It is common knowledge that many chronic physical diseases increase mortality. Mental disorders also substantially increase the mortality through suicide and the damaging effects of these disorders on physical health. Physical effects could be secondary to mental disorder or be part of the disorder itself. Social health is also linked to mortality. Old age and changes in social circumstances are probably increasing social isolation and loneliness in many societies.
Loneliness is shown to be associated with increased systolic blood pressure, higher vulnerability for heart conditions, sleeping problems, increased fibrinogen and natural killer cell responses to stress and greater cognitive decline.Would loneliness increase mortality as well?
The authors consider social loneliness distinct from emotional loneliness. Adverse health could be result of social isolation ( limited social network, lack of social support) or a consequence of an emotional state of loneliness.This study address this key question. ie it investigates whether feelings of loneliness, rather than social isolation factors, are associated with an in- creased risk of mortality.
Amsterdam Study of the Elderly (AMSTEL) is a randomly selected general practice cohort ( 65-84) of 4051 participants.Social isolation was operationalized as either living alone or not/no longer being married or by the lack of social support.Feelings of loneliness were operationalized as experiencing loneliness assessed through structured questionnaire.
At baseline, more women (27 %) reported feelings of loneliness than men (12%; p<0.001 ). Women were also more socially isolated in terms of being single or no longer married and living alone (p<0.001). At 10 years’ follow-up, 53% of participants had died (60.8% of men and 47.2% of women).
The death rate was higher in men reporting feelings of loneliness at baseline (79%) compared to women reporting loneliness (54%).
The death rate was also higher for men with social isolation than women with social isolation.
When adjusted for social isolation and other confounding factors (depressive disorder (including sub-threshold depression), demographic characteristics, common medical disorders, cognitive functioning and functional disabilities) feelings of loneliness was associated with a significantly increased risk of mortality in men (HR 1.30, 95% CI 1.04 to 1.63), but not women (HR 1.04, 95% CI 0.90 to 1.24). Following adjustment, no higher risk of mortality was found in men or women reporting social isolation.
Conclusions : Subjective feeling of loneliness is associated with increased risk of mortality in 10 yrs time in older men.This is independent of social isolation.
Limitations: Significant baseline difference between genders. severity of loneliness not measured. No measurement of changes in parameters after baseline measures.
Clinical practice: Identifying emotional loneliness and addressing that in older men might help in increasing their longevity.
Summary of the article:
Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL).Holwerda TJ, Beekman AT, Deeg DJ, Stek ML, van Tilburg TG, Visser PJ, Schmand B, Jonker C, Schoevers RA.Psychol Med. 2012 Apr;42(4):843-53