Loneliness: A Significant Stressor that Requires Intervention
Laurie A. Theeke, PhD, FNP-BC, is an alumna of the Robert Wood Johnson Foundation Nurse Faculty Scholars program and an associate professor of nursing at West Virginia University School of Nursing.
The Burden of Stress in America, a new report commissioned by NPR, RWJF, and the Harvard School of Public Health, makes it clear that Americans are experiencing extremely stressful life events that are contributing to poor health outcomes. As a researcher who studies loneliness and how it contributes to poor health, I found the report somewhat alarming. Many of the life events identified by survey respondents are already associated with loneliness in the health and social science literature. Stressful events like new illness and disease, losing a spouse or loved one, or major life transitions can all lead to a personal experience of loneliness. This is very concerning because loneliness is a unique psychological stressor that can be hard to recognize or remedy without professional help.
Loneliness is a significant biopsychosocial stressor that contributes to multiple chronic conditions. We have known since the 1950s that there is an association between loneliness and cardiovascular problems like hypertension (Hawkey, Masi, Berry, & Cacioppo, 2006). More recent studies have identified loneliness as a major predictor of stroke as well.
In addition, loneliness creates considerable anxiety and is a major predictor of depression. Newer studies report that loneliness may also be contributing to the obesity problem in America, which is interesting since The Burden of Stress in America report notes that 39 percent of Americans were eating more in response to stress.
It has become clear that loneliness is a predictor of functional decline and mortality in older adult populations (Buchman et al., 2010; Luo, Hawkley, Waite, & Cacioppo, 2012). And it is clear that when people develop loneliness, they often engage in negative health behaviors such as stress eating, smoking, substance use, or diminished exercise time.
I found it particularly interesting that survey respondents reported that they are aware that the major stress in their lives is contributing to negative emotional well-being, and preventing them from spending time with friends. The findings in this report are significant and make it even more important that we assess for and treat loneliness. Let’s think about how we can support screening programs for loneliness and subsequent treatment. Assessing for loneliness can be as easy as asking three simple questions from the Three-Item Loneliness Scale (Hughes, Waite, Hawkley, & Cacioppo, 2004):
1. How often do you feel that you lack companionship?
2. How often do you feel left out?
3. How often do you feel isolated from others?
Asking these questions would be a great way to begin recognizing loneliness in others. Once recognized, it will be important for health care teams to use an intervention that targets thinking errors that often come with loneliness, such as feelings of social undesirability, stigma, and negative thoughts about self in relation to others and community.
My research team, with support from the RWJF Nurse Faculty Scholars program, has developed a new intervention for loneliness called LISTEN (Loneliness Intervention using Story Theory to Enhance Nursing sensitive outcomes). LISTEN has demonstrated feasibility, acceptability, and effectiveness for diminishing loneliness in the first randomized trial.
It seems significant to me that the major way that people are reporting coping with stress is by regularly spending time with friends, meditating, praying, going outdoors, engaging in healthy behaviors, and spending time with pets. Several of these coping mechanisms may also help to stave off loneliness during very stressful times of transition.
The NPR/RWJF/Harvard School of Public Health report contributes to our knowledge about what people may be sacrificing when they take on excessive obligations. The toll may be too much and very costly to the health care system.
Buchman, A. S., Boyle, P. A., Wilson, R. S., James, B. D., Leurgans, S. E., Arnold, S. E., & Bennett, D. A. (2010). Loneliness and the rate of motor decline in old age: the Rush Memory and Aging Project, a community-based cohort study. BMC geriatrics, 10, 77. doi: 10.1186/1471-2318-10-77
Hawkey, L. C., Masi, C. M., Berry, J. D., & Cacioppo, J. T. (2006). Loneliness is a unique predictor of age-related differences in systolic blood pressure. Psychology and aging, 21(1), 152-164. doi: Doi 10.1037/0882-79126.96.36.199
Hughes, M. E., Waite, L. J., Hawkley, L. C., & Cacioppo, J. T. (2004). A Short Scale for Measuring Loneliness in Large Surveys: Results From Two Population-Based Studies. Research on aging, 26(6), 655-672. doi: 10.1177/0164027504268574
Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: a national longitudinal study. Social science & medicine, 74(6), 907-914. doi: 10.1016/j.socscimed.2011.11.028