Positive and negative experiences with the COVID-19 pandemic among lonely and non-lonely populations in Germany

The COVID-19 pandemic is causing an epidemic of loneliness. Previous studies have shown the differences in positive and negative experiences of lonely and non-lonely people in a non-pandemic setting. However, it is unclear how the drastic alteration of the COVID-19 pandemic may influence peoples' reactions and beliefs, especially among those who feel lonely. Our study aims to examine the positive and negative experiences among lonely and non-lonely people. We undertook a cross-sectional online survey of the general population in Germany (N = 1,758) from May 2020 to May 2022. We assessed their feelings of loneliness with the short eight-item UCLA Loneliness Scale (ULS-8), their positive and negative experience of living in the COVID-19 pandemic as well as their psychological distress regarding the pandemic with the COVID-19 Peritraumatic Distress Index (CPDI). We found lonely individuals (ULS-8 score ≥ 16) reported fewer positive experiences of living in the COVID-19 pandemic, for example, less time with loved ones [z(1, 756) = −2.5, p = 0.012] and less sense of togetherness [z(1, 756) = −2.39, p = 0.017] as compared to non-lonely individuals. Meanwhile, they experienced more negative experiences, for example, worry and fear [z(1, 756) = 6.31, p < 0.001] compared with non-lonely individuals. Interestingly, lonely people were less likely to view the pandemic as a conspiracy than non-lonely people were [z(1, 756) = −3.35, p < 0.001]. Our results may give insight into attribution bias and the negative affect of lonely people during the COVID-19 pandemic as well as highlight the experience of non-lonely people and raise the question of differences in conspiracy beliefs. For pandemic preparedness and response, decision-makers may focus on interventions to foster social cohesion, empower people, build resilience, and most importantly provide timely social care.


. Introduction
With the start of lockdown during the beginning of COVID-19, it was uncertain how long the significant changes that governments made would last. Those changes brought grand challenges to life, such as preventing the virus from spreading around the world (e.g., wearing a mask) (1), staying at home to protect children and vulnerable adults (2)(3)(4), and staying connected when physically apart (5)(6)(7). The World Health Organization reported that the global prevalence of anxiety and depression increased by a massive 25% in the first year of COVID-19 (8). Beyond health challenges, COVID-19 has also exacerbated social challenges (9)(10)(11)(12)(13)(14), including attitudes toward social roles (e.g., gender roles) (15). However, dealing with this adversity is a chance to bring forward positive aspects as well. Wong's Existential Positive Psychology theory states that the great adversity that exists in life is a chance to bring forward positive experiences, indicating that suffering can promote strength and wellbeing (16). Wong et al. proposed that faith, courage, creativity, and the meaning of life are essential to transform suffering into flourishing (17). Existential positive psychology seeks to integrate various ways that help people experience positive states in times of suffering (17). To prepare for and respond to future pandemics, it is crucial to reflect on both positive and negative experiences that we had during the ongoing COVID-19 pandemic. When looking back, the COVID-19 movement restrictions did have a positive impact on the living environment (i.e., reduction in air pollution and emission of greenhouse gases) (7). In addition to making life more environmentally friendly compared to before COVID-19, the adaption to the new way of living (e.g., spending more time at home) provided opportunities for introspection (18). For example, people can for once rethink what is really important in their life, how they truly want to spend their time, and what they value most (18). This is a unique opportunity to generate ideas as well as to evaluate one's life. Moreover, staying at home during the lockdown enabled people to spend more time with loved ones (i.e., family members that live together in lockdown) (19). Another positive outcome of the unexpected COVID-19 lockdown was more time for hobbies (20). People chose hobbies that can be done in solidarity like spending time in nature and engaging in creative activities (20). Finally, working from home has advantages, such as greater work control and an improved work-life balance (21), which may lead to less work-related stress.
Despite the potential positive experiences of COVID-19, it is important to understand perceived negative experiences as well (22). Existential positive psychology suggests that negative experiences can add meaning to life by striving to overcome them (23). Considerable studies across countries reported negative effects of COVID-19 on mental health, including feeling worried, anxious, restricted, lonely, angry, depressed, and having sleep problems (24-29). People experience negative cognitive states, such as COVID-19-related worry, which can be an indicator of negative mood (26,30). Moreover, such negative feelings or experiences are most common among vulnerable populations (e.g., the elderly, pregnant women and their children, people with disabilities, and chronic long-term health conditions) (2,31). In addition, perceiving COVID-19 as more dangerous than seasonal influenza (32) was associated with a heightened perception of worry and fear (33). Interestingly, many people even believed the whole pandemic was a hoax and made up of secret organizations, possibly to change the "world order, " which is a narrative deeply rooted in antisemitism (34).
Strikingly, loneliness played a key role in triggering stressrelated behaviors and cognition during lockdown (35). Even before COVID-19, loneliness was described as a "behavioral epidemic" in the population (36). During COVID-19, physical distancing can worsen this situation, as positive social contact is a key factor in battling loneliness (37). Other factors that can increase feelings of loneliness and may have been intensified under COVID-19 are living alone, infrequent contact with family or friends, dissatisfaction with living circumstances, chronic work and/or social stress, small social network as well as a poor quality social network, and marital or family conflict (38). A representative study from Germany showed that the prevalence of loneliness increased from 11% before COVID-19 to 27% during COVID-19 (37). Our recent study showed that up to 66% of people in Germany sometimes or always felt lonely amid COVID-19 (39). Furthermore, loneliness increased with a small effect size in the population that reinforces a "loneliness epidemic" (40). Similar results have been reported in the association between increased prevalence of loneliness, depression, and anxiety (41, 42).
The Evolutionary Theory of Loneliness (ETLs) conceptualizes that loneliness has an adaptive and nonconscious function of a person perceiving the world as more threatening (43). Furthermore, if people feel no sense of solidarity, it leads to them operating in a "selfish" mode, which can help them protect themselves in a potentially dangerous situation (43). This state is extremely aversive and thus is conceptualized to bring people to renew their social connections (38) and to protect themselves from being alone in a hostile environment (43). Considering these points, it highlights that lonely individuals may perceive an objectively neutral situation as more hostile than nonlonely individuals may. That raises an interesting question of whether lonely and non-lonely people react differently in the ongoing COVID-19 pandemic. Spithoven et al. highlighted that lonely people process information differently from non-lonely individuals (44). Lonely individuals interpret information with more negative expectations and have a hostile attribution bias and negative evaluation of self and others (44). They also tend to have a higher sensibility for socially threatening and socially negative stimuli (44). These cognitive biases tend to reinforce and strengthen counterproductive social behaviors (44,45). These findings undermine the fact that in a socially shifting situation like a lockdown, lonely people may perceive the world differently from non-lonely people. One of the popular beliefs amid COVID-19 was conspiracy theories. There were mixed results on loneliness relating to belief in conspiracy theories. On the one hand, the induction of loneliness increases paranoid ideation (46) that correlated with COVID-19 conspiracy beliefs (47). On the other hand, instead of loneliness, people who endorse conspiracy theories are influenced by their personal willingness to conspire (48) and by social contagion through conventional and social media (49). The inconsistent results are encouraging a better understanding of the role of loneliness in conspiracy endorsement. While there is a surfeit of studies measuring the negative experiences among lonely people amid COVID-19 (2, 8-14, 26, 31, 35), there is a lack of studies on positive outcomes. To better prepare for and respond to the future pandemic, it is crucial to understand both positive and negative lessons we have learned during the COVID-19 pandemic. In this study, we aim to examine the positive and negative experiences during COVID-19 among lonely and non-lonely individuals in Germany. We expect that there will be different positive and negative experiences of living in COVID-19 among lonely and non-lonely people. Specifically, we hypothesize that lonely individuals will report less positive and more negative experiences than nonlonely individuals will. Finally, we assume the belief in conspiracy theories will be independent of individuals' feelings of loneliness.

. . Participants and procedure
We conducted an anonymous online survey using the Siuvo platform (https://www.siuvo.com) for psychological assessments in healthcare settings between May 2020 and May 2022 in Germany. The survey was distributed using a QR code shared primarily through social media, advertisements, and newsletters. We recruited participants who were aged 18 years and above and gave informed consent. We collected our data conveniently by recruiting populations who had access to the Internet. We used G * Power Version 3.1.9.6 to determine sample size. According to a previous study in Germany (50), 32% of people reported being lonely in Germany under the first nationwide lockdown in March 2020. We calculated a sample size of 1,434, which gives an α error rate of 5%, power of 90%, a "small" effect size (d = 0.2), and an allocation ratio of 0.32. Considering a 20% dropout rate, 1,721 participants were set as the target sample size. We collected socio-demographic data (i.e., sex, age, and years of education), used a short form of the UCLA Loneliness Scale (ULS-8) to assess feelings of loneliness, as well as the COVID-19 Peritraumatic Distress Instrument (CPDI) and asked individuals' positive and negative experiences of living in the COVID-19 pandemic. We also asked our participants if they have less contact with their family amid COVID-19 and if they have been diagnosed with a mental illness in the past 3 months. The Ethics Committee of Charité-Universitätsmedizin Berlin (EA2/143/20) approved the study.
. . Measurement of loneliness and perceived positive and negative experiences amid COVID-and COVID--related distress Loneliness was assessed by using the well-established short eight-item UCLA Loneliness Scale (ULS-8) in a validated German version (39,51,52). Each item was answered on a 4-point Likert scale with total scores ranging from 8 to 32, with higher scores suggesting a higher degree of loneliness. Participants who reported at least sometimes (a cutoff score ≥16) to always feeling lonely were considered "lonely people" (53). We used the 24-item COVID-19 Peritraumatic Distress Index (CPDI) questionnaire to capture peritraumatic psychological distress in the general population amid COVID-19 (54). Each item was answered on a 5-point Likert scale, with higher scores suggesting a higher psychological distress level (a score between 28 and 51 indicates mildto-moderate distress). Perceived positive experiences during COVID-19 were assessed with a nominal scale by asking, "Do you perceive any positive experiences of the COVID-19 pandemic?" Participants had to choose one of the nine following categorical statements compared to before COVID-19: (1) "No positive effects at all, " (2) "A more environmentally friendly world, " (3) "Time to think about life, " (4) "More time for loved ones, " (5) "More time for hobbies, " (6) "Less work-related stress, " (7) "Less social pressure, " (8) "An increased sense of togetherness, " and (9) "Other positive experiences." Perceived negative experiences during the pandemic were assessed with a nominal scale by asking, "Did you perceive any negative experiences of the COVID-19 pandemic?" Participants had to choose one of the five following categorical statements that made them feel the most psychological distressed in times of COVID-19: (1) "Corona per se is a dangerous infectious disease, " (2) "The epidemic was deliberately manufactured to serve the interest of powerful forces, " (3) "A feeling of imminent threat, " (4) "An edge and worries in general, " and (5) "Other negative experiences." The items on positive and negative experiences were based on

. . Data analysis
We performed statistical analysis by using R Statistical Software (version 4.1.2; R Foundation for Statistical Computing, Vienna, Austria). Differences were considered statistically significant at p < 0.05 and highly statistically significant at p < 0.01. To check the influences of socio-demographic factors (i.e., sex, age, and years of education) on the loneliness scores, we conducted a multiple linear regression analysis. We used the chi-square test to evaluate if there are differences between non-lonely and lonely people in reporting their contact with families and having been diagnosed with a mental illness in the past 3 months. We used independent sample t-tests to examine differences in CPDI scores in non-lonely and lonely people as well as in men and women. We used logistic regression analysis to examine whether there was a significant difference between non-lonely and lonely people in choosing each category of positive and negative experiences. We used the chi-square test to compare men and women and investigate the effects of gender. Finally, we performed logistical regression analyses to understand whether gender, age, and loneliness played a role in conspiracy beliefs.

. . Group description
A total of 4,226 participants got access to our survey, 2,466 participants responded to it, 1,858 participants completed it, and 100 participants did not meet the data quality control. Our final sample consists of 1,758 participants (1,304 women (74.2%), age range: 18-75, M = 33.37, SD = 12.24), as shown in Table 1. Each participant completed the survey only once. Of note, 1,354 (77.02%) participants were categorized as "lonely, " as they reported feeling lonely at least sometimes. Our regression analysis revealed that people with less years of education [t ( (4) = 177.9, p = < 0.001], and there was no significantly higher proportion of lonely people who were diagnosed with a mental illness as compared to nonlonely people [χ 2 (1) = 3.84, p = 0.0501]. There were gender differences in reporting psychological distress: CPDI scores were significantly higher in women than men (p < 0.001), indicating that women had higher COVID-19-related distress than men.

. . Less positive experiences of living in COVID-among lonely individuals
We found that lonely people were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely people [z (1,756) = 2.92, p = 0.004], as shown in Figure 1. In our sample, due to a higher proportion of women, we also conducted additional analyses of men and women separately. In general, we did not find a significant difference between men and women in perceiving no positive experiences during the pandemic [χ 2 (1) = 1.4, p = 0.24]. However, we found lonely women were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely women (p = 0.007). In lonely men, we did not find that they were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely men (p = 0.85). Furthermore, lonely people experienced significantly less time with loved ones . . More negative experiences of living in COVID-among lonely individuals Lonely participants reported "worry" significantly more often than non-lonely participants [z (1,756) = 6.31, p < 0.001], as shown in Figure 2. There was no significant difference between lonely and non-lonely individuals in experiencing "danger"  Table 2. When comparing men with women, we found that women reported worry as a negative experience more often [χ 2 (1) = 7.29, p = 0.007] than men. Conversely, men reported perceiving the pandemic as dangerous more often as a negative outcome [χ 2 (1) = 5.29, p = 0.007] than women. We did not find a significant difference between men and women in having conspiracy beliefs [χ 2 (1) = 3.68, p = 0.055] and perceiving the pandemic     among lonely and non-lonely people. We found less positive and more negative experiences among lonely people as compared with non-lonely people. Regarding positive experiences, lonely people reported perceiving no positive experiences of living during the pandemic more than non-lonely people. In line with previous studies, lonely people tend to have negative feelings more often (62). Negative feelings and thinking can hint at a generally depressed mood in lonely people, as loneliness can be a sign of depression (63). The negative effect of a depressed state can lead people to withdraw from social life even more (64, 65), which can be an alarming situation during an already-implemented lockdown. In line with Wong's Existential Positive Psychology theory (17), positives cannot exist apart from negatives. Wong conceptualizes wellbeing not only as pursuing positive goals but also as overcoming and mastering negative experiences (17). The absence of positive experiences being especially prominent in lonely people may reflect that they desire ways to deal with negativity and savor positive experiences. In addition to the positive experiences among non-lonely and lonely people, we found that lonely women were more likely to report no positive experience of living during the COVID-19 pandemic as compared to non-lonely women. There was no such a significant difference between non-lonely and lonely men. Further research is needed to examine different positive and negative experiences among non-lonely and lonely men and women. Furthermore, we found that lonely people perceived "spending more time with loved ones" significantly less than non-lonely people did. It is unclear whether such a perception plays a role in developing and maintaining a desired social relationship that is associated with defying loneliness: Did people not spend enough time with their loved ones and then became lonely, or were they lonely and withdrew themselves even more from social contacts? Another interesting aspect would be to exhibit if lonely people actually spend less time with loved ones than non-lonely people or if they just perceive it as such, as lonely people tend to have more negative and less satisfying social interactions, which contribute to negative moods and interactions (66). In this context, we found that lonely people reported less sense of togetherness than non-lonely people. A sense of togetherness reflects solidarity that comes hand in hand with achieving a common goal (67). Interestingly, loneliness as "selfish" mode can inhibit our sense of solidarity (43, 68, 69). The ETL suggests this "selfish" mode as a response to avoid a dangerous situation (43). However, people may be at risk of developing chronic loneliness, if they continue with this mode over time (70). Loss of sense of togetherness may reinforce this vicious circle. Laitinen and Pessi suggested that chaos and conflict in societies can oppose solidarity, along with the maximization of self-interest (71). Furthermore, our findings uncovered various aspects of what it feels like to be lonely amid COVID-19. Although closer friendships seem to remain intact  in the pandemic (72), it is associated with less general peer-topeer contact (73) and worse recognition of one's own and others' emotions (74), which can lead to more distress and loneliness (73). When looking back at the possible evolutionary functions of loneliness, solidarity and spending time with a peer group help increase social skills for battling loneliness, which in turn lessens their risk for mortality (43). The absence of those social experiences and their effects on the mind and body can be a particular danger for lonely people.
Regarding the negative experiences of living during the pandemic, our results were consistent with the previous studies showing an association between loneliness and worry (75). In our study, lonely people worried significantly more than nonlonely people did. Strikingly, nearly two times as many of the non-lonely individuals believed that the whole pandemic was a hoax and made up of secret powers compared to lonely people. Recent research explains what draws people to conspiracy beliefs. Reasons to believe in conspiracy theories are that they give self-contained explanations for insecure situations, make people feel special, and give them a positive self-image for knowing information that nobody else knows and/or satisfy people's needs for safety and security (76). Other important socio-demographic data related to conspiracy beliefs are socio-economic status, education and political positions (76). Finally, our results showed that non-lonely individuals experienced more "other" negative outcomes of COVID-19 than lonely participants did. Negative experiences that were not mentioned before may include, among other factors, prolonged grievances for loved ones who died (77)(78)(79), financial hardships (80, 81), and family problems (82, 83).
Generalizability and representativeness are limited in our study populations (e.g., people 18 ± 75 years old), although our socio-demographic characteristics are consistent with other published surveys during COVID-19 (84, 85). To reduce sampling bias, respondents were from Germany's 16 federal states and worked in various fields, such as office administration, healthcare, education, civil service, sales, agriculture, arts, sports, and media. Moreover, our sample consists of a high rate of women, which is consistent with other published surveys during COVID-19 (84, 85). Our findings cannot establish a cause-and-effect relationship or analyze momentary experiences and daily behavior over a period. We cannot rule out the varying influences of COVID-19 and its related measures (e.g., lockdowns, public health, social, and economic measures) on our observed results. Future studies may also consider different sociodemographic factors (e.g., marital status, migration background, and household) that may have influences on the observed effects. A depth quality assessment is needed to uncover other potential positive and negative experiences with the COVID-19 pandemic.

. Conclusion
The COVID-19 crisis may be a chance to reconsider personal and social priorities. Our study showed that lonely people reported more negative and less positive experiences during the COVID-19 pandemic than non-lonely people. To prepare for and respond to future pandemics, decisionmakers may seek to spread positive energy among vulnerable populations (e.g., people who feel lonely), build trust and confidence in dealing with negative experiences (e.g., worry and fear), and improve communication. Future studies may focus on effective, adaptive, and scalable interventions to foster social cohesion, empower people helps build resilience, and, most importantly, provide timely social care.

Data availability statement
The datasets are available, with restrictions, due to confidentiality in line with Berlin Data Protection Act (Berliner Datenschutzgesetz -BlnDSG). Interested individuals can contact stresshealth@charite.de.

Ethics statement
The studies involving human participants were reviewed and approved by Ethics Committee of Charité -Universitätsmedizin Berlin. The participants provided their written informed consent to participate in this study.

Author contributions
Conceptualization, writing-review and editing, and supervision: SL. Methodology, data collection, and data curation: LW and SL. Data analysis and writing-original draft preparation: LW. Both authors have read and agreed to the published version of the manuscript.

Funding
This study was supported by internal research funds from the Charité -Universitätsmedizin Berlin (SL). We acknowledge support by the Open Access Publication Fund of the Freie Universität Berlin.