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Loneliness: “the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively” (Perlman & Peplau, 1984). All of us experienced moments of loneliness, but what we don’t expect about it is that it may considerably vary, depending on quality, quantity and multidimensionality.

80% of people under 18 experienced loneliness occasionally in their life (Galanki & Vasilopoulou, 2007). This percentage varies in a U-curve pattern over the lifetime (Pinquart & Sorensen, 2001), but 15-30% of the individuals experience chronic loneliness instead (Heinrich & Gullone, 2006). What’s this variability due to? Is it possible for it to be linked to the social network extension alone?

Hawkley & Cacioppo (2010) wrote in their review: “Loneliness is synonymous with perceived social isolation, not with objective social isolation. People can live relatively solitary lives and not feel lonely, and conversely, they can live an ostensibly rich social life and feel lonely nevertheless”. When talking about perceptions, the factors to be considered become numerous, individual and subjective: personality, ethnicity, age, health status, they’re just some examples of things which can influence loneliness experience.

Loneliness and health

Dottoressa - Solitudine
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This multidimensionality becomes even more important when the enormous risks connected to chronic and intense loneliness are taken into consideration. It is enough to think that a premature death risk is incremented by 29% by social isolation and by 26% by perceived loneliness. This risk augmentation is even more surprising because it is comparable to the one experienced by subjects with pathological conditions, as grade 2 or 3 obesity (Holt-Lunstad, Smith, Baker, Harris & Stephenson, 2015).

This happens because, in front of a loneliness experience (be it real or subjective), numerous direct and indirect factors  can compromise aspects related to physical health, sleep, physiological functioning, genic expression and immunitary system, to quote some of them (for a review: Hawkley & Cacioppo, 2010). Starting from the current conditions, the loneliness problem could become epidemic by the year 2030 (Linehan et al., 2014), although its influence is already becoming more serious in relation to the COVID-19 emergency. 

Based on these premises, it is evident how important and urgent it is to define the specific factors that play an individualized role in the temporal and causal determination of experiencing loneliness. A better comprehension of the phenomenon can promote preventive and therapeutic approaches appositely tailored for the “treatment” of loneliness. 

This is the direction taken in Fransenn, Stijnen, Hamers & Schneider’s study (2020): the analysis conducted on the dutch population highlighted how three different age groups (young adults, early middle-aged adults and late middle-aged adults) had different correlations between loneliness perception and the presence of various factors. For example: young adults are particularly sensitive to the frequency of contacts with their friends; early middle-aged adults perceive more loneliness if they’re unemployed; late middle-aged adults’ loneliness perception is linked to their physical health status. 

The clinical implications derived from this study are crucial and consistent with the points previously illustrated:  “Factors associated with loneliness across the adult life span may be understood from an age-normative life-stage perspective. Accordingly, there is no one-size-fits-all approach to reduce loneliness among adults, suggesting that a variety of interventions or an indirect approach may be necessary” (Franssen, Stijnen, Hamers & Schneider, 2020). The study results, besides enriching the theoretic framework, give a contextual frame for the tailoring of personalized interventions, be them therapeutic or preventive, for the management of the loneliness phenomenon.

We interviewed the authors of the aforementioned study, who answered ScientifiCult’s questions.

The interview

Acting on loneliness

Uomo solo in un parcheggio - Solitudine
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As described by Perlman & Peplau’s loneliness definition you indicated in the introduction of your research, loneliness isn’t exclusively connected to quantitative factors, but also to qualitative ones. This is also reflected in some aspects took into consideration during your study, such as ethnicity, financial status, education and psychological stress. Talking about the qualitative factors that make a network effective against loneliness (e.g.: strength, constancy, positivity, etc.), which ones do you think  would be potential candidates in countering loneliness? And, according to your hypothesis, how would they be related to age?

We believe there is not one single qualitative factor that may reduce or prevent loneliness. On the contrary, all qualitative social network factors should be taken into account. We showed in our study that a broad set of factors was associated with loneliness. However, the importance of these factors may differ between individuals according to, for example age. We found that frequency of contact with friends was more strongly associated with loneliness among young adults compared to older adults. This may reflect the differences in relationships that are important to a person across the different life phases. For example, a broad social network may be important for young adults, while a smaller network with more close ties may be important for older adults.

Given the correlational nature of your study, it would not therefore be possible to determine a directionality between perceived loneliness and the factors you explored. Therefore, do you believe that interventions aimed at reducing the perceived loneliness could – at the same time – enhance the perceived quality of life and the factors you investigated? If so, which factors do you think would be better improved, in your opinion?

Individuals who feel lonely may perceive a lower quality of life. Therefore, interventions aiming to reduce loneliness may be effective in improving quality of life as well. Furthermore, interventions targeting the factors associated with loneliness may have the same effect: positively influencing the factors associated with loneliness and thereby reducing loneliness. For example, group-based physical activity interventions may not online improve health but may also reduce loneliness. On top of that, if feelings of loneliness are reduced and health is improved, this may contribute to a better quality of life as well.

In your paper, it is explained that ethnicity plays a role in the perception of loneliness. What kind of approach do you think would be more efficient to counter loneliness, when considering this factor? Would you suggest an approach based on cultural integration or one based on the formation of ethnical groups that work as a support network?

In our research paper we suggest that intervention should be developed for specific age groups. In line with this, interventions based on cultural integration may be effective for young adults, while for older adults the ethnical groups may be effective to prevent/reduce loneliness. As mentioned before, frequency of contact with friends is an important factor in relation to loneliness. Therefore, interventions based on cultural integration may help broaden and diversify the social network of young adults. In contrast to this, older migrants miss their country of origin, especially their family, more compared to younger migrants (Ciabuna, Fokkema & Nedelcu, 2016). In our study we also showed that the association between frequency of family contact and loneliness was stronger among older adults compared to young adults. Therefore, formation of ethnical groups could be effective for older adults as it provides opportunities to share memories about the country of origin.

On the basis of your results in the present study, which ones do you think could be the potential implications for loneliness management in the clinical-therapeutic practice? More specifically, how could it be adapted to the different age groups? And what kind of possible social and political interventions could be derived from these results?

We suggest, based on the results of our study, that interventions to counter loneliness should be adapted to the factors that are relevant for a specific age group. There is no one-size-fits- all approach. Awareness of these age-specific factors is a first starting point in choosing any approach to counter loneliness. This should be followed by an assessment of factors at individual level or among specific age groups, preferably by means of one-on-one conversations, to find out which factors are most relevant. This information can then be used to tailor the intervention to these factors and/or to choose appropriate implementation strategies.

Research and methodology

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A common problem in cross-sectional studies is the difference between the life experiences for the compared age groups. For example, the educational environment in which young adults get their education today is quite different from the one where elder people got their own. How important do you think these differences between life experiences in the three age groups are in influencing your research results? And in which ways was this influence shown?

In our study we did not investigate period or cohort effects on loneliness. Therefore, it is hard to say whether differences between life experiences have influenced our results. However, societal changes may influence feelings of loneliness, but every age cohort has its own difficulties. For example, young adults today experience social pressure (i.e., by social media) and stress as they pursue personal (e.g., having many friends), educational, or career goals. While 20th-century young adults had to deal with the pressure to find a partner and start a family. These differences in life experiences may mediate the factors associated with loneliness across age groups.

In your paper, a trend that negatively correlates age and psychological distress (e.g. the risk of depression) to the loneliness perception is shown. The more people get old, the less the psychological distress makes them feel lonely. How would you explain these results?

We mention that psychological distress is a factor associated with loneliness across all three age groups, because the magnitude of the association was nearly similar across the age groups.

COVID-19 and loneliness

Tablet lockdown - Solitudine loneliness
Photo by Elena Mozhvilo

Is there any plan to continue these studies by including a longitudinal analysis? If so, which variables and questions do you think it would be particularly interesting to examine, for such a development?

At the moment there is no plan to continue this study with longitudinal analysis. However, we are exploring if there is a possibility to perform a study to investigate the impact of the current COVID-19 pandemic on feelings of loneliness.

In the light of the recent developments related to the COVID-19 lockdown, how important do you think that the “new technologies and the ability to use them” factor has been in determining the loneliness perception for the different age groups? In which ways? Do you think this has been true even before the lockdown? Could it be true for the future as well?

What we have learned as a community from the COVID-19 lockdown is how important new technologies and the ability to use them are in staying in touch with friends, family, colleagues, etc. when face-to-face contact is impossible. We think that the young adults were more familiar with these new technologies before the lockdown than the older age groups and therefore were more inclined to use them. On the other hand, not being able to socialize with friends may have impacted young adults more than the older age groups, despite the use of technologies. Thus, new technologies and the ability to use them may certainly impact the loneliness perception although research is needed to study the exact impact.

Bibliography

  • Franssen, T., Stijnen, M., Hamers, F., & Schneider, F. (2020). Age differences in demographic, social and health-related factors associated with loneliness across the adult life span (19–65 years): a cross-sectional study in the Netherlands. BMC Public Health, 20(1). doi: 10.1186/s12889-020-09208-0
  • Galanaki, E., & Vassilopoulou, H. (2007). Teachers and children’s loneliness: A review of the literature and educational implications. European Journal of Psychology of Education, 22(4), 455-475. Retrieved November 3, 2020, from http://www.jstor.org/stable/23421518
  • Hawkley, L., & Cacioppo, J. (2010). Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms. Annals Of Behavioral Medicine, 40(2), 218-227. doi: 10.1007/s12160-010-9210-8
  • Heinrich, L., & Gullone, E. (2006). The clinical significance of loneliness: A literature review. Clinical Psychology Review, 26(6), 695-718. doi: 10.1016/j.cpr.2006.04.002
  • Holt-Lunstad, J., Smith, T., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives On Psychological Science, 10(2), 227-237. doi: 10.1177/1745691614568352
  • Linehan, T., Bottery, S., Kaye, A., Millar, L., Sinclair, D., & Watson, J. (2014). 2030 vision: The best and worst futures for older people in the UK. London, England: Independent Age and International Longevity Centre-UK.
  • Pinquart, M., & Sorensen, S. (2001). Influences on Loneliness in Older Adults: A Meta-Analysis. Basic And Applied Social Psychology, 23(4), 245-266. doi: 10.1207/s15324834basp2304_2