The Lonely Have Plenty of Company

The Centers for Disease Control and Prevention (CDC) says notes that social isolation rivals smoking, obesity and physical activity as a risk factor for premature death. According to the CDC, social isolation increases the risk of dementia by approximately 50%, the risk of heart disease by 29% andthe risk of stroke by 32%.

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Americans are lonely.

So lonely that U.S. Surgeon General Vivek H. Murthy, M.D., MBA, has declared loneliness an epidemic.

During a September 2022 lecture series at Yale School of Management (SOM), Murthy cited a 2018-2020 survey that found 60% of Americans were lonely. Loneliness “is both common and consequential, and that is one of the reasons why I wanted to raise the alarm that this is a public health crisis,” Murthy, a Yale SOM alumnus, told the audience.

Loneliness is “an unpleasant emotional response to perceived isolation” and a psychological mechanism that motivates individuals to seek social connections, as defined by the UCLA Loneliness Scale, which was released in 1978.

A lack of social connections can lead to loneliness, although researchers have found the two conditions can exist independently. When they occur in tandem, it is called social isolation loneliness.

According to a June 2022 survey conducted by Morning Consult, 3 in 5 employees of Cigna had “feelings of loneliness” and stress-related absenteeism, a symptom of loneliness, which cost the U.S. economy an estimated $154 billion annually.

Many studies have documented that the COVID-19 pandemic worsened social isolation loneliness. But long before COVID-19, public researchers and officials were investigating and talking about the psychological and physiological consequences of social isolation and loneliness.

In 1979, a year after the UCLA Loneliness Scale was first published, Lisa F. Berkman, Ph.D., and S. Leonard Syme, Ph.D., published their landmark study that found socially isolated people were twice as likely to die in any given year compared with those with strong social connections. Fast forward to 2015 when Julianne Holt-Lunstad, Ph.D., a professor of psychology and neuroscience at Brigham Young University in Provo, Utah, published a study connecting social isolation loneliness to a 26% increased risk for premature mortality.

In 2020, a National Academies of Sciences, Engineering and Medicine consensus study reported that social isolation in people 50 years old and older “presents a major risk for premature mortality, comparable to other risk factors such as high blood pressure, smoking or obesity.”

The Centers for Disease Control and Prevention (CDC) says notes that social isolation rivals smoking, obesity and physical activity as a risk factor for premature death. According to the CDC, social isolation increases the risk of dementia by approximately 50%, the risk of heart disease by 29% andthe risk of stroke by 32%.

“The research is showing that (social isolation and loneliness) are both related to poor health outcomes, and both independently are tied to poor health outcomes,” says Nancy A. Hodgson, Ph.D., RN, a professor of nursing at the University of Pennsylvania in Philadelphia. “The more that you are socially isolated and the more that you are perceiving loneliness, the more your risk goes up.”

In February 2023, Chinese researchers reported findings in the journal JACC: Heart Failure that separated the medical consequences of social isolation from those associated with loneliness. Theyreported that social isolation “was only a risk factor when loneliness was not also present.”

It’s stressful

Humans are not built to be lonely or socially isolated, Hodgson says. Social isolation loneliness leads to psychological distress, anxiety, worry and depression, which, in turn, can trigger stress hormones and inflammation.

“The biological response (to loneliness) is through our stress responses,” Hodgson says. “Your body is just always on high alert, which is not good. It has higher levels of inflammatory markers circulating, so your body is always in inflammation mode.”

Continual inflammation weakens the body’s immune system, making it less resilient to illness and infectious disease and negative health outcomes. Stress and inflammation are linked to heart disease and dementia.“In many ways, dementia is like heart disease in that the same processes that are at play in the vasculature of your heart are at play in dementia,” Hodgson says.

The COVID-19 pandemic may have amplified social isolation loneliness. But why were so many Americans experiencing loneliness before 2020?

“People are having fewer children and there are no longer multigenerational households,” Hodgson says. “We have choices now and don’t have to stay in the towns we are raised in. And children are choosing not to stay. That is part of the answer.”

As disheartening as the number of older adults who are feeling lonely and isolated is, the number of younger adults suffering social isolation loneliness is truly worrisome. The 2018-2020 study cited by Murthy at Yale also found that a staggering 75% of younger people were feeling lonely.

In 2021, Harvard University’s Making Caring Common Project conducted a survey that showed that 36% of respondents reported “serious loneliness,” whereas 42% said fewer nonfamily members care about them than they would like. Forget social media. The survey’s authors say social media “can be hell for lonely people.”

Instant communication isn’t necessarily a meaningful connection, Milena Batanova, Ph.D., director of research and evaluation at the project, wrote in an email to Managed Healthcare Executive. It may be quick, but it also creates room for misinterpretation, things left unsaid — or things said that should not have been said.

Research shows that people need close, physical and eye contact, along with an interested listener who asks authentic questions. “We have to ask ourselves whether we’re in balance, what we’re giving up, spiritually, emotionally and intellectually, for all that we’re gaining by the convenience and flexibility of our digital lives,” she writes.

Despite the evidence that digital interaction can hollow out rather than nourish healthful social ties, there are some efforts to address loneliness digitally.

Wisdo Health, a peer-support community and clinical navigation platform, along with Humana Medicare Advantage, conducted a study to see whether the platform could address loneliness.

The yearlong study involved almost 1,400 Humana Medicare Advantage members 65 years and older. The members also had one or more chronic diseases and had joined the Wisdo Health platform in the past 12 months. The program used persona mapping and artificial intelligence to match users with trained peers who had similar experiences and could provide emotional support and companionship. Within 90 days of joining, 58% of participants reported lower loneliness rates, whereas 13% no longer screened positive for loneliness, according to Wisdo Health. After one month, participants reported a decrease of 6.5 days, on average, in the number of mentally and physically unhealthy days.

The program reported a 25% referral success rate to teletherapy services based on in-app messages sent to at-risk members, a 10% reduction in inpatient visits, 4% fewer emergency department visits and 6% fewer urgent care visits. At the end of one year, 42% of the participants remained active on the app after joining,

Robert Calandra, an independent journalist in the Philadelphia area, is a frequent contributor to Managed Healthcare Executive.