Recognising loneliness

The subjective nature of loneliness, and stigmatisation of those who feel lonely, can make it difficult to identify loneliness in others; be it in social, professional or clinical situations. Knowing the risk factors for loneliness can help to identify those who might be at risk, and asking the right questions is necessary to recognise those who may be in need of help.

A conceptual model of loneliness (Figure 1, below) developed by Dr Michelle Lim and colleagues at Melbourne’s Swinburne University helps to explain how life’s circumstances might precipitate loneliness in individuals. It identifies four components, the specifics of which will be unique for everyone.

Risk factors

The Campaign to End Loneliness reports risk factors and triggers for loneliness in different demographic groups, which include:

For young people:

• Difficulty making friends
• Changing school
• Abuse or bullying
• Bereavement
• Family conflict
• Illness of disability
• Having an eating disorder
• Depression
• Long periods of isolation from family and friends during the COVID-19 pandemic

For older people:

• Being single, divorced or separated
• Living alone
• Living in aged care
• Poor health
• Low income or poverty
• Bereavement
• Retirement
• Giving up driving
• Lack of public transport or other facilities
• Digital exclusion

For ethnic minorities:

• Not feeling valued, included, safe, and able to join in community activities
• Discrimination and xenophobia

Detailed information about triggers and risk factors for loneliness in different population groups in Australia is not available.

Asking the right questions

Ending Loneliness Together provides a guide for organisations that wish to measure loneliness, and suggests two ways to measure it:

1. A direct measure of loneliness, consisting of the question 
   • “How often do you feel lonely?”
2. An indirect measure of loneliness – A version of the ‘UCLA Loneliness Scale’, which consists of four questions
   • “How often do you feel that you are ‘in tune’ with the people around you?”
   • “How often do you feel that no one really knows you well?”
   • “How often do you feel you can find companionship when you want it?”
   • “How often do you feel that people are around you but not with you?”
      

Practical guidance for using these measures, to ensure that responses are valid, is available.

Even though it has been suggested that such measures “can diagnose if a patient has abnormally high levels of loneliness”, their validation for different patient populations is not well established, but work is underway. For example, a recent study says loneliness can be used to predict one-year mortality in patients with coronary heart disease.

Lonely men are more stigmatised than lonely women, which might be why men are more reluctant to admit to feeling lonely. Hence, indirect measures of loneliness are more likely than direct measures to accurately identify lonely men. The same might be true of different cultural groups, or people of different ages. 

Mitigating the adverse effects of loneliness on health requires accurate ways to identify the problem in everyone, but the conceptual model of loneliness suggests we need not wait for ideal evidence to guide practice. Simply asking patients about their social wellbeing creates a connection with them that may improve feelings of isolation and help address this wicked problem.