Isolation. To be alone; separated from others. It’s a condition mankind naturally avoids and will take extreme measures to prevent. Humans have a legitimate need to belong. To be a part of something. Children long for parents. Adolescents seek friends and groups to identify with. Adults seek friends, spouses and children. Elderly seek family and friends. We need community to survive and thrive, and the fear of isolation often leads people to seek out support groups, clubs, group activities, and other social groups. Even gangs are built on our need for community.

Despite technological advances designed to connect people, statistics show that we are more isolated and lonely than ever before. Social media may give us the illusion of being connected to more people, but relationships are increasingly distant and shallow, leaving us lonely and isolated. As the seeds of loneliness and isolation grow, they not only affect our emotional and psychological health, but spring up into weeds of deteriorating physical health.

Nearly 35 percent of all US adults over the age of 45, 80 percent of those under 18 years, and 40 percent of those over 65 years are reported as lonely. We can assume the number is much higher when unreported incidences are considered. Concern lies in the fact that loneliness and isolation are bio-psychosocial determinants of health worldwide.

HPA Activation

Perceived social isolation and loneliness are stressors that activate the hypothalamic-pituitary-adrenocortical (HPA) axis, increasing glucocorticoids which exert their effects on glucose regulation, metabolism, inflammatory control, cardiovascular, reproductive, and neuroendocrine health. Long-term HPA activation (formerly considered adrenal fatigue) has been well-established as a root cause of chronic metabolic, endocrine, inflammatory and psychological health challenges. In fact, nearly half of all incidences of anxiety include perceived loneliness. It is interesting to note that objective isolation is not linked to HPA activation; only perceived isolation and loneliness. Individuals can be socially active, but still feel disconnected and lonely, or individuals can live solitary lives, but feel connected and lack loneliness. Identifying perceived loneliness and/or isolation is important when assessing causes of HPA activation and consequential health outcomes.

Cardiovascular Health

Isolation and loneliness are linked to one of our greatest causes of mortality – cardiovascular disease – and most especially among women. Both objective or perceived social isolation and loneliness can lead to physical inactivity and loss of motivation for engaging in healthier lifestyles and using coping mechanisms. HPA activation triggers inflammatory responses and immune activation, leading to higher blood pressure, increased vascular resistance, insomnia, and other cardiovascular risk factors. In a systematic review and meta-analysis of the association between loneliness or social isolation and incidents of cardiovascular disease or stroke, “poor social relationships were associated with a 29% increase in risk of incident CHD and a 32% increase in risk of stroke.” In another study assessing the association between loneliness and risk of incident coronary heart disease (CHD) over a 19-year follow-up period, loneliness was prospectively associated with increased risk of incident CHD in women after controlling for age, race, education, income, marital status, hypertension, diabetes, cholesterol, physical activity, smoking, alcohol use, systolic and diastolic blood pressures, body mass index, and depression. Interestingly, no significant association was noted among men in the study, although other studies have shown association within both sexes.

Mortality

Loneliness and social isolation have been well-established as risk factors for early mortality. A meta-analysis of mortality and its association with loneliness, social isolation, or living alone found a 29%, 26%, and 32% increased likelihood of mortality, respectively. Several confounding factors were accounted for and there were no differences between objective or perceived isolation. However, loneliness and isolation were greater predictors of death among individuals younger than 65 years.

As we face the reality of an increasing number of individuals feeling lonely or isolated, we must be aware of the numerous, and perhaps, even life-threatening consequences, and seek to offer emotional, psychological and physical therapies to combat these emotions. Similar to our epidemic of chronic stress, loneliness and isolation should not be ignored if we are going to give others hope for healing and the gift of a long, healthy, enriched life.