Loneliness and Health

by

Aparna Shankar

• LAST REVIEWED: 30 October 2019
• LAST MODIFIED: 30 October 2019
• DOI: 10.1093/obo/9780199828340-0253

Introduction

In January 2018, the UK became the first country in the world to appoint a Minister for Loneliness. This highlights growing concerns about loneliness in societies, and its deleterious effects on individual health and well-being. Loneliness or perceived social isolation is a subjective experience relating to dissatisfaction with one’s social relationships. Most research has focused on the experience of loneliness in old age, but levels of loneliness are also known to be high among teenagers and young adults. While poor health may be associated with increased feelings of loneliness, there is now considerable evidence on the role of loneliness as a risk factor for poor mental and physical health. Studies suggest that loneliness is associated with an increased risk of developing dementia and chronic diseases, and also with a higher rate of Mortality. Risky Health Behaviors, a poor cardiovascular profile, and compromised immune functioning have all been proposed as potential pathways through which loneliness may affect health. However, much still remains to be understood about these Mechanisms. This bibliography starts with a section on chapters and reviews that provide a theoretical basis for understanding the associations between social relationships and health, as well as some reviews of the Health Effects of loneliness. This is followed by sections that focus on specific outcomes, health effects (mortality, general health and physical function, cognitive function and Mental Health), and Healthcare Utilization. The subsequent section examines research into the pathways through which loneliness affects health. The final section examines interventions to reduce loneliness and the associated effects on health outcomes.

General Overviews

These sources review associations of loneliness with health, suggest a theoretical framework and possible Mechanisms through which loneliness affects health. House, et al. 1988 is an early review of social relationships and health and identifies pathways through which social relationships may act. Holt-Lunstad 2018 uses a systems approach to organize social influences on health, with implications for research and intervention. Cacioppo and Cacioppo 2018; Cacioppo, et al. 2011; and Hawkley and Capitanio 2015 outline the “evolutionary theory of loneliness”—this series of papers draws on animal studies to identify the role social connectedness plays in different species and the associated Health Effects of isolation. Using this, genetic evidence, and a range of observational and experimental studies in humans, the authors provide a framework to understand how the need for social connection has an evolutionary basis, and outline the nature of cognitive, behavioral, and biological changes observed in response to a lack of these connections (loneliness). A detailed consideration of loneliness and its determinants across the life course, particularly in relation to the “reaffiliation motive,” is presented in Qualter, et al. 2015. Courtin and Knapp 2017 and Ong, et al. 2015 provide brief reviews on the health effects of loneliness, specifically in later life. Leigh-Hunt, et al. 2017 provides an overview of reviews of the health effects of loneliness, with an emphasis on public health implications.

• Cacioppo, J. T., and S. Cacioppo. 2018. Loneliness in the modern age: An evolutionary theory of loneliness (ETL). In Advances in experimental social psychology, Vol. 58. Edited by James M. Olson, 127–197. Cambridge, MA: Academic Press.

  DOI: 10.1016/bs.aesp.2018.03.003

  This chapter outlines the Cacioppo evolutionary theory of loneliness (ETL), reviewing animal and human studies in the area. The theory proposes that beneficial social relationships are associated with greater survival and evolutionary fitness. Loneliness leads to a range of behavioral and physiological changes aimed at ensuring survival. While beneficial in the short-term, these changes have an adverse effect on health and well-being in the long term. The chapter also sets out the Mechanisms through which loneliness affects health and longevity.

• Cacioppo, J. T., L. C. Hawkley, G. J. Norman, and G. G. Berntson. 2011. Social isolation. Annals of the New York Academy of Sciences 1231.1: 17–22.

  DOI: 10.1111/j.1749-6632.2011.06028.x

  This brief review aims to identify the processes through which loneliness affects health. It draws on experimental studies of the biological effects of isolation in animals, as well as studies of loneliness in humans, to outline how a lack of social connections can affect biological processes and thereby health.

• Courtin, E., and M. Knapp. 2017. Social isolation, loneliness and health in old age: A scoping review. Health and Social Care in the Community 25.3: 799–812.

  DOI: 10.1111/hsc.12311

  This review of 128 studies focused on Health Effects of loneliness and social isolation in later life. Over half of the studies focussed on loneliness, and the majority found loneliness to be associated with poorer health. However, 51 percent of the research in the area had been carried out in the United States and there was limited research looking at subgroups who may be at a greater risk of loneliness or poor health. Available online by subscription or purchase.

• Hawkley, L., and J. P. Capitanio. 2015. Perceived social isolation, evolutionary fitness and health outcomes: A lifespan approach. Philosophical Transactions Royal Society B 370:20140114.

  DOI: 10.1098/rstb.2014.0114

  This paper briefly outlines the evolutionary theory of loneliness and the health effects of loneliness across the lifespan. The review highlights how loneliness is related to worse health, greater depression, poorer Sleep, and impaired cognition across the lifespan, from childhood into later life.

• Holt-Lunstad J. 2018. Why social relationships are important for physical health: A systems approach to understanding and modifying risk and protection. Annual Review of Psychology 69:437–458.

  DOI: 10.1146/annurev-psych-122216-011902

  This paper reviews the current literature on social relationships (including loneliness) and health. The review uses the social ecological model—considering the individual, relationship, community, and society level—as a framework to understand the effect of social relationship factors on health. Available online by subscription or purchase.

• House, J. S., K. Landis, and D. Umberson. 1988. Social relationships and health. Science 241.2865: 540–545.

  DOI: 10.1126/science.3399889

  This is an early review recognizing the role of poor social relationships in causing poor health. The review goes beyond previous work on social support, discussing how the mere presence of relationships has a protective effective on health and recommends that studies separate out different dimensions of relationships. The review suggests that social relationships may promote healthier behaviors and thereby affect health, but also proposes a direct route through emotional, motivational, or neuroendocrine effects seen as a consequence of the presence of others. Available online by subscription or purchase.

• Leigh-Hunt, N., D. Bagguley, K. Bash, et al. 2017. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 152:157–171.

  DOI: 10.1016/j.puhe.2017.07.035

  This paper provides an overview of forty systematic reviews and meta-analyses examining the effect of social isolation and loneliness on health, finding evidence in support of effects on Mortality and cardiovascular disease but weaker evidence for other health conditions and Health Behaviors. The overview also notes the need for more longitudinal research, research in non-English-speaking countries, and studies that consider the wider socioeconomic implications of isolation and loneliness. Available online by subscription or purchase.

• Ong, A. D., B. N. Uchino, and E. Wethington. 2015. Loneliness and health in older adults: A mini-review and synthesis. Gerontology 62.4: 443–449.

  DOI: 10.1159/000441651

  This mini-review examines loneliness, its prevalence, determinants, and health effects, and potential interventions in later life.

• Qualter, P., J. Vanhalst, R. Harris, et al. 2015. Loneliness across the life span. Perspectives on Psychological Science 10.2: 250–264.

  DOI: 10.1177/1745691615568999

  According to the evolutionary theory of loneliness, feelings of loneliness can be adaptive in the short term as they encourage individuals to reach out and build social connections. This is termed the “reaffiliation motive.” This review examines loneliness and its determinants at different point across the life course, in relation to the reaffliation motive. Available online by subscription or purchase.