Loneliness and Mental Health Problems in Adults: Isolating the Evidence
This article is based on the talk by Dr Farhana Mann at RCPsychIC 2019. Dr Farhana Mann is a psychiatrist and Wellcome Clinical Research Fellow at the Division of Psychiatry, UCL. She is particularly interested in social relationships, loneliness and their association with mental health.
- The definition of loneliness within the context of research work is the mismatch between what someone has and what someone wants. This subjective appraisal is not about solitude but is related to social networks, social isolation, and other concepts. [Wang et al. 2017], [Hare-Duke et al. 2019]
- The UK has high levels of loneliness and it is often people over the age of 50 who talk about being lonely as a problem.
- However, there is increasing evidence that this also occurs in younger people which peaks within the 16-24-year-old age group. Little is known of loneliness in children, although a study reported that 20% of 8-year-olds talked of being lonely, and 5% said they were ‘always lonely’.
- Longitudinal studies show poorer outcomes in cardiovascular and respiratory disease from baseline loneliness after adjusting for variables. Sleep problems, emergency services use and GP attendance all appear to be associated with loneliness.
- A meta-analysis of 148 international studies revealed a significantly increased risk of all-cause mortality in people who were lonely,[Holt-Lunstad et al. 2010] and there is evidence for an altered immune system function.
Across 148 studies (308,849 participants), the random effects weighted average effect size was OR = 1.50 (95% CI 1.42 to 1.59), indicating a 50% increased likelihood of survival for participants with stronger social relationships.
- In mental health, there are associations between loneliness and depression, anxiety, phobias, suicide/parasuicide, dementia, eating disorders and psychosis.
- Two important questions need to be addressed on whether loneliness at baseline is associated with poor outcomes over time in people with mental health problems, and also whether loneliness is associated with the onset of new mental health problems in the general population.
- From a total of 34 studies, a marked association between loneliness and poorer outcomes in depression was revealed.
- One study in schizophrenia/schizoaffective disorder reported a significant association and four studies in bipolar disorder all showed a strong link with depressive symptomology.
- Two studies in anxiety showed that social support was predictive of less remission and better quality of life, but this was not observed in PTSD. Global mental health was also improved with social support.
- There are research gaps in evaluating people with more severe mental health problems. The launch of the UK Research and Innovation (UKRI)-funded Loneliness and Social Isolation in Mental Health research network this month will bring together researchers across a range of disciplines to collaborate in finding ways to reduce the burden of mental ill-health by addressing loneliness and social isolation among young people, as well as marginalised groups across the life course. [Pitman et al. 2018]