Prof Christina Victor, Professor of Gerontology and Public Health at Brunel University London, has joined an international team of experts in calling for a unified approach to addressing the global challenge of loneliness.
The group, which also included academics from as far afield as New Zealand, the USA and Ireland, published a letter in the medical journal The Lancet in response to the growing concerns about the rates and consequences of loneliness.
The signatories include experts from the Institute of Public Health in Ireland; Columbia University; George Mason University; University of Auckland; Swansea University; Ulster University; St James’s Hospital; University of Chicago; Trinity College Dublin; Boston College; University of California; Vrije Universiteit Amsterdam; and Brunel University London.
The letter is based on discussions of international researchers at a meeting hosted in Belfast by the Institute of Public Health in Ireland. This has led to the establishment of an International Loneliness and Social Isolation Research Network.
While demographic shifts suggest that the number of people experiencing loneliness will increase, experts say that it is important to recognise that most older adults are not chronically lonely and that young adults are also affected.
Experts say that loneliness can be defined as a “subjective negative experience that results from inadequate meaningful connections”, and have called for a standardised approach to defining and measuring loneliness to help inform those developing policy and services in this area.
The expert group added that charities, community sectors, and governments, who are delivering programmes often have an inadequate evidence to plan from and need a more coherent message from research, and a stronger evidence base.
And while more research is needed to find out the full consequences of loneliness, the evidence shows association with poor health and wellbeing, non-communicable diseases, and depression.
Prof Victor said that in a time when as a society we have never had more opportunities to connect with people, there is a growing focus on loneliness and its association with poor health outcomes.
She said: “Our understanding of loneliness is still limited and is often stereotypical. While it is often confused with a lack of social engagement, the reality is that some people with lots of friends can still feel lonely and those who live alone may not.
“Although loneliness is a very personal experience, addressing loneliness is not simply a matter for individuals but is also an issue for public health and society as a whole. By building the evidence and pooling expertise, we can support governments and policymakers to make better informed decisions to address this challenge.”
Letter in full
A unified approach to loneliness
Globally, there are growing concerns about rates and consequences of loneliness, especially among older adults. In response, 2018 saw the launch of a UK loneliness strategy and the first minister for loneliness in the world appointed. In the USA, the National Academies of Sciences, Engineering, and Medicine set up a special committee to examine the problem.1 Demographic shifts suggest that the numbers experiencing loneliness are likely to increase.
However, it is important to recognise that most older adults are not chronically lonely and loneliness is also experienced by other age groups, especially young adults. Large gaps remain in our understanding of loneliness, rates and drivers of loneliness in different populations, its effect on health and wellbeing, and evidence on effective interventions. We believe loneliness can be defined as a subjective negative experience that results from inadequate meaningful connections, but neither definitions nor assessments of loneliness have achieved wide-scale consensus. The variety of scales and single-item measures of loneliness used to date should be standardised to advance knowledge with an agreed common set of valid measures.
Currently, there is inadequate causal evidence of the consequences of loneliness but associations with poor health and wellbeing have been established. The evidence shows associations with depression, anxiety, non-communicable diseases, poor health behaviours, stress, sleep, cognition, and premature mortality (with the evidence especially strong for depression).2 However, further work is required to establish causality between loneliness and specific health outcomes, and vice versa, as well as to investigate social consequences that remain unclear.
Structural and cultural changes (eg, technology and social media use) and societal forces (eg, perceptions and expectations around ageing and ageism) and their effect on loneliness also need to be better understood. The evidence base for loneliness interventions is characterised by poorly constructed trials with small samples, a lack of theoretical frameworks, undefined target groups, heterogeneous measures of loneliness, and short follow-up periods. Within this context the charity, voluntary or community sectors, and government are delivering programmes, often with inadequate empirical evidence.
Key therapeutic elements of interventions must be identified, as well as their optimal intensity, frequency, and duration. Although inevitably more complex to implement and evaluate, evidence indicates that interventions must be tailored and matched to specific root causes of loneliness.
This Correspondence is based on discussions from a meeting in Belfast, held in December, 2018, of international researchers that led to the establishment of an International Loneliness and social Isolation research NetworK (I-LINK) to drive this work. Research, policy, and practice can only benefit from a greater pooling of expertise and knowledge exchange to address this global challenge.
Linda Fried, Thomas Prohaska, Vanessa Burholt, Annette Burns, Jeannette Golden, Louise Hawkley, Brian Lawlor, Gerard Leavey, Jim Lubben, Roger O’Sullivan, Carla Perissinotto, Theo van Tilburg, Mark Tully, Christina Victor
Institute of Public Health in Ireland, Dublin D08 NH90, Ireland (RO’S); Institute of Public Health in Ireland, Belfast, Ireland (RO’S); Mailman School of Public Health, Columbia University, New York, NY, USA (LF); College of Health and Human Services, George Mason University, Fairfax, VA, USA (TP); School of Nursing and School of Population Health, University of Auckland, Auckland, New Zealand (VB); Institute of Public Health in Ireland (AB, ROS), School of Health Sciences (MT), and Bamford Centre for Mental Health and Well Being, Ulster University, Coleraine, Ireland (AB, ROS, GL); Mercer’s Institute for Successful Ageing, St James Hospital, Dublin, Ireland (JG); National Opinion Research Center, University of Chicago, Chicago, IL, USA (LH); Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland (BL); University of California, Los Angeles Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA (JL); School of Social Work, Boston College, Boston, MA, USA (JL); Department of Medicine, University of California, San Francisco, CA, USA (CP); Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (TvT); and College of Health and Life Sciences, Brunel University London, London, UK (CV)
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