Although people are becoming more connected through social media and other outlets, the great irony is that many people still feel lonely. This loneliness, in turn, can have profound effects on a person’s health and well-being. Loneliness as a public health problem has intensified during the COVID-19 pandemic. Knowing how to recognize loneliness and what can help patients overcome their feelings of loneliness is key.
The AMA policy identifies loneliness as a public health problem that affects people of all ages. The new policy also supports evidence-based efforts to combat loneliness.
The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they wish patients knew about today’s healthcare headlines.
In this installment, two psychiatrists took time to discuss what patients need to know about loneliness as a public health issue. These AMA members are:
- Tiffany Bell Washington, MD, MPH, is an outpatient general, child and adolescent psychiatrist working with Centurion and also in private practice in North Carolina. She is an American Psychiatric Association delegate to the AMA Young Physicians Section, an alternate delegate to the Psychiatry Section Council, and a member of the AMA Ambassador Program, which provides people with the skills and knowledge to speak confidently about AMA initiatives and the value of AMA Membership.
- Frank Clark, MD, an adult outpatient psychiatrist at Prisma Health in Greenville, South Carolina, and an associate clinical professor at the University of South Carolina School of Medicine – Greenville. He is also an American Psychiatric Association delegate to the AMA Council on Psychiatry.
“Loneliness is essentially the feeling of discomfort or distress when someone feels there is a gap between the relationship they would like and the relationship they actually have,” Dr. Bell said. Washingtonadding that “you can be in a crowd full of people, you can know them all and still feel lonely.”
“So you might have a lot of superficial social connections, but what you really want is something deeper — someone who knows you inside out,” she said. “It’s really based on perceiving the difference between the relationship you would like and the relationship you have with others.”
“Loneliness was already an epidemic in itself, but the global COVID-19 pandemic has led to a significant increase in loneliness over the past few years,” said Dr. Bell Washington, who took a course in the final year of her MPH program at Harvard TH School in community medicine Chan, where she learned the serious complications of loneliness. “A 2021 online survey found that 36 percent of all Americans — which includes 61 percent of young adults and 51 percent of mothers with young children — feel ‘severely lonely.'”
Additionally, the Centers for Disease Control and Prevention (CDC) “found that 63 percent of young adults also suffer from significant symptoms of anxiety or depression,” she said. “This means we have a generation of young people hungry for deeper connection who often lack the skills or opportunities to achieve it.”
“One’s 20s are filled with myriad social expectations, including separating from the primary family, finding a partner, developing a career and finding a ‘tribe,'” said Dr. Bell Washington. “For many, this time is compounded by the unrealistic social media life that is often unattainable. It only adds to the loneliness that young people feel.”
“A person experiencing loneliness often describes feeling alone. This is different from social isolation where there is little social connectedness,” Dr Clarke said. “Social isolation can be a consequence of loneliness, but there are many people who experience loneliness and are still socially connected.”
Also, “there are some people who I would consider socially isolated, but they’re perfectly fine,” said Dr. Bell Washington. “The pandemic revealed that although some people thought of themselves as loners when they really should be alone all the time (due to quarantine or isolation), they discovered that they actually value social connection and would rather be with other people.”
“We get these dopamine spikes when someone likes our status,” Dr Clarke said, referring to a social media post. Many, conversely, feel “sad or upset when they don’t get a certain number of likes or over 1 million followers on their social media accounts.
“And if you have an identity crisis — and if you let social media dictate who you are — that can create some loneliness,” he added. “We have to consider the psychiatric consequences of loneliness. These include depression and anxiety.
“We are all at risk of loneliness in our lives,” Dr Clarke said. “There was a report that came out of the National Academies of Sciences, Engineering and Medicine. It revealed that more than a third of adults aged 45 and over reported feeling lonely, and around a quarter of adults aged 65 and over considered themselves socially isolated.
“Social isolation alone is associated with a 50% increased risk of developing neurocognitive disorder and other serious medical conditions,” he added. “No one is immune to loneliness and social isolation, but there are certain groups that are at increased risk.”
“When we think about historically marginalized groups in terms of immigrants, as well as the LGBTQ+ community, these are groups that have been shown to be at high risk of loneliness and social isolation,” Dr Clarke said.
“Anyone can suffer from loneliness, and those at greatest risk are those who are unable to heal loneliness when they feel it,” reiterated Dr. Bell Washington. She added: “The fear of being alone in solitude only worsens the isolation. It’s easy to feel like you’re the only one who needs social connectivity, but that’s not true. There’s no shame in being single. We are made for connection.”
“There is some evidence to note that people who experience social isolation and loneliness are at increased risk of premature death,” said Dr Clarke, adding that “social isolation and loneliness are associated with a 29% increased risk of heart disease and 32% risk of stroke.
“I’m a romantic and a poet, and there’s something to be said for heartbreak — literally and figuratively,” he said. “If you already feel lonely, it will affect your heart. If you feel socially isolated, it will affect your heart.
Looking at “immigrants and the LGBTQ+ group, why do these groups feel so isolated and lonely? Well, discrimination is a factor that can be a barrier to them feeling socially connected,” Dr Clarke said. “The other thing would be language barriers if we’re talking about immigrants for whom English is not their primary language.”
“It can be difficult to form relationships with others when historically marginalized groups continue to be stigmatized,” he said. “We must acknowledge our implicit and explicit biases if we hope to strive to embrace humanity in the form of diversity, equity, and inclusion.”
“Sometimes we are in denial. When we’re in denial, it’s easy to avoid these feelings that we know are bubbling to the surface, but we’re just trying to keep suppressing them,” said Dr. Clark. “If you’re feeling lonely, the first thing is, admit it, and then ask yourself: What is contributing to my loneliness?”
“Loneliness is not your fault. Social isolation is not your fault,” he said. “Because, again, there are probably precipitating and sustaining factors that contribute to these states of being.”
“We need to remember that we are enough and that we belong,” Dr. Clark said.
“If we want people to live longer and healthier lives, we need to be better at researching how loneliness affects our communities,” Dr Clarke said. “Everyone needs a support system. Even the person who says they have a shy temperament and are more introverted, they still need a support system. “When we look at our AMA declaring this a public health issue, it speaks to the importance of advocating for connectivity for all communities that will allow them to thrive,” he said. “For example, support systems are a positive, prognostic factor for individuals who suffer from mental illness, substance use disorders, and personality disorders.”
“We need to make sure that people have the resources available to them that will enable them to cultivate connectedness,” Dr. Clarke said, adding that “those resources need to be diverse, equitable and inclusive.”
“People assume that if someone is doing well and making money and having a family that they can’t be lonely, but that’s not true,” said Dr. Bell Washington. “We all benefit from having a deeper connection with others, no matter what stage of life we are in.”
“We really can’t minimize anyone’s struggle because we all have different struggles that we deal with,” she said. “We are human, we have needs and we have the right to express those needs. We should always be kinder than necessary because you never know the hidden struggles that people go through.
“Loneliness is something to be taken seriously,” said Dr. Bell Washington. Loneliness “can have serious mental and physical complications that worsen if ignored.” She added that “social isolation and loneliness lead to a higher risk of high blood pressure, heart disease, obesity, anxiety, depression, memory problems and even death.”
“This is not a sign of weakness. You don’t have to be a superhero. You don’t have to be strong all the time and there’s nothing wrong with wanting or looking for relationships,” she said. “The same things we needed as little kids; we need it as adults too. So of course you need sleep, healthy food and exercise, but you also need a relationship.
“That relationship looks different for different people. For some, it may be a connection to a higher power, family or friends,” said Dr. Bell Washington. “I advise all patients to make sure they are taking care of themselves and to get help if you need it.” Washington
“If you notice that you’re sad or worried more days, that would be a sign that you probably need to reach out to someone,” said Dr. Bell Washington. “In addition to confiding in a trusted family friend, I would recommend contacting your GP.
“They can make sure you’re not suffering from depression or other mood problems as a result of your loneliness,” she added. “Your doctor would be a great person because he can be sure to give you some help as well.”
“Obviously, then, if you get to the point where you feel so alone and so isolated that you start to feel hopeless or suicidal, you should contact your doctor immediately,” said Dr. Bell Washington, noting that “there is also a new 988 mental health hotline. Whatever you do, don’t suffer in silence, please get help!”