How Do We Prevent Loneliness?

Rita Rubin, an independent journalist, explores the challenges with developing interventions to reduce loneliness. In a new perspective article, published in JAMA, Rubin reviews recent studies on the impact of loneliness and programs to improve social connection. She also reports on interviews with researchers and practitioners devoted to reducing loneliness. Ultimately, there is a consensus that loneliness is connected to adverse health outcomes, but solutions are unclear.

“The association between loneliness and physical ailments and the fact that loneliness is distressing are reason enough to intervene… [yet] there is a dearth of evidence to support what intuitively seems like good advice for lonely individuals—take a class, get a dog, do volunteer work,” writes Rubin.

Loneliness is “a distressing discrepancy between desired and actual levels of social contact,” explains Rubin. Loneliness is different from social isolation, as someone can feel lonely without being isolated, and vice versa. However, both have been linked to negative health outcomes. Loneliness has been identified as an epidemic with some scholars placing the dangers to one’s health on the same level as smoking cigarettes.

Christina Victor, professor of gerontology and public health at Brunel University London, addresses the misconception that loneliness can be easily fixed by a one-time interaction with a stranger. She gives the example of charities connecting isolated elderly with volunteers, so they do not spend holidays alone. This intervention is not backed by research, as one-time interactions with strangers have not been shown to reduce loneliness and seniors are actually more likely to feel lonely in the summer than Christmas.

Rubin also reports on the research of Julianne Holt-Lunstad, professor of psychology and neuroscience at Brigham Young University. Holt-Lunstad identified loneliness as a public health threat, based on her research finding that social isolation increases one’s risk of dying prematurely.

Scholars, like Victor, have noted limitations in loneliness research. The main issues are that the majority of studies have been cross-sectional or failed to control for confounding factors, making it unclear whether loneliness is actually causing negative health outcomes. Despite these limitations, Holt-Lunstad and her colleague, Timothy Smith, state “The cumulative evidence points to the benefit of including social factors in medical training and continuing education for healthcare professionals.”

Unfortunately, “recognizing loneliness gets little attention in healthcare,” according to Rubin. And even when individuals are appropriately identified, Rubin notes “the evidence suggests that what many people would consider common sense solutions don’t necessarily lift the veil of loneliness.” ‘

One example of this is “befriending” where a volunteer regularly meets with an individual identified as lonely to develop an emotionally supportive relationship. A recent systematic review on befriending programs found only modest improvement in depression and anxiety symptoms and these benefits were often not statistically significant.

According to Laurie Theeke, associate professor of nursing at West Virginia University, befriending interventions are flawed because they adopt a universal approach that treats each lonely person the same. Instead, Theeke identifies loneliness as a psychological construct connected to depression and anxiety. Theeke and colleagues have developed “Loneliness Intervention using Story Theory to Enhance Nursing-sensitive outcomes” (LISTEN) as an individualized approach.

LISTEN participants engage in 2-hour group sessions for five weeks. These courses include education about aging and space to talk about their loneliness and what patterns in their thoughts or behaviors may contribute to it. Theeke says this program “is like teaching a person how to fish” by providing them the skills to foster more social connection. According to Theeke, this program also combats the stigma of “social undesirability” often associated with loneliness by normalizing the experience.

Loneliness affects people across the lifespan. An abundance of research suggests that both loneliness and social isolation are linked to negative health outcomes and poorer quality of life. However, researchers have yet to find effective solutions. Rubin calls for more attention in healthcare to identify individuals experiencing loneliness and more individualized programs, like LISTEN, to combat loneliness.

 

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Rubin, R. (2017). Loneliness might be a killer, but what’s the best way to protect against it? JAMA. Advance online publication. doi:10.1001/jama.2017.14591 (Full Text)