Loneliness. We all know the feeling of being isolated, alone, unconnected. For most of us it might just be an off-day, but loneliness can become a chronic condition in others, particularly among the elderly but also the young, who can feel isolated despite being part of a crowd.
Persistent loneliness is also much more than just a state of mind or an occasional sense of melancholy; it is a condition that can cause health problems and bring on clinical depression.
"There can be powerful physiological effects from loneliness," says Dr Declan Lyons, a consultant psychiatrist at St Patrick's University Hospital. "Loneliness is a type of isolation that can as a consequence have a detrimental effect on health."
He draws a clear distinction between being alone and being lonely.“There is a difference between solitude and loneliness. Solitude gives a person a chance to reflect, to reminisce,” he says.
Loneliness, on the other hand, particularly if experienced over long periods, can cause damage. “It can be mediated by the stress hormone cortisol, which has negative cardiovascular effects and affects the immune system negatively. But it can also be a trigger for depression in older people,” he says.
Lyons has a wealth of experience in this area, given that he works with the mental health of older adults. The elderly are often found on the margins of society, with a changed role in life. Family-rearing is over, so isolation increases. There can be problems getting about, bereavements can cause a deeper isolation and difficulties with memory can be an impediment to social exchange.
Loneliness is universal
But older people are not the only ones who suffer. "Loneliness is universal and not just a function of getting older," says Prof Brian Lawlor, director of the Neuro-Enhancement for Independent Lives (Neil) programme at Trinity College Dublin.
There is emotional loneliness, where a person at any age loses a confidant and no longer has someone close to confide in. And there is social loneliness, the more common form, where a person, young or old, does not have a peer group with whom they can connect to dissipate isolation.
Bereavement is a common cause for emotional loneliness and so this is much more common with older people.
“With younger people, the issue is social isolation,” says Lyons. “Younger people may not have learned the skills to socialise properly and to build rapport with people. That is of real concern.”
The isolation that can follow overuse of new technology is also a problem, because people actually become “socially de-skilled”, he says. “We are at risk of doing that deskilling on a population level. We say yes to technology. We don’t say no, though. Younger people may have other mental problems: phobias, shyness, seeing life in black-and-white terms.”
For young and old, the clinical response is to seek ways to reduce isolation, and to encourage people to engage with society and their peers.
“Reconnecting is of fundamental importance,” says Lyons. “Older people need to be more aware of replenishing their social network at a broad range of ages. They need to be more proactive, join groups, become volunteers. Older people need to remain enthusiastic and passionate about issues.”
Lawlor agrees. “The treatment for loneliness is first being aware of it. What we do for people who are lonely is help build connections for them, keep them involved.”
People who have regular engagement with others and who remain active do better and are healthier and less likely to develop mental health issues. Isolation and dementia are not certainties as we age, Lyons says.
“Nothing is inevitable. It is about raising the profile of taking part. Some will feel very ashamed and embarrassed they don’t have friends on call, but many older people lose friends and spouses. Really it is about how older people can make a contribution to society.”
A befriending intervention
The Neil programme organised a study in an effort to break down isolation and deliver long-lasting benefits. Lawlor carried out a two-year study in which volunteers, all older than 55, made 10 home visits in a “befriending intervention”.
The study achieved its primary outcome: to reduce loneliness among the group receiving the visits. But it had an important secondary effect: the volunteers also experienced a decrease in loneliness. Both groups reported that they enjoyed the intervention. Lawlor believes this low-cost method could be incorporated into existing support services or via NGOs working in the area.
KNOCK-ON PROBLEMS: LONELINESS AS A RISK FACTOR
Loneliness can be a “pernicious condition”, says consultant psychiatrist Prof Brian Lawlor, but it isn’t just a feeling. It can have a profound influence on physical and mental health.
Sustained loneliness, whether emotional or social, causes physical damage and leaves sufferers at greater risk of developing clinical depression, he says.
“It can have cardiovascular impacts about equivalent to smoking or obesity based on studies. This includes mortality, sleep problems, frailty and cognitive impairment. People who are lonely are more likely to develop Alzheimer’s disease.”
A number of studies from the US and the Netherlands have shown this, he says. “Loneliness seems to be a risk factor for dementia in a Dutch study.”
Some work has been done looking at whether there is a genetic component to the likelihood of a person being lonely, and clinicians are of the view that there is a genetic contribution, he says.
The link between depression and loneliness is a strong one. “The more lonely a person is, the more likely it is they will also be depressed. That is shown in our data consistently. And not having a social network is additive for depression,” Lawlor says. “If you treat a person for depression but you don’t deal with the loneliness, then you won’t solve the problem.”
People need to realise that loneliness can kill the physical brain but also affect mental health. “But if you join [activities], it is good for brain health.”
