A 2016 survey of more than 2,000 American adults found 72 percent report having felt a sense of loneliness, with nearly a third (31 percent) experiencing loneliness at least once a week. The survey was conducted online by Harris Poll on behalf of the American Osteopathic Association in September.
Isolation is often an underlying factor in many of the most common health conditions, including chronic pain, substance abuse and depression, according to osteopathic physicians.
Long working hours, increased use of social media—in many cases surpassing in-person interaction—and a mobile workforce traveling or living far from family contribute to the high rates of loneliness, noted Jennifer Caudle, DO, assistant professor of family medicine at Rowan University School of Osteopathic Medicine.
“Loneliness is an invisible epidemic masked by our online personas, which are rarely representative of our real emotions,” said Dr. Caudle. “It’s important for patients to understand how their mental and emotional well-being directly affects the body. By taking a whole-person approach to care, osteopathic physicians are trained to address these underlying issues that can quietly erode patients’ health.”
Damage to the Immune Response
Research links loneliness to a number of dysfunctional immune responses, suggesting that being lonely has the potential to harm overall health.
In one study, researchers found that people who were more lonely showed signs of elevated latent herpes virus reactivation and produced more inflammation-related proteins in response to acute stress than did people who felt more socially connected.
These proteins signal the presence of inflammation, and chronic inflammation is linked to numerous conditions, including coronary heart disease, Type 2 diabetes, arthritis and Alzheimer’s disease, as well as the frailty and functional decline that can accompany aging.
Reactivation of a latent herpes virus is known to be associated with stress, suggesting that loneliness functions as a chronic stressor that triggers a poorly controlled immune response.
“It is clear from previous research that poor-quality relationships are linked to a number of health problems, including premature mortality and all sorts of other very serious health conditions. And people who are lonely clearly feel like they are in poor-quality relationships,” said Lisa Jaremka, a postdoctoral fellow at the Institute for Behavioral Medicine Research at Ohio State University and lead author of the research.
“One reason this type of research is important is to understand how loneliness and relationships broadly affect health. The more we understand about the process, the more potential there is to counter those negative effects – to perhaps intervene. If we don’t know the physiological processes, what are we going to do to change them?”
The results are based on a series of studies conducted with two populations: a healthy group of overweight middle-aged adults and a group of breast cancer survivors. The researchers measured loneliness in all studies using the UCLA Loneliness Scale, a questionnaire that assesses perceptions of social isolation and loneliness.
Jaremka presented the research at the Society for Personality and Social Psychology annual meeting in New Orleans.
The researchers first sought to obtain a snapshot of immune system behavior related to loneliness by gauging levels of antibodies in the blood that are produced when herpes viruses are reactivated.
Participants were 200 breast cancer survivors who were between two months and three years past completion of cancer treatment with an average age of 51 years. Their blood was analyzed for the presence of antibodies against Epstein-Barr virus and cytomegalovirus.
Both are herpes viruses that infect a majority of Americans. About half of infections do not produce illness, but once a person is infected, the viruses remain dormant in the body and can be reactivated, resulting in elevated antibody levels, or titers – again, often producing no symptoms but hinting at regulatory problems in the cellular immune system.
Lonelier participants had higher levels of antibodies against cytomegalovirus than did less lonely participants, and those higher antibody levels were related to more pain, depression and fatigue symptoms. No difference was seen in Epstein-Barr virus antibody levels, possibly because this reactivation is linked to age and many of these participants were somewhat older, meaning reactivation related to loneliness would be difficult to detect, Jaremka said.
Previous research has suggested that stress can promote reactivation of these viruses, also resulting in elevated antibody titers.
“The same processes involved in stress and reactivation of these viruses is probably also relevant to the loneliness findings,” Jaremka said. “Loneliness has been thought of in many ways as a chronic stressor – a socially painful situation that can last for quite a long time.”
In an additional set of studies, the scientists sought to determine how loneliness affected the production of proinflammatory proteins, or cytokines, in response to stress. These studies were conducted with 144 women from the same group of breast cancer survivors and a group of 134 overweight middle-aged and older adults with no major health problems.
Baseline blood samples were taken from all participants, who were then subjected to stress – they were asked to deliver an impromptu five-minute speech and perform a mental arithmetic task in front of a video camera and three panelists. Researchers followed by stimulating the participants’ immune systems with lipopolysaccharide, a compound found on bacterial cell walls that is known to trigger an immune response.
In both populations, those who were lonelier produced significantly higher levels of a cytokine called interleukin-6, or IL-6, in response to acute stress than did participants who were more socially connected. Levels of another cytokine, tumor necrosis factor-alpha, also rose more dramatically in lonelier participants than in less lonely participants, but the findings were significant by statistical standards in only one study group, the healthy adults.
In the study with breast cancer survivors, researchers also tested for levels of the cytokine interleukin 1-beta, which was produced at higher levels in lonelier participants.
When the scientists controlled for a number of factors, including sleep quality, age and general health measures, the results were the same. “We saw consistency in the sense that more lonely people in both studies had more inflammation than less lonely people,” Jaremka said.
“It’s also important to remember the flip side, which is that people who feel very socially connected are experiencing more positive outcomes,” she said.
Loneliness Can Add 30 Points To Your Blood Pressure
In another study conducted at the Center for Cognitive and Social Neuroscience at the University of Chicago, researchers found that if you are over 50 and lonely, you could be adding 30 points to your blood pressure and raising significantly your chances of suffering from hypertension. The increase in blood pressure due to loneliness was present after taking into account a person’s emotional state (how sad or stressed the person was).
The older the lonely person gets, the higher his/her blood pressure seems to get, said the researchers. Lead researcher, Louise Hawkley, said “The take-home message is that feelings of loneliness are a health risk, in that the lonelier you are, the higher your blood pressure. And we know that high blood pressure has all kinds of negative consequences.”
229 people were monitored in this study, aged 50-68. The participants had to answer a questionnaire which determined each person’s level of loneliness.
Hawkley said it is not as simple as that. She said “Remember, people can feel lonely even if they are with a lot of people. You can think of Marilyn Monroe or Princess Diana – there was certainly nothing lacking in their social lives, yet they claimed to have felt intensely lonely. They may want to go out and make friends, and yet they have a nagging lack of trust with whomever they want to interact with, or they may feel hostile. So, they end up behaving in ways that force potential partners away.”
Loneliness Is Gene Deep
Loneliness has a molecular signature is reflected in the lonely person’s DNA. This was the conclusion of a new US study by scientists at the University of California Los Angeles (UCLA) and other US academic centers.
The study is published in an issue of the journal, Genome Biology. The researchers discovered a distinct pattern of gene expression in immune cells of people who are chronically extremely lonely.
Study author Steve Cole, associate professor of medicine at the Division of Hematology and Oncology at the David Geffen School of Medicine at UCLA, member of the Cousins Center for Psychoneuroimmunology, and member of UCLA’s Jonsson Comprehensive Cancer Center said in a press release that:
“What this study shows is that the biological impact of social isolation reaches down into some of our most basic internal processes: the activity of our genes.” Cole and colleagues suggest that feelings of isolation are linked to changes in gene expression that drive inflammation, one of the first responses of the immune system. They hope the study gives a framework for understanding how social factors and increased risk of heart disease, viral infections and cancer are linked.
Scientists already know that social environments affect health. People who are lonely and socially isolated die earlier. What they don’t know is if the higher rate of death among lonely people is because of reduced social resources or because of the effect of isolation on their bodily functions, or perhaps both.
However, Cole and the other researchers found that changes in the way immune cells express their genes were directly linked to the “subjective experience of social distance”. The differences were independent of other known risk factors like health status, weight, age and use of medication, they said. “The changes were even independent of the objective size of a person’s social network,” said Cole.
Cole and colleagues enrolled 14 participants from the Chicago Health, Aging, and Social Relations Study and scanned their DNA using a chip technology called DNA microarrays that allowed them to survey all known human genes in the samples. 6 of the participants scored in the top 15 per cent of a well known psychological test for loneliness that was developed in the 70s called the UCLA Loneliness Scale. The remaining 8 participants scored in the bottom 15 per cent of the Loneliness Scale.
The DNA survey showed that 209 gene transcripts (where the gene gets its code ready to start making proteins) were expressed differently between the two groups. All the genes coded for leucocytes, agents of the immune system. 78 of the gene transcripts were “over expressed” (resulting in too much protein) and 131 were “under expressed” (not enough protein) in the lonely individuals compared to the others.
The over expressed genes included many that control immune system functions like inflammation. However, it was also interesting that the under expressed genes were those involved in antiviral responses and production of antibodies.
“These data provide the first indication that human genome-wide transcriptional activity is altered in association with a social epidemiological risk factor. Impaired transcription of glucocorticoid response genes and increased activity of pro-inflammatory transcription control pathways provide a functional genomic explanation for elevated risk of inflammatory disease in individuals who experience chronically high levels of subjective social isolation.”
Distinguishing between the various aspects of loneliness that are closely linked to these changes in gene expression, the scientists discovered: “What counts at the level of gene expression is not how many people you know, it’s how many you feel really close to over time,” said Cole. He added that the findings could identify molecular targets for blocking the negative health impact of social isolation.
Loneliness Can Spread Through Social Networks
A US study of social networks found that a person’s loneliness can spread to others, in that when they become lonely they move to the edge of the network and transmit feelings of loneliness to their few remaining friends who also become lonely, leading to an effect that the researchers described as an unravelling at the edges of our social fabric.
The study, which was sponsored by the National Institute on Aging, is the work of John T Cacciopo of the University of Chicago, James H Fowler of the University of California, San Diego, and Nicholas A Christakis of Harvard University and is about to be published in the December issue of the Journal of Personality and Social Psychology.
Cacciopo, a social neuroscientist and lead investigator on the study, is Tiffany and Margaret Blake Distinguished Service Professor in Psychology at Chicago. He told the press that:
“We detected an extraordinary pattern of contagion that leads people to be moved to the edge of the social network when they become lonely.”
“On the periphery people have fewer friends, yet their loneliness leads them to losing the few ties they have left,” he added.
Loneliness is often associated with mental and physical diseases that can shorten life, said Cacioppo, so it is important for us to recognize it and help people reconnect with their social group before they move to the edges.
He and his co-authors wrote that while previous studies have already shown that a person’s loneliness and the number of people they are connected to in a network are linked, we don’t know much about “the placement of loneliness within, or the spread of loneliness through, social networks”.
Using longitudinal data from a large-scale study, they found that loneliness, like a bad cold, spreads in groups: people share their loneliness with others.
Cacioppo and colleagues used data on 5,124 people in the second generation of participants from the Framingham Heart Study, which has been tracking the health of individuals and their descendants for more than 60 years. The data set included information taken every two to four years on participants’ friends and social contacts.
For the study, Cacioppo and colleagues charted the friendship histories of participants and linked them to their reports of loneliness. This showed a pattern of loneliness that spread as people reported fewer close friends, and that lonely people appeared to transmit loneliness to others, and then moved to the edges of their social networks.
“Loneliness is disproportionately represented at the periphery of social networks and spreads through a contagious process,” wrote the researchers.
For example, one pattern might start when a participant reports one extra day a week of loneliness. This is followed by similar reports among his or her next-door neighbors who are also close friends. The pattern of loneliness then spreads as the neighbors spend less time together.
“These reinforcing effects mean that our social fabric can fray at the edges, like a yarn that comes loose at the end of a crocheted sweater,” explained Cacioppo.
The researchers also found that:
- Women were more likely to report “catching loneliness from others” than men (perhaps reinforcing findings from studies that suggest women rely more on emotional support than men).
- Loneliness occurred in clusters and extended up to three degrees of separation.
- A person’s chances of reporting increased loneliness were more likely to be linked to changes in friendship networks than changes in family networks.
The authors concluded that the study helps us better understand the social forces that drive loneliness.
Society may benefit by “aggressively targeting the people in the periphery to help repair their social networks and to create a protective barrier against loneliness that can keep the whole network from unraveling,” they added.
Other studies suggest that as people become lonely they trust other people less and less, and this leads to a cycle of less trusting and more loneliness, which leads to less trusting, and so on, and as time goes by it becomes harder and harder to make friends.
Cacioppo said researchers have seen this social tendency reflected in monkey colonies that drive out members who have been removed and then reintroduced. He said such a pattern makes it all the more important for us to recognize and offset loneliness before it spreads.
The first step in addressing loneliness is to determine whether those feelings are caused by depression. A physician can diagnose any existing mental health conditions and suggest treatment options. To limit loneliness, physicians recommend some simple steps to help increase real social engagement:
- Consider a digital cleanse. Social networks can offer real connections, but the curated platforms may over-emphasize the success of others, which can lead to feelings of inadequacy. For more empowering activities, consider enrolling in a continuing education course or spending time enjoying nature.
- Exercise with others. Participating in a running club, group fitness course or team sport can have dual benefits, creating opportunities to meet new people while also improving physical health. Many sports stores, churches and community groups offer free weekly activities including fun runs and yoga.
- Buy local. Developing a routine that includes visiting a local shopkeeper, coffee shop, farmers’ market or gym builds roots in the community. Creating relationships with local vendors can lead to a sense of shared history and camaraderie.
- Step out of your comfort zone. Introducing yourself to nearby neighbors or engaging with people in the building elevator—while initially uncomfortable—can begin the process of developing community and has the added bonus of alleviating loneliness for others.
- Change jobs, schools or cities. This drastic option is not always possible, and certainly not easy, but it may have the most significant impact. Start by identifying the culture that would best fit your personality and work toward a transition.
“Face-to-face communication is critical for emotional and mental health,” Dr. Caudle added. “Seeking out meaningful human interactions makes patients happier and, ultimately, healthier overall.”
Loneliness has negative effects on your immune system, creates a genetic signature and can spread through social networks. Our digital addictions seem to be contributing to our disconnectedness. Additional studies indicate loneliness significantly shortens lives and can lead to or magnify dementia and Alzheimer’s.
Today is National Cheer up the Lonely Day. Visit with the lonely and bring happy things to talk about. Keep the conversation upbeat, and lively. When you leave, give a big hug and let them know you enjoyed the stay. Sending cards or making a phone call is okay if they live too far away to visit, but what a lonely person really needs is face to face time with other people.
If you are feeling lonely, other studies indicate you are more likely to see a physician with increased frequency. To find a healthcare professional, use HealthLynked. It is a first of its kind medical network built as a social ecosystem with a higher purpose – improving healthcare. Go to HealthLynked.com to learn more, sign up for free, connect with your doctor, find a new doctor, and securely store and share your health information. Download our HealthLynked app available on Apple and Android devices.
 Caldwell, Emily. The Immune System Taxed By Loneliness, Similar To The Effect Of Chronic Stress. Medical News Today, Tuesday 22 January 2013
This work was supported by grants from the National Institutes of Health, the American Cancer Society Postdoctoral Fellowship and a Pelotonia Postdoctoral Fellowship from Ohio State’s Comprehensive Cancer Center.
Co-authors include Christopher Fagundes of the Institute for Behavioral Medicine Research (IBMR); Juan Peng of the College of Public Health; Jeanette Bennett of the Division of Oral Biology; Ronald Glaser of the Department of Molecular Virology, Immunology and Medical Genetics; William Malarkey of the Department of Internal Medicine; and Janice Kiecolt-Glaser of the Department of Psychiatry, all at Ohio State. Bennett, Glaser, Malarkey and Kiecolt-Glaser are also IBMR investigators.
 Lombardi, Yvonne. Loneliness Can Add 30 Points To Your Blood Pressure If You Are Over 50. Medical News Today. Wednesday, 29 March 2006.
 Paddock, Catharine PhD. Loneliness Is Gene Deep. Medical News Today. Friday, 14 September 2007
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