Loneliness, An Underrated Significant Health Risk?

According to the most recent statistics, loneliness is at "epidemic" levels in the U.S. In a 2018 Cigna insurance health survey1,2,3 of 20,000 individuals aged 18 and over:

  • 46% report sometimes or always feeling lonely
  • 47% say they feel left out
  • 47% say they do not have meaningful in-person social interactions or extended conversations on daily basis
  • 43% sometimes or always feel the relationships they have aren't meaningful
  • 43% report feeling isolated

    The loneliest are young adults between the ages of 18 and 22. This age group also rated their health the lowest, which correlates with science linking loneliness with a greater risk for obesity,4 heart disease,5 anxiety,6 dementia7 and reduced life span.8 In fact, maintaining strong and healthy social connections has been linked to a 50% reduced risk of early death.9,10 Similarly, emotional loneliness is linked with an increased risk of all-cause mortality.11

    Studies have also shown that people who are lonely are more likely to experience higher levels of perceived stress,12 increased inflammation,13 reduced immune function14 and poor sleep.15,16

    A 2011 study17 found that for each 1-point increase on the UCLA loneliness scale,18 an individual is 8% more likely to experience some sort of sleep disruption. Research19 has also shown that lack of sleep has the effect of triggering feelings of loneliness, so the two problems tend to feed on each other.

    Somewhat surprisingly, seniors over the age of 77 — an age group well-known for loneliness — had the lowest loneliness score in Cigna's survey;20 77% also rated their physical health as good, very good or excellent, compared to just 65% of younger Gen X'ers.

    Loneliness Translates Into Higher Health Care Costs

    Even the U.S. Health Resources & Services Administration (HRSA) acknowledges21 there's an "epidemic" of loneliness in the U.S., and that it's taking a mounting toll on public health.

    According to HRSA,22 a panel presentation by the National Institute for Health Care Management — a nonprofit research firm for the health insurance industry — revealed social isolation among seniors is costing the federal government $6.7 billion each year in added health care spending, as "poor social relationships" are associated with a 29% higher risk of heart disease and a 32% increased risk of stroke.

    Research by the AARP Foundation — an organization dedicated to empowering American seniors — presents a similar picture. In its 2018 survey,23 "Loneliness and Social Connections," the AARP reports that 35% of adults over 45 struggle with loneliness. Among those making less than $25,000 a year, the loneliness ratio is 1 in 2.

    Aside from financial woes, a diagnosis of depression or anxiety, living in an urban community and the increased use of technology for communication are identified as factors that increase feelings of loneliness.24

    Investigating Loneliness

    Why is loneliness becoming an increasingly prevalent experience? Through interviews with leading experts around the world, author and investigative journalist Johann Hari has tried to sort out why so many of us struggle with loneliness, depression and anxiety, and what we can do to turn the tide.

    In the featured video, "The Loneliness Epidemic," filmmaker Matt D'Avella interviews Hari about his findings. In his book, "Lost Connections," Hari investigated the causes behind rising anxiety and depression rates.

    Through his travels and interviews, he identified nine scientifically verified causes of depression — only two of which are biological. The remaining seven are all related to how we live.

    Once we understand these root causes, it opens up a broader range of possible solutions, Hari notes, pointing out that all around the world, the most effective strategies are the ones that address the real reasons behind people's distress.

    Loss of Tribal Communities Have Taken a Toll

    In his book, Hari cites research looking at reported loneliness scales. One question in this study was, "How many close friends do you have that you can turn to in a crisis?"

    The most common answer in the past used to be five. Today, the most common answer is "none." Half of Americans also say that nobody really knows them well. Historically, mankind survived because we banded together and worked as a group. Our very survival often depended on being part of a tribe.

    Without a tribe, "we're depressed and anxious for a reason," Hari says. "You're in terrible danger; you're about to die … We are the first humans ever, in the long … history of our species to try to disband our tribes, and it is making us feel awful."

    Recreating Holistic Communities

    Understanding this, how can we fix it? In "Lost Connections," Hari details how Sir Sam Everington,25 a British doctor in East London, tackled the problem by inviting patients struggling with depression and anxiety to gather and do things together as a group.

    As city slickers, none knew much about gardening, so they decided to turn an abandoned plot of land behind Everington's practice into a group garden. In learning about gardening, and meeting to share and implement their newfound knowledge, they formed a "tribe."

    And with that, "they did what people do when they are part of a tribe," Hari says, "they began to care about each other … they began to solve each other's problems." As one of the participants told Hari, "As the garden began to bloom, we began to bloom."

    Hari cites a similar program in Norway, which showed group gardening to be twice as effective as antidepressants. In his view, there are obvious reasons for this. Forming relationships addresses the reasons people feel bad in the first place.

    The Paradoxical Role of Technological Hyperconnectedness

    Paradoxically, while loneliness and anxiety are at an all-time high, modern humans are also the most interconnected technologically. Video calls are readily available and social media platforms abound. We're sharing more of our lives with more people than ever before — or so it seems. Yet it's not making us feel more connected.

    Hari admits it's a complex issue. To understand this paradox better, he visited the world's first internet rehab center in Spokane, Washington. A vast majority of patients are young men addicted to multiplayer games. To address their addiction, a key question that needs to be answered is, "What are these young men getting out of playing these games?" Hari says:

    "I think what they're getting is a kind of hollow version of the thing they used to get from society long ago — They get sense of tribe, they get a sense of status, they get the sense they're good at something, they get the sense they're moving around. Young people barely leave their homes now. It's incredible how rarely children play outdoors."

    The problem is, "we didn't evolve to talk through screens," Hari says, likening the problem with internet game addiction to that of pornography versus real sex. If all you know about sex is from viewing pornography, dissatisfaction is bound to arise because it doesn't fulfill the biological need of actual sex.

    Hari points out that even when people can see each other on a screen, the feeling of being fully "seen," as when you are physically face to face, remains absent.

    "Human beings have a need to be seen," he says, adding "the leading expert on loneliness in the world, [the late] professor John Cacioppo,26 said … if social media is a waystation for meeting people offline … it's a good thing. [But] if it's the last stop of the line, generally something's gone wrong."

    Hari points out that when the internet, and social media in particular, arrived on the scene, the sense of community was already waning, and social media gave the appearance of giving back to us something of what we'd lost — friends and status being two examples.

    But it's not a proper replacement. Hari refers to social media as a "parody" of the social connectedness we used to have in the past. "So, what we need to do, in very practical ways, is to restore what we've lost," Hari says.

    Is There a Connection Between Materialism and Happiness?

    As noted by D'Avella, modern humans are living exceptionally safe and materially comfortable lives. However, materialism and consumerism also serves as a distraction from personal interrelationships. Is there a correlation between material wealth and happiness? he wonders.

    Hari cites research by professor Tim Kasser,27 who has studied materialistic values and goals. Like junk food has led to a mass deterioration of health, Kasser believes "junk values" have infiltrated and deteriorated our mental space as well. Kasser's research conclusively showed that the more you're driven by money and status, the more likely you are to succumb to depression. Hari says:

    "I believe this is because everyone knows they have natural physical needs, right? You need food, you need water, you need shelter, you need clean air — if I took these things away from you, you'd be in real trouble real fast. But there's equally strong evidence that all human beings have natural psychological needs.

    You need to feel you belong … that your life has meaning and purpose, you need to feel that people see you and value you, you need to feel you've got a future that makes sense. Our culture is good at lots of things … but we're getting less and less good at meeting these deep underlying psychological needs."

    Kasser also did research to identify ways to undo some of these effects. The answer turned out to be simple. When people would meet on a regular basis to discuss their materialistic values — such as the feeling they "needed" a certain brand sneaker — it didn't take long before they began shifting their values, realizing these material acquisitions would not make a difference in their life.

    They would also discuss moments in which they felt most satisfied with life, and once the participants had identified activities that made them feel good, they were asked to figure out ways of incorporating more of that into their day-to-day lives.

    "Just that process of meeting every couple of weeks and checking in with each other … led to a measurable shift in people's values," Hari says. "They became less materialistic, which we know relates to less depression and anxiety."

    According to Hari, research clearly shows that poverty is linked to unhappiness. We all need some basics. But once the basics are covered, additional money does not translate into greater happiness. What's more, it's the constant seeking of more money that ultimately corrupts your values and lead to unhappiness.

    On the Minimalism Movement

    D'Avella brings up the minimalism movement with its focus on simpler living with fewer material belongings, favoring "simple pleasures" and human interactions instead. Is this movement part of the answer? The answer is likely yes.

    Hari cites a simple study from the late 1970s in which children were divided into two groups. One group was shown two advertisements for a popular toy while the other group was not shown any advertisements. The two groups were then told to choose between two options: Play with a friendly boy who did not have the toy in question, or play with an unfriendly boy who had the toy.

    Children who'd just seen the advertisements overwhelmingly chose to play with the unfriendly boy with the toy, whereas children who'd not been exposed to the advertisements overwhelmingly chose to play with the friendly boy. "Just two ads were enough to prime those kids to choose an inanimate lump of plastic over the possibility of fun and connection," Hari says.

    This, in essence, proves advertising works. Its very purpose is to first make you feel dissatisfied or inadequate, and then present the solution to that dissatisfaction — buy this thing and you won't be dissatisfied or inadequate anymore. Advertising sells solutions to manufactured wants.

    "The idea that we might want to step off that treadmill — I've got a limited amount of time in which to be alive; maybe I'll spend my time on things that are more meaningful — seems to me to be a really positive step," Hari says.

    Loneliness Linked to Increased Risk of Parkinson's Disease: Study

    While doctors have long known that genetics, toxins, and head injuries can increase the risk of developing this progressive movement disorder, 2023 research published in JAMA Neurology indicates that loneliness could also play a pivotal role.

    This is the first time an emotional state has been established as a potential risk factor for the neurodegenerative disease, according to the study authors.

    To see if loneliness is linked to Parkinson’s risk, researchers at Florida State University conducted a large cohort study. They analyzed data on nearly 500,000 participants aged 38 to 73 years from the UK Biobank biomedical database and research resource, which houses extensive genetic and health data from over half a million UK residents.

    The researchers tracked health surveys and status over 15 years. In that time, over 2,800 people developed Parkinson’s disease.

    Participants self-reported loneliness by answering: “Do you often feel lonely?”

    Social isolation was measured by the frequency of friend or family visits, frequency of leisure or social activities, and household size.

    Researchers controlled for various factors known to influence risk, including demographics, diabetes, genes, socioeconomic status, social isolation, smoking, physical activity, and body mass index (BMI).

    Results showed loneliness was significantly associated with later Parkinson’s diagnosis. This held true across age, genetic risk, and sex. However, accounting for chronic conditions like diabetes reduced the association by 13.1 percent.

    In sensitivity analysis excluding participants under 50, the relationship persisted. Loneliness did not link to Parkinson’s in the first five years after baseline but became associated over the subsequent 10 years.

    Overcoming Loneliness

    If you struggle with loneliness, you're certainly not alone. A number of remedies are addressed in the featured interview with Hari. Following are several other strategies, pulled from a variety of sources, that can help address loneliness:28,29

    Join a club — Proactive approaches to meeting others include joining a club and planning get-togethers with family, friends or neighbors, Meetup.com is an online source where you can locate a vast array of local clubs and get-togethers. Many communities also have community gardens where you can benefit from the outdoors while mingling with your neighbors.

    Learn a new skill — Consider enrolling in a class or taking an educational course.

    Create rituals of connection — Rituals are a powerful means for reducing loneliness. Examples include having weekly talk sessions with your girlfriends and/or making meal time a special time to connect with your family without rushing.

    Consider a digital cleanse — If your digital life has overtaken face-to-face interactions, consider taking a break from social media while taking proactive steps to meet people in person.

    Research shows Facebook may be more harmful than helpful to your emotional well-being, raising your risk of depression — especially if your contacts' posts elicit envy. In one study,30 Facebook users who took a one-week break from the site reported significantly higher levels of life satisfaction and a significantly improved emotional life.

    Make good use of digital media — For others, a phone call or text message can be a much-needed lifeline. Examples of this include sending encouraging text messages to people who are struggling with loneliness, offering support and help to live healthier lives and follow through on healthy lifestyle changes.

    Exercise with others — Joining a gym or signing up with a fitness-directed club or team sport will create opportunities to meet people while improving your physical fitness at the same time.

    Shop local — Routinely frequenting local shops, coffee shops or farmers markets will help you develop a sense of community and encourage the formation of relationships.

    Talk to strangers — Talking to strangers in the store, in your neighborhood or on your daily commute is often a challenge, but can have many valuable benefits, including alleviating loneliness (your own and others'). Talking to strangers builds bridges between ordinary people who may not otherwise forge a connection.

    People of the opposite gender, different walks of life or different cultures hold a key to opening up to new ideas or making connections with old ones. 

    Volunteer — Volunteering is another way to increase your social interactions and pave the way for new relationships.

    Adopt a companion pet — A dog or cat can provide unconditional love and comfort, and studies show that owning a pet can help protect against loneliness, depression and anxiety. The bond that forms between a person and a companion pet can be incredibly fulfilling and serves, in many ways, as an important and rewarding relationship. The research on this is really quite profound.

    For instance, having a dog as a companion could add years to your life,31 as studies have shown that owning a dog played a significant role on survival rates in heart attack victims. Studies have also revealed that people on Medicaid or Medicare who own a pet make fewer visits to the doctor.32

    The unconditional acceptance and love a dog gives to their owner positively impacts their owner's emotional health in ways such as:

    • Boosting self-confidence and self-esteem
    • Helping to meet new friends and promoting communication between elderly residents and neighbors
    • Helping you cope with illness, loss and depression
    • Reducing stress levels
    • Providing a source of touch and affiliation

    If you're looking for a furry friend, check out your local animal shelter. Most are filled with cats and dogs looking for someone to love. Petfinder.com33 is another excellent resource for finding a pet companion.

    Move and/or change jobs — While the most drastic of all options, it may be part of the answer for some. To make it worthwhile, be sure to identify the environment or culture that would fit your personality best and consider proximity to longtime friends and family.

    Sources and References

    This article is part of the mental health series of articles.

    ♬ original sound - One Day MD



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