Loneliness: a new public health challenge emerges Loneliness is proving to be more than just part of the human condition. New research shows it’s a serious public health problem, for young people as much as the elderly. The evidence is startling. Feeling lonely can pose a bigger risk for premature death than smoking or obesity, according to research by Julianne Holt-Lunstad, Professor of Psychology and Neuroscience at Brigham Young University in Utah, USA. Links to depression may not be surprising, but the idea that loneliness can be associated with poorer cardiovascular health and, in old age, a faster rate of cognitive decline and dementia is repositioning loneliness as a public health issue.

Many nations around the world now suggest we are facing a ‘loneliness epidemic’ ‘There is robust evidence that social isolation and loneliness significantly increase risk for premature mortality, and the magnitude of the risk exceeds that of many leading health indicators,’ Holt-Lunstad told the 125th Annual Convention of the American Psychological Association in August 2017, adding, ‘Many nations around the world now suggest we are facing a ‘loneliness epidemic’. The challenge we face is what can be done about it.’ Holt-Lunstad drew on data from two meta-analyses for her presentation. The first found greater social connection conferred a 50 per cent reduced risk of early death. The second examined 70 studies and concluded that social isolation, loneliness or living alone posed risks for premature death that were as big as or bigger than obesity, smoking (less than 15 cigarettes a day) and air pollution.

Pinpointing the causes ‘We know that the impacts of feeling lonely and isolated impede your health, whether that’s your mental health or physical health,’ says Irene Verins, Manager, Mental Wellbeing at VicHealth. ‘We need to identify the factors that influence loneliness – at the level of the individual, the local community and wider society – to get some idea, or a clue, as to where to look for solutions. New research is required that tells us about levels and experiences of loneliness in Australia. ‘We also know that loneliness impacts more on those people who are the most vulnerable. We need to look at how we could approach the issue of loneliness for the most disadvantaged in the community first.’ Loneliness can affect people at any point, but is more common among two key groups: older individuals aged 75 and above and, perhaps surprisingly, young people aged 15–25. Figures released in April 2018 by the UK’s Office for National Statistics showed individuals aged 16–24 reported feeling lonely more often than people in older age groups. The statistics also identified a particular risk of loneliness among young people who were renting and who did not feel a sense of belonging to the local area. Although research in Australia is currently limited, a 2015 survey funded by VicHealth found one in eight young people aged 16–25 reported a very high intensity of loneliness. Loneliness is commonly understood as an emotional response to the perceived mismatch between the amount of personal contact a person wants and the amount they have. In the UK, the Campaign to End Loneliness intensifies the focus to identify two types of loneliness: individual and social. Individual loneliness occurs when a person is missing someone special such as a partner or close friend with whom they had a close, emotional bond. Social loneliness refers to the absence of a social network made up of a wide group of friends, neighbours and colleagues. The quality of those social connections is also important. Relationships need to be reciprocal, with those involved both sharing a sense of happiness, satisfaction and self-worth. (In 2012, a team at the University of California published the results of a study that found significant numbers of older people who identified as lonely were either married or lived with others.) What could solutions look like? As loneliness and social isolation can arise from very different factors, interventions to alleviate them will also be varied. They could include projects that support connections, such as online groups, volunteering programs and befriending projects, and other approaches such as local neighbourhood approaches. Interventions can be aimed at the individual, community or societal level.

The most effective way to reduce loneliness is to make people feel connected to their community. ‘The most effective way to reduce loneliness is to make people feel connected to their community,’ says Verins. ‘Those communities may not be geographic – for example, they may be online for LGBTI youth or rural young people – but what’s important is they share common interests and develop meaningful connections.’ Holt-Lunstad suggests interventions ranging from a bigger focus on social skills training in schools, to making social connectedness checks part of standard medical screenings. Human Resources departments could prepare workers for retirement socially as well as financially, she says. Planning out suburbs so they are walkable and include social spaces where people can meet up, such as gardens or recreation centres, is also crucial. Media campaigns could raise awareness about loneliness while also removing some of the label’s stigma. Public Health England, in its 2015 Reducing social isolation across the lifecourse report, highlighted that ‘access to transport is also vitally important for building and maintaining social connections’.

Evidence-based campaigns Experts emphasise that any interventions to reduce loneliness and social isolation should be evidence-based. The Campaign to End Loneliness in the UK, which launched in 2011, began by building a research base and connecting different groups interested in reducing loneliness so they could learn from each other. It then partnered with health and community organisations to scale up successful initiatives.

Its first public campaign about loneliness was in 2017, and during this year it will launch the Be More Us movement to promote social connectedness right across the country and generations. ‘British people are famously awkward and a bit stiff upper lip, so our new movement is about breaking down those barriers and finding what we have in common,’ says Alice Stride, the Campaign to End Loneliness’s Media Communications Manager. ‘Intergenerational friendships and intergenerational connections are going to be a really important part of everybody’s solution to loneliness, not just for older people but for younger people, too.’

Online tools are also showing their worth. Australian initiative Gather My Crew is a free, online rostering tool that helps family, friends and community members to organise themselves in support of someone who needs help. Rostered tasks can include practical help, like lending a hand to someone who is in poor health by picking up their kids from school or doing their supermarket shopping. But they can also include social visits or phone calls to a friend, family member or neighbour at risk of social isolation. Another Australian online initiative is the Moderated Online Social Therapy program (MOST) from Orygen. MOST is proving useful for vulnerable young people experiencing mood disorders, anxiety and psychosis. ‘It’s sort of like Facebook but we also build in online therapy with clinicians and peer workers,’ says Dr Simon Rice, a clinical psychologist and Research Fellow at Orygen. ‘Young people, who sometimes are quite socially isolated and lonely, get a huge benefit from that online connection with other people in a safe, supported environment. That can be quite restorative to their sense of self and their confidence in their functioning as well. ‘We encourage young people to use the skills and confidence they’re learning in the online environment and use them offline. We want those skills to translate.’ Taking a positive approach Dr Michelle Lim leads the Social Connectedness Laboratory at Melbourne’s Swinburne University of Technology. Her six-week Positive Connect study used strengths-based group therapy to assist young people experiencing psychosis and social anxiety build their social interaction skills. The study had just a 10 per cent dropout rate from participants, compared to the usual 50 per cent. ‘Often psychologists are overly focused on deficits and risk,’ Lim explains. ‘In our traditional method in health services, we often go, ‘Hey, so what’s wrong with you today? How depressed are you? Are you feeling suicidal?’ And we forget to ask what’s right with you. ‘In the Positive Connect study, we never once mentioned the word lonely, and we never once mentioned the word psychosis. It was very much about let’s not focus on deficits and illness, let’s focus on strengths and be about building healthy social connections, to reconnect with people and change acquaintances into friends.’

There are currently 130-odd more Men’s Sheds in Australia than there are McDonald’s restaurants. Not that it’s a race. A well-known community initiative that tackles social isolation is the Australian Men’s Shed Association. Its CEO David Helmers says, with a little humour, ‘There are currently 130-odd more Men’s Sheds [987 Sheds] in Australia than there are McDonald’s restaurants. Not that it’s a race.’ The Sheds target men who are no longer in paid employment, through retirement, redundancy or other reasons. Men can come to the Shed to build and repair items for the community, but that’s not the place’s main purpose. ‘The most important thing is the men getting together, building those relationships, that brotherhood that exists in the Sheds. They’re finding new friendships but, most importantly, finding meaningful purpose,’ says Helmers.