Loneliness is defined as an unpleasant, emotionally distressing state that arises when a person feels that the quality or quantity of their social relationships falls short of what they desire (Perlman D & Peplau LA, 1981). Importantly, it is not synonymous with simply being alone; people can feel lonely when objectively isolated, but they can also feel alone even when surrounded by people. Lonely individuals often feel that they lack a sense of companionship, that others don’t understand them or share their interests, and that they find it hard to reach out and make new friends. Many people will experience loneliness temporarily at some point in their lives, but for some it can become a chronic and pervasive problem that compromises their mental and physical health.
Researchers and policymakers have taken a growing interest in loneliness in recent years, as the evidence grows that it is a social and public health problem of significant importance. Recent research suggests that loneliness is associated with a 26% increase in risk of early mortality (Holt-Lunstad J. et al, 2015), placing it in a similar league to other well-known risk factors such as smoking and obesity. This year in the UK, Prime Minister Theresa May announced a cross-government strategy to reduce loneliness in society, and appointed a Minister for Loneliness (Tracey Crouch MP) to tackle the issue at policy level.
In the pursuit of solutions to loneliness, it is important to consider that there may be vulnerable groups in society who merit particular attention, such as individuals suffering from mental health problems. Loneliness frequently co-occurs with depression, anxiety and self-harm, and lonely individuals are more likely to seek help from healthcare services for mental health problems compared to non-lonely individuals (Matthews et al, 2018). The burden of loneliness could be particularly taxing for people already struggling with their mental health. However, what can be done to help reduce loneliness in this group is not yet well-understood.
A recent publication by researchers at University College London (Mann et al, 2017), aimed to address this knowledge gap. The paper, published in Social Psychiatry and Psychiatric Epidemiology, presents an overview of the existing interventions to reduce loneliness in people with mental health problems, the evidence base for different types of approach, and the broader considerations involved in delivering interventions.
The authors conducted a scoping review by searching the literature and holding discussions with experts in the field. In doing so, they identified two broad categories of interventions:
- The first they refer to as ‘direct’ interventions, which are those aimed specifically at reducing feelings of loneliness. These included counselling approaches to reduce maladaptive patterns of thinking, training in social skills, support to access new opportunities for social contact, and involvement in community-based groups.
- The second category, ‘indirect’ interventions, refers to more general efforts to improve individuals’ well-being which may, in turn, have a reducing effect on loneliness. These could, for example, include efforts to reduce inequality and lack of opportunity.
Of the interventions reviewed, those geared towards reducing maladaptive social cognitions showed the most promise. This is consistent with previous research conducted in this area (Masi et al, 2011), and with the notion that loneliness can form part of a self-reinforcing cycle of negative thoughts that can be difficult to escape from (Cacioppo et al, 2009). However, the authors note that none of the interventions they examined had a thoroughly sound evidence base.
The authors also identified a number of challenges to tackling loneliness:
- First, there is a stigma attached to the concept, which could be felt particularly strongly by those already feeling marginalised (such as people with mental health problems)
- Second, as a highly private and intimate feeling, loneliness can be difficult to measure with a simple questionnaire, and it is important to ensure that researchers are working with gold-standard measures
- Third, loneliness can be experienced differently from one person to the next, and therefore there is unlikely to be a ‘one-size-fits-all’ approach.
Finally, the authors raise an important question: where does the responsibility to intervene lie in the first place? Should we expect loneliness to be solved solely in doctors’ offices, or at charity events? The authors propose that responsibility is distributed across three ‘levels’ – society, community and the individual:
- At the societal level: policymakers, charities and the media all have a role to play in shaping the wider landscape
- At the community level: family and friends, local organisations and healthcare practitioners can all play a part in supporting lonely individuals and creating opportunities for social contact
- Finally, at the individual level: people struggling with loneliness should have access to help and support to improve their circumstances.
The authors conclude that despite the diverse range of interventions in use, there is a need to strengthen the evidence base through high-quality research, in order to find out what works and which approaches work best for different people. They also emphasise that loneliness, and interventions to reduce it, do not operate in a vacuum but are embedded within a wider social context that includes employment, housing and public services, all of which have the potential to shape outcomes for people with mental health problems.
Strengths and limitations
This review presents a thorough and informative overview of what we currently know about the problem of loneliness, and what still needs to be done to tackle it. Among its strengths is the fact that the authors included grey literature as well as published studies in their review, and approached other experts in the field for comment, allowing for considerable breadth and depth.
On the other hand, the paper does not provide details on the methods the authors used for their literature searches, such as the search terms used or the criteria by which publications were selected. Such a targeted, systematic approach may have been beyond the scope of the authors’ aims here; however, they do mention that they are conducting an “ongoing related systematic review” which may follow this report.
Implications for practice
With policy-makers currently focusing on strategies to reduce loneliness in society, reviews of the evidence such as this are valuable for guiding decisions. The ‘levels of responsibility’ model is highly instructive in this regard. An important point raised by the authors is that as well as intervening to reduce loneliness, there is a need to look at the bigger picture and invest in primary prevention, to limit the extent to which loneliness becomes a problem in the first place. Overall, the paper makes a compelling case for making loneliness a higher priority, both in research and public health.
Conflicts of interest
Dr Farhana Mann (lead author of this review) and Dr Timothy Matthews (author of this blog) are both members of a cross-disciplinary network of loneliness researchers, funded by the ESRC.
Mann F, Bone JK, Lloyd-Evans B. et al (2017) A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems. Soc Psychiatry Psychiatr Epidemiol (2017). doi:10.1007/s00127-017-1392-y https://link.springer.com/article/10.1007/s00127-017-1392-y
Cacioppo JT, Hawkley LC. (2009) Perceived social isolation and cognition.Trends Cogn Sci. 2009 Oct;13(10):447-54. doi: 10.1016/j.tics.2009.06.005. Epub 2009 Aug 31. [PubMed abstract]
Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. (2015) Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015 Mar;10(2):227-37. doi: 10.1177/1745691614568352. [PubMed abstract]
Masi CM, Chen HY, Hawkley LC, Cacioppo JT. (2011) A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev. 2011 Aug;15(3):219-66. doi: 10.1177/1088868310377394. Epub 2010 Aug 17.
Matthews T, Danese A, Caspi A, Fisher HL, Goldman-Mellor S, Kepa A, Moffitt TE, Odgers CL, Arseneault L. (2018) Lonely young adults in modern Britain: findings from an epidemiological cohort study. Psychol Med. 2018 Apr 24:1-10. doi: 10.1017/S0033291718000788. [Epub ahead of print] [PubMed abstract]
Perlman D, Peplau LA. (1981) Toward a social psychology of loneliness (PDF). In R Gilmour & S Duck (Eds.) Personal relationships: 3. relationships in disorder. (pp 31-36). London: Academic Press.