“Social relationships, or the relative lack thereof, constitute a major risk factor for health—rivaling the effect of well-established health risk factors such as cigarette smoking, blood pressure, blood lipids, obesity and physical activity.”1Although this quote was from a meta-analysis published about 28 years ago, only in recent years has chronic loneliness or social isolation come to the fore as a risk factor for significant health consequences. In contrast to my other blogs, the current blog does not focus on patients with cancer: rather, I believe the topic is both important and relevant to all humans, including patients, providers, and caregivers. Part One of the blog will cover the distinction between loneliness and social isolation, the prevalence and timeline of loneliness, and the physical, cognitive, and psychological consequences of loneliness. Part Two will cover the proposed mechanisms by which chronic loneliness impacts health and provide suggestions to help individuals build stronger social connections.
HOW DO YOU DEFINE LONELINESS? WHAT IF SOMEONE JUST ENJOYS BEING ALONE?
You are absolutely right, there is a difference between being alone and loneliness. Loneliness is defined as the perception of social isolation, or the subjective experience of being lonely.2 Loneliness can also be described as the “dissatisfaction with the discrepancy between desired and actual social relationships.3 In other words, one can lead a fairly solitary existence and not feel lonely, or one may be among people all day and not feel connected. The defining factor is the level of satisfaction with the quality of one’s social relationships.
HOW PREVALENT IS LONELINESS? DOES LONELINESS VARY OVER THE LIFETIME?
It is believed that loneliness is increasing due to the decline of both the quality and quantity of social relationships. (I call this the “Starbucks” phenomenon, referring to the fact that even though we may be among people, often we are immersed in our own world, looking at our phones or computer screens, rather than interacting with each other. Next time you are at Starbucks, look around and count how many people are actually talking to each other). Statistically (and more objectively), it is believed that at any one time about 15-30% of the population is experiencing chronic loneliness.4 Rates of loneliness may vary throughout the lifetime, with about 80% of individuals under 18 and 40% of adults over the age of 65 reporting being lonely. Satisfaction with the quality of social relationships rises during middle age, but then decreases among individuals 70 or older.5 It is speculated that by 2030 the prevalence of loneliness may be at epidemic proportions.4
WHAT ARE THE CONSEQUENCES OF CHRONIC LONELINESS?
Loneliness increases the risk of death as much as smoking and more than obesity or physical inactivity! Chronic loneliness may impact individuals in the following domains:
- Physical: Chronic loneliness has been documented to be associated with changes in the cardiovascular, immune, and nervous systems, and raises the risk of cardiovascular disease and stroke.6
- Cognitive: Perceived social isolation has been found to be a risk factor for accelerated cognitive decline, poorer executive function, and lower overall cognitive functioning.7
- Psychological: Chronic loneliness is correlated with lower self-esteem, lower self-efficacy, less frequent use of active coping skills, more depression, and hypersensitivity to perceived social slights.7
- House JS, Landis KR, Umberson D: Social relationships and health. Science 241:540-545, 1988
- Holt-Lunstad J, Smith TB, Baker M, et al: Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Persp Psych Science 10:227-237, 2015
- Peplau LA, Perlman D (Eds): Loneliness: a sourcebook of current theory, research, and therapy. New York, NY: Wiley, 1982
- Heinrich LM, Gullone E: The clinical significance of loneliness: a literature review. Clin Psychol Rev 26:695-718, 2006
- Pinquart M, Sorensen S: Influences on loneliness in older adults: a meta-analysis. Basic App Soc Psych 23:245-266, 2001
- Valtorta NK, Kanaan M, Gilbody S, et al: Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 102:1009-1016, 2016
- Cacioppo JT, Hawkley LC: Perceived social isolation and cognition. Trends Cogn Sci 13:447-454, 2009