We Need to Understand the Difference Between Isolation and Loneliness

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How many close friends and relatives do you have with whom you feel comfortable and with whom you can discuss private matters? How many of them do you see at least once a month? Do you join any group? These are among questions in a survey called the Berkman-Syme Social Networking Index, which doctors use to determine if someone is “socially isolated.” Persons with fewer than six confidants, spouses, and group affiliations are considered isolated. These circumstances make them less likely to let them know they have someone to listen to when they need to talk, give advice about a problem, or show them love and affection.

But you may have many connections, or even close connections, and still feel lonely. To assess this subjective condition, clinicians can use the three-item UCLA Loneliness Scale, which asks: How often do you feel that you lack friendships? How often do you feel left out? How often do you feel isolated?

Social isolation and loneliness tend to go together. But researchers have become increasingly aware that you can experience one and not the other. This means that these conditions can have different causes, different health effects, and different potential solutions. A report from the National Academies of Sciences, Engineering and Medicine in February 2020 noted: One-third of Americans over 45 feel lonely; A quarter of those over the age of 65 are socially isolated. Each condition increases a person’s risk of premature death from any cause – as much or more than smoking or lack of physical activity – as well as their risk of heart disease and stroke. Social isolation increased the risk of dementia by 50 percent, and loneliness was associated with higher rates of depression, anxiety and suicide. Older adults, along with people from marginalized groups, are at higher risk for both isolation and loneliness.

And that was before the pandemic forced many people to physically distance themselves from others, which has almost certainly exacerbated both isolation and loneliness in unforeseen ways. “The truth is, we’re in some degree of data-free territory,” Carla Perissinotto, one of the report’s authors and a professor of medicine at the University of California, San Francisco, told the Senate Special Committee on Aging in June 2020. “We don’t know how long we have to be alone or isolated, or how severe it has to be for us to have lasting negative consequences.”

More than a year later, a complex picture began to emerge. In July, researchers at Northeastern University and elsewhere reported the results of an ongoing national survey that began in April 2020. They asked participants how many people in their social circle they could trust to take care of them if they got sick; lend them money; talking to them when they have a problem or feel depressed; or to help them find work. The number of people reporting one or none in each group tended to be highest last fall; this was a period in which respondents also reported decreased time spent in person with non-household members. Support and affinity with others increased in roughly cascade between December and April as vaccines became available and restrictions began to be lifted. At this point, however, respondents began to say more and more that they lacked all four types of support, even as their face-to-face contact continued to increase. Seeing other people again “can take a little bit of reality check,” says Louise Hawkley, principal research scientist at NORC at the University of Chicago. You may discover that someone you thought could support could not, perhaps because of that person’s own pandemic struggles. Katherine Ognyanova, associate professor of communications and information at Rutgers University and author of the study, says: “There has never been research on an event of this magnitude before. We’re just learning what’s going on and how to deal with it.”

Before the pandemic, there were few studies that attempted to evaluate both social isolation and loneliness in the same group of participants to directly compare their effects. (Researchers also often use conflicting definitions and criteria to measure concepts such as “support,” “isolation,” and “loneliness.”) An analysis of existing studies published in 2015 by Julianne Holt-Lunstad in the journal Perspectives on Psychological Science in psychology at Brigham Young University. and neuroscience professor and colleagues, social isolation increased the risk of death by an average of 29 percent; loneliness increased by 26 percent and living alone by 32 percent. A report published in the journal Health Psychology in 2018 found evidence that social isolation exacerbates the impact of loneliness on death and vice versa. Holt-Lunstad says we tend to imagine it’s okay to be isolated by choice if you’re happy. “But what the evidence suggests is that this may be an erroneous assumption,” he adds. “We should not be in such a hurry to reject the isolation on our own.”

However, exactly how each condition causes its associated health effects is still an open question. Loneliness can increase stress and inflammation, but it can disrupt sleep and trigger unhealthy behaviors like alcohol and smoking, says Lis Nielsen, director of the behavioral and social research division at the National Institute of Aging. On the other hand, isolation can make it difficult to access medical care or nutritious food or exercise, which can create stress. Men are more at risk of being socially isolated, while women are more at risk of being alone. Being single, widowed or divorced is related to both; i.e. low income and less educated. A study of incarcerated persons published in the journal JAMA Network Open in 2019 noted: The longer a person stays in solitary confinement, the greater the risk of death. (Over the past 18 months, many prisons have essentially used solitary confinement as a way to quarantine inmates.) “It’s kind of traumatizing,” says lead author Lauren Brinkley-Rubinstein, associate professor of social medicine at North University. Carolina is in Chapel Hill. Afterwards, people cannot “step back as it is”.

Figuring out how to reduce the effects of social isolation and loneliness on those most at risk has taken on new importance with the resurgence of Covid-19 cases. “We may not be able to do much about the isolation piece if we are forced into more restraints,” Perissinotto says, “but we can aim for solitude.” However, current technological solutions appear to have mixed results. A survey of adults aged 55 and older during the pandemic, published this month by Hawkley and colleagues in the Journal of the American Geriatrics Society, found higher rates of loneliness, depression, and decreased happiness despite an increase in distance contact than before; Another survey using different criteria and published in The Journals of Gerontology: Series B in April found increased physical isolation, stable levels of digital communication, and no increase in loneliness among adults over 50. “It’s complicated,” says Holt-Lunstad. “There is some evidence to suggest that technology helps maintain social connections, and there is some evidence that it actually increases loneliness.” Indeed, youth, who are often assumed to be more digitally savvy than the general population, reported particularly high rates of loneliness and related depression. And surveys often fail to reach extremely vulnerable groups, including those without internet access and people living with dementia.

Because the causes of social isolation and loneliness are so different – ​​from mobility issues that keep one home-bound to the grief of losing a spouse – alleviating them requires an “individualized approach,” Perissinotto said. There is no single proven intervention; instead, he recommends thinking about what kinds of links are missing and looking for ways to create them. To the extent that the pandemic has disrupted our social lives, it has also prepared us to develop new relationships. Being alone or isolated is now “an experience we are all familiar with on some level,” Hawkley says. “I think this will help further research and attempts to resolve the issue.”

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