Defining loneliness & social isolation, risk factors, measurement, prevalence, impact, stigma, strategies to address, social work practice approach
Three sections follow:
Background Material that provides the context for the topic
A suggested Practice Approach
A list of Supporting Material / References
Introduction: Three key facts about loneliness
Loneliness is a critical issue of our time. Loneliness carries risks associated with poorer health outcomes, lower workplace productivity, and decreased quality of life, yet remains severely neglected within our communities. It is not routinely monitored and consequently not well managed.
Loneliness is not equivalent to social isolation. Solutions that reduce social isolation may not reduce loneliness.
Loneliness is a consequence of a multitude of factors and therefore solutions will differ across different communities and individuals. A one-size-fits-all solution will not work (Ending Loneliness Together, 2020).
Defining Loneliness and Social Isolation
Social isolation: An objective, measurable lack of contact with social connections, usually when a person experiences a low number of social interactions, e.g. a person may engage in social relationships but both the frequency and amount of engagement within the interactions do not provide enough social connection (Strawa, 2022). Put simply, social isolation is an absence of social connections (Smith & Lim, 2020).
Loneliness is not equivalent to social isolation (Ending Loneliness Together, 2020). Smith and Lim (2020) describe it simply as a subjective dissatisfaction with relationships. Strawa expands on this definition: loneliness is a person’s subjective feeling about, or perception of, the quality their social connections. Usually, loneliness is a negative feeling of being unsatisfied with their social relationships and connections. Some approaches differentiate between types of loneliness:
Positive loneliness: voluntarily reducing the quality and quantity of social connections, usually temporarily, e.g. for solitude, privacy.
Negative loneliness: a feeling that social interactions and connections are less than someone would like. Usually just referred to as ‘loneliness’.
Emotional loneliness (synonymous with emotional isolation): a perceived lack of close emotional or intimate connection, often from a specific companion.
Social loneliness: a perceived lack of social connections with people who have similar interests (Strawa, 2022).
A substantial body of evidence shows that when people feel lonely, this can have a detrimental impact on their wellbeing, health, productivity, and functioning in daily life (Ending Loneliness Together, 2020).
Risk factors for loneliness
Transitions in life are important risk factors for loneliness: (i) from school to work or study or simply moving away from home, (ii) from work to retirement, (iii) from a relationship to bereavement and widowhood, (iv) experiencing declining physical health, (v) change in financial circumstances, (vi) movement to an aged care facility.
Specific groups can face loneliness at times: Single parents, people with a disability, carers, those from low socio-economic backgrounds, those with a migrant background, those who are from non-English speaking backgrounds, and those who live alone are more likely to be vulnerable to problematic or enduring levels of loneliness.
Other risk factors for loneliness include socio-environmental factors, such as the culture and climate within workplaces and the way that social communication tools are used. Additional factors, such as urban design, access to community spaces (e.g., parks, libraries, neighbourhood houses) and transport accessibility, are likely to facilitate a person’s capacity to initiate and maintain meaningful social connections (Ending Loneliness Together, 2020).
Measuring loneliness and social isolation
The Campaign to End Loneliness (2019) suggests two tools for measuring loneliness in adults and children. The first relies on the University of California, Los Angeles three-item loneliness scale and adds a fourth direct question about loneliness. The reason for asking the four questions together is that the stigma of loneliness may mean that people underreport their feelings if asked directly. The other questions also help in understanding other aspects that contribute to a person’s feelings of loneliness. The same questions are used for adults and children, but with different endings (included in italics) for questions one and three.
1. How often do you feel that you [lack companionship]? have no one to talk to?
Hardly ever or never Some of the time Often
2. How often do you feel left out?
Hardly ever or never Some of the time Often
3. How often do you feel [isolated from others]? alone?
Hardly ever or never Some of the time Often
4. How often do you feel lonely?
Hardly ever or never Some of the time Often
The Campaign to End Loneliness (2019) also suggests another scale where questions are positively worded and do not make explicit mention of loneliness so as to be as inclusive and widely useful as possible. This scale is based on the conceptualisation of loneliness as a subjective state, taking place when there is a mismatch between the social contact a person has, and the social contact the person wants. Practitioners ask respondents about the extent to which they agree with three statements:
1. I am content with my friendships and relationship.
Disagree _______________________________________ Agree
2. I have enough people whom I can ask for help at any time
Disagree _______________________________________ Agree
3. My relationships are as satisfying as I would want them to be.
Disagree _______________________________________ Agree
How common is loneliness?
Loneliness is a critical issue of our time. A subjective sense of social isolation - that is, simply feeling lonely - is equally important to being physically isolated. Many people who feel lonely suffer in silence, as this issue is stigmatising, driven by a fear of being unneeded or looking weak, vulnerable, or inept. Based on Australian online surveys conducted in 2018 and 2019, it is estimated that at least one in four Australians aged 12 to 89 experience problematic levels of loneliness, i.e. around 5 million Australians at any given time (Ending loneliness Together, 2020; Smith & Lim, 2020). Those aged 18 to 25 years and 56 to 65 years showed increased vulnerability to loneliness in the 2028-2019 surveys (Ending Loneliness Together 2020; Strawa, 2022).
People with disability, carers, people from a migrant or non-English speaking backgrounds, lower income households, and people living alone are also more likely to report problematic experiences of loneliness or social isolation. Australians rarely look to their community for assistance (Ending Loneliness Together, 2020; Strawa, 2022).
Nearly 3 in 10 (28%) people with disability aged 15–64 experience loneliness compared with 16% of those without disability. This is even higher among people with severe or profound disability (37%) than those with other disability (27%). Among people with disability, younger age groups have higher rates of loneliness than older age groups (AIHW, 2022).
Workplace loneliness is an unpleasant feeling that occurs when employees are dissatisfied with their relationships with the people they work with, and the organisations they work for. Approximately 37% of Australian workers feel lonely while nearly a quarter do not engage in any activities to connect them with their colleagues. The flow-on impact on workplace safety, absenteeism, employee retention, and business productivity means that workplace loneliness is also a significant issue for the Australian economy. Loneliness is associated with poorer job performance and job satisfaction, lower organisational commitment and reduced creativity. Lonely employees report more workplace errors, take more sick leave and have a stronger intention to quit (Ending Loneliness Together, 2020).
The impact of loneliness
Loneliness is associated with a 26% greater risk of premature mortality, with similar figures applying to those living alone or socially disconnected. It is associated with numerous chronic health conditions, e.g. cancer, coronary heart disease, stroke, elevated blood pressure, elevated levels of cholesterol and impaired cardiac function. In spite of this, loneliness is not routinely assessed as an indicator of health. Loneliness is a precursor to poorer mental health outcomes, including depression and increased suicide ideation. However, it is rarely seen as a major focus of mental health treatment with limited recognition that one can remain lonely after mental health care (Ending Loneliness Together, 2020; Smith & Lim, 2020).
Loneliness in children and adolescents plays out in poorer mental and physical health outcomes, including increased rates of anxiety, depression, suicidal ideation, and substance use. Attendance, engagement, academic achievement at school and overall school experience can be negatively impacted. (Ending Loneliness Together, 2020; Strawa, 2020).
Loneliness and social isolation have been shown to significantly impact older adults, both physically and emotionally. Negative effects associated with loneliness in old age include quality of life, cognition, subjective health, stress and depression, decreased quality of sleep, disability, cardiovascular disease, increases use of health care services, increased mortality, and institutionalisation (Berg-Weger & Morley, 2020). Older people experiencing loneliness are more at risk of elder abuse (Strawa, 2022).
Lubben et al. (2015), echoing a similar theme to that outlined above, suggest studies have demonstrated a link between social isolation and
Susceptibility to the common cold,
Ability to survive a natural disaster
Increase in both morbidity and mortality
Poor overall health and wellbeing
Adherence to desired health practices
Symptoms of psychological distress
Cognitive impairment and dementia
Financial scams and manipulations
The stigma of loneliness and its impact
The stigma of loneliness means that many more people are uncomfortable talking about their feelings of social isolation and disconnection. This means that there are countless people living with persistent loneliness who do not access the help that is available in their community. Furthermore, this stigma makes it difficult for service providers to intervene and help address loneliness. No amount of investment in services and interventions to reduce loneliness will be successful unless the stigma of loneliness is also addressed.
This stigma is often social stigma—fear of being judged adversely by the community, which has some basis in fact where others can think a lonely person has something wrong, or are unfriendly, or loneliness is their fault. Furthermore, in the media, loneliness is commonly viewed as an indication of personal failure. Stigma can also be self-stigmatisation, leading to loss of self-esteem. Therefore to address loneliness, there is a need to lift the stigma associated with it. Loneliness should be seen as a normal experience that motivates us to connect with others and repair or rebuild our social bonds (Ending Loneliness Together, 2020).
Addressing loneliness and social isolation
Understanding people’s experiences of social isolation and/or loneliness has implications for the interventions that can provide support. Research evidence suggests that practitioners should consider both social isolation and loneliness when supporting individuals and their families. Four general groupings can be used to describe individual experiences of social isolation and/or loneliness. These groupings can help practitioners to choose appropriate interventions or supports (Strawa, 2020).
Loneliness interventions are programs and services that are designed to assist people to be more socially connected and decrease experiences of loneliness. Some interventions focus on support for the individual whilst others look at implementing wider community changes. Interventions can be direct or indirect. Direct interventions focus specifically on loneliness (e.g., social skills training to improve ability to make friendships), whereas indirect interventions do not have loneliness as a primary outcome but may assist people with loneliness in an indirect way (e.g., a mental health support group where people may make connections with others). Direct interventions include:
Changing cognitions, i.e. changing patterns of thinking where people perceive themselves to be lonely thereby experiencing low self-esteem and have difficulty trusting others. These negative perceptions can contribute to greater interrelationship difficulties which subsequently maintain feelings of loneliness. Existing therapies, such as Cognitive Behavioural Therapy, that target negative cognitions, are now being used to address loneliness. Several studies have demonstrated that CBT effectively reduces the feeling of loneliness by increasing positive thinking, enhancing pro-social behaviours and challenging negative perceptions that may be hindering relationship-building.
Social skills training and psycho-education increase understanding of the importance of social relationships and enhance social and conversational skills. Both can be delivered on an individual or group basis.
Supported socialisation, where people are guided and encouraged by an aide to attend social events or take part in services can alleviate loneliness. The supporters may include peers, professionals and family members who assist individuals looking to increase their socialisation. Supporters provide motivation and encouragement, while working with people who are lonely to set their own targets and review their needs (George, Fang & Lauria, 2021; Lubben at al., 2015).
Williams et al. (2021) offer a similar approach suggesting effective interventions for loneliness include psychological therapies, skill development, education, and social facilitation:
Social facilitation via group meeting between neighbours can improve social isolation but not necessarily loneliness
Psychological therapies such as mindfulness, meditation and laughter therapy can be effective with loneliness
Leisure and skill development programs such as exercise programs, gaming interventions and gardening improved loneliness; gardening improved social isolation.
Education on friendship and social integration decreased loneliness.
For older people, medical interventions may be necessary in some situations, e.g. major depression, but developing compassionate social communities is a key approach to dealing with loneliness. A variety of group therapies such as laughter therapy, reminiscence therapy, horticulture therapy, exercise and dancing can all reduce loneliness. Circle of Friends is one example of a group therapy. The group of approximately eight older adults who have self-identified as being lonely or socially isolated meet 12 times over three months. with a facilitator The purpose of the group is to make new friends, feel less lonely, share feelings of loneliness with others and experience meaningful things together. The ideal outcome is to transition into a self- supportive group who continues to meet after the initial three months. Each session includes three components: 1) art and inspiring activities with discussion; 2) group exercise and health-themed discussion; and 3) therapeutic writing with sharing and reflecting on issues related to loneliness (Berg-Weger & Morley, 2020).
Bessaha et al (2019) list interventions for addressing loneliness to specific groups:
Parents and Caregivers Cognitive group therapy, sharing experiences with others via telehealth interventions, virtual online groups, SMS text messaging.
People with Mental Illnesses Internet forums, group-based online programs, community-based interventions, mindfulness-based stress reduction interventions, group psycho-education.
People with Disabilities Interventions at the individual level, and in a community setting.
People with Chronic Illnesses Individual psychosocial support using technology and community interventions, using group support structures and technology.
Immigrants and Refugees Face-to-face contact in a group format.
The Australian Government report into loneliness as part of the Australia’s Welfare 2021 study suggests that having paid work, caring for others, engaging in volunteer work and maintaining active membership of community organisations are associated with reduced social isolation, but may not necessarily be a protective factor against loneliness. It suggests owning a pet can increase social connections—triggering conversations, facilitating contact with neighbours. It found that being in a relationship is a greater protective factor against loneliness for men than women (AIHW, 2021).
Smith and Lim (2020) summarise the above by suggesting the broad strategies that have demonstrated effectiveness in combatting loneliness are those that facilitate engagement in meaningful, satisfying group activities, and psychological interventions to address the maladaptive cognitions associated with loneliness. However, they warn that many programs to address social connectedness and wellbeing are of uncertain benefit. They stress that just increasing social connection will not necessarily address social isolation and loneliness.
One of the central themes to emerge from the above material is the need to adapt any interventions around social isolation and loneliness to the individual circumstances of the person being supported:
Loneliness is understood to be complex and multifaceted; people are lonely for different reasons. Some people experience transient loneliness, that is a sense of loneliness related to their current circumstances, whereas others experience chronic loneliness that recurs throughout their lives. There is no ‘one size fits all’ solution to loneliness, so a range of interventions and approaches are necessary (George, Fang & Lauria, 2021).
The links between social isolation and loneliness are well-established but the success of interventions depends on how well practitioners understand an individual’s needs and the causes of their experience (Strawa, 2020).
A one-size-fits-all approach does not exist when addressing social isolation and/or loneliness.There remains uncertainty about what is effective for different population groups, particularly for prevention and for addressing the more complex condition of loneliness, because there is surprisingly little evidence to guide strategies of mitigate these conditions.Social isolation and loneliness are distinct conditions and a solution to reduce social isolation may not lead to lower incidence of loneliness. Addressing loneliness is more complex and nuanced than simply increasing social connection (Smith & Lim, 2020).
On the other hand, social workers are well placed to support cross-sector collaboration to address social isolation and loneliness because of their emphasis on person-centred and community-based interventions (Lubben et al., 2015). A practice approach in this area appears to revolve around the following (not necessarily in order):
Becoming aware of individual circumstances through a BPSS assessment,
Awareness of risk factors for loneliness,
Asking questions to understand/measure the level of social isolation and loneliness,
Working with the person to devise a plan to respond to his or her unique circumstances.
The information in the Background Material section above can help with the above. For example
The bio-psycho-social-spiritual assessment forms part of the initial information gathering. This is covered in a separate topic on this website and can be accessed via the content tab. If loneliness emerges as an issue, explore if stigma is an issue for the person and take steps to address this.
Is the person a member of an ‘at-risk’ group? Single parents, people with a disability, carers, those from low socioeconomic backgrounds, those with a migrant background, those who are from non-English speaking backgrounds, and those who live alone.
Is the person transitioning from one living situation to another? School to work/study/home, work to retirement, bereavement/widowhood, decline in physical health, financial pressure, movement to aged care.
Are there other factors? Workplace issues, access to community facilities, transport.
Two approaches to measuring loneliness and social isolation are outlined
It may be relevant to explore (in more detail than discovered by the BPSS) the impact loneliness is having on the person. This awareness-raising may provide motivation for change.
With a comprehensive knowledge of the person’s situation, consider whether/which direct interventions may be options. Interventions may include
Changing cognitions (increasing positive thinking, enhancing pro-social behaviours, challenging negative perceptions, addressing stigma)
Social skills training
Psychological therapies, e.g. mindfulness, meditation, CBT, laughter therapy, and others in the previous material
Supported socialisation through group work, exercise groups, other interest groups, volunteer work
Strategies to help address loneliness are available. They may be useful to incorporate into material to offer to lonely or socially isolated people. The Victorian health department (VicHealth, 2019) suggests:
Act, not react. Understand that feeling lonely is normal and it is a signal for you to do something different in your current social relationships.
Signal. Signal to others your willingness to connect. Simple acts such as smiling and open body language helps others know you are willing to interact.
Speak. A confidante can help alleviate loneliness; this can be a professional person such as a school counsellor or a teacher.
Focus. Getting more friends may help some but for others it could be easier to focus on improving the quality of a few relationships.
Find ‘your people’. Join a sports team, choir, art class or volunteer – spending time with like-minded people with common interests is a great way to make friends.
Take the time. Repeated social interactions with others also builds trust.
Set realistic expectations. Friendships and relationships are dynamic. Your connection with a person wavers over time so don’t get down on yourself if you’re not seeing certain friends all the time.
Manage social fears. Your fear of being judged by others may stop you from interacting with people. Seek help to gain more confidence around social interactions to make this easier.
Manage feeling down. If you think you feel sadder and more depressed about your social situation than you should, speak to someone you trust or a health professional (VicHealth, 2019).
More recently Lim (2021) suggests the following for what to do when one feels lonely:
Think positive. When worrying in social situations, try shifting your focus to the other person or topic of conversation.
Forget comparison. Instead of focusing on what you lack, try to focus on and develop the things you have.
Expect change. It’s natural for relationships to change over time.
Sit with discomfort. Meeting new people, despite some discomfort, can help to improve your social confidence.
Active listening. Show you are engaged via actions and words.
Practice small talk. Start small talk and it may lead to deeper conversations.
Say names. Offering your name, and saying theirs, can make for a more connected conversation.
Go offline. Make time to interact with others in real life.
Start a conversation. A simple hello can help others and you feel connected.
Be kind. Helping others makes us feel good and can help build more meaningful connections.
Join in. Find what local activities suit your interests and join in.
Reconnect. Take small steps to reconnect with old friends.
AIHW: Australian Institute of Health and Welfare. (2021). Australia’s welfare snapshots 2021: Social isolation and loneliness. https://www.aihw.gov.au/reports/australias-welfare/social-isolation-and-loneliness
AIHW: Australian Institute of Health and Welfare. (2022). People with disability in Australia 2022. DIS 72. AIHW, Australian Government.
Berg-Weger, M., & Morley, J. E. (2020). Loneliness in old age: An unaddressed health problem. Journal of Nutrition, Health and Ageing, 24(3), 243-245. http://dx.doi.org/10.1007/s12603-020-1323-6
Bessaha, M. L., Sabbath, E. l., Morris, Z., Malik, S., Scheinfeld, L., & Saragossi, J. (2019). A systematic review of loneliness interventions among non-elderly adults. Clinical Social Work Journal, 48, 110-125. https://doi.org/10.1007/s10615-019-00724-0
Campaign to End Loneliness. (2019). Measuring loneliness. https://www.campaigntoendloneliness.org/frequently-asked-questions/measuring-loneliness/
Ending Loneliness Together. (2020). Ending Loneliness Together in Australia. https://endingloneliness.com.au/whitepaper-ending-loneliness-in-australia/
George, L., Fang, L., & Lauria, E. (2021). Addressing loneliness: Initiatives in Australia. Friends for good. https://friendsforgood.org.au/assets/downloads/FriendsForGood-ResearchReport-AddressingLoneliness.pdf
Lim, M. (2021). What to do if you feel lonely. Ending Loneliness Together, resources/tip sheets. https://endingloneliness.com.au/resources/
Lubben, J., Gironda, M., Sabbath, E., Kong, J., & Johnson, C. (2015). Social isolation presents a grand challenge for social work. Grand Challenges for Social Work Initiative, Working Paper 7. https://grandchallengesforsocialwork.org/publications/social-isolation-presents-a-grand-challenge-for-social-work-working-paper-no-7/
Smith, B., & Lim, M. H. (2020). How the COVID-19 pandemic is focusing attention on loneliness and social isolation. Public Health Research and Practice, 30(2), e3022008. https://doi.org/10.17061/phrp3022008
Strawa, C. (2022). Understanding and defining loneliness and social isolation. AIFS. https://aifs.gov.au/resources/resource-sheets/understanding-and-defining-loneliness-and-social-isolation
Vic Health. (2019). The young Australian loneliness survey: Understanding loneliness in adolescence and young adulthood - research summary. https://www.vichealth.vic.gov.au/media-and-resources/publications/young-australian-loneliness-survey
Williams, C. Y. K., Townson, A.T., Kapur, M., Ferreira, A. F., Nunn, R., Galante, J., Phillips, V., Gentry, S., Usher-Smith, J. A. (2021). Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review. PLoS ONE 16(2): e0247139. https://doi.org/10.1371/journal. pone.0247139