Dr. Julianne Holt-Lunstad
Appearances
Health Chatter
Loneliness
Um, and, and so, uh, when, when we think about how to, um, really ultimately we need to meet those, um, social needs. And so, um, So one way to reduce that signal is to actually meet those social needs. However, it is possible that we could dampen that signal without meeting those needs. And so that might be potentially problematic.
Health Chatter
Loneliness
Imagine just dampening your hunger or thirst without actually getting any food or water. And so we have to be really careful about just focusing specifically on the signal and kind of ignoring the needs. uh, but, but they are, uh, um, importantly, uh, uh, connected.
Health Chatter
Loneliness
There's also instances in where, um, that signal seems to be, um, not for lack of better terms, maybe, um, uh, not well calibrated in the sense of, it would be like still continuing to feel hungry, even though there's plenty of food available and you're getting plenty of food. Right. And so there are, um, Maureen F Curtin she, her, her, her, or other kinds of therapeutic techniques.
Health Chatter
Loneliness
that individuals who find themselves stuck in this feeling of loneliness can learn various techniques and skills to help begin to alleviate when that signal has become dysregulated.
Health Chatter
Loneliness
There is some evidence on that. And interestingly, the public perception is that for some reason that perhaps introverts don't need as much social connection, they prefer less, and so they may be less lonely. And in fact, I remember seeing during the pandemic, all sorts of memes that, you know, said introverts have been training for this our whole lives.
Health Chatter
Loneliness
Let's reach out and support our extroverted friends. You know, this idea that all the extroverts were suffering and the introverts were just kind of like happy as a clam.
Health Chatter
Loneliness
And yeah. The data doesn't seem to actually support that. And in fact, there were some surveys done during the pandemic that showed actually that introverts were suffering more. And when we look at just prevalence rates, there is some evidence to suggest that introverts are at greater risk for becoming both isolated and lonely.
Health Chatter
Loneliness
And so what this suggests is, A, we shouldn't make assumptions about who is lonely and who isn't because anyone could potentially be suffering. But that we all have these human needs for social connection, although we may have different preferences for how those needs are met.
Health Chatter
Loneliness
Well, it's a really complex issue. It's something, though, that is on the top of, I think, most people's minds. And so Certainly, if we look at the correlations and we look at trends over time, there seems to be a coexistence, I should say, that as various technologies have been introduced, that it has changed the way that we interact socially and or that
Health Chatter
Loneliness
These changes have co occurred at the same time, and so it makes it really difficult to say did it cause that right, but that they are co occurring, and so we also have to really be careful about thinking about what do we mean by technology. And so there is a number of kinds of technologies that have been implemented that have that could potentially have an impact right from, you know,
Health Chatter
Loneliness
just the introduction of the television. There are, you know, people are able to get their entertainment in in private spaces versus going out into public spaces. And then most, you know, much of the attention more recently has been on social media. I'll note that I did serve on a recent National Academies consensus report On on that issue on adolescent health and it the data is very complex.
Health Chatter
Loneliness
So we see both harms and potential benefits and that occurs. I both between different uses and different groups of people, but also even within the same people and. So i'll just give one example. So for for people who have, for instance, rare health conditions. Or people who are members of marginalized communities or minoritized communities where they may not be getting adequate support locally.
Health Chatter
Loneliness
Sometimes these can be online sources, can be sources of support or lifelines to support. But often those, and particularly marginalized groups, those same uses can also be sources of online harassment and bullying. And so you can experience both positive and negative kinds of social experiences on these platforms.
Health Chatter
Loneliness
But then we also have to think about even other kinds of technology and how particularly during the pandemic, we got really comfortable using more tools to interact more remotely. Many people are now preferring to work remotely. We can now stream just about whatever we want to get our entertainment at home without ever leaving the house.
Health Chatter
Loneliness
We can order our groceries, order our food without leaving the house. And so in a way, a lot of these technological advancements are making things more touchless, automated, and can potentially reduce our contact with other humans.
Health Chatter
Loneliness
And so technology is really complex because it brings all sorts of incredible conveniences and things that we love, but also can potentially have some other kinds of consequences as well.
Health Chatter
Loneliness
Happy to. So first off, I should just mention that loneliness and isolation can often go hand in hand with depression, but it is independent of depression. And so many studies have shown independent effects over and above any effects of depression. So it is something different. It's not the same thing. So just measuring depression won't be enough.
Health Chatter
Loneliness
But there are standardized and validated instruments for measuring loneliness. The most widely used is a short version of the UCLA Loneliness Scale. And I will note that I was part of the Gravity Project that helped bring the isolation, loneliness, and social support into the electronic health record. So it is available there.
Health Chatter
Loneliness
And I know it's available in Epic, which is one of the most commonly used ones. However, I am told that it's an option. And so different systems may build it in differently. So it might take some work to find it, but it is there. And so you can assess it. And in fact, it's been recommended
Health Chatter
Loneliness
Yeah, no, I mean, it's not new, but certainly we are hearing a lot more about it in public discourse for sure. So I've been doing research on this for a little over two decades, and certainly I'm not the first to do research on this. And so the scientific evidence around this has been building for decades.
Health Chatter
Loneliness
not only by the National Academies of Science and the Institute of Medicine to assess this in medical settings, but also the Surgeon General's Advisory, part of those recommendations, that's also included in that. I served on both of those.
Health Chatter
Loneliness
And for clinicians or healthcare providers who might be listening, I also published a piece in the New England Journal of Medicine that provides a framework, because I know clinicians Often they may experience patients who are dealing with this, but may not feel like they have the adequate tools to deal with it.
Health Chatter
Loneliness
And so we provide a very simple framework that we call the EAR framework, which is an acronym for Educate, Assess and Respond. So the Educate is helping patients become aware of how this is relevant to their health. and their treatment.
Health Chatter
Loneliness
The assessment is, you know, assessing this and including this in the electronic health records so that you can see how people's or your patient's levels might be changing over time. And then respond is also really responding in a way that is responsive to their needs. And so in a way, it's not a coincidence that ear suggests that you ought to really listen, right?
Health Chatter
Loneliness
And really listen to what might be going on and and so that you can connect them with the most appropriate resources. So whether that is integrating more, you know, social support throughout their treatment, you know, either in in a clinical setting or whether that is referring them to resources out in their community. But hopefully that that will help.
Health Chatter
Loneliness
a quite a bit of stability for for many individuals. But one of the things that we do find in in research is that when it is consistently high over time, that that is what is linked to greater risk. So and when we see that, so when it's persistent over time,
Health Chatter
Loneliness
But I think one thing that, well, I should say there were growing concerns in the public even before the pandemic. So we saw the UK appoint a minister for loneliness back in, I think it was 2017 or 2018. And we started hearing things like concerns of, quote unquote, loneliness epidemic.
Health Chatter
Loneliness
When it tends to go away or has only been occurring for a short period of time, it is still associated with some poorer outcomes, but not to the extent of those that have more persistent levels. And so I think that's actually really hopeful in the sense that that there's opportunities for us to intervene and to, you know, change that risk trajectory in a way that can can help people.
Health Chatter
Loneliness
So, um, I, I will give the caveat that most of my research is focused on humans, but, but, um, certainly there has been a lot of interest in how we can connect to non-humans, whether that is a pet, um, a robot or even God. Um, right. Right. And so there have been, uh, um, studies that have looked into this, there is a fair body of evidence that is looking in that has examined pets.
Health Chatter
Loneliness
It's not as strong and robust as the human literature. And unfortunately, a lot of the studies are more correlational. and so it or lack adequate um kinds of control groups um but uh there there does seem to be um some some benefit associated with that uh but like i said the evidence isn't as strong the interesting uh note is that in some ways some of the evidence
Health Chatter
Loneliness
suggest that, for instance, having dogs is more beneficial, but in a but often the. The the mechanism is that because you need to walk a dog you're leaving the House. you're more likely to engage with other humans when you're out, but you're also getting more physical activity.
Health Chatter
Loneliness
So there may be additional kinds of factors that are playing a role other than simply just the companionship of that pet.
Health Chatter
Loneliness
together you know the pecking of a woodpecker but it's interesting it'll be interesting to see if there's research on that so you know it is interesting that there is starting to grow some interesting evidence around even just um being out in nature and so then yeah okay well the the the pet can bring you out in nature as well right correct but some of the benefits of just even spending time in nature correct and so you don't have to do it with a pet you can just connect with
Health Chatter
Loneliness
Although it sounds like your dog is helping you notice things that you wouldn't have otherwise.
Health Chatter
Loneliness
But then we experienced a global pandemic in which we all needed to reduce our social contact in order to reduce the spread of the virus. this really had a a global impact on people's levels of not only social contact but just isolation and feeling lonely and uh
Health Chatter
Loneliness
We see the highest prevalence rates in that adolescent to young adult range.
Health Chatter
Loneliness
Um, so, you know, I, I, I, there are many hypotheses. I wish I could just say, this is it. And, um, but there may be many factors contributing to this. And, uh, and, and so, uh, one factor is that when you look across generations, adolescence just seems to be a hard time for people. Um, so developmentally, uh, It's a time when you are trying to figure out who you are.
Health Chatter
Loneliness
Also, that young adulthood period is when you are often leaving your home of origin for the first time. And so all of these kinds of developmental changes can be difficult And on top of that, you also don't have the years of wisdom and experience behind you to deal with them. And so there's that aspect of it.
Health Chatter
Loneliness
But there is some evidence to suggest that this generation may be somewhat different compared to previous generations when they were adolescents. And so because of that, some are suspecting the role of technology and social media and to what extent that is playing. I will note that that is highly debatable and highly charged when people talk about it. But certainly is something that
Health Chatter
Loneliness
you know, all generations are pretty much using. But this generation kind of started with this at a critical time. And so that may be one potential explanation. There's also other kinds of explanations around just the emphasis on economic success and how so many young kids are, you know, so to speak, overscheduled and may not have as much time for socializing.
Health Chatter
Loneliness
But then you now, in terms of looking to the future and thinking about younger generations, we also have to think about the impact of the pandemic.
Health Chatter
Loneliness
And so going forward, we're going to have this generation of kids that, depending on what stage of infancy, childhood, adolescence, or young adulthood they dealt with this, is that there was a two to three year period where there was significant reductions in social contact, socializing. at very important developmental stages.
Health Chatter
Loneliness
And to what extent is this going to have long-term kinds of effects on their social skills and other kinds of ways that we might not have even You know that we aren't even thinking of yet.
Health Chatter
Loneliness
And, and so we can look at kind of what's the data we have now, but then also thinking about like what's the data going to look like going forward, I should point out that, interestingly, when we look at the American time you survey. This is data on how Americans spend the minutes of their day. And they they look at this.
Health Chatter
Loneliness
everyone to some extent, really felt it, whether it was themselves very profoundly lonely, or people they knew and cared about really, really struggling. And so I think this brought greater public awareness to some of the kind of at least the emotional effects, but we have very good evidence of the physical effects as well.
Health Chatter
Loneliness
And so there was some data that was released not too long ago that is from 2003 to 2020. And what we see is significant increases in time spent in isolation, significant decreases in time spent with family, both household and non-household family, time spent with friends, time spent with others, and time spent in companionship.
Health Chatter
Loneliness
And when you look at the age breakdown, one of the most dramatic reductions is you can see in the young Um, category from 2003. So over the past 20 years, uh, uh, young people, there has been a dramatic drop in time spent with friends.
Health Chatter
Loneliness
And that started well before the pandemic, so going back 20 years. And so it does raise concerns about kind of where we are at in these trends, what led to these trends, and where we're going in the future. And is there reason to believe that these trends will reverse, or are they going to continue to get worse?
Health Chatter
Loneliness
So there are studies that have shown some gender differences, but when you look overall, so when meta-analyses take into account all the different studies, the differences are essentially zero. So that doesn't mean that we experience it the same, but rather the prevalence rates are equivalent.
Health Chatter
Loneliness
Yeah. So one of the things I want to make clear is there's nothing about someone's race that makes them more prone to, to isolation or loneliness. It's rather the conditions that they may face.
Health Chatter
Loneliness
Yeah. Yeah. And so, you know, um, you may face more, um, uh, discrimination, you may face more, um, kind of systemic kinds of barriers. that need to be considered. You also mentioned migration.
Health Chatter
Loneliness
So that is something that is one of the explanations for why perhaps we are even seeing these high prevalence rates in low and middle income countries is that we're seeing due to economic situations that often younger generations are migrating and leaving their area of origin to seek out economic opportunities, which often leave the older generation behind.
Health Chatter
Loneliness
And then there's, of course, when you are now displaced from your network, that can also have impacts on the younger generation. So these life changes, systemic kinds of barriers, particularly associated with marginalization and
Health Chatter
Loneliness
Yeah, so I served as the lead scientific editor on the US Surgeon General's Advisory on this topic. And one thing I should note is that it does more than just kind of raise the alarm bells or provide the evidence on why this is something that is a major health concern, but it also provides a framework and a framework for a national strategy, as well as detailed recommendations
Health Chatter
Loneliness
across different kinds of recommendations for the health care sector, for the tech sector, for government. But it also provides recommendations for individuals, for parents. So I would highly recommend that. And that is something that is freely available online. I do know that the report is a little bit long, but if you go to the end, that's where you find all of the recommendations.
Health Chatter
Loneliness
Well, I wonder if it makes sense to maybe first define what loneliness means. Because in the public discourse, we hear loneliness being used quite broadly. And it is often used as a catch-all term to encompass all the ways in which we can perhaps lack social connection. But of course, it actually means something a little bit more narrow than that.
Health Chatter
Loneliness
Oh, it was very much my pleasure. Thank you so much for having me on the show.
Health Chatter
Loneliness
And so I think it's first important to distinguish it from isolation because we also use the terms isolation and loneliness interchangeably. And so isolation is really more objectively being alone, having few relationships, infrequent social contact.
Health Chatter
Loneliness
Whereas loneliness is really more the subjective feeling, a distressing feeling that comes from the discrepancy between our desired level of connection and our actual level of connection. And so of course they often can co-occur because objectively being alone can increase our risk of feeling alone.
Health Chatter
Loneliness
Uh, but often people, um, are not isolated, um, uh, and, and, you know, they're surrounded by other people, um, and, and still feel lonely. Uh, so we often hear terms like feeling lonely in a crowd, um, feeling lonely at a party, even feeling lonely in a marriage. And conversely, we can be objectively alone, but not feel lonely. And so we might actually, enjoy that time of solitude.
Health Chatter
Loneliness
But one of the important things to note is that both isolation and loneliness are associated with risk, but they're also part of a larger aspects of how we might lack connection. So we might lack connection because we don't have people to rely on for support. We might lack connection because of poor quality relationships.
Health Chatter
Loneliness
And all of these different ways of lacking connection are all associated with risk. So Dr. And then, conversely, having connection is is associated with better kinds of outcomes and actually protective. Dr. And so, when we start to ask you know, then, when you ask the question of is this a public health issue and and is this more of an individual issue or a societal issue. It's all of the above.
Health Chatter
Loneliness
And so we know that, for instance, loneliness can be felt very personally. But we also know that the ways in which we might lack connection and the barriers that people face to connection can not just originate within the individual, but also originate in their communities and society. And so there may be all sorts of barriers to connection and underlying causes to that that may be playing a role.
Health Chatter
Loneliness
And of course, the pandemic is just a very good illustrative example of how something external can be contributing to that that's really outside of someone's control. Of course, there are many other kinds of factors, you know, whether you live in a safe neighborhood could you know that could influence the extent to which you feel comfortable.
Health Chatter
Loneliness
engaging with others, there are many, many factors that that can occur and so really what we what we think about when we think of you know, is this a public health issue. First off, we have very strong and robust evidence of the impacts on objective health outcomes. And the other is that we have good evidence of a significant portion of the population that is affected by this.
Health Chatter
Loneliness
And so from that standpoint, we really do need to take a public health approach to this issue.
Health Chatter
Loneliness
That's a great question. And, you know, for a while we really had limited evidence in terms of, um, the types of countries that were, we had data on. So most of the evidence was coming from North America, Europe, mostly wealthy nations. Western nations, right? And we're now starting to see data globally. And in fact, I participated as an academic advisor on a recent Gallup and Meta survey.
Health Chatter
Loneliness
It was a global survey of the global state of connection. And it surveyed 142 countries. And What was interesting is we found that nearly a quarter of the global population reported feeling either fairly or very lonely. But what was interesting was among the 29 countries that reported more than a third, 22 of those 29 were in Africa.
Health Chatter
Loneliness
And so what this suggests is that this is indeed a global issue and not just something that is experienced in these, you know, wealthier Western kinds of nations. Certainly not just the U.S.
Health Chatter
Loneliness
So I should give one caveat to that global state of connection survey, and that was that it simply used one item, and many other surveys use more comprehensive assessments of loneliness. And so when we look at kind of differentiating these, we see slightly different results when we look at a more comprehensive assessment versus a single item assessment.
Health Chatter
Loneliness
And so trying to identify that consistently has been a little bit challenging. I will follow up with a note on the global aspect of that is that the World Health Organization has established a commission on social connection to really address some of these issues on a global level. And I am part of their technical advisory group, so I will be advising them on that work.
Health Chatter
Loneliness
And so over the next three years, the commission will be tackling some of these issues to really try and find out the kind of narrow in on on some of these as currently that data looking at, you know, which countries are the loneliest or least lonely, we're not getting consistent findings that suggest a particular area is far better than others. But we're getting hints at that.
Health Chatter
Loneliness
And so I think it's really promising and hopefully we'll have some more firm answers soon.
Health Chatter
Loneliness
Well, I can say that at least the global happiness index that the Gallup does, they consistently show that the Nordic countries tend to rate themselves as the happiest countries.
Health Chatter
Loneliness
Yeah. So first off, I just want to mention I've actually been to several of the Blue Zones several times. I direct an international study program. And I'll just note that one distinction between the Blue Zones and some of this other data is the Blue Zones are focused on hotspots where there are higher concentrations of centenarians. So in a way, those are kind of like looking at
Health Chatter
Loneliness
that outliers right whereas the other kind of data that we're looking at is where the overall country um is is faring better or worse than others so just wanted to make that that slight distinction um but of course social connection is is an incredible um uh predictor of longevity and and so that's really important um to answer your next question about um social connection and and
Health Chatter
Loneliness
how that relates to loneliness. I think it's also helpful to really put into context that loneliness is something that is actually adaptive. And I know that sounds really strange to hear, but it's part of normal human experience. much like hunger and thirst. Although it feels a little uncomfortable, it's a biological signal that motivates us to seek out a biological need.
Health Chatter
Loneliness
And so just like hunger motivates us to seek out food, loneliness motivates us to seek out social connection. And so from that standpoint, Um, it, it is something that is, um, uh, normal in the short term, but when it becomes chronic is when it, um, um, and, and those needs are, are left unmet. That can be problematic.