Conventional perceptions of loneliness must be debunked to develop tailored solutions

In this guest blog Dr Roger O’Sullivan Director of Ageing Research and Development, the Institute of Public Health in Ireland & Visiting Professor at Ulster University reflects on the issue of loneliness, its impact on health and wellbeing and some of the global research on the contributing factors.

Loneliness came to the fore as a key public health issue during the COVID-19 pandemic but we need to understand more fully the very personal nature of loneliness and how to tackle its root causes.

Too often our understanding and approaches to loneliness are stereotypical in terms of who we think may be lonely, why they are lonely, and what will help.

Loneliness is a very personal experience – it’s the difference between an individual’s preferred and actual experience of their social or emotional connections. Not everyone who is lonely is socially isolated and not everyone who is socially isolated is lonely.

For example, some people with lots of friends can still feel lonely and those who live alone may not. There are also varying types (emotional, social and existential loneliness) and frequencies of loneliness (transient, situational, occasional and chronic) as well as different causes.

However, there is a tendency to focus on issues such as age in isolation rather than considering wider aspects such as health or deprivation.

In Northern Ireland, data before and during the pandemic indicates that geography matters with regard to loneliness. According to Northern Ireland Statistics and Research Agency (NISRA) data, loneliness was found to be higher in urban areas than rural ones both before and during the pandemic (figure one). However, what is less clear is why there is a geographical difference.

The NISRA data also indicates that during 2020 loneliness was found to be twice as high in the most deprived areas of NI compared to the least (figure two).

A recent paper using longitudinal data on people aged 50+ living in England may shine some light on the matter. It found that deprivation rather than urban/rural classification has an independent effect on loneliness[1].

Low social capital, especially in terms of low trust, is also a risk factor for loneliness – at place-based level this can be perceptions of neighbourhood as ‘tight or close-knit’ or the length of time living in an area. Likewise ‘living alone’ and ‘living alone not by choice’ has been found to be associated with loneliness before and during the pandemic.

It may be that people in rural areas are geographically isolated but are not necessarily lonely. Or it could be that rural areas have less transient populations and so there are connections that can help address the risk factors for loneliness.

It is important to understand that not everyone is at an equal risk of loneliness – a global study recently found personal finances and mental health were overarching and consistently cross-cutting predictors of loneliness and social isolation both before and during the pandemic[2].

Loneliness is an issue that must be taken seriously – it is associated with depression and anxiety, non-communicable diseases (e.g. diabetes), health behaviours (e.g. smoking), stress, sleep, cognition, frailty and premature mortality.[3]

A 2021 Lancet article powerfully illustrates the association of loneliness and social isolation with poor physical health outcomes. It moves beyond the view that frail people become lonely and/or  isolated and argues that both loneliness and social isolation actually increase the risk of developing frailty.[4]

Learning from the field indicates that interventions must be tailored and matched to specific root causes of loneliness in the individual, supporting personalized solutions. We must understand the type, the frequency, and the cause of loneliness before we jump to a solution.[5]

A public health approach places greater emphasis on primary prevention and population-based strategies that can support better social health. We now have the opportunity to recognise the social and economic factors that increase the risks of loneliness as well as wider societal, community/neighbourhood and individual risk factors.

Supporting infrastructures and groups that help to facilitate and support social capital, engagement and enable connections within the community and society as a whole – whether that is in rural areas or urban areas – are more important than ever.

STEPS TO LOOKING AFTER YOUR MENTAL HEALTH

Here are some steps that may help:

• Connect with others – reach out and spend time building and developing your connections.
• Be active – walk, cycle, garden, find something you enjoy and that works for you.
• Take notice – take notice of how you are feeling and of your environment; listen and take action when you feel lonely.
• Keep learning – try something new, such as learning a new language, to paint, or to dance.
• Give – do something nice for others, such as volunteering, it may help you and help others even more.

[1] Victor CR, Pikhartova J. Lonely places or lonely people? Investigating the relationship between loneliness and place of residence. BMC Public Health. 2020 May 27;20(1):778. DOI: 10.1186/s12889-020-08703-8

[2] O’Sullivan, R.; Burns, A.; Leavey, G.; Leroi, I.; Burholt, V.; Lubben, J.; Holt-Lunstad, J.; Victor, C.; Lawlor, B.; Vilar-Compte, M.; Perissinotto, C.M.; Tully, M.A.; Sullivan, M.P.; Rosato, M.; Power, J.M.; Tiilikainen, E.; Prohaska, T.R. Impact of the COVID-19 Pandemic on Loneliness and Social Isolation: A Multi-Country Study. Int. J. Environ. Res. Public Health 2021, 18, 9982. https://doi.org/10.3390/ijerph18199982

[3] Prohaska, T.; O’Sullivan, R.; Leavey, G.; Burns, A. A public health approach to loneliness and isolation among older adults. In The SAGE Handbook of Social Studies in Health and Medicine, 2nd ed.; Scrimshaw, S.C., Lane, S.D., Rubinstein, R.A., Fisher, J., Eds.; Sage: London, UK, in press.

[4] O’Sullivan, R.; Lawlor, B.; Burns, A.; Leavey, G. Will the pandemic reframe loneliness and social isolation? Lancet Health Longev. 2021, 2, e54–e55

[5] Prohaska, T.; Burholt, V.; Burns, A.; Golden, J.; Hawkley, L.; Lawlor, B.; Leavey, G.; Lubben, J.; O’Sullivan, R.; Perissinotto, C.; et al. Consensus statement: Loneliness in older adults, the 21st century social determinant of health? BMJ Open 2020, 10, e034967.