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The study by Dr. Dutton and co-authors Mihriye Mete, PhD; Marcela Cámpoli, PhD; Nicole R. Schwab, BA; Phyllis Givens, MPH; and Jessica McCann sought to understand the impact of loneliness and social network on mental health.
The height of the COVID-19 pandemic found many people feeling isolated due to quarantine and social distancing requirements. Our research, conducted during the pandemic, found that among middle-aged and older patients with chronic illnesses, the quality of a person’s social network and their feelings of loneliness impact mental health-related quality of life and perceived stress.
Social determinants of health (SDOH) are the factors that impact health outside of the doctor’s office. These include access to education, housing, food, transportation, job opportunities, exposure to discrimination, and the cleanliness of the environment.
Social connection is an underappreciated SDOH that includes social support, isolation, and loneliness. Studies have shown that loneliness increased during the pandemic, with 19% of people surveyed saying they felt lonely on more days than usual.
According to the U.S. Centers for Disease Control and Prevention (CDC), social isolation impacts the physical health of older adults, including:
- Significant increase in the risk of premature death
- 50% increase in the risk of developing dementia
- 29% increase in the risk of heart disease and a 32% higher risk of stroke
- Higher rates of depression, anxiety, and suicide
Studies have shown that older patients with severe illness often face social isolation. This is associated with more difficulty managing their condition and an increased risk of death. Among the participants, 40% lived with HIV/AIDS, 30% were diagnosed with cancer, and 20% faced another critical illness. Most (71%) identified as Black or African American, 18% were other non-white ethnicities (15% identified as Hispanic), and 11% were white.
To understand whether and how the diversity of participants’ social networks and their experience of feeling lonely are related, we studied how these factors correspond to a person’s stress and mental wellness and whether self-compassion and difficulty regulating emotion could affect their outcomes in situations such as loss of a spouse, living alone, age-related hearing loss, and other factors.
Collaborative partners for better health.
In order to study loneliness, we partnered with Food & Friends, a community-based organization that provides home delivery of medically appropriate healthy meals and groceries to critically ill neighbors in the DC region, to help identify and enroll 200 participants with an average age of 59.
We reached the participants by telephone and used screening questionnaires to assess characteristics including:
- Perceived stress: How a person feels about the stress in their life.
- Mental health-related quality of life: A measure of how happy and satisfied a person feels.
- Loneliness: Feeling sad or isolated when a person feels disconnected from others.
- Social network diversity: The number of different kinds of people involved in a person’s life, for example, friends, family, colleagues, and community members.
- Self-compassion: Treating oneself with kindness and understanding.
- Emotion regulation: The ability to manage or control emotions healthily.
Exploring the relationship between these factors helped us understand the risks to older patients with severe illnesses and revealed opportunities for providers to help lower the impact of social isolation.
Results: Loneliness has a significant impact.
Statistical analysis revealed that mental health-related quality of life and perceived stress were strongly related to loneliness, self-compassion, and emotion regulation but not to the diversity of one’s social network.
Mental health related quality of life.
Our analysis has demonstrated that loneliness has a significant, negative impact on mental health-related quality of life, regardless of demographic differences or the diversity of one’s social network.
The participants in our study reported much lower mental-health-related quality of life than most people. Specifically, we learned they have:
- Elevated levels of perceived stress: 54% reported feeling at least moderately stressed, while 13% said they felt highly stressed.
- Extensive loneliness: 62% said they experience moderate loneliness; 21% said their loneliness was severe.
- Average levels of self-compassion
- More difficulty regulating their emotions compared to adults in the DC area.
Among participants with difficulty regulating emotions and with lower self-compassion, the effect of loneliness was even more substantial. However, people who are better able to feel kindly toward themselves had a higher mental health-related quality of life, even if they were lonely.
Our study found that feeling lonely can make people feel more stressed. After considering personal demographics and network diversity, we found that feelings of loneliness significantly indicate perceived stress. Participants with difficulty regulating emotions and low self-compassion reported even more perceived stress.
The good news: Providers can help.
These findings suggest that addressing loneliness and improving coping skills like being kind to yourself and regulating emotions can help people feel better, even in circumstances like a global pandemic.
Interventions by clinicians and mental health professionals can help reduce loneliness and bolster social networks for a positive effect on patients. Social skills training, cognitive behavioral therapy, group therapy, and prescribing social activities and resources reduce loneliness significantly.
Further, helping patients learn coping mechanisms like self-compassion and emotional regulation can build skills that mitigate the harmful effects of loneliness, even among high-risk populations. Dialectical behavior therapy and mindfulness-based stress reduction are both techniques that have proven effective in this regard.
We will continue our work to understand the role of social connection, especially loneliness, as a SDOH. More extensive studies with longitudinal data and participant narratives can help shed more light on self-compassion and emotion regulation in critically ill older adults.
While the COVID-19 pandemic has waned, patients facing life-threatening illnesses remain at high risk for negative consequences from social isolation. Consideration of these factors is among the many other social determinants of health to help improve the quality of life for all patients, especially the most vulnerable.