Social and emotional loneliness among college students during the COVID-19 pandemic: the predictive role of coping behaviours, social support, and personal resilience

Objective To determine the inuence of coping behaviors, resilience, and social support on students' emotional and social loneliness during the COVID ‐ 19 pandemic. Design and Methods A cross ‐ sectional research design was used to gather data from 303 college students from the Central Philippines using four standardized scales through an online survey. Findings Loneliness among students was high during the coronavirus pandemic. Resilience, coping behaviors, and social support were identied as protective factors against loneliness. Practice Implications Interventions directed toward increasing resilience, social support, and coping behaviors may help decrease emotional and social loneliness caused by the mandatory lockdown during the COVID ‐ 19 pandemic.


Introduction
The COVID-19 pandemic, which originated from Wuhan, China, in November 2019, has brought many unprecedented challenges and has had serious implications on the economy and health of many countries around the globe. Since the onset of the pandemic, many countries, including the Philippines, implemented various public health measures, including the mandatory lockdown for the entire country, to curtail the spread of the coronavirus. In addition, various measures have been imposed, including strict social and physical distancing, targeted community quarantines, mandatory closures of all schools and non-essential establishments, and strict travel restrictions. Public and private sectors were mandated to allow only 30% of their current workforce to go to work while strict curfews were imposed to limit the movement of the citizen and to contain the spread of the virus. These public health measures were imposed to ' atten the curve', or slow or prevent the transmission of the COVID-19 virus, thus increasing the capacity of the healthcare institutions to adequately manage con rmed cases of the disease.
However, particularly among young people, these measures may have had profound emotional and psychological consequences, including social isolation and loneliness, and resulting from the disruption in their daily routines and social interactions with peers and family.
Loneliness, a negative subjective experience in an individual which arises when social relations and interactions are perceived to be insu cient (Peplau & Perlman, 1982), has been identi ed as a potential consequence of the mandatory lockdown imposed by the government to limit the spread of the coronavirus infection (Bu et al., 2020;Rauschenberg et al., 2020). Mounting evidence has shown a higher prevalence rate of loneliness among young people during the COVID-19 pandemic, when compared to older adults (Barreto et al., 2020). Various studies have estimated that at least 38% to 50% of young people aged 18-24 years old experienced higher levels of loneliness during the mandatory lockdown (Bu et al., 2020;Rauschenberg et al., 2020), with women having higher odds of experiencing loneliness than men (Losada-Baltar et al., 2020;Salo et al., 2020).
Loneliness is an important health concern that has been strongly associated with various adverse mental and psychological consequences. Evidence has identi ed loneliness as a strong precursor of stress, depression, anxiety, and suicide, which could potentially exacerbate pre-existing psychological and mental issues (Holmes et al., 2020;Lim et al., 2020). Recent studies have shown that social isolation and loneliness due to home con nement measure increase the risk of psychological distress, depression, and anxiety in an individual, with a longer duration of loneliness considered as a strong precursor of adverse psychiatric symptoms (Rauschenberg et al., 2020;Loades et al., 2020). Further, other reports have strongly linked loneliness to various diseases such as stroke, hypertension, and other heart issues, as well as other cognitive issues such as dementia (Valtorta et al., 2016;Kuiper et al., 2015). Therefore, measures to address loneliness among young people should be explored to prevent the occurrence of the associated mental health consequences.
Social support, personal resilience, and coping abilities were identi ed as protective factors against adversity and stressful conditions such as disaster situations and disease outbreaks (Turner, 2015;Labrague et al., 2016;Yu et al., 2020;Xiao et al., 2020).). Available studies have shown that during stressful events, a resilient individual and those who have an adequate support system and coping skills are less likely to be stressed or feel lonely (Ogińska-Bulik & Michalska 2020;Wu et al., 2016). Adequate support that originates from peers and family was also observed to be vital to assist an individual in effectively managing stress-provoking situations such as disaster events, emergency crises, and infectious disease outbreaks (Langan et al., 2017). During the COVID-19 pandemic, where stress and loneliness are high, personal resilience, positive coping behaviours, and adequate social support may assist frontline health care workers to adequately cope with the burden associated with the pandemic (Cooper et al., 2020) and sustain their mental health and psychological wellbeing (Labrague et al., 2018;Labrague & De los Santos, 2020). Despite the increasing evidence highlighting the value of building resilience and increasing organisational and social support to assist an individual in attaining positive mental health outcomes (e.g., the reduction of anxiety, stress, depression) during the COVID-19 pandemic, studies looking into how these factors contribute to the curtailment of loneliness among college students during the COVID-19 pandemic remain unexplored.

Aim of the Study
The closure of all schools compel many academic institutions to shift to remote learning and obliging at least 3,408,815 young people in the country to stay at home (Commission on Higher Education, 2020) in order to prevent further transmission of the virus. As a consequence of the mandatory lockdown, these students, particularly those aged 21 years old and below, were restricted from going outside of their homes and socialising with their peers. This situation has led to many worries of the ill effects, including loneliness and other mental health concerns, of the disruptions in social interactions with their peers.
Despite evidence showing the vulnerability of college students to experience loneliness during this pandemic, no studies were located examining the role of coping behaviours, social support, and personal resilience in predicting emotional and social loneliness in students. Hence, this study examined the in uence of coping behaviours, social support, and personal resilience on emotional and social loneliness among college students during the implementation of mandatory lockdown during the coronavirus pandemic.

Methods
Research Design This is a cross-sectional study utilising an online-based data collection approach was conducted during the second month of mandatory lockdown.

Samples and Settings
This study included college students enrolled in nursing schools in the Central Philippines. Sample calculation was performed using the G*power program software. A sample size of 261 was required for ve predictors to attain an 80% power, with an effect size of 0.05 and alpha set at 0.05 (Soper, 2020). Three hundred students were initially invited; however, only 261 responded. To qualify for the study, students had to: a) be currently enrolled in a college or university, b) be a full time student, and c) be either male or female.

Instrumentations
Loneliness Scale: To examine the overall loneliness in students, the 6-item Loneliness Scale (Gierveld & Tilburg, 2006) was used. Students responded to the questionnaire by answering 'yes', 'more or less', or 'no'. To score their responses, 'yes' and 'more or less' were scored 1, and 'no' was scored 0. The possible score ranged from 0 to 6, the scale of which was categorised into 'not lonely' (0-1), 'moderately lonely' (2-4), and 'severely lonely' (5-6). Previous research con rmed the predictive validity of the scale as evidenced by its signi cant correlation with mental disorders and physical health, with an acceptable reliability value of 0.76 (Gierveld & Tilburg, 2006) and a Cronbach's alpha of 0.87 in the current study.
Brief Resilience Scale: To examine the capacity to rebound back from distressing events among students, the 4-item Brief Resilience Scale was used (Smith et al., 2008). Participants responded to each item of the scale by responding on a Likert scale which ranged from 0 to 5. Previous research con rmed the reliability of the scale, with an internal consistency of 0.91 (Labrague & De los Santos, 2020) and an internal consistency of 0.87 in the present study.
Coping Behaviours Questionnaire: To identify the coping abilities of the students, the modi ed version of the Coping Behaviour Questionnaire (COPE) (Carver et al., 1989;Savitsky et al., 2020) was used. The scale consisted of 8 items answerable by a 5-point Likert scale ('strongly disagree' as 1 to 'strongly agree' as 5), which was classi ed into four dimensions: humour, consultation and seeking information, spiritual and sources of support, and mental disengagement. The scale had an acceptable validity and an excellent reliability (α = 0.87) based on the previous study (Savitsky et al., 2020), as well as an internal consistency of 0.87 in the present study.
Perceived Social Support Questionnaire: Students' opinion of the degree of support received from others when confronted by stressful events was assessed using the Perceived Social Support Questionnaire (Lin et al., 2019). The scale comprised of 6 items answerable by a 5-point Likert-type scale from 1 to 5. The overall scale score was categorised into 'low' (1.00-2.99), 'moderate' (3.00-4.30), and 'high' (4.31-5.00), and the scale demonstrated an excellent criterion validity and excellent reliability (α = 0.89) based on the previous research (Labrague & De los Santos, 2020); it had a Cronbach's alpha of 0.87 in the current study.

Data Collection and Ethical Considerations
Before the data collection, the research protocol was submitted to the Research Review Committee of the Ethics Committee of the Public State University, Philippines for ethical approval. The online questionnaire with the use of Google Forms was sent to all prospective students through their emails. The rst part of the online questionnaire comprised of brief information to inform the students about the purpose of the research and a letter seeking their permission to join in the study. The online survey was conducted from 20 June to 20 July 2020, during the second month of the mandatory lockdown.

Data Analysis
The SPSS Statistics software, version 23, was used to analyse the data collected. We used frequencies, standard deviations (SDs), and means to present the data. Correlations between key study variables were examined using the student t-test, analysis of variance, and the Pearson's r correlation coe cient. To identify potential predictors of loneliness, independent variables which signi cantly correlated with loneliness were considered into the model (multiple linear regression).

Results
Three hundred three college students joined in the study. Most of the participants were female (80.86%), in the 1 st and 2 nd level of education (58.74%), and currently enrolled in a public nursing school (67.33%). Table 1 presents the complete characteristics of the students.
An independent t-test showed a difference in the mean scale score of the social isolation subscale when grouped according to gender, with female students reporting an increased social loneliness (t = -2.137; p = 0.034). Meanwhile, using Pearson's r correlation coe cient, age (r = -0.205; p = 0.001), readiness (r = -0.187; p = 0.002), and willingness to care (r = -0.168; p = 0.007) for COVID-19 patients correlated signi cantly with emotional loneliness. Finally, personal resilience, coping behaviours, and social support correlated signi cantly with emotional and social loneliness (all p < 0.001).
To examine the effects of the different students' variables on emotional and social loneliness, a multiple linear regression analysis was conducted (Table 3 and 4). The regression models explained 14.7% and 33.3% of the variances of the emotional and social loneliness scales (F = 8.48; p = 0.001; F = 26.965; p = 0.001). Among the different students' variables, age (β = -0.168, p = 0.005) predicted emotional loneliness, with younger students experiencing higher levels of such. Further, a higher level of emotional loneliness was attributed to lower scores in the social support scale (β = -0.176, p = 0.014). On the other hand, gender (being female) (β = 0.109, p = 0.045), resilience (β = -0.214, p < 0.001), and coping behaviours (β = -0.455, p < 0.001) predicted social loneliness.

Discussion
The results of the study showed that loneliness was prevalent among college students during the period of mandatory lockdown to curtail the transmission of coronavirus, with 56.7% experiencing moderate levels of loneliness and 23.6% feeling severely lonely. Students reported higher levels of emotional loneliness than social loneliness, which is in accordance with previous research (Diehl et al., 2018). When we compared our result to previous studies in which young adolescents were participants, we found higher levels of loneliness in our samples. In three previous studies conducted among young adults, the percentage of participants reporting moderate to severe loneliness ranged from 2.5% to 18.4% (Diehl et al., 2018;Hysing et al., 2020;Singh et al., 2020). Such an increased percentage of students reporting loneliness in this study may be attributed to the mandatory lockdown being imposed by the government to control the transmission of coronavirus. Tull et al. (2020) suggested that measures such as home con nement, social distancing, and quarantine to control infection greatly contribute to a sense of loneliness among young people as they restrict them from socialising with their peers. In addition, closure of schools could partly play a role in the development of loneliness among students as school routines and activities were identi ed as essential coping mechanisms, especially for young people (Auger et al., 2020).
Overall, students reported moderate levels of coping behaviours and social support during the lockdown period, which is in line with studies conducted prior (Labrague et al., 2018) and during the coronavirus outbreak (Labrague & De los Santos, 2020). Among the different coping styles, the most commonly used during the lockdown period were 'consultation and seeking information' and 'spiritual and seeking support'. These coping behaviours were classi ed as problem-focused behaviours which aim to reduce the sources of stress by targeting its causes (Labrague et al., 2018a), and they have been associated with positive physical, mental, and psychological outcomes in students . Personal resilience, on the other hand, was rated low by students. As personal resilience offers protection against stressful events such as emergency and disaster situations (Turner, 2015) and disease outbreaks (Labrague & De los Santos, 2020) by strengthening an individual's ability to endure the burden through the pandemic, building resilience through evidence-based interventions should be prioritised.
Among the different predictive variables, age predicted emotional loneliness, with younger students experiencing higher levels of emotional loneliness during the COVID-19 pandemic. This result con rms previous studies showing a higher tendency of younger individuals to feel emotionally lonely during the coronavirus pandemic Bu et al., 2020;Rauschenberg et al., 2020). In a large scale study comprising 35,712 UK adults, younger adults were found particularly at risk of experiencing severe loneliness during the pandemic in comparison to the older age group (Bu et al., 2020). This result also lends support to earlier studies, which reported younger people to be signi cantly lonelier than older respondents (Barreto et al., 2020;Child & Lawton, 2019). A few possible explanations are offered here. First, younger adults such as college students are heavily affected by infection control policies that prevent young people aged 21 and below from going outside, thereby increasing social isolation, resulting in the loss of links to their peers, and making vulnerable to emotional loneliness (Matthews et al., 2016). Further, when compared to older adults, younger people were less likely to use positive coping strategies which are vital to combat the negative psychological effects of social isolation.
With regards to gender, the results of our study showed higher levels of social loneliness among female students when compared to their male counterparts. An increased social loneliness score in female students may be explained by the fact that women, compared to men, value participation in social activities more highly, prefer greater interpersonal connectedness, and are more sensitive to the interpersonal context (Barreto et al., 2020, thus making them more vulnerable to social loneliness during a mandatory lockdown where social contact with peers is limited. This result corroborates previous studies, which identi ed female young adults to be particularly more at risk of experiencing social loneliness than male young adults (Bu et al., 2020;Liu et al., 2020). Social support, personal resilience, and adequate coping skills have been identi ed as vital personal resources to effectively manage and bounce back from stressful situations such as disease outbreaks and disasters (Duncan, 2020). In this study, a higher level of emotional loneliness was attributed to lower scores in the personal resilience category, while a higher level of social loneliness was attributed to lower scores in the coping and social support categories, suggesting the importance of building individual resilience and coping behaviours and enhancing social support to combat the negative psychological and mental effects of disease control protocols such as the home quarantine, social distancing, and lockdown measures during the pandemic. Further, this study's result provides support to earlier studies involving the general population and linking personal resilience to reduced anxiety, stress, and depression (Foster et al., 2020;Labrague & De los Santos, 2020) and improved overall mental and psychological health (Cooper et al., 2020). In a study involving young adolescents, adequate coping skills and resilience were identi ed as protective factors against loneliness and other negative effects of social distancing and lockdown measures during the pandemic (Groarke et al., 2020). In a recent study by Savitsky et al. (2020), higher levels of resilience and positive coping skills related to decreased levels of pandemicrelated anxiety among students during the mandatory lockdown.
In our study, increased social support was strongly linked with signi cantly lower emotional loneliness in students during the period of mandatory lockdown. This result highlights the value of adequate emotional support that originates from peers and family when facing adversity and may provide individuals with resources to cope with loneliness associated with social distancing and lockdown measures. In addition, our result concurs with the ndings of Bu et al. (2020), who reported that young people with an adequate support system experienced decreased levels of loneliness compared to those young people who perceived lower social support. Apart from the protective effects of social support against social loneliness during the COVID-19 pandemic, previous studies (Xiao et al., 2020;Labrague & De los Santos, 2020) recognised the importance of an adequate support system in enhancing emotional state, psychological wellbeing, and mental health among individuals.
A few limitations were identi ed in the study. First, although a sample calculation was conducted to determine the required sample size, determining the accurate prevalence of emotional and social loneliness in young people requires much larger and heterogeneous samples. Second, while we found evidence linking personal resilience, coping behaviours and social support to emotional and social loneliness, randomised control trials (RCTs) may be needed to examine the e cacy of resilience intervention and other measures in enhancing coping skills and social support in reducing loneliness among students. Finally, other factors not included in the study that might in uence loneliness among students should be considered in future studies.

Conclusion
To our knowledge, this is research is one of the earliest to examine loneliness among college students during the height of the COVID-19 pandemic, although several studies assessing loneliness among young adolescents before the COVID-19 pandemic were found. This study suggests that disease control measures (e.g., mandatory lockdown and social distancing) to contain the virus have increased the levels of loneliness, particularly in younger and female students. Further, students who had higher levels of personal resilience and coping behaviours, and those who perceive greater social support, reported a lower level of loneliness.
Implications for nursing practice Empirically tested interventions and strategies directed towards increasing personal resilience, social support, and coping behaviours may help reduce emotional and social loneliness in students during the mandatory lockdown during the COVID-19 pandemic. Additionally, educators can better support the emotional state of the college students during the COVID-19 pandemic by strengthening their coping skills and their personal resilience. Mann et al., (2017) identi ed a few strategies to effectively address loneliness in young people, including social skills training, psycho-education, and socialisation. However, with the mandatory lockdown and social distancing requirements, the use of digital technologies to deliver these interventions may be supported. Through the use of social networking sites and other communication technologies, social connection and interaction can be maintained. Finally, support from family may provide a sense of safety to students in order to lessen their apprehensions regarding the pandemic.