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diagnostic criteria (e.g., "feeling nervous, anxious or on edge) [59]. The four-point Likert scale is
recorded as "not at all," "several days," "more than half the days," and "nearly every day" [60].
The GAD-7 was validated in a large sample and had good psychometric properties [57]. It
showed high reliability in our sample with a Cronbach alpha of .90.
Depression was measured using the Centre for Epidemiologic Studies Depression Scale
(CES-D) [61]. Designed to measure the symptoms of depression in the general population, this
measure is a structured, self-report questionnaire consisting of 20 items related to depressive
symptoms that occurred in the past week [62]. Participants respond to items such as "I thought
my life had been a failure" on a four-point Likert scale ranging from "rarely or none of the time
(less than one day)," "some or little of the time (1-2 days)," "occasionally or a moderate amount
of time (3-4 days)," and "most or all of the time (5-7 days)" [61]. The CES-D showed high
reliability in our sample with a Cronbach alpha of .93.
Loneliness was measured using the UCLA Loneliness Scale (Version 3) [63]. The
measure includes 20 items: 11 negatively worded items (e.g., How often do you feel that you
lack companionship?) and nine positively worded items (e.g., How often do you feel outgoing
and friendly?). Responses are recorded on a four-point Likert scale ranging from "never (1),"
"rarely (2)," "sometimes (3)," to "always (4)," and negatively worded items are reverse-scored
[64]. The scores are combined to provide a total loneliness score. A higher score indicates higher
levels of loneliness [65]. This scale showed high reliability in our sample with a Cronbach alpha
of .94.
Loneliness was also measured by the Howatt Loneliness Scale. This 12-item scale
includes seven positively worded items (e.g., I am confident in my ability to meet new people)
and five negatively worded items (e.g., I often felt left out). Responses are recorded on a five-
