Brian Lawlor
Roger O'Sullivan
Gerry Leavey
Jim Lubben- 1The Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
- 2Ageing Research and Development Division, The Institute of Public Health, Dublin, Ireland
- 3The Bamford Centre for Mental Health and Well Being, Ulster University, Coleraine, United Kingdom
- 4School of Social Work, Boston College, Chestnut Hill, MA, United States
- 5Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, United States
In 2023, The Lancet published an editorial entitled “Loneliness as a health issue,” which underscored the complexity of addressing loneliness and emphasized the key role that health professionals can play (1). Reports from the US Surgeon General (2) and the National Academies of Sciences, Engineering, and Medicine (3) also stress the importance of mobilizing the health sector, recognizing that healthcare professionals have a crucial position in addressing loneliness and social isolation, particularly due to their interaction with high-risk populations. Despite an increased awareness of social isolation and loneliness during the COVID pandemic, it remains uncertain whether the healthcare community fully recognize it as a significant health risk (4, 5). Historically, a patient's level of social connections was considered a personal matter (6), yet since the 1980s, there has been growing recognition of the impact of social connections on health. In House's seminal paper published in Science in 1988, the authors provided evidence that the quality of social relationships has the same impact on health and mortality as cigarette smoking and other major biomedical and psychosocial risk factors (7). Over the past 40 years there has been increasing siloing and demarcation between the health and social care systems and professions. This separation has not served patients well and may also have contributed to why medical specialties see loneliness as more of a social issue. However, loneliness and social isolation are important risk factors for all-cause mortality, stroke, heart disease, depression, suicide and dementia (8–10). Both are also key contributing factors and potentially treatable aspects of multimorbidity and the geriatric giants of cognitive impairment and frailty (2, 3, 11).
Doctors, for example, whether in primary, secondary or tertiary care, have the potential to play a key position in identifying lonely patients who need support. However, while concerns have been raised about the potential medicalization of loneliness (12), the reality is that this topic receives insufficient attention by doctors in their training or in their practice (4). So why is it that the medical field in general has been slow to acknowledge the importance of loneliness and social isolation for health and to act on this stark message? There are several possible explanations: the first of which is the stigma that is associated with social isolation and loneliness. Few people will ever admit to feeling lonely. Loneliness is often considered as a personal failure or weakness. For some clinicians, loneliness may be regarded as a natural aspect of aging and loss. Additionally, loneliness may be regarded as part of being human, or an emotion rather than a treatable disorder or condition. However, like depression, loneliness can have different levels of severity, duration and quality and we now know that chronic and persistent loneliness and social isolation negatively impacts quality of life, functioning and many and major health outcomes (13). Social isolation and loneliness can be confused and while they often overlap and co-occur, they can exist separately, and both should be measured to evaluate health risks and potential interventions (14–16). Some would argue that issues around definition and measurement of these social constructs have stalled the incorporation of loneliness and social isolation into mainstream medicine (17, 18). The assessment of other biomedical risk factors such as hypertension, obesity and smoking are easier to quantify, and the subjective nature of loneliness harder to capture. While this is a challenge, and the overlap with social isolation and its measurement is a reality, the compelling nature of the growing evidence of the risk of loneliness and social isolation to health, even with these measurement caveats, should override this argument (13, 17–19).
It is imperative that mainstream medicine and geriatrics regard social isolation and loneliness as important risks to health and include them as part of comprehensive medical risk assessments and mainstream medical practice (20). We need much more than the recommendation of establishing a connection with the patient (1). Empathic connection is key but a cultural shift that involves a systematic approach embedded in both training and practice that becomes as natural as checking one's weight and blood pressure is also required (10). We must go beyond a medical social history that simply consists of “do you smoke, drink, live alone or are you married” to one that includes a more nuanced exploration of the quality and quantity of the person's social relationships, how satisfied they are with their social engagement and clarity around whether the person feels lonely or not. This level of medical social history taking and assessment is the first step toward a comprehensive plan to tackle the health risks of loneliness and social isolation.
Author contributions
BL: Writing – original draft, Writing – review & editing. RO'S: Writing – original draft, Writing – review & editing. GL: Writing – original draft, Writing – review & editing. JL: Writing – original draft, Writing – review & editing.
Funding
The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
1. Lancet T. Loneliness as a health issue. Lancet. (2023) 402:79. doi: 10.1016/S0140-6736(23)01411-3
2. The U.S. Surgeon General's. Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General's Advisory on the Healing Effects of Social Connection and Community. (2023). Available at: https://www.hhs.gov/about/news/2023/05/03/new-surgeon-general-advisory-raises-alarm-about-devastating-impact-epidemic-loneliness-isolation-united-states.html (accessed July 25, 2024).
3. National National Academies of Sciences Engineering and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: National Academies Press (US) (2020).
4. O'Sullivan R, Lawlor B, Burns A, Leavey G. Will the pandemic reframe loneliness and social isolation? Lancet Healthy Long. (2021) 2:e54–5. doi: 10.1016/S2666-7568(20)30066-0
5. O'Sullivan R, Burns A, Leavey G, Leroi I, Burholt V, Lubben J, et al. Impact of the COVID-19 pandemic on loneliness and social isolation: a multi-country study. Int J Environ Res Public Health. (2021) 18:9982. doi: 10.3390/ijerph18199982
6. Holt-Lunstad J, Perissinotto C. Social isolation and loneliness as medical issues. N Engl J Med. (2023) 388:193–5. doi: 10.1056/NEJMp2208029
7. House JS, Landis KR, Umberson D. Social relationships and health. Science. (1988) 241:540–5. doi: 10.1126/science.3399889
8. Crooks VC, Lubben JE, Petti DB, Little D, Chiu V. Social network, cognitive function and dementia incidence in elderly women. Am J Public Health. (2008) 98:1221–1227. doi: 10.2105/AJPH.2007.115923
9. Lubben JE, Gironda MW. Measuring social networks and assessing their benefits. In:Phillipson C, Allan G, Morgan D., , editors. Social Networks and Social Exclusion. Hants, England: Ashgate (2004). p. 20–49.
10. Lubben J. Addressing social isolation as a potent killer! Public Policy Aging Rep. (2017) 27:136–138. doi: 10.1093/ppar/prx026
11. Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. (2024) 404:572–628. doi: 10.1016/S0140-6736(24)01296-0
12. McLennan AK, Ulijaszek SJ. Beware the medicalisation of loneliness. Lancet. (2018) 391:1480. doi: 10.1016/S0140-6736(18)30577-4
13. Prohaska T, Burholt V, Burns A, Golden J, Hawkley L, Lawlor B, et al. Consensus statement: loneliness in older adults, the 21st century social determinant of health? BMJ Open. (2020) 10:e034967. doi: 10.1136/bmjopen-2019-034967
14. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Persp Psychol Sci. (2015) 10:227–37. doi: 10.1177/1745691614568352
15. Smith KJ, Victor C. Typologies of loneliness, living alone and social isolation, and their associations with physical and mental health. Ageing Soc. (2019) 39:1709–30. doi: 10.1017/S0144686X18000132
16. Cudjoe TK, Roth DL, Szanton SL, Wolff JL, Boyd CM, Thorpe Jr RJ. The epidemiology of social isolation: national health and aging trends study. J Gerontol. (2020) 75:107–13. doi: 10.1093/geronb/gby037
17. Fried L, Prohaska T, Burholt V, Burns A, Golden J, Hawkley L, et al. A unified approach to loneliness. Lancet. (2020) 395:2. doi: 10.1016/S0140-6736(19)32533-4
18. Pomeroy ML, Mehrabi F, Jenkins E, O'Sullivan R, Lubben J, Cudjoe TK. Reflections on measures of social isolation among older adults. Nature Aging. (2023) 3:1463–4. doi: 10.1038/s43587-023-00472-4
19. Lubben JE, Blozik E, Gillmann G, Iliffe S, Kruse WR, Beck JC, et al. Performance of an abbreviated version of the lubben social network scale among three European community-dwelling older adult populations. Gerontologist. (2006) 46:503–13. doi: 10.1093/geront/46.4.503
Keywords: loneliness, health, risk, care, training, social isolation
Citation: Lawlor B, O'Sullivan R, Leavey G and Lubben J (2024) Do doctors appreciate that social isolation and loneliness are health issues? Front. Public Health 12:1477228. doi: 10.3389/fpubh.2024.1477228
Received: 07 August 2024; Accepted: 13 November 2024;
Published: 19 December 2024.
Edited by:
Giulio Gabrieli, Italian Institute of Technology (IIT), ItalyReviewed by:
Marian Peacock, The University of Sheffield, United KingdomCopyright © 2024 Lawlor, O'Sullivan, Leavey and Lubben. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Roger O'Sullivan, cm9nZXIub3N1bGxpdmFuJiN4MDAwNDA7cHVibGljaGVhbHRoLmll