This Deadly Condition Affects One in Four People

Conservative estimates suggest that at least 25 percent of people suffer chronically from a condition that considerable evidence suggests is a key driver of numerous negative outcomes. These outcomes include cognitive decline, lower mental and physical health, decreased overall well-being, worse sleep, and increased morbidity and mortality.

One hundred percent of the population has the potential to experience this condition at some point in their lives. Men tend to report this condition more than women, and younger people more than older people. It’s also a condition that’s generally treatable, or at least we have ways to address it. We know this condition by the same name in both scientific and non-scientific circles.

It’s loneliness.

Loneliness is a big enough problem that public officials in both the United States and the United Kingdom have labeled it an “epidemic” and are suggesting steps to address it at the national level. Regardless of whether national-level initiatives can really help with loneliness, it does highlight perhaps the magnitude of the problem.

But what is loneliness? First of all, loneliness is different from being alone. A person can be lonely while surrounded by others, and it’s possible for a person to be completely alone yet not feel lonely. The key to understanding loneliness is that it centers upon a feeling of social isolation, regardless of the degree to which a person is around other people.

Looking at how researchers measure loneliness is one way to understand what it is. Multiple validated measures of loneliness exist, but for a brief illustration, consider the three-item scale below.

The next questions are about how you feel about different aspects of your life. For each one, tell me how often you feel that way.

• First, how often do you feel that you lack companionship: (1) hardly ever, (2) some of the time, or (3) often?

• How often do you feel left out: (1) hardly ever, (2) some of the time, or (3) often?

• How often do you feel isolated from others? Is it (1) hardly ever, (2) some of the time, or (3) often?

These questions assess three different facets of loneliness: relational connectedness, social connectedness, and self-perceived isolation. Relational connectedness has to do with having quality relationships with other people, social connectedness has to do with feeling like you’re part of a group, and self-perceived isolation is your subjective sense of whether you’re separated from others or not. If you add your scores, you’ll end up with a score from 3 to 9. Researchers have sometimes categorized scores from 3 to 5 as “not lonely” and scores from 6 to 9 as “lonely.”

Many people experience loneliness at some points in their lives. That’s completely normal and expected. Yet too many people live with chronic loneliness, a condition that takes a negative toll on both their physical and mental health.

Why does loneliness matter?

Loneliness is painful, of course, and perhaps that fact alone makes it something that we should avoid. But the negative outcomes of loneliness far exceed its subjectively unpleasant nature. As reported by NPR in May 2023,

… the physical consequences of poor connection can be devastating, including a 29% increased risk of heart disease; a 32% increased risk of stroke; and a 50% increased risk of developing dementia for older adults.

"It's hard to put a price tag, if you will, on the amount of human suffering that people are experiencing right now," Surgeon General Dr. Vivek Murthy told All Things Considered.

"In the last few decades, we've just lived through a dramatic pace of change. We move more, we change jobs more often, we are living with technology that has profoundly changed how we interact with each other and how we talk to each other."

"And you can feel lonely even if you have a lot of people around you, because loneliness is about the quality of your connections."

Across age groups, people are spending less time with each other in person than two decades ago. The advisory reported that this was most pronounced in young people aged 15-24 who had 70% less social interaction with their friends.

Here’s more from the Surgeon General on the dangers of social disconnectedness and small steps we can take to alleviate it.

Additionally, human connection matters even more when the going gets tough. We need each other for instrumental and emotional support, for making life easier and for a shoulder to lean upon. The perceived social isolation of loneliness is a barrier to these resources, making lonely people all the more susceptible to the negative outcomes of adversity.

What might we do about loneliness?

Some years ago, psychologist John Cacioppo outlined a few ways to address loneliness in an interview published in The Atlantic. Specifically, he suggested a few steps for lonely people themselves. In his words:

Do volunteer service in something that you enjoy. I've developed the acronym EASE—ease your way back into social connections. The first E stands for “extend yourself,” but extend yourself safely. Do a little bit at a time.

The A is “have an action plan.” Recognize that it’s hard for you. Most people don’t need to like you, and most people won't. So deal with that, it's not a judgment of you, there's lots of things going on. Ask [other people] about themselves, get them talking about their interests.

The S is “seek collectives.” People like similar others, people who have similar interests, activities, values. That makes it easier to find a synergy.

And finally when you do those things, “Expect” the best. The reason for that is to try to counteract this hyper-vigilance for social threat.

Cacioppo’s advice seems reasonable, as do many of the Surgeon General’s big (and small) ideas as articulated here. But there’s something about this whole problem and the solutions presented that just seems really sad.

First of all, many of the proposed solutions to loneliness seem easier said than done in a society that feels increasingly connected in superficial ways through social media yet disconnected in deep ways through our struggling civic, cultural, and religious institutions.

Secondly, it makes me wonder: Whose job is it to help create a more socially connected society, one that makes loneliness rare? From a public health perspective, it’s not obvious to me that there’s anything wrong with the Surgeon General taking the problem seriously and proposing solutions. Yet the fact that government agencies both in the United States and the United Kingdom are creating campaigns to address the loneliness epidemic also feels like an indictment: In a big way, it seems like we have failed each other.

Creating a world in which we all want to live and grow old requires consistent effort, small acts of kindness, and selfless service for others. Too often, it seems like the message inculcated in our youth and taken for granted in many adults I encounter is one of make money, use it for yourself, and strive for a life of luxury and leisure. I have no problem with people making money and having fun, but there’s something wrong with a world in which we live only as atomized individuals, never taking responsibility for building and maintaining meaningful social connections.

What if we all took seriously the idea of enhancing social connections in our own lives and in our communities? How might that shape the ways in which we interact, the ways in which we organize, work, and worship? What if we focused—really focused—on strengthening marriages and families, those fundamental building blocks of society?

I don’t have all of the answers to these questions, but I do think we can start by looking in the mirror and taking some personal responsibility for the problem. We might start by considering our own spheres of influence and how we might, within those areas under our control, eradicate loneliness around us and build the social connections we all need to thrive.

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References and for further reading

Barreto, Manuela, Christina Victor, Claudia Hammond, Alice Eccles, Matt T. Richins, and Pamela Qualter. "Loneliness around the world: Age, gender, and cultural differences in loneliness." Personality and Individual Differences 169 (2021): 110066. https://www.sciencedirect.com/science/article/pii/S0191886920302555

Hawkley, Louise C., and John T. Cacioppo. "Loneliness matters: A theoretical and empirical review of consequences and mechanisms." Annals of Behavioral Medicine 40, no. 2 (2010): 218-227. https://academic.oup.com/abm/article/40/2/218/4569527

Hughes, Mary Elizabeth, Linda J. Waite, Louise C. Hawkley, and John T. Cacioppo. "A short scale for measuring loneliness in large surveys: Results from two population-based studies." Research on Aging 26, no. 6 (2004): 655-672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2394670/

Khazan, Olga. “How loneliness begets loneliness.” The Atlantic (April 6, 2017). https://www.theatlantic.com/health/archive/2017/04/how-loneliness-begets-loneliness/521841/

Lam, Jeffrey A., Emily R. Murray, Kasey E. Yu, Marina Ramsey, Tanya T. Nguyen, Jyoti Mishra, Brian Martis, Michael L. Thomas, and Ellen E. Lee. "Neurobiology of loneliness: a systematic review." Neuropsychopharmacology 46, no. 11 (2021): 1873-1887. https://www.nature.com/articles/s41386-021-01058-7

Park, Caroline, Amna Majeed, Hartej Gill, Jocelyn Tamura, Roger C. Ho, Rodrigo B. Mansur, Flora Nasri et al. "The effect of loneliness on distinct health outcomes: a comprehensive review and meta-analysis." Psychiatry Research 294 (2020): 113514. https://www.sciencedirect.com/science/article/abs/pii/S0165178120331759

Steptoe, A., Shankar, A., Demakakos, P. and Wardle, J., 2013. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences, 110(15), pp.5797-5801. https://www.pnas.org/doi/abs/10.1073/pnas.1219686110