Loneliness is a public health problem that increases the risk of illness and death

Unwanted isolation is as much a cause of concern as smoking, obesity or pollution, and many experts say it’s at epidemic levels

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A woman sits alone in a Cardiff coffee shop.Matthew Horwood (Getty Images)
Jessica Mouzo

Loneliness is harmful to your health. It may not be attention-grabbing, but experts say it can be as bad as smoking, obesity or environmental pollution. Argentine neuroscientist Facundo Manes defines it as “a biological alarm bell that reminds us that we are social beings.” And when that bell rings, disease is looming. Scientists have found that loneliness and social isolation increase the risk of mortality by about 30%. It causes an increased risk of cardiovascular disease, stroke, dementia and mental health conditions like depression. A recent study published in Jama Surgery found that loneliness can have negative effects on the postoperative recovery of older adults.

Loneliness and social isolation are now considered global public health problems and many experts call it an epidemic, although precise measurement is difficult. A 2021 paper by the World Health Organization (WHO) found that between 20% and 34% of older adults in China, Europe, Latin America and the United States feel lonely. Another recent study published in the British Medical Journal found (despite a significant lack of data) that loneliness varies by region and age group. The prevalence of loneliness for adolescents ranged from 9.2% in Southeast Asia to 14.4% in the Eastern Mediterranean region. The lowest prevalence of loneliness was consistently observed in northern European countries (from 3% in young adults to 5.2% in the elderly) and the highest in Eastern Europe (7.5% in young adults and over 21% in the elderly).

Statistics aside, the scientific community agrees that loneliness (a self-perceived feeling of dissatisfaction with the frequency of social contacts) and social isolation ( the objective measure that quantifies actual social contacts) are harmful to your health. The WHO report states, “They both shorten the lives of older people, harm physical and mental health and diminish quality of life.”

The study of more than 4,000 older adults published in Jama Surgery found an association between patients who experienced loneliness after having emergency surgery and a higher likelihood of death within 30 days. “The results suggest that loneliness may be an important social determinant of postoperative outcomes, particularly for nonelective surgery.”

A lack of companionship can make you sick and eventually even kill you. A 2015 scientific review estimated that loneliness, social isolation, and living alone all raised the risk of death by 26%, 29%, and 30%, respectively. Esther Roquer, president of the Catalan Society of Geriatrics, said, “Loneliness kills just like a disease, and has a cascading effect of producing more ailments. I view it as a geriatric syndrome, like frailty. It has a high prevalence among the elderly and an impact on their health.”

In older people, loneliness begins with events like a serious fall, job retirement or the death of a spouse. They become housebound, and their frailty, dependence, and inability to drive or leave home marks the turning point toward loneliness, says Roquer. Like a dog that bites its own tail, the increased social isolation leads to a diminished ability for doing daily tasks.

What we get to see is the tip of the iceberg. Many times, these people are so isolated that they don’t come to us. We have to go looking for them
Esther Roquer, president of Catalan Society of Geriatrics

Poor social relationships have also been associated with a roughly 30% increase in the risk of serious cardiovascular problems or stroke. A scientific literature review published in Public Health noted that socially isolated adults have a two to three times greater risk of dying after a myocardial infarction, while people with stronger social relationships have a 50% greater chance of survival.

María Rosa Fernández, president of the Spanish Society of Cardiology’s Vascular Risk and Cardiorespiratory Rehabilitation Association, explains that cardiologists are so conscious of the negative impacts of loneliness that they immediately ask patients who have suffered serious heart problems like a heart attack about their psychosocial support. “It’s fundamental. A patient who has suffered a serious cardiac episode and lives alone is more likely to experience similar problems again. A person without sufficient family support is also more at risk of developing heart failure,” said Fernández.

In terms of mental health, there is evidence that having large and diverse social networks and quality emotional relationships can protect against depression. Likewise, loneliness and low social participation were associated with a higher risk of dementia and even sleep problems. Loneliness has also been linked to poor lifestyle habits, such as smoking and heavy alcohol consumption. These harmful behaviors are, in turn, exacerbated by less exposure to healthy behaviors or health advice because of the same reduced social contact.

A vicious cycle

Experts acknowledge that we still lack a clear understanding of how loneliness affects disease. But some specialists describe it as a continuous and vicious cycle. One theory is that loneliness triggers a neuroendocrine response. “People who feel lonely or who are considered to be socially isolated may show elevated activity of the hypothalamic-pituitary-adrenal axis, an increased response to chronic stress, elevated blood pressure and high blood cortisol levels,” stated a British study published in the Journal of the Royal Society of Medicine. The elevated levels of these physiological mechanisms are linked to an increased risk of cardiovascular disease and death.

It all makes sense, says Fernández. “The hypothalamic-pituitary-adrenal axis is activated in stressful situations and loneliness causes stress.” But she also notes the significant influence of a person’s lifestyle. “All social and psychosocial factors have an impact on cardiovascular health. The exact cause is not known, but not all lifestyles are the same. Someone who lives as a couple or in a family has less cardiovascular risk. Human beings are made to live in groups and in the company of others.”

From a psychological perspective, the British study points out that loneliness is associated with higher rates of depression and suicide, as well as interrelated behaviors and habits that lead to poorer cardiovascular health. “Harmful behaviors associated with higher mortality are more common in those who are alone or isolated. They are more likely to smoke, drink alcohol, and make poor dietary choices. They are less likely to leave home for regular exercise, and to take their prescribed medications as directed.” Lack of companionship is also associated with cognitive decline, which “can influence social and behavioral risk factors, for example, by affecting medication adherence, physical activity, and the ability to seek help.” The vicious cycle again.

It is not that loneliness causes dementia, says Teresa Moreno, coordinator of the Spanish Society of Neurology’s Neuro Geriatric Study Group, but it does accelerate its symptoms. “There are things that make the symptoms more noticeable, and social isolation and depression increase the progression of dementia. The more you use your brain, the less you notice the symptoms. Getting together with people and having a social life reduce the symptoms. The more we can delay those symptoms, the better.” Moreno adds that neurodegenerative conditions get worse with loneliness.

Furthermore, socially isolated people are less likely to go to emergency health services and ask for help. “What we get to see is the tip of the iceberg. Many times, these people are so isolated that they don’t come to us. We have to go looking for them,” said Roquer.

Young people are also affected

While older people usually experience more loneliness and social isolation, young people are not exempt. Several studies have identified an association between loneliness in young people and increased tobacco consumption. The most socially isolated adolescents were more likely to smoke, a habit that causes serious health problems.

Experts say more focus on loneliness is needed, along with therapies for addressing its health impacts. There is no pill or potion to cure loneliness, but there are strategies that can minimize the harm it can cause. Roquer advocates social prescribing, which consists of recommending activities within a community setting. “It’s a complex problem that requires good coordination between different disciplines. At the community level, we should promote volunteering and intergenerational strategies involving the elderly. We also need policies to combat ageism and address the digital divide,” she said.

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