In 2023, the Surgeon General of the United States published a public health advisory – called a Surgeon General’s Advisory, or SGA – describing what we now know as The Loneliness Epidemic.
The SGA is a special form of communication “…that call the American people’s attention to an urgent public health issue and provides recommendations for how it should be addressed. Advisories are reserved for significant public health challenges that require the nation’s immediate awareness and action.”
This recent advisory, called “Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community” follows another SGA on mental health among youth and adolescents called “Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory (SGA) 2021.”
Read about the mental health challenges outlined in that SGA – and how we can help support adolescent mental health – in this recent article on our blog:
Improving Adolescent Mental Health: A National Challenge
Here’s how the U.S. Surgeon General, Dr. Vivek Murthy, describes the loneliness epidemic and its effect on our society:
“Loneliness is far more than just a bad feeling—it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day, and even greater than that associated with obesity and physical inactivity. The harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations.”
Loneliness not only affects physical, psychological, and emotional health, it also affects the structure and function of our economy and economic systems. Loneliness and lack of social connection impacts performance, productivity, engagement, and achievement at all levels of public and private business and commerce.
How Do We Define Social Isolation and Loneliness?
Isolation and loneliness are similar, but they’re not the same thing. Loneliness is most often a result of isolation, although we all know it’s possible to feel lonely when we’re not necessarily alone or isolated from others. Research cited in the SGA indicates thatsocial isolation increases risk of premature death by 29 percent.
Mental health experts consider a person socially isolated when they:
- Connect with a limited number of people
- Have relatively few or no social roles, such a friend, mentor, teammate, activity partner
- Do not join/participate in social or activity groups
- Rarely interact with others
Next, let’s define loneliness.According to the SGA, loneliness is a subjective, internal condition that can happen to anyone. Research indicated loneliness increases risk of premature death by 26 percent. In psychological and emotional terms,loneliness is defined by:
- A gap between social needs and social experiences
- A gap between emotional needs and emotionally gratifying experiences
- Recurring feelings of emptiness
- Persistent unfulfilled need/want to connect with others
- Wanting to feel wanted, but regularly feeling unwanted
Most of us understand these definitions right away. Feeling lonely happens when we need social contact but don’t get it, and isolation occurs when we’re physically and psychologically disconnected from other human, whether family, friends, or people in our community. What’s news to most of us in the bullets above is the fact that both isolation and loneliness can lead to premature mortality, which is medical terminology for preventable death.
Physical Health, Mental Health, and Wellbeing: The Effect of Loneliness and Isolation
A surprising feature of the SGA report was the data on the impact of loneliness and isolation on physical health. It makes sense that isolation and loneliness have an adverse effect on mental health. Most of us agree that after a certain length of time, isolation and loneliness change from the positive, i.e. the solitude and peace we need to recharge, to negative, i.e. the unfulfilled need and desire for human connection. And we can all probably agree that wanting and needing connection without getting it can be, in a word, miserable.
However, what most of don’t know that research connects loneliness and isolation to:
- Increased risk of stroke
- Increased risk of heart disease
- Elevated risk of hypertension
- Increased risk of infectious disease
- Increased risk of cognitive decline
- Elevated risk of dementia
In addition, research connects a high level of social isolation and a low level of social connection to increased risk of premature mortality. In fact, isolation and loneliness increase this risk more than:
- Smoking over 15 cigarettes every day
- Consuming 6 servings of alcohol every day
- Leading an inactive lifestyle
- Air pollution
- Obesity
That information is eye-opening. Being lonely, which is an internal emotional state, can impact your health more than smoking and drinking, which are external intoxicants with physical properties that cause negative consequences. This another reminder that the mind-body connection is real, and a component of overall health we need to include in our approach to disease and healing.
Now let’s look at the impact of isolation and loneliness on mental health.
Isolation and Loneliness: Impact on Depression, Anxiety, Suicide, and Self-Harm
Depressive Disorders/Anxiety Disorders
- Middle-aged adults: loneliness increases likelihood of developing depressive disorders
- Older adults: isolation and loneliness increase rates of anxiety disorders and depressive disorders
- Children, adolescents, and young adults: isolation and loneliness increase likelihood of developing both anxiety depressive disorders
- Children and adolescents: presence of at least one close friend or confidant can reduce risk of developing depressive disorders
Suicide and Self-Harm
- Males who live alone are twice as likely to die by suicide than those who live with another person
- Females who live alone show an increased likelihood of engaging in self-harming behavior, compared to women who live with another person
These facts are not a surprise when you consider this conclusion from a 2010 study called “The Interpersonal Theory of Suicide”:
“Social isolation is arguably the strongest and most reliable predictor of suicidal ideation, attempts, and lethal suicidal behavior among samples varying in age, nationality, and clinical severity.”
The authors of that study continue:
“In contrast, marriage, children, and greater number of friends/family are associated with decreased risk for lethal suicidal behavior.”
In other words, the strongest protective factor against suicide and self-harm is social connection, which is also a powerful protective factor against depression, and an important component of recovery from severe anxiety.
But what exactly do we mean by social connection?
Social Connection and Mental Health
When we say social connection, we mean all the various ways in which people connect with other people, including:
- Peer relationships
- Social roles
- Family relationships/family life
- Work relationships/work life
- Interactions during typical activities, e.g. at the grocery store, running errands, etc.
Research shows there are three core components to social connection:
Component 1: Structure
- How many relationships we have overall
- The variety of our social interactions
- How many family members we have
- How many friends we have
- Our current relationship status
Component 2, Function
- Social support
- Emotional support
- Advice
Component 3, Quality
- Our level of fulfillment/satisfaction in relationships
- The stress or difficulty associated with our relationships
- Whether we feel included or excluded by the people we’re connected to
- Help/support during an emergency or crisis
Research shows us that social connection is essential for optimal physical, emotional, and psychological health and wellbeing, and also shows that over the past 20 years, our overall level of social connection in the U.S. has decreased dramatically.
A study that compared the time we spend alone in 2003 to the time we spend alone in 2020 showed the following:
- Time alone, general population: 24 more hours per month in 2020 than in 2003.
- Time with friends, general population: 20 fewer hours per month in 2020 than in 2003.
- Teen/young adult time with friends: 55 fewer hours per month in 2020 than in 2003
That’s the data: we spend far more time alone than we did less that 20 years ago, and it’s having a negative impact on our physical and emotional health.
How to Improve Social Connection and Reduce Isolation
The research we cite above – and the loneliness epidemic itself – is relevant to everyone in the country, including the children, adolescents, and young adults we support. Our children, adolescents, and young adults need to know and understand the importance of strong social connections and a robust support network.
This is true for everyone, but it’s more important for people with clinical mental health disorders than others, because family support, peer support, and fulfilling social connections are all protective factors against developing mental health disorders, and essential components of healing for people in treatment. And while it’s important for everyone, it’s especially important for adolescents, for whom being seen, being heard, being needed, and feeling wanted/connected can make all the difference in the world.
Here are several ways we improve social connection and reduce isolation:
- Understand the negative consequences of isolation and loneliness.
- Understand the benefits of social connection
- Increase the number and quality of our social connections
As adults, it’s our job to teach the core values of connection to our children. These include kindness, respect, and a community service mindset. When we model these values for children, adolescents, and young adults in our daily lives, they have a chance not only to see how to stay connected, but feel what it’s like to be connected.
When they feel a real connection, they understand. And what happens next?
Almost without fail, they pay it forward, and perpetuate a virtuous cycle that benefits us all.
