By Pravik Solanki and Susie Westbury

Dear reader, we live in strange times. We’ve been told countless times of the evils of sugar, the perils of experimenting with drugs, and the hazards of straying from the Mediterranean diet. But there’s an important warning that’s never a part of these conversations, something that has an even worse impact on mortality than obesity: loneliness and social isolation.(1)

You might be surprised to hear that these are pretty different things. Loneliness is the subjective feeling of dissatisfaction with the quality or quantity of relationships, characterised by a sense of lowness, abandonment, and helplessness. Social isolation, on the other hand, is the objective and measurable state of having limited social connections and interactions with others. You would think that loneliness and social isolation would go hand-in-hand, but research shows that they often exist independently of each other.

Picture a young med jaffy in a lecture hall full of people, feeling disconnected from everyone around them. Conversely, imagine an avid trekker who can spend entire weeks alone in the outback, without any subjective sense of loneliness. What’s scary, is that in theory, both of these people have the same deteriorating health outcomes. After accounting for multiple covariates, the increased risk of death is 26% for loneliness, and 29% for social isolation (researchers deemed the 3% difference insignificant).(1) In fact, research shows being socially isolated is equal to the effect of smoking 15 cigarettes every day, or drinking 6 standard drinks of alcohol daily.(2)

So why is being isolated or feeling alone so deadly? The reasons are not fully understood, but theories suggest the impact of loneliness on behaviours may contribute in part to declining health. These may include a decrease in physical activity and increase in health-compromising habits (such as smoking, drinking, and malnutrition).(3) A lack of relationships may also diminish personal motivation to be healthy, and reduces opportunities for others to encourage seeking medical help.(4) However, some studies show that loneliness predicts mortality even if health behaviours are accounted for, hinting that loneliness and isolation trigger a fundamental biophysiological shift.(5) Evidence supporting this theory include laboratory findings of elevated circulating cortisol and proliferation of proinflammatory gene expression in people suffering from loneliness.(5)

We often assume that it’s the elderly who are most at risk of being lonely, and that’s just not true. The 25-44-year-old age group suffers loneliness at a rate of 3.5 times that of the elderly population.(6) In fact, the research shows that almost half of all loneliness is caused by a drastic social change, of the sort we’re likely to go through when we’re young (think moving out of home, starting a new job, or even going rural for placement).(6) Our prized youth is a wonderful thing, but it’s also a time of big and scary transitions.

There’s something else that puts us at risk – the glowing rectangles we eagerly shove in front of our faces every day. In other words, our phones and computers – the cursed blessings that get us in touch with whoever we want, whenever we want it. On the one hand, this is a fantastic invention, because it increases our ability to communicate and have connections with others. But on the other hand, it’s a misleading illusion, where communication often lacks the depth and psychosocial complexity of ‘real’ communication. While online communication will remain a necessary part of our lives, we should not be under the impression that all our social needs can be met through it. A life glued to screens is not a social life at all.

If we’re not careful, studying medicine can be a very lonely path. We will work within a culture of stoicism that frowns upon demonstrations of personal weakness, leading to silence around internal struggles and to feelings of isolation. This is reflected in the devastating depression and suicide rates within the medical profession.

Aristotle once remarked that humans are inherently social creatures. We now have the sociological evidence to back that up — there is empirically something powerful and irreplaceable about human connection. As we toil forwards in this strange and sometimes lonely world they call medicine, it would do us well not to forget this fact.

So next time you’re having a study break, could we make that coffee for two?

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Based on research done for Australian Red Cross by Susie Westbury, Pravik Solanki, Hannah Li, Laura McArthur, and Henry Truong

References

1. Holt-Lunstad J, Smith T, Baker M, Harris T, Stephenson D. Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives on Psychological Science [Internet]. 2015 [cited 6 September 2017];10(2):227-237. Available from: http://journals.sagepub.com.ezproxy.lib.monash.edu.au/doi/full/10.1177/1745691614568352
2. Tickner, R. Improving wellbeing and quality of life through personal connection – Social connectedness programs report 2012/13. Australian Red Cross, 2013 Nov. 16p. Available from: http://www.redcross.org.au/files/20131125_Social_Connectedness_Report_LOW_RES.pdf
3. Hackett R, Hamer M, Endrighi R, Brydon L, Steptoe A. Loneliness and stress-related inflammatory and neuroendocrine responses in older men and women. Psychoneuroendocrinology [Internet]. 2012 [cited 3 September 2017];37(11):1801-1809. Available from: http://www.sciencedirect.com.ezproxy.lib.monash.edu.au/science/article/pii/S0306453012001060?via%3Dihub
4. Steptoe A, Shankar A, Demakakos P, Wardle J. Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences [Internet]. 2013 [cited 3 September 2017];110(15):5797-5801. Available from: http://www.pnas.org.ezproxy.lib.monash.edu.au/content/110/15/5797.full
5. Cacioppo J, Cacioppo S, Capitanio J, Cole S. The Neuroendocrinology of Social Isolation. Annual Review of Psychology [Internet]. 2015 [cited 6 September 2017];66(1):733-767. Available from: https://doi-org.ezproxy.lib.monash.edu.au/10.1146/annurev-psych-010814-015240
6. Franklin, A. A lonely society? Loneliness and liquid modernity in Australia. Aust J Soc Issues [Internet]. 2012; 47(1):11-28. Available from: http://onlinelibrary.wiley.com/doi/10.1002/j.1839-4655.2012.tb00232.x/full

Feature image by Marco Verch at Wikimedia Commons.