Loneliness and Social Isolation

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C
HAPTE
R 26
Loneliness and
Social
Isolation
Jenrry de
Jong Gierueld
Theo
uan Tilburg
Pearl A. Dvkstra
Given that all people seek
happiness and all
people desire to be huppy, the feelings of
loneliness
as registered among adolescents,
young adults (Marcoen, Goossens,
& Caes,
tg87; Sippola & Bukowski, 1999), midlife
and older adults (see among many others,
Lopata, 1996) reveal a major problem
in society. Although there is a general
core to loneliness - the evaluation of a
discrepancy between the desired and the
achieved
network of relationships as a neg-
ative experience - the forms of loneliness
and their antecedents vary enormously
according
to personal and contextual deter-
minants. Despite the fact that loneliness
is not treated as a specific clinical entity
[Mijuskovic, ryg6), Russell, Peplau, and
Cutrona [r98o) presented evidence on the
uniqueness
of loneliness as a phenomenon
in its own right. After being largely ignored
by social scientists until the mid-zoth
century, an ever-increasing flow of work
since
the r97os amply testifies to the utility
of loneliness as an important concept.
This chapter addresses the concepts of
loneliness and social isolation using theo-
retical ideas and empirical evidence from
various sources and disciplines including
psychology,
sociology,
and anthropology.
The Concepts of Loneliness and
Social Isolation
Loneliness
The oldest publication about loneliness is
Ubt, die Eínsamkeít (Zímmermann, ry8j-
1786). More recent effiorts
to conceptual-
ize loneliness started in the r95os with the
publication "Loneliness" by Fromm Reich-
man (r9;q). Empirical research into loneli-
ness was supported by the efforts of Perlman
and Peplau (r98r), who defined loneliness
as "the unpleasant experience that occurs
when a person's network of social relations
is deficient in some important way, either
quantitatively or qualitatively" [p. ]r). A
second definition of loneliness, frequently
used in European countries, is formulated
as
follows:
Lonelmess is a situation experienced
by
the indiuidual as one where there is
an unpbasant or inadmissible lnck "f
+8s
In: Cambridge handbook of personal relationships / A.Vangelisti and
D.Perlman, eds. Cambridge: Cambridge University Press, 2006. - p.
485-500.
de Jong Gierveld, J., van Tilburg, T.G., & Dykstra, P.A. (2006). Loneliness and
social isolation. In D. Perlman & A. Vangelisti (Eds.), The Cambridge handbook of
personal relationships (pp. 485-500). Cambridge, UK: Cambridge University Press.
ISBN-13 978-0-521-82617-4 hardback; 978-0-521-53359-1 paperback

486
(quality ofl certain relationships. This
includes situations, in which the number
of existing relationships is smaller than
is consiàered
desirable or admissible,
as
well as situations where the intimacy one
wishes
for has not been
realized. (De Jong
Gieruelà,
gB7, p.
no)
Central to both definitions is that loneliness
is a subjective and negative experience, and
the outcome of a cognitive evaluation of the
match between the quantity and quality of
existing relationships and relationship stan-
dards.
The opposite of loneliness
is belong-
ingness
or embeddedness.
Social Isolation
Social isolation concerns
the objective char-
acteristics of a situation and refers to the
absence
of relationships
with other people.
The central question is this: To what extent
is he or she alone?
There is a continuum
running from social isolation at the one end
to social participation at the other. Persons
with a very small number of meaningful ties
are, by definition, socially isolated. Loneli-
ness is not directly connected to objective
social
isolation; the association
is of a more
complex nature.
The Relationship Behaeen Social Isolation
and Lonekness
Loneliness is but one of the possible out-
comes of the evaluation of a situation
characterized by a small number of rela-
tionships. Socially isolated persons
are not
necessarily
lonely,
and lonely persons
are
not
necessarily
socially isolated in an objective
sense.
An individual who is well positioned
in terms of objective
social
participation can
occupy virtually any position on the subjec-
tive continuum. Where a person ends up
on the subjective continuum depends on
his or her relationship
standards.
Some peo-
ple with a small number of social contacts
might feel lonely; others might feel sufÊ-
ciently embedded. An example of the latter
situation is
that of a
person
who prefers
to be
alone and opts for privacy as
a
means
toward
avoiding
undesired
social
contacts
and rela-
tionships. Acknowledging the importance of
relationship standards,
Perlman and Peplau
THE CAMBRIDCE HANDBOOK OF PERSONAL
RELATIONSHIPS
[r98r) developed a cognitive or cognitive
discrepancy theoretical approach to loneli-
ness
that focuses on the subjective evalua-
tion of relationships in association
with the
personal
standards
for an
optimal network of
social relationships. The cognitive approach
also considers
the activities a person might
undertake to restore the imbalance between
the actual and the ideal situation. Thus,
a person's position on the subjective con-
tinuum is affected not only by the type,
nature and the saliency of the contacts
missed, but also by the time perspective
required to "solve" and upgrade problematic
relationships, and the capacities to change
the situation.
Typ"t ofLonekness
Several
components
of loneliness
can
be dis-
tinguishe d. Zimmerman Q7
8
5
/ ry 86) difFer-
entiated between a positive and a negative
type of loneliness.
The positive type of lone-
liness is related to situations such as the
voluntary withdrawal from the daily has-
sles of life and is oriented toward hlgher
goals: reflection, meditation, and commu-
nication with God. Nowadays, the posi-
tive type of loneliness is more frequently
referred to by a separate concept: privacy.
Privacy is voluntary; it concerns a freely
chosen situation of [temporary) absence
of
contacts with other people. The negative
type of loneliness is related to an unpleas-
ant or inadmissible lack of personal rela-
tionships and contacts with important oth-
ers,
as formulated in the definitions given in
this chapter. This is the concept of loneli-
ness
that is nowadays
used in theories and
research.
Moreover, it is the type of lone-
liness that best fits the everyday concept
of loneliness.
Weiss (rW ZJ
differentiated between emo-
tional loneliness,
stemming from the absence
of an intimate figure or a close emotional
attachment [a partner, a best friend), and
social
loneliness
stemming from the absence
of a broader group of contacts,
or an engag-
ing social network [friends, colleagues,
and
people in the neighborhood). Emotional
loneliness
arises
when a partner relationship
dissolves
through widowhood or divorce and
is characl
ness, ab:
rype of I
ing a ner
port fror
pensate
[stroebe
r996).
T
to the
friends v
Weiss [r
reportec
moved t
ers.
The:
intimate
by the
others r,
tion bet
has aga
]ېfs, f,
to bettt
express
Giervel
& Van'
Jong G
Smit, {
and En
[SELST
Ernst 8
valid ar
emotic
section
Meast
Loneli
Lone11
those r
feelinl
[Borys
defici<
alwayr
direct
oÍ "lc
likely
loneli
ing a
other
In dl
mentr
that 1
loneli

LONELINESS AND SOCIAL ISOLATION +Bt
is characterized by intense feelings of empti-
ness, abandonment, and forlornness. This
type of loneliness is only solvable by start-
ing a new intimate relationship.
Social sup-
port from family and friends cannot com-
pensate the loss of the attachment figure
(Stroebe, Stroebe, Abakoumkin, & Schut,
ryg6).
The social
type of loneliness is related
to the absence of a wider network of
friends with common interests.
According to
Weiss
(rgll), social loneliness
is frequently
reported by young homemakers, who have
moved to an area where they are newcom-
ers.
Their husbands,
however supportive and
intimate, cannot fill the gap that is caused
by the absence of a group of friends and
others
with whom to socialize. The distinc-
tion
between social
and emotional loneliness
has again been gaining attention. In recent
years, researchers have used the two types
to better understand the determinants and
expressions
of loneliness.
Both the De Jong
Gierveld
loneliness
scale
[De Jong Gierveld
& Van Tilburg, r999a, rgggb; Dykstra & De
Jong
Gierveld, zoo4; Van Baarsen,
Snijders,
Smit, & Van Duijn, zoor) and the Social
and
Emotional Loneliness
Scale
for Adults
(SELSA); [DiTommaso & Spinner; r9g3;
Ernst
& Cacioppo, 1999) have
proved to be
valid and reliable measuring instruments for
emotional
and social loneliness
(see
the next
section
for addiUonal information').
Measuring Instruments
Loneliness has a negative connotation.
Lonely people carry a social stigma. For
those
reasons
it is embarrassing
to talk about
feelings
of loneliness, in particular for men
[Borys
& Perlman, 1985), and people with
deficiencies in their relationships do not
always
admit to being lonely. The use of
direct
questions
including the words "lonely"
or "loneliness"
to investigate loneliness is
likely to result in underreporting. Some
loneliness
scales
consist of items exclud-
ing any reference to loneliness, whereas
other
scales
include one or more such items.
In discussing different measuring instru-
ments,
Shaver and Brennan [r99rJ argued
that the exclusion of explicit references to
loneliness gives rise to disagreements on
content validity. In their view, it is unclear
whether one is measuring
relationship sat-
isfaction or loneliness.
We disagree: Many
instruments are validated by showing they
correlate with self-reports of loneliness.
We
describe two loneliness scales that have
no explicit references to loneliness and
have been used in many research projects
[Pinquart
& Sórensen, zoorb].
The UCLA Loneliness Scale [Russell,
Peplau, & Cutrona, r98o) has been trans-
lated into several languages.
In the original
version, all the items were worded in a neg-
ative or "lonely" direction. Because
of con-
cerns about how the negative wording of
the items might affect scores
[i.e., response
sets), a revised version
of the scale
was devel-
oped that included items worded in a
lonely
and a nonlonely direction. The wording of
the items and the response format have
been simplified to facilitate administration
of the measure
to less educated populations
fRussell, ryg6).
De Jong Gierveld and colleagues
con-
ducted qualitative research as
the first step
in developing a loneliness
scale. The r9B5
version (De Jong Gierveld & Kamphuis,
r9B
5; De Jong Gierveld & Van Tilburg,
r999a) consists of rr items. Five items are
positively phrased, and six are negatively
phrased. The reliability and homogeneity
of the scale have proven to be satisfac-
tory in different Dutch samples adopting
difterent modes of data collection [Van
Tilburg & De Leeuru,
i99r). Using the scale
in self-administered questionnaires
results
in higher scale means than if the scale
is used in face-to-face
or telephone inter-
views (De Leeuw, rggz). This finding is in
line with Sudman and Bradburn's (rgl +)
observation that, compared with interviews,
the more anonymous the setting in which
selÊadministered surveys are completed,
the more the results show self-disclosure
and reduce the tendency of respondents
to
present
themselves
in a favorable
light. The
De Jong Gierveld scale was not developed
to assess types of loneliness
but rather to
measure the severity of feelings of loneli-
ness.
Researchers can
choose to use the scale
as a one-dimensional
measure. As a whole,
the scale is moderately, yet sufficiently

488
homogeneous. The items were, however;
developed with Weiss's (tgl1J distinction
between social and emotional loneliness
in mind. For that reason, researchers
can
choose to use two subscales (one for emo-
tional and one for social loneliness)
that have
moderate intercorrelations.
Conceptual Approaches to
Understanding Loneliness
Several theoretical approaches
have been
used for analyzing loneliness [Derlega &
Margulis, ry82; Perlman & Peplau, r98r).
Weiss (rgl+), a leading proponent of the
attachment perspective,
suggested
that there
are
different provisions of relationships (e.g.,
attachment,
sense
of worth, etc.), each asso-
ciated with a specific type of relationships.
He contended that as long as
the provider
is trustworthy, we can obtain guidance and
assistance,
often needed during stressful
sit-
uations, and in alleviating loneliness. The
main approaches to loneliness focus on
individual-level characteristics that predis-
pose people to become lonely or to persist
in being lonely [Marangoni & Ickes, 1989;
Rokach & Brock, ryg6).ln our view, greater
insight into loneliness will be gained by
bringing together individual level character-
istics and contextual characteristics.
Exam-
ples
of the latter are
sociocultural factors and
sociostructural characteristics
of the individ-
ual's environment. In this section,
we start
with a description of the individual level
factors contributing to loneliness.
We con-
tinue with the sociocultural factors
that con-
tribute to loneliness, more specifically, the
social standards.
Finally, the sociostructural
factors modulating the risks
of loneliness
are
addressed,
particularly the socioeconomic
characteristics
of the contextual setting.
The Cognitiue Approach to Lonekness
(Individual Leuel)
Thanks to the efforts of Peplau
and Perlman
[1982)
who, at the end of the r97os,
brought
together loneliness researchers from the
United States, Canada, and Europe, mea-
THE CAMBRIDGE HANDBOOK OF PERSONAL
RELATIONSHIPS
suring instruments and research into the
determinants of loneliness became more or
less
"standardized."
From that point in time,
loneliness
research
in different regions
of the
world has been largely
comparable
in terms
of design and theoretical modeling. Draw-
ing on the cognitiue approach to loneliness
(Dykstra & De Jong
Gierveld, rgg4; Perlman
& Peplau, r98rJ, analyses
focus on subjec-
tive experiences and on cognitive processes
that mediate the association
between rela-
tionship characteristics
and the experience
of loneliness.
A shortage
of achieved
as com-
pared with desired relationships does not
directly and inevitably lead to loneliness
but
is first perceived
and evaluated.
Social com-
parisons
are key to this process.
For
example,
social
comparison
may affect how large
and
important a social deficit is believed to be
(Perlman
& Peplau,
r98r).
Researchers adopting the cognitive
approach typically include the following
characteristics
in their models: [aJ descrip-
tive characteristic.s
of the social network
(intimate relationships as
well as the broader
group of acquaintances,
colleagues,
neigh-
bors, and extended hrJ; ft) relationship
standards, [.J personality characteristics
[".g., social skills, selÊesteem, shyness,
anxiety, introversion); and (d) background
characteristics (".g., gender and healthJ.
First, we address
various components of the
network of social relationships.
MARITAL AND PARTNER STATUS
From Durkheim onward, marriage has
been seen as an avenue toward alleviat-
ing social
isolation and loneliness.
Research
has repeatedly shown the protective effect
of an intimate partner bond on the phys-
ical, financial and mental well-being of
both men and women [Waite & Gallagher,
zoooJ. Although, in Western and Northern
Europe "ne\M"
partnerships
such as consen-
sual unions and "living apart and together"
relationships
are
becoming
increasingly pop-
ular, it is the content and not the form of
the partner bond that matters (Coleman,
Ganong, & Fine, 2ooo; De Jong Gierveld,
2oo4; Dykstra, zoo4). A partner does not
alwa
Persc
most
very
speal
ner t
lonel
bonc
Shah
St
abse.
peotr
a kel
worl
posil
with
Sóre
smal
partt
p€fSt
and,
towt
livin
dissc
who
parL
and
are I
[Lor
ofd
cont
inm
ings
&t
unÍ
reso
ings
shor
ship
abo''
KIN F
Invc
part
lone
the
ilY, I
ical
mai
stre:

LONELINESS AND SOCIAL ISOLATION +89
always
provide protection against
loneliness.
Persons with a partner who is not their
most supportive network member tend to be
very lonely 0á" Tilburg, 1988). Generally
speaking, howeveq persons with a part-
ner bond tend to be better protected from
loneliness than persons without a partner
bond [Dannenbeck, r995; Wenger, Davies,
Shahtahmasebi,
& Scott, r996).
Several
mechanisms can explain why the
absence
of a
partner in the household makes
people more vulnerable to loneliness. First,
a
key structuring influence in the social
net-
work is missing:
The size and broader com-
position of the network are strongly linked
with the presence of a partner (Pinquart &
Sórensen,
zoora). Persons living alone
have
smaller networks than those living with a
partner. Second, when help is needed, the
persons
living alone lack in-house support
and,
by definition, have to orient themselves
toward others outside the household. Third,
living alone is,
in many cases,
the result of the
dissolution of a partner relationship. Those
who remain alone after the death of the
partner are specifically at risk of loneliness,
and
the effects on the intensity of loneliness
are
recognizable
over a long period of time
(Lopata,
ryg6; Stevens,
rg8gJ. The effects
of divorce on loneliness are also known to
continue over long periods of time: Divorce
in middle adulthood continues to affect feel-
ings
of loneliness
even at older ages
(Dykstra
& De Jong Gierveld, zoo4). Remarriage,
unmarried cohabitation, and dating help to
resolve
loneliness to a certain extent. Find-
ings
reported by Peters and
Liefbroer [1997)
show that previous disruptions of partner-
ships have an efFect
on loneliness over and
above
current partner status.
KIN RELATIONSHIPS
Involvement in relationships other than a
partner can also help to prevent or alleviate
loneliness.
Hagestad
[r98r, 1998) described
the socially integrative role of the fam-
ily, arguing that communication and histor-
ical conversations across generations help
maintain continuity across life phases and
strengthen a sense
of belonging. The central-
ity of the parent-child bond in people's lives
is undisputed [Rossi
& Rossi,
r99o). Adult
children are an important source of compan-
ionship, closeness, and sharing, particularly
for those who live alone. Dykstra [1993)
and
Pinquart (zoo1J have shown, for example,
that contacts with children are more likely
to reduce
loneliness among formerly married
than among married older adults. Divorce
often impairs the relationship between par-
ents and children, especially
in the case of
fathers
(Kaufman &Uhlenberg, 1998;
Kitson
& Morgan, rggo). The low level of contact
with adult children is the reason divorced
fathers tend to be lonelier than divorced
mothers fPinquart, zoo3). Siblings
are spe-
cial in many ways (Bedford, r989; Cicirelli,
rggr; Connidis, 1989;
Gold, 1987): There
is the common blood tie, the shared his-
tory of growing up together and of having
the same background. The loss of a sibling
has been found to contribute to loneliness
among older persons (Gold, rg8Z). Siblings
serve a particularly important function in
alleviating the loneliness of those who lack
the intimate attachment of a partner and
have no children (Pinquart, zooT).
NONKIN RELATIONSHIPS
The importance of friends for psychologi-
calwell-being is well documented
(Blieszner
& Adams, r99z; Rawlins, rgg5): the joy of
spending
time together, the compassion
evi-
dent in keeping up with personal ups and
downs, and the exchange of ideas. Rela-
tionships with friends, colleagues,
and other
nonkin relationships serve to connect peo-
ple to circles outside their immediate fam-
ily. The benefits of belonging to a set of
interlocking networks can lower the risks of
social
loneliness
[Connidis & Davies, r99o)
Wagner, Schutze, & Lang, r999J. More-
ove{, best friends can step in and function
as confidants and in doing so help allevi-
ate emotional loneliness, in particulaq, for
never partnered or childless
adults [Dykstra,
rgg3; Pinquart, zoq). Involvement in
formal organizations is another source of
sociability: Church attendance, activities in
voluntary associations,
and volunteer work

4go
bring people together and are a means of
forming attachments [Pilusuk & Minkleq
r98oJ and in this way help to prevent or
combat loneliness [Van Tilburg, De Jong
Gierveld, Lecchini, & Marsiglia,
r9g8).
SIZE AND COMPOSITION OF THE NETWORK
Generally speaking, as the number of rela-
tionships in the social network increases
and as
the amount of emotional and social
support exchanged increases,
the intensity
of loneliness
decreases
fVan Tilburg, r988).
The four closest
ties in a person's
network
provide the greatest degree of protection
against loneliness.
The protection provided
by additlonal relationships is marginal [Van
Tilburg, r99o). Diversity across relationship
types also serves
to protect against loneliness.
People with networks composed of both
strong and weak ties are
less
prone to loneli-
ness
than people with strong ties only [Van
Tilburg, r99o). Moreove4, research
(Dykstra,
rygo; Silverstein
& Chen, ryg6) has shown
that people with networks that consist
primarily or entirely of kin ties are more
vulnerable to loneliness
than people with
more heterogeneous networks. Those who
are dependent on family members for social
contacts because
they lack alternatives tend
to have the highest levels of loneliness.
RELATIONSHIPS STANDARDS
The cognitive approach to loneliness
empha-
sizes that people evaluate whether their
relationships measure up to their standards.
Standards
might be what a person aims for
in relationships
[".g.,
a certain
degree
of inti-
macy, of frequency of contactsJ. Standards
might also be desires
to have specific types
of relationships [".g., an intimate partneq,
best friends, supportive colleagues).
Stan-
dards develop over the course of life. Child-
hood experiences
shape needs and desires
for attachment (Bowlby, ry74), which are
altered with new relationship experiences.
Standards regarding partner relationships
are
a case in point. Research
has
shown that
over the course of time, men and women
who have lost their partner by death start
downplaying the advantages of having a
THE CAMBRIDGE HANDBOOK OF PERSONAL
RELATIONSHIPS
partner and start upgrading the advantages
of being single
(Dykstra & De Jong
Gierveld,
rgg4; Stevens,
rgSq). In doing so, they free
the way for other relationships. The less
importance attached
to having a
partner, the
less
lonely the widowed were found to be.
PERSONALITY
CHARACTERISTICS
People
with poor social
skills
and
psycholog-
ical resources
are likely to experience diffr-
culty developing and maintaining relation-
ships, and for that reason might feel lonely
[Windle & Woods, zoo4). Similarly, people
with a neurotic or anxious personality might
harbor unrealistic relationship standards,
and their unmet social needs
might give rise
to feelings
of loneliness
fcf Jones
& Carver,
199r). Feeling socially uncomfortable, fear
of intimacy, being easily intimidated by
others, being unable to communicate ade-
quately to others and developmental deficits
such
as childhood neglect
and
abandonment
are reported by lonely people as the main
causes of their feelings
of loneliness
(Rokach
& Brock, 1996).
Characteristics
such as low
self-esteem, shyness and low assertiveness
can predispose people to loneliness and
might also make it more difÊcult to recover
from loneliness (Peplau
& Perlman,
r98zJ.
GENDER
Chodorow [rqZ8) described the gender-
specific socialization of men and women,
arguing that men and women differ in the
values
they ascribe
to different types of rela-
tionships. Men socialized to be emotion-
ally independent prefer undemanding rela-
tionships and tend to rely on their wives
and partners for social and emotional sup-
port. Women are socialized to have more
complex affective needs
in which an exclu-
sive relationship to a man is not enough.
Results from a meta-analysis fPinquart &
Sórensen,
zoon) of roz studies
that investi-
gated gender difterences in loneliness show
that women report significantly higher lev-
els of loneliness than men. This is more
pronounced in studies in which loneli-
ness is measured with single-item indica-
tors than for studies using higher quality
lone
ferer
relu,
dire,
tion
r98
5
for r
nom
socii
lines
1999
first
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and
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(see
Lon<
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LONELINESS AND SOCIAL ISOLATION 4gr
loneliness measuring instruments. This dif-
ference might be related to men's greater
reluctance to report loneliness in response
to
direct questions [see the measurement sec-
tion of this chapter; and Borys & Perlman,
rqSS). In multivariate analyses controlling
for marital status,
partner history, socioeco-
nomic factors, and the functioning of the
social
network, the efFect of gender on lone-
liness decreases
(Baltes, Freund, & Horgas,
1999) and becomes
insignificant for those
in
first marriages [Dykstra, zoo4).
HEALTH
Loneliness is associated with a variety of
measures of physical health. Those who
are in poor health, whether this is mea-
sured objectively or subjectively, tend to
report higher levels of loneliness
(Havens,
&
Hall, zoor; Kramer, Kapteyn, Kuik, & Deeg,
2ooz; Mullins, Hall Elston, & Gutkowski,
g96; Penninx et aI., rggg; Steverink,
Westerhof,
Bode,
& Dittmann-Kohli, zoor).
The causal mechanisms underlying the asso-
ciation between loneliness and health are
not well understood, although new lines of
research on the psychophysiology mecha-
nisms and other pathways connecting lone-
liness and health outcomes [see Cacioppo
et a1.,
zooz; Hawkley & Cacioppo, zooj)
Loving, Heffneq, & Kiecolt-Glaser, this vol-
ume). Does Poor health lead to loneli-
ness via difficulties in maintaining social
relationships? Or does poor health lead to
an increase in support and a decrease in
lonelinessT Penninx et al. frqqq) and Van
Tilburg and Broese van Groenou (zooz)
showed
that investing in relationships by giv-
ing support might pay off in times of need:
Poor health mobilizes network members
and increases support giving. Does loneli-
ness
produce Poor health? Could they mutu-
ally influence each other? Perhaps there is
no direct causation but rather an indirect
relationship through a third factor. One pos-
sible reason for the loneliness-health asso-
ciation involves preventive health behaviors
[see
Cacioppo,
Hawkley, & Bernston, zoo3).
Lonely individuals are less likely to engage
in behaviors such as exercise, remember-
ing to take medications or see their doc-
tors, good
nutrition, and
relaxation fAartsen,
zooj; Mahon, Yarcheski,
& Yarcheski, zoor;
Pérodeau
& du-Fort, zooo).
Loneliness in Context
Empirical studies have focused on
individual-level determinants of loneli-
ness. Much less attention has been paid
to the ways in which social isolation and
loneliness are
patterned socially. A relatively
new area of research
concerns
[a) the soci-
etal patterning of standards for evaluating
one's social network of relationships and
O) the societal patterning of social and
economic resources contributing to social
integration. These contextual-level factors
aftect the intensity of loneliness either
indirectly via the composition and size of
the individual's network of relationships or
directly via differences in the evaluation of
a given context. DifFerences
between neigh-
borhoods in mutual concern for the other's
well-being are an example of societal pat-
terning of resources
at the contextual level.
As Thomése, Van Tilburg, and Knipscheer
(zoo3) showed, as mutual concern for the
other's well-being and the shared feeling
of community embeddedness increase,
the risk of loneliness at the individual
level decreases.
In this section, we first address the out-
comes of international comparative research
into the relationship on socially differen-
tiated standards and loneliness. Next we
discuss theoretical ideas on contextual diÊ
ferences in social and economic resources
and loneliness.
NORMATIVE CLIMATE
People's relationship standards are shaped
by the normative climate in which they find
themselves.
The normative climate in and of
itself can be conducive to loneliness.
Norms
and values afFect
people's ideas about the
optimal size of the network, and the obliga-
tions and duties of family members.
Johnson and Mullins (rq8Z) suggested
that loneliness
is high in collectivist-oriented
communities where sensitivitv to social

492 THE CAMBRIDGE HANDBOOK OF
exclusion is stronger than in individualis-
tic communities. This hypothesis has been
tested in a number of studies on differ-
ences
between North America and Europe.
Rokach, Orzeck, Cripps, Lackovic-Grgin,
and Penezic [zoor) compared Canadians
and Croatians [from central-south
Europe)
assuming
that North American culture poses
a lower loneliness
risk than European cul-
ture because of its emphasis on individ-
ual achievement and impersonal relation-
ships.
However; their findings revealed that
Canadians
experienced
more loneliness than
Croatians. Van Tilburg, Havens, and De
Jong Gierveld [zoo4) observed, in line
with Johnson and Mullins's hypothesis, that
the likelihood of being emotionally lonely
among older adults without a partner and
of being socially lonely among all older
adults in the study was highest in Tuscany,
Italy, followed by the Netherlands and Man-
itoba, Canada. Swedish centenarians were
more often lonely, in contrast to centenar-
ians in Georgia, United States,
who seldom
reported being lonely [Martin, Hagberg, &
Poon,
rggT). Stack's
[rqq8) analysis ofWorld
Values Surveys data showed that adults in
Italy and Japan reported more loneliness
than adults in the United States
and Canada,
whereas adults in a number of Western and
Northern European countries as well as
in
Australia reported less loneliness than in the
United States and Canada
[after controlling
for several individual characteristics such
as
marital and parental status, self-reported
health, socioeconomic status,
education, and
gender). The assumed dlchotomy of two
types of cultures might be too simple. Dif-
ferences within a cultural system are over-
looked. Considerable
variability exists within
North America, for example, as illustrated
by research among immigrants and people
born and
raised in North America where the
experience of loneliness differed by country
of origin and cultural background [Good-
win, Cook, & Yung
, zoor; Rokach & Sharma,
1996). No one has
yet offered a comprehen-
sive explanation to account for the range of
cultural differences that have been found.
A set of studies has examined differ-
ences
in older adult loneliness across
Europe
PERSONAL
RELATIONSHIPS
(imamoflu, Ktiller, imamoflu, & Kuller,
rgg3;
Jylha & Jokela,
1990). Findings showed
that although living alone became
progres-
sively less common from Northern Europe
to Southern Europe, experiences
of loneli-
ness
progressively
increased.
According to
the authors the crossnational differences are
attributable to differences in normative cli-
mate. Living alone generally gives rise to
loneliness, but this is the more so in coun-
tries where older adults without a partner
are expected to live with their families [..g.,
Greece, Italy) and the less so in countries
where older adults without a partner prefer
to live alone
(".g.,
Finland).
In general,
the problems of lonely peo-
ple cannot be regarded as
individual failures
only. Characteristics of the societal context,
such as
prevailing standards
concerning mat-
rimony and the nuclear family, the emphasis
on individual fulfillment, and high expec-
tations about romantic relationships might
also be considered
loneliness-provoking
fac-
tors, especially so for those living on their
own and parents without parents [Ernst &
Cacioppo,
1999).
SOCIOECONOMIC CONTEXT
Perlman and Peplau
(r98r) argued that in any
setting,
factors that increase the frequency of
interaction and
foster
group
cohesiveness are
likely to affect the incidence of loneliness. In
our view, the dimension of socioeconomic
equality versus inequality is among these fac-
tors. Unfortunately empirical research con-
necting socioeconomic inequality [a con-
cept at the contextual level) to individual
loneliness is virtually nonexistent.
Phillipson
[zoo4) has started a program of research
in the United Kingdom that is oriented
toward investigating
the consequences
of the
deepening social and economic inequality
and the socially deprived circumstances of
groups of impoverished inhabitants of urban
neighborhoods compared with the affluent
subgroups, taking loneliness as the depen-
dent variable [Phillipson, zoo4). Research
by Scharf Phillipson, and Smith [zoo4) in
some of the most deprived neighborhoods
of the United Kingdom indicated significant
numb
sion
resou
encin
being
exclu
those
and tl
In
conor
reseal
One I
tigate
nomi
uals'
and n
O'
indus
and r
persir
from
cente
main.
nomi
tions
that ''
well-
consi
cial r
ACTOS
neigh
mech
beinp
of so,
own.
a dirr
persc
cono
is an
tual l
comÍ
persc
leadi:
W
(rgg,
socie
uct 1
incor
cludr
Co-o
with

LONELINESS AND SOCIAL ISOLATION 497
numbers of people prone to social exclu-
sion (".g., from social relations, material
resources, and basic services) and experi-
encing neighborhood exclusion.
The risk of
being affected by multiple forms of social
exclusion and loneliness was greatest for
those belonging to minority ethnic groups
and the age
group of 7j years
and over.
In our view, the links between socioe-
conomic inequality and loneliness are a
research area
worth pursuing. In doing so,
one can learn from research that inves-
tigates the relationship between socioeco-
nomic inequalities and indicators
of individ-
uals' well-being, such as health, morbidity,
and mortality.
O'Rand (zoor) postulated that across
industrialized countries, major structural
and demographic changes have generated
persistent social inequalities and shifts away
from social welfare policies toward market-
centered strategies for income and health
maintenance. In her view, the growing eco-
nomic and social inequalities within popula-
tions form the fundamental social condition
that yields negative outcomes in health and
well-being. O'Rand's concept of inequality
consists of economic, social, and psychoso-
cial components and operates multilevel:
across societal planes, the state, and the
neighborhood to the individual. The causal
mechanism by which inequality affects well-
being operates through people's perceptions
of societal fairness more than directly on its
own. O'Rand distinguished, on one hand,
a direct pathway connecting inequality and
persons'
well-being via individuals' socioe-
conomic resources.
On the other hand,
there
is an indirect pathway by which contex-
tual level inequality and atomizaiíon at the
community level reduce trust and increase
persons' perceptions
of relative deprivation,
leading to negative outcomes.
Within the same paradigm, Wilkinson
(rqg+) investigated the relationship between
societal characteristics
- gross
national prod-
uct per capita and differences in relative
income and life expectancy. He con-
cluded that the Organization for Economic
Co-operation and Development countries
with the longest life expectancy are not the
wealthiest but those with the smallest
spread
of incomes and the smallest proportion of
the population in relative poverty.
Wilkinson
(rgg+) postulated that the link between
socioeconomic inequalities and health or
mortality is mediated by cognitíue
processes
of social comparison, feelings
of deprivation
and disadvantage
that can leadto depression.
Kawachi, Kennedy, Lochner, and Prothow-
Stith (rggl) provided evidence for the link
between social inequality at the macro-
level and perceived fairness and distrust at
the microlevel. Using General Social Sur-
vey data from the United States,
they found
an inverse relationship between the degree
of income inequality at the state level and
the perceived
lack of fairness and mistrust.
The perceived lack of fairness was oper-
ationalized with the item, "Most people
would try to take advantage
of you if they
got a chance,"
and social mistrust with the
item, "Generally speaking, would you say
that most people can be trusted or that
you can't be too careful in dealing with
people?"
The concept of trust is also central
in Ross, Mirowsky, and
Pribesh's
[zoor) work
on neighborhood disadvantage and pow-
edessness.
Neighborhood disadvantage
was
measured as the sum of the percentage of
households with incomes below the federal
poverty line and the percentage of female-
headed households with children. Results
indicated that when controlled for individ-
ual disadvantage, residents
of disadvantaged
neighborhoods experienced
lower levels of
trust. Mistrust and absence
of faith in other
people promoted and reinforced a sense of
powerlessness.
The promise of the previously described
theoretical ideas for research
into loneliness
is that contextual and individual determi-
nants might be integrated under an over-
arching cognitive theory, connecting social
and economic inequality to the cognitive
processes
of persons' perceptions of soci-
etal fairness and trust, which in turn affect
people's
vulnerability to social isolation and
loneliness. In the near future, the analy-
ses and description of the core mechanisms
of the overarching cognitive theory needs
attention. Until now this type of multilevel

494
research is scarce. Moreover, some of the
central theoretical concepts
need
better def-
initions and valid and reliable measuring
instruments. We need to work toward a
research and sample design that enables
multilevel research into social isolation
and loneliness.
Coping and Interventions
Some
individuals recover
from loneliness
by
using their own strategies,
or by letting time
do the healing.
Others require outside pro-
fessional
help. The most obvious approach
is
to help people develop
satisfying personal
relationships (Rook, ry84).
This can be done
by improving how they interact with oth-
ers through social skills training or forms of
psychotherapy aimed at changing dysfunc-
tional interpersonal
dispositions
(".g.,
fear
of
rejection). It can also
be done by improving
opportunities for interactions through pro-
grams
aimed at removing barriers
for social
interaction (e.g., providing transportationJ
or at bringing people together [".g., discus-
sion groups). Pilusuk and Minkler [r98o)
emphasized the importance of develop-
ing programs that have opportunities for
so-called unintentional network building,
that is, the development of friendships is
a by-product of the shared activity, not
the explicit purpose.
Nevertheless, programs
with an explicit focus on improving personal
relationships have proven to be effective.
In the Netherlands, the Friendship Enrich-
ment Program [FEP) in which participants
are taught how to nourish friendships and go
about making friends has
been successful
in
alleviating
loneliness (Stevens,
2oor; Stevens
& Van Tilburg, zooo). The beneficial
effects
of the FEP might be limited to specific
groups,
however. The authors noted that the
participants were selÊselected
and wanted
to learn about friendship. The FEP might
work best for individuals who actively want
to become less
lonely. Moreove4 given that
only women participated in the evaluation
study, the question of whether men will also
benefit from the FEP cannot be answered.
THE CAMBRIDGE HANDBOOK OF PERSONAL
RELATIONSHIPS
Interventions aimed at improving rela-
tionships might not always be feasible or
appropriate, as in the case of people who
have unrealistically demanding or excessive
needs for support. Such people are more
likely to benefit from cognitive interven-
tions aimed at modifying relationship expec-
tations. Individuals with severely limited
physical mobility are likely to benefit from
interventions aimed at increasing
their reper-
toire of rewarding solitary activities. Rook
[rq8+) pointed out that although encour-
aging lonely individuals to develop enjoy-
able
solitary activities seems like a last
resort,
solitary activities relieve people from depen-
dence
on others
and thus may increase
their
sense
of personal
control.
In a recent review of interventions tar-
geting social isolation among the elderly,
Findlay (zoo3) lamented the lack of evi-
dence showing that they work. Few evalu-
ative studies on the effectiveness of lone-
liness
interventions have been carried out.
The few studies that have been done are
flawed by weak methodologies. Findlay con-
cluded that future programs aimed at reduc-
ing social isolation should have evaluation
built into them at inception. This advice is
heeded
in a
program of research
that is cur-
rently being carried out under the auspices
of the Sluyterman van Loo Foundation in the
Netherlands. This foundation commissioned
r7 interventions
aimed
at reducing
loneliness
among the elderly under the condition that
their effectiveness
would be evaluated
by the
three authors of this chapter together with
Tineke Fokkema of the Netherlands Inter-
disciplinary Demographic Institute. The
interventions are diverse (".g., home vis-
its by volunteers, social program for nurs-
ing home residents, educational program
for the hearing impaired, Internet usage).
Under our supervision,
the collection
of data
has been standardized as far as possible.
Key variables
such as loneliness,
marital his-
tory, social
network characteristics,
relation-
ship standards, and health and personality
characteristics
are measured
the same
way in
each
of the projects.
All but two of the inter-
ventions are randomized control trials. A
first report is
scheduled for the end of zoo5.
AnI
It is
direc
is, th
peop
tive r
discr
tity (
ship
from
o8Y,
unde
the c
doinl
as ag
the s,
ity cl
have
effec
econ
or co
Futu
whic
ship
contr
Refe
Aarts
bet
age
Un
Balter
A.
Ag
IE,
to
Ca
Bedfc
ofr
ica
Bliesz
shi;
Borys
en(
cha
Bowl
me.
Ins

LONELINESS AND SOCIAL ISOLATION 495l
An Evaluative Conclusion
It is broadly agreed that loneliness is not
directly connected to social isolation, that
is, the absence of relationships with other
people. Loneliness is defined as the nega-
tive outcome of a cognitive evaluation of a
discrepancy between (the quality and quan-
tity of) existing relationships and relation-
ship standards.
An increasing flow of work
from disciplines such as
psychology, sociol-
ogy, and anthropology has broadened the
understanding of the mechanisms behind
the onset and continuation of loneliness. In
doing so,
next to background variables such
as age,
gender,
and health, characteristics of
the social network of relationships,
personal-
ity characteristics, and relationship standards
have been addressed.
The socially isolating
effects of deprivations brought by social and
economic circumstances at the community
or country level require further exploration.
Future research should address the ways in
which people's
evaluations of their relation-
ship networks are affected by the normative
context in which thev find themselves.
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