Loneliness Is the Quiet Health Epidemic Impacting Your Heart, Brain, and Longevity

oneliness is an all-too-human emotion that poets, novelists, and songwriters have for centuries tried to capture in words in every language. But some researchers contend that it’s more than a feeling: It’s a scourge, an illness, a condition to be treated like a disease—and an infectious and deadly one at that.

According to a literature review, lacking a social connection is considered more dangerous than smoking 15 cigarettes a day and deadlier than obesity. Thus it makes sense how feeling alone can translate into physical ailments. Humans are social creatures, which doesn’t mean we simply enjoy being social; it means we need to be. It’s how we survive—together, in groups, finding strength in numbers even if, unlike our ancestors, we wouldn’t literally starve to death if we didn’t have a go-to crew.

Being socially isolated, by contrast, hurts emotionally and psychologically, and its stresses take a physical toll. Persistent loneliness (lasting longer than two weeks) is linked to high blood pressure, depression, heart disease, and stroke among other conditions, including Alzheimer’s disease. This appears to be due to increased inflammation; in excess, inflammation is associated with chronic disease.

“People think of their relationships as related to emotional well-being; they don’t recognize the profound effect they have on physical health,” says Brigham Young psychology professor Julianne Holt-Lunstad, Ph.D. According to Holt-Lunstad’s research, lonely people have a 26% increased likelihood of early death. For those who have little or no social contact, that rises to 29%, and it jumps to 32% for people who live alone. “We need to take our social relationships as seriously as we take our diet, exercise, nutrition, and everything else that we know impacts our health,” she says.

Why we're lonelier than ever

If loneliness is a disease, it’s one that’s reached pandemic proportions. A growing number of Americans now live by themselves, which is one reason we’re experiencing greater loneliness than ever before. Another factor is the lightning-fast evolution of technology. “We have had more change in the last 24 years than we did in the previous 2,500,” says Dilip Jeste, M.D., director of UC-San Diego’s Department of Healthy Aging. “Social changes have been dramatic, and loneliness is definitely a part of that.” This is related to—but by no means all about—social media. In fact, according to a recent survey of 20,000 U.S. adults by Cigna, the loneliest members of Generation Z (people roughly between ages 7 and 22) are evenly split between those who use social media and those who don’t.

In general, young folks and the very oldest are known to be the loneliest, with people under age 20 registering as the loneliest of all, according to the Cigna poll. Younger people get lonely when they don’t feel they have many social connections; for them, it’s often a numbers game, and making more friends is usually within reach. The older adults, by contrast, opt for quality over quantity, and while saddened when loved ones die, they are developmentally better equipped to cope with that loneliness and loss. “They’re actually happier than you think,” says Dr. Jeste.

That’s why it’s the people in the middle of this U-curve (the 30-to-60 crowd) who researchers are coming to understand may be the most vulnerable of all, due to a mix of factors. Ironically, people in their middle years tend to be pretty busy with other humans—children, parents, coworkers, friends. We’re often frustrated by our lack of “alone time,” and it’s hard to imagine that people who are so darn busy can also feel lonely.

But loneliness is not simply about being alone. What it really hinges on is the quality of your relationships: The more satisfied you are with them, the less lonely you are. Middle age is when that dissatisfaction often runs highest—and when illness begins to brew. “The loneliness-related diseases old people get diagnosed with can take decades to develop, but often start to emerge on a cellular level in early middle age and even before then,” says Steve Cole, Ph.D., professor of psychiatry, medicine, and biobehavioral science at UCLA’s David Geffen School of Medicine.

Midlife friendships matter

The reasons we’re lonely are different in early as opposed to late middle age. The earlier years are a time when long friendships can fade out as we crank it up at work and spend happy hours with colleagues who can help us get ahead, but with whom we are also in competition. Childhood friends may be replaced with new “mom friends,” people with whom we have no history and little in common except parenthood. At work, we can “get sucked up into the world and start doing what’s expedient and profitable instead of what’s the most deeply nurturing,” says Cole. Having random people around—especially those who serve more of a functional purpose than an emotional one—is often not enough to stave off loneliness.

According to a 2016 study of some 15,000 people ages 18 through 79, those between 30 and 49 reported the deepest dissatisfaction with their relationships. Norwegian researchers Magnhild Nicolaisen and Kirsten Thorsen discerned in their research that these were the ages filled with the most regret, a time when memories of a more carefree life were still fresh in people’s minds. Nicolaisen also points to the “sandwich squeeze,” when many middle-aged adults are caring for both children and sick or disabled elderly parents. She notes that limited time to just hang out with friends and have fun leads to disappointment and, ultimately, loneliness.

Vulnerability to loneliness peaks in the 50s.

And as midlifers push through their 40s, the social scaffolding starts to collapse: Parents die, couples divorce, children move away, people lose their jobs, and we may be too busy to properly attend to the emotional fallout. Vulnerability to loneliness peaks in the 50s, according to Dr. Jeste. “For the first time, you become aware of mortality,” he says, noting that it’s when women enter menopause and men go into andropause. It’s also when many
illnesses—arthritis, diabetes, high blood pressure—make their debut. “It’s a time when we can no longer count on perfect health as we could when younger,” says Cole. “Put that
all together and you have a sort of situational invitation to be lonely and socially dissatisfied.”

Looking at the "longterm lonely"

Unfortunately, when it comes to loneliness’s effect on health, people in midlife are the least studied, says Cole. What we do know is this: In her 2015 meta-analysis of 70 studies, Holt-Lunstad concluded that middle-aged people who were lonely had a higher risk of death from any cause than those in other age groups. Lonely people tend to drink more, eat less healthily, and engage in risky behaviors such as using drugs and having indiscriminate sex either to feel better or to numb themselves. Holt-Lunstad’s conclusion is ominous, especially for midlifers living solo: “Although living alone can offer conveniences and advantages, this meta-analysis indicates that physical health is not among them.”

Fortunately, loneliness is generally short-term and self-correcting. But the less resilient among us, people Cole describes as “lonely day in and day out,” he says, are “where we see the most significant biological ramifications.” The inflammatory signal can affect the brain and change behavior in a way that potentially makes people even more socially sensitive and withdrawn and thus prone to loneliness, explains Cole. Researchers say chronic loneliness triggers distrust of others, paranoia, and an expectation of emotional pain. And when someone is in that sort of anguish, his or her general demeanor can become repellent, as is often noted in mental illness. “It’s a vicious cycle,” says Cole.

When the problem is left unchecked, the consequences can be dire. Suicide rates rates over the past two decades have risen most significantly in the 45 to 65 age group, which has the highest suicide rate of any, according to the Suicide Prevention Resource Center. In addition, a 2018 study of suicide notes published by the American Association of Suicidology cites loneliness as a core message in 23% of the notes studied.

Protecting yourself from loneliness

Wealth, education, a close community, and a successful career are known to protect against loneliness. And a healthy marriage mitigates it, Pew research found. But that’s not a shield: Nearly three in 10 people who are unhappy with their family life report feeling lonely, pointing once again to the importance of relationship quality. Neuroscientist Stephanie Cacioppo, Ph.D., of the University of Chicago, is an ardent proponent of exercising, relying on deep friendships, and practicing gratitude. She should know: Last year her beloved husband, John Cacioppo, who also happened to be a leading authority on loneliness, died unexpectedly. She has said that she is “living proof we can recover from loneliness.” She and her husband worked across from each other in the same office. When he died, she has said, “I never thought I would survive, but thanks to sports and social support, I have a taste for life again.”

Like any disease, loneliness is easier to prevent than to treat. In her 2017 paper “Advancing Social Connection as a Public Health Priority in the United States,” Holt-Lunstad outlined a plan that emphasized educational tools to guide children in grades K-12 through the nuances of social interaction so that they’d grow up with greater sensitivity to the impact of their behavior and that of others. “The importance of social connections also needs to be part of medical training,” Holt-Lunstad adds. “Doctors have to be part of the discussion around lifestyle factors that influence health.”

The prescription is not so clear for those of us who are long out of school. Holt-Lunstad is calling for large-scale campaigns like those that created awareness of the dangers of smoking, obesity, and drug use. Others are trying to discover medicinal fixes. But for now, the best thing we can do for ourselves, for our health, is to nurture our friendships. It just might save our lives.

6 Ways to Feel Less Lonely, and More Connected

1.  Look up old friends. They probably want to catch up too.
2. Talk to strangers. Even 30 seconds of friendly conversation with a store clerk or cabdriver has a positive impact on mood.
3. Practice gratitude. Focus on things in your life that make you feel fortunate: your pets, perhaps, or a nice place to live…even a sunny day.
4. Exercise and get enough sleep. Both contribute to mood regulation and overall health.
5. Take a class. Sign up for something you’ve never tried, like dance, art, or meditation. Active learning exercises your brain, and you may make some new friends.
6. Volunteer. It’s hard to feel sorry for yourself when you’re helping improve the lives of others. Data shows that volunteering gives people purpose, which raises their self-
   esteem, in turn making them less lonely.