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Expert Q&A

Is Loneliness a Public Health Crisis?

by Jeanine Barone  

carla perissinottoCarla Perissinotto, MD, is an associate professor of medicine in the Division of Geriatrics at the University of California, San Francisco. She has published numerous papers on loneliness among older people and is currently a member of a National Academy of Sciences committee working on a consensus study on social isolation and loneliness in people over 50. We spoke with Dr. Perissinotto about the increasing focus on loneliness as a public health issue, both for older adults and for young people of the social-media generation. Her responses represent her opinions alone, not those of the National Academy of Sciences.

Is loneliness the same as social isolation?

They are not the same. Loneliness is the subjective feeling of being alone or isolated; or it’s the discrepancy between actual and desired relationships. Social isolation is something quantifiable in terms of the number of relationships or contacts someone has with others. This is why you can still feel lonely even while surrounded by other people.

Is loneliness especially a problem for older people, or are younger people also affected?

This is an interesting question. There are many risks that place older adults at higher risk of experiencing loneliness, including the loss of a spouse or partner, a life transition (such as moving or retirement), and other changes, such as hearing or visual impairment, that can make it hard to feel connected to others. So there are certainly greater risks for loneliness as we age.

However, new reports and research suggest that teenagers and young adults are also at high risk—and potentially at higher risk for loneliness than older adults. We don’t completely understand why, but there is some concern that the overwhelming use of social media is changing how we form and maintain relationships. There was an article in The Atlantic last year about this, looking at cell phone use and young people. It found that teens who spent more time each day on their “screens” visiting social networking sites than actually seeing their friends in person were more likely to say that they’re lonely much of the time.

Why is loneliness being discussed as a public health problem, rather than a personal issue?

It’s starting to be considered a public health problem because of the large number of people affected and because of the many adverse health effects that are associated with loneliness. In one study I published in 2012, 43 percent of adults over 60 reported experiencing loneliness. That’s a huge swath of the population.

The health effects of loneliness aren’t my area of research, but there is a host of literature in this area. Research has shown that people who are lonely have a higher risk of cardiovascular disease, Alzheimer’s dementia, worsening diabetes control, loss of independence, and even death compared with those who are less lonely. This can be independent of whether or not they are actually socially isolated; that is, the feeling of aloneness itself is the risk factor. One hypothesis is that there’s a heightened stress response when people are lonely, and that this affects the immune system.

What causes loneliness—and why is it becoming more problematic?

There is no one cause, and the cause can be different for different people, depending on their circumstances. There are many ways that someone can become lonely. As I mentioned in the first answer, it could be life changes, physical changes, and, for some, lifelong traits in terms of how we cope with changes in relationships and how we view these changes. Other examples: I have patients who want to connect with others, but they can’t get out of their homes because of stairs, so they feel really lonely. Others have recently lost a lifelong partner, and this is devastating. And still others want to connect, but their hearing impairment makes it hard to connect even on the phone.

We don’t really know why loneliness is becoming more problematic, but we do know that our lives are becoming more complex. For example, while technology and social media can be amazing tools to connect with others, some think that they are also preventing us from forming real relationships. Vivek Murthy, the former U.S. surgeon general, has talked about loneliness as an epidemic that is affecting not just our health but our work performance.

Are certain people more likely to be lonely?

In my research women, those of lower socioeconomic status, older adults, and minority populations were more likely to be lonely. It’s hard to understand why; we need to understand this better. Interestingly, in my study, the majority of people who reported feeling lonely were living with others, and over 60 percent of people who were lonely were married. Marriage and partnership tend to be protective against loneliness, but these findings show that you can still be lonely even when married.

Aside from talking with a counselor or therapist, what other practical advice can you suggest for ameliorating loneliness?

Delve in and try to get a better understanding of why you may be lonely. Be open about it — you'd be surprised that when you admit it and talk about it, there are others like you. Be bold: Take a risk and make that phone call or actually see someone in person rather than sticking to texts or emails. Be mindful about how loneliness affects your health. My colleague Julianne Holt-Lunstad, who is a major researcher in this area, has written about how we focus on maintaining our physical health, but we don’t do enough to take care of our social health. And with that, I am off to dinner with family, in person, while I send a group WhatsApp message to my friends and family outside of the U.S. whom I can't see as easily.

This opinion does not necessarily reflect the views of the UC Berkeley School of Public Health or of the editorial board at BerkeleyWellness.com.

Also see Is Social Media Addiction Real? and Spotting Depression in Older Adults.