A Measure of the Problem

On the surface, determining a person’s sense of loneliness and social isolation should be straightforward: just ask them how they feel and who they are socially connected with. But the reality is much more complicated, says Professor Chen Yu-chih, Assistant Professor of Social Work and Social Administration, who is working with collaborators in the US, UK and South Korea in response to a call from the World Health Organization for a measure that would allow for international comparisons.

While standardised questionnaires for loneliness exist, different countries have different ideas about what makes a person socially isolated.

“Social isolation is about things like social network size and quality, social participation, social support and proximity to people. In China, living in a rural area is considered an indicator of social isolation. In the UK and US, participation in religious activities, such as attending church, is a measure,” he said. “We are using large datasets of about 20,000 people each from China, the UK, US and South Korea to try to find more general denominators.”

The data, collected between 2011 and 2018, is also allowing Professor Chen to test the connections between physical activity, depression, social isolation and health. While the full results will not be available for at least another year, a couple of interesting early findings have emerged.

One is a correlation of sorts between social isolation and loneliness. While people can feel lonely yet not be socially isolated, or vice versa, if they are both lonely and isolated, they have a higher risk of severe mental distress.

The other result is a lower reporting of loneliness in China, which Professor Chen said may be attributable to cultural reasons. “Chinese people tend not to share their feelings so that may be why they report a lower rate of loneliness,” he said. He will dig deeper into this as the full results emerge.

Reluctance to engage

Professor Benjamin Ho Mu-hsing, Assistant Professor of Nursing, has also found that it can be difficult to get lonely people to join qualitative studies and accept interventions. He has been working with data from more than 10,700 older adults in the 2018 China Health and Retirement Longitudinal Study, in which 28 per cent reported feeling lonely.

“People who suffer from loneliness won’t usually come to an interview and share what they think, so it is frustrating,” he said. “We can only capture how people feel in the moment. We don’t have very concrete concepts or measures beyond things like a self-reporting loneliness scale.”

His attempts to use robots and pets in Taiwan and New Zealand have also shown the limits of interventions when lonely people are unreceptive to outreach – those most lonely or isolated are less willing to interact.

Professor Ho thinks it might be better to categorise loneliness as a variable rather than a focus itself and try to treat it alongside depression or other mental health issues with things like cognitive behavioural therapy.

The young are lonely, too

Medical sociologist Professor Tarani Chandola of the Department of Sociology has also shown how loneliness has effects beyond mental health. He was part of a longitudinal study using data from the UK Biobank that found higher levels of loneliness among those aged over 50 were associated with higher levels of physical ill-health, including mobility and cognitive frailty, and higher mortality.

Life events, such as widowhood and the death of friends, were closely associated with feeling lonely. But that did not explain emerging evidence from another group – the 16 to 25 year-olds in Britain are the loneliest group in their society, followed by those over 65.

“This is becoming more and more common. Mental health issues, which never used to be too bad for young adults, have increased quite dramatically in the last 10 or 20 years. And that’s correlated with a very large increase in loneliness around the world amongst young people,” he said.

Possible causes could be the rise of social media and an increase in online gaming, alongside traditional factors like inadequate sleep. People under 40 are also more susceptible to the negative effects of toxic relationships, which Professor Chandola found in other research he did measuring levels of biological stress. “There tends to be a focus on older people when it comes to loneliness, but perhaps it is even more important to look at what is happening amongst young people,” he said.

He is now investigating the different effects of social isolation and loneliness on biological stress markers because these would entail different kinds of interventions. If loneliness is the main factor, then therapy might be the best approach. If social isolation is driving both stress and loneliness, then it may be better to do more work fostering social connections. “We need more research to be done on this gap,” he said.