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Loneliness is an unpleasant emotional response to perceived isolation. Loneliness is also described as social pain – a psychological mechanism which motivates individuals to seek social connections. It is often associated with a perceived lack of connection and intimacy. Loneliness overlaps and yet is distinct from solitude. Solitude is simply the state of being apart from others; not everyone who experiences solitude feels lonely. As a subjective emotion, loneliness can be felt even when a person is surrounded by other people. Hence, there is a distinction between being alone and feeling lonely. Loneliness can be short term (state loneliness) or long term (chronic loneliness). In either case, it can be intense and painful.

The causes of loneliness are varied. Loneliness can be a result of genetic inheritance,^[1] cultural factors, a lack of meaningful relationships,^[2] a significant loss, an excessive reliance on passive technologies (notably the Internet in the 21st century),^[3] or a self-perpetuating mindset.^[4] Research has shown that loneliness is found throughout society, including among people in marriages along with other strong relationships, and those with successful careers. Most people experience loneliness at some points in their lives, and some feel it often. The effects of loneliness are also varied. Transient loneliness (loneliness which exists for a short period of time) is related to positive effects, including an increased focus on the strength of one's relationships.^[5][6] Chronic loneliness (loneliness which exists for a significant amount of time in one's life) is generally correlated with negative effects, including increased obesity, substance use disorder, risk of depression, cardiovascular disease, risk of high blood pressure, and high cholesterol.^{[7][8][9][10]} Chronic loneliness is also correlated with an increased risk of death and suicidal thoughts.

Medical treatments for loneliness include beginning therapy and taking antidepressants. Social treatments for loneliness generally include an increase in interaction with others, such as group activities (such as exercise or religious activities), re-engaging with old friends or colleagues, and becoming more connected with one's community. Other social treatments for loneliness include the ownership of pets^[11][12] and loneliness-designed technologies, such as meetup services or social robots (although the use of some technologies in order to combat loneliness is debated).

Loneliness has long been a theme in literature, going back to the Epic of Gilgamesh. However, academic coverage of loneliness was sparse until recent decades. In the 21st century, some academics and professionals have claimed that loneliness has become an epidemic,^[13] including Vivek Murthy, the Surgeon General of the United States.^[14] However, this claim has been disputed, with critics arguing that loneliness has not increased, but rather only academic focus on the topic has.^[15]

Causes

Existential

Loneliness has long been viewed as a universal condition which, at least to a moderate extent, is felt by everyone. From this perspective, some degree of loneliness is inevitable as the limitations of human life mean it is impossible for anyone to continually satisfy their inherent need for connection. Professors including Michele A. Carter and Ben Lazare Mijuskovic have written books and essays tracking the existential perspective and the many writers who have talked about it throughout history.^[16][17] Thomas Wolfe's 1930s essay God's Lonely Man is frequently discussed in this regard; Wolfe makes the case that everyone imagines they are lonely in a special way unique to themselves, whereas really every single person sometimes experiences loneliness. While agreeing that loneliness alleviation can be a good thing, those who take the existential view tend to doubt such efforts can ever be fully successful, seeing some level of loneliness as both unavoidable and even beneficial, as it can help people appreciate the joy of living.^[2][18]

Cultural

Culture is discussed as a cause of loneliness in two senses. Migrants can experience loneliness due to missing their home culture.^[19] Studies have found this effect can be especially strong for students from countries in Asia with a collective culture, when they go to study at universities in more individualist English speaking countries.^[20] Culture is also seen as a cause of loneliness in the sense that western culture may have been contributing to loneliness, ever since the Enlightenment began to favour individualism over older communal values.^[18][6][2]

Lack of meaningful relationships

For many people the family of origin did not offer the trust building relationships needed to build a reference that lasts a lifetime and even in memory after the passing of a loved one. This can be due to parenting style, traditions, mental health issues including personality disorders and abusive family environments. Sometimes religious shunning is also present.

This impacts the ability of individuals to know themselves, to value themselves and to relate to others or to do so with great difficulty.

All these factors and many others are overlooked by the standard medical or psychological advice that recommends to go meet friends, family and to socialise. This isn't always possible when there is no one available to relate to and an inability to connect without the skills and knowledge on how to proceed. With time a person might become discouraged or develop apathy from numerous trials, failures or rejections brought on by the lack of interpersonal skills.

As the rate of loneliness increases yearly among people of every age group and more so in the elderly, with known detrimental physical and psychological effects, there is a need to find new ways to connect people with each other and especially so at a time when a whole lot of the human attention is focused on electronic devices, it is a challenge.^[21]

Relationship loss

Loneliness is a very common, though often temporary, consequence of a relationship breakup or bereavement. The loss of a significant person in one's life will typically initiate a grief response; in this situation, one might feel lonely, even while in the company of others. Loneliness can occur due to the disruption to one's social circle, sometimes combined with homesickness, which results from people moving away for work or education.^[2][6]

Situational

All sorts of situations and events can cause loneliness, especially in combination with certain personality traits for susceptible individuals. For example, an extroverted person who is highly social is more likely to feel lonely if they are living somewhere with a low population density, with fewer people for them to interact with. Loneliness can sometimes even be caused by events that might normally be expected to alleviate it: for example the birth of a child (if there is significant postpartum depression) or after getting married (especially if the marriage turns out to be unstable, overly disruptive to previous relationships, or emotionally cold.) In addition to being impacted by external events, loneliness can be aggravated by pre-existing mental health conditions like chronic depression and anxiety.^[2][6]

Self perpetuating

Long term loneliness can cause various types of maladaptive social cognition, such as hypervigilance and social awkwardness, which can make it harder for an individual to maintain existing relationships, or establish new ones. Various studies have found that therapy targeted at addressing this maladaptive cognition is the single most effective way of intervening to reduce loneliness, though it does not always work for everyone.^[4][22][23]

Social contagion

Loneliness can spread through social groups like a disease. The mechanism for this involves the maladaptive cognition that often results from chronic loneliness. If a man loses a friend for whatever reason, this may increase his loneliness, resulting in him developing maladaptive cognition such as excessive neediness or suspicion of other friends. Hence leading to a further loss of human connection if he then goes on to split up with his remaining friends. Those other friends now become more lonely too, leading to a ripple effect of loneliness. Studies have however found that this contagion effect is not consistent – a small increase in loneliness does not always cause the maladaptive cognition. Also, when someone loses a friend, they will sometimes form new friendships or deepen other existing relationships.^{[24] [4][25][26][27]}

Internet

Studies have tended to find a moderate correlation between extensive internet use and loneliness, especially ones that draw on data from the 1990s, before internet use became widespread. Contradictory results have been found by studies investigating whether the association is simply a result of lonely people being more attracted to the internet, or if the internet can actually cause loneliness. The displacement hypothesis holds that some people choose to withdraw from real world social interactions so they can have more time for the internet. Excessive internet use can directly cause anxiety and depression, conditions which can contribute to loneliness – yet these factors may be offset by the internet's ability to facilitate interaction, and to empower people. Some studies found that internet use is a cause of loneliness, at least for some types of people.^[3][28] Others have found internet use can have a significant positive effect on reducing loneliness.^[29][30] The authors of meta studies and reviews from about 2015 and later have tended to argue that there is a bidirectional causal relationship between loneliness and internet use. Excessive use, especially if passive, can increase loneliness. While moderate use, especially by users who engage with others rather than just passively consume content, can increase social connection and reduce loneliness.^[31][32][33]

Genetics

Smaller early studies had estimated that loneliness may be between 37–55% hereditable.^[34] However, in 2016, the first Genome-wide association study of loneliness found that the heredity of loneliness is much lower, at about 14–27%.^[1] This suggests that while genes play a role in determining how much loneliness a person may feel, they are less of a factor than individual experiences and the environment.

Other

People making long driving commutes have reported dramatically higher feelings of loneliness (as well as other negative health impacts).^[35][36]

Typology

Two principal types of loneliness are social and emotional loneliness. This delineation was made in 1973 by Robert S. Weiss, in his seminal work: Loneliness: The Experience of Emotional and Social Isolation^[37] Based on Weiss's view that "both types of loneliness have to be examined independently, because the satisfaction for the need of emotional loneliness cannot act as a counterbalance for social loneliness, and vice versa", people working to treat or better understand loneliness have tended to treat these two types of loneliness separately, though this is far from always the case.^[38][20]

Social loneliness

Social loneliness is the loneliness people experience because of the lack of a wider social network. They may not feel they are members of a community, or that they have friends or allies whom they can rely on in times of distress.^[37][20]

Emotional loneliness

Emotional loneliness results from the lack of deep, nurturing relationships with other people. Weiss tied his concept of emotional loneliness to attachment theory. People have a need for deep attachments, which can be fulfilled by close friends, though more often by close family members such as parents, and later in life by romantic partners. In 1997, Enrico DiTommaso and Barry Spinner separated emotional loneliness into Romantic and Family loneliness.^[20][39] A 2019 study found that emotional loneliness significantly increased the likelihood of death for older adults living alone (whereas there was no increase in mortality found with social loneliness).^[39]

Family loneliness

Family loneliness results when individuals feel they lack close ties with family members. A 2010 study of 1,009 students found that only family loneliness was associated with increased frequency of self harm, not romantic or social loneliness.^[40][20]

Romantic loneliness

Romantic loneliness can be experienced by adolescents and adults who lack a close bond with a romantic partner. Psychologists have asserted that the formation of a committed romantic relationship is a critical development task for young adults, but is also one that many are delaying into their late 20s or beyond. People in romantic relationships tend to report less loneliness than single people, provided their relationship provides them with emotional intimacy. People in unstable or emotionally cold romantic partnerships can still feel romantic loneliness.^[41][20]

Other

Several other typologies and types of loneliness exist. Further types of loneliness include existential loneliness, cosmic loneliness – feeling alone in a hostile universe, and cultural loneliness – typically found among immigrants who miss their home culture.^[18] These types are less well studied than the threefold separation into social, romantic and family loneliness, yet can be valuable in understanding the experience of certain subgroups with loneliness.^[16][20]

Lockdown loneliness

Lockdown loneliness refers to "loneliness resulting because of social disconnection due to enforced social distancing and lockdowns during the COVID-19 pandemic and similar other emergency situations" such as the COVID-19 pandemic.^[42]

Demarcation

Differences between feeling lonely and being socially isolated

There is a clear distinction between feeling lonely and being socially isolated (for example, a loner).^[43] In particular, one way of thinking about loneliness is as a discrepancy between one's necessary and achieved levels of social interaction,^[44] while solitude is simply the lack of contact with people. Loneliness is therefore a subjective yet multidimensional experience; if a person thinks they are lonely, then they are lonely. People can be lonely while in solitude, or in the middle of a crowd. What makes a person lonely is their perceived need for more social interaction or a certain type or quality of social interaction that is not currently available. A person can be in the middle of a party and feel lonely due to not talking to enough people. Conversely, one can be alone and not feel lonely; even though there is no one around, that person is not lonely because there is no desire for social interaction. There have also been suggestions that each person has their own optimal level of social interaction. If a person gets too little or too much social interaction, this could lead to feelings of loneliness or over-stimulation.^[45]

Solitude can have positive effects on individuals. One study found that, although time spent alone tended to depress a person's mood and increase feelings of loneliness, it also helped to improve their cognitive state, such as improving concentration. It can be argued some individuals seek solitude for discovering a more meaningful and vital existence.^[46] Furthermore, once the alone time was over, people's moods tended to increase significantly.^[47] Solitude is also associated with other positive growth experiences, religious experiences, and identity building such as solitary quests used in rites of passages for adolescents.^[48]

Transient vs. chronic loneliness

Another important typology of loneliness focuses on the time perspective.^[49] In this respect, loneliness can be viewed as either transient or chronic.

Transient loneliness is temporary in nature; generally it is easily relieved. Chronic loneliness is more permanent and not easily relieved.^[50] For example, when a person is sick and cannot socialize with friends, this would be a case of transient loneliness. Once the person got better it would be easy for them to alleviate their loneliness. A person with long term feelings of loneliness, regardless of if they are at a family gathering or with friends, is experiencing chronic loneliness.

Loneliness as a human condition

The existentialist school of thought views individuality as the essence of being human. Each human being comes into the world alone, travels through life as a separate person, and ultimately dies alone. Coping with this, accepting it, and learning how to direct our own lives with some degree of grace and satisfaction is the human condition.^[51]

Some philosophers, such as Sartre, believe in an epistemic loneliness in which loneliness is a fundamental part of the human condition because of the paradox between people's consciousness desiring meaning in life and the isolation and nothingness of the universe.^[52] Conversely, other existentialist thinkers argue that human beings might be said to actively engage each other and the universe as they communicate and create, and loneliness is merely the feeling of being cut off from this process.

In his 2019 text, Evidence of Being: The Black Gay Cultural Renaissance and the Politics of Violence, Darius Bost draws from Heather Love's theorization of loneliness^[53] to delineate the ways in which loneliness structures black gay feeling and literary, cultural productions. Bost limns, "As a form of negative affect, loneliness shores up the alienation, isolation, and pathologization of black gay men during the 1980s and early 1990s. But loneliness is also a form of bodily desire, a yearning for an attachment to the social and for a future beyond the forces that create someone's alienation and isolation."^[54]

Prevalence

Thousands of studies and surveys have been undertaken to assess the prevalence of loneliness. Yet it remains challenging for scientists to make accurate generalisations and comparisons. Reasons for this include various loneliness measurement scales being used by different studies, differences in how even the same scale is implemented from study to study, and as cultural variations across time and space may impact how people report the largely subjective phenomena of loneliness.^[32][55]

One consistent finding has been that loneliness is not evenly distributed across a nation's population. It tends to be concentrated among vulnerable sub groups; for example the poor, the unemployed, and immigrants. Some of the most severe loneliness tends to be found among international students from countries in Asia with a collective culture, when they come to study in countries with a more individualist culture, such as Australia.^[20] In New Zealand, the fourteen surveyed groups with the highest prevalence of loneliness most/all of the time in descending order are: disabled people, recent migrants, low income households, unemployed, single parents, rural (rest of South Island), seniors aged 75+, not in the labour force, youth aged 15–24, no qualifications, not housing owner-occupier, not in a family nucleus, Māori, and low personal income.^[56]

Studies have found inconsistent results concerning the effect of age, gender and culture on loneliness.^[57] Much 20th century and early 21st century writing on loneliness assumed it typically increases with age. In high-income countries, on average, one in four people over 60 and one in three over 75 feels lonely.^[58] Yet as of 2020, with some exceptions, recent studies have tended to find that it is young people who report the most loneliness (though loneliness is still found to be a severe problem for the very old).^[59] There have been contradictory results concerning how the prevalence of loneliness varies with gender. A 2020 analysis based on a worldwide dataset gathered by the BBC found greater loneliness among men, though some earlier work had found the opposite, or that gender made no difference.^{[57][20][60][55]}

While cross-cultural comparisons are difficult to interpret with high confidence, the 2020 analyses based on the BBC dataset found the more individualist countries like the UK tended to have higher levels of loneliness. However, previous empirical work had often found that people living in more collectivist cultures tended to report greater loneliness, possibly due to less freedom to choose the sort of relationships that suit them best.^[57][61]

Increasing prevalence

In the 21st century, loneliness has been widely reported as an increasing worldwide problem. In 2017, loneliness was labelled a growing "epidemic" by Vivek Murthy, the Surgeon General of the United States. It has since been described as an epidemic thousands of times, by reporters, academics and other public officials. A 2010 systematic review and meta analyses had stated that the "modern way of life in industrialized countries" is greatly reducing the quality of social relationships, partly due to people no longer living in close proximity with their extended families. The review notes that from 1990 to 2010, the number of Americans reporting no close confidants has tripled.^[15] Worldwide though there is little historical data to conclusively demonstrate an increase in loneliness. Several reviews have found no clear evidence of an increase in loneliness even in the US^{[citation needed]}. Professors such as Claude S. Fischer and Eric Klinenberg opined in 2018 that while the data doesn't support describing loneliness as an "epidemic" or even as a clearly growing problem, loneliness is indeed a serious issue, having a severe health impact on millions of people.^{[62][63][64][65]} However, a 2021 study found that adolescent loneliness in contemporary schools and depression increased substantially and consistently worldwide after 2012.^[13][66]

A comparative overview of the prevalence and determinants of loneliness and social isolation in Europe in the pre-COVID period was conducted by Joint Research Centre of the European Commission within the project Loneliness in Europe.^[67] The empirical results indicate that 8.6% of the adult population in Europe experience frequent loneliness and 20.8% experience social isolation, with eastern Europe recording the highest prevalence of both phenomena.^[68]

In Australia, the annual national Household, Income and Labour Dynamics in Australia (HILDA) Survey has reported a steady 8% rise in agreement with the statement "I often feel very lonely" between 2009 and 2021, responses indicating "strongly agree" rose steadily by over 20% in that same time period. This is a reversal of the trend seen from the start of the survey in 2001 until 2009 where these figures had both been steadily decreasing.^[69]

Effects

Transient

While unpleasant, temporary feelings of loneliness are sometimes experienced by almost everyone, they are not thought to cause long term harm. Early 20th century work sometimes treated loneliness as a wholly negative phenomenon. Yet transient loneliness is now generally considered beneficial. The capacity to feel it may have been evolutionarily selected for, a healthy aversive emotion that motivates individuals to strengthen social connections.^[5] Transient loneliness is sometimes compared to short-term hunger, which is unpleasant but ultimately useful as it motivates us to eat.^[22][20][70]

Chronic

Long-term loneliness is widely considered a close to entirely harmful condition. Whereas transient loneliness typically motivates us to improve relationships with others, chronic loneliness can have the opposite effect. This is as long-term social isolation can cause hypervigilance. While enhanced vigilance may have been evolutionary adaptive for individuals who went long periods without others watching their backs, it can lead to excessive cynicism and suspicion of other people, which in turn can be detrimental to interpersonal relationships. So without intervention, chronic loneliness can be self-reinforcing.^[20][70]

Benefits

Much has been written about the benefits of being alone, yet often, even when authors use the word "loneliness", they are referring to what could be more precisely described as voluntary solitude. Yet some assert that even long-term involuntary loneliness can have beneficial effects.^[71][6]

Chronic loneliness is often seen as a purely negative phenomena from the lens of social and medical science. Yet in spiritual and artistic traditions, it has been viewed as having mixed effects. Though even within these traditions, there can be warnings not to intentionally seek out chronic loneliness or other conditions – just advise that if one falls into them, there can be benefits. In western arts, there is a long belief that psychological hardship, including loneliness, can be a source of creativity.^[6] In spiritual traditions, perhaps the most obvious benefit of loneliness is that it can increase the desire for a union with the divine. More esoterically, the psychic wound opened up by loneliness or other conditions has been said, e.g. by Simone Weil, to open up space for God to manifest within the soul. In Christianity, spiritual dryness has been seen as advantageous as part of the "dark night of the soul", an ordeal that while painful, can result in spiritual transformation.^[72][6] From a secular perspective, while the vast majority of empirical studies focus on the negative effects of long term loneliness, a few studies have found there can also be benefits, such as enhanced perceptiveness of social situations.^[6][73]

Brain

Studies have found mostly negative effects from chronic loneliness on brain functioning and structure.^[24] However, certain parts of the brain and specific functions, like the ability to detect social threat, appear to be strengthened. A 2020 population-genetics study looked for signatures of loneliness in grey matter morphology, intrinsic functional coupling, and fiber tract microstructure. The loneliness-linked neurobiological profiles converged on a collection of brain regions known as the default mode network. This higher associative network shows more consistent loneliness associations in grey matter volume than other cortical brain networks. Lonely individuals display stronger functional communication in the default network, and greater microstructural integrity of its fornix pathway. The findings fit with the possibility that the up-regulation of these neural circuits supports mentalizing, reminiscence and imagination to fill the social void. ^[74]

Physical health

Chronic loneliness can be a serious, life-threatening health condition. It has been found to be strongly associated with an increased risk of cardiovascular disease, though direct causal links have yet to be firmly identified.^[7][75] People experiencing loneliness tend to have an increased incidence of high blood pressure, high cholesterol, and obesity.^[8]

Loneliness has been shown to increase the concentration of cortisol levels in the body and weaken the effects of dopamine, the hormone that makes people enjoy things.^[8] Prolonged, high cortisol levels can cause anxiety, depression, digestive problems, heart disease, sleep problems, and weight gain.^[76]

Associational studies on loneliness and the immune system have found mixed results, with lower natural killer (NK) cell activity or dampened antibody response to viruses such Epstein Barr, herpes, and influenza, but either slower or no change to the progression of AIDS.^[8]

Based on the ELSA, a study found that loneliness increased the risk of dementia by one-third. Not having a partner (being single, divorced, or widowed) doubled the risk of dementia. However, having two or three closer relationships reduced the risk by three-fifths.^[77][78] And based on the large UK Biobank cohort, a study found that individuals who reported feeling lonely had a higher risk of developing Parkinson's disease.^[79]

Death

A 2010 systematic review and meta- analyses found a significant association between loneliness and increased mortality. People with good social relationships were found to have a 50% greater chance of survival compared to lonely people (odds ratio = 1.5). In other words, chronic loneliness seems to be a risk factor for death comparable to smoking, and greater than obesity or lack of exercise.^[15] A 2017 overview of systematic reviews found other meta-studies with similar findings. However, clear causative links between loneliness and early death have not been firmly established.^[7]

Mental health

Loneliness has been linked with depression, and is thus a risk factor for suicide.^[80] A study based on more than 4,000 adults aged over 50 in the English Longitudinal Study of Ageing (ELSA), looked at loneliness. Nearly one in five of those who reported being lonely had developed signs of depression within a year.^[9][10] Émile Durkheim has described loneliness, specifically the inability or unwillingness to live for others, i.e. for friendships or altruistic ideas, as the main reason for what he called egoistic suicide.^[81][82] In adults, loneliness is a major precipitant of depression and alcoholism.^[83] People who are socially isolated may report poor sleep quality, and thus have diminished restorative processes.^[84] Loneliness has also been linked with a schizoid character type in which one may see the world differently and experience social alienation, described as the self in exile.^[85]

While the long-term effects of extended periods of loneliness are little understood, it has been noted that people who are isolated or experience loneliness for a long period of time fall into a "ontological crisis" or "ontological insecurity," where they are not sure if they or their surroundings exist, and if they do, exactly who or what they are, creating torment, suffering, and despair to the point of palpability within the thoughts of the person.^[86][87]

In children, a lack of social connections is directly linked to several forms of antisocial and self-destructive behavior, most notably hostile and delinquent behavior. In both children and adults, loneliness often has a negative impact on learning and memory. Its disruption of sleep patterns can have a significant impact on the ability to function in everyday life.^[80]

Research from a large-scale study published in the journal Psychological Medicine, showed that "lonely millennials are more likely to have mental health problems, be out of work and feel pessimistic about their ability to succeed in life than their peers who feel connected to others, regardless of gender or wealth".^[88][89]

In 2004, the United States Department of Justice published a study indicating that loneliness increases suicide rates profoundly among juveniles, with 62% of all suicides that occurred within juvenile facilities being among those who either were, at the time of the suicide, in solitary confinement or among those with a history of being housed thereof.^[86]

Pain, depression, and fatigue function as a symptom cluster and thus may share common risk factors. Two longitudinal studies with different populations demonstrated that loneliness was a risk factor for the development of the pain, depression, and fatigue symptom cluster over time. These data also highlight the health risks of loneliness; pain, depression, and fatigue often accompany serious illness and place people at risk for poor health and mortality.^[90]

The psychiatrist George Vaillant and the director of longitudinal Study of Adult Development at Harvard University Robert J. Waldinger found that those who were happiest and healthier reported strong interpersonal relationships.^[91]

Suicide

Loneliness can cause suicidal thoughts (suicidal ideation), attempts at suicide and actual suicide. The extent to which suicides result from loneliness are difficult to determine however, as there are typically several potential causes involved.^[7][2] In an article written for the American Foundation for Suicide Prevention Dr. Jeremy Noble writes, "You don't have to be a doctor to recognize the connection between loneliness and suicide".^[92] As feelings of loneliness intensify so do thoughts of suicide and attempts at suicide.^[93] The loneliness that triggers suicidal tendencies impacts all facets of society.

The Samaritans, a nonprofit charity in England, who work with people going through crisis says there is a definite correlation between feelings of loneliness and suicide for juveniles and those in their young adult years.^[93] The Office of National Statistics, in England, found one of the top ten reasons young people have suicidal idealizations and attempt suicide is because they are lonely.^[94] College students, lonely, away from home, living in new unfamiliar surroundings, away from friends feel isolated and without proper coping skills will turn to suicide as a way to fix the pain of loneliness.^[94] A common theme, among children and young adults dealing with feelings of loneliness is they didn't know help was available, or where to get help. Loneliness, to them, is a source of shame.^[94]

Older people can also struggle with feelings of severe loneliness which lead them to consider acting on thoughts of suicide or self-harm. In some countries, senior citizens appear to commit a high proportion of suicides, though in other countries there is a significantly higher rate for middle-aged men. Retirement, poor health, loss of a significant other or other family or friends, all contribute to loneliness. Suicides caused by loneliness in older people can be difficult to identify. Often they don't have anyone to disclose their feelings of loneliness and the despair it brings. They may stop eating, alter the doses of medications, or choose not to treat an illness as a way to help expedite death so they don't have to deal with feeling lonely.^[7][2]

Cultural influences can also cause loneliness leading to suicidal thoughts or actions. For example, Hispanic and Japanese cultures value interdependence. When a person from one of these cultures feels removed or feels like they can't sustain relationships in their families or society, they start to have negative behaviors, including negative thoughts or acting self-destructively. Other cultures, such as in Europe, are more independent. While the cause of loneliness in a person may stem from different circumstances or cultural norms, the impact lead to the same results – a desire to end life.

Society level

High levels of chronic loneliness can also have society wide effects. Noreena Hertz writes that Hannah Arendt was the first to discuss the link between loneliness and the politics of intolerance. In her book The Origins of Totalitarianism Arendt argues that loneliness is an essential prerequisite for a totalitarian movement to gain power. Hertz states that the link between an individual's loneliness and their likelihood to vote for a populist political party or candidate has since been supported by several empirical studies. In addition to increasing support for populist policies, Hertz argues that a society with high levels of loneliness risks eroding its ability to have effective mutually beneficial politics. Partly as loneliness tends to make people more suspicious about each other. And also as some of the ways individuals alleviate loneliness, such as technological or transactional substitutes for human companionship, can reduce peoples political and social skills, such as their ability to compromise and to see other points of view.^[95][96][97]

However, the link between loneliness and political attitudes remains underexplored and ambiguous. Studies investigating the relationship between loneliness and voter orientation directly found that lonely individuals tend to abstain from elections rather than support populist parties.^{[98][99][100]} This inconsistency might stem from differences in the definition and operationalization of loneliness. While Hertz applies a broader definition of loneliness, the empirical studies that contradict her point use self reported, directly measured loneliness as predictor for voting behavior.

Physiological mechanisms linked to poor health

There are a number of potential physiological mechanisms linking loneliness to poor health outcomes. In 2005, results from the American Framingham Heart Study demonstrated that lonely men had raised levels of Interleukin 6 (IL-6), a blood chemical linked to heart disease. A 2006 study conducted by the Center for Cognitive and Social Neuroscience at the University of Chicago found loneliness can add thirty points to a blood pressure reading for adults over the age of fifty. Another finding, from a survey conducted by John Cacioppo from the University of Chicago, is that doctors report providing better medical care to patients who have a strong network of family and friends than they do to patients who are alone. Cacioppo states that loneliness impairs cognition and willpower, alters DNA transcription in immune cells, and leads over time to high blood pressure.^[101] Lonelier people are more likely to show evidence of viral reactivation than less lonely people.^[102] Lonelier people also have stronger inflammatory responses to acute stress compared with less lonely people; inflammation is a well known risk factor for age-related diseases.^[103]

When someone feels left out of a situation, they feel excluded and one possible side effect is for their body temperature to decrease. When people feel excluded blood vessels at the periphery of the body may narrow, preserving core body heat. This class protective mechanism is known as vasoconstriction.^[104]

Relief

The reduction of loneliness in oneself and others has long been a motive for human activity and social organization. For some commentators, such as professor Ben Lazare Mijuskovic, ever since the dawn of civilization, it has been the single strongest motivator for human activity after essential physical needs are satisfied. Loneliness is the first negative condition identified in the Bible, with the Book of Genesis showing God creating a companion for man to relieve loneliness. Nevertheless, there is relatively little direct record of explicit loneliness relief efforts prior to the 20th century. Some commentators including professor Rubin Gotesky have argued the sense of aloneness was rarely felt until older communal ways of living began to be disrupted by the Enlightenment.^[16][18][6]

Starting in the 1900s, and especially in the 21st century, efforts explicitly aiming to alleviate loneliness became much more common. Loneliness reduction efforts occur across multiple disciplines, often by actors for whom loneliness relief is not their primary concern. For example, by commercial firms, civic planners, designers of new housing developments, and university administration. Across the world, many departments, NGOs and even umbrella groups entirely dedicated to loneliness relief have been established. For example, in the UK, the Campaign to End Loneliness. With loneliness being a complex condition, there is no single method that can consistently alleviate it for different individuals; many different approaches are used.^[22][64][6]

Medical treatment

Therapy is a common way of treating loneliness. For individuals whose loneliness is caused by factors that respond well to medical intervention, it is often successful. Short-term therapy, the most common form for lonely or depressed patients, typically occurs over a period of ten to twenty weeks. During therapy, emphasis is put on understanding the cause of the problem, reversing the negative thoughts, feelings, and attitudes resulting from the problem, and exploring ways to help the patient feel connected. Some doctors also recommend group therapy as a means to connect with other patients and establish a support system.^[105] Doctors also frequently prescribe anti-depressants to patients as a stand-alone treatment, or in conjunction with therapy. It may take several attempts before a suitable anti-depressant medication is found.^[106]

Doctors often see a high proportion of patients with loneliness; a UK survey found that three-quarters of Doctors believed that between 1–5 patients visited them each day mainly out of loneliness. There isn't always sufficient funds to pay for therapy, leading to the rise of "social prescription", where Doctors can refer patients to NGO and Community led solutions such as group activities. While preliminary findings suggest social prescription has good results for some people, the evidence to support its effectiveness is not strong, with commentators advising that for some people it is not a good alternative to medical therapy.^{[107][2][108][109][32]}

NGO and community led

Along with growing awareness of the problem of loneliness, community led projects explicitly aiming for its relief became more common in the latter half of the 20th century, with still more starting up in the 21st. There have been many thousands of such projects across North and South America, Europe, Asia and Africa. Some campaigns are run nationally under the control of charities dedicated to loneliness relief, while other efforts may be local projects, sometimes run by a group for which loneliness relief is not their primary objective. For example, housing associations that aim to ensure multi generational living, with social interaction between younger and older people encouraged, in some cases even contractually required. Projects range from befriending schemes that facilitate just two people meeting up, to large group activities, which will often have other objectives in addition to loneliness relief. Such as having fun, improving physical health with exercise, or participating in conservation efforts.^[110][6][32]

Government

In the UK, the Jo Cox Commission on Loneliness began pushing to make tackling loneliness a government priority from 2016. In 2018, this led to Great Britain becoming the first country in the world to appoint a ministerial lead for loneliness, and to publish an official loneliness reduction strategy. There have since been calls for other countries to appoint their own minister for loneliness, for example in Sweden and Germany. Various other countries had seen government led anti loneliness efforts even before 2018 however. For example, in 2017 the government of Singapore started a scheme to provide allotments to its citizens so they could socialise while working together on them, while the Netherlands government set up a telephone line for lonely older people. While governments sometimes directly control loneliness relief efforts, typically they fund or work in partnership with educational institutions, companies and NGOs.^{[111][112][113][114][6][115]}

Pets

Pet therapy, or animal-assisted therapy, can be used to treat both loneliness and depression. The presence of animal companions, especially dogs, but also others like cats, rabbits, and guinea pigs, can ease feelings of depression and loneliness among some patients. Beyond the companionship the animal itself provides there may also be increased opportunities for socializing with other pet owners. According to the Centers for Disease Control and Prevention there are a number of other health benefits associated with pet ownership, including lowered blood pressure and decreased levels of cholesterol and triglycerides.^[11][12]

Technology

Technology companies have been advertising their products as helpful for reducing loneliness at least as far back as 1905; records exist of early telephones being presented as a way for isolated farmers to reduce loneliness. Technological solutions for loneliness have been suggested much more frequently since the development of the internet, and especially since loneliness became a more prominent public health issue at around 2017. Solutions have been proposed by existing tech companies, and by start-ups dedicated to loneliness reduction.^[2]

Solutions that have become available since 2017 tend to fall under 4 different approaches. 1) Mindfulness apps that aim to change an individual's attitude towards loneliness, emphasising possible benefits, and trying to shift towards an experience more similar to voluntary solitude. 2) Apps that warn users when they're starting to spend too much time online, which is based on research findings that moderate use of digital technology can be beneficial, but that excessive time online can increase loneliness. 3) Apps that help people connect with others, including to arrange real life meetups. 4) AI related technologies that provide digital companionship. Such companions can be conventionally virtual (having existence only when their application is switched on), can have an independent digital life (their program may run all the time in the cloud, allowing them to interact with the user across different platforms like Instagram & Twitter in similar ways to how a real human friend might behave), or can have a physical presence like a Pepper robot. As far back as the 1960s, some individuals had stated they prefer communicating with the ELIZA computer program rather than regular human beings. AI driven applications available in the 2020s are considerably more advanced, able to remember previous conversations, with some ability to sense emotional states, and to tailor their interaction accordingly. An example of a start-up working on such technology is Edward Saatchis Fable studio. Inspired by the Joi character in Blade Runner 2049, Saatchi seeks to create digital friends that can help alleviate loneliness. As they'll be in some senses beyond human, untainted by negative motivators like greed or envy, and with enhanced powers of attention, they may be able to help people be kinder and gentler to others. And so assist with loneliness relief on a society wide level, as well as directly with individuals.^{[2][116][117]}

Effectiveness of digital technology interventions

A 2021 systematic review and meta-analysis on the effectiveness of digital technology interventions (DTIs) in reducing loneliness in older adults found no evidence supporting that DTIs reduce loneliness in older adults with an average age from 73 to 78 years (SD 6–11).^[118] DTIs studied included social internet-based activities, that is, social activities via social websites, videoconferencing, customized computer platforms with simplified touch-screen interfaces, personal reminder information and social management systems, WhatsApp groups, and video or voice networks.^[118]

Religion

Studies have found an association with religion and the reduction of loneliness, especially among the elderly. The studies sometimes include caveats, such as that religions with strong behavioural prescriptions can have isolating effects. In the 21st century, numerous religious organisations have begun to undertake efforts explicitly focusing on loneliness reduction. Religious figures have also played a role in raising awareness of the problem of loneliness; for example, Pope Francis said in 2013 that loneliness of the old (along with youth unemployment) were the most serious evils of the age.^{[119][120][121][110][6]}

Others

Nostalgia has also been found to have a restorative effect, counteracting loneliness by increasing perceived social support.^[122] Vivek Murthy has stated that the most generally available cure for loneliness is human connection. Murthy argues that regular people have a vital role to play as individuals in reducing loneliness for themselves and others, in part by greater emphases on kindness and on nurturing relationships with others.^[2]

Effectiveness

Professor Stella Mills has suggested that while social loneliness can be relatively easy to address with group activities and other measures that help build connections between people, effective intervention against emotional loneliness can be more challenging. Mills argues that such intervention is more likely to succeed for individuals who are in the early stages of loneliness, before the effects caused by chronic loneliness are deeply engrained.^[110]

A 2010 meta-study compared the effectiveness of four interventions: improving social skills, enhancing social support, increasing opportunities for social interaction, and addressing abnormal social cognition (faulty patterns of thoughts, such as the hyper-vigilance often caused by chronic loneliness). The results of the study indicated that all interventions were effective in reducing loneliness, possibly with the exception of social skill training. Results of the meta-analysis suggest that correcting maladaptive social cognition offers the best chance of reducing loneliness.^[22] A 2019 umbrella review of systematic reviews focussing on the effectiveness of loneliness relief efforts aimed just at older people, also found that those targeting social cognition were most effective.^[23]

A 2018 overview of systematic reviews concerning the effectiveness of loneliness interventions, found that generally, there is little solid evidence that intervention are effective. Though they also found no reason to believe the various types of intervention did any harm, except they cautioned against the excessive use of digital technology. The authors called for more rigorous, best practice compliant research in future studies, and with more attention to the cost of interventions.^[32]

History

Loneliness has been a theme in literature throughout the ages, as far back as Epic of Gilgamesh.^[16][18] Yet according to Fay Bound Alberti, it was only around the year 1800 that the word began to widely denote a negative condition. With some exceptions,^[123] earlier writings and dictionary definitions of loneliness tended to equate it with solitude – a state that was often seen as positive, unless taken to excess. From about 1800, the word loneliness began to acquire its modern definition as a painful subjective condition. This may be due to the economic and social changes arising out of the enlightenment. Such as alienation and increased interpersonal competition, along with a reduction in the proportion of people enjoying close and enduring connections with others living in close proximity, as may for example have been the case for modernising pastoral villages.^[124][6] Despite growing awareness of the problem of loneliness, widespread social recognition of the problem remained limited, and scientific study was sparse, until the last quarter of the twentieth century. One of the earliest studies of loneliness was published by Joseph Harold Sheldon in 1948.^[125] The 1950 book The Lonely Crowd helped further raise the profile of loneliness among academics. For the general public, awareness was raised by the 1966 Beatles song "Eleanor Rigby".^[6]

According to Eugene Garfield, it was Robert S. Weiss who brought the attention of scientists to the topic of loneliness, with his 1973 publication of Loneliness: The experience of emotional and social isolation.^[126] Before Weiss's publication, what few studies of loneliness existed were mostly focussed on older adults. Following Weis's work, and especially after the 1978 publication of the UCLA Loneliness Scale, scientific interest in the topic has broadened and deepened considerably, with tens of thousands of academic studies having been carried to investigate loneliness just among students, with many more focussed on other subgroups, and on whole populations.^{[127][20][6][73]}

Concern among the general public over loneliness increased in the decades since "Eleanor Rigby"'s release; by 2018 government-backed anti-loneliness campaigns had been launched in countries including the UK, Denmark and Australia.^[64]