keynote: social connection as an antidote to loneliness · julianne holt-lunstad, ph.d. brigham...
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Keynote: Social Connection as an Antidote to Loneliness
Julianne Holt-Lunstad, Ph.D.Brigham Young University
How I got here?
Relationship Quality
Lab experiments on Stress
Naturalistic studiesOutside the lab
Risk for premature mortality
Interventions
Possible factors contributing to loneliness emerging as a global issue
Lag time?
Divisive Politics?
Technology?
Changing Demographics?
Regardless of the reason . . .
Regardless of whether it is increasing or just now being recognized . . .
There is evidence of importance of addressing this issue.
What exactly is the issue?
• Is it the perception of loneliness?
• Lacking social contact, interaction, or perceived support?
• Lacking a close intimate partner or someone in the home to rely on in times of need?
• Being in a strained relationship or lacking supportive relationships?
Measurement Approaches• Structural
– The existence and interconnections among differing social ties and roles
– Examples: Size of social network (Social isolation/integration), marital status, living alone
• Functional
– Functions provided or perceived to be available by social relationships
– Examples: Received support, Perceived support, Perceived Loneliness
• Quality
– The positive and negative qualities of relationships
– Examples: relationship satisfaction, conflict, ambivalence
Social Connection
Structural:
The connection to others via the existence of
relationships and their roles
Functional:
A sense of connection that
results from actual or perceived support or inclusion
Quality:
The sense of connection to others that is
based on positive and negative
qualities
High LowRisk Continuum
Low High
Social Connection as a Fundamental Human Need
Loneliness=symptom/motivationIsolation=Objective lackQuality=Lack high quality/ nourishing
Why is this important?
UK Prevalence Rates
• 33% of adults often or very often feel lonely (BBC Survey
2018)
• 28% of UK adults live alone (ONS, 2017)
– Over half (51%) of all people aged 75 and over live alone (Office for National Statistics 2010).
– Living alone has increased over the past 20 years (ONS).
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
Severe Obesity[BMI>40) [B]
Adult Smokers [E]
Inactivity [D]
Obesity {BMI>30] [B]
Living Alone
Loneliness [A]
Percentage of the U.K. Population
Social Connections
Leading Health Indicators
Prevalence of Social and Health Conditions in U.K. Adult Population
Note. A = BBC Survey 2018; Other sources estimate loneliness prevalence 20-52%.
B = ONS, 2017; C = NHS, 2016; D=Gove.UK; E=Centers for Disease Control (2016)
Why is this important?
Cumulative Meta-Analytic Evidence
There are now multiple meta-analyses including– Hundreds of prospective studies– Millions of participants
Protective effect (increased survival/decreased risk)• Social relationships (broadly defined); Holt-Lunstad et al. 2010), • social contact frequency (Shor & Roelfs 2015)• family ties (Shor et al. 2013)
Increased risk for premature mortality• loneliness and social isolation (Holt-Lunstad et al. 2015)• divorce (Sbarra et al. 2011, Shor et al. 2012a)• single (Roelfs et al. 2011)• widowhood (Shor et al. 2012b)
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8
AirPollution:Lowvs.high[J]
Obesity:BMIof>29(HR)[I]
PhysicalActivity(controllingforadiposity)[H]
SocialConnection:Loneliness[G]
FluVaccine:Pneumococcalvaccinationinadults(forpneumoniamortality)[F]
SocialConnection:Divorce(HR)[E]
AlcoholConsumption:Abstinencevs.Excessivedrinking(>6drinks/day)[D]
SocialConnection:Averageacrossmultipleindicators[A]
SmokingCessation:Ceasevs.ContinuesmokingamongpatientswithCHD[C]
Smoking<15cigarettesdaily[B]
SocialConnection:Highvs.lowsocialsupportcontrasted[A]
SocialConnection:Complexmeasuresofsocialintegration[A]
ComparisonofDecreasedMortalityacrossSocialConnectionandLeadingHealthIndicators
Note. Odds(lnOR)andHazards(lnHR).Effect size of zero indicates no effect. The effect sizes were estimated from meta analyses: ; A = Holt-Lunstad,
Smith and Layton, 2010; B = Shavelle, Paculdo, Strauss, and Kush, 2008; C = Critchley and Capewell, 2003; D= Holman, English, Milne, and Winter, 1996; E = Shor, Roelfs, and Bougy, 2012; F= Fine, Smith, Carson, Meffe, Sankey, Weissfeld, Detsky, and Kapoor, 1994; G = Holt-Lunstad, Smith,
Baker, Harris, and Stephenson, 2015; H= Katzmarzyk, Janssen, and Ardern, 2003; I= Flegal, Kit, Orpana, & Graubard, 2013;J = Schwartz, 1994.
SocialConnectionsLeadingHealthIndicators
Social Connections have a Profound Effect on Risk for Mortality
What the Evidence tells us
• Effect is robust relative to other risk factors
• Consistent across cause of death, gender, country of origin.
• Objective and Subjective indicators predict risk
• Meta-analytic evidence: – Continuous not dichotomous issue
Evidence doesn’t support a threshold effect.
-30
-20
-10
0
10
20
30
40
50
0 5 10 15 20 25
Threshold
0
1
2
5
10
15
20
Low Social Connection High
Dose-Response Effect in early and late life (Yang et al, 2016)
Continuous
Ris
k B
en
efit
How community and connection can help tackle loneliness?
Low Social Connection High
Individual-level interventions typically only target those on the
extreme low end
Figure: Holt-Lunstad Annual Review of Psychology 2018
Dose Response Effect: Yang PNAS 2016
Low Social Connection High
Holt-Lunstad Annual Review of Psychology 2018
Population-based Connection-focused interventions may shift the distribution.
A Call to Action!
21
Increase Awareness
1
Reduce Stigma
2
Activate Programs
3
Evaluate Programs
4
Small actions that we can all participate in/do to help tackle loneliness
General Approaches to Reduce Risk
Supporting and Maintaining Existing Relationships
Building New Relationships
Psychological Approaches to change thinking about
relationships
Applying the General Approaches to our own lives
Supporting and Maintaining Existing Relationships
Building New Relationships
Psychological Approaches to change thinking about
relationships
Prioritize your relationshipsAs part of a healthy lifestyleBe responsive
Be a friend/support to others. Befriend those different than you
Positive AttitudeReframingRelationships take time to develop
Conclusion
Let’s be more open. Let’s be more together.
Let’s Be More Us
