BY Samuel Mathis MD, MBA
Recently, my department hosted a grand rounds lecture that focused on the need for community and the rising loneliness epidemic across America. Research has now shown that loneliness affects health as much as smoking 15 cigarettes per day. In 2020, the health insurer Cigna published a report discussing loneliness and factors that contribute to it. Since then, the epidemic of loneliness and its health effects have only gotten worse.
Before we can review strategies to address loneliness in our patient population, we must first understand the risks and contributors. Feelings of isolation seem to be more prevalent in younger patients (Gen Z, Gen Alpha) than older adults (1). Men and those who heavily use social media were also found to be more prone to feeling isolated and lonely (1). In 2023, the US Surgeon general came out with a report around loneliness. In that report, they note three vital components of social connection, the structure (type of relationship), function (goals of relationships), and quality (positive and negative aspects of the interactions) (2). The report found that many direct social networks are getting smaller and purposeful direct interactions with others are declining (2). This may be impacted by social media and the unrealistic personification of life presented on these platforms.
The health effects of loneliness are profound. Research shows that a lack of social connection correlates to increased risk of all-cause mortality (2). These effects are primarily seen in cardiovascular health with studies finding that improved social connection results in lower rates of hypertension and cardiovascular disease (2). Additionally, social connection not only affects the development of diabetes, but it also impacts disease management (2). There is also an increased examination of social connection’s effect on cognitive ability, anxiety, and depression. There is strong evidence that those with stronger social support networks have improved cognitive functioning and mood scores (2).
Knowing the risks of loneliness, it now becomes our responsibility to address this with our patients. The first step in managing loneliness is to assess the issue within the population. There are numerous questionnaires available, but I find that simply asking patients how often they have felt lonely or socially isolated over the past two weeks to be a good preliminary question to start the discussion. The University of California Los Angelos has both a 20-item and 3-item screening questionnaire available to better evaluate the degree and type of loneliness someone may be experiencing.
When patients screen positively, they should be provided with education and resources to address loneliness. Patients should be informed of their risks associated with loneliness and encouraged to find connection with family, friends, and others in the community. Physicians can work with social workers and community organizations to provide resources on ways for patients to get involved with those whom they share common interests (2). In my city, we have community organizations for older adults with classes, projects, and volunteer activities. Patients can be encouraged to engage with religious organizations or volunteer opportunities to give their connection purpose. Additionally, as research comes out showing the connection between social media use and loneliness, patients should be encouraged to seek personal connections more than electronic interactions. Parents should be encouraged to monitor their children’s online content and to promote social time with family, friends, and colleagues. Warning signs of social isolation, like spending more time alone, high online time, limited interactions with friends, and excessive attention seeking behavior should prompt further evaluation (2).
Finally, on an individual level, if you or someone you know is feeling overwhelmed with feelings of loneliness, encourage them to seek help. Invest time into healthy relationships, work to be fully present when engaging with others in conversations, find ways to volunteer, and stop behaviors that lead you to feel disconnected. Engaging with others of different backgrounds and experiences is a great way to broaden our understanding of others. Local community groups, civic engagement, and religious organizations can be great places to connect with people whom we may find common ground. Connection is so important in our lives and oftentimes, the first step to becoming more connected is to recognize our own need for it in our lives.
References:
- Demarinis S. Loneliness at epidemic levels in America. Explore (NY). 2020;16(5):278-279. doi:10.1016/j.explore.2020.06.008
- Office of the Surgeon General (OSG). Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community [Internet]. Washington (DC): US Department of Health and Human Services; 2023–. PMID: 37792968.