Is Loneliness Just Another Form of Depression?

A few weeks ago I attended a panel discussion looking at the stigma of mental illness. It was well attended by a wide variety of mental health professionals and I had the opportunity to speak to a few of them about my work with loneliness. Typically, I got two responses: one response was to acknowledge the importance of loneliness they see in their clients, and two, they subsumed loneliness as a form of depression. Indeed the thinking that loneliness is somehow a form of depression has a long history and it is not unusual that I get asked the question, “isn’t loneliness just a form of depression?” One of the most powerful results of this thinking is that loneliness is not a problem to be treated specifically, but rather, a symptom of a deeper, underlying depression. This thinking can occur not only in the therapist that may be treating a client, but also in a client, who is unable to successfully name their feeling as loneliness instead of depression.

Partly the reason that loneliness has been assumed to be a form of depression is due to the fact that the two tend to be highly correlated. Weeks, Michela, Peplau, & Bragg (1980) discussed this concept more than three decades ago, highlighting the problem of co-occurrence of depression and loneliness. Their research concluded that loneliness and depression were in fact two separate constructs. But how then are they different? Cacioppo & Patrick (2008) aptly describe loneliness as a social pain, a result of the lack of intimate relationships desired by a person. It is, in a very real sense, a motivational drive, such as hunger or sleepiness. This loneliness “drive” is linked to the need to belong, a need that has been argued is along the same lines as physical needs such as the need for food or sleep (Baumeister & Leary, 1995). More recent work by Eisenberger, Lieberman, & Williams (2003) also found that being rejected activates the same part of the brain associated with physical pain. Loneliness is a perfectly natural reaction a person would have if his/her need to belong is not being met. Depression, on the other hand, is a much more general feeling of sadness, hopeless, or dejection. Unlike loneliness, it isn’t consistently triggered by a particular class of stimuli (such as a lack of social connection/belonging that is associated with loneliness). It is also not a motivational drive, signaling us that a need is not being fulfilled. As Cacioppo & Patrick (2008) point out: “loneliness reflects how you feel about your relationships. Depression reflects how you feel, period.” (pg. 83).

If these two concepts are, in fact distinct, then we can assume there are four possible states with regards to loneliness and depression. To feel (1) lonely and depressed, (2) lonely but not depressed, (3) depressed but not lonely, and (4) neither lonely nor depressed. The first scenario is the one most typically seen and, in general, correlations tend to range from .4 to .6 (Weeks et al., 1980). Later research also demonstrates that there might be a reciprocal interplay between loneliness and depression with the net result of increasing both (Cacioppo, Hughes, Waite, Hawkley, & Thisted, 2006). However, it is also possible to experiences states (2) and (3) and there is research to show that the co-occurrence between loneliness and depression has its limitations (Weeks et al., 1980). One can think of scenarios where people are traveling and feeling lonely because their interactions with loved ones is limited, but they are not depressed. In other words, typical symptoms associated with depression are not apparently, such as feelings of worthlessness, helplessness, hopelessness, fatigue, and loss of interest are not present. Similarly, one could be severely depressed and isolated and yet not feel lonely because he/she desires little contact with others.

So the next time you, someone you know, or a client, comes in and says they feel sad, one should really stop and wonder why exactly they feel sad. If it is that that sadness is related to a lack of social connections or a sense of belonging, then perhaps loneliness is the real problem and not depression. They may actually not be depressed at all. Understanding loneliness as a fundamental problem that needs to be dealt with, arguably, can lead to much more effective results than simply lumping everything together as depression.

References:

Baumeister, R. F., & Leary, M. R. (1995). The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497–529.

Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. a. (2006). Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychology and Aging, 21(1), 140–51.

Cacioppo, J. T., & Patrick, W. (2008). Loneliness: Human nature and the need for social connection (p. 317). New York: W.W. Norton & Company, Inc.

Eisenberger, N. I., Lieberman, M. D., & Williams, K. D. (2003). Does rejection hurt? An FMRI study of social exclusion. Science (New York, N.Y.), 302(5643), 290–2.

Weeks, D. G., Michela, J. L., Peplau, L. a, & Bragg, M. E. (1980). Relation between loneliness and depression: a structural equation analysis. Journal of Personality and Social Psychology, 39(6), 1238–44.