Loneliness and social isolation can both contribute to poor health1, 2 but they are not the same thing. Social isolation is experienced when someone has minimal contact with others, whereas loneliness is a subjective state of distress that is experienced when someone’s interpersonal relationships do not meet their expectations or needs3.
We can be lonely even if we’re not alone, just as we can be alone without being lonely.
Around one in six Australians often feel lonely4. Like depression, identifying men who feel lonely requires that you ask the right questions. Men are less likely than women to disclose feeling lonely so rather than asking directly, questions that avoid the ‘L-word’, like, “Are there people who are close to you or who you can turn to for support?” are useful.
Feeling lonely is more common than being socially isolated, with around one in 10 Australian males, and one in 12 females having a low level of social support. Social isolation is lowest for younger (15-24 years) and older (>60 years) age groups at 7-9%, but conversely rates of loneliness are highest for young (15-24 years) and old (>74 years) Australians, at 17-20%. These age-related differences in loneliness and social isolation reflect complexity in people’s experience of being lonely.
Examination of risk factors, correlates and triggers for loneliness led to development of a conceptual model that helps to explain the complex causes of loneliness5. Triggers for loneliness are life events that affect relationships, including moving house, school or workplace; the loss of a friend or family member; becoming a parent or developing a disease. A trigger or combination of triggers may or may not cause loneliness, depending on each individual’s response, which will be influenced by their personal circumstances5.
In addition to age and gender, demographic features that are risk factors and correlates of loneliness include:
- Marital status: Married people are less likely to be lonely than those who are single, divorced or widowed
- Living arrangements: Living alone is associated with being lonely, as is living in a nursing home (when compared to living in the community)
- Socio-economic status: Loneliness decreases as education and income increase, and as local area socioeconomic disadvantage decreases
- Place of birth: Migrants report greater loneliness than locals, and the greater the differences between the places people come from and where they live, the greater their loneliness5.
Loneliness is associated with poor health and other variations in physiology, including5:
- Brain function: Functional MRI studies suggest loneliness is related to inhibited reward-based activity in the ventral striatum. Electrophysiological studies suggest loneliness is associated with hypervigilance to social threats
- Brain structure: Volumes of grey or white matter may be different in brain regions associated with social perception and understanding
- Brain connectivity
- Activation of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, which may link loneliness and disease development
- Immune activation: Loneliness is associated with a proinflammatory state
- Genetics: Loneliness may be partly inherited, and there are various genes associated with loneliness.
Both loneliness and social isolation increase the risk of all-cause mortality, with “essentially no difference between objective and subjective measures of social isolation when predicting mortality”, and the associations “suggest more of a continuum than a threshold at which risk becomes pronounced”2.
Social isolation and loneliness both seem to have slightly different effects in men and women1, 2. A large US study found that being unmarried, not having an affiliation with a club or organisation (e.g. sporting club, church group), and infrequent participation in religious activities increases risk of death in men. Social isolation increased the risk of mortality to a degree equivalent or greater than that of established risk factors such as smoking, hypertension, obesity and hypercholesterolaemia1.
A meta-analysis of studies investigating associations between loneliness and mortality observed that the effect of loneliness is “slightly higher in men than in women” but the reasons why are unknown2.
Social isolation and loneliness can affect anyone at any time. Asking patients simple questions about their living arrangements, their frequency of contact with family and friends, and their participation in social activities can help to identify people who are socially isolated. You can find out about loneliness by asking people how often they lack companionship, or feel left out or isolated7.
Unfortunately, there is not a great deal of evidence to guide interventions to reduce loneliness, and addressing social isolation can be limited by health and economic factors8. Social prescribing might be one way to address loneliness and social isolation, but their complexity suggests that there is probably no simple solution.
1. Pantell et al., 2013. Social isolation: A predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health
2. Holt-Lunstad et al, 2015. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science
3. Lim, 2018. Australian Loneliness Report: a survey exploring the loneliness levels of Australians and the impact on their health and wellbeing. Australian Psychological Society and Swinburne University
4. Relationships Australia, 2018. Is Australia experiencing an epidemic of loneliness? Findings from 16 waves of the Household Income and Labour Dynamics of Australia Survey
5. Lim et al., 2020. Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions. Social Psychiatry and Psychiatric Epidemiology
6. Kung et al., 2021. Economic Aspects of Loneliness in Australia. Australian Economic Review
7. Hughes et al., 2004. A Short Scale for Measuring Loneliness in Large Surveys. Research on Aging
8. Liebmann et al., 2022. Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature. BMC Health Services Research