Features Health and wellness
Health risks of loneliness

Sometimes being alone can be good for a person to reflect, relax, read and recharge. Being alone does not make a person necessarily lonely. It is the perception of being alone that makes the person lonely. Research has shown that this form of isolation is unhealthy and can lead to long-term health issues.  

What is loneliness? There are a number of definitions that go beyond the common one of being in a state of solitude. It is the state of mind individuals will feel when disconnected and isolated, leading to an inability to find connection in one’s life.

There are many reasons why people can end up alone: death of a loved one, breakup of a relationship, changing jobs and moving to another city, living alone for the first time as an adult, the list goes on. Most individuals are resilient and eventually will, over a short period of time, be able to connect with others. 

Several different types of loneliness have been identified in the psychiatric literature.

Intimate loneliness
Intimate loneliness, or what is termed emotional loneliness, is the perceived absence of a significant someone (e.g., a spouse); a person one can rely on for emotional support during crises, who provides mutual assistance, and who affirms one’s value as a person. This form of intimate connection often has considerable self-other overlap (such as that observed between close friends or spouses).

Relational/social loneliness
It refers to the perceived presence/absence of quality friendships or family connections within one’s relational space. It is a “sympathy group” that can include among 15 to 50 people and comprises core social partners whom we see regularly and from whom we can obtain high-cost instrumental support (e.g. loans, help with projects, child care). Like intimate loneliness, social loneliness is found in women and men, though there is some evidence that this dimension may tend to play a slightly greater role in influencing loneliness in women than in men.

Situational loneliness
Environmental factors like unpleasant experiences, discrepancy between the levels of one’s needs and social contacts, interpersonal conflicts, disasters and distance from family can lead to loneliness in old age.

Developmental loneliness
The majority of individuals have an innate desire for intimacy and to be connected to others. This is essential in our development and is balanced with the need for individualism. When an individual is not able to balance individuality and intimacy, it can result in a loss of meaning in one’s life, which then leads to emptiness and loneliness in that person. Contributing factors can be personal inadequacies, significant separations, living on the margins of society, poverty, physical/psychological disabilities and developmental deficits, which can often lead to developmental loneliness.

Internal loneliness
Many individuals with low self-esteem and low self-worth seemingly feel lonelier than their counterparts. It has been theorized that the reasons for this type of loneliness are personality factors, feelings of guilt or worthlessness and poor coping strategies in dealing with life’s challenges.

Health Risks
A meta-analysis of 40 articles examining the effects of social isolation and loneliness that appeared in the journal Public Health identified a significant association between social isolation and loneliness with increased all-cause mortality and social isolation with cardiovascular disease. 

A 2012 survey looked at data from a cross-section of the Swiss population. Of the over 20,000 participants ranging in age from 15 to 74, approximately 64.1 per cent reported never feeling lonely. Those who self-identified as being lonely were more often affected by physical and mental health problems, such as self-reported chronic diseases including high cholesterol levels, diabetes, moderate and high psychological distress, and depression and impaired self-perceived health. In addition, loneliness is a risk factor for cognitive decline and the progression of Alzheimer’s disease, recurrent strokes, obesity, elevated blood pressure, decreased sleep and premature death. Loneliness was also significantly associated with problematic lifestyle factors such as smoking and substance abuse. 

In late childhood and early adolescence, loneliness results in impaired sleep, symptoms of depression and poorer general health. These same effects are seen across the lifespan, but also with increased doctor visits in adolescence and increased emergency department use in early to middle adulthood.

In terms of age, loneliness was more common in those over the age of 60. This led to the British government declaring loneliness as a “hidden killer” of the elderly. In 2018, the British government even appointed a Minister of Loneliness. This year, the government of Japan did the same.

Treating loneliness is difficult, however increasing social contact coupled with exercise, walks in nature and mindfulness therapy seems to be beneficial. The internet may give the illusion of connectedness but a 2017 study in the American Journal of Preventive Medicine found that young adults who spend more than two hours on social media daily are twice as lonely as those who spend 30 minutes. Instead of using the internet to soothe loneliness or boredom, it is recommended to reduce screen time and find ways to share your time with others in person. Face-to-face interaction reduces loneliness.

Volunteering also fights loneliness. Focusing on the needs and feelings of others provides relief from the weight of one’s own problems. Turning your attention toward someone else helps them feel valued and supported, which allows meaningful, fulfilling relationships the space to grow. Seeking out social interaction with close and distant acquaintances bolsters well-being and reduces lonely feelings. Taking on new subjects and skills expands life experience and creates opportunities to connect with others. Educating oneself can boost self-confidence and reduce feelings of inadequacy and loneliness. Common interests can be a powerful bond in forming a community of like-minded people aspiring toward similar goals.

Loneliness in our society is increasing, as are the negative health consequences of being lonely. The COVID-19 pandemic is exacerbating this state. If you are lonely, do not feel ashamed or afraid to ask for help. See your family physician for an assessment and treatment. The emergency services community is a brotherhood and sisterhood, but we must be aware of what to look out for to help care of ourselves and our brothers and sisters, including retirees. Keep in mind you are not alone in feeling alone. •

Suggested Readings
Cacioppo, S. et al (2015) Loneliness: clinical import and interventions. Perspectives of Psychological Science Mar; 10(2): 238–249.doi: 10.1177/1745691615570616;

www.mentalhealth.org.uk/coronavirus/loneliness-during-coronavirus 

Social connection is the cure

Peter Collins is the operational forensic psychiatrist with the Ontario Provincial Police’s Criminal Behaviour Analysis Section. He is also a member of the crisis/hostage negotiation team of the Toronto Police Service Emergency Task Force. Dr. Collins’ opinions are his own. Contact him at peter.collins@utoronto.ca.