Loneliness has been defined as a disparity between a person’s desired relationships and their actual relationships (Perlman & Peplau, 1982). Loneliness has been associated with poor physical health outcomes and increased odds of developing mental health problems (Mann et al, 2017). For more on the links between loneliness and mental health problems, check out Timothy Matthews’ blog Tackling Loneliness in People with Mental Health Problems.
Whilst loneliness is addressed fruitfully when discussing older adults, its acknowledgment in young people is disproportionately lower, despite a similar peak in rates of loneliness among those aged 16-24 years (Victor & Yang, 2012). As enduring loneliness has been associated with early mortality (Hawkley & Cacioppo, 2010), there is a pressing need for research to investigate how loneliness relates to health problems throughout the life course.
Underlying mechanisms of loneliness
Although an association has been highlighted between loneliness and poor physical and mental health outcomes, the mechanisms behind this are still somewhat unclear. One promising avenue is that poor health behaviours, such as sitting or resting during waking hours with minimal energy expenditure (otherwise known as sedentary behaviour), may be a key ingredient at play. Some previous findings have seen sedentary behaviour associated with health problems, independent of physical exercise. However, the evidence base investigating this area is limited to small and sparse studies. To demystify this, Davy Vancampfort and colleagues (2019) set out to investigate sedentary behaviours and loneliness in a large, multi-national analysis of survey data from 148,045 young people aged 12-15 years.
The study analysed data from the Global School-based Student Health Survey, which was jointly developed by the WHO and the US centres for Disease Control and Prevention (CDC). For the purposes of this study the authors included 52 of the most recent nationally representative datasets, consisting of 9 low-income (N = 18,576), 27 lower middle-income (N = 68,008) and 16 upper middle-income (N = 61,461) countries based on the World Bank classification. For these included countries the survey was conducted between 2003 and 2016.
Perceived loneliness was assessed with the question “During the past 12 months, how often have you felt lonely?”. Participants were categorised as lonely if they answered ‘most of the time’ or ‘always’, and not lonely if they answered ‘never’, ‘rarely’ or ‘sometimes’.
Leisure-time sedentary behaviour (LTSB) was assessed with the question “How much time do you spend during a typical or usual day sitting and watching television, playing computer games, talking with friends, or doing other sitting activities?” with answer options ranging from <1 to >8 hours per day, excluding time at school and when doing homework.
The analysis was restricted to those aged 12–15 years. The authors used a multivariate logistic regression analysis to estimate the association between LTSB and loneliness. All regression analyses were adjusted for age, sex, food insecurity (a proxy for lower socioeconomic status), anxiety-induced insomnia (a proxy for mental health problems), number of friends, physical activity, parental support/involvement, bullying victimisation, and country. Less than 2.5% of the data were missing except for bullying victimisation in which 8.2% of the data was missing.
Rates of loneliness
- The mean total prevalence of loneliness in this study was 10.3%, and frequencies were relatively consistent between the different income level countries.
- Age-sex adjusted analyses of prevalence of loneliness between countries found wide variation which ranged from 2.3% in Laos to 28.5% in Afghanistan.
Rates of leisure time sedentary behaviour (LTSB)
- A linear pattern of >3 hours of LTSB and income of country was found:
- 5% low-income
- 23.1% in lower-middle income
- 41.6% in upper middle countries.
LTSB and loneliness
- Authors reported that a dose-response trend was found between loneliness and increasing hours spent in LTSB per day
- Adolescents who engaged in LTSB for more than 3 hours per day were 29% more likely to experience loneliness
- Spending 5-8 hrs a day sedentary was associated with a 37% increase on odds for loneliness
- This increase nearly doubled to 66% among those spending more than 8 hours a day sedentary
- This association was independent of covariates, including physical exercise
- Among people spending 3-4 hours a day sedentary, only female participants showed elevated loneliness.
|Leisure time sedentary behaviour per day||Increased odds for loneliness|
- No significant heterogeneity was found for country-income groups
- A pooled estimate of >3 hours of LSTB and loneliness found a 30% increase in the odds of becoming lonely. However, the authors did not acknowledge that this can only be considered as weak evidence of an association, given the corresponding p value of p=0.065.
- This study was the first multinational study to investigate the relationship between sedentary behaviour and perceived loneliness in adolescence, and it is by far the largest study on this topic.
- The authors concluded that the results of the current study provided consistent evidence that adolescents who engage in sedentary behaviour for 3 or more hours a day are more likely to experience loneliness.
- Moreover, this finding generalises across a large number of countries, adding further weight to the connection between sedentary behaviour and loneliness.
Strengths and limitations
- The study focuses on adolescents, an age group in which loneliness is particularly common. Loneliness has been widely-studied in older populations, but it is important to expand the evidence base on the experience of loneliness in younger people.
- The current study was the largest so far to explore loneliness and young people, covering a multitude of countries. As a result, it can be said that the study is cross-culturally generalisable to adolescents aged 12-15 years.
- Some of the previous literature in this area was conducted prior to the advent of social media, which may have changed the ways in which young people connect with each other and spend their leisure time. This study presents more contemporary data.
- The authors controlled for number of friends and family support, which can sometimes be conflated with subjected feelings of loneliness. Adjusting for these potential confounders increases the validity of findings.
- Low and Middle Income countries were included in the study in an attempt to investigate this previously neglected gap in the literature. This is useful in exploring factors related to differing income levels such as access to electronic devices and environmental factors.
- Evidence in support of a relationship between depression and loneliness has been confirmed in several studies as discussed. However, no measure of psychopathology was included. Therefore, it is unclear if the reported link between sedentary behaviour and loneliness is independent of depression (or other mental health problems).
- As the study is cross-sectional, directionality or causality of the relationships cannot be established. For example, the association between sedentary behaviour and loneliness could be secondary to other factors such as chronic illness or severe mental illness. Nonetheless, both loneliness and sedentary behaviour are known risk factors for health problems, so the finding that they co-occur remains cause for concern. In the future, longitudinal and intervention studies may provide more information regarding causality and underlying mechanisms.
- Sedentary behaviour was only broken down into hours per day without further information of the nature of the sedentary behaviour. This may mask a more nuanced relationship between sedentary behaviour and loneliness. For example, sedentary behaviour may have been social (i.e. watching a film with friends). Further research could focus on different categories of sedentary behaviour to elucidate the relationship it has with loneliness.
- Despite this study analysing data from 52 countries, there is a lack of acknowledgment of cultural differences, decreasing its cultural validity. Furthermore, whilst the authors list several measures used to control for confounding (such as food insecurity, number of friends, physical activity), it is unclear if these varied between countries or between different country income categories.
- Finally, the survey relied on self-reported sedentary behaviour, which may be difficult to remember, thus opening itself to the potential of recall bias. Therefore, in the future, wearable technology may be a more objective way to measure sedentary behaviour.
Implications for practice
The authors proposed two explanations for their findings which have implications for practice:
- A cyclical relationship between sedentary behaviour, loneliness and mental health problems
Loneliness often co-occurs with mental health problems and sedentary behaviour is thought to contribute to mental health problems. In turn, mental health problems may lead to more sedentary behaviour, which may lead to increased feelings of loneliness. The implication of this is that interventions need to be introduced which break this cycle, and one of the easier parts to tackle is sedentary behaviour, thus interventions that reduce sedentary behaviour may in turn reduce both loneliness and mental health problems.
- Social media use
Excessive or compulsive use of digital technology may provide an explanation as it has been suggested to be associated with increased sedentary behaviour and increased feelings of loneliness. However, the measure of sedentary behaviour did not disentangle time spent online versus, for example, time spent watching TV, which means it was not possible to test this. Social media could be a positive or negative influence on loneliness and health behaviours, depending on what people use it for (Teppers et al, 2014).
Conflicts of interest
Vancampfort D, Ashdown-Franks G, Smith L, Firth J, Van Damme T, Christiaansen L, Stubbs B, Koyanagi A. (2019) Leisure-time sedentary behavior and loneliness among 148,045 adolescents aged 12–15 years from 52 low- and middle-income countries. Journal of Affective Disorders, Volume 251, Pages 149-155. https://doi.org/10.1016/j.jad.2019.03.076.
Perlman, D., & Peplau, L. A. (1982). Theoretical approaches to loneliness. Loneliness: A sourcebook of current theory, research and therapy, 123-134.
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of Behavioral Medicine, 40(2), 218-227.
Mann, F., Bone, J. K., Lloyd-Evans, B., Frerichs, J., Pinfold, V., Ma, R., … & Johnson, S. (2017). A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems. Social Psychiatry and Psychiatric Epidemiology, 52(6), 627-638.
Teppers, E., Luyckx, K., Klimstra, T. A., & Goossens, L. (2014). Loneliness and Facebook motives in adolescence: a longitudinal inquiry into directionality of effect. Journal of Adolescence, 37(5), 691-699.
Victor, C. R., & Yang, K. (2012). The prevalence of loneliness among adults: a case study of the United Kingdom. The Journal of Psychology, 146(1-2), 85-104.
- Photo by Todd Diemer on Unsplash
- Photo by Kelly Sikkema on Unsplash
- Photo by Boudewijn Huysmans on Unsplash
- Photo by Dose Juice on Unsplash
- Photo by HUI GAO on Unsplash
“Loneliness has been defined as a disparity between a person’s desired relationships and their actual relationships”
According to this definition, I am not lonely, as I absolutely do not desire any relationship.
“Perceived loneliness was assessed with the question “During the past 12 months, how often have you felt lonely?”. Participants were categorised as lonely if they answered ‘most of the time’ or ‘always’, and not lonely if they answered ‘never’, ‘rarely’ or ‘sometimes’.”
Technically, I always feel lonely, because I am objectively alone. So according to this measure I am lonely.
That discrepancy between measuring tool and the meaning that is associated with the measure is something I’ve experienced many many many times in psychiatric evaluation procedures.