Theodore L. Caputi MPH

Behavioral Health Matters

Loneliness

Lonely in Lockdown?

Here are three things to know about the loneliness epidemic.

Posted Apr 06, 2020

Feeling lonely while social distancing? You may be lonely, but at least you’re not alone. Millions of people around the world are experiencing their first prolonged period without regular social interaction.

Many of us—yes, including many self-described introverts—are beginning to realize the importance of water-cooler chats, team lunches, happy hours, coffee dates, and game nights. If you are one of those people, I urge you to use this experience as an impetus to build empathy towards those who faced loneliness long before the lockdown and to learn more about a public health crisis that will last long after COVID-19 has faded away—the loneliness epidemic.

It may feel strange, at first, to think of loneliness as a public health concern. Sure, loneliness can be uncomfortable or embarrassing, but could it affect more than our egos?

Turns out, hundreds of studies over the past 50 years have documented a strong correlation between loneliness and bad health outcomes, including cardiovascular disease, Alzheimer’s disease, depression, anxiety, and premature death.1 Biomedical researchers have found that loneliness interferes with the body’s inflammatory response2 and even prompts brain cravings similar to hunger.3 Perhaps the most poignant finding comes from Holt-Lunstad’s landmark 2010 meta-analysis: loneliness is associated with an increased risk of early death comparable to that of smoking 15 cigarettes per day.4

Loneliness isn’t just severe; it’s common.5 For example, a 2018 survey administered by Cigna found that nearly half of American adults report feeling lonely at least sometimes,6 and an AARP survey found that over one-third of Americans over 45 experienced chronic loneliness.7 The problem of loneliness is not restricted to older generations. In fact, research suggests that young people are at a particularly high risk of loneliness,8 with some describing Generation Z as the loneliest generation.9 In addition, experts have pointed to declines in household size, marriage rates, volunteerism, and religious affiliation as a cause for concern that loneliness may markedly increase in the decades to come.10

So what should every person know about loneliness?

What is loneliness?

Most researchers think of loneliness as a gap between what we feel we need from other people and what we feel we are receiving from other people. When we desire support from our friends, family, or other loved ones but don’t receive it, we feel lonely.11

This means that, while linked, loneliness is different from “social isolation." Social isolation is when an individual does not have regular social contact with others. Many socially isolated individuals do feel lonely, but if they do not feel an unmet need for support from others, they may not.

On the other hand, millions of individuals who are not socially isolated nevertheless struggle with loneliness—a significant proportion of currently married people feel lonely.7 Both social isolation and loneliness can have negative effects on human health,12 but loneliness may be more challenging to detect.

Loneliness can be tough to overcome.

When we are feeling lonely, sometimes the solution is as simple as an invitation to join a club or a phone call from an old friend. However, this is not always the case. Neurological research suggests that, compared with non-lonely individuals, lonely individuals receive larger neural punishments (and smaller neural rewards) for interacting with others.13 That is, lonely people perceive social interactions more negatively than their non-lonely peers, making them less inclined to pursue meaningful social interaction.14

In these cases, cognitive behavioral therapy (CBT) can teach individuals to fight against negative reactions to social interactions.15 Interventions using CBT to combat these feedback mechanisms have shown significant promise in reducing loneliness—often outperforming interventions that increase social contact or improve social skills.

We can all play a role in mitigating the loneliness epidemic.

Remember any feelings of loneliness you may be facing now, and let those feelings motivate you to act even after the lockdown is over. Simple steps include the following:

  • Spread awareness of loneliness. Many people feel embarrassed by their loneliness. If we reduce the stigma surrounding loneliness, we can make it easier for lonely people to seek out therapeutic help and social connections.
  • Form a weekly habit of taking a few minutes to reconnect with a friend or family member. If the quarantine has taught us anything, it’s how to use Skype, Facebook Messenger, Zoom, and FaceTime. Use these tools to form meaningful connections with those who may feel isolated.
  • Campaign to make loneliness a government priority. Government support is necessary to discover and implement the best interventions to reduce loneliness. The United Kingdom (UK) government has taken a global leadership role in this respect, having appointed an official “Minister for Loneliness” and produced a formal loneliness mitigation strategy involving community groups, businesses, and other stakeholders. Other nations can follow suit. Further, government health agencies can work to make CBT more accessible to those who need it.
  • Support local and national non-profit organizations that aim to reduce loneliness. Organizations like the Campaign to End Loneliness and Little Brothers sponsor programs to build human connection among lonely individuals, and they need your support.

For many of you, your feelings of loneliness may die out when the lockdown ends and normal times resume. But try not to forget how loneliness feels. Recall the simple things others did to make you feel less lonely—a call from your mother, a remote board game with a friend—and pay it forward. Commit to joining the fight against loneliness. 

References

1. Hawkley LC, Cacioppo JT. Loneliness and pathways to disease. Brain, Behavior, and Immunity. 2003;17(1, Supplement):98-105. doi:10.1016/S0889-1591(02)00073-9

2. Cole SW, Capitanio JP, Chun K, Arevalo JMG, Ma J, Cacioppo JT. Myeloid differentiation architecture of leukocyte transcriptome dynamics in perceived social isolation. Proc Natl Acad Sci USA. 2015;112(49):15142-15147. doi:10.1073/pnas.1514249112

3. Denworth L. The Loneliness of the “Social Distancer” Triggers Brain Cravings Akin to Hunger. Scientific American. https://www.scientificamerican.com/article/the-loneliness-of-the-social-distancer-triggers-brain-cravings-akin-to-hunger/. Published April 2, 2020. Accessed April 2, 2020.

4. Holt-Lunstad J, Smith TB, Layton JB. Social Relationships and Mortality Risk: A Meta-analytic Review. PLOS Medicine. 2010;7(7):e1000316. doi:10.1371/journal.pmed.1000316

5. Lee EE, Depp C, Palmer BW, et al. High prevalence and adverse health effects of loneliness in community-dwelling adults across the lifespan: role of wisdom as a protective factor. Int Psychogeriatr. 2019;31(10):1447-1462. doi:10.1017/S1041610218002120

6. Cigna. Cigna U.S. Loneliness Index. May 2018. https://www.multivu.com/players/English/8294451-cigna-us-loneliness-survey/docs/IndexReport_1524069371598-173525450.pdf. Accessed April 2, 2020.

7. Anderson GO. Loneliness Among Older Adults: A National Survey of Adults 45+. AARP. doi:10.26419/res.00064.001

8. Victor CR, Yang K. The Prevalence of Loneliness Among Adults: A Case Study of the United Kingdom. The Journal of Psychology. 2012;146(1-2):85-104. doi:10.1080/00223980.2011.613875

9. Trinko K. Gen Z is the loneliest generation, and it’s not just because of social media. USA TODAY. https://www.usatoday.com/story/opinion/2018/05/03/gen-z-loneliest-generation-social-media-personal-interactions-column/574701002/. Accessed April 2, 2020.

10. Holt-Lunstad J. The Potential Public Health Relevance of Social Isolation and Loneliness: Prevalence, Epidemiology, and Risk Factors. Public Policy Aging Rep. 2017;27(4):127-130. doi:10.1093/ppar/prx030

11. Coyle CE, Dugan E. Social Isolation, Loneliness and Health Among Older Adults. J Aging Health. 2012;24(8):1346-1363. doi:10.1177/0898264312460275

12. Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. PNAS. 2013;110(15):5797-5801. doi:10.1073/pnas.1219686110

13. Selfhout M, Denissen J, Branje S, Meeus W. In the eye of the beholder: perceived, actual, and peer-rated similarity in personality, communication, and friendship intensity during the acquaintanceship process. J Pers Soc Psychol. 2009;96(6):1152-1165. doi:10.1037/a0014468

14. Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends Cogn Sci (Regul Ed). 2009;13(10):447-454. doi:10.1016/j.tics.2009.06.005

15. Masi CM, Chen H-Y, Hawkley LC, Cacioppo JT. A Meta-Analysis of Interventions to Reduce Loneliness. Pers Soc Psychol Rev. 2011;15(3). doi:10.1177/1088868310377394