Loneliness is an emerging public health threat

Loneliness is an emerging public health threat
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Everyone feels isolated sometimes, but with one in five Americans chronically lonely, has loneliness reached epidemic proportions? In 1988, the journal Science published a landmark study suggesting isolation was as strong a risk factor for morbidity and mortality as sedentary lifestyle, high blood pressure and smoking or obesity. Since then, loneliness has become an increasing public health concern and health officials are now taking the idea of an epidemic seriously. As the population ages, the burden of social isolation on public health will only increase.

Loneliness is one aspect of interrelated conditions such as isolation due to illness, disability or age; the social and language-based isolation of being an immigrant; depression; poverty; discrimination, etc.

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This past summer, two surveys made news, marking the extent of loneliness in the U.S. and other economically developed countries. Since these and other studies are new, we can anticipate learning more about the interrelationships of factors that contribute to loneliness over time. That shouldn't stop us from addressing the problem now, but may help provide better perspective.

The most recent survey, from The Economist and the Kaiser Family Foundation, finds that 9 percent of adults in Japan, 22 percent in America and 23 percent in Britain “always” or “often” feel lonely or lack companionship. Another study of 20,000 U.S. adults, 18 and older, published in May by Cigna and market research firm Ipsos, reveals nearly half of American adults reported “sometimes” or “always” feeling alone (46 percent) or left out (47 percent); more than one in four Americans (27 percent) “rarely” or “never” feel that people understand them; and 43 percent of Americans “sometimes” or “always” feel their relationships lack meaning and they are isolated. One finding stands out: Generation Z (22 years and younger) scored the lowest of every age-group and appears to be more prone to experiencing significant loneliness. Gen Z may be the loneliest generation.

Regarding health impacts, several recent studies have found that loneliness is a risk factor for decreased resistance to infection, cognitive decline and conditions such as depression and dementia.

A UC San Francisco 2010 study found loneliness to be a predictor of functional decline and death among adults 60 and older. Over six years, lonely subjects were more likely to experience decline in activities of daily living (24.8 percent vs. 12.5 percent); develop difficulties with upper extremity tasks (41.5 percent vs. 28.3 percent); experience decline in mobility (38.1 percent vs. 29.4 percent) or climbing (40.8 percent vs. 27.9 percent); and face increased risk of death (22.8 percent vs. 14.2 percent). It appears that without social interaction, we languish and decline, though it’s possible that greater longevity, coupled with functional decline, leads to social isolation.

At the other end of the spectrum are challenges faced by young adults. Two 2017 national surveys of adolescents, in grades eight to 12, found among lonely individuals, especially females, depressive symptoms and suicide rates increased between 2010 and 2015. The studies found adolescents who spent more time on social media and devices such as smartphones more likely to report mental health issues, though it’s not clear if the self-directed isolation of screen time leads to or results from loneliness.

While we need to know more about causes to stanch this epidemic, many studies identify ways to minimize the effect of loneliness. Socializing with friends and family and increasing meaningful face-to-face interactions decreases loneliness. Those with active social lives report better health. Strong social affiliations — such as being part of a religious group, hobbyist circle or exercise group — have positive effects. Doctors in the United Kingdom make “social prescriptions,” specifying patients take part in structured social activity.

It seems a widely held belief that pet ownership mitigates loneliness. While evidence supporting this belief is weak, one recent study found that having a pet results in later reporting of feelings of isolation among elderly women.

Lonely people are often less active. Increased activity may have very beneficial effects, such as reducing feelings of loneliness, though not by itself. Physical activity seems to work in combination with good relationships, though there may be reverse causation here: Those who are less lonely may tend to maintain physical activity.

While technology may contribute to isolation, it can also help. Simple phone conversations with loved ones can confer isolation-busting benefits. Phone calls or direct messaging on social media can also help. Even robot technology is being used to combat the loneliness arising from physical and social isolation for people of all ages in several industrialized countries.

Finally, regarding those isolated adolescents: Studies find those who spend more time taking part in in-person social interactions, sports and exercise; doing homework; reading print media and attending religious services were less likely to experience feelings of isolation and depression.

As National Depression Education and Awareness Month begins, it makes sense to consider loneliness as a public health challenge, but one for which we have some answers.

The social isolation that is its hallmark can be alleviated through a combination of elements; most important among these is socializing. Our friendships, strong social affiliations and family relationships are the keys to beating loneliness and leading a more fulfilling life.

Jonathan Fielding, M.D., is a professor of public health and pediatrics at University of California, Los Angeles.