Lonely people are not just sadder: they are unhealthier and die younger

Healthcare workers and policymakers in high-income countries are increasingly worried about loneliness. In 2017, US surgeon general Vivek Murthy called loneliness a root cause and contributor to the modern epidemics of alcoholism, drug addiction, obesity, violence, depression and anxiety.

In 2018, then UK prime minister Theresa May appointed a minister for loneliness. “For far too many people, loneliness is the sad reality of modern life,” May said when announcing the new position. The appointment was in response to a commissioned report that found that more than nine million people in the UK, often or always, felt lonely. Other research has found that loneliness varies between countries with 9 per cent of adults in Japan, 22 per cent in the US and 23 per cent in Britain “always or often feeling lonely”.

Research conducted by Prof Rose Anne Kenny, head of the academic department of medical gerontology at Trinity College Dublin and the principal investigator of the Irish Longitudinal Study on Ageing (Tilda) found that a quarter of Irish adults feel lonely some of the time and 5 per cent often feel lonely. Living alone doubles the likelihood of experiencing loneliness. Men who live alone are lonelier than women who live alone. Loneliness increases with age and lonely people are more likely to suffer from depression.

Some of the Covid-19 imposed pandemic interventions, such as self- isolation and social distancing, have exaggerated loneliness for many

It is becoming clearer that loneliness can pose a serious threat to both mental and physical health. “I think most people recognise that it impacts our emotional wellbeing and maybe even our mental health, but very few people recognise the profound effects it has on our neurobiology, which influences our long-term health,” Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University, Utah, told Time magazine.

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The evidence also shows that loneliness can significantly increase the risk of early death. It is associated with Alzheimer’s and other types of dementia as well as mental health disorders including depression and anxiety. It has also been linked to a range of chronic diseases such as heart disease, stroke, type 2 diabetes and cancer.

[ Challenging myths about . . . loneliness ]

Prof Kenny says that although the causal pathways are not fully understood, a large review of the published literature in 2019, conducted by researchers in University College London, identified a beneficial effect on brain function as well as a protective effect against dementia were found with three lifestyle factors: social networks, physical leisure and non-physical activities.

The evidence suggests that these lifestyle factors improve brain function through converging pathways that include building cognitive reserve or brain cell formation and reducing the likelihood of vascular disease. Keeping stress levels low by socialising, physical activity and other non-physical activities also seems to have a key factor in optimal brain function. Prof Kenny states that a higher susceptibility to stress doubles the risk of dementia by triggering chronically high cortisol levels.

“If you take nothing else from this publication other than a determination to build friendships, it will make a difference to your biological age and a difference to others whom you befriend,” Prof Kenny concludes.

Mindfulness practice has been shown to reduce loneliness and to shift gene expression profiles away from a predominantly pro-inflammatory profile associated with increased risk for chronic disease

Unfortunately, some of the Covid-19 imposed pandemic interventions, such as self- isolation and social distancing, have exaggerated loneliness for many. The long-term consequences of these global public health approaches have yet to be fully realised and public health strategies to mitigate these inevitable consequences are needed.

The World Health Organisation (WHO) and the United Nations (UN) have acknowledged the breadth of the problem of loneliness and social isolation and have taken this on at global level. But there is a dearth of evidence-based loneliness programmes and interventions, leaving a research gap that needs filling to justify scaling up of interventions at individual, community and society level.

In a review in Nature (2022) on loneliness and health, principal research scientist Louise Hawkley from the University of Chicago, states that among the few studies providing evidence of health benefits, mindfulness practice has been shown to reduce loneliness and to shift gene expression profiles away from a predominantly pro-inflammatory profile associated with increased risk for chronic disease. Exercise programmes have also been shown benefits for both physical activity and loneliness levels.

“Nevertheless, many of the physiological processes that lead to poor health in older age are not reversible, even when loneliness is, pointing to the need to prevent loneliness early and across the life course,” Dr Hawkley said.

[ Is loneliness a trend of our era? ]

Michelle Lim, the scientific chairwoman of Ending Loneliness Together, a network of Australian organisations, and researcher at Swinburne University, Melbourne, says there is no one size that fits all. “The key to beating loneliness is not just increasing the number of people a person sees but making more fulfilling connections. Reducing loneliness is not just about having people around you but having a meaningful relationship with them.”

Prof Holt-Lunstad agrees. In the same interview, she suggested getting busy to distract yourself and enrich your life – like getting out in nature, taking up a creative hobby or meditating. In a study she conducted during the pandemic, Prof Holt-Lunstad found that people become less lonely after doing small acts of kindness for their neighbour, such as walking their dog or taking out the bins.

“For someone who might be feeling lonely, they don’t need to wait for someone else to contact them or do nice things for them – they can take the initiative. One of the best ways we can help ourselves is to help others.”

• Dr Catherine Conlon is a public health doctor and former director of human health and nutrition at Safefood