By Laura Freeman

There are no vaccines to protect us from this epidemic. Even before COVID, it was sweeping the nation, increasing the risks for disease and premature death. The Surgeon General’s recent call to action has been echoed by the CDC and the American Heart Association.

Loneliness and social isolation are having roughly the same impact on our health and lifespan as smoking 15 cigarettes a day. The physical health consequences of this failure to connect are increasing the risk of heart disease by 29 percent, stroke by 32 percent, dementia 50 percent and premature death 60 percent.

The causes for this disconnect are widespread. Although the problem is too broad for the healthcare sector to solve alone, providers are in a position to spot the negative physical effects of loneliness in their patients, opening the potential to recognize developing health issues while intervention is still possible.

There are obvious links between feeling alone and mental health issues like depression and anxiety. But how do these feelings affect physical health? We’ve all heard about cases of broken heart syndrome when one spouse dies soon after the other. We’ve read studies about orphanages in eastern Europe where children who weren’t touched or nurtured failed to thrive. But why do married men tend to live longer than single men?

“The support of someone who cares goes a long way toward reducing the impact of stress on the body,” clinical psychologist and associate professor at UAB Medicine Megan Hays, PhD, ABPP, FAACVPR said. “Relationships can also have a positive biochemical effect. Just petting a therapy animal, getting a big hug from someone you love or having a satisfying romantic encounter releases Oxytosin, a hormone that has a lot of positive health effects. Known as the bonding hormone, it can improve mood, reduce blood pressure and cortisol levels and ease anxiety. It can also moderate pain and help people better tolerate it.

“Inflammation, immune response, and sleep problems, which are linked to other health risk factors, all seem to be better in people with good relationships. Across the lifespan, physical health and mental health are inextricably linked to each other and to the quality of our relationships.”

There has been a lot of concern about the impact of loneliness on older people. Some surprising research shows that the two highest peaks in loneliness are in young people in their teens and early 20s, and in adults in their 40s. It is lowest in people in their early 60s.

Why is GenZ, one of the most active groups on social media, also the most likely to suffer from social isolation? “Screen time doesn’t replace the real life interaction that we need,” said UAB assistant professor Margaret Canter, PhD. “Texts can’t provide the same level of connectedness. The more time people spend with digital media, the less time they have to interact in real life situations.

“Since quarantining during the pandemic, young people seem more inclined to see home as their safe place, especially with the wave of mass shootings and violence. And with the spike in inflation, it’s harder to pay for after-school activities and sports programs, which was where many children learned how to make friends.

“Young people are under a lot of pressure as they move away from home, and go out into the world to establish their own identity. At a time in life when building new relationships is so important, it’s getting harder.”

Lonely teens and young adults may be more inclined to turn to drugs to dull the ache of depression, or to negative behaviors like cutting or eating disorders. Anger unbuffered by the support of good relationships may be turned inward into thoughts of suicide, or outward in thoughts of violence.

The next spike in loneliness comes in the 40s, a time of transition.

“Many of the factors involved in social isolation tend to cluster around milestones in life,” Hays said. “In their 40s, people’s children leave the nest. They may be dealing with divorce, the aging or loss of their parents and possibly the early loss of a spouse, sibling or friend. They may have lost touch with the friends and support structures of their youth and are coming to terms with how the passage of time is shrinking the unlimited possibilities of their early years.”

In these years, alcoholism or substance abuse may become a pattern of self-medication. Suicide rates tend to climb as stress and disappointment increase in isolation. Negative health behaviors may lay the groundwork for future chronic illnesses through poor eating habits, lack of activity and no one to help them buffer stress.

“The impact of isolation varies from one person to another depending on whether they tend to be introverts or extroverts,” Hays said “An introvert may interpret time alone as an enjoyable interlude of quiet. However, for an extrovert, being alone is a recipe for disaster.

“Being married or in a relationship tends to be protective, but it is no guarantee. Relationships can also be unhappy. It may be necessary to grow beyond a bad relationship to establish a good one.”

Retirement is another milestone when people need to be aware of maintaining and building new friendships. The early 60s statistically tend to be when family, social and work relationships are at their best. However, how the years that follow go can depend on whether people think of retirement as something they retire from or retire to.

Despite intentions to stay in touch, contact with long-time work friends tends to lessen. These relationships need to be replaced with new friends met through shared interests.

“People should prepare as much for the emotional and social side of retirement as they do the financial side,” Hays said. “Everyone needs either meaningful work or a purpose that gives them a reason to get up in the morning. Think about new things you’d like to try. Join a group that shares that interest. That’s how you meet interesting people you will enjoy being around.”

In the later senior years, relationships shift as health, mobility and access to transportation change. Loss of a spouse and friends can make life more lonely, and loss of health and autonomy can make keeping a positive outlook more difficult. However the positive effects on the risks of illnesses and dementia make social contact worth the effort.

What can health professionals do to reduce the effects of loneliness on their patients? The Surgeon General’s plan includes screening questions in regular health assessments and advises providers to be aware of milestones that may increase the risk of isolation.

Canter said, “Part of my job is teaching our pediatric residents how to recognize loneliness, depression, anxiety and other emotional challenges in children. It’s a skill we need to pass on when dealing with patients throughout their lives.”