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The variable quality of friendship demonstrated the strongest association with HA. Our study showed an exponential distribution of HA in a general adult population. There was no evident cut-off point to distinguish participants with severe HA based on their WI-6 score, indicating the importance of analysing HA as a complex, continuous construct. HA demonstrated strong associations with quality of friendship and participation in an organized activity. Our study showed an exponential distribution of HA in a general adult population. There w