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Loneliness: An Elusive Danger to Health

Loneliness is a complex and devastating emotional state described by a subjective sense of isolation or disconnection from meaningful social relationships. As social creatures, humans' inherent need for social interaction, support, and stimuli is integral to their well-being. However, the mere presence of these social elements does not guarantee a sense of belonging; instead, kinship is closely linked to the individual perception of one's social connections and interactions. This article delves into the complex repercussions of loneliness on various facets of health, from cardiovascular and metabolic consequences to immunologic responses. Loneliness leaves an indelible mark on mental health, too, with links to depression, dementia, suicidal thoughts, and personality disorders. As society moves to recognise loneliness as a public health concern, strategies and interventions become imperative (Cacioppo & Cacioppo, 2018).


Where Does It Come From?

Loneliness is caused when an individual's social network fails to align with their preferences, either in terms of quantity or attributes (Pop et al., 2022). The crux lies within this discrepancy between the objective reality of social presence and the subjective experience of belonging. While not classified as a clinical diagnosis, loneliness represents a significant psychological state that can affect both physiological and mental well-being, particularly when constant. This emotional state is not confined to specific life stages, yet heightened levels are often observed in late adolescence and among the elderly. An analogy can be made between loneliness and hunger, as the sensation of loneliness acts as a social parallel to the biological need for sustenance. Much like hunger triggers the imperative to eat, loneliness prompts an innate urge to establish new social relationships (Morr et al., 2022).

It is vital to recognise that loneliness is not synonymous with solitude. The size of one's social network does not necessarily shield against loneliness; an individual may feel isolated despite having an extensive and diverse social circle. Conversely, it is possible to lead a life with only a few meaningful social connections and experience no loneliness whatsoever. In a clinical setting, researchers examine what is known as "social isolation". This term typically refers to a state where a person experiences a reduction in both the quantity and quality of their interactions with others. This is an objective concept that can be assessed by observing an individual's social network (Benjamin & Gummanur, 2023; Freedman & Nicolle, 2020).


Impact on Health

Long-lasting loneliness takes a toll on health. It is important to note that the adverse health effects linked to loneliness are not easily predicted just by looking at someone's level of social isolation or support. This fact sets loneliness apart from other concepts that are commonly mixed up with it (Cacioppo et al., 2010). Investigations reveal that loneliness can have severe effects on the cardiovascular system, contributing to conditions like coronary heart disease and stroke (Valtorta et al., 2016), while also exerting detrimental influences on brain health, potentially leading to dementia (Kuiper et al., 2015). Loneliness's link to metabolic syndrome (Whisman, 2010), often accompanied by depression (Henriksen et al., 2019), further underscores its systemic consequences. Alarmingly, loneliness has been correlated with increased mortality across various causes, increasing the likelihood of death by 26% in reported cases of loneliness (Holt-Lunstad et al., 2015). This evidence implies that loneliness operates systemically within the body, culminating in pathological consequences (Karelina & Devries, 2011).

It is currently believed that loneliness impacts health through three ‘pathways’: poor health behaviors, heightened stress response, and inadequate physiological repairing activity. The first one emphasises the fact that lonely individuals are more susceptible to developing unhealthy behaviours, such as smoking, decreased physical activity, and disrupted sleep patterns (Cacioppo et al., 2002; Hawkley et al., 2009).

Understanding stress and its impact on the body involves examining it from two angles: exposure and perception. The body interprets psychological stressors as threats and activates the sympathetic nervous system (SNS) and the hypothalamic-pituitary-adrenocortical (HPA) axis. Together, these systems set off an inflammatory response (Irwin & Cole, 2011). When perceived as a source of stress, loneliness becomes a catalyst for inflammatory processes, starting a physiological stress cascade. During acute stress situations, the initial activation of the SNS primes the immune system, mobilising leukocytes into the bloodstream. Simultaneously, stress-induced vagal withdrawal lowers acetylcholine levels, promoting inflammatory activity in tissues such as the liver, spleen, heart, and gastrointestinal tract. Acute psychological stressors release interleukin-1 beta (IL-1β), activating the HPA axis and releasing cortisol. Brain IL-1β, the leukocytic pyrogen, induces low-grade inflammation and elevated cytokine levels under severe stress. In moments of intense stress, the adrenal medulla releases epinephrine. This triggers the activation of corticotropin-releasing hormone, which, in turn, stimulates the sympathetic nervous system. This stimulation leads to an elevation in adrenocorticotropic hormone and the subsequent release of adrenocortical steroids (Pourriyahi et al., 2021).

Loneliness and Immunologic Factors

Although the stress response is a shared aspect of the human experience, its intensity varies among individuals (Hawkley & Cacioppo, 2003). Loneliness plays a significant role in shaping this reaction, as lonely individuals perceive routine events as more stressful than their non-lonely counterparts. This heightened perception is particularly evident in how social stressors contribute to increased levels of pro-inflammatory cytokines in the blood and the brain. As a result, those who are lonely exhibit a more pronounced increase, resulting in an elevated inflammatory response (Leschak & Eisenberger, 2019). Numerous studies have confirmed that individuals who experience loneliness exhibit a more pronounced increase in inflammation during stressful situations (Brown et al., 2018). This heightened response is associated with the conserved transcriptional response to adversity (Uchida et al., 2018), which not only can be triggered by loneliness but can also contribute to it, forming a reciprocal relationship between inflammation and perceived social stressors. The interplay between stress and challenging interpersonal relations appears to magnify inflammatory responses, particularly evident when faced with biologically demanding stressors such as endotoxin (Jaremka, Lindgren, et al., 2013).

Elevated interleukin-6 (IL-6) levels have also consistently been connected with loneliness (Balter et al., 2019; Smith et al., 2020). IL-6 is known for its diverse roles in promoting acute-phase reactants and regulating immune functions essential for acquired immunity. However, imbalanced production of IL-6 can have detrimental health effects and contribute to age-related diseases (Tanaka et al., 2014). Another pro-inflammatory cytokine, TNF-α, involved in immune response regulation and vascular processes, positively correlates with loneliness (Jaremka, Fagundes, et al., 2013). Loneliness is also associated with altered levels of interleukin-2 and interleukin-10, as seen in studies exploring the cytokine profile of breast cancer survivors and its connection to psychosomatic factors (Henneghan et al., 2020).

C-reactive protein (CRP) is a key marker for inflammation and infection and is extremely important in the immune response. It activates the complement system, recognises pathogens, and interacts with Fcγ receptors. Lonelier individuals have been shown to have higher CRP levels (Nersesian et al., 2018; Vingeliene et al., 2019). MCP-1 is a crucial chemokine that regulates monocyte and macrophage migration and is associated with inflammatory diseases. Those who experience loneliness, particularly women and those with type 2 diabetes, exhibit higher MCP-1 levels in response to mental stress, yet again showing higher inflammation rates as a consequence of loneliness (Hackett et al., 2019). In addition to inflammatory markers, loneliness also affects humoral immunity—elders experiencing loneliness exhibit reduced levels of immunoglobulins. Loneliness affects mucosal immunity, potentially making individuals more susceptible to infections, as evidenced by decreased salivary IgA levels linked to stress (Pourriyahi et al., 2021). Interferon levels are lower in lonely individuals, affecting antiviral defence—both type I and type II interferons are down-regulated in response to perceived social isolation. This suggests loneliness may compromise the body's ability to mount an effective immune response against viruses (Cole et al., 2015).

Loneliness and Metabolic and Cardiovascular Factors

Cortisol can be thought of as an indicator of psychological stress. This hormone follows a natural daily pattern, it peaks around 30 minutes after waking up and gradually decreases, reaching its lowest levels at midnight. This rhythmic pattern can be effectively measured using specific cortisol indices. The Cortisol Awakening Response (CAR) measures how much cortisol increases in the first 30 to 45 minutes after waking. The diurnal slope represents the rate at which cortisol decreases from its highest point in the morning to its lowest point. Loneliness has been correlated with alterations in cortisol dynamics, specifically showing an attenuated CAR (Lai et al., 2018).

Studies suggest an association between loneliness and type 2 diabetes mellitus (Foti et al., 2020), hyperglycaemia (Rico-Uribe et al., 2018), and elevated haemoglobin A1c (Shiovitz-Ezra & Parag, 2019) and fasting blood sugar levels (Whisman, 2010). Lonely individuals often have higher triglyceride levels (Abdellaoui et al., 2019) and lower high-density lipoprotein cholesterol (Badcock et al., 2019). Loneliness is also related to an increased body mass index and obesity (Keenan et al., 2018), including central obesity (Kwon et al., 2018), higher waist circumference, and greater body fat (Yen et al., 2018). Individuals with altered dietary habits due to loneliness exhibit increased food consumption and higher intake of sugary beverages (Henriksen et al., 2014), possibly tied to deregulated appetite-related hormones like ghrelin and leptin (Jaremka et al., 2018). Loneliness is further linked to hypertension (Rico-Uribe et al., 2018), which might cause elevated systolic (Kobos et al., 2020) and diastolic (Steptoe et al., 2004) blood pressures, altered cardiovascular function, and reduced autonomic cardiac control. These physiological manifestations contribute to higher rates of cardiovascular diseases, including coronary heart disease, stroke, and increased cardiovascular mortality (Stringhini et al., 2018). This holds true even for individuals with stable coronary heart disease receiving medication as secondary prevention (Hagström et al., 2018).

The Impact of Loneliness on Mental Health and Psychiatric Disorders

As aforementioned, loneliness, which is often overlooked, is more than just a feeling of being alone, as it has detrimental effects on mental well-being (West et al., 1986).

Loneliness and depression often intertwine, sharing common symptoms such as helplessness and emotional pain. Individuals experiencing loneliness are reported to suffer from more depressive symptoms, feeling less happy, satisfied, and more pessimistic. The overlap in the characteristics between these two reaches such a degree that some consider loneliness a subset of depression. However, a crucial distinction lies in the underlying hope of the lonely person – the belief that reunification with a longed-for person could remedy their situation. Nonetheless, depression and loneliness often appear in tandem (Mushtaq et al., 2014).

Loneliness emerges as a significant factor linked to an over two-fold increase in the risk of dementia, positioning itself as not only a consequence but potentially a prodromal stage of cognitive decline. The impact extends to a swifter deterioration in various cognitive areas, including global cognition, semantic memory, perceptual speed, and visuospatial ability (Holwerda et al., 2014). The association between loneliness and Alzheimer's disease can be explained in two ways. First, loneliness might be a consequence of dementia, perhaps as a response to diminished cognitive abilities or as a direct result of the pathology contributing to dementia. Second, loneliness could compromise the neural systems crucial for cognition and memory, making lonely individuals more vulnerable to the effects of age-related neuropathology and reducing neural reserves (Wilson et al., 2007).

Research on suicide has consistently shown a strong association between suicidal thoughts, self-harm, and loneliness. As the degree of loneliness increases, so does the prevalence of suicidal thoughts and self-harming behaviours. The peak season for loneliness corresponds to the peak season for suicide, which occurs in winter and spring. Notably, there are minimal gender differences concerning the link between loneliness and suicide (Stravynski & Boyer, 2001). Loneliness is also related to specific personality disorders, specifically borderline personality disorder (BPD) and schizoid personality disorder. In BPD, the intolerance of aloneness is a central feature that influences and amplifies other symptoms. Regarding schizoid personality disorder, the lack of emotional security and contentment in interpersonal relationships contributes to its manifestation (Mushtaq et al., 2014).

Loneliness: A Pandemic

Urbanisation, changes in communication patterns, and the development of social media have undoubtedly contributed to the reinforcement of loneliness. Despite being recognised as a public health concern and even being labelled as a pandemic, effectively addressing this issue remains incredibly difficult (Lonergan-Cullum et al., 2022; Pop et al., 2022).

Public awareness campaigns are a crucial strategy to educate communities about the detrimental effects of loneliness and advocate the cause of social inclusion. Loneliness remains a somewhat overlooked and stigmatised concept in the modern world; it is often viewed through a lens of negativity and embarrassment; therefore, opening up about it is challenging (Abdellaoui et al., 2019). Addressing loneliness at a societal level requires a shift in perspective and behaviour. The complexity and individuality of loneliness make it resistant to simple solutions. Rather than approaching it as a puzzle that needs to be solved, a more pragmatic stance involves efforts to make loneliness a less painful experience. This nuanced approach acknowledges the enduring nature of loneliness while fostering awareness and understanding to alleviate its impact (Vingeliene et al., 2019). Encouraging non-lonely individuals to extend small gestures—a smile or a kind word—to those who are perceived as lonely can make a significant difference. This way, one acknowledges, with compassion, the shared vulnerability of the human experience, recognising that everyone has been confronted with loneliness at some point (Killeen, 1998).

Strategies to Combat Loneliness

Experiencing periods of loneliness is an inherent part of the human journey, and it is crucial to recognise that these feelings do not imply inherent flaws. Life transitions (for example, graduating, moving, becoming a single parent, or being unemployed) can trigger a sense of isolation. Building self-esteem becomes pivotal in lessening the impact of loneliness, as low self-esteem can hinder social interactions. Engaging in manageable activities and progressively building upon them is a positive strategy. Staying occupied through volunteering or pursuing hobbies provides a sense of purpose and fosters connections with others, which eventually soothes loneliness. Exploring personal interests—participating in evening classes or sports—can be instrumental in redirecting focus from loneliness. Embracing solitude, although unfamiliar at first, can be a liberating experience, promoting self-reflection and confidence. It is essential to realise that feelings of loneliness are transient and may surface during different stages of life. Embracing these emotions and focusing on the present circumstances can be empowering. The internet should be used with caution. Online content can exacerbate feelings of inadequacy, as people often curate idealised versions of their lives. While online communities can be a way to socialise, spending time with people in person is also important. Relying on and trusting new online connections might be as beneficial as dangerous. Persistent and unexplained loneliness may signal underlying issues such as depression, necessitating open discussions with friends, family, counsellors, or healthcare professionals. There is nothing wrong with seeking professional help; trying to fix one's situation is a testament to resilience and the opposite of weakness (12 Ways to Beat Loneliness - Heart Matters Magazine - BHF, n.d.; Coping with Loneliness and Isolation - HSE.Ie, n.d.).


Loneliness is an underestimated and complex emotional state that has a profound impact on human well-being. Rooted in the misalignment between an individual's social preferences and reality, loneliness goes well beyond solitude. Its implications on health are alarming, with systemic consequences affecting cardiovascular, metabolic, and immunologic factors. Loneliness intensifies the stress response and compromises the immune system, leading to inflammation and susceptibility to infections. Mental health is especially susceptible. Depression, dementia, suicidal thoughts, and personality disorders are just the tip of the iceberg of potential consequences. The challenge lies in how we address loneliness as a societal issue to combat stigma and raise awareness. Public campaigns, a shift in perspective, and small gestures of kindness are crucial in mitigating loneliness. In an increasingly interconnected world where human connections often remain superficial, loneliness presents a substantial problem.

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