In a study of nearly 3,500 men and women ages 30 to 65, researchers in Finland found that people who lived alone were more likely that their peers to receive a prescription for antidepressant drugs. One-quarter of people living alone filled an antidepressant prescription during the seven-year study, compared to just 16 percent of those who lived with spouses, family, or roommates.
"Living alone may be considered a mental-health risk factor," says lead author Laura Pulkki-Råback, Ph.D., a lecturer at the University of Helsinki's Institute of Behavioral Sciences. The study was published today in the journal BMC Public Health.
Surveys of the study participants suggest that solo living may weaken social networks and produce "feelings of alienation from society" that could steer people toward depression, Pulkki-Råback says. "People living alone were more cynical in their attitudes," she explains. "Being cynical and living alone may predispose to hopelessness and negative feelings, ultimately leading to depression."
John Newcomer, M.D., a professor of psychiatry at the University of Miami Miller School of Medicine, says depression and feelings of isolation usually go hand in hand, and it's not always clear which comes first.
"Being depressed certainly can cause you to not only feel, but [also] become, more isolated," he says. "You feel hopeless that you're ever going to be able to have relationships, but even at another level, you ... just don't feel like getting up and going out. You're undermotivated to do the various steps that are necessary to achieve social engagement."
Loneliness and isolation can affect your quality of life -- and maybe one's quantity of life, too. According to a pair of studies published today in the Archives of Internal Medicine, living alone -- or even just feeling lonely -- may increase a person's risk of premature death.
One study followed nearly 45,000 people ages 45 and up who had heart disease or a high risk of developing the condition. Those who lived alone, the study found, were more likely to die from heart attacks, strokes, or other heart complications over a four-year period than people living with family or friends, or in some other communal arrangement.
The risk was highest in middle-aged people, just 14% of whom lived alone. Solo living increased the risk of heart problems and early death by 24% among people ages 45 to 65, and by only 12% among people ages 66 to 80. And there was no association at all in people age 80 and older, a group in which living alone is common.
Why is living alone potentially harmful? Especially among the middle-aged, a demographic in which living with a spouse or partner is the norm, living alone may be a sign of social or psychological problems, such as relationship trouble, a weak support system, job stress, or depression-- all of which have been linked to heart disease. Living alone "could be a little red flag" that a patient may be at a higher risk of bad outcomes.
Although it may not be a routine part of a check-up, the quality of our social connections can have a major impact on our health. People who experience long periods of loneliness have been found to develop serious health problems, including cardiovascular disease, dementia and decreased mobility, at much higher rates than people who don’t feel isolated. A major review of research into the effects of social disconnectedness on health, published in the journal PLOS Medicine in 2010, declared loneliness is just as dangerous to health as smoking and takes an even greater toll than obesity or physical inactivity.
There are growing concerns about the effects of loneliness on health as more Canadians live alone, potentially making some vulnerable to social isolation. For the first time, singleton households outnumber those consisting of couples with children, according to census figures released last year. Loneliness is often dismissed as a minor social issue that only affects a segment of the elderly population. But as it turns out, it’s a far larger issue.
“I think we’ve underestimated the importance of the social milieu just as fish underestimate the importance of water,” said John Cacioppo, director of the Center for Cognitive and Social Neuroscience at the University of Chicago.
How can a human emotion have such a powerful hold over physical health?
Researchers don’t yet have a complete understanding of the relationship, but they say prolonged feelings of loneliness or isolation can cause hormonal, genetic and other changes that may contribute to the risk of developing health problems. Scientists have also discovered that social isolation actually changes the way our brains function. For example, a recent experiment involving Romanian orphans showed that children raised in an institutional environment that was notorious for neglect had significantly less grey and white brain matter and far less electrical signalling than those raised in foster care.
“We’re a social species and if you don’t have others around you [that] you can trust …your brain effectively knows it’s on the social perimeter,” said Cacioppo. “All social species, when they’re on the perimeter, they’re at risk.”
Cacioppo, whose groundbreaking research discovered, among other things, that lonely people are more likely to develop vascular resistance, a prime risk factor for high blood pressure, said the health effects are extremely complex and likely developed as an evolutionary response. When we’re cut off from social networks, we suffer more frequent sleep disturbances and have higher stress levels as the brain goes into a high alert, protective mode, he says.
Britain is emerging as a leader in addressing social isolation on a population-wide level. Its government announced in November plans to map the incidence of loneliness across the country in order to develop strategies for what Health Minister Jeremy Hunt described as an urgent issue.
Of course, the relationship between loneliness and ill health is more complex than the number of people who sleep under one roof. Being alone doesn’t lead to health problems. But when people feel disconnected and cut off from the world, it’s a different story. Although living alone may put some individuals at greater risk of experiencing those feelings, research shows that people who live with others can also feel isolated.
“Living alone doesn’t mean people are lonely,” said Carsten Wrosch, professor in the department of psychology in the Centre for Research in Human Development at Concordia University in Montreal.
A study published last year in the JAMA Internal Medicine journal found people over 60 who felt lonely were more likely to experience functional decline and death than those who weren’t, regardless of whether they lived alone.
“Simply solving the issue by placing people living with others is not going to single-handedly remove the adverse health effects,” said Emily Bucholz, a Yale University PhD candidate who co-authored a commentary on social isolation and health.
One of the biggest challenges in developing comprehensive strategies that help socially isolated people develop meaningful connections is the fact that few people want to talk about it.
“People would far rather have some awful diagnosis than just admit they were lonely,” said Jacqueline Olds, clinical professor of psychiatry at Harvard Medical School who co-authored The Lonely American: Drifting Apart in the Twenty-First Century. “Almost anything would be preferable to saying, ‘I’m just as lonely as can be.’”
If governments put a greater focus on the potentially devastating consequences of social isolation, it would be a major step to helping those in need, she said. In the meantime, there are groups working to reach those who would otherwise fall through the cracks.
The Langley Senior Resources Society has established several programs to encourage seniors to create and maintain social networks. Volunteer drivers are on hand to take seniors shopping or to do home visits with those who aren’t comfortable venturing out. They also have a “telephone buddy” system that connects trained senior volunteers with socially isolated elderly individuals.
The B.C. centre also recently ran a series of workshops on “Letting Go of Loneliness.” The workshops focused on helping elderly individuals accept that while they may never replace the lifelong friends and partners who have died, they can still create new relationships. The response to the programs has been overwhelmingly positive, says Janice McTaggart, director of outreach and volunteer services.
“When you have other things to think about and other things to talk about, you don’t dwell on your issues quite as much,” she said. “Lots of people that come to the centre here tell us we saved their lives.”