If you feel alone, you’re not alone. Loneliness is a global and growing problem, and a new study shows just how deadly it can be.
Loneliness is creating a growing global health crisis — an epidemic, some health experts say — fueled by aging populations, fragmented families and migration to soulless cities, among other things. A new study adds to a growing body of research showing that loneliness can be as deadly as obesity or smoking. The research also points to the roots of the complex problem and hints at possible solutions.
Some perspective, from around the world:
The percentage of Americans living by themselves has risen from less than 15 percent in 1960 to more than 25 percent today, according to the U.S. Census Bureau, and there are more than 35 million Americans living alone now. The figure is likely to increase as the population ages, experts say.
But the problem of loneliness goes beyond living alone. In a survey just last year by the polling firm Ipsos, conducted for the health company Cigna, 46 percent of Americans said they sometimes or always feel lonely. One in five said they rarely or never feel close to others. Other results of the survey:
- The loneliest group was ages 18–22, while the least lonely were those 72 and older.
- Those who were employed and had good relationships with coworkers were less lonely than their opposites.
- People with higher incomes were less lonely than the poor.
Meanwhile, even though the typical older person may not be as lonely as the young, the plight of the lonely elderly is well documented. Perhaps they don’t always show up in fancy surveys. As one example of the scope of the problem, last year, the U.K. appointed a minister of loneliness, stating that “200,000 older people have not had a conversation with a friend or relative in more than a month.”
In Japan, the problem long ago became acute. The country’s post-WWII baby boom and subsequent economic stagnation created a highly fragmented society, with declining births and an aging, lonely population, many of whom die alone and frequently go undiscovered for days or weeks. The Japanese even have a word — kodokushi — to describe this “lonely death” phenomenon.
“This is particularly a problem in the larger cities, such as London, New York and Tokyo but is a general phenomenon,” says Magnus Jensen, a Queen Mary University of London researcher and fellow in cardiology at the Barts Heart Centre. Jensen led a new study that adds to much research showing that living alone is a strong risk factor for heart disease and, more generally, for dying sooner. But there’s an interesting twist to his findings.
As Bad as Smoking
Jensen and colleagues studied the health histories of 3,300 men from Copenhagen for more than 32 years.
“We found that living alone was a strong risk factor for death from cardiovascular disease and for decreased longevity,” he told me in an email interview. Jensen’s team ruled out several potential contributing factors.
“This relationship was not explained by health behavior (smoking, diabetes, blood pressure, lipids, etc), psychosocial factors (including depression), frequency of doctor visits, housing conditions or working conditions,” he said.
Importantly, living alone was not a risk factor for the men in the highest socio-economic positions.
“This could be due to stronger social resources in the highest social group,” Jensen told me. “In fact, in the 81 percent who did not have a university degree or were [not] in an executive position, living alone was as strong a risk factor as being a current smoker (almost 90 percent increased risk of mortality).”
The findings were detailed Jan. 24 in the European Heart Journal.
Much research has illustrated the negative effects of social isolation.
A study last year looked at the health outcomes of patients with heart disease, and whether it was linked to loneliness, including among those who lived with someone but still said they sometimes felt alone. “Feeling lonely was associated with poor outcomes in all patients regardless of their type of heart disease, and even after adjusting for age, level of education, other diseases, body mass index, smoking, and alcohol intake,” the researchers found.
“Loneliness is a strong predictor of premature death, worse mental health, and lower quality of life in patients with cardiovascular disease, and a much stronger predictor than living alone, in both men and women,” said study leader Anne Vinggaard Christensen at the Heart Centre at Copenhagen University Hospital.
“Our study indicates that it is not so much living alone as it is feeling lonely that is associated with an increased mortality rate,” Christensen said via email.
In yet more research — a review of 148 studies involving 300,000 people — researchers found that “greater social connection is associated with a 50 percent reduced risk of early death.”
The same team looked at 70 other studies involving 3.4 million people in North America, Europe, Asia and Australia. They examined social isolation, loneliness and living alone, finding that all three factors “had a significant and equal effect on the risk of premature death, one that was equal to or exceeded the effect of other well-accepted risk factors such as obesity.”
“There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,” said study leader Julianne Holt-Lunstad, professor of psychology at Brigham Young University.
Given the aging population, “the effect on public health is only anticipated to increase,” Holt-Lunstad points says. “Indeed, many nations around the world now suggest we are facing a ‘loneliness epidemic.’ The challenge we face now is what can be done about it.”
The former U.S. Surgeon General, Vivek H. Murthy, has called loneliness an epidemic. “We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s,” he said in 2017.
Others stop short of declaring an epidemic.
“To call it an epidemic of loneliness risks having it relegated to the advice columns,” argues University of Chicago researcher John Cacioppo. Eric Klinenberg, professor of sociology at New York University, thinks of it this way: “I don’t believe we have a loneliness epidemic. But millions of people are suffering from social disconnection.”
The Challenge to Define Happiness
“Happiness is not a state like Vermont,” said Abraham Maslow. Or maybe it is but sometimes we’re stuck in New Jersey.
What’s Going On?
While a lot is known about the manifestations of loneliness, we know less about the mental and physical mechanisms behind the poor health outcomes. But the science is emerging.
One 2012 study suggested just how much loneliness can affect mental well-being. The research involving 3,500 working-age men and women in Finland, published in BioMed Central’s open access journal BMC Public Health, found those who lived alone were 80 percent more likely to take antidepressants. Depression, in turn, is has been linked to higher mortality rates in many studies.
Antidepressants notwithstanding, lonely older people are less likely to take their prescribed medications than the socially well connected, and less likely to show up for doctor appointments, according to Sachin Jain, an adjunct professor of medicine at Stanford University School of Medicine.
At the cellular level, some research into humans and monkeys has suggested loneliness leads to stress that can compromise the body’s immune system. Social isolation seems to trigger a “fight or flight” response that’s less pronounced when one is around other people. That means release of chemicals that cause inflammation, putting a person at higher risk for cancer, diabetes and cardiovascular disease.
In one 2017 study, people who call themselves lonely were more likely to suffer symptoms of the common cold.
Meanwhile, the psychology of loneliness—what truly makes one person feel isolated when another does not—is often misunderstood.
“Loneliness has been associated with objective social isolation, depression, introversion, or poor social skills,” wrote John Cacioppo (the University of Chicago researcher) and Stephanie Cacioppo last year in The Lancet. “However, studies have shown these characterizations are incorrect, and that loneliness is a unique condition in which an individual perceives himself or herself to be socially isolated even when among other people.”
Social Media’s Role
As the recent Cigna survey revealed, loneliness is more pronounced among younger people. However, the survey did not find a significant difference in the loneliness levels of those who use social media a lot versus a little.
In fact, despite popular belief, there’s very little solid evidence that social media fuels loneliness or depression. One small study last year — a survey of college students — did find that “students who used their phones the most reported higher levels of feeling isolated, lonely, depressed and anxious.”
In another study, University of Pennsylvania psychologist Melissa Hunt measured social media use among a group of students age 18 to 22. After measuring a baseline, she split them into groups. The experimental group had their time on Facebook, Snapchat and Instagram limited to 10 minutes per platform per day. (Anyone hooked on social media knows just how ludicrously low that limit is.)
“Using less social media than you normally would leads to significant decreases in both depression and loneliness,” Hunt found. “These effects are particularly pronounced for folks who were more depressed when they came into the study.”
The findings were published in December 2018 in the Journal of Social and Clinical Psychology.
Hunt doesn’t recommend quitting social media altogether, a goal she calls unrealistic. But noting how social media is one giant, often negative comparison of your life to the glorious lives depicted by others, she said: “When you’re not busy getting sucked into clickbait social media, you’re actually spending more time on things that are more likely to make you feel better about your life.”
Solutions for an Aging Population
But as the situation in Japan shows, an aging population — if not addressed socially — presents serious problems. And the U.S. population is aging in a big way, according to the latest data from the U.S. Census Bureau.
“The aging of baby boomers means that within just a couple decades, older people are projected to outnumber children for the first time in U.S. history,” said Jonathan Vespa, a demographer with bureau. There will also be fewer people working for every retired person, and by 2060 the median age will increase to 43 from 38 today.
Jensen, the researcher from Queen Mary University of London whose new study found the well-being of those with socioeconomic means doesn’t suffer from living alone, offers this perspective:
“The important thing is not whether you live alone or not, but if you are socially isolated or not,” he said. “If you make sure to maintain social relations, living alone is most likely just fine.”
One way to get back in the game is to volunteer, science suggests. A study of widowed older people found volunteering two hours a week reduced their level of loneliness. Volunteering has been shown to lower blood pressure and, so long as one’s intentions are altruistic, increase lifespan.
A growing movement among U.S. healthcare providers calls for addressing loneliness through new systems involving doctors, nurses and others to provide home visits and have more phone conversations with patients after they leave the hospital.
Jensen offered thoughts for policymakers:
“We can now identify individuals at particular risk who should be a target for policy interventions on social isolation/loneliness. Secondly, we should perhaps think about how we, the modern human, should structure our life in the future.”
The plight of the “modern human” is the key to all this. The evolution of technology and society has outpaced the evolution of the human psyche. We are simply not fit to thrive in the world we’ve created.
“The human species has been living in small families and villages for hundreds of thousand of years, but within the last 50–100 years we are starting to live together in very large cities,” Jensen points out, noting the incredibly irony of the shift: “And the more concentrated we live, the more people are living alone.”
He wonders whether people should continue living alone, or whether everything from architecture to social structures should be rethought.
“In order words,” he said, “why don’t we shape our cities around people instead of shaping people around cities?”
And here’s a thought: As a group, the youngest adults self-identify as the loneliest, while the oldest among us increasingly die alone. Perhaps the two need to get together.
Whether you are lonely or not, I hope you’ll take my Happiness Survey, to help me better understand who is happy, who is not, and why.