Loneliness can indeed kill

It’s said to be as bad for your health as smoking up to 15 cigarettes a day, and it’s impacting people all over the country.^[] There is no easy test or simple prescription for it, but its impact is so great that last year the Surgeon General declared it an epidemic: loneliness.

“Loneliness is far more than just a bad feeling—it harms both individual and societal health. It is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death,” Vivek H. Murthy, MD, the 19th and 21st Surgeon General of the United States, wrote in his 2023 Advisory on the Healing Effects of Social Connection and Community.

Data from the American Psychiatric Association suggests that in early 2024, 30% of adults felt lonely at least once a week over the past year.^[] 10% reported that they felt lonely every day. 30% of those between the ages of 18 and 34 said they felt lonely every day or several times a week.

It’s something Carla Marie Manly, PhD, a clinical psychologist in California, sees all too often.

“In my work, I see many people struggling with issues related to loneliness. Many of my clients suffered with loneliness pre-pandemic, but the pandemic surely worsened feelings of loneliness in nearly all of my clients. Even clients who did not suffer from loneliness pre-COVID now feel lonely and isolated, as they lost, or simply have not restored, their pre-COVID social connections,” she tells MDLinx.

“Given the socially oriented nature of our species, we have an unconscious, primary drive to be connected to others for companionship and safety. When a person is deprived of this primary need for connection, their nervous system perceives the separation as a threat to survival. As a result of the perceived threat of being alone and separated from others, the body’s stress response, which creates elevated levels of cortisol—and adrenaline is triggered…If the urge for social interaction is ignored or not met, the feelings of loneliness will persist and create a chronic state of stress that is harmful mentally, emotionally, and physically. In fact, chronic loneliness, and the stress it creates, can lead to higher levels of inflammation in the body; this can lead to a greater risk of illnesses such as diabetes and heart disease.”

What else can loneliness do?

The Surgeon General’s 82-page advisory on loneliness and isolation notes that loneliness can raise the risk of premature death by 26%.^[] It’s also associated with an increased risk of disease, viruses, anxiety and depression as well as lower academic achievement and worse performance at work.

 Shane G. Owens, PhD, a board-certified behavioral and cognitive psychologist based in New York, says there are numerous factors that contribute to society’s loneliness.

“The world seems designed to promote loneliness. Our phones give us immediate access to knowledge and entertainment that used to require interaction with other people. Social media passes for meaningful interaction,” he says.

The Surgeon General’s Advisory suggests that healthcare workers should “explicitly acknowledge social connection as a priority for health.”

Owens argues that it is crucial for physicians to form good bonds with their patients, and to ask them about social connection.

“People who visit doctors more frequently—who need physicians the most—will be more likely to take an active role in their care if they feel like the doctor likes and respects them. Once that relationship is established, you can ask a patient anything, including important questions like, ‘What do you do when you get together with your friends?’ and, ‘How do you feel when you’re with people you care about?’ and expect honest answers. It’s important to assess the balance between social media use and being physically present with others and the quality of the person’s relationships,” he says.

Both Owens and Manly say that physicians should also consider their own feelings of social connection or isolation when addressing the issue of loneliness with their patients.

“None of us, regardless of our profession, are immune [to] the devastating effects of constant loneliness. And for those—such as physicians—whose careers tend to be physically, emotionally, and mentally demanding, a lack of social connection often results due to sheer exhaustion,” Manly says.  

“If a physician feels isolated and lonely, it’s critical that they reach out for support to create the balance, joy, and connection that we all need.”