Loneliness has serious health risks and the solution is social
(27 February 2014)
Dr Keming Yang looks at how those suffering from loneliness have a higher risk of death.
First published in The Conversation
Anyone who has experienced feelings of loneliness knows how terrible it is. In his poem To Edith, Bertrand Russell calls loneliness “the solitary pain” and evokes the “ecstasy and peace” his wife gave him after “so many lonely years”. Those who seek out loneliness are normally confusing it with spiritual solitude.
Unfortunately, loneliness can do much more harm than simply produce an unpleasant feeling. It has an enormous impact on physical health too. Researchers have shown that the list of damages to your health caused by loneliness runs scarily long: depression, cognitive dysfunction, high blood pressure, inflammation, altered immunity to disease – the list goes on.
Most frightening of all is the connection between loneliness and an increased risk of death. This was raised recently at the American Association for the Advancement of Science’s annual meeting in a seminar on the science of resilient ageing. John Cacioppo gave an alarming warning from his research on the topic: older adults with the highest levels of loneliness are nearly twice as likely to die prematurely than those with the lowest levels of loneliness.
Cacioppo and his colleagues did not claim that loneliness directly caused mortality. What they aimed to find out was whether loneliness affected mortality through depression, self-reported health conditions and physical functions. Analysing the data collected from the Health and Retirement Study, they found that health conditions and physical functions were significant mechanisms but depression was not.
This makes sense. Except for suicide, which is relatively rare and usually caused by serious depression, psychological problems can only increase the risk of death by creating physical problems. In other words, those suffering from loneliness have a higher risk of death because loneliness makes their physical health deteriorate. Lonely people who keep themselves physically active and healthy should enjoy low risk of death, just as the non-lonely ones do.
If we connect the above medical consequences of loneliness with the figure estimated by Campaign to End Loneliness that 800,000 people in England suffered from “chronic loneliness”, then we would understand why Health Secretary Jeremy Hunt has called the situation a “national shame”. But health secretaries in many other countries should be much more worried than Hunt.
My research into age and loneliness across Europe shows that loneliness is actually much less prevalent in Britain than most other European countries. The most worrying cases are the former Communist countries of Eastern Europe where between 10-16% of surveyed adults reported frequent loneliness; Ukraine has the highest rate of 23%. The Nordic countries, however, are more successfully managing to keep loneliness in older people at bay. The causes behind these national differences are unclear, but at the individual level, having intimate and close social relations is clearly necessary.
But what makes people feel lonely in the first place? The definition of loneliness is also an explanation for it. It is most commonly defined as a deficit of desired social relations. That is, people feel lonely because they do not have the social relations they want. A person could have one good friend or spouse and not feel lonely, or have lots of social interactions that they find unsatisfactory and that leave them feeling lonely anyway.
This kind of definition is inherently comparative and complicated, varying from person to person. Loneliness is the difference between the existing social relations and desired ones; if a person desires more social relations than they have, the feeling of loneliness emerges.
Simple arithmetic does not work when defining loneliness. It is very hard, if possible at all, to pin down what social relations people want – everybody has their own criteria. People may not even know what levels of social interaction they want and it could depend on different situations they find themselves in. Even measuring existing social relations is a great challenge.
Social relations also have different aspects, for example the quantity and quality of personal interactions, a person’s position in a set of relations and their social position at different points in time. Due to the complexity of these aspects, loneliness is usually measured by respondents’ own assessment or their reactions to a set of statements.
Without knowing what kind of social relations people would like to have and they actually have, we will not know the immediate causes of loneliness. The current practice is to discover significant associations between reported loneliness and some sensible “risk factors”. These include a person’s marital status, living arrangement, physical mobility and health conditions. Analyses of these associations are helpful as they could identify the groups vulnerable to loneliness.
To better tackle the serious problem of loneliness, we need valid and reliable information about people’s social lives. This will make it possible to identify the immediate causes of loneliness and improve people’s health.