Loneliness, Social Isolation, and its Effects on Physical and Mental Health

Loneliness is defined in the Merriam-Webster Dictionary as being without company, separated from others. It is an unpleasant emotional response to perceived isolation. Social isolation, on the other hand, is an apparent (objective isolation) or perceived (subjective isolation) lack of contact between an individual and society.^1–3

Previous estimates of adult social isolation ranges from 15–40%.⁴ The National Academies of Sciences, Engineering, and Medicine (NASEM) asserts that more than one-third of adults aged 45 and older are lonely. Nearly one-fourth of adults aged 65 and older are socially isolated.⁵ Demographic data on social isolation and loneliness in children and adolescents are unfortunately scarce.

The COVID-19 pandemic led to physical distancing to minimize spread of infection. This unfortunately created social distancing and increased social isolation. In young individuals subject to social isolation, higher levels of cortisol occur causing an increase in BMI. Social isolation can also lead to a sedentary lifestyle and the associated adverse health consequences.⁶ Social isolation for infection control of COVID-19 needs to be differentiated from generic social isolation. The latter is more patient-driven among those not wanting to be around people.

Understanding loneliness and social isolation is important considering that these conditions have been associated with poor health. Research demonstrates adverse effects on the cardiovascular, immune, and neuroendocrine systems.^7–10 This is even more common in the elderly, minorities, and the poor.¹¹

There is evidence indicating that robust social support may lower the risk of cardiovascular disease.¹² One of the proposed mechanisms underlying this association is the “reactivity hypothesis of disease.”¹³ According to this hypothesis, individuals with high reactivity are at an increased risk for cardiovascular disease. Social support acts as “buffer” for stress-induced cardiovascular reactivity¹⁴ and promotes healthy behaviors such as exercise which also reduces stress.¹⁵

The multi-site Enhancing Recovery in Coronary Heart Disease (ENRICHD) study incorporated comprehensive social support interventions. There was no difference in long-term survival between the intervention and control groups. Participants in the intervention group reported benefits of increased social supports at six months. Another potential pathway studied the role of social supports in behavioral processes including health behaviors and medical regimen compliance.^16,17 Social support was posited as health-promoting, facilitating healthy behaviors such as diet, exercise, abstinence from smoking, and increased adherence to medical regimens. The psychological processes linked to mood, assessment, feeling of control^18–20 and practice of health behaviors²¹ seem the mechanisms underlying the positive association between social support and cardiovascular health.

Apart from the physiological negative effects outlined above, social isolation has harmful effects on mental health. These include worsening of depression, anxiety, and suicidal ideation. Studies have shown a greater prevalence of depressive symptoms and suicidal ideation due to social isolation in adolescence than in adulthood.^{22, 23} A systematic review of 63 studies of more than 50,000 children and adolescents found a significant association between loneliness and mental health problems. Loneliness was additionally associated with future mental health problems up to nine years later.²⁴ Qualter, P., et al. (2010),²⁵ reported that length of loneliness predicted future mental health problems. As a consequence of pandemic-related increases in social isolation, parents and children have reported worsening of child mental health.²⁶

For example, cases of suicidal ideation in March and July 2020, and suicidal attempts in February through July 2020 were found to be significantly higher in comparison to data from 2019.²⁷ An increased use of emergency room services was also observed during the pandemic.²⁸ Mental health concerns noted in children during this period varied from excessive clinginess, fear of safety, worrying to increased depressive anxiety, and difficulty in academics.²⁴ Sexual minority youth were found to be most vulnerable to the mental health effects of social isolation.²⁹ While the use of electronics, such as social media, increased during the period in an effort to stay connected and cope, it created additional youth problems such as phone addiction, excessive usage, and decreased physical activity.

In summary, both loneliness and social isolation are concepts that have existed for a long time. The consequences of the COVID-19 pandemic have exacerbated loneliness and social isolation. The immersion individuals of all age, especially children, in digital devices and electronics such as cell phones, the internet, computer gaming, and solitary social media that will endure even as COVID-19 wanes.

Loneliness and social isolation can present across the life span and cause troubling physical and mental significant sequala. Recognition of loneliness and social isolation is of paramount significance so that interventions can be done to prevent further deterioration of physical and mental health and decrease morbidity and mortality. This may be done as screening assessments for loneliness, social isolation and depression across several venues including educational, work force, and healthcare to prevent. Digital technology which was extremely helpful during the pandemic to help connecting people. However, it is also difficult to gauge the level of engagement in activities on a digital platform compared to traditional in person activity or club. An ideal approach would be to encourage students to get involved in more in-person activities when available and appropriate. New paradigms are need to identify loneliness and social isolation across all populations.