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Kim Mills: Even before the COVID-19 pandemic scrambled our social connections some two years ago, Americans were worried about an epidemic of loneliness. A pre-pandemic report from the National Academies of Sciences, Engineering, and Medicine found that more than a third of people over age 45 reported, in 2020, being lonely. One Kaiser Family Foundation poll in 2018 found that 2 in 10 Americans often or always felt lonely.
Researchers know that loneliness can be bad for our mental and physical health. We humans are social creatures and we need meaningful connections with other people in our lives. But are we lonelier than ever these days? Or are fears of a loneliness pandemic overblown? What's the difference between being alone and lonely? Can you be lonely even if your life is full of people? How exactly does loneliness affect our physical and mental health? Are some groups or types of people more at risk than others? And if you feel lonely or isolated, or you're worried about someone else who does, what can you do to make a difference?
Welcome to Speaking of Psychology, the flagship podcast of the American Psychological Association that examines the links between psychological science and everyday life. I'm Kim Mills.
Our guest today is Dr. Louise Hawkley, a psychologist and a principal research scientist at NORC, an independent research institution at the University of Chicago. She studies the effects of loneliness on health, the factors that increase the risk of loneliness and the types of interventions that can help alleviate it. She collaborates with sociologists, physicians, epidemiologists, and others, to better understand the complexities of social life, especially as people age. Dr. Hawkley has published more than 100 peer-reviewed articles and book chapters, and speaks often to the media on loneliness and social isolation.
Thank you for joining me today, Dr. Hawkley.
Louise Hawkley, PhD: Thank you very much for having me. It's a delight to be part of this podcast.
Mills: Thank you. Well, in your work, you talk about the difference between feeling lonely and being alone, or what researchers call “social isolation.” How are those two things different and how are they related?
Hawkley: That's a very good opening question, because it is often confused by people who talk about loneliness, because they assume it means that you're alone. Whereas in, from our perspective, as researchers, we talk about loneliness as a feeling of being alone. Even though one doesn't have to be alone to feel that way. Social isolation is being alone or having infrequent interactions. Feeling lonely is like feeling isolated regardless of the circumstances, and we've all been in that kind of circumstance where we are with people, but we don't feel connected to them. In other words, we feel lonely. Or we can be all alone and not feel lonely. So there is that disconnect. However, when you say, how are they related? It is true on average that there is some degree of relationship, people who are more isolated have a greater risk of being somewhat lonelier than people who are less isolated.
Mills: So, I mentioned in the introduction that loneliness is bad for our physical and mental health. What kinds of health problems does loneliness cause? And why is it harmful?
Hawkley: Lots to say about both of those parts of the question. Certainly on an emotional mental health basis, there are pretty obvious correlates, you could say. But even causally, people who are lonely tend to be at greater risk for depression, or at least become more depressive over time. Their symptoms of depression increase in number or severity, even if it doesn't reach the clinical threshold for depression. So there is that connection. There's also a relationship between loneliness and anxiety. Certainly, more generic feelings of wellbeing and purpose and meaning in life are thwarted by feelings of loneliness. People tend not to feel as good about themselves and their lives when they're lonely. From the perspective of physical health, lots of, I'll call them consequences. Some of them have a pretty good evidentiary base there's a really a direct causal relationship. But, of course, that's always difficult to determine when you're talking about loneliness since you can't make people feel lonely and see what happens to their health.
But it is the case that cardiovascular health in its many forms, whether it's heart problems, hypertension, stroke, those types of outcomes are more prevalent the lonelier people are. That's a pretty robust association. There are also associations with other diseases of inflammation, which is the root of a lot of the chronic diseases of aging. So there is some evidence for loneliness being associated with diabetes. Certainly, with cognitive decline and dementias, which is a very disturbing and real outcome of interest to a lot of older adults. There are also connections with sort of intermediary pathways, shall we say? So, loneliness is related to increased risk for hypertension, which is itself sometimes a correlate of other diseases. But it's also a sign that there's something run amok with inflammatory process in the body, potentially. There are links with gene expression, which is an interesting and novel way of thinking about loneliness, getting deep into our system and affecting the very proteins that are needed to maintain health and fight off disease.
So, in the case of lonelier older adults, they seem to be showing a greater upregulation, more activation of genes that are promoting inflammation rather than stanching inflammation. And likewise, they're showing underactivation of those genes that code for proteins that would diminish inflammation. So, it's putting your foot on the gas and foot off the brake and all wheels forward, we're going to go for the inflammation route. Well, that's a potential pathway then for a lot of the chronic diseases of aging. There are other relationships with lifestyle factors, you could say. So lonely people tend to be less active and to decline in their physical activity over time, more so than people who are more connected. Their sleep is not as salubrious. So, they might get the same amount of sleep, but they wake up tired. And some of the studies where we and others have used sensors to actually measure the kinds of sleep they're getting, what seems to be interfered with is this continuity of sleep.
People who are lonelier tend to see more disruption of their sleep, it's fragmented sleep. And sometimes it's not even fragmented to the point where they are aware that it's fragmented, but they're not staying in a deep sleep. And they're losing out on the healthful stages of sleep. I should say, that one of the biggest things that I think motivated a lot of interest in loneliness and social isolation was the publication that looked at mortality differences between people who are more or less socially isolated or more or less lonely. And found that there is a mortality difference where people who have good social relationships tend to live longer. People who are lonely, who are socially isolated, have an increased risk of premature mortality. So, that got the ball rolling and thinking about, “Well, this is real. This is really doing something important in the body, that we can't even live as long if we're lonelier.” So it's fueled research in the area.
Mills: What about social isolation? Is that also bad for people's health all by itself? So, if someone doesn't have a lot of social connections, but they don't feel lonely. Are they still at risk for the same kinds of physical and mental illnesses and conditions?
Hawkley: I don't often study social isolation by itself, but we tend to look at it as an interactive factor. So, people who are isolated and lonely are probably going to have worse outcomes than those who are just isolated. But there are discreet impacts of different measures of social isolation and this is where we get into some difficulty with how to even think about what social isolation is. So how do you measure it? What are you talking about? We can talk about people living alone. Is that, by itself, isolation? Is it bad for you? Maybe, maybe not. Maybe it depends on whether you chose to live alone, as opposed to here you are now with, family has fled, spouses died, you're living alone and perhaps have lost your social network. You're living alone. And it feels quite different than the person who has decided they want to live alone and they have lots of social opportunities outside the house. Whereas, this first person hasn't got anything left to fill a social need.
So when we talk about social isolation, we have to be careful about how we're talking about it, what we mean by isolation. And then yes, there are discreet health impacts, but I think there is room for additional research there to understand under what conditions, under what type of isolation. What are we talking about when we say it has negative impacts and it'll vary depending on how we think about and define social isolation.
Mills: So how much do people vary in their need for social connection? For example, at one extreme, The Atlantic magazine published a story recently about people who choose jobs where they work all night and sleep during the day, because they say that they would rather have this life of isolation and darkness and that they're happy that way. So, how much variation is there in our need for other people?
Hawkley: Well, it's a good question. There is definitely variation. When I was working with John Cacioppo, we developed a model of loneliness, and evolutionary theory based model, where the foundation of any evolutionary theory is there has to be variation and there is reason for variation. And so the idea there, with loneliness, is that, although we're all innately social, we have very different social needs and possibly for very good reasons. There are people, think of hunter-gatherer days, people who would feel very comfortable leaving their socially safe surround, their tribe, their community, to go look for food, to go fight off the enemy. And they could be gone for long periods of time and not feel the pain of social isolation. Others don't have that same freedom. They don't feel that they can safely leave. They're much more bound to their social community and it's a need that differs for them as it does for us still; we have that variation in the population.
The night owl story is an interesting one. And I think for some people, as you put it, they say they like it that way, but we have to be careful when we are relying on self-report, because people can justify any life decision they make. And it may be that they've convinced themselves that they prefer it that way, but is it really good for them? And this is where I think of how people say that, they're sleeping fine in the city, despite traffic and sirens. Everything's fine. Their sleep is just great. But then you do a sleep study and you realize it's affecting them. It affects their sleep patterns, their sleep stages. It can give rise to increased heart rate, blood pressure, increased stress hormone circulation. So, we just have to be careful that we don't assume that people who say they prefer it are actually better off with what they say they prefer.
Mills: And of course you've turned your circadian rhythm upside down as well. And we didn't evolve to sleep at night and be awake during the day. So are some demographic groups more at risk for loneliness than others? For instance, are men more vulnerable than women?
Hawkley: I'd like to start that answer by reflecting on some research we did some years back, where we identified different dimensions or facets of the loneliness experience. So, we found that loneliness has what we called an intimate connectedness component. That's sort of the opposite of loneliness, an intimate connectedness, which was most closely related to or reflected in having a close, romantic relationship, like having a spouse, typically alleviated that need for an intimate connection. There was also a relational connectedness component that was dyadic in the form of close friendships. Have you got a confidant? Is there at least one person you can talk to outside of whatever spouse or partner you may have? Do you have confidants? And then there was a third component we identified as collective connectedness, and that reflects more the group sense of belonging, that you have some group of meaning to you where you feel you are of them. Those are your peeps, so to speak.
And in the discussion about people who are at risk for loneliness, I think when you talk about a gender difference, you talk about a difference in vulnerability to certain types or forms of loneliness. Oftentimes, at least in married heterosexual, married partnerships, the woman is the social manager of the calendar. So, she will create the contacts and create the opportunities for the husband to have a social life. So, if she were to die, he suffers because he's lost that social manager. But in other ways, if that person, if that man has developed good group connections, whether it's pick-up basketball or going to see the football game or play cards, if that connection is still alive, that is how men tend to be more satisfied, shall we say. That kind of connection fills their need more so than it does for women.
Whereas, women really rely more on the dyadic connections, the confidants, the face-to-face talk, heart-to-heart about whatever is on your mind. So there are those kinds of differences and therefore differences in who's vulnerable to what. But if you think also of collective connectedness as this form of loneliness that has to do with feeling like you belong, then I think it helps one understand why a lot of peripheralized populations in the country are lonelier than others. I think here of LGBT folks, they're on the periphery. Think of disabled people. You can even think about elderly, because of ageism. They're kind of pushed to the side and they are some peripheral group that we will pay attention to when we have to in whatever way is expedient to us. And so they can be at higher risk.
That said, it seems clear from research I and others have done over the last decade or so, that contrary to popular opinion, older adults are not at highest risk of loneliness if you look at the whole age span. People who are in young adulthood tend to be even more at risk, tend to become lonelier. And although we have yet to have really good data to support this, we have some ideas to the kinds of things that might contribute. But one of the things that I think is going to play a role in helping us understand that age difference in loneliness, is that young adults are at a point in life where they're still looking for their niche. They're finding a career, they're finding a home, they're finding a partner, if they're going to have one. They are subject to stereotypes, just as older adults are subject to stereotypes. In their case, the stereotype is you're a young adult, you should be independently making your way through this world. Well, anybody who's lived any length of time, I think appreciates that you don't get through life independently.
You get through life with the help of others. And it takes time for young adults to, at least in some cases, to find place in their view of life, to think, “I don't have to be totally responsible on my own for everything to be good.” There is value to having a social safety net, if you want to call it that. And it can be just for the companionship, the support, it doesn't have to be for anything terribly concrete. But knowing that others are there for you is really helpful to navigating that period of life.
In older adulthood, the increase in loneliness really doesn't happen until oldest old age, meaning probably 80 to 85-plus, because that's the age when people start losing a lot. They've lost a spouse. They've lost siblings. They may have even lost children, god forbid. They have lost health, ability. Maybe they've lost their independence and have to live in a care home of some kind. All of those losses really stack themselves against the social wellbeing of an older adult. That's not as prevalent as we'd like to think it is. There aren't that many people who we can write off as being in that category of having lost everything.
So I think we have to be careful when we talk about older adulthood, we're talking about this huge age range from 65 to a hundred. That's 35 years. We would never lump together 15-to-50 year-olds, that's another 35-year range, because there's so much diversity. There's as much diversity in older adulthood, and so we have to be careful when we think about who's at risk and not just call it older adults. It isn't all older adults.
Mills: We are living in an aging population here in the U.S. And is this something that concerns you a lot as Baby Boomers age? We're hitting those numbers up there. We're getting old.
Hawkley: Yes, yes. There will be more older adults, definitely. And so one would think even if all else is equal, we'll have more people who are suffering from loneliness and isolation. The work we've done, recently, both with American data and with U.K. data where we compared two generations, the Baby Boom generation and the Silent Generation. We were looking at whether if we compared them at the same age, were Baby Boomers at 60 years of age any lonelier than the Silent Generation when they were 60 years old? No evidence for that, in either country. In fact, there's some evidence that suggests that Baby Boomers are perhaps at an advantage. They may be less lonely than the earlier generation. Hard to say yet what that will be attributable to.
But one can imagine that with this latest generation, there's a lot more autonomy, self-directed push toward getting their needs met. Whereas the Silent Generation was perhaps more subject to the stereotypes and the expectations of a life that is no longer possible for them. Family isn't there to support them like they might have thought it was going to be. Baby Boomers are much less likely to rely solely on nuclear family. They've developed a broader network. They've moved around and have a lot of different people and structures that are helping to support their aging. So, they may be in a better position, remains to be seen.
Mills: So, I was looking at some numbers related to loneliness and isolation, and it seems like there are now something like 36 million single-person households in the US. That the marriage rate has been steadily dropping since the 1950s and the proportion of Americans who have never married is now higher than it has ever been, I think it's about 35% now. Are we becoming a nation of loners?
Hawkley: It seems that way, doesn't it? That those kinds of numbers certainly look that way. It does make me wonder what the downstream consequences are going to be, long term consequences. I don't know. I think it really is going to depend a lot on whether this being alone is accompanied by what LGBT folks call families of choice. I mean, it's just getting people around you that need not be a spouse in a traditional two-child family or whatever it might have been in the past. But it is some way of connecting themselves to a community. Community is another key word in thinking about loneliness. So, we'll see what all this lone living means. Eric Klinenberg's book on living alone kind of, he interviewed a lot of people who chose to live alone. And the argument there was that it's not necessarily a bad thing. So, I think it really depends on what people do with their aloneness.
Mills: And I think there's also a growing trend toward communities where you can age in place and people coming together. So, younger people will support the older people in the community, making sure that they get their groceries. They go to the doctor's appointment, that they're safe. And perhaps we, boomers, will be protected from, being completely isolated as we age, if we age in place.
Hawkley: That intergenerational component is, I think, really important because it tackles ageism at the same time where you dissolve the stereotypes that young have about old and old have about young. Having these kinds of aging in place communities cuts both ways. It isn't just the young people helping the older people. It's the older people taking care of the kids while mom is out having to do an errand. So it's a mutually beneficial arrangement or it can be, and I think that's something we should be training our eyes and minds toward.
Mills: So what kind of advice would you give to people who are feeling lonely? Not isolated, but they really feel lonely. Where do you start in identifying the causes of your loneliness and then what do you do to mitigate it?
Hawkley: That's lots of things that could be offered there. I think if it's a case of realizing that you are lonely in spite of your social circumstances, that is you have people around you, but you're not feeling it. You're not feeling connected. It may be a matter of learning to identify the types of people, the groups where you might feel more at home. I mean, to take a stark example, if you're a bookworm, don't go to a dance bar to find somebody to talk to. I mean, like looks for like for this purpose, you want to find a connection with people who are like you. But there are difficulties that people have once they've been lonely for some time. And this is part of our evolutionary theory or model where it's a spiral, you feel lonely and there is a kind of a knee-jerk reaction to that where you consider yourself possibly not likable.
So you start feeling a little defensive, maybe a little anxious that people are looking for the negative stuff in you, and you don't want them to see that. So you tend to withdraw so that they don't see that. But that of course means you're not opening yourself up to the positive things either. And those expectations that people might not be nice toward you tend to be reinforced. It's a self-fulfilling prophecy. If you're expecting to see the negative stuff, you're going to see the negative stuff. And so you will maybe have less quality in your interactions and that's really important for feelings of loneliness you want to have. If you want to get over those feelings, you want a good quality, not just a superficial interaction. So, you want to recognize that's happening, that your brain is being hijacked essentially, and making you think things are perhaps not the way they really are.
So reality check. Maybe the person that didn't talk to me at the grocery checkout had a bad morning, just had an accident and just couldn't talk. So it's not me, it's them. So learning to re-attribute the causes of your loneliness can be helpful. There are instances where I think it's worthwhile talking with a professional. There can be difficulties surmounting these thinking problems, if you want to call them that, where we get caught up in cycles of thought that perpetuates the loneliness rather than get us out of it.
But I also want to make sure that people appreciate that this isn't all the problem of the lonely person. They're not the victim here. They're not solely responsible. We live in a society that pushes people to the edge, if they don't match exactly what we want. And there has to be a place for society to appreciate, for communities at the community level or neighborhood level to appreciate diversity, that we all belong. We all have a place. And how can we ensure that? How can we make space for everyone to offer what they have to offer to the group and make them feel like they belong? And I don't say this in a make them forceful kind of way, but create a space that is safe and open and receptive to all comers.
Mills: So, there've been a lot of headlines in the past two years about whether the social distancing precautions and isolation that a lot of us have taken during COVID pandemic have caused a secondary loneliness pandemic. Do you think that's happened or is that overblown? Is that just the media latching onto a convenient term?
Hawkley: It's a good point there because I think the media does capitalize on, I'll call it the sensationalistic news, that it is possibly overblown. But I think the jury's still out. I think the long-term consequences of the pandemic on things like loneliness, have yet to be seen. I think we saw a little bit of the unexpected, even when the pandemic started in that the data indicated an initial, very brief spike in loneliness that quickly almost normalized. But then what about the long haul? When we're not interacting in the fashion that we have been accustomed to, is there a slow drag on our sense of social fit, social connection? And does that take a longer-term toll on how we feel about our social lives? I think that's still up for more research, frankly.
Mills: So, we don't really know yet then whether some of these remote connections, Zoom and so forth, are replacing those in-person interactions.
Hawkley: Well, the study that I did, which was done about six to eight months into the pandemic from September of 2020 through January of 2021, this was using data from the National Social Life, Health, and Aging Project. We specifically asked older adults, how have you changed how you are interacting with family and with friends during this time? And have you increased, decreased or stayed the same and how often you have in person interactions? How about by phone? How about by messaging, whether it's email or text or social media? What about video calls? And although we saw some small percentage of older adults actually increase their use of these remote technologies. When it came time to looking at how lonely they felt, it didn't matter how much they used that technology. The fact that they decreased their in-person interaction frequency was not compensated by these increased remote technology uses.
However, having said that, we don't yet know what is an adequate dose. It's not to say that the remote types of social interaction aren't useful at all, but we don't know how much is required when, for how often. And we didn't have a big percentage of the population who showed an increase. Why is that? We have to look at even basic things like broadband access. Could they have used video calling? What about just their ability to use devices or knowledge in how to access the internet, even if they have it? So there are those hurdles that have to be gotten over. And I think we've made a step in the direction toward older adults becoming more facile in that way. If for no other reason that a lot of the health-related deliveries are now by remote means.
And so I think there's more attention being paid, people getting familiar with this technology and using it. At the same time, I'd also say it's never going to replace in person. And we know that from other research, even in younger people, where it's not a substitute, it's a nice supplement. It's nice in addition to in person, but it does not compensate for the richness of a visual, oral smell, taste, touch interaction with a human being.
Mills: There's some people I'd rather not smell, but okay.
Hawkley: Got it.
Mills: So, what's next for you? What are you looking at now? I mean, there has to be just, there's so many questions I'm sure related to the pandemic and the isolation that we've been living through.
Hawkley: For my personal work right now, I'm heading more in the direction of what can we do about it from policy level on down? So what my work, for example, with the Illinois Aging Services is to understand what it is they've been doing and tried to do during the pandemic to help older adults maintain some social connection. And we're just doing an evaluation. Here we have a population that was targeted by Governor Pritzker's budget. We need to help older adults avoid or get over social isolation and through the area agencies on aging, programming has been rolled out. Is it effective? If we learn anything from these kinds of attempts, we want to make sure that there's evidence that makes these particular interventions scalable. We want to disseminate these. We don't want to reinvent the wheel everywhere we go for how we're going to deal with this. And certainly the pandemic was prime time people out of desperation, or the visions of dollar signs, came up with all kinds of ideas for what they could do to alleviate loneliness and isolation.
Some will work, some won't. We need the data and then scale that. Also, I’m doing work with the AARP Foundation. We developed an interactive map for them, where you can see how social isolation overlaps with other risk factors at a county level in the states. So, if you look at something like broadband access, it's pretty clear there's an inverse association between broadband access and social isolation. If you have broadband access, you're in a county that has lower prevalence of social isolation in older adults. And there are other variables that one can look at this map. But the point of the map is to identify where are these high-risk counties? What distinguishes them from other counties? And then what can we do about it.
Mills: Well, Dr. Hawkley, this has been really interesting. I very much appreciate you taking the time to speak with us today. Thank you.
Hawkley: Thank you. It was a pleasure to have this conversation. Important topic.
Mills: You can find previous episodes of Speaking of Psychology on our website at www.speakingofpsychology.org or wherever you get your podcasts. And if you're listening to us on Apple, please leave a review. If you have comments or ideas for future podcasts, you can email us at speakingofpsychologyatapa.org. Speaking of Psychology is produced by Lea Winerman. Our sound editor is Chris Condayan.
Thank you for listening. For the American Psychological Association, I'm Kim Mills.
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