Loneliness: A Modern Epidemic Psychiatry Is Poised to Address

Loneliness, like the opioid and suicide crises, is a behavioral epidemic of modern times, said past APA President Dilip Jeste, M.D., in an address at the 50th Anniversary Conference of the Black Psychiatrists of America, held in April at National Harbor, Md.

“Loneliness carries serious physical, cognitive, and mental health consequences and is especially prevalent in minority groups,” Jeste said.

He said several trends unique to the modern era—the growth of consumerism and the decline of religion, along with globalization and the proliferation of technology in the last two decades—have combined to create the contemporary epidemic of loneliness. “Psychiatrists and mental health professionals have an opportunity, even a responsibility, to address the modern epidemics of loneliness, suicides, and opioid abuse,” Jeste said.

The former APA president went through a burgeoning body of research on the health effects of loneliness and social isolation—a problem that public health officials and even some political leaders now recognize as a widely prevalent artifact of a fragmented society. Quoting former U.S. Surgeon General Vivek Murthy, M.D., Jeste explained that the reduction in life span linked to loneliness “is similar to that caused by smoking 15 cigarettes a day, and it’s greater than the impact on life span of obesity.”

Loneliness Impacts Health

At the BPA conference, Jeste reported several lines of research showing a link between loneliness and disease. A 2016 JAMA Psychiatry study found a novel association between loneliness and amyloid-beta (Aβ) burden in the brain cells of older adults, suggesting a link between loneliness and risk of Alzheimer’s. (Aβ is a protein deposit that has been strongly associated with dementia and Alzheimer’s.)

That study analyzed data from 79 older adults without Alzheimer’s or dementia in the Harvard Aging Brain Study, comparing Aβ levels as measured by positron emission tomography (PET) scans and scores on loneliness. The researchers also screened participants for the presence of a gene mutation that has been associated with Alzheimer’s.

They found that compared with individuals in the Aβ-negative group, those in the Aβ-positive group were 7.5-fold more likely to be classified as lonely than nonlonely. Furthermore, the association of high Aβ levels and loneliness was stronger in carriers of the Alzheimer’s gene mutation than in noncarriers.

In addition, a study in the March Journal of Affective Disorders reported data from 5,066 adults aged 50 years or older who participated in The Irish Longitudinal Study on Ageing. It found greater objective isolation (as measured by number of friends and social contacts) and perceived social isolation (as measured by self-reported feelings of isolation) predicted a higher risk of developing major depression or generalized anxiety disorder two years later.

Jeste said individuals in minority communities may be especially prone to loneliness. “Older LGBT people are especially vulnerable to loneliness as they are more likely to be single, live alone, and have lower levels of contact with relatives,” he said. “They are also less likely to engage with local services, with recent findings showing that over 80% of older LGBT people do not trust professionals to understand their culture or lifestyle.”

Wisdom: ‘Vaccine’ Against Loneliness

If loneliness is a disease of epidemic proportions, Jeste said that humans possess a natural behavioral “vaccine” in the form of wisdom—a quality long associated with religion or philosophy that is now garnering serious scientific research. It is an aspect of “positive psychiatry,” a new focus on patients’ strengths and positive attributes—such as resilience—for which Jeste has been an internationally recognized champion.

In the 2009 JAMA Psychiatry article “The Neurobiology of Wisdom,” Jeste and Thomas Meeks, M.D., reported that a search in a public, medical database using the keyword “wisdom” found that the number of related articles increased sevenfold from the 1970s through 2008.

“The topic of wisdom is also being discussed in prominent lay media, clinical medicine, and learning theory,” Jeste and Meeks wrote. “Although there is no consensual definition of wisdom, we believe that wisdom is a unique psychological construct, not just a collection of desirable traits with a convenient unifying label.”

Jeste and Meeks identified six components of wisdom:

• Socially positive behaviors that promote the common good above self-interest, such as empathy, compassion, and altruism

• Social decision making, or the ability to respond effectively to complex social situations

• Self-reflection, or insight

• Healthy impulse control and emotional regulation

• Decisiveness during uncertainty

• Spirituality

Jeste said that a variety of public health initiatives are aimed at addressing widespread loneliness, some of which are promoting the wisdom that comes with aging. For instance, a 2009 article in the Journals of Gerontology: Series B described the work of the Experience Corps, a community-based intergenerational program designed to promote the health of older adults while simultaneously addressing unmet social and academic needs of elementary school–aged children. (Experience Corps began as a research endeavor in the 1990s but has since been adopted by the AARP Foundation.)

Experience Corps trains older adults to volunteer at least 15 hours a week as mentors and tutors in public elementary schools to enhance children’s literacy and behavioral management skills. Results of the effort in Baltimore public schools showed improvement in children’s grades and in overall health of participating seniors.

“I believe that APA is in a unique place to take a leadership role in tackling these serious psychosocial crises and work with other organizations, government agencies, and public institutions to help develop strategic plans,” Jeste told Psychiatric News in comments after the BPA meeting. “As the largest psychiatric organization in the world, APA can make a real impact. We can work with other interested societies such as the American Academy of Social Work and Social Welfare, which has launched a campaign to eradicate social isolation. We can also enlist influential thinkers like former Surgeon General Vivek Murthy, M.D., who has characterized loneliness as a growing public health crisis.

“By presenting a positive framework for reducing loneliness through behavioral interventions that enhance components of wisdom like compassion, emotional regulation, and spirituality, we will also aid in destigmatizing psychiatry and mental illnesses.” Jeste said. ■