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Disentangling Loneliness: Differential Effects of Subjective Loneliness, Network Quality, Network Size, and Living Alone on Physical, Mental, and Cognitive Health
Abstract and Figures
Objective:
To examine whether different measures of social disconnectedness-subjective loneliness, network quality, network size, living alone-have differential effects on the health of older adults.
Methods:
We used a longitudinal sample of the German Aging Survey ( N = 4,184) and analyzed seven measures of health (life satisfaction, positive affect, negative affect, depression, cognitive performance, physical functioning, and pulmonary function) via regression analyses.
Results:
We found that subjective loneliness and network quality best predicted mental health; contrarily, network size and living alone best predicted physical and cognitive health.
Discussion:
Different measures of social disconnectedness have differential effects on health. Therefore, using only global measures or one aspect of social disconnectedness might obfuscate potential health hazards. Researchers and practitioners should be mindful of differences between these measures and should include multiple aspects of social disconnectedness in their research and practice. Future studies should explore the causes why these measures and their effects differ.
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... According to the bottom-up theory of life satisfaction proposed by Headey et al. (1991), various factors, including social isolation, play a significant role in shaping individuals' overall sense of contentment with their lives (Gan et al., 2020;Liu et al., 2020). Specifically, social isolation can contribute to the psychological burden experienced by older adults, rendering them more vulnerable and potentially leading to a decrease in their life satisfaction (Beller & Wagner, 2018;Taylor et al., 2018;. On one hand, individuals who are socially disconnected may engage in behaviors such as smoking and alcohol abuse, which can have detrimental effects on their health and well-being, ultimately hindering their ability to evaluate their lives positively (Cacioppo et al., 2015;Thoits, 2011). ...
... These factors, in turn, have a positive impact on older adults' life satisfaction (Du et al., 2023;;McNamara et al., 2021). Social disconnectedness and loneliness are significant issues for older adults in the community, as they increase their psychological burden and make it difficult to maintain a positive outlook on life (Beller & Wagner, 2018;. Negative emotions such as anxiety and pessimism often accompany feelings of loneliness, further undermining older adults' mental health (Domènech-Abella et al., 2019;Freak-Poli et al., 2022). ...
... This study did not examine more closely differences in how loneliness and social isolation influence different chronic health conditions 76 , as there is evidence that the pathway to disease could differ for loneliness and social isolation (e.g., loneliness better predicted poorer mental health; social isolation better predicted poorer physical and cognitive health) 77 , Previous relationships have been established between specific health conditions and loneliness and social isolation, for example, cardiovascular disease and Type 2 diabetes were associated with loneliness and social isolation, but the same effect was not found for other disorders including chronic obstructive pulmonary disease and cancer 28 . ...
Loneliness and social isolation, experienced more long-term, has been shown to increase mortality and lead to poorer health outcomes in specific cohorts. However, it is unclear what the prevalence of chronic loneliness and social isolation is, and which demographic groups are most at risk of reporting more chronic forms. A psychometrically validated classification system was used to identify people who met criteria for episodic and chronic loneliness and social isolation using the Household Income and Labour Dynamics in Australia (HILDA) survey waves 14–18. The prevalence of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded that of social isolation (overall 17%; 13% episodic, 4% chronic). There was consistency in the demographic characteristics (from age, sex, household type, income) of those who experienced loneliness and social isolation. However, people with a long-term health condition had an elevated risk of episodic loneliness (AOR 1.24, 95% CI 1.11–1.39) and a markedly higher risk of chronic loneliness (AOR 2.01, 95% CI 1.76–2.29), compared with those without a long-term health condition. Loneliness, both episodic and chronic subtypes, is more prevalent than social isolation. However, both chronic loneliness and social isolation remains neglected and poorly targeted within current practice and policy.
... In our study, we found no signi cant association between social isolation and utilization of mental health services. This aligns with previous research which indicated that loneliness, has a stronger in uence on mental health outcomes while social isolation is more strongly associated to physical health implications [41]. ...
Background
Loneliness and social isolation among older adults are associated with a significant health burden. However, less is known about the impact of loneliness and social isolation on health service use (HSU). The aim of this study is to examine whether loneliness and social isolation are associated with increased HSU among older adults in Australia.
Methods
Data were derived from three waves (2009, 2013, and 2017) of the nationally representative longitudinal Household Income and Labour Dynamics of Australia (HILDA) survey from individuals aged 65 years and older. Outcomes included health professional visits and hospital admissions in the past year. Generalized estimating equations were used to investigate longitudinal associations between the experience of loneliness and/or social isolation with HSU.
Results
Compared to older adults who neither experienced loneliness nor social isolation, loneliness was significantly associated with more General Practitioner (GP) visits (incident rate ratio [IRR] = 1.13, 95%-CI [1.05, 1.23] and more hospital admissions (IRR = 1.29, 95%-CI [1.11,1.50)). Social isolation was associated with more GP visits (IRR = 1.14, 95%-CI [1.05,1.29]). Experiencing both loneliness and social isolation was associated with more GP visits (IRR = 1.44, 95%-CI [1.04–1.97]) and more hospitalisations (IRR = 1.75, 95%-CI [1.2, 2.56]).
Conclusions
Loneliness and social isolation among older adults were significantly associated with increased health service use, including more visits to GPs and higher hospital admission rates. The findings highlight the need to address these factors for improved health outcomes and potential reduction in healthcare costs.
... However, a recent meta-analysis by Ernst and colleagues [13] suggested a small yet significant effect size in the differences between feelings of loneliness before and after the pandemic. Several researchers argue that there are differential associations between loneliness and social isolation with health outcomes, such that loneliness contributes more to mental health outcomes while social isolation is more important in predicting declines in cognitive and physical health [14,15,16,17]. However, other studies suggest that the differential health implications of loneliness and social isolation are much more difficult to disentangle; for example both constructs are associated with increased risk for cardiovascular disease and interact in their relation with mortality [18,3,19]. ...
Loneliness is linked to wide ranging physical and mental health problems, including increased rates of mortality. Understanding how loneliness manifests is important for targeted public health treatment and intervention. With advances in mobile sending and wearable technologies, it is possible to collect data on human phenomena in a continuous and uninterrupted way. In doing so, such approaches can be used to monitor physiological and behavioral aspects relevant to an individuals loneliness. In this study, we proposed a method for continuous detection of loneliness using fully objective data from smart devices and passive mobile sensing. We also investigated whether physiological and behavioral features differed in their importance in predicting loneliness across individuals. Finally, we examined how informative data from each device is for loneliness detection tasks. We assessed subjective feelings of loneliness while monitoring behavioral and physiological patterns in 30 college students over a 2-month period. We used smartphones to monitor behavioral patterns (e.g., location changes, type of notifications, in-coming and out-going calls/text messages) and smart watches and rings to monitor physiology and sleep patterns (e.g., heart-rate, heart-rate variability, sleep duration). We also collected participants loneliness feeling scales multiple times a day through a questionnaire app on their phone. Using the data collected from their devices, we trained a random forest machine learning based model to detect loneliness levels. We found support for loneliness prediction using a multi-device and fully-objective approach. Furthermore, behavioral data collected by smartphones generally were the most important features across all participants. The study provides promising results for using objective data to monitor mental health indicators, which could provide a continuous and uninterrupted source of information in mental healthcare applications
... Similar results relating to the effect of low social support and loneliness, were also reported from studies conducted in Ireland, the Netherlands, and Germany. Together, these studies establish that social support, social isolation, and loneliness are strongly linked to depression and anxiety [51][52][53][54]. ...
Social support has been shown to have many positive effects on our lives, health, and ability to grow and flourish. Lack, or diminished social support results in loneliness. This thematic review focuses on the elderly, and the loneliness that is part of the life of many of them. The review highlights the social connections and the expectations that the elderly may have of them, and how being connected to others may alleviate, loneliness. Loneliness is known to negatively affect one’s health, social life, familial relationships, and feelings, and their effect on the elderly is described. We all yearn for social support, and the review examines what are the elderly’s expectations from their social support network. Expectations which will significantly affect their commitment to that network, and feeling fulfilled by it. The review concludes with a focus on successful aging and how they can control and minimize their loneliness and feelings of isolation.
... With respect to our research question, we consider this a strength of the study because the BSI scale allowed for a combined assessment of social loneliness and its associated burden as one possible aspect affecting mental health during the pandemic. Nevertheless, loneliness is a multifaceted construct (e.g., social and emotional loneliness, [70]) and we do not differentiate between the different facets of loneliness and its varying effects on mental, physical, or psychological health [71]. This should be considered when interpreting the results and attempting to draw general conclusions about loneliness based on our BSI measure during the pandemic. ...
Background
Feelings of loneliness and the burden of social isolation were among the most striking consequences of widespread containment measures, such as “social distancing”, during the COVID-19 pandemic. Because of the potential impact on people’s health, there has been increased interest in understanding the mechanisms and factors that contributed to feelings of loneliness and the burdens of social isolation. However, in this context, genetic predisposition has been largely ignored as an important factor. This is problematic because some of the phenotypic associations observed to date may in fact be genetic. The aim of this study is, therefore, to examine the genetic and environmental contributions to the burden of social isolation at two time points during the pandemic. In addition, we examine whether risk factors identified in previous studies explain genetic or environmental contributions to the burden of social isolation.
Methods
The present study is based on a genetically sensitive design using data from the TwinLife panel study, which surveyed a large sample of adolescent and young adult twins during the first (N = 798) and the second (N = 2520) lockdown in Germany.
Results
We find no substantive differences in genetic and environmental contributions to social isolation burden over the course of the pandemic. However, we find the determinants highlighted as important in previous studies can explain only a small proportion of the observed variance in the burden of social isolation and mainly explained genetic contributions.
Conclusions
While some of the observed associations appear to be genetic, our findings underscore the need for further research, as the causes of individual differences in burden of social isolation remain unclear.
... Last, but not least, the issue might also be conceptual in nature and more emphasis should be put on alternative dimensions of culture. Indeed, several empirical findings suggest that the quality of social contacts is more relevant than their quantity in predicting loneliness (Pinquart and Sorensen, 2003;Hawkley et al., 2008;Beller and Wagner, 2018;Taylor et al., 2018;Heu et al., 2021b). If we place more emphasis on the quality of social interactions rather than their quantity, then individuals originating from cultures characterized by stricter social norms and prohibitions may be more at risk of loneliness compared to individuals in more indulgent societies where enjoyment of one's life is more loose, regardless of the extent of social networks or desired frequency of social interactions. ...
Loneliness is increasingly being recognized as an important economic and public health issue. This paper investigates the relationship between historically rooted norms that drive individuals to conform to predefined behavioral standards and contemporary perceptions of social interactions and attitudes towards loneliness. Using a sub-population of second-generation immigrants, we identify an intergenerationally transmitted component of culture that reflects the importance of restrained discipline and rules characterizing highly intensive pre-industrial agricultural systems. We show that this cultural dimension influences perceptions of the quality of social relationships and significantly affects the likelihood of experiencing loneliness. The identified trait is then used to instrument loneliness in a two-stage model for health. We find that loneliness directly affects body mass index and some specific mental health issues. We argue, however, that loneliness may influence other health outcomes indirectly due to its economically significant effect on the increased body mass index. The results are robust to a battery of sensitivity checks. Our findings add to a growing body of research on the importance of attitudes in predicting significant economic and health outcomes, opening up a new channel via which deeply-rooted geographical, cultural, and individual characteristics may influence comparative economic development processes.
... Bien que la santé mentale des aînés ait été moins bonne au cours de la troisième vague que de la deuxième vague 3 , on ne sait pas si les associations entre les expériences sociales et la santé mentale positive ont varié à différents stades de la pandémie. Il est également possible que les personnes ayant connu une situation d'isolement ou éprouvé un sentiment de solitude de façon chronique (vs temporaire) avant ou pendant la pandémie aient couru un risque accru de moins bonne santé mentale45 .Conformément aux études menées antérieurement18,19,28 , le fait de vivre seul a été utilisé comme indicateur de l'isolement social. Il s'agit d'une mesure facilement accessible et utile (quoiqu'imparfaite) de l'isolement social chez les aînés, en particulier lorsque les données utilisées sont fondées sur la population 20 . ...
Introduction
L’isolement social et la solitude sont associés à une moins bonne santé mentale chez les aînés. Toutefois, on en sait moins sur la façon dont ces expériences sont associées de manière indépendante à une santé mentale positive pendant la pandémie de COVID-19.
Méthodologie
Nous avons analysé les données des cycles de 2020 et de 2021 de l’Enquête sur la COVID-19 et la santé mentale pour être en mesure d’estimer le degré d’isolement social (le fait de vivre seul), la solitude et divers indicateurs d’une santé mentale positive (bonne santé mentale autoévaluée, fort sentiment d’appartenance à la communauté locale et satisfaction moyenne à l’égard de la vie) chez les aînés en général (65 ans ou plus) et en fonction de divers groupes sociodémographiques. Nous avons également effectué des régressions logistiques et linéaires pour analyser séparément et conjointement la façon dont l’isolement social et la solitude sont associés à une santé mentale positive.
Résultats
Près de 3 aînés sur 10 ont déclaré vivre seuls, et plus du tiers ont déclaré éprouver un sentiment de solitude en raison de la pandémie. Analysés séparément, le fait de vivre seul et le sentiment de solitude ont été associés à une santé mentale positive plus faible. Dans l’analyse conjointe, le sentiment de solitude est demeuré un important facteur indépendant associé aux trois indicateurs de santé mentale positive (globalement et dans tous les groupes sociodémographiques), mais le fait de vivre seul ne s’est révélé un facteur important que dans le cas d’un fort sentiment d’appartenance à la communauté locale dans la population globale, pour les hommes et pour les 65 à 74 ans.
Conclusion
De manière générale, l’isolement social et la solitude ont été associés à un bien-être inférieur chez les aînés au Canada pendant la pandémie. La solitude est demeurée un facteur important associé à tous les indicateurs de santé mentale positive après ajustement pour l’isolement social, mais non l’inverse. Ces résultats montrent qu’il faut repérer et soutenir adéquatement les aînés qui souffrent de solitude pendant (et après) une pandémie.
Objective:
This study examined whether social activity diversity, a novel concept indicating an active social lifestyle, is associated with lower subsequent loneliness, and decreased loneliness is further associated with less chronic pain over time.
Methods:
2528 adults from the Midlife in the United States Study (Mage = 54 yrs) provided data at baseline (2004-2009) and 9 years later. Social activity diversity was operationalized by Shannon's entropy that captures the variety and evenness of engagement across 13 social activities (0-1). Participants reported feelings of loneliness (1-5), presence of any chronic pain (yes/no), the degree of chronic pain-related interference (0-10), and the number of chronic pain locations. Indirect associations of social activity diversity with chronic pain through loneliness were evaluated, adjusting for sociodemographics, living alone, and chronic conditions.
Results:
Higher social activity diversity at baseline (B = -0.21, 95%CI = [-0.41, -0.02]) and an increase in social activity diversity over time (B = -0.24, 95%CI = [-0.42, -0.06]) were associated with lower loneliness 9 years later. An increase in loneliness was associated with 24% higher risk of any chronic pain (95%CI = [1.11, 1.38]), greater chronic pain-related interference (B = 0.36, 95%CI = [0.14, 0.58]), and 17% increase in the number of chronic pain locations (95%CI = [1.10, 1.25]) at the follow-up, after controlling for corresponding chronic pain at baseline and covariates. Social activity diversity was not directly was associated with chronic pain, but there were indirect associations through its association with loneliness.
Conclusion:
Diversity in social life may be associated with decreased loneliness, which in turn, may be associated with less chronic pain, two of the prevalent concerns in adulthood.
The associations between social isolation, loneliness and the risk of mortality from all causes, cardiovascular disease (CVD) and cancer are controversial. We systematically reviewed prospective studies on the association between social isolation, loneliness and mortality outcomes in adults aged 18 years or older, as well as studies on these relationships in individuals with CVD or cancer, and conducted a meta-analysis. The study protocol was registered with PROSPERO (reg. no. CRD42022299959). A total of 90 prospective cohort studies including 2,205,199 individuals were included. Here we show that, in the general population, both social isolation and loneliness were significantly associated with an increased risk of all-cause mortality (pooled effect size for social isolation, 1.32; 95% confidence interval (CI), 1.26 to 1.39; P < 0.001; pooled effect size for loneliness, 1.14; 95% CI, 1.08 to 1.20; P < 0.001) and cancer mortality (pooled effect size for social isolation, 1.24; 95% CI, 1.19 to 1.28; P < 0.001; pooled effect size for loneliness, 1.09; 95% CI, 1.01 to 1.17; P = 0.030). Social isolation also increased the risk of CVD mortality (1.34; 95% CI, 1.25 to 1.44; P < 0.001). There was an increased risk of all-cause mortality in socially isolated individuals with CVD (1.28; 95% CI, 1.10 to 1.48; P = 0.001) or breast cancer (1.51; 95% CI, 1.34 to 1.70; P < 0.001), and individuals with breast cancer had a higher cancer-specific mortality owing to social isolation (1.33; 95% CI, 1.02 to 1.75; P = 0.038). Greater focus on social isolation and loneliness may help improve people’s well-being and mortality risk.
In 1978, when the Task Panel report to the U.S. President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. In 2011, a meta-analysis on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation of maladaptive social cognition. We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, there is increasing evidence for the potential efficacy of integrated interventions that combine (social) cognitive behavioral therapy with short-term adjunctive pharmacological treatments.
Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
© The Author(s) 2015.
Objective:
The objective of this study was to test a conceptual model of loneliness in which social structural factors are posited to operate through proximal factors to influence perceptions of relationship quality and loneliness.
Methods:
We used a population-based sample of 225 White, Black, and Hispanic men and women aged 50 through 68 from the Chicago Health, Aging, and Social Relations Study to examine the extent to which associations between sociodemographic factors and loneliness were explained by socioeconomic status, physical health, social roles, stress exposure, and, ultimately, by network size and subjective relationship quality.
Result:
Education and income were negatively associated with loneliness and explained racial/ethnic differences in loneliness. Being married largely explained the association between income and loneliness, with positive marital relationships offering the greatest degree of protection against loneliness. Independent risk factors for loneliness included male gender, physical health symptoms, chronic work and/or social stress, small social network, lack of a spousal confidant, and poor-quality social relationships.
Discussion:
Longitudinal research is needed to evaluate the causal role of social structural and proximal factors in explaining changes in loneliness.
This article reports the development and validation of a scale to measure global life satisfaction, the Satisfaction With Life Scale (SWLS). Among the various components of subjective well-being, the SWLS is narrowly focused to assess global life satisfaction and does not tap related constructs such as positive affect or loneliness. The SWLS is shown to have favorable psychometric properties, including high internal consistency and high temporal reliability. Scores on the SWLS correlate moderately to highly with other measures of subjective well-being, and correlate predictably with specific personality characteristics. It is noted that the SWLS is suited for use with different age groups, and other potential uses of the scale are discussed.
The revolutionary study of how the place where we grew up constrains the way we think, feel, and act, updated for today's new realities
The world is a more dangerously divided place today than it was at the end of the Cold War. This despite the spread of free trade and the advent of digital technologies that afford a degree of global connectivity undreamed of by science fiction writers fifty years ago. What is it that continues to drive people apart when cooperation is so clearly in everyone's interest? Are we as a species doomed to perpetual misunderstanding and conflict? Find out in Cultures and Organizations: Software of the Mind.
A veritable atlas of cultural values, it is based on cross-cultural research conducted in seventy countries for more than thirty years. At the same time, it describes a revolutionary theory of cultural relativism and its applications in a range of professions. Fully updated and rewritten for the twenty-first century, this edition:
Reveals the unexamined rules by which people in different cultures think, feel, and act in business, family, schools, and political organizations
Explores how national cultures differ in the key areas of inequality, collectivism versus individualism, assertiveness versus modesty, tolerance for ambiguity, and deferment of gratification
Explains how organizational cultures differ from national cultures, and how they can--sometimes--be managed
Explains culture shock, ethnocentrism, stereotyping, differences in language and humor, and other aspects of intercultural dynamics
Provides powerful insights for businesspeople, civil servants, physicians, mental health professionals, law enforcement professionals, and others
Geert Hofstede, Ph.D., is professor emeritus of Organizational Anthropology and International Management at Maastricht University, The Netherlands. Gert Jan Hofstede, Ph.D., is a professor of Information Systems at Wageningen University and the son of Geert Hofstede.
Many older adults live alone. For example, in the United States, over 45 % of women over the age of 75 years live alone.1 Much attention has been placed on older adults who are living alone, because of the recent studies that have shown that both loneliness and social isolation are associated with poor health outcomes.1–4 These studies have also suggested that living alone is not necessarily indicative of having poor social support or of feeling lonely. While it may be reasonable to believe that living alone is a good proxy for these types of social measures, there is increasing recognition that the measures of social well-being are complex concepts and go beyond simply describing the situational facts of a person’s life. In actuality, social isolation and loneliness are complex self-perceptions that may not be fully captured by whether or not someone lives alone. This demands that as clinicians, we must dig deeper into a patient’s personal perspective. For example, measures of lonelin ...