Not many people willingly cop to being lonely. It carries with it a social stigma of pathos that, at the very least, may hurt your self-esteem.
But what if it can damage much more than that? What if it carries the same health risk as smoking 15 cigarettes a day? What if social isolation is twice as harmful as obesity and as lethal as alcoholism?
Today, researchers from across the sciences are asking, “Can loneliness kill you?”
Recent public debate over this issue has centered largely on the isolating influence of social media on creating what has been referred to as a “loneliness epidemic” in the culture. However, APA member and social-connectedness expert Julianne Holt-Lunstad, PhD, warns that the problem goes much deeper and that substantial evidence of it predates the technology boom.
“There have indeed been dramatic shifts in how people are connecting and interacting socially now,” Holt-Lunstad says, adding: “But the majority of the epidemiological data we have that established this as a risk factor for premature mortality was conducted before widespread use of most of these technologies.”
If anyone understands the gravity of the public health threat it poses—and the difficulty of getting it on the public health agenda—it is she.
Holt-Lunstad, a psychology professor at Brigham Young University, was the first U.S. researcher to publish a large-scale analysis of studies establishing poor social support as a major contributor to morbidity.
“I remember thinking early in my career, ‘Why doesn’t everyone else recognize this?’” says Holt-Lunstad, who read early studies about social connection while a graduate student. “Is it perhaps because the evidence isn’t as strong as I think it is? Or because it is being measured in a variety of different ways … that don’t give it that level of precision the medical community demands? That’s when I decided to do that first meta-analysis.”
Her trailblazing 2010 study, Social Relationships and Mortality Risk: A Meta-analytic Review (PLOS Medicine), blew the doors open on links between social connectivity and mortality and generated buzz in the media as well as in the medical establishment.
Significantly, it showed that people with strong social bonds are 50 percent less likely to die over a given period of time than those who have fewer social connections.
The meta-analysis combined data from148 studies that tracked the social habits of more than 300,000 people worldwide. The research team developed extensive coding for variables that could be weighted to get the overall magnitude effect of social connection on health—no matter the sample sizes of the studies.
These findings were confirmed with a follow-up meta-analysis published in 2015, which expanded the sample to more than 3.4 million individuals worldwide and teased out more nuances.
“We wanted to know: Does it vary by country (It does not!)? Does it vary by cause of death (Doesn’t matter!)? Is it stronger for men vs. women (Equally strong!)?” says Holt-Lunstad emphatically. “This was a snapshot of real life, right? With implications for real-life health outcomes.”
Developing interventions to tackle this public health threat has a host of challenges—not the least of which is fine-tuning our understanding of the quantity and quality of social relationships and their impact on long-term health and morbidity.
For starters, what are the differences between isolation and loneliness?
“The way they are conceptualized and measured is quite different,” says Holt-Lunstad. Isolation is defined more by the actual size of one’s network or the frequency of contact, she says, whereas loneliness “is thought to be more of a subjective experience or perception of isolation, a discrepancy between one’s desired and actual level of connection.”
Further, she observes: “Someone can be lonely but not isolated, or isolated but not lonely.”
These distinctions are important when designing measures and interventions for each. One of the ways Holt-Lunstad has attacked these issues is to gather data on biological pathways connected to the experience of social connectivity.
“Participants come to my lab and I hook them up to equipment to look at their cardiovascular functioning. I’ve also taken saliva and blood samples to look at the neuroendocrine piece. I measured the physiology among those who had more or less supportive people in their network. In some studies, I asked them to bring in a friend and measured their physiology while interacting with them.”
The results from this multidisciplinary research have yielded some fascinating information:
- Loneliness and social isolation are linked to around a 30 percent increased risk of having a stroke or developing coronary artery disease. http://heart.bmj.com/content/102/13/987
- Higher relationship quality raises your levels of oxytocin, the so-called “love hormone.” http://journals.sagepub.com/doi/full/10.1177/0265407514536294
- Blood pressure and anxiety are higher for people with ambivalent relationships than for those with supportive ones. http://www.sciencedirect.com/science/article/pii/S0167876014001342?via%3Dihub
- The presence of a supportive person—or even just thinking about them—can reduce cardiovascular and neuroendocrine responses to stress.
Holt-Lunstad’s life and work intersected perilously in 2011 when her husband was diagnosed with stage 4 cancer. The working mother of two suddenly found herself dependent on friends to help her keep the family running while supporting her hospitalized husband.
Fiercely independent by nature, she says it was “an eye-opener to me of just how hard it is to accept support.”
“One of these social barriers is that we value our independence so highly,” she reflects. “Needing others is viewed as a weakness rather than a conceptualization of interdependence—that we can rely on others and they can rely on us.”
Fortunately, her husband made a recovery, and Holt-Lunstad used her experiences to galvanize her mission to get the issue of social connectivity even more forcefully onto the public health agenda.
She recently testified before the U.S. Senate Special Committee on Aging, where she outlined the greater social changes that underpin today’s loneliness epidemic. This summer, she and her cohorts published something of a manifesto in the American Psychologist http://www.apa.org/pubs/journals/releases/amp-amp0000103.pdf, where they offered supporting data and detailed recommendations for advancing social connection as a U.S. public health priority.
“It’s incredibly gratifying that it’s getting the attention that it deserves but of course there’s still a long way to go,” she says. “If you look at CDC’s Social Detriments of Health it’s very peripheral, which is surprising since we know there is substantial evidence of lifestyle factors influencing health.
“It may sound a bit audacious,” she continues, “but I’ve been thinking about how we might have consensus guidelines around social connection, as we do around physical activity and sleep. If we expect the public to take this seriously for their health it seems we need something like that so they know what to do and how well they’re doing.
“Of course, these would need to be evidence-based and subject to periodic review as the science progresses, just as nutritional guidelines are,” she continues, “But by having these guidelines it could have a cascading effect on public health.”
Social-connectivity assessment and intervention could become part of medical education and the conversations doctors have with their patients at well-checks, she says. It could become part of K–12 health education, helping children to be more inclusive, build community and improve their mental health.
“When we look at the increase in anxiety and depression in kids and teens, social-connectedness interventions could potentially help reduce those,” says Holt-Lunstad. “I don’t want to claim this will solve all the world’s problems, but it could potentially help and it may be one of the root causes of some of our pressing public health issues.”