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Surviving Loneliness

How dangerous is loneliness to your health?

Although loneliness is something we all have to deal with at times, does chronic loneliness lead to serious health risks? A new article published in Health Psychology suggests that might be the case, especially over the long run. 

A team of researchers at the Ohio State College of Medicine and the National Cancer Institude conducted two studies looking at the long term effects of loneliness on survival. Loneliness, defined as the experience of perceived social isolation,  has long been linked to various medical concerns, including heart disease. In terms of relative survival, loneliness appears to be as great a health risk as being obese and inactive. Even when other medical problems are controlled for, the effect of loneliness on health is extreme.

The two studies focused on the effect of lonelines on the depression, chronic pain, and fatigue symptom cluster found in a wide range of chronic medical conditions. These three symptoms are often found together since they are mutually reinforcing and can lower quality of life and long-term survival. According to research, lonely people seem especially prone to developing depression, pain, and fatigue over time. Based on the middle-range theory of unpleasant symptoms, these unpleasant symptoms have a joint impact on long-term health outcomes.

In the first study, 115 older adults (average age 56.7 years) consisting of 49 cancer survivors and 66 non-cancer controls were interviewed about six months after cancer surgery. They were then interviewed a second time twelve months later. All participants received the same questionnaire examining loneliness,  pain, depresssion, fatigue, and health outcomes. They were also questioned about quality of sleep and amount of aerobic exercise received regularly.   As expected, lonelier people had consistently higher levels of depression, pain, and fatigue.   Over a one-year period, loneliness also predicted changes over time with symptoms increasing more rapidly for lonelier people. Even when additional factors such as quality of sleep and exercise were taken into account, the relationship between loneliness and the depression-fatigue-pain symptom cluster was still strong.

The second study used a sample of 229 older adults (average age 69.68 years) consisting of 125 caregivers for a spouse with dementia and 104 non-caregiver older adults. Caregivers were examined since they often show greater distress than non-caregivers living in the community. The people in the study fillled out questionnaires during four periods separated by one year each. While many of the questionnaires were similiar to the first study, the people in the second study were also questioned about marital quality. Most of the results were the same as in the first study with loneliness being significantly linked to depression, pain, and fatigue with the symptoms growing stronger over time. Unlike the first study however, controlling for sleep quality and exercise greatly weakened the relationship between loneliness and the other factors. Lack of aerobic exercise and poor sleep quality appear to worsen the effect of loneliness.

Overall, loneliness appears strongly linked to symptoms such as depression, chronic pain, and fatigue and this link appears consistent across different samples of older adults. Sleep and aerobic exercise also appear to play a strong role in helping to offset the effect of loneliness on health in older adults. Pain, depression, and fatigue are commonly found together with chronic pain being reported by around 46 percent of adults with 13 to 27 percent reporting depression, 30 percent reporting fatigue and many people reporting all three at once.   

How pain, depression, and fatigue are linked to loneliness is still hard to determine. It is possible that lonely people slip into a "downward spiral" making the symptoms of pain and depression worse which, in turn, makes people more isolated than before. Having a good social support network might also make pain and depression easier to handle while feeling distressed can make people more isolated.   

Can helping people reduce their feeling of loneliness reduce the pain and depression that seems to go with it? While treatment usually focuses on dealing with these symptoms separately, helping people to overcome feelings of loneliness might be an effective way of learning to cope better with pain and depression. Though pain is usually linked to diseases such as arthritis and  fatigue is often a side-effect of medical treatments such as chemotherapy for cancer, dealing with loneliness can make a difference in helping people cope better with chronic illness.   

Recognizing that loneliness can be as serious a problem as pain and depression can be the key to living a healthier life as people grow older.

Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada.

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