Loneliness, the silent killer

Laboratório de Investimento Social
“Loneliness is not just an unpleasant emotion. Loneliness and social isolation can have grave consequences on mental and physical health. Knowing that, there is much more that can be done.”

Moving from ambiguous to clear

Loneliness can be defined as the negative emotional state experienced when there is a difference between desired and actual social relationships. Social isolation on the other hand refers to a low objective number of relationships or activities. Most people experience feelings of loneliness at one point or another in life, but for some it becomes a persistent or chronic state. Older people are more vulnerable to loneliness and social isolation than any other age group. The transition to retirement, loss of friends and family, living alone, loss of mobility and sensory impairment are some of the factors contributing to the problem. About 20% of those aged 60 and over report feeling lonely often in Portugal.

Unfortunately, researchers, health practitioners, the public sector and non-profit organizations have to some extent ignored loneliness as a serious mental health condition. This is perhaps the result of loneliness being perceived as an elusive and ambiguous concept, as well as a general lack of knowledge existing on the subject. Luckily, recent years of research, media attention and information campaigns (such as the Campaign to End Loneliness in the UK) have brought loneliness out of the shadows.

Today, the negative impact loneliness has on mental and physical health is well documented. For example, loneliness and isolation has been found to have a higher impact on mortality than obesity, and about the same impact as smoking 15 cigarettes per day (Holt-Lunstad, Smith and Layton 2010). Such findings, combined with a lack of attention towards the problem, are why loneliness in recent years has been dubbed “the silent killer”. We also know that loneliness can predict increased cortisol levels, increased blood pressure, reduced physical activity, Alzheimer, depression and more. Loneliness truly is not just an unpleasant emotion, and its implications to public health cannot be ignored.

Addressing loneliness

Addressing loneliness is not so straightforward. 7 Meta-analysis have reviewed the results of interventions and programs addressing loneliness. From these reviews it is clear that several actions can reduce loneliness. Such as improving existing relationships, establishing new social connections or changing the way individuals think about social connections through psychological support. However, researchers argue that most results are mixed, modest or even low, when comparing to the results achieved when addressing other mental health issues. There is a need for further research, and there is a need for innovation in services to tackle loneliness. To identify new and existing best practices to tackle loneliness, to learn and to innovate, measurement is key.

Loneliness can be measured using validated and simple scales, such as the UCLA loneliness scale. The revised 3-item UCLA scale asks three questions with three possible answers to each question. The score from each question is added together for a total score range of 3-9. Although no measurement can perfectly capture such a complex human emotion, measurement scales help us convert loneliness from an ambiguous and subjective feeling to an objective number. Measuring and using such numbers can help non-profits and public sector organisations working with loneliness better demonstrate the positive impact they have, and give them a more detailed understanding of what works. Unfortunately, few organizations working with loneliness measure it. There may be a brilliant non-profit program to tackle loneliness out there, but without evidence of effect, we cannot really know.

Investing to tackle loneliness

The perception of loneliness as an ambiguous concept, combined with mixed success in tackling it, may discourage public sector commissioners from spending to reduce loneliness. Social investments, which seek to generate both social and financial return, can play an important role in this context. By using mechanism such as the Social Impact Bond, promising loneliness programs can be funded, while risk is transferred to investors. Social Impact Bonds would not only be a useful mechanism to fund promising programs, but also as a means of innovating and gathering evidence of what works.

One such promising program is Shared Lives in the UK. Shared Lives works with adults and elderly with learning disabilities, with physical disabilities and with elderly living alone or in social isolation. In Shared Lives, the adult or elderly in need moves in with or regularly visits a Shared Lives carer, and together they share family, social networks and community life. Shared Lives carers are ordinary people and families who are carefully recruited, selected, matched with a person in need and trained by Shared Lives. According to surveys, almost all of the people supported in Shared Lives have been able to make new friends after entering Shared Lives, and over a third have made five or more new friends. 87% have said that Shared Lives has a positive effect on the mental health of the person supported. Through social investment mechanisms, knowledge sharing and networks, promising services such as Shared Lives can be replicated and scaled in Portugal.

We should not continue to underestimate the negative effects loneliness has on individuals and our public health, and we should not continue to underinvest. We can do more.

As individuals, we can invest not only our money but perhaps more importantly our time, to tackle loneliness. Non-profit organizations working with lonely elderly, teenagers or refugees are always in need of additional volunteers to become home visitors, mentors and friends. Even in our personal lives, we all know someone who would appreciate a visit or a call.

Jan Tveterås

Jan integrates the second edition of the SIB research Programme and is currently developing a feasibility study for a Social Impact Bond for the methodology of Shared Lives.

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