” https://academic.oup.com/gerontologist/article/61/6/878/6298550”

Purpose in Life, Loneliness, and Protective Health Behaviors During the COVID-19 Pandemic

Yoona Kang, PhD, Danielle Cosme, PhD, Rui Pei, PhD, Prateekshit Pandey, MA, José Carreras-Tartak, BA, Emily B Falk, PhD The Gerontologist, Volume 61, Issue 6, September 2021, Pages 878–887, https://doi.org/10.1093/geront/gnab081 Published: 14 June 2021

背景和目標

保持社交距離雖然可以有效減少COVID-19的擴散，但也可能增加了隔離感。本研究預設生活目標感作為心理資源進行檢驗，這種資源可以降低孤獨感並使人更願意主動參與健康保護行為。

研究設計和方法

在 COVID-19 大流行期間，調查研究517 名成年人（平均值 = 37.71，SD = 11.30；範圍 = 19-73）的生活目標程度、目前和大流行之前的孤獨感程度、以及打算做些什麼來預防 COVID-19 擴散。

結果

當「年齡愈增長」、「生活目標感愈強」、「孤獨感愈弱」對於參與 COVID的「防疫行為的傾向愈強」存有關聯。

孤獨感愈強則愈不願意積極地保持社交距離和參與健康促進行為（譬如洗手），不過，這種連結並不存在於生活目標感比較強的民眾。

排除生活目標感比較低的條件，愈年長者的孤獨感愈弱。

討論和意涵

心理資源（譬如生活目標）與保護性的健康促進行為有關。

此外，壓力源會降低參與健康保護行為的意願，而生活目標或意義感可以「減少孤獨感」，並「抵消壓力源」的負面影響。

本研究還發現年長者在COVID-19處於隔離情境時的複原力。

# The pandemic caused by the coronavirus disease 2019 (COVID-19) has threatened the health of millions across the globe. Avoiding close contact with others by putting physical distance between people, or “social distancing,” is one of the most effective strategies to slow the spread of the virus along with other health-promoting recommendations such as handwashing. While social distancing is critical to stay safe during the pandemic, it also has increased stress associated with social isolation and loneliness. Research on the psychological impact of the COVID-19 pandemic shows that stay-at-home orders increased loneliness (Tull et al., 2020), and social isolation exacerbated the negative effect of pandemic-related life changes on well-being (Birditt et al., 2021; Losada-Baltar et al., 2021; Minahan et al., 2021). Furthermore, people may cope with stress by engaging in unhealthy behaviors (Mezuk et al., 2017). Stress associated with loneliness and/or loneliness itself as a stressor during a pandemic may diminish people’s engagement with protective health behaviors against the COVID-19. Following the call to identify protective factors for at-risk populations during the pandemic (Resnick et al., 2021), the current study examined whether greater availability of psychological resources would be associated with increased resilience and protection against illness in the face of challenges. Specifically, we tested purpose in life as a psychological resource that may protect individuals from loneliness during social isolation and encourage health-protective behaviors to counteract COVID-19 risk.

社會斷連壓力及心理資源

對 COVID-19 大流行心理影響的研究表明，居家令增加了孤獨感（Tull 等人，2020 年），社會孤立加劇了與大流行相關的生活變化對幸福感的負面影響（Birditt 等人， al.，2021 年；Losada-Baltar 等人，2021 年；Minahan 等人，2021 年）。此外，人們可能會通過從事不健康的行為來應對壓力（Mezuk 等，2017）。

與孤獨相關的壓力和/或孤獨本身作為大流行期間的壓力源可能會減少人們對 COVID-19 的保護性健康行為的參與。在呼籲確定大流行期間高危人群的保護因素之後（Resnick 等人，2021 年），當前的研究檢查了心理資源的更多可用性是否與在面臨挑戰時增強彈性和抵禦疾病的能力有關。具體來說，我們測試了人生目標作為一種心理資源，它可以保護個人在社會隔離期間免受孤獨感，並鼓勵採取健康保護行為來抵消 COVID-19 風險。

生活目標感是健康保護因子

人生目的是指感覺自己的生活有意義，方向感和一系列源自個人價值觀的目標（Ryff，1989）。生活目的是心理幸福感六因素模型中幸福感的六個組成部分之一，該模型確定了有助於健康的心理資源 (Ryff, 1995, 2014; Ryff & Keyes, 1995)。即使在世界看起來毫無意義和可怕的時候也能找到意義和目的的信念是人類繁榮和幸福的核心（Ryff，2014；Ryff & Singer，2003，2008）。面對逆境，人生目標提供了實現目標的方向，並激發了與個人價值觀一致的行動，從而提高了復原力和對疾病的保護（Ryff 等，1998）。支持這一框架，生活目標始終與減輕壓力、增強幸福感和對健康保護行為的更大開放性相關（Roepke 等人，2014 年；Ryff 和 Singer，1998 年）。具體而言，更強的人生目標感與長壽（Boyle 等人，2010 年）、心髒病等與年齡相關的疾病（Cohen 等人，2016 年）和認知障礙（Lewis 等人，2010 年）的風險降低具有獨特的相關性。 al., 2017) 以及對成功老齡化至關重要的更健康的生活方式，包括體育活動 (Hooker & Masters, 2016) 和使用預防性健康服務 (Kim et al., 2014)。

# In the face of challenges that threaten health and well-being, individuals use various coping strategies based on their appraisal of the stressor and resource availability (e.g., stress and coping model; Lazarus & Folkman, 1984). When resources are scarce, individuals may engage in dysfunctional coping strategies that temporarily relieve but eventually exacerbate the stress (Biggs et al., 2017). For example, stress may create a trade-off between mental well-being and physical health behaviors (Mezuk et al., 2010) or deprioritize health behaviors (Mezuk et al., 2017). If, instead, protective resources such as purpose in life are available, individuals are more able to effectively fight off the deleterious effects of stress (Ryff & Singer, 2003). Some evidence from prepandemic research suggests that purpose in life may benefit individuals during the COVID-19 pandemic: A stronger sense of purpose has been associated with less perceived loneliness among older adults aged 60 and older (Neville et al., 2018). Furthermore, purpose in life may promote receptivity to health-protective behaviors. For example, individuals with a greater sense of self-transcendent purpose showed lower neural activity associated with defensiveness in response to self-relevant health messages (Kang et al., 2017) and lower conflict-related processing in the brain while exposed to health messages, which in turn predicted the likelihood of endorsing protective health recommendations (Kang et al., 2019). Taken to the context of a global pandemic, having clear goals that give meaning to life and knowing which actions would bring oneself closer to those goals may reduce the conflict between the stress of loneliness and the need to engage in health behaviors to protect oneself and others (Kang et al., 2019; Ryff & Singer, 1998).

面對威脅健康和福祉的挑戰，個人根據他們對壓力源和資源可用性的評估使用各種應對策略（例如，壓力和應對模型；Lazarus & Folkman，1984）。當資源稀缺時，個人可能會採用功能失調的應對策略，這些策略可以暫時緩解但最終會加劇壓力（Biggs 等，2017）。例如，壓力可能會在心理健康和身體健康行為之間做出權衡（Mezuk 等，2010）或降低健康行為的優先級（Mezuk 等，2017）。相反，如果有生活目標等保護性資源，個人就能更有效地抵禦壓力的有害影響（Ryff & Singer，2003 年）。來自大流行前研究的一些證據表明，在 COVID-19 大流行期間，生活目標可能使個人受益：在 60 歲及以上的老年人中，更強的目標感與更少的孤獨感有關（Neville 等，2018）。此外，生活目的可能會促進對健康保護行為的接受。例如，具有更強自我超越目的感的個體表現出較低的神經活動與防禦性相關的自我相關健康信息（Kang 等人，2017 年），以及在接觸健康信息時大腦中與衝突相關的處理能力較低，這反過來預測了支持保護性健康建議的可能性（Kang 等，2019）。考慮到全球大流行的背景，擁有賦予生命意義的明確目標並知道哪些行動將使自己更接近這些目標，可以減少孤獨壓力與採取健康行為以保護自己和他人的需要之間的衝突（Kang 等人，2019 年；Ryff 和 Singer，1998 年）。

生活目標感如同一種具有保護性的資源，使個人面對負面因子時能有比較有效的抵禦壓力能力（Ryff & Singer，2003 年）。

譬如60歲及以上的年長者的生活目標感愈強，孤獨感愈弱（Neville 等，2018）。

生活目標感可能會促進對健康保護行為的接受。譬如，具有愈強的超越自我目標感在自我健康訊息時表現出愈低的防禦性神經活動(Kang et al., 2017)，也會在接觸健康訊息時降低大腦衝突訊息處理，這反過來預測了支持保護性健康建議的可能(Kang et al., 2019)。

換言之，具有明確的生活目標感可以賦予生活意義感，並且也比較會採取與目標一致性的行動，有助於減少孤獨的壓力感，也會自發地採取既保護自己亦保護他人的健康行為(Kang et al., 2019; Ryff & Singer, 1998)。

# Age and Loneliness During a Pandemic

# Older populations face the highest risk of severe illness and mortality from COVID-19 worldwide (Jordan et al., 2020; Shahid et al., 2020), with over nine out of 10 deaths caused by COVID-19 being adults 55 years and older in the United States (CDC.gov as of January 2021). In addition to the physical risk, however, it is unclear whether older individuals are also more vulnerable to psychological risks such as loneliness during a pandemic. On the one hand, recent studies highlight remarkable resilience among older populations, such that older compared to younger adults during the COVID-19 pandemic reported lower levels of stress (Birditt et al., 2021; Knepple Carney et al., 2021; Nelson & Bergeman, 2021) and loneliness (Losada-Baltar et al., 2021; Minahan et al., 2021; Polenick et al., 2021). On the other hand, evidence generally points to increased age-related vulnerability for loneliness, from research conducted both prior (Pinquart & Sorensen, 2001) and during (Luchetti et al., 2020; Portacolone et al., 2021) the COVID-19 pandemic.

大流行期間的年齡與孤獨感

年長者在 COVID-19大流行期間可能面臨更大的生命健康風險(Jordan et al., 2020; Shahid et al., 2020); 最新的心理學研究COVID-19發現：通常伴隨年齡將增加孤獨脆弱性，包括在COVID-19 大流行之前（Pinquart & Sorensen，2001）及大流行期間（Luchetti 等，2020；Portacolone 等，2021），但是另一方面年長者的心理壓力感比年輕人低(Birditt et al., 2021; Knepple Carney et al., 2021; Nelson & Bergeman, 2021)孤獨感也是(Losada-Baltar et al., 2021; Minahan et al., 2021; Polenick et al., 2021)，反映年長者似乎有比較好的適應力或韌性。

# The Current Study

# The unfortunate paradox of the pandemic is that people are forced to choose protective health behavior potentially at the cost of psychological health: Those who adhere to social distancing measures may end up experiencing increased isolation. Trade-offs between mental well-being and physical health behaviors may further exacerbate physical health risks. The current study tested purpose in life as a component of well-being that can confer protection against illness, increase resilience, and promote protective health behaviors during a health crisis. Specifically, we examined the relationships among purpose in life, loneliness, and intentions to engage in COVID-protective behaviors such as social distancing and handwashing across age, with a specific focus on outcomes among older age groups. We publicly preregistered our prediction that purpose in life would be associated with decreased loneliness and enhanced preventive health intentions (https://osf.io/39vfg/). We also tested whether purpose in life may moderate the links between age and loneliness, as well as the link between loneliness and intentions to engage in COVID-protective behaviors.

目前的研究

大流行的悖論是，人們被認為：那些採取保持社交距離措施的人將會更孤立。而心理健康和身體健康行為之間的權衡可能加劇了身體健康風險。 既有研究忽略了人的自發性與動機，本研究主要探討生活目標、孤獨感和跨年齡層之參與 COVID 保護行為（例如保持交距離和洗手）傾向之間的關係，並特別關注年長族群。

# Method
# Participants

# We recruited 865 adults through Amazon’s Mechanical Turk (MTurk) as part of a larger study about COVID-19 prevention behaviors. A subset of 659 participants was randomly chosen to answer questions relevant to the current report. Data from 142 participants were excluded following preregistered data quality assessment standard operating procedures (https://osf.io/xwbhu/; Supplementary Material SI1), leaving the final sample of 517 participants who had usable data (meanage = 37.71; medianage = 35, SDage = 11.29; rangeage = 19–72; 282 men, 232 women, 2 other, 1 not reported; 362 White, 92 Black or African American, 39 Asian, 7 American Indian or Alaska Native, 1 Native Hawaiian or Other Pacific Islander, 16 Other). The sample size was determined by the larger data collection protocol, but the available sample size of n = 517 allowed us to detect an effect size of f2 = 0.02 with 80% power (alpha = 0.05, two-tailed).

方法

參與者

透過Amazon’s Mechanical Turk (MTurk) 招募了865 名參與者，留下可用的 517 名參與者。

# Procedures

# We collected data from April 4 to April 6, 2020, shortly after the global outbreak of COVID-19. All participants provided informed consent approved by the University of Pennsylvania Institutional Review Board, filled out an online survey, and were compensated via MTurk. The survey items used in this study were a subset of a larger project that tested message framing effects by exposing participants to health messages related to COVID-19 framed in different ways. Please see https://osf.io/bydv3/ for the complete list of survey measures included in the project and https://osf.io/xwbhu/ for data quality assessment standard operating procedures.

程序

收集COVID-19 全球爆發後不久的數據( 2020 年 4 月 4 日至 4 月 6 日)，

調查項目: https://osf.io/bydv3/，

操作程序: https://osf.io/xwbhu/。

# Measures
# Purpose in life

# Individual differences in purpose in life were measured by a modified seven-item version of the Psychological Well-Being Scales (WBS; Ryff, 1989) that includes a purpose in life subscale that assesses individuals’ sense of purpose as one of the key components of eudaimonic well-being (Ryff, 2014; Ryff & Singer, 2008). WBS has shown reliability and validity in nationally representative samples (Ryff, 2014), and the modified seven-item purpose in life subscale used in the current study was psychometrically evaluated and validated in a previous large-scale study (Abbott et al., 2006). Participants rated the degree to which they agreed with statements such as “I have a sense of direction and purpose in life,” rated on a 1 (strongly disagree) to 6 (strongly agree) scale. Scores were averaged across seven items, with higher scores reflecting a greater sense of purpose in life (Cronbach α = 0.81).

測量

自變數：生活目標

生活目標的個體差異是通過修改後的心理幸福感量表 (WBS; Ryff, 1989) 的七個項目測量。

包括: 生活目標分量表，用於評估個人感知的關鍵部分之一（Ryff，2014 年；Ryff 和 Singer，2008 年）。 參與者對諸如”我有人生方向和目標感”等陳述的同意程度進行評分，評分範圍為 1（非常不同意）到 6（非常同意）。 七個項目的分數平均，分數越高反映生活目標感越強（Cronbach α = 0.81）。

# Loneliness

# As preregistered, participants’ current perceived level of loneliness was assessed by a single-item measure of loneliness (“Currently, how lonely are you?”) using a 1 (not lonely at all) to 7 (very lonely) scale. In addition, to explore whether the results are specific to the pandemic context, we asked participants how lonely they felt prior to the COVID-19 pandemic (“Prior to the outbreak of COVID-19, how lonely were you?”). The current and prepandemic levels of loneliness were highly correlated (r = 0.72, p < .001, 95% CI [0.68–0.76]).

# A global single-item question on loneliness has been used among older adults in previous studies (Jylhä, 2004; Sundström et al., 2020), and was suggested to be sufficient to gauge the prevalence of loneliness (Luanaigh & Lawlor, 2008), able to capture a subjective experience of loneliness as understood by the participants and not as predefined by the researcher (Jylhä & Saarenheimo, 2010). Furthermore, a single-item loneliness question showed reliability and validity comparable to a multiitem scale across six ethnic groups aged 40 and older (Victor et al., 2021).

孤獨

捕捉參與者理解的孤獨的主觀體驗，而不是研究人員預先定義的 (Jylhä & Saarenheimo, 2010). 詢問: 參與者目前感知的孤獨感（“目前，你有多孤獨？”）使用 1（根本不孤獨）到 7（非常孤獨）量表來估計。 參與者在 COVID-19 大流行之前他們感到多麼孤獨（“在 COVID-19 爆發之前，你有多孤獨？”）。 目前和大流行前的孤獨感顯著相關（r = 0.72，p < .001，95% CI \[0.68--0.76\]）。

# COVID-preventive intentions

# Participants rated the degree to which they intended to engage in protective health behaviors that prevent contracting and spreading the coronavirus over the next 2 weeks, using a scale ranging from 1 (definitely won’t) to 7 (definitely will). Please see Supplementary Material SI2 for the full description of the items. In addition, participants’ perceived norms and beliefs regarding COVID-protective behaviors were assessed (Supplementary Material SI2 and SI3). Ten protective behavior items included avoiding social contact, that is, social distancing (n = 4), hand hygiene (n = 4), and staying at home (n = 2). As preregistered, items were averaged to create a single COVID-preventive intention score per participant (Cronbach α = 0.82). We also conducted exploratory analyses to determine whether effects were driven by specific types of prevention behaviors that are more (e.g., social distancing) or less (e.g., handwashing) directly linked to loneliness versus stress in general. Results suggested that the overall relationships were not specific to the types of protective health behaviors (Supplementary Material SI4) and so we treated them together as a single measure as planned (https://osf.io/39vfg/). Questions were selected based on recommendations made by the Centers for Disease Control and Prevention at the time of study designing (March 2020), which placed the greatest emphasis on social distancing and handwashing.

COVID預防意圖(Y)

參與者使用從 1（絕對不會）到 7（肯定會）的量表對他們打算在未來 2 週內參與預防covid-19的保護性健康行為的程度進行評分。 十項保護行為項目包括避免社交接觸，即社交距離（n = 4）、手部衛生（n = 4）和呆在家裡（n = 2）。

# Demographics

# Participants self-reported their age, ethnicity, gender, the number of household members, and socioeconomic status (SES) measured by the MacArthur Scale of Subjective Social Status (Adler et al., 2000).

人口統計

參與者自我報告了他們的年齡、種族、性別、家庭成員數量和社會經濟地位 (SES)，由麥克阿瑟主觀社會地位量表 (Adler et al., 2000) 衡量。

# Analysis Plan

# Separate regression analyses tested preregistered and exploratory hypotheses regarding the associations among purpose in life, age, loneliness, and COVID-preventive intentions. First, we tested whether purpose in life was associated with loneliness, as well as COVID-preventive intentions. Second, we tested whether loneliness was associated with COVID-preventive intentions. Third, we tested whether purpose in life moderated the link between age and loneliness. Finally, although not preregistered, we explored whether the relationship between loneliness and COVID-preventive intentions differed across different levels of purpose in life. Following our preregistered standard operating procedures, outliers larger than 3 SD from the mean were replaced with mean ±3 SD. As preregistered, all analyses controlled for the condition assignment for which participants received health messages related to COVID-19 framed in different ways as part of a parent study. All reported p values are two-tailed. Analyses were performed in R (v3.6.1, www.r-project.org) using the R-studio interface (v1.2.1335).

分析計劃

  • 分別的回歸分析測試了關於生活目標、年齡、孤獨感和 COVID 預防傾向之間關聯和探索性假設。 首先，我們測試了生活目標是否與孤獨、預防 COVID 的意圖有關。

  • 其次，我們測試了孤獨是否與預防 COVID 的意圖有關。 第三，我們測試了生活目標是否會調節年齡與孤獨感之間的關聯。

  • 最後，探索孤獨感和 COVID 預防意圖之間的關係是否因不同生活目標而不同。

  • 所有報告的 p 值都是雙尾的。

  • 使用 R-studio 界面進行分析。 All reported p values are two-tailed. Analyses were performed using the R-studio interface .

# Results

# Our analyses focused on the relationships among purpose in life, feelings of loneliness, age, and intentions to engage in COVID-protective behaviors. We further tested whether the links between (a) age and loneliness and (b) loneliness and COVID-preventive intentions differed by purpose in life. Please see Table 1 for the bivariate correlations among main study variables and demographics and Table 2 summarizing results from regression analyses testing associations among purpose in life, loneliness, age, and COVID-preventive intentions. All the data, analysis scripts, and output reported in this manuscript are available at https://github.com/cnlab/covid_purpose.

結果

分析生活目標、孤獨感、年齡和參與 COVID 保護行為的意圖之間的關係。 （a）年齡與孤獨感 （b）孤獨感與預防 COVID 的意圖之間的聯繫是否因生活目的而異。

表 1 :主要研究變量和人口統計數據之間的雙變量相關性，

表 2: 總結了回歸分析測試生活目標、孤獨感、年齡和 COVID 預防意圖之間的關聯的結果。

<https://github.com/cnlab/covid_purpose>

\[資料集及語法\]

# Purpose in Life Predicting Loneliness and COVID-Preventive Intentions

# First, we tested whether having a stronger sense of purpose in life was associated with lower loneliness and higher COVID-preventive intentions. We found that across participants, individuals with stronger purpose in life were less lonely, such that a stronger sense of purpose was associated with lower loneliness for both the current (B = −0.77, t (511) = −9.13, p < .001, 95% CI [−0.93 to −0.60]) and prepandemic levels of loneliness (B = −0.94, t (511) = −13.05, p < .001, 95% CI [−1.08 to −0.80]). Furthermore, having a greater sense of purpose was associated with stronger intentions to engage in COVID-protective behaviors (B = 0.33, t (511) = 9.10, p < .001, 95% CI [0.26–0.41]). A stronger sense of purpose was also associated with higher levels of perceived norms and beliefs that COVID-protective behaviors are socially approved and effective (Supplementary Material SI2 and SI3).

預測孤獨感和預防 COVID-19 的意圖的”生活目標”

  1. 生活目標感愈強是否與孤獨感愈低、COVID 預防意圖愈強高有關。 結果發現，在所有參與者中，生活目標愈明確的人愈不那麼孤獨，顯然，目標感愈強的人降低當前的孤獨感 (B = -0.77, t (511) = -9.13, p < .001 , 95% CI \[-0.93 to -0.60\]) 、大流行前的孤獨感（B = -0.94, t (511) = -13.05, p < .001, 95% CI \[-1.08 to -0.80\]）。
  2. 此外，愈強的目標感與愈積極地自發參與 COVID 保護行為的意圖相關（B = 0.33，t (511) = 9.10，p < .001，95% CI \[0.26--0.41\]）。 愈強的目標感也與愈高的認知規範和信念有關，即 COVID 保護行為得到社會認可和有效（補充材料 SI2 和 SI3）。
# Loneliness Predicting COVID-Preventive Intentions

# Next, we tested whether loneliness was associated with COVID-preventive intentions. As predicted, individuals who reported higher levels of loneliness, for both the current (B = −0.11, t (511) = −5.89, p < .001, 95% CI [−0.15 to −0.07]) and prepandemic levels of loneliness (B = −0.18, t (511) = −9.28, p < .001, 95% CI [−0.22 to −0.14]), also reported lower intentions to engage in COVID-protective behaviors. Higher current levels of loneliness were also associated with lower perceived norms and beliefs that COVID-protective behaviors are socially approved and effective (Supplementary Material SI5).

“孤獨感”預測 COVID 防疫意圖

  1. 孤獨是否與預防 COVID 的意圖有關。 對於當前 (B = -0.11, t (511) = -5.89, p < .001, 95% CI \[-0.15 to -0.07\]) 和大流行前的孤獨，孤獨程度較高的個體 (B = -0.18, t (511) = -9.28, p < .001, 95% CI \[-0.22 to -0.14\])，參與 COVID 保護行為的意圖較低。
  2. 目前的孤獨感較高也與較低的認知規範和信念有關，即 COVID 保護行為具有社會認可效應（補充材料 SI5）。
# Purpose in Life Moderating the Relationship Between Age and Loneliness

# We examined purpose in life as a potential moderator of the relationship between age and loneliness. First, we found that age was negatively associated with loneliness, such that older compared to younger individuals reported feeling less lonely currently (B = −0.02, t (511) = −2.86, p = .004, 95% CI [−0.04 to −0.01]) and recalled having felt less lonely prior to the COVID-19 pandemic (B = −0.02, t (511) = −3.19, p = .001, 95% CI [−0.04 to −0.01]).

# Contrary to our preregistered prediction, we did not detect a significant interaction between purpose in life and age in predicting current levels of loneliness (B = −0.01, t (509) = −1.07, p = .287, 95% CI [−0.02 to 0.01]); rather, the purpose was related to reduced loneliness across age. Although this is consistent with previous evidence linking purpose in life to enhanced well-being (Roepke et al., 2014), recent work suggests that lower levels of purpose in life are especially harmful to at-risk populations, predictive of increased mortality risk among individuals aged 50 and older (Shiba et al., 2021). As such, we further explored the relationship between age and loneliness for people with different levels of purpose in life. Simple slopes analyses (Aiken et al., 1991) examined whether age predicted loneliness at 1 SD below the mean (3.3), at the mean (4.3), and 1 SD above the mean (5.3) levels of purpose. Following procedures by Aiken et al. (1991), all variables were mean-centered for simple slopes analyses. Results indicated purpose as a protective factor for older ages, such that older age was associated with less loneliness only at high and mean, but not lower levels of purpose in life (Figure 1). Please see Supplementary Material SI6 for median-split analysis results for additional robustness checks.

# 迴歸分析及調節效應、Simple slopes analyses 分析步驟:
# 1. 背景變項
# 2. +x1+x2
# 3. +x1+x2+ x1*x2
# 4. Simple slopes analyses (-1sd,+1sd)
# 調節變數 (moderator) : 也會影響 IV 和 DV 之間的關係。 ex, moderator = 0 ，IV 跟 DV 的顯著，但 moderator = 1 ，IV 跟 DV 不顯著。
# Moderator=qualitative 的(如：性別、種族、階級)，=quantitative (如：得到不同程度的獎勵)，影響iV 對 DV方向 (男生則有影響，女生則無影響) 或是強度 (對男生來說，IV 對 DV 的影響比對女生來說，IV 對 DV 的影響來得大)。ANOVA =moderator 交互作用 (interaction)。regression將IV、moderator和IV*moderator  放進去。測試"有沒有 moderation ，看 c 是否為顯著。a或b可顯著或不顯著，並不影響測試moderation。另外，
# moderator 與 IV 或 DV 沒有相關性。

生活目標調節年齡與孤獨感的關係

  1. 生活目標作為年齡與孤獨感之間關係的潛在調節因素。首先，我們發現年齡與孤獨感呈負相關\[註:此研究採用線上眾包，可能有技術中介性\]，因此年輕人比年長者感覺孤獨（B = -0.02, t (511) = -2.86, p = .004, 95% CI \[-0.04 to -0.01\]) 、 回憶起 COVID-19 大流行之前也是感到比較孤獨（B = -0.02，t (511) = -3.19，p = .001，95% CI \[-0.04 到 -0.01\]）。
  1. 我們沒有發現生活目標和年齡在預測當前孤獨程度方面存在顯著的交互作用（B = -0.01，t (509) = -1.07，p = .287，95% CI \[-0.02到 0.01\]);反而，目標感與減少各個年齡段的孤獨感有關。 這可能意味著，較低的生活目標感不利於年長者，可能使50 歲及以上的人死亡風險增加（Shiba 等人，2021 年）。
  1. 因此，進一步探討了年齡與生活目標不同的人的孤獨感之間的關係。簡單斜率分析結果表明，生活目標是年長者的保護因子，因此，只有在生活目標感較低時，才與較孤獨感愈低相關（圖 1）。

簡單的斜率分析:

A. 在更高和平均的生活目標水平下，年齡越大孤獨感越低，比平均值高 1 個標準差 (B = -0.03, t (509) = -2.41, p = .016, 95% CI \[ -0.05 至 -0.00\]）和生活中的平均目標水平（B = -0.02，t (509) = -2.52，p = .012，95% CI \[-0.03 至 -0.00\]）。然而，這種關係在目標水平較低時減弱，因此在低於平均目標 1 SD 時，年齡不再與當前的孤獨感相關（B = -0.01，t (509) = -1.00，p = .319，95% CI \[-0.03 到 0.01\])。然而，斜率彼此之間沒有顯著差異（ps > .50）。

  1. 簡單斜率分析顯示了不同年齡的生活目標與當前孤獨感之間的關係，低於平均值 1 SD（26.4 歲）、平均值（37.7 歲）、高於平均值 1 SD（49 歲）和高於 2 SD平均（60.3 歲）年齡。 目標感和孤獨感之間的關聯在年齡上沒有顯著差異，但在年齡較大的個體中定向最強（B）。
# Exploratory Analyses: The Relationship Between Loneliness and COVID-Preventive Intentions at Different Levels of Purpose in Life

# Although not preregistered, we further explored purpose in life as a protective psychological resource that may buffer against the deleterious effect of loneliness on COVID-protective behaviors, based on previous work suggesting that psychological resources promote resilience in the face of stress (Ryff & Singer, 2003). Specifically, we tested whether the negative relationship between loneliness and COVID-preventive intentions differed across three levels of purpose. Although the interaction between purpose and loneliness on preventive intentions was marginal (B = 0.03, t (509) = 1.61, p = .109, 95% CI [−0.01 to 0.07]), results from exploratory simple slopes analysis indicated that higher loneliness was associated with lower COVID-preventive intentions only at the lower and mean, but not high levels of purpose in life (Supplementary Figure S1A). Please see Supplementary Material SI6 for median-split analysis results for additional robustness checks and Supplementary Figure S1B for results that further parsed out these relationships at four different levels of age.

# All results remained parallel when we controlled for gender, ethnicity, SES, the total number of household members, and age (in models that did not include age as a predictor variable; Supplementary Material SI7) and repeated the analyses using a subset of the sample who were randomly assigned to a condition where they did not receive any COVID-19 messages as part of a larger project that included additional messaging manipulations (n = 178; Supplementary Material SI8).

探索性分析：孤獨感與生活中不同層次的 COVID 預防意圖之間的關係

雖然沒有預先註冊，但我們進一步探索了生活的目的，作為一種保護性心理資源，可以緩衝孤獨對 COVID 保護行為的有害影響，基於先前的工作表明心理資源可以促進面對壓力的彈性（Ryff & Singer， 2003）。

具體而言，我們測試了孤獨感與 COVID 預防意圖之間的負相關是否在三個目的層次上有所不同。儘管目的和孤獨感對預防意圖的影響很小（B = 0.03, t (509) = 1.61, p = .109, 95% CI \[-0.01 to 0.07\]），但探索性簡單斜率分析的結果表明孤獨感較高與較低的 COVID 預防意圖相關，僅在較低的和平均的，而不是較高的生活目標水平（補充圖 S1A）。請參閱補充材料 SI6 了解中值分割分析結果以獲得額外的穩健性檢查和補充圖 S1B 了解在四個不同年齡水平上進一步解析這些關係的結果。

當我們控制性別、種族、SES、家庭成員總數和年齡（在不包括年齡作為預測變量的模型中；補充材料 SI7）並使用樣本的子集重複分析時，所有結果保持平行他們被隨機分配到一個條件下，他們沒有收到任何 COVID-19 消息，作為包括額外消息處理的更大項目的一部分（n = 178；補充材料 SI8）。

# Discussion

# Psychological resources can protect individuals from illness and increase resilience against stress (Lazarus & Folkman, 1984; Ryff, 1989), such as in times of a health crisis. The current study examined purpose in life as a psychological resource and a key component of well-being (Ryff, 2014) that may help buffer against loneliness and promote protective health behaviors during the COVID-19 pandemic. Purpose in life was strongly associated with lower loneliness across age in the current study. This result is consistent with previous studies that linked a stronger sense of purpose to lower loneliness among older populations (Neville et al., 2018). However, little is known about the relationship between purpose and loneliness among younger age groups, and the current finding is among the first to show that purpose predicted lower loneliness across a wider range of ages. Furthermore, having a stronger sense of purpose was associated with both the current and prepandemic levels of loneliness, suggesting some degree of generalizability of the current findings beyond the specific context of the COVID-19 pandemic. We note, however, that the prepandemic loneliness was measured at the same time point as the current loneliness and represents how lonely participants thought they were, which might not be a correct reflection of how lonely they actually were prior to the pandemic.

討論

心理資源可以保護個人免受疾病的侵害並增強對壓力的抵抗力（Lazarus & Folkman，1984；Ryff，1989）。

譬如生活目標感作為一種心理資源和幸福感的關鍵組成部分（Ryff，2014 年）進行了研究，這可能有助於在 COVID-19 大流行期間緩解孤獨感並促進保護性健康行為。

本研究中，人生目標與不同年齡層的孤獨感降低密切相關。與之前研究一致（Neville 等，2018）。

目前的發現是第一個表明目標可以預測更廣泛年齡層的孤獨感較低的發現之一。

此外，愈強的目標感與當前和大流行前的孤獨感程度有關，這表明​​當前發現在 COVID-19 大流行的特定背景之外具有一定程度的普遍性。

然而，大流行前的孤獨感與當前的孤獨感是在同一時間點測量的，它代表了參與者認為他們有多孤獨，可能不是他們在大流行之前實際有多孤獨的正確反映。

# Purpose in life was also associated with greater intentions to engage in health behaviors (i.e., disease-protective behaviors including social distancing and handwashing) in our data. This result complements previous literature on purpose in life and health, further supporting that having a strong sense of purpose in life can enhance well-being by promoting openness to health-protective behaviors and counteracting stress (Roepke et al., 2014). The current result also extends previous findings that showed purpose in life increased the use of preventive health care service (Kim et al., 2014) to wider areas of daily life and habits. That is, beyond enhancing individuals’ health, purpose in life may promote the health of communities by reducing the preventable infectious diseases burden and may have important public health implications, especially in times of epidemic and pandemic health emergencies.

#\[研究意涵\] ### 習慣領域、疾病負擔、健康促進

生活目標也與參與健康行為（即疾病保護行為，包括社交距離和洗手）的更大意圖相關。

補充了先前關於生活和健康目的的文獻，進一步支持強烈的生活目的感可以通過促進對健康保護行為的開放和對抗壓力來增強幸福感（Roepke 等，2014）。 擴展了之前的研究結果，即生活目的將預防性醫療保健服務的使用（Kim 等，2014）擴展到更廣泛的日常生活和習慣領域。

也就是說，除了增強個人健康之外，人生目標還可以透過減少可預防的傳染病負擔來促進社區的健康，並且可能具有重要的公共衛生影響，尤其是在流行病和大流行衛生緊急情況下。

# Older compared to younger individuals reported feeling less lonely in our study. This result seemingly contradicts the broader literature on age-related risk for loneliness (Berg-Weger & Morley, 2020; Pinquart & Sorensen, 2001); however, it bolsters growing evidence that people may cultivate resilience as they grow older (van Kessel, 2013). In the context of the COVID-19 pandemic, at least six recent studies reported “unexpected” findings that older individuals outpaced younger counterparts in terms of their ability to cope with stress and loneliness (Birditt et al., 2021; Knepple Carney et al., 2021; Losada-Baltar et al., 2021; Minahan et al., 2021; Nelson & Bergeman, 2021; Polenick et al., 2021). Our result continues to highlight extraordinary resilience among older adults and challenges ageism prevalent during a global crisis (Colenda et al., 2020; Vervaecke & Meisner, 2021), indicating that older adults are not uniformly vulnerable. Instead, the link between age and loneliness differed by purpose in life, suggesting that older individuals with a weaker sense of purpose may not benefit from age-related resilience. Therefore, interventions that enhance purpose in life may be particularly effective for older adults who tend to experience a decline in purpose after 60 years of age (Pinquart, 2002).

#\[探索研究：新發現\] ## 打破刻板印象，韌性與年齡

本研究中，與年輕人相比，年長者比較不那麼孤獨感。結果似乎與年齡孤獨風險文獻相矛盾（Berg-Weger & Morley，2020；Pinquart & Sorensen，2001）。

研究證據反映，人隨著年齡的增長可能會孕育復原力或韌性（van Kessel，2013）。 在 COVID-19 大流行的情境下，近來至少有六項研究報告了”出乎意料”的發現，即年長者面對壓力和孤獨感的能力方面超過了年輕人（Birditt 等人，2021 年；Knepple Carney 等人，2021 年）。 , 2021；Losada-Baltar 等人，2021 年；Minahan 等人，2021 年；Nelson & Bergeman，2021 年；Polenick 等人，2021 年）。

此結果也接續檢驗年長者具有復原力優勢，並挑戰在COVID-19的全球危機期間普遍存在的年齡歧視（Colenda 等，2020；Vervaecke 和 Meisner，2021），彰顯年長者未必總是脆弱。

然而，年齡和孤獨感之間的關聯因生活目標感而異，反映目標感較弱的年長者可能無法從與年齡相關的韌性中受益。因此，提高生活目標感的干預措施可能對 60 歲後生活目標趨於下降的年長者特別有效（Pinquart，2002 年）。

# Feeling lonelier was associated with lower intentions to engage in COVID-protective behaviors. This result is consistent with prior research that showed stress may prompt individuals to rely on dysfunctional coping strategies (Biggs et al., 2017; Lazarus & Folkman, 1984) and diminish people’s engagement in health behavior (Mezuk et al., 2017). In the context of a pandemic, the desire to reach out to others, even at the expense of risking health, might be a natural response in times of extreme social isolation and loneliness (Mezuk et al., 2010). Nevertheless, loneliness was not associated with COVID-19 risk behaviors among individuals with a strong sense of purpose. This suggests that purpose in life may provide additional resources needed to engage in positive coping strategies, even when the health behavior (e.g., social distancing) may temporarily result in increased isolation. By providing a clear sense of long-term goals that are aligned with personal values, purpose in life may protect individuals from illness (Ryff & Singer, 1998) and the deadly threat of social isolation (Pantell et al., 2013). Furthermore, previous work suggests that highly purposeful individuals may experience less conflict during health decision making (Kang et al., 2019). When presented with the options to resolve stress associated with loneliness by engaging in COVID-risk behaviors versus to maintain health behaviors that may result in greater isolation but will protect the self and others, individuals with a strong sense of purpose may experience less conflict in choosing the latter, having clear views about one’s core values and goals.

感覺更孤獨與參與 COVID 保護行為的意願較低有關。這一結果與先前的研究一致，該研究表明壓力可能促使個人依賴功能失調的應對策略（Biggs 等，2017；Lazarus & Folkman，1984）並減少人們對健康行為的參與（Mezuk 等，2017）。

在大流行的背景下，渴望與他人接觸，即使不惜以健康為代價，這可能是極端社會孤立和孤獨時期的自然反應（Mezuk 等，2010）。

儘管如此，孤獨感與具有強烈目標感的個體的 COVID-19 風險行為無關。
這表明，即使健康行為（例如，社交距離）可能暫時導致孤立感增加，生活目標可能會提供參與積極應對策略所需的額外資源。通過提供與個人價值觀一致的長期目標的明確意識，生活目標可以保護個人免受疾病（Ryff & Singer，1998 年）和社會孤立的致命威脅（Pantell 等人，2013 年）。

此外，之前的工作表明，目標明確的個人在做出健康決策時可能會遇到較少的衝突（Kang 等，2019）。當提出通過參與 COVID 風險行為來解決與孤獨相關的壓力的選項時，與保持可能導致更大程度的孤立但會保護自己和他人的健康行為相比，具有強烈目標感的個人在選擇時可能會遇到較少的衝突後者，對自己的核心價值觀和目標有明確的看法。

# Current results should be interpreted in the context of limitations inherent in the study design. First, the current study was conducted online via MTurk to expedite data collection within the constraints posed by the pandemic that made in-person data collection difficult. Researchers have warned against overgeneralizing MTurk data of older adults as they may differ from the general older adult population across demographics and health status (Ogletree & Katz, 2020). Please see Supplementary Material SI1 for measures we took to improve MTurk data quality control. Second, we used single-item measures to assess participants’ levels of loneliness, which has been used successfully in past studies (Jylhä, 2004; Sundström et al., 2020). However, a single-item question cannot distinguish different types of loneliness, which would be important when considering interventions for loneliness (Luanaigh & Lawlor, 2008). Finally, while we intended to examine age differences across adulthood, our results focused on predictive models based on a sample with only a small number of older adults aged 55 and older (n = 49). Future work may oversample older adults aged 65 and older to match the age distribution of the general population.

研究限制

目前的結果應該在研究設計固有的局限性的背景下進行解釋。首先，目前的研究是通過 MTurk 在線進行的，以在大流行造成的限制內加快數據收集，這使得面對面的數據收集變得困難。

研究人員警告不要過度概括老年人的 MTurk 數據，因為它們在人口統計和健康狀況方面可能與一般老年人口不同（Ogletree & Katz，2020 年）。請參閱補充材料 SI1，了解我們為改進 MTurk 數據質量控製而採取的措施。

其次，我們使用單項測量來評估參與者的孤獨程度，這已在過去的研究中成功使用（Jylhä，2004；Sundström 等，2020）。然而，單項問題無法區分不同類型的孤獨，這在考慮對孤獨進行干預時很重要（Luanaigh & Lawlor，2008）。

最後，雖然我們打算檢查成年期的年齡差異，但我們的結果側重於基於樣本的預測模型，該樣本僅包含少數 55 歲及以上的老年人 (n = 49)。未來的工作可能會對 65 歲及以上的老年人進行過度抽樣，以匹配一般人群的年齡分佈。

# Despite limitations, the current study offers novel insights into the relationships among purpose in life, loneliness, age, and protective health behaviors during a global pandemic. Notwithstanding the physical susceptibility to COVID-19, older, compared to younger, individuals in our study were able to better adapt to the drastic shift in social life during a pandemic. Our results also suggest that purpose in life is a valuable psychological resource that may empower individuals to make life-saving health decisions that protect their own health and those around them. Furthermore, the buffering effects of purpose may particularly protect against loneliness and offset the relationship between loneliness and COVID-protective behaviors. More generally, the current results suggest potential value in testing interventions that foster a sense of purpose in life, which may help buffer negative consequences of stress related to loneliness that diminish people’s motivation to engage with health-protective behaviors. That is, the purpose may help at-risk individuals to overcome threats to health and well-being by providing a sense of meaning and connection even in times of extreme isolation and stress.

“意義感”和”聯繫感”

儘管存在局限性，但目前的研究為全球大流行期間生活目的、孤獨感、年齡和保護性健康行為之間的關係提供了新的見解。

儘管身體對 COVID-19 有易感性，但與年輕人相比，我們研究中的老年人能夠更好地適應大流行期間社會生活的急劇變化。

我們的研究結果還表明，人生目標是一種寶貴的心理資源，可以使個人做出挽救生命的健康決定，以保護自己和周圍人的健康。

此外，目標的緩衝作用可以特別防止孤獨，並抵消孤獨與 COVID 保護行為之間的關係。

更一般地說，目前的結果表明，在測試可培養生活目標感的干預措施方面具有潛在價值，這可能有助於緩衝與孤獨相關的壓力的負面後果，從而降低人們參與健康保護行為的動機。也就是說，即使在極端孤立和壓力的情況下，該目的也可以通過提供”意義感”和”聯繫感”來幫助處於危險中的個人克服對健康和福祉的威脅。