Annals of Behavioral Medicine

, Volume 40, Issue 2, pp 218–227

Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms

Original Article

Abstract

As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.

Keywords

Loneliness Regulatory loop Physiology Health behavior Sleep Intervention 

References

  1. 1.
    Berguno G, Leroux P, McAinsh K, Shaikh S. Children's experience of loneliness at school and its relation to bullying and the quality of teacher interventions. Qualitative Report. 2004; 9: 483–499.Google Scholar
  2. 2.
    Pinquart M, Sorensen S. Influences on loneliness in older adults: A meta-analysis. Basic and Applied Social Psychology. 2001; 23: 245–266.Google Scholar
  3. 3.
    Weeks DJ. A review of loneliness concepts, with particular reference to old age. International Journal of Geriatric Psychiatry. 1994; 9: 345–355.CrossRefGoogle Scholar
  4. 4.
    Peplau L, Perlman D. Perspectives on loneliness. In: Peplau L, Perlman D, eds. Loneliness: A sourcebook of current theory, research, and therapy. New York: Wiley; 1982.Google Scholar
  5. 5.
    Hawkley LC, Hughes ME, Waite LJ, et al. From social structure factors to perceptions of relationship quality and loneliness: The Chicago Health, Aging, and Social Relations Study. Journal of Gerontology: Social Sciences. 2008; 63B: S375–S384.Google Scholar
  6. 6.
    Wheeler L, Reis H, Nezlek J. Loneliness, social interaction, and sex roles. J Pers Soc Psychol. 1983; 45: 943–953.PubMedCrossRefGoogle Scholar
  7. 7.
    Russell D, Peplau LA, Cutrona CE. The revised UCLA Loneliness Scale: Concurrent and discriminant validity evidence. J Pers Soc Psychol. 1980; 39: 472–480.PubMedCrossRefGoogle Scholar
  8. 8.
    Cacioppo JT, Hawkley LC, Ernst JM, et al. Loneliness within a nomological net: An evolutionary perspective. Journal of Research in Personality. 2006; 40: 1054–1085.CrossRefGoogle Scholar
  9. 9.
    Cacioppo JT, Hawkley LC. Perceived social isolation and cognition. Trends in Cognitive Sciences. 2009; 13: 447–454.PubMedCrossRefGoogle Scholar
  10. 10.
    Heinrich LM, Gullone E. The clinical significance of loneliness: A literature review. Clin Psychol Rev. 2006; 26: 695–718.PubMedCrossRefGoogle Scholar
  11. 11.
    Theeke LA. Predictors of loneliness in U.S. adults over age sixty-five. Arch Psychiatr Nurs. 2009; 23: 387–396.PubMedCrossRefGoogle Scholar
  12. 12.
    Caspi A, Harrington H, Moffitt TE, Milne BJ, Poulton R. Socially isolated children 20 years later: Risk of cardiovascular disease. Arch Pediatr Adolesc Med. 2006; 160: 805–811.PubMedCrossRefGoogle Scholar
  13. 13.
    Eaker ED, Pinsky J, Castelli WP. Myocardial infarction and coronary death among women: Psychosocial predictors from a 20-year follow-up of women in the Framingham Study. Am J Epidemiol. 1992; 135: 854–864.PubMedGoogle Scholar
  14. 14.
    Olsen RB, Olsen J, Gunner-Svensson F, Waldstrøm B. Social networks and longevity. A 14 year follow-up study among elderly in Denmark. Soc Sci Med. 1991; 33: 1189–1195.PubMedCrossRefGoogle Scholar
  15. 15.
    Penninx BW, van Tilburg T, Kriegsman DM, et al. Effects of social support and personal coping resources on mortality in older age: The Longitudinal Aging Study Amsterdam. Am J Epidemiol. 1997; 146: 510–519.PubMedGoogle Scholar
  16. 16.
    Seeman T. Health promoting effetcs of friends and family on health outcomes in older adults. American Journal of Health Promotion. 2000; 14: 362–370.PubMedGoogle Scholar
  17. 17.
    Shiovitz-Ezra S, Ayalon L. Situational versus chronic loneliness as risk factors for all-cause mortality. Int Psychogeriatr. 2010; 22: 455–462.PubMedCrossRefGoogle Scholar
  18. 18.
    Sugisawa H, Liang J, Liu X. Social networks, social support, and mortality among older people in Japan. J Gerontol. 1994; 49: S3–13.PubMedGoogle Scholar
  19. 19.
    Thurston RC, Kubzansky LD. Women, loneliness, and incident coronary heart disease. Psychosom Med. 2009; 71: 836–842.PubMedCrossRefGoogle Scholar
  20. 20.
    Hawkley LC, Cacioppo JT. Aging and loneliness: Downhill quickly? Current Directions in Psychological Science. 2007; 16: 187–191.CrossRefGoogle Scholar
  21. 21.
    Hawkley LC, Masi CM, Berry JD, Cacioppo JT. Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychol Aging. 2006; 21: 152–164.PubMedCrossRefGoogle Scholar
  22. 22.
    Hawkley LC, Thisted RA, Masi CM, Cacioppo JT. Loneliness predicts increased blood pressure: Five-year cross-lagged analyses in middle-aged and older adults. Psychol Aging. 2010; 25: 132–141.PubMedCrossRefGoogle Scholar
  23. 23.
    DeNiro DA. Perceived alienation in individuals with residual-type schizophrenia. Issues Ment Health Nurs. 1995; 16: 185–200.PubMedCrossRefGoogle Scholar
  24. 24.
    Neeleman J, Power MJ. Social support and depression in three groups of psychiatric patients and a group of medical controls. Soc Psychiatry Psychiatr Epidemiol. 1994; 29: 46–51.PubMedGoogle Scholar
  25. 25.
    Richman NE, Sokolove RL. The experience of aloneness, object representation, and evocative memory in borderline and neurotic patients. Psychoanalytic Psychology. 1992; 9: 77–91.CrossRefGoogle Scholar
  26. 26.
    Goldsmith SK, Pellmar TC, Kleinman AM, Bunney WE. Reducing Suicide: A National Imperative. Washington, DC: National Academy Press; 2002.Google Scholar
  27. 27.
    Gow AJ, Pattie A, Whiteman MC, Whalley LJ, Deary IJ. Social support and successful aging: Investigating the relationships between lifetime cognitive change and life satisfaction. Journal of Individual Differences. 2007; 28: 103–115.CrossRefGoogle Scholar
  28. 28.
    Tilvis RS, Kahonen-Vare MH, Jolkkonen J, et al. Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol (A Biol Sci Med Sci). 2004; 59: M268–M274.Google Scholar
  29. 29.
    Wilson RS, Krueger KR, Arnold SE, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007; 64: 234–240.PubMedCrossRefGoogle Scholar
  30. 30.
    Cacioppo JT, Ernst JM, Burleson MH, et al. Lonely traits and concomitant physiological processes: The MacArthur social neuroscience studies. Int J Psychophysiol. 2000; 35: 143–154.PubMedCrossRefGoogle Scholar
  31. 31.
    Hawkley LC, Thisted RA, Cacioppo JT. Loneliness predicts reduced physical activity: Cross-sectional and longitudinal analyses. Health Psychol. 2009; 28: 354–363.PubMedCrossRefGoogle Scholar
  32. 32.
    Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychology and Aging. 2006; 21: 140–151.PubMedCrossRefGoogle Scholar
  33. 33.
    Segrin C. Social skills, stressful events, and the development of psychosocial problems. Journal of Social & Clinical Psychology. 1999; 18: 14–34.Google Scholar
  34. 34.
    Heikkinen R-L, Kauppinen M. Depressive symptoms in late life: A 10-year follow-up. Arch Gerontol Geriat. 2004; 38: 239–250.CrossRefGoogle Scholar
  35. 35.
    Wei M, Russell DW, Zakalik RA. Adult Attachment, Social Self-Efficacy, Self-Disclosure, Loneliness, and Subsequent Depression for Freshman College Students: A Longitudinal Study. Journal of Counseling Psychology. 2005; 52: 602–614.CrossRefGoogle Scholar
  36. 36.
    Cacioppo JT, Hawkley LC, Thisted RA. Perceived social isolation makes me sad: Five year cross-lagged analysis of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations study. Psychol Aging. 2010; 25: 453–463.Google Scholar
  37. 37.
    Newall N, Chipperfield J, Clifton R, et al. Causal beliefs, social participation, and loneliness among older adults: A longitudinal study. Journal of Social and Personal Relationships. 2009; 26: 273–290.CrossRefGoogle Scholar
  38. 38.
    Tice DM, Bratslavsky E. Giving in to feel good: The place of emotion regulation in the context of general self-control. Psychological Inquiry. 2000; 11: 149–159.CrossRefGoogle Scholar
  39. 39.
    McAuley E, Morris KS, Motl RW, et al. Long-term follow-up of physical activity behavior in older adults. Health Psychol. 2007; 26: 375–380.PubMedCrossRefGoogle Scholar
  40. 40.
    Penedo FJ, Dahn JR. Exercise and well-being: A review of mental and physical health benefits associated with physical activity. Curr Opin Psychiatr. 2005; 18: 189–193.CrossRefGoogle Scholar
  41. 41.
    Lauder W, Mummery K, Jones M, Caperchione C. A comparison of health behaviours in lonely and non-lonely populations. Psychology, Health, and Medicine. 2006; 11: 233–245.PubMedCrossRefGoogle Scholar
  42. 42.
    Akerlind I, Hornquist JO. Loneliness and alcohol abuse: A review of evidences of an interplay. Soc Sci Med. 1992; 34: 405–414.PubMedCrossRefGoogle Scholar
  43. 43.
    Stranahan AM, Khalil D, Gould E. Social isolation delays the positive effects of running on adult neurogenesis. Nature Neurosci. 2006; 9: 526–533.PubMedCrossRefGoogle Scholar
  44. 44.
    Mullington JM, Haack M, Toth M, Serrador JM, Meier-Ewert HK. Cardiovascular, inflammatory, and metabolic consequences of sleep deprivation. Prog Cardiovasc Dis. 2009; 51: 294.PubMedCrossRefGoogle Scholar
  45. 45.
    Gangwisch JE, Heymsfield SB, Boden-Albala B, et al. Short sleep duration as a risk factor for hypertension: Analyses of the first national health and nutrition examination survey. Hypertension. 2006; 47: 833–839.PubMedCrossRefGoogle Scholar
  46. 46.
    King CR, Knutson KL, Rathouz PJ, et al. Short sleep duration and incident coronary artery calcification. JAMA. 2008; 300: 2859–2866.PubMedCrossRefGoogle Scholar
  47. 47.
    Kripke DF, Garfinkel L, Wingard DL, Klauber MR, Marler MR. Mortality associated with sleep duration and insomnia. Arch Gen Psychiatry. 2002; 59: 131–136.PubMedCrossRefGoogle Scholar
  48. 48.
    Ohayon MM. Prevalence and correlates of nonrestorative sleep complaints. Arch Intern Med. 2005; 165: 35–41.PubMedCrossRefGoogle Scholar
  49. 49.
    Cacioppo JT, Hawkley LC, Crawford LE, et al. Loneliness and health: Potential mechanisms. Psychosom Med. 2002; 64: 407–417.PubMedGoogle Scholar
  50. 50.
    Friedman EM, Hayney MS, Love GD, et al. Social relationships, sleep quality, and interleukin-6 in aging women. PNAS. 2005; 102: 18757–18762.PubMedCrossRefGoogle Scholar
  51. 51.
    Jacobs JM, Cohen A, Hammerman-Rozenberg R, Stessman J. Global sleep satisfaction of older people: The Jerusalem Cohort Study. J Am Geriatr Soc. 2006; 54: 325–329.PubMedCrossRefGoogle Scholar
  52. 52.
    Mahon NE. Loneliness and sleep during adolescence. Perceptual & Motor Skills. 1994; 78: 227–231.Google Scholar
  53. 53.
    Cacioppo JT, Hawkley LC, Berntson GG, et al. Do lonely days invade the nights? Potential social modulation of sleep efficiency. Psychol Sci. 2002; 13: 385–388.CrossRefGoogle Scholar
  54. 54.
    Akerstedt T, Hume K, Minors D, Waterhouse J. The meaning of good sleep: A longtitudinal study of polysomnography and subjective sleep quality. J Sleep Res. 2009; 3: 152–158.CrossRefGoogle Scholar
  55. 55.
    Hawkley LC, Preacher KJ, Cacioppo JT. Loneliness impairs daytime functioning but not sleep duration. Health Psychol. 2010; 29: 124–129.PubMedCrossRefGoogle Scholar
  56. 56.
    Hawkley LC, Burleson MH, Berntson GG, Cacioppo JT. Loneliness in everyday life: Cardiovascular activity, psychosocial context, and health behaviors. J Pers Soc Psychol. 2003; 85: 105–120.PubMedCrossRefGoogle Scholar
  57. 57.
    Franklin SS, Gustin WI, Wong ND, et al. Hemodynamic patterns of age-related changes in blood pressure: The framingham heart study. Circulation. 1997; 96: 308–315.PubMedGoogle Scholar
  58. 58.
    Schiffrin EL. Vascular stiffening and arterial compliance: Implications for systolic blood pressure. Am J Hypertens. 2004; 17: S39–S48.CrossRefGoogle Scholar
  59. 59.
    Cheitlin MD. Cardiovascular physiology-changes with aging. The American Journal of Geriatric Cardiology. 2003; 12: 9–13.PubMedCrossRefGoogle Scholar
  60. 60.
    Folkow B, Svanborg A. Physiology of cardiovascular aging. Physiol Rev. 1993; 73: 725–764.PubMedGoogle Scholar
  61. 61.
    Toro L, Marijic J, Nishimaru K, et al. Aging, ion channel expression, and vascular function. Vascular Pharmacology. 2002; 38: 73–80.PubMedCrossRefGoogle Scholar
  62. 62.
    Danesh J, Wheeler JG, Hirschfield GM, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2004; 350: 1387–1397.PubMedCrossRefGoogle Scholar
  63. 63.
    Yusuf S. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study). Lancet. 2004; 364: 937–952.PubMedCrossRefGoogle Scholar
  64. 64.
    Beevers G, Lip GY, O'Brien E. ABC of hypertension: The pathophysiology of hypertension. Br Med J (Clinical research ed). 2001; 322: 912–916.CrossRefGoogle Scholar
  65. 65.
    Black HR, Bakris GL, Elliott WJ. Hypertension: epidemiology, pathophysiology, diagnosis, and treatment. In: Fuster V, Alexander RW, O’Rourke RA, eds. Hurst's the Heart. 10th ed. New York: McGraw-Hill; 2001:1553-604.Google Scholar
  66. 66.
    Guyenet PG. The sympathetic control of blood pressure. Nature Rev Neurosci. 2006; 7: 335–346.CrossRefGoogle Scholar
  67. 67.
    Girod JP, Brotman DJ. Does altered glucocorticoid homeostasis increase cardiovascular risk? Cardiovasc Res. 2004; 64: 217–226.PubMedCrossRefGoogle Scholar
  68. 68.
    Nijm J, Jonasson L. Inflammation and cortisol response in coronary artery disease. Ann Med. 2009; 41: 224–233.PubMedCrossRefGoogle Scholar
  69. 69.
    Whitworth JA, Schyvens CG, Zhang Y, Mangos GJ, Kelly JJ. Glucocorticoid-induced hypertension: From mouse to man. Clin Exp Pharmacol Physiol. 2001; 28: 993–996.PubMedCrossRefGoogle Scholar
  70. 70.
    Kiecolt-Glaser JK, Ricker D, George J, et al. Urinary cortisol levels, cellular immunocompetency, and loneliness in psychiatric inpatients. Psychosom Med. 1984; 46: 15–23.PubMedGoogle Scholar
  71. 71.
    Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L. Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology. 2004; 29: 593–611.PubMedCrossRefGoogle Scholar
  72. 72.
    Pressman SD, Cohen S, Miller GE, et al. Loneliness, social network size, and immune response to influenza vaccination in college freshmen. Health Psychol. 2005; 24: 297–306.PubMedCrossRefGoogle Scholar
  73. 73.
    Adam EK, Hawkley LC, Kudielka BM, Cacioppo JT. Day-to-day dynamics of experience-cortisol associations in a population-based sample of older adults. Proc Nat Acad Sci USA. 2006; 103: 17058–17063.PubMedCrossRefGoogle Scholar
  74. 74.
    Dickerson SS, Kemeny ME. Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychol Bull. 2004; 130: 355–391.PubMedCrossRefGoogle Scholar
  75. 75.
    Cole SW, Hawkley LC, Arevalo JM, et al. Social regulation of gene expression in human leukocytes. Genome Biology. 2007; 8: R189.181–R189.113.CrossRefGoogle Scholar
  76. 76.
    Cole SW. Social regulation of leukocyte homeostasis: The role of glucocorticoid sensitivity. Brain Behav Immun. 2008; 22: 1049–1055.PubMedCrossRefGoogle Scholar
  77. 77.
    Levine S, Mody T. The long-term psychobiological consequences of intermittent postnatal separation in the squirrel monkey. Neurosci Biobehav Rev. 2003; 27: 83–89.PubMedCrossRefGoogle Scholar
  78. 78.
    Pan Y, Liu Y, Young KA, Zhang Z, Wang Z. Post-weaning social isolation alters anxiety-related behavior and neurochemical gene expression in the brain of male prairie voles. Neurosci Lett. 2009; 454: 67–71.PubMedCrossRefGoogle Scholar
  79. 79.
    Poletto R, Steibel JP, Siegford JM, Zanella AJ. Effects of early weaning and social isolation on the expression of glucocorticoid and mineralocorticoid receptor and 11beta-hydroxysteroid dehydrogenase 1 and 2 mRNAs in the frontal cortex and hippocampus of piglets. Brain Res. 2006; 1067: 36–42.PubMedCrossRefGoogle Scholar
  80. 80.
    Dixon D, Cruess S, Kilbourn K, et al. Social Support Mediates Loneliness and Human Herpesvirus Type 6 (HHV-6) Antibody Titers. Journal of Applied Social Psychology. 2001; 31: 1111–1132.CrossRefGoogle Scholar
  81. 81.
    Glaser R, Kiecolt-Glaser JK, Speicher CE, Holliday JE. Stress, loneliness, and changes in herpesvirus latency. J Behav Med. 1985; 8: 249–260.PubMedCrossRefGoogle Scholar
  82. 82.
    Kiecolt-Glaser JK, Garner W, Speicher C, et al. Psychosocial modifiers of immunocompetence in medical students. Psychosom Med. 1984; 46: 7–14.PubMedGoogle Scholar
  83. 83.
    Straits-Troster KA, Patterson TL, Semple SJ, et al. The relationship between loneliness, interpersonal competence, and immunologic status in HIV-infected men. Psychology and Health. 1994; 9: 205–219.CrossRefGoogle Scholar
  84. 84.
    Miller GE, Kemeny ME, Taylor SE, Cole SW, Visscher BR. Social relationships and immune processes in HIV seropositive gay and bisexual men. Ann Behav Med. 1997; 19: 139–151.PubMedCrossRefGoogle Scholar
  85. 85.
    Cattan M, White M. Developing evidence based health promotion for older people: A systematic review and survey of health promotion interventions targeting social isolation and loneliness among older people. Internet Journal of Health Promotion. 1998; 13: 1–9.CrossRefGoogle Scholar
  86. 86.
    Cattan M, White M, Bond J, Learmouth A. Preventing social isolation and loneliness among older people: A systematic review of health promotion interventions. Aging & Society. 2005; 25: 41–67.CrossRefGoogle Scholar
  87. 87.
    Findlay R: Interventions to reduce social isolation amongst older people: Where is the evidence? Abstracts in Social Gerontology. 2004; 47.Google Scholar
  88. 88.
    McWhirter BT. Loneliness: A Review of Current Literature, with Implications for Counseling and Research. Journal of Counseling and Development. 1990; 68: 417–422.Google Scholar
  89. 89.
    Perese E, Wolf M. Combating loneliness among persons with severe mental illness: Social network interventions' characteristics, effectiveness, and applicability. Issues in Mental Health Nursing. 2005; 26: 591–609.PubMedCrossRefGoogle Scholar
  90. 90.
    Rook KS. Promoting social bonding: Strategies for helping the lonely and socially isolated. Am Psychol. 1984; 39: 1389–1407.CrossRefGoogle Scholar
  91. 91.
    Lipsey MW, Wilson DB. Practical Meta-Analysis. Thousand Oaks: Sage; 2001.Google Scholar
  92. 92.
    Cacioppo JT, Patrick B. Loneliness: Human Nature and the Need for Social Connection. New York: Norton; 2008.Google Scholar
  93. 93.
    Routasalo PE, Tilvis RS, Kautiainen H, Pitkala KH. Effects of psychosocial group rehabilitation on social functioning, loneliness and well-being of lonely, older people: Randomized controlled trial. J Adv Nurs. 2009; 65: 297–305.PubMedCrossRefGoogle Scholar
  94. 94.
    Pitkala KH, Routasalo P, Kautiainen H, Tilvis RS. Effects of psychosocial group rehabilitation on health, use of health care services, and mortality of older persons suffering from loneliness: A randomized, controlled trial. J Gerontol (A Biol Sci Med Sci). 2009; 64: 792–800.Google Scholar
  95. 95.
    Wilson DS. Evolution for Everyone: How Darwin's Theory Can Change the Way We Think About Our Lives. New York: Delacorte; 2007.Google Scholar
  96. 96.
    Cacioppo JT, Amaral DG, Blanchard JJ, et al. Social neuroscience: Progress and implications for mental health. Perspectives on Psychological Science. 2007; 2: 99–123.CrossRefGoogle Scholar
  97. 97.
    Donaldson ZR, Young LJ. Oxytocin, vasopressin, and the neurogenetics of sociality. Science. 2008; 322: 900–904.PubMedCrossRefGoogle Scholar
  98. 98.
    Lovejoy CO. Reexamining human origins in light of Ardipithecus ramidus. Science. 2009; 326: 74e71–74e78.Google Scholar
  99. 99.
    Emler N. Gossip, reputation, and adaptation. In: Goodman R, Ben Ze'ev A, eds. Good Gossip. Lawrence: University of Kansas Press; 1994: 34–46.Google Scholar
  100. 100.
    Kahneman D, Krueger AB, Schkade DA, Schwarz N, Stone AA. A survey method for characterizing daily life experience: The day reconstruction method. Science. 2004; 306: 1776–1780.PubMedCrossRefGoogle Scholar

Copyright information

© The Society of Behavioral Medicine 2010

Authors and Affiliations

  1. 1.Center for Cognitive and Social NeuroscienceUniversity of ChicagoChicagoUSA
  2. 2.Department of PsychologyUniversity of ChicagoChicagoUSA

Personalised recommendations