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Published in final edited form as: Eat Behav. 2024 Jul 9;54:101903. doi: 10.1016/j.eatbeh.2024.101903

Loneliness as a Moderator of the Association of Affective Symptoms and Binge Eating among College Women

Tyler B Mason 1
PMCID: PMC11618821  NIHMSID: NIHMS2009113  PMID: 39002467

Abstract

Affective symptoms (e.g., depression, anxiety, shame) are a potent risk factor for binge eating. However, less is known on the role of loneliness as a moderator of affective symptoms and binge eating. This objective of the current study was to investigate main effects and interactions of affective symptoms and loneliness in relation to binge eating in college women. A sample of 556 undergraduate women completed self-report questionnaires of affective symptoms, loneliness, and binge eating. Results revealed significant interactions between each affective symptom variable and loneliness in relation to binge eating, such that loneliness strengthened the positive association of affective symptoms and greater binge eating. The findings of this study demonstrate an important role of loneliness to binge eating among college women, especially those with underlying affective vulnerabilities. More theoretical and treatment-oriented work on the role of loneliness in binge eating is needed to understand mechanisms and interventions/preventions.

Keywords: binge eating, loneliness, affective symptoms, college students

Binge eating is a maladaptive eating behavior that is associated with psychiatric disorders, physical health complaints, and reduced quality of life (Hudson et al., 2007; Kessler et al., 2013). There have been increases in binge eating across the past few decades, particularly among college students (Daly & Costigan, 2022; Serra et al., 2020). College is a transitional period in which adolescents often leave the familiarity of their home environment, including family and close friends (Ruberman, 2014; Worsley et al., 2021). In addition, college is associated with a host of stressors such as navigating the college social environment as well as academic stress, which may be multiplied given that established support systems may be less available (Limone & Toto, 2022; Ruberman, 2014; Worsley et al, 2021). Furthermore, college students are often solely responsible for their food choices and must navigate unhealthful college food environments (Li et al., 2022). Altogether, these factors make college a risky time for the development of binge eating and related eating disorders.

Affective symptoms, including depression, anxiety, and shame, are important risk factors for binge eating, with numerous cross-sectional and prospective studies demonstrating positive associations between affective symptoms and binge eating (Duarte-Guerra et al., 2022; Mason & Lewis, 2014; O’Loghlen et al., 2022; Puccio et al., 2016; Rosenbaum & White, 2013). Yet, affective symptoms are not invariably associated with binge eating, with many individuals reporting elevated affective symptoms not engaging in binge eating. As such, a necessary area for future research on affective symptoms and binge eating is to uncover potential moderators, or factors that modify the association between affective symptoms and binge eating (MacKinnon & Luecken, 2008).

The role of loneliness in relation to binge eating and as a candidate moderator of the relationship between affective symptoms and binge eating is understudied. Consistent with increases in binge eating, loneliness has risen dramatically in the last decade and is particularly affecting younger generations (Cigna, 2018; Gallup, 2022). Compared to other age groups, emerging adults aged 19–29 show the highest levels of feeling “very/fairly lonely” at 27% (Gallup, 2022). Furthermore, a poll of 2,430 college students found that 39% reported feeling loneliness in the previous day, with loneliness being slightly higher among females compared to males (41% vs 35%). Elevated loneliness is associated with more disordered eating, including binge eating (Mason et al., 2016; Southward et al., 2014), but its role as a moderator of the association of affective symptoms and binge eating is unclear.

Individuals experiencing loneliness report lower social support (Zhang & Dong, 2022), and loneliness is typically considered a state in which people wish their social connections and support were better (Heinrich & Gullone, 2006). Social support and connection have often been conceptualized as buffers of stressors and adversity (Cohen & Wills, 1985). That is, when individuals are experiencing adversity, such as affective symptoms, social support can help mitigate the negative effects on behavioral health. In addition, loneliness has been shown to be associated with less mental health help-seeking and resiliency (Maiden et al., 2021). Given these detrimental effects, loneliness may amplify the concurrent association between elevated affective symptoms and binge eating, although this has not been tested.

To better understand the role of loneliness in binge eating, the current study examined loneliness as a moderator of the association of affective symptoms (i.e., depressive symptoms, anxiety, and body shame) and binge eating. It was expected that there would be main effects of affective symptoms and loneliness in relation to binge eating such that higher affective symptoms and loneliness would be positively associated with binge eating. In addition, it was hypothesized that women with high loneliness would have a stronger positive association between affective symptoms and binge eating. Findings will increase understanding of the role of loneliness in binge eating by contributing to future theory and intervention development. This report is a secondary data analysis of a study focused on college women’s binge eating (see Mason et al., 2016; 2018). As such, the sample only includes female college students. Given that binge eating affects all genders (Breton et al., 2023), studying these research questions among female college students only is a limitation but will offer new data on associations among affective symptoms, loneliness, and binge eating that can be extended to males and gender diverse individuals in future work.

Method

Participants and Procedure

Five-hundred fifty-six college women completed an online survey at a single timepoint between September 2013 to March 2014.. Participants were recruited through the psychology department participant pool at a large Mid-Atlantic university, and course credit or extra credit was received for completing the questionnaire. The study was approved by an institutional review board. Participants signed up for the study then completed informed consent and a battery of questionnaires. They were able to skip any question they did not want to answer. The mean age was 22.42 (SD=6.61) and the mean BMI was 25.00 (SD=5.98). Most women were White (46.1%) or Black (34.7%) followed by two or more races (12.0%), Asian (4.0%), American Indian/Alaskan Native (1.4%), Native Hawaiian/Other Pacific Islander (0.9%), and Other (0.9%). Seven percent of women reported being Hispanic with the other 93% being non-Hispanic. About 85% of women described their sexual identity as only heterosexual, with the other 15% including women identifying as lesbian, bisexual, mostly heterosexual, or another sexual orientation. A minority of women reported dieting in the past week (22%) or past month (33%).

Measures

Demographics.

Women completed a demographic questionnaire of race, ethnicity, age, height, weight, sexual identity, and dieting history.

Depressive symptoms.

The 10-item short Center for Epidemiological Studies Depression scale (CESD; Andresen et al., 1994) was used to measure depressive symptoms. Items were rated on a scale from 1 (rarely or none of the time [less than 1 day]) to 4 (most or all of the time [5–7 days]). The short CESD has shown adequate internal consistency, test-retest reliability, and concurrent validity (González et al., 2017). The Cronbach’s alpha in the current study was .81.

Anxiety.

The Zung Self-Rating Anxiety Scale (SAS; Zung, 1971) was used to measure symptoms of anxiety. Participants responded to items on a 4-point scale from 1 (a little of the time) to 4 (most of the time). The SAS has shown adequate psychometric properties in prior studies (Dunstan & Scott, 2020; Zung, 1971). The Cronbach’s alpha in the current study was .85.

Body shame.

The 8-item Body Shame subscale of the Objectified Body Consciousness Scale (OBCS; McKinley & Hyde, 1996) was used to assess body shame. Participants responded to items using a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). The reliability and validity of the body shame subscale was previously demonstrated by Cronbach’s alpha>.70 as well as a negative correlation with body esteem and positive correlation with body surveillance (McKinley & Hyde, 1996). The Cronbach’s alpha in the current study was .83.

Loneliness.

The Friendship Scale (Hawthorne, 2006) was used to measure loneliness. The Friendship Scale includes 6-items, which are responded to on a 5-point scale ranging from to 1 (not at all) to 5 (almost always). Sample items include: “I felt isolated from other people” and “When with other people, I felt separate from them.” Research has shown evidence of reliability and validity (Hawthorne, 2006). The Cronbach’s alpha in the current study was .83.

Binge eating.

Eleven items from the Eating Disorder Inventory - Bulimia Scale (EDIB; Garner et al., 1983) and the Eating Disorder Diagnostic Scale (EDDS; Stice et al., 2000) were used to measure binge eating. Like prior studies (Mason et al., 2016; Sherry & Hall, 2009), only items focusing on the behavioral components of binge eating (e.g., consumption of food) were included. As such, items that focus on affective experiences surrounding binge eating, body image, and compensatory behaviors were not included. This allowed for isolation of the behavioral aspects of binge eating only in the assessment of binge eating (Sherry & Hall, 2009). The response options consisted of a Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Items were averaged together to create a composite binge eating score.

This 11-item scale was used in a previous cross-sectional study of women and showed a unidimensional factor structure, adequate reliability, and convergent validity (Mason et al., 2016). An exploratory factor analysis of the 11 items in the current sample found evidence for unidimensional factor structure based on Eigenvalues>1 and the scree plot, with the one factor solution explaining 65% of the variance. The Cronbach’s alpha in this study was .94. This binge eating measure showed a moderately strong correlation with the number of self-reported days in which binge-eating occurred in the past 7 days (r=.54, p<.001).

Statistical Analysis Plan

Analyses were completed in SPSS version 28.0. Descriptive statistics and bivariate correlations were computed for study variables. Three multiple linear regressions using the SPSS PROCESS Macro (Hayes, 2013) were conducted to independently examine main effects and interactions between affective symptoms (i.e., depressive symptoms, anxiety, and body shame) and loneliness in relation to binge eating. Independent variables were centered to reduce multicollinearity and then used to create interaction terms. Age and BMI were included as covariates in all models. Bootstrap confidence intervals (CIs) were used for significance testing, such that bootstrap CIs not including 0 were considered significant. Significant interactions were plotted at the mean and ±1 standard deviation, and conditional effects were calculated. As a sensitivity analysis, alternative models were run with loneliness as the dependent variable and affective symptoms, binge eating, and their interaction as the independent variables.

Results

Age was positively correlated with BMI, and BMI was positively correlated with body shame and binge eating. Affective symptoms, loneliness, and binge eating were significantly positively correlated (see Supplementary Table 1).

The results of the linear multiple regressions are reported in Table 1. There were significant main effects of depressive symptoms and loneliness as well as a significant interaction between depressive symptoms and loneliness in relation to binge eating. The model explained 16% of the variance in binge eating. Main effects showed that higher depressive symptoms and loneliness were independently associated with greater binge eating. The interaction is displayed in Figure 1A. Conditional effects analyses revealed that there was a positive association between higher depressive symptoms and binge eating at -1SD (effect=0.39, SE=0.16, t=2.40, p=.017), mean (effect=0.63, SE=0.12, t=5.17, p<.001), and +1SD (effect=0.86, SE=0.14, t=6.15, p<.001) levels of loneliness. The figure showed that the positive association between depressive symptoms and binge eating strengthened as loneliness increased.

Table 1.

Multiple linear regressions examining main effects and interactions of affective symptoms and loneliness in relation to binge eating.

B CI R R2 F
Model 1 – Depressive symptoms 0.40 0.16 20.38*
 Intercept 1.86 [1.34, 2.39]
 Age −0.01 [−0.03, 0.007]
 Body mass index 0.02 [0.002, 0.04]
 Depressive symptoms 0.63 [0.39, 0.86]
 Loneliness 0.23 [0.08, 0.39]
 Depressive symptoms × Loneliness 0.31 [0.08, 0.54]
Model 2 - Anxiety 0.40 0.16 21.30*
 Intercept 1.82 [1.30, 2.35]
 Age −0.01 [−0.03, 0.004]
 Body mass index 0.03 [0.007, 0.04]
 Anxiety 0.78 [0.50, 1.05]
 Loneliness 0.27 [0.11,0.42]
 Anxiety × Loneliness 0.40 [0.09, 0.70]
Model 3 – Body shame 0.53 0.28 42.31*
 Intercept 2.30 [1.81, 2.80]
 Age −0.004 [−0.02. 0.01]
 Body mass index −0.001 [−0.02, 0.02]
 Body shame 0.47 [0.39, 0.55]
 Loneliness 0.23 [0.10, 0.36]
 Body shame × Loneliness 0.13 [0.04, 0.22]
Open in a new tab

For predictors, CIs that do not include 0 are significant.

*

p < .001.

Figure 1.

Figure 1.

Open in a new tab

Interactions between affective symptoms and loneliness in relation to binge eating plotted at one standard deviation below the mean (−1 SD), mean, and one standard deviation above the mean (+1 SD) levels of loneliness.

There were significant main effects of anxiety and loneliness as well as a significant interaction between anxiety and loneliness in relation to binge eating. The model explained 16% of the variance in binge eating. Main effects showed that higher anxiety and loneliness were independently associated with greater binge eating. The interaction is displayed in Figure 1B. Conditional effects analyses revealed that there was a positive association between greater anxiety and binge eating at −1SD (effect=0.47, SE=0.20, t=2.34, p=.020), mean (effect=0.78, SE=0.14, t=5.48, p<.001), and +1SD (effect=1.08, SE=0.17, t=6.38, p<.001) levels of loneliness. Inspection of the figure suggests that the positive association between anxiety and binge eating strengthened as loneliness increased.

There were significant main effects of body shame and loneliness as well as a significant interaction between body shame and loneliness in relation to binge eating. The model explained 28% of the variance in binge eating. Main effects showed that greater body shame and loneliness were independently associated with higher binge eating. The interaction is displayed in Figure 1C. Conditional effects analyses revealed that there was a positive association between higher body shame and binge eating at −1SD (effect=0.37, SE=0.05, t=6.85, p<.001), mean (effect=0.47, SE=0.04, t=11.43, p<.001), and +1SD (effect=0.57, SE=0.05, t=10.35, p<.001) levels of loneliness. According to the figure, the positive association between body shame and binge eating strengthened as loneliness increased.

The results of the sensitivity analyses are displayed in Supplemental Table 2. The interaction between depressive symptoms and binge eating in relation to loneliness was significant. Although, there were not interactions between anxiety and binge eating or body shame and binge eating in relation to loneliness.

Discussion

The purpose of this study was to examine the moderating role of loneliness in the cross-sectional association between affective symptoms and binge eating in college women. As expected, loneliness was significantly associated with greater binge eating, and each two-way interaction between affective symptoms and loneliness weas significant. Overall, findings affirm the salience of loneliness to binge eating in college women and establish loneliness as a transdiagnostic moderator across both general and body-specific affective symptoms.

Loneliness strengthened the association between affective symptoms (i.e., depressive symptoms, anxiety, and body shame) and binge eating, such that high levels of both affective symptoms and loneliness were related to the greatest levels of binge eating. According to the stress buffering hypothesis of social support (Cohen & Wills, 1985), individuals who feel lonelier may be less likely to have supportive connections that help buffer the negative effects of affective symptoms. Lack of buffering resources may be associated with greater use of binge eating as a coping mechanism or for reward. In addition, synergistic effects may exist between affective symptoms and loneliness that potentiate increased risk for binge eating (Chen et al., 2023). Loneliness affects numerous psychobiological systems (e.g., appetitive, cognitive, circadian, inflammatory; Jin et al., 2024; Kurina et al., 2011; Simmons et al., 2016; Smith et al., 2020), which may be associated with greater binge eating risk among those with affective symptoms. For example, some research suggests that elevated affective symptoms along with high loneliness is associated with a heightened state of reduced self-regulation (Kong et al., 2018).

Further, body shame is a well-evidenced vulnerability to binge eating (Nechita et al., 2021), although the mechanisms are unclear. Loneliness may be one mechanism leading to increased binge eating among women with body shame. Research has showed associations between daily perceived social isolation (i.e., loneliness) and binge eating in women (Mason et al., 2016). Based on these results, body shame may serve as an underlying vulnerability by which daily experiences of loneliness serve to lead to binge eating. While several potential explanations for the current associations are offered here, more theoretical research is necessary to understand the complex mechanisms underlying the associations between affective symptoms, loneliness, and binge eating.

In addition to developing new theoretical models, targeting loneliness in preventions and interventions for binge eating and associated eating disorders is warranted. Specifically, the current findings indicate it could be particularly worthwhile to focus on reducing loneliness among individuals reporting vulnerabilities to binge eating, like affective symptoms. Extant psychotherapies for binge eating currently do not target loneliness explicitly, although some do tap inter-related interpersonal constructs (Ray et al., 2020). Integration of treatment elements focused on improving loneliness, including novel mHealth strategies, may bolster efforts to prevent binge eating and associated eating disorders, especially among individuals with elevated affective symptoms (Bordini et al., 2021; Hickin et al., 2021; Theeke et al., 2015). Furthermore, given the current sample focused on college students, it may be critical to use therapeutic strategies that consider the unique aspects of loneliness within emerging adulthood and while navigating the college environment (Kirwan et al., 2023; Zahedi et al., 2022).

A primary implication of this study is for more routine assessment of loneliness in research and clinical work, especially among people with affective symptoms. This will allow for researchers to clarify the role of loneliness in disordered eating and other psychopathology and for clinicians to provide appropriate therapeutic strategies for loneliness. Also, the findings of this study are consistent with recent public health reports on the epidemic of loneliness and need for policies addressing loneliness (U.S. Office of the Surgeon General, 2023). Policies for school- and community-based interventions, which may include modifying the built environment and encouraging social connection among students and the larger community, are needed to address loneliness and its impact on binge eating.

While findings provide new insight into associations among affective symptoms, loneliness, and binge eating in college women, there were several limitations. First, this was a cross-sectional study, thus neither causality nor directionality can be established. For example, it is possible that binge eating may lead to affective symptoms and loneliness or that effects are bidirectional. Sensitivity analyses supported the hypothesized directionality for anxiety and body shame but suggested an alternative model could be possible for depressive symptoms. Second, while the sample was diverse regarding several demographic characteristics, this study used a convenience sample of college women. As such, it is unclear whether current findings generalize to other samples (e.g., adolescents, males). Binge eating affects all genders and is understudied in male and gender diverse populations (Breton et al., 2023; Halbeisen et al., 2022), which necessitates extension of findings to samples with greater gender diversity. Third, only retrospective self-report questionnaires were used to measure study variables. Self-report questionnaires may be biased by retrospective reporting biases, which could lead to over- or under-estimation of symptoms and behaviors (Van den Bergh et al., 2016). In addition, individuals may be influenced by social desirability biases; although, this is likely reduced by the anonymous nature of study completion (Joinson, 1999). Future research should utilize other more sophisticated designs and methodologies to assess causality, directionality, and limit retrospective reporting biases as well as recruit more robust samples that are representative of the population. Fourth, the Friendship Scale is only one of many available measures of loneliness; other measures exist and vary on length, item content, and dimensionality of loneliness (e.g., UCLA Loneliness Scale) (Maes et al., 2022). Research will be needed to further clarify how measurement choice impacts associations between loneliness and binge eating. Fifth, other eating disorder symptoms (e.g., purging, restriction) and substance use were not examined in the current study. Future studies should examine the interactive role of affective symptoms and loneliness in relation to other eating disorder symptoms and substance use.

Supplementary Material

1

Highlights.

  • Binge eating is a significant problem among college women.

  • Affective symptoms and loneliness were examined in relation to binge eating.

  • Loneliness strengthened the positive association of affective symptoms and greater binge eating.

Funding:

This project was supported in part by grants K01DK124435 from the National Institute of Diabetes and Digestive and Kidney Diseases Award Number (NIDDK).

Declaration of interests

Tyler Mason reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Footnotes

Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Conflict of interest statement: The authors have no conflicts of interest to disclose.

Data availability statement:

The data is available by request from the corresponding author.

References

  1. Andresen EM, Malmgren JA, Carter WB, & Patrick DL (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10, 77–84. [PubMed] [Google Scholar]
  2. Bordini RA, Münscher JC, Baumgartner KA, Hagos S, Hornig J, Gampe S, … & Herzberg PY (2021). Strangers in a strange land: designing a mobile application to combat loneliness and isolation among foreign university students. Journal of Technology in Behavioral Science, 6, 81–87. 10.1007/s41347-020-00171-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Breton É, Juster RP, & Booij L (2023). Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations. Brain and Behavior, 13(4), e2871. 10.1002/brb3.2871 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chen Z, Song X, Lee TM, & Zhang R (2023). The robust reciprocal relationship between loneliness and depressive symptoms among the general population: Evidence from a quantitative analysis of 37 studies. Journal of Affective Disorders. 10.1016/j.jad.2023.09.035 [DOI] [PubMed] [Google Scholar]
  5. Cigna (2018). Cigna U.S. loneliness index. Retrieved from https://www.cigna.com/assets/docs/newsroom/loneliness-survey-2018-full-report.pdf
  6. Cohen S, & Wills TA (1985). Stress, social support, and the buffering hypothesis. Psychological Bulletin, 98(2), 310. [PubMed] [Google Scholar]
  7. Daly M, & Costigan E (2022). Trends in eating disorder risk among US college students, 2013–2021. Psychiatry Research, 317, 114882. 10.1016/j.psychres.2022.114882 [DOI] [PubMed] [Google Scholar]
  8. Duarte-Guerra LS, Kortchmar E, Maraviglia ECS, da Silva Costa T, Lasmar CM, Morin RMR, … & Wang YP (2022). Longitudinal patterns of comorbidity between anxiety, depression and binge eating symptoms among patients with obesity: a path analysis. Journal of Affective Disorders, 303, 255–263. 10.1016/j.jad.2022.02.030 [DOI] [PubMed] [Google Scholar]
  9. Dunstan DA, & Scott N (2020). Norms for Zung’s self-rating anxiety scale. BMC Psychiatry, 20, 1–8. 10.1186/s12888-019-2427-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gallup. (2022). The global state of social connections. Retrieved from https://www.gallup.com/analytics/509675/state-of-social-connections.aspx
  11. Gallup. (2023). College Students Experience High Levels of Worry and Stress. Retrieved from https://www.gallup.com/education/509231/college-students-experience-high-levels-worry-stress.aspx
  12. Garner DM, Olmstead MP, & Polivy J (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2(2), 15–34. [DOI] [Google Scholar]
  13. González P, Nuñez A, Merz E, Brintz C, Weitzman O, Navas EL, Camacho A, Buelna C, Penedo FJ, Wassertheil-Smoller S, Perreira K, Isasi CR, Choca J, Talavera GA, & Gallo LC (2017). Measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D 10): Findings from HCHS/SOL. Psychological Assessment, 29(4), 372–381. 10.1037/pas0000330 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Halbeisen G, Brandt G, & Paslakis G (2022). A plea for diversity in eating disorders research. Frontiers in Psychiatry, 13, 820043. 10.3389/fpsyt.2022.820043 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Hawthorne G (2006). Measuring social isolation in older adults: Development and initial validation of the friendship scale. Social Indicators Research, 77(3), 521–548. doi: 10.1007/s11205-005-7746-y [DOI] [Google Scholar]
  16. Hayes AF (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. NY: Guilford. [Google Scholar]
  17. Heinrich LM, & Gullone E (2006). The clinical significance of loneliness: A literature review. Clinical Psychology Review, 26(6), 695–718. 10.1016/j.cpr.2006.04.002 [DOI] [PubMed] [Google Scholar]
  18. Hickin N, Käll A, Shafran R, Sutcliffe S, Manzotti G, & Langan D (2021). The effectiveness of psychological interventions for loneliness: A systematic review and meta-analysis. Clinical Psychology Review, 88, 102066. 10.1016/j.cpr.2021.102066 [DOI] [PubMed] [Google Scholar]
  19. Hudson J, Hiripi E, Pope H, & Kessler R (2007). The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 61, 348–358. doi: 10.1016/j.biopsych.2012.05.018 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Jin E, & Hwang SSH (2024). A preliminary study on the neurocognitive deficits associated with loneliness in young adults. Frontiers in Public Health, 12, 1371063. 10.3389/fpubh.2024.1371063 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Joinson A (1999). Social desirability, anonymity, and Internet-based questionnaires. Behavior Research Methods, Instruments, & Computers, 31(3), 433–438. 10.3758/BF03200723 [DOI] [PubMed] [Google Scholar]
  22. Kessler RC, Berglund PA, Chiu WT, Deitz AC, Hudson JI, Shahly V, … & Xavier M (2013). The prevalence and correlates of binge eating disorder in the World Health Organization World Mental Health Surveys. Biological Psychiatry, 73(9), 904–914. 10.1016/j.biopsych.2012.11.020 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Kirwan EM, O’Súilleabháin PS, Burns A, Ogoro M, Allen E, & Creaven AM (2023). Exploring loneliness in emerging adulthood: A qualitative study. Emerging Adulthood, 11(6), 1433–1445. 10.1177/21676968231194380 [DOI] [Google Scholar]
  24. Kong D, Davitt J, & Dong X (2018). Loneliness, depressive symptoms, and cognitive functioning among US Chinese older adults. Gerontology and Geriatric Medicine, 4, 2333721418778201. 10.1177/233372141877820 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Kurina LM, Knutson KL, Hawkley LC, Cacioppo JT, Lauderdale DS, & Ober C (2011). Loneliness is associated with sleep fragmentation in a communal society. Sleep, 34(11), 1519–1526. 10.5665/sleep.1390 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Li X, Braakhuis A, Li Z, & Roy R (2022). How does the university food environment impact student dietary behaviors? a systematic review. Frontiers in Nutrition, 9, 840818. 10.3389/fnut.2022.840818 [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Limone P, & Toto GA (2022). Factors that predispose undergraduates to mental issues: A cumulative literature review for future research perspectives. Frontiers in Public Health, 10, 831349. 10.3389/fpubh.2022.831349 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. MacKinnon DP, & Luecken LJ (2008). How and for whom? Mediation and moderation in health psychology. Health Psychology, 27(2, Suppl), S99–S100. 10.1037/0278-6133.27.2(Suppl.).S99 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Maes M, Qualter P, Lodder GM, & Mund M (2022). How (not) to measure loneliness: a review of the eight most commonly used scales. International Journal of Environmental Research and Public Health, 19(17), 10816. 10.3390/ijerph191710816 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Maiden R, Gagne D, & Hayslip B (2021). Loneliness and isolation as barriers to mental health services in a rural community. Innovation in Aging, 5, 1037. 10.1093/geroni/igab046.3709 [DOI] [Google Scholar]
  31. Mason TB, Heron KE, Braitman AL, & Lewis RJ (2016). A daily diary study of perceived social isolation, dietary restraint, and negative affect in binge eating. Appetite, 97, 94–100. 10.1016/j.appet.2015.11.027 [DOI] [PubMed] [Google Scholar]
  32. Mason TB, & Lewis RJ (2014). Profiles of binge eating: The interaction of depressive symptoms, eating styles, and body mass index. Eating Disorders, 22(5), 450–460. 10.1080/10640266.2014.931766 [DOI] [PubMed] [Google Scholar]
  33. Mason TB, & Lewis RJ (2016). Minority stress, body shame, and binge eating among lesbian women: Social anxiety as a linking mechanism. Psychology of Women Quarterly, 40(3), 428–440. 10.1177/0361684316635529 [DOI] [Google Scholar]
  34. Mason TB, Smith KE, Lavender JM, & Lewis RJ (2018). Independent and interactive associations of negative affect, restraint, and impulsivity in relation to binge eating among women. Appetite, 121, 147–153. 10.1016/j.appet.2017.11.099 [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. McKinley NM, & Hyde JS (1996). The objectified body consciousness scale: Development and validation. Psychology of Women Quarterly, 20(2), 181–215. doi: 10.1111/j.1471-6402.1996.tb00467.x [DOI] [Google Scholar]
  36. Nechita DM, Bud S, & David D (2021). Shame and eating disorders symptoms: A meta-analysis. International Journal of Eating Disorders, 54(11), 1899–1945. 10.1002/eat.23583 [DOI] [PubMed] [Google Scholar]
  37. O’Loghlen E, Grant S, & Galligan R (2022). Shame and binge eating pathology: A systematic review. Clinical Psychology & Psychotherapy, 29(1), 147–163. 10.1002/cpp.2615 [DOI] [PubMed] [Google Scholar]
  38. Puccio F, Fuller-Tyszkiewicz M, Ong D, & Krug I (2016). A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders, 49(5), 439–454. 10.1002/eat.22506 [DOI] [PubMed] [Google Scholar]
  39. Ray MK, Grammer AC, Davison G, Fitzsimmons-Craft EE, Wilfley DE (2020). Psychotherapy for Binge Eating. In: Frank G, Berner L (eds) Binge Eating. Springer, Cham. 10.1007/978-3-030-43562-2_18 [DOI] [Google Scholar]
  40. Rosenbaum DL, & White KS (2013). The role of anxiety in binge eating behavior: a critical examination of theory and empirical literature. Health Psychology Research, 1(2), e19. doi: 10.4081/hpr.2013.e19 [DOI] [PMC free article] [PubMed] [Google Scholar]
  41. Ruberman L (2014). Challenges in the transition to college: The perspective of the therapist back home. American Journal of Psychotherapy, 68(1), 103–115. 10.1176/appi.psychotherapy.2014.68.1.103 [DOI] [PubMed] [Google Scholar]
  42. Serra R, Kiekens G, Vanderlinden J, Vrieze E, Auerbach RP, Benjet C, … & Bruffaerts R (2020). Binge eating and purging in first-year college students: Prevalence, psychiatric comorbidity, and academic performance. International Journal of Eating Disorders, 53(3), 339–348. 10.1002/eat.23211 [DOI] [PubMed] [Google Scholar]
  43. Sherry SB, & Hall PA (2009). The perfectionism model of binge eating: Tests of an integrative model. Journal of Personality and Social Psychology, 96(3), 690–709. 10.1037/a0014528 [DOI] [PubMed] [Google Scholar]
  44. Simmons WK, Burrows K, Avery JA, Kerr KL, Bodurka J, Savage CR, & Drevets WC (2016). Depression-related increases and decreases in appetite: dissociable patterns of aberrant activity in reward and interoceptive neurocircuitry. American Journal of Psychiatry, 173(4), 418–428. 10.1176/appi.ajp.2015.15020162 [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Smith KJ, Gavey S, RIddell NE, Kontari P, & Victor C (2020). The association between loneliness, social isolation and inflammation: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 112, 519–541. 10.1016/j.neubiorev.2020.02.002 [DOI] [PubMed] [Google Scholar]
  46. Southward MW, Christensen KA, Fettich KC, Weissman J, Berona J, & Chen EY (2014). Loneliness mediates the relationship between emotion dysregulation and bulimia nervosa/binge eating disorder psychopathology in a clinical sample. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 19, 509–513. 10.1007/s40519-013-0083-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Stice E, Telch CF, & Rizvi SL (2000). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychological Assessment, 12(2), 123–131. 10.1037/1040-3590.12.2.123 [DOI] [PubMed] [Google Scholar]
  48. Theeke LA, Mallow JA, Barnes ER, & Theeke E (2015). The feasibility and acceptability of LISTEN for loneliness. Open Journal of Nursing, 5(5), 416–425. doi: 10.4236/ojn.2015.55045 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. United States. Public Health Service. Office of the Surgeon General. (2023). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General. [Google Scholar]
  50. Van den Bergh O, & Walentynowicz M (2016). Accuracy and bias in retrospective symptom reporting. Current Opinion in Psychiatry, 29(5), 302–308. doi: 10.1097/YCO.0000000000000267 [DOI] [PubMed] [Google Scholar]
  51. Worsley JD, Harrison P, & Corcoran R (2021). Bridging the gap: exploring the unique transition from home, school or college into university. Frontiers in Public Health, 9, 634285. 10.3389/fpubh.2021.634285 [DOI] [PMC free article] [PubMed] [Google Scholar]
  52. Zahedi H, Sahebihagh MH, & Sarbakhsh P (2022). The magnitude of loneliness and associated risk factors among university students: a cross-sectional study. Iranian Journal of Psychiatry, 17(4), 411–417. doi: 10.18502/ijps.v17i4.10690 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Zhang X, & Dong S (2022). The relationships between social support and loneliness: a meta-analysis and review. Acta Psychologica, 227, 103616. 10.1016/j.actpsy.2022.103616 [DOI] [PubMed] [Google Scholar]
  54. Zung WW (1971). A rating instrument for anxiety disorders. Psychosomatics: Journal of Consultation and Liaison Psychiatry, 12(6), 371–379. 10.1016/S0033-3182(71)71479-0 [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

1
NIHMS2009113-supplement-1.docx (22.4KB, docx)

Data Availability Statement

The data is available by request from the corresponding author.

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