29 October 2021
This article was guest written for Ending Loneliness Together by Dr Michelle Lim, Australia’s leading scientific expert in loneliness, Director of the Social Health and Wellbeing (SHAW) Laboratory, and Chair and Scientific Chair of Ending Loneliness Together.
Loneliness, defined as a subjective feeling of social isolation, where you feel your current relationships fail to meet your social needs [1] , was an emerging issue before the onset of the SARS-CoV-2 pandemic. Our need to feel part of a group, in order to thrive and flourish, has long been part of human nature [2]. Hence, when we feel like no one understands us, and no one has our back, that is we feel lonely (perhaps persistently or in a distressing level), our health suffers.
While loneliness is not by any means a new condition, the research has extended to better understand the health impact beyond the effects of physical social isolation. The scientific evidence that loneliness should be considered a determinant of poor health, independent of social isolation [3] has been growing for the last three decades. Loneliness works synergistic with social isolation to lead to poorer outcomes, including mortality [4].
“Loneliness is rarely a focus within mental health care, highlighting a major gap in translating research into clinical practice.”
Higher levels of loneliness predicted higher levels of depression, social anxiety, and nonclinical paranoia in the general community [5]. In adults aged 50-68, loneliness predicted more depression but not vice versa [6]. Loneliness has been associated with many mental disorders. People who reported loneliness were also more likely to report having a diagnosis of depression (10.85 times more likely), reported a phobia (11.66 times more likely), and obsessive-compulsive disorder (9.78 times more likely) [7].
Australians who reported a psychotic disorder identified loneliness as one of three top challenges in daily life [8], but loneliness is rarely a focus within mental health care, highlighting a major gap in translating research into clinical practice. Even after accounting for the presence of clinical mental disorders, higher loneliness is significantly associated with suicidal ideation and attempts. Those who were identified in the highest loneliness group were 3.45 times more likely to have made a suicide attempt in their lifetime, and 17.37 times more likely to have made a suicide attempt in the past 12 months [9].
“You are more likely to report higher loneliness, depression, and social anxiety symptoms if you are younger (aged 18-25), unemployed, had lower income, and lived alone.”
Social restrictions, a public health measure to curb the rate of infectious diseases, increases social isolation, reducing the frequency of in-person interactions, which could lead to increased loneliness. The COVID-19 pandemic highlighted the importance of loneliness and social isolation [10]. In cross-sectional studies, stay-home orders contributed to higher depression and loneliness, together with lower income and younger age, in the USA [11], and were associated with higher anxiety, depression, and loneliness in Germany [12].
My colleagues and I examined the impact of social restrictions on loneliness, depression, and social anxiety over the first six months of the pandemic . In this study, we coded country-mandated social restrictions by reviewing government websites and extracted a social restrictions severity through an independent coding process. As country-mandated lockdown and social restrictions ease, we found that loneliness reduced, depression remained unchanged, and social anxiety symptoms increased as social restrictions severity eased in the first six months of the pandemic. You are more likely to report higher loneliness, depression, and social anxiety symptoms if you are younger (aged 18-25), unemployed, had lower income, and lived alone.
Loneliness continues to be treated as a by-product of mental health problems as opposed to an underlying driver of mental ill health and continue to be seen as an issue that affects specific groups of people (e.g., people with a mental illness).
As Australia moves towards social and economic recovery, it is clear that we should work together to combat the onset of chronic loneliness beyond traditional health service delivery models. Our current models of health care, including mental health care, have not yet accounted for importance role of loneliness in both prevention and targeted approach.
We can synergise and work together to address loneliness for better health outcomes, including better mental health. The figure illustrates different points of interventions, mainly within the prevention, to prevent loneliness, and intervention to address distressing feelings of loneliness. There are three pathways where we can address loneliness: 1) within health services sectors; 2) within our community and social service sectors; 3) within our community.
“We can synergise and work together to address loneliness for better health outcomes, including better mental health.”
We can synergise and work together to address loneliness for better health outcomes, including better mental health. The figure illustrates different points of interventions, mainly within the prevention, to prevent loneliness, and intervention to address distressing feelings of loneliness. There are three pathways where we can address loneliness: 1) within health services sectors; 2) within our community and social service sectors; 3) within our community.
Health care goes across prevention (e.g., health promotion) and intervention (e.g., acute-chronic services). Health promotion services are just beginning to understand the importance of meaningful social connection to both physical and mental health.
Within clinical services, there is no emphasis on promoting meaningful social relationships outside their model of care. There are constraints to what clinicians can do (i.e., inability to offer reciprocated care which has been shown to moderate the distress of mental health symptom severity [13] ).
Second, there are no guidelines of how to identify people at risk of loneliness, including the lack of sector training programs in our frontline workers in the health sectors (e.g., GPs, nurses, health care intake workers). Recent research has noted that GPs are reluctant themselves to speak about loneliness to patients [14].
The recent focus on social prescribing offers hope but many programs primarily focused on reducing social isolation. We can tweak and modify the frameworks that underlie these programs, specifically, to be consistent with the evidence-base, and its effectiveness on loneliness. When done well, social prescribing programs has shown a reduction in loneliness but the effects are short-term. The over reliance of social connection on linked workers (i.e., volunteers) mean that when program is complete, the person may experience loneliness again [15].
We have to look towards informal community and social supports around us to manage loneliness. The capacity for our fellow citizens to not just manage their own loneliness but also to empower themselves to help others is under-utilised. Community awareness of loneliness is low and often ladened with misconceptions of what loneliness is and is not. This can inhibit people from reaching out early for fear of stigma associated with loneliness [16].
With thanks to Dr Michelle Lim for this article. You can learn more about Dr Lim’s profile and work here.
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