Effects of social isolation and loneliness

Below is some of the empirical evidence on the effects of social isolation and loneliness.

The Economics of Loneliness – What Happens Next Podcast

This podcast, featuring our Managing Director – Glenys Reid, explores the trend of loneliness across Australia and the globe and the increase of this following the COVID induced lockdowns.

What Happens Next? with Whitney Fitzsimmons | Episode 7 | KPMG Australia Podcast Series

Social Relationships and Mortality Risk: A Meta-analytic Review.

Researchers reviewed 148 studies (amounting to 308,849 participants) and found that stronger social connections resulted in a 50% increased likelihood in survival where participants had stronger social connections. This remained consistent across age, gender, initial health status, cause of death and follow up period. The researchers concluded that the influence of social relationships on risk for mortality is comparable with well-established risk factors for mortality such as smoking and alcohol consumption and exceeds the influence of other risk factors such as physical inactivity and obesity. As such social connectedness should be taken as seriously as other factors that influence mortality.

Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316. https://doi.org/10.1371/journal.pmed.1000316

The Relation of Social Isolation, Loneliness, and Social Support to Disease Outcomes Among the Elderly

This study examined relations between social isolation, loneliness, and social support to health outcomes in a sample of New Mexico seniors. The researchers questioned a random sample of 755 southern New Mexico seniors and found that belongingness support relates most consistently to health outcomes.

Joe TomakaSharon ThompsonRebecca Palacios First Published June 1, 2006 Research Article  https://doi.org/10.1177/0898264305280993 

Aging Health. 2006 Jun;18(3):359-84. doi: 10.1177/0898264305280993.

Loneliness Rivals Obesity, Smoking as Health Risk

This study (conducted by the health insurer Cigna) found that Facebook and other web-based communities – as well as other things in modern life – are boosting levels of loneliness in the United States. Loneliness, in turn, is undermining Americans mental and physical health. This has been labelled “the social media paradox” in that social media may have allowed Americans to become more connected to others than at any time in history but that many people report feeling more lonely and isolated than ever before. “Loneliness was found to have the same impact on mortality as smoking 15 cigarettes a day, making it even more dangerous than obesity” (Douglas Nemecek, MD, chief medical officer for behavioural health, Cigna).

The survey found widespread loneliness, with nearly half of Americans reporting they felt alone, isolated, or left out at least some of the time. The nation’s 75 million millennials (ages 23-37) and Generation Z adults (18-22) were found to be lonelier than any other U.S. demographic and reported being in worse health than older generations. In addition, 54% of respondents said they feel no one knows them well, and four in 10 reported they “lack companionship,” their “relationships aren’t meaningful” and that they “are isolated from others.”

The former US Surgeon General Vivek H. Murthy, MD advised that loneliness should be targeted in public health campaigns like those designed to combat smoking, boosting immunizations, combatting obesity and preventing the spread of the AIDS virus.  

Nick Tate ( Medically Reviewed by Brunilda Nazario, MD on May 04, 2018)https://www.webmd.com/balance/news/20180504/loneliness-rivals-obesity-smoking-as-health-risk

Social isolation, loneliness in older people pose health risks

This report by the National Institute on Aging (part of the US Department of Health and Human Services) looked at the links between social isolation and loneliness and the higher risks that they posed for a variety of physical and mental conditions: high blood pressure, heart disease, obesity, weakened immune systems, anxiety, depression, cognitive decline, Alzheimer’s disease and even death.

The report noted that people who find themselves unexpectedly alone due to the death of a spouse or partner, separation from friends or family, retirement, loss of mobility, and lack of transportation are at particular risk. Conversely, people who engage in meaningful, productive activities with others tend to live longer, boost their mood, and have a sense of purpose. These activities seem to help maintain their well-being and may improve their cognitive function.

Chronic loneliness activates a biological defence mechanism which, according to Steve Cole, Ph.D., director of the Social Genomics Core Laboratory at the University of California, Los Angeles, acts like a fertilizer for other diseases. He noted that “The biology of loneliness can accelerate the build-up of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease. Loneliness promotes several different types of wear and tear on the body.”

People who feel lonely may also have weakened immune cells that have trouble fighting off viruses, which makes them more vulnerable to some infectious diseases. Loneliness may indeed alter the tendency of cells in the immune system to promote inflammation, which is necessary to help our bodies heal from injury

H Eating 23rd April 2019 National Institute on Aging.

Loneliness and Health in Older Adults: A Mini-Review and Synthesis

This paper identifies the fact that extensive research has documented the importance of social relationships for promoting mental health and protecting against the development and progression of physical illness and disease. Integrative reviews of the literature provide consistent evidence that social relationships – both quantity and quality – are a major contributing factor in lowering broad-based morbidity and mortality. By contrast, loneliness has been linked to diminished longevity particularly among older individuals in whom declining economic resources, illness, widowhood, and impaired mobility may result in increased risk for social isolation.

At older ages, loneliness is also a major risk factor for broad-based morbidity (both psychological and physical). Growing evidence indicates that loneliness is associated with a wide range of health outcomes in later life, even after adjusting for objective indices of social isolation. For example, independent of objective features of social relationships (e.g., living arrangement, number and frequency of contacts, presence and propinquity of caregivers), loneliness has been associated with impaired daytime functioning, reduced physical activity, lower subjective well-being, and poorer physical health. Moreover, loneliness has been shown to prospectively predict increased depressive symptomatology, impaired cognitive performance, dementia progression, significant likelihood of nursing home admission, and multiple disease outcomes (e.g., hypertension, heart disease, and stroke in older persons) .

Anthony D. OngBert N. Uchino, and Elaine Wethington   Loneliness and Health in Older Adults: A Mini-Review and Synthesis Gerontology. 2016; 62(4): 443–449.

Published online 2015 Nov 6. doi: 10.1159/000441651

The Growing Problem of Loneliness

Cacioppo and Cacioppo noted that loneliness makes a person irritable, depressed, and self-centred, and is associated with a 26% increase in the risk of premature mortality. In industrialised countries around a third of people are affected by loneliness, with one person in 12 being affected severely. These proportions are continuing to increase with loneliness being considered contagious. Income, education, sex, and ethnicity are not protective against loneliness. The effects of loneliness are not attributable to some peculiarity of the character of a subset of individuals. Instead, they are a result of loneliness affecting ordinary people. Loneliness is often stigmatised, trivialised, or ignored. Regardless, loneliness is emerging as a public health problem. Doctors are encountering loneliness, but most do not have the information needed to deal effectively with it in their patients.

The researchers note that loneliness has become a public health problem that could largely be solved within our lifetime but that doing so would require the full engagement and support of the medical community. This is required as the physical health and mental health of a growing number of afflicted individuals and their families and friends is at stake.

John T Cacioppo and Stephanie Cacioppo The Growing Problem of Loneliness Lancet. 2018 Feb 3;391(10119):426. doi: 10.1016/S0140-6736(18)30142-9.PMID: 29407030 

Relationship Between Loneliness, Psychiatric Disorders and Physical Health. A Review on the Psychological Aspects of Loneliness

Loneliness is the absence of imperative social relations and lack of affection in current social relationships. Loneliness is one of the main indicators of social well-being. Loneliness is caused not by being alone, but by being without some definite needed relationship or set of relationships. Loneliness reminds us of the pain and warns us of the threat of becoming isolated. If humans become lonely, then various psychiatric and physical problems may develop.

Contrary to popular belief that it is the elderly in society who are the most lonely, the researchers noted that loneliness is generally reported more amongst adolescents and young children than in other age groups. The reason for this is that older people have had time to develop coping skills and can adjust accordingly to solitude, whereas these skills are not present in adolescents. Adolescence is also the time of life when being accepted and loved is of major importance to the formation of one’s identity and any rejection can lead to the development of loneliness. However, the researchers also noted that elderly who have physical illness, disability or live alone report higher prevalence of loneliness, compared to elderly without physical illness and disability and those who live with spouses and families. Furthermore loneliness gradually diminishes through the middle adult years, and then again increases in old age (i.e., ≥70 years).

The report analysed in more detail both the psychiatric and physical health issues that are related to loneliness.

The report outlined 4 broad types of interventions for helping to reduce and alleviate loneliness. These are: (1) Developing social skills, (2) Giving social support, (3) Developing opportunities for social interaction, and (4) Recognizing maladaptive social cognition.

The authors concluded that loneliness is one of the main indicators of social well-being and can lead to various psychiatric and physical disorders. If left unattended, loneliness can have serious consequences for mental and physical health

Raheel Mushtaq, Sheikh Shoib, Tabindah Shah, and Sahil Mushtaq Relationship Between Loneliness, Psychiatric Disorders and Physical Health ? A Review on the Psychological Aspects of Loneliness  J Clin Diagn Res. 2014 Sep; 8(9): WE01–WE04.

Published online 2014 Sep 20. doi: 10.7860/JCDR/2014/10077.4828

Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

In this article researchers tested the association between social isolation (living alone, unmarried, without social support), feelings of loneliness and incident dementia in a cohort of 2173 non-demented community-living older persons. Participants were followed for 3 years when a diagnosis of dementia was assessed.

The results showed that after adjusting for other risk factors, older persons with feelings of loneliness were more likely to develop than people without such feelings. Social isolation was not associated with a higher dementia risk.

Tjalling Jan Holwerda Dorly J H DeegAartjan T F BeekmanTheo G van TilburgMax L StekCees JonkerRobert A Schoevers  Feelings of loneliness, but not social isolation, predict dementia onset: results from the Amsterdam Study of the Elderly (AMSTEL)

Loneliness and eating disorders

This article examines the link between loneliness and eating disorders by undertaking a systematic review of the literature that links loneliness and eating disorders and through a survey of themes connecting the 2 conditions. Characteristics that have been associated with loneliness clearly relate to all eating disorders including anorexia nervosa, bulimia nervosa, and ednos (eating disorders that are not otherwise specified which includes binge eating disorder). Loneliness contributes to and fuels eating disorder symptoms. Negative interpersonal relationships, both real experiences and individuals’ skewed perceptions, exacerbate eating disorders and feelings of loneliness. The authors note that understanding this relationship is vital, so that clinicians can appreciate a patient’s struggles and work to target these intense emotions within the treatment setting.

Levine MP. Loneliness and eating disorders. J Psychol. 2012 Jan-Apr;146(1-2):243-57. doi: 10.1080/00223980.2011.606435. PMID: 22303623.

The Hidden Voice of Loneliness

This report stated that by reducing loneliness the quality of life for people with dementia could be improved. Local authorities and other carers should understand the needs of people with dementia in the context of living within the community, and work together to commission a wide range of services to ensure that they are not socially isolated or lonely. Examples include social groups, such as dementia cafés, services suitable for younger people with dementia, befriending services that allow people with dementia living alone to have regular contact with a person they trust and accessible transport to allow people with dementia to attend social clubs or other services.

Kane M, Cook L. Dementia 2013: the hidden voice of loneliness. London: Alzheimer’s Society; 2013.

Loneliness and risk of Alzheimer’s Disease

The authors noted that whilst social isolation in old age had been associated with the risk of developing dementia, the risk associated with loneliness was not well understood. They hypothesised that loneliness is associated with increased risk of Alzheimer’s disease. A total of 823 older persons were recruited from senior citizen facilities in and around Chicago. At death, a uniform post-mortem examination of the brain was conducted to quantify Alzheimer’s disease pathology within the brain. During follow-up, 76 subjects developed clinical Alzheimer’s disease with the risk of developing Alzheimer’s disease more than doubling in those who were lonely.  

Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, Tang Y, Bennett DA. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007;64(2):234–40.