Loneliness in pregnant and postpartum women and parents of children aged five years or younger: a scoping review protocol

Researchers have only recently begun to conduct studies on the concept of loneliness during pregnancy and the transition into parenthood. Extensive study of loneliness in older adults has connected loneliness with mental and physical well-being, and with depressive symptoms, impaired sleep, increased vascular resistance, increased systolic blood pressure, etc. New parents’ experience of loneliness, however, has not been a specific focus of study. Research indicates that although loneliness is common across the lifespan, its highest incidence is in those aged 16 to 24, and risk of loneliness and related factors rises during transitional periods. The few studies targeting maternal loneliness indicate it may be predominantly situational. Transition-to-motherhood studies illustrate the importance of social support, which in turn is seen as predicting postpartum depression. Scarcity of parenthood-loneliness inquiries leaves a gap in our understanding of new parenthood. Further inquiry is needed to identify effects of loneliness on the health and well-being of parents and their children. (Clarivate Analytics) will be used to manage citations and remove duplicates. Covidence (Veritas Health Innovation), an online systematic reviewing platform, will be used to screen and review search results. Two reviewers (JK, RP), working independently of each other, will screen the titles and abstracts of the articles returned by the searches, then screen the selected full-text articles, and extract data into REDCap. A third reviewer (SS) will be available to cast the deciding vote in case no consensus is reached between the two reviewers. Results will be given in narrative form, and will be mapped and illustrated.

reviews to ensure transparency and reproducibility. Multiple databases were searched. EndNote (Clarivate Analytics) will be used to manage citations and remove duplicates. Covidence (Veritas Health Innovation), an online systematic reviewing platform, will be used to screen and review search results. Two reviewers (JK, RP), working independently of each other, will screen the titles and abstracts of the articles returned by the searches, then screen the selected full-text articles, and extract data into REDCap. A third reviewer (SS) will be available to cast the deciding vote in case no consensus is reached between the two reviewers. Results will be given in narrative form, and will be mapped and illustrated.

Discussion
This scoping review aims to capture the state of the current literature on loneliness in pregnancy and new parenthood in order to identify gaps and make recommendations for future areas of study and related interventions.

Introduction
Researchers have only recently begun to conduct studies on the concept of loneliness during the transition into new parenthood. A rare survey, published in 2015 in Great Britain, revealed a loneliness prevalence rate of more than 25% in first-time moms (AXA Healthcare, 2015). It is true that loneliness in the population of older adults has been well studied, revealing a prevalence rate of 25 to 29% (Ong, Uchino, & Wethington, 2016). Studies of loneliness in older adults have shown connections between loneliness and mental and physical well-being, with correlating effects on depressive symptoms, impaired sleep, increased vascular resistance and increased systolic blood pressure, to name a few (Cacioppo, Grippo, London, Goossens, & Cacioppo, 2015). Yet the experience of new parents with loneliness as a specific target of research has not been systematically studied. Research on loneliness in the older adult is helping scientists to understand the physiological pathways between loneliness and associated health outcomes. Current research, however, indicates that loneliness is common across the lifespan, with the highest reported frequency of loneliness in those aged 16 to 24 years (Pyle & Evans, 2018), and even suggests people may be at greater risk for loneliness and related risk factors during periods of transition (Cann & Jopling, 2011 Rokach, 2004Rokach, , 2007. Situational or transitional loneliness is experienced during crises and developmental changes throughout the lifespan, and may include life experiences such as death of a loved one or transition to college (Beck & Young, 1978). Studies on the transition into motherhood illustrate the importance of social support (Barclay, Everitt, Rogan, Schmied & Wyllie, 1997), and social support has been identified as a predictor of postpartum depression (Beck, 2001).

Why is it important to do this review?
The research community has largely neglected to focus on loneliness in the new-parent population.
The current approach to parenthood-loneliness inquiry has not been systematic and, therefore, leaves a gap in our understanding of new parenthood. Loneliness is typically a secondary aim or additional measure within a larger study, and few articles target the associations of loneliness on health outcomes in pregnancy and parenthood. A review of research focused on the loneliness experienced during new parenthood reveals little collective knowledge in which to support our understanding of the nature of loneliness within this population. Further inquiry is needed so that we may understand the implications of loneliness on the health and well-being of parents and the resulting impact on their children.

Study Design
In accordance with scoping review procedure, we will conduct our scoping review as outlined by No search limits will be applied for dates, language or study type.
Other sources: We will check the reference lists of our selected studies for eligible inclusion.
Grey literature: The British governmental website gov.uk, the Jo Cox Commission on Loneliness, the Campaign to End Loneliness, and the British Red Cross's Action on Loneliness websites will be used to begin the greyliterature search. Additional sites may be identified from these sources.

Data extraction, mapping and presentation
EndNote (Clarivate Analytics) will be used to manage citations and remove duplicates. Covidence (Veritas Health Innovation), an online systematic reviewing platform, will be used to screen and review search results (Covidence). REDCap, hosted at The University of Utah, will be used to chart extracted data from our selected studies. Results will be given in narrative form, and will be mapped through relevant illustration.
Two reviewers, working independently of each other, will screen the titles and abstracts of the articles returned by the searches. These reviewers, again working independently of each other, will then screen the selected full-text articles, and data extraction will be done by them. A third reviewer will be available to cast the deciding vote in the case that no consensus can be reached between the two reviewers.
Charting the data Study data will be captured and managed with REDCap, electronic data capture tools that are hosted at The University of Utah. Data elements will include:  Manual, 2015), no quality assessment of selected articles will be performed, as our goal is to rapidly map the literature and identify gaps.

Dissemination of results
Following completion of data extraction, a manuscript will be submitted for peer review and publication.

Study status 8
The protocol for this study has been finalized as of February, 2020. Screening of titles and abstracts is complete full-text review is nearing completion. Completion of the manuscript for this scoping review is estimated for June of 2020.

Discussion
The data gathered through this study should prove useful to policy makers, researchers and clinicians. The review will search the published literature and will miss unpublished reports and studies, as well as ongoing studies. As the research area of parental loneliness grows, future reviews may be necessary. Additionally, although non-English studies will be searched and tagged, they will not be included in the full-text data extraction process, except in cases where an English translation is available.

Conclusion
This scoping review will capture the state of the current literature on loneliness in pregnancy and new parenthood in order to identify gaps and make recommendations for future areas of study and related interventions.

Availability of supporting data and materials
Medline search strategy attached and available upon request.

Trial Status
Not applicable Not applicable

Consent for publication
Not applicable