Loneliness, an often neglected but critically important emotional state, was the theme of the 2022 Mental Health Foundation (MHF) awareness week last month (#IveBeenThere). At the beginning of the pandemic, 5% of UK adults reported feeling lonely ‘often’ or ‘always’, or a similar proportion to 2016-2017. By February 2021, this had risen to 7.2%, representing 3.7 million adults (MHF, 2022a). After lockdown, 41% of adults in the UK across all age ranges and communities reported feeling lonelier since lockdown, with one-third feeling that their loneliness will get worse (British Red Cross, 2022).
As part of Mental Health Awareness Week, the MHF (2022b) published a report citing loneliness as a leading public health challenge of our time, with 1 in 4 adults affected. With no single cause or solution, it has been described as the feeling we get when our need for rewarding social contact and relationships is not met. Research shows a clear link between loneliness and mental health issues, and the physical health effects appear to be comparable to smoking 15 cigarettes a day (Dyal and Valente, 2015). Negative health effects of loneliness include high blood pressure, high cholesterol, obesity, poor nutrition, vasoconstriction and an increased inflammatory response in the body. Another effect can be a rise in cortisol levels, which, if present over a prolonged period, can cause anxiety, depression, suicidal ideation, digestive problems, heart disease, sleep problems and weight gain.
Those affected by loneliness can find it harder to enjoy things so they tend to avoid social situations, causing a further decline in mental health and deepening feelings of loneliness. Deficits in motivation, exercise and a general decline in energy and morale have also been noted in those affected, which can seriously impact on self-care, as well as an increase in risk-taking behaviours and lower concordance with medical treatments (Holt-Lunstad, 2018).
One misconception is that loneliness is a choice, but it can be forced on any of us in any circumstances. The stereotypes around who feels lonely can make it harder for people to recognise it in themselves or in others. This leaves gaps in the way we, as a society, can respond. If we are to provide a buffer against the negative effects of loneliness on our mental health, we must challenge the stigma around it and accept that certain life events and factors increase our chances of developing severe and lasting loneliness, which is different to feelings of isolation. Known risk factors include being aged 16-24 years, single, unemployed, being a carer, living alone, living in rented accommodation, being from an ethic minority group and/or being LGBTQ+.
The effects of loneliness can be overlooked, especially among the older population. The data are distressing: 1 in 5 older people in the UK live with depression (British Geriatric Society/Royal College of Psychiatrists, 2019). Explanations for greater loneliness in this age group have included socio-economic factors and challenging life events such as the loss of a loved one or spouse, retirement, relocation or loss of independence due to illness or disability.
As well as being deeply distressing for individuals, loneliness puts enormous pressure on healthcare and public services, given the costs associated with the aforementioned comorbidities, additional GP visits, community nursing, longer hospital stays, and the increased likelihood of requiring residential care.
Social relationships do not solely affect individual emotional wellbeing, they also affect long-term mental health outcomes and communities (Barreto, et al, 2021). A lack of social connection is as a serious risk factor, yet social aspects can often be overlooked in healthcare practice, when in fact this could be the required antidote. The stress-buffering effects of social re-connection must not be underestimated. Social prescribing puts emphasis on building social connections that can be positive for positive mental health, quality of life and longevity. Nurses are uniquely placed to identify, prevent and mitigate the adverse effects of loneliness, and they can offer lifelines by way of personalised care to alleviate this painful experience. It is crucial that we empower nurses, and other health professionals, to be confident to ask themselves, their colleagues, their family, friends and patients one simple question: How often do you feel lonely?