generalizable.

Justice. Refers to the ethical principle that emphasizes fairness in the treatment

of participants, ensuring equitable access and representation (Beauchamp and

Childress, 2019). Emphasizing the importance of promoting equitable recruitment

practices that respect diversity, provide equal opportunities for participants to

express their experiences, and address power dynamics.

Qualification of the Researcher and Adviser. The research's success relied on

the researchers' direct communication with participants, adhering to qualitative

inquiry principles. They played various roles, including interviewer, translator,

transcriber, and encoder, building rapport and using empathy to inspire stories.

They employed probing inquiries and observation methods to gain deeper

insights. Advisors play a crucial role in helping people on their academic and

career journeys. They require a strong background in education, real-world

experience, excellent communication skills, familiarity with the resources that are

out there, and a dedication to moral principles. With the use of these credentials,

advisers can help mentees succeed and develop, build trust, and facilitate candid

communication.

Adequacy of Facilities. To carry out the study protocol and guarantee the safety

and protection of human research participants, facilities must be suitable

(Concha, 2021). As scholars, we'll make use of and incorporate thorough

assessment that considered several factors, including the availability of

equipment and technological resources, was carried out during the study. We will

begin by outlining the specific demands and requirements needed to finish this

study, keeping in mind the intricacy and nature of the investigation.

Community Involvement. This study will disseminate findings about nursing

students' experiences in clinical learning settings, ensuring equitable treatment

for community members. Participants will be informed about the study's purpose,

potential dangers, and power disparities. Researchers must also respect cultural

awareness and honor community values, beliefs, and rituals to minimize potential

harm or exploitation.
REFERENCES

Ahmed, Cerda, and Maloof. 2023. Breaking the Vicious Cycle: The

Interplay Beteen Loneliness, Metabolic Illness, and Mental Health. Frontiers in

Psychiatry, Volume 14.

https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2023.113486

5/full

Alice Delerue Matos, Fátima Barbosa, Cláudia Cunha, Gina Voss, and

Filipa Correia. 2021. Social Isolation, Physical Inactivity and Inadequate Diet

Among European Middle-Aged and Older Adults. BMC Public Health, Volume 21,

Page 924. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-

021-10956-w

https://pubmed.ncbi.nlm.nih.gov/33992074/

Berg-Weger and Morley. 2020. Loneliness in Old Age: An Unaddressed

Health Problem. The Journal of Nutrition, Health, and Aging, Volume 24, Issue 3,

Pages 243-245.

https://www.sciencedirect.com/science/article/pii/S1279770723011089?via

%3Dihub
 Briguglio, Vitale, Galentino, Banfi, Dina, Bona, Panzica, Porta, Dell'Osso,

and Glick. 2020. Healthy Eating, Physical Activity, and Sleep Hygiene (Hepas) as

the Winning Triad for Sustaining Physical and Mental Health in Patients at Risk

for or with Neuropsychiatric Disorders: Considerations for Clinical Practice.

Neuropsychiatric Disease and Treatment, Volume 16, Pages 55-70.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6955623/

Bryan Roy Bautista Milloria, Anna Mae Despi Marzon, and Reynaldo

Moral. 2024. Disconnected in a Connected World Examining Social Isolation and

Social Media Use Among College Students at Saint Cecilias College Cebu.

American Journal on Education and Evaluation Studies, Volume 1, No.4.

https://www.researchgate.net/publication/

382299269_Disconnected_in_a_Connected_World_Examining_Social_Isolation_

and_Social_Media_use_Among_College_Students_at_Saint_Cecilias_College_

Cebu

Carandang, Shibanuma, Kiriya, Vardeleon, Asis, Murayama, and Jimba.

2020. Effectiveness of Peer Counseling, Social Engagement, and Combination

Interventions in Improving Depressive Symptoms of Community-Dwelling Filipino

Senior Citizens. PLoS ONE, 15 (4). https://journals.plos.org/plosone/article?

id=10.1371/journal.pone.0230770

Carandang, Shibanuma, Kiriya, Vardeleon, Asis, Murayama, and Jimba.

2020. Effectiveness of Peer Counseling, Social Engagement, and Combination

Interventions in Improving Depressive Symptoms of Community-Dwelling Filipino

Senior Citizens. PLoS ONE, 15 (4). https://journals.plos.org/plosone/article?

id=10.1371/journal.pone.0230770

Charls N.C. N, Akhil Sasikumar, and Dr. P. Bhujanga Rao. 2023. The

Impact of Physical Activity on Mental Health. International Journal of Advance

Research and Innovative Ideas in Education, Volume 9, Issue 6.

https://www.researchgate.net/publication/378869664_THE_IMPACT_OF_PHYSI

CAL_ACTIVITY_ON_MENTAL_HEALTH

Eileen Graham, Shevaun D Neupert, and Toni Antonucci. 2023.

Loneliness, Social Isolation, and Health Within the Context of a Global

Pandemic. Innovation in Aging 7, (Supplement_1):80-81.

https://www.researchgate.net/publication/376734766_LONELINESS_SOCIAL_IS

OLATION_AND_HEALTH_WITHIN_THE_CONTEXT_OF_A_GLOBAL_PANDEM

IC

Geon Lee and Chulwoo Kim. 2024. Social Isolation and Mental Well-Being

Among Korean Older Adults: A Focus on Living Arrangements. Frontiers in Public

Health, Volume 12.

https://www.frontiersin.org/journals/public-health/articles/10.3389/

fpubh.2024.1390459/full

George Christopher, Fatma Magdi, Adebis hertiage Samuel. 2024. An

Integrative Review of the Psychosocial Impacts of COVID-19 on Frail Older

Adults: Lessons to Be Learned in Pandemic.

https://www.researchgate.net/publication/381479161_An_Integrative_Review_of
_the_Psychosocial_Impacts_of_COVID-

19_on_Frail_Older_Adults_Lessons_to_Be_Learned_in_Pandemic

Goldman, Khanna, El Asmar, Qualter, and El-Osta. 2024. Addressing

Loneliness and Social Isolation in 52 Countries: A Scoping Review of National

Policies. BMC Public Health, Volume 24, Article Number 1207.

https://link.springer.com/article/10.1186/s12889-024-18370-8

Hoang, King, Moore, Reich, Sidhu, Tan, Whaley, and McMillan. 2022.

Interventions Associated with Reduced Loneliness and Social Isolation in Older

Adults: A Systematic Review and Meta-analysis. JAMA Network Open, 5(10).

https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2797399

Ines Blix, Marianne Skogbrott Birkeland, & Siri Thoresen. 2021. Worry and

Mental Health in the Covid-19 Pandemic: Vulnerability Factors in the General

Norwegian Population. BMC Public Health, 21, Article number: 928.

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-10927-1

Jaymar C. Reponte and Saramie S. Belleza. 2023. Influence of Physical

Health and Emotional Intelligence to Classroom Management of Secondary

Teachers. United International Journal for Research & Technology, Volume 04.

https://uijrt.com/articles/v4/i9/UIJRTV4I90011.pdf

Lally, Tully, and Samaniego. 2019. Mental Health Services in the

Philippines. BJPsych International, Volume 3, Pages 62-64.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6646843/
 M. Tzankova-Kaloyanova. 2020. Population Awareness of the

Consequences of Lack of Physical Activity. Trakia Journal of Sciences, Vol. 18,

Suppl. 1, pp 837-841.

https://www.researchgate.net/publication/363208828_POPULATION_AWARENE

SS_OF_THE_CONSEQUENCES_OF_LACK_OF_PHYSICAL_ACTIVITY

M. Tzankova-Kaloyanova. 2020. Population Awareness of the

Consequences of Lack of Physical Activity. Trakia Journal of Sciences, Vol. 18,

Suppl. 1, pp 837-841.

https://www.researchgate.net/publication/363208828_POPULATION_AWARENE

SS_OF_THE_CONSEQUENCES_OF_LACK_OF_PHYSICAL_ACTIVITY

Masud Akhtar, Muhammad Akram Riaz, Muhammad Akbar, Ifraz

Adeel, Humaira Hussain, and Saima Waqar. 2022. Impact of Relaxation

Techniques on Occupational Stress Among Working Women. Journal of

Education and Social Studies, Volume 3, Pages 110-115.

https://www.researchgate.net/publication/365759935_Impact_of_Relaxation_Tec

hniques_on_Occupational_Stress_among_Working_Women

Mengsha Luo and Lydia Li. 2022. Social Isolation Trajectories in Midlife

and Later-life: Patterns and Associations with Health. International Journal of

Geriatric Psychiatry,Volume 37, Pages 1–11.

https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5715

Mioara Grigoras and Anamaria Ciubara. 2021. Looking Into Pandora's Box

Between "Everything" and "But" -Depression, Pain of Losses the Next Pandemic
of Humanity? BRAIN. Broad Research in Artificial Intelligence and

Neuroscience, 12(2), 326-334.

https://lumenpublishing.com/journals/index.php/brain/article/view/4470

Mariam Ter-Stepanian, Alexa Martin-Storey, Roxanne Bizier-

Lacroix, Michèle Déry, Jean-Pascal Lemelin & Caroline E. Temcheff. 2019.

Trajectories of Verbal and Physical Peer Victimization Among Children with

Comorbid Oppositional Defiant Problems, Conduct Problems and Hyperactive-

Attention Problems. Child Psychiatry & Human Development, Volume 50, pages

1037–1048. https://link.springer.com/article/10.1007/s10578-019-00903-7#citeas

Mioara Grigoras and Anamaria Ciubara. 2021. Looking Into Pandora's Box

Between "Everything" and "But" -Depression, Pain of Losses the Next Pandemic

of Humanity? BRAIN. Broad Research in Artificial Intelligence and

Neuroscience, 12(2), 326-334.

https://lumenpublishing.com/journals/index.php/brain/article/view/4470

National Academies of Sciences, Engineering, and Medicine. 2020. Social

Isolation and Loneliness in Older Adults: Opportunities for the Health Care

System. National Academies Press. https://books.google.com.ph/books?

hl=en&lr=&id=SDbnDwAAQBAJ&oi=fnd&pg=PR1&dq=informing+intervention+an

d+policies+regarding+social+isolation+and+loneliness+&ots=c7n4qRVTg0&sig=

PjzHEqO8A0f0aMI7P69aQ99Kp9c&redir_esc=y#v=onepage&q=informing

%20intervention%20
 National Institute of Aging. 2019. Social Isolation, Loneliness in Older

People Pose Health Risks. Research Highlights.

https://www.nia.nih.gov/news/social-isolation-loneliness-older-people-pose-

health-risks

Nguyen, Taylor, Taylor, Ambroise, Hamler, Qin, and Chatters. 2024. The

role of subjective, interpersonal, and structural social isolation in 12-month and

lifetime anxiety disorders. BMC Public Health, Volume 24, Article no. 760.

https://link.springer.com/article/10.1186/s12889-024-18233-2?

fbclid=IwY2xjawGJM0RleHRuA2FlbQIxMAABHYkSUpMCltjRmQ10sZPOO75bqg

3VCol2ePsa63CZq16r5kuA1_xdxxrt8w_aem_VDObuYjZXFqPokR5r3wlcQ#Sec1

Palmes, Trajera, and Ching. 2021. Relationship of Coping Strategies and

Quality of Life: Parallel and Serial Mediating Role of Resilience and Social

Participation among Older Adults in Western Philippines. International Journal of

Environmental Research and Public Health, 18, no. 19.

https://www.mdpi.com/1660-4601/18/19/10006

Paxton-Willing, Nevers, Nofziger, Rogers, and Riggs. 2024. Lessons

Learned from Efforts to Prevent Behavioral Health Problems and Promote Mental

Wellbeing in the Us Military. Mental Health & Prevention, Volume 34.

https://www.sciencedirect.com/science/article/pii/S2212657024000126

Ronald M. Rapee, Ella L. Oar, Carly J. Johnco, Miriam K. Forbes, Jasmine

Fardouly, Natasha R. Magson, and Cele E. Richardson. 2019. Adolescent

Development and Risk for the Onset of Social-Emotional Disorders: A Review

and Conceptual Model. Behaviour Research and Therapy, Volume 123, Pages 1-

14. https://www.sciencedirect.com/science/article/abs/pii/S0005796719301871?

via%3Dihub

Yasuko Uchigata. 2018. The still persistent stigma around diabetes: is

there something we can do to make it disappear? Diabetology International,

Volume 9, Pages 2009-2011. https://link.springer.com/article/10.1007/s13340-

018-0373-z#citeas