Mar 12, 2024 09:38 PM
https://www.ama-assn.org/delivering-care...and-health
"Even though people are becoming more connected through social media and other outlets, the great irony is that many people still feel lonely. That loneliness, in turn, can have far-reaching implications on a person’s health and well-being. Loneliness as a public health issue was also intensified during the COVID-19 pandemic. But even with the end to the COVID-19 public health emergency, loneliness still remains a pressing issue. Knowing how to recognize loneliness and what can help patients overcome feeling lonely is key.
AMA policy adopted last year identifies loneliness as a public health issue that affects people of all ages. The policy also supports evidence-based efforts to combat loneliness. This year, the AMA doubled down and adopted policy to further address the growing public health problem of loneliness and isolation.
Understanding that lack of social connection has profound effects on mental and physical health, U.S. Surgeon General Vivek H. Murthy, MD, released an advisory on the epidemic of loneliness and isolation. About half of U.S. adults experience loneliness, which presents a major public health threat that is akin to smoking and obesity.
The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.
In this installment, two psychiatrists took time to discuss what patients need to know about loneliness as a public health issue. These AMA members are:
Tiffani Bell Washington, MD, MPH, an outpatient general, child and adolescent psychiatrist working with Centurion and also in private practice in North Carolina. She is an American Psychiatric Association delegate to the AMA Young Physicians Section, alternate delegate to the Section Council on Psychiatry and a member of the AMA Ambassador Program.
Frank Clark, MD, an adult outpatient psychiatrist at Prisma Health in Greenville, South Carolina, and associate clinical professor at the University of South Carolina School of Medicine-Greenville. He is also an American Psychiatric Association delegate to the AMA Section Council on Psychiatry.
There’s a gap in feeling connected
“Loneliness is essentially the feeling of being uncomfortable or in distress when someone feels that there is a gap between the connection they would like and the connection they actually have,” said Dr. Bell Washington, adding that “you can be in a crowd full of people, you can know all of them, and you can still feel lonely.”
“So, you might have a lot of superficial social connections, but what you really want is something deeper—someone to know you on the inside,” she said. “It's really based on perception of the difference between the relationship you'd like and the relationship that you have with others.”
Younger people are feeling lonelier
“Loneliness was already an epidemic of its own, but the global COVID-19 pandemic caused loneliness to increase substantially over the past few years,” said Dr. Bell Washington, who took a course during the last year of her MPH program at Harvard T.H. Chan School of Public Medicine where she learned the serious complications of loneliness.
“A 2021 online survey found that 36% of all Americans—which includes 61% of young adults and 51% of mothers with young children—feel ’serious loneliness,’” she said.
Additionally, the Centers for Disease Control and Prevention “found 63% of young adults also suffer significant symptoms of anxiety or depression,” Dr. Bell Washington said. “That means we have a generation of young people hungry for deeper connection who often do not have the skills or opportunities to achieve it.”
“One’s 20s are filled with countless social expectations including separating from one’s nuclear family, finding a partner, developing a career and finding a ‘tribe,’” she said. “For many this time is complicated by unrealistic social media lives which are often unattainable. That only amplifies the loneliness that young adults feel.”
Social isolation can play a role
“An individual experiencing loneliness will often describe feeling alone. This is distinct from social isolation where there is a paucity of social connectedness,” said Dr. Clark. “Social isolation can be a sequela of loneliness, but there are plenty of individuals who experience loneliness and are still socially connected.”
Additionally, “there are some people who I would consider socially isolated, but they feel perfectly fine with it,” said Dr. Bell Washington. “The pandemic revealed that though some people considered themselves loners, when they truly had to be alone all of the time (due to quarantine or isolation), they found out that they actually do value social connection and would have preferred to be with other people.”
Social media affects loneliness
“We get these dopamine surges when someone likes our status,” said Dr. Clark, referring to a social media posting. Many, conversely, feel “sad or upset when they do not receive a certain number of likes or have over 1 million followers on their social media accounts.
“And if you’re having an identity crisis—and if you’re letting social media dictate who you are—that can create some loneliness,” he added. “We must be mindful of the psychiatric sequelae of loneliness. These include depression and anxiety.”
Everyone is at risk for loneliness
“We’re all at risk for loneliness in our lives,” said Dr. Clark. “There was a report that came out from the National Academies of Science, Engineering and Medicine. It revealed that more than one-third of adults 45 or older reported feeling lonely and about a quarter of adults 65 or older were considered to be socially isolated.
“Social isolation in itself was associated with a 50% increased risk of developing a neurocognitive disorder and other serious medical conditions,” he added. “No one is immune to loneliness and social isolation, but there are certain groups who are at increased risk.”
“When we think about historically marginalized groups in terms of immigrants—as well as the LGBTQ+ community—those are groups that have been shown to be at high risk for loneliness and social isolation,” Dr. Clark said.
“Anyone can suffer from loneliness and the highest risk is for those who are not able to remedy the loneliness when they feel it,” Dr. Bell Washington echoed. She added, “The fear of being alone in your loneliness only makes the isolation worse. It is easy to feel you’re the only one who needs social connectedness, but that is not true. There is no shame in being lonely. We were built for connection.”
It’s linked to health complications
“There is some evidence to note that people who are experiencing social isolation and loneliness are at increased risk for premature death,” said Dr. Clark, adding that “social isolation and loneliness were associated with a 29% increased risk of heart disease and a 32% risk of stroke.”
“Now, I’m a romantic and a poet, and there’s something to be said about the broken heart—literally and figuratively speaking,” he said. “If you’re already feeling lonely, that’s going to impact your heart. If you’re feeling socially isolated, that’s going to impact your heart.”
"Even though people are becoming more connected through social media and other outlets, the great irony is that many people still feel lonely. That loneliness, in turn, can have far-reaching implications on a person’s health and well-being. Loneliness as a public health issue was also intensified during the COVID-19 pandemic. But even with the end to the COVID-19 public health emergency, loneliness still remains a pressing issue. Knowing how to recognize loneliness and what can help patients overcome feeling lonely is key.
AMA policy adopted last year identifies loneliness as a public health issue that affects people of all ages. The policy also supports evidence-based efforts to combat loneliness. This year, the AMA doubled down and adopted policy to further address the growing public health problem of loneliness and isolation.
Understanding that lack of social connection has profound effects on mental and physical health, U.S. Surgeon General Vivek H. Murthy, MD, released an advisory on the epidemic of loneliness and isolation. About half of U.S. adults experience loneliness, which presents a major public health threat that is akin to smoking and obesity.
The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines.
In this installment, two psychiatrists took time to discuss what patients need to know about loneliness as a public health issue. These AMA members are:
Tiffani Bell Washington, MD, MPH, an outpatient general, child and adolescent psychiatrist working with Centurion and also in private practice in North Carolina. She is an American Psychiatric Association delegate to the AMA Young Physicians Section, alternate delegate to the Section Council on Psychiatry and a member of the AMA Ambassador Program.
Frank Clark, MD, an adult outpatient psychiatrist at Prisma Health in Greenville, South Carolina, and associate clinical professor at the University of South Carolina School of Medicine-Greenville. He is also an American Psychiatric Association delegate to the AMA Section Council on Psychiatry.
There’s a gap in feeling connected
“Loneliness is essentially the feeling of being uncomfortable or in distress when someone feels that there is a gap between the connection they would like and the connection they actually have,” said Dr. Bell Washington, adding that “you can be in a crowd full of people, you can know all of them, and you can still feel lonely.”
“So, you might have a lot of superficial social connections, but what you really want is something deeper—someone to know you on the inside,” she said. “It's really based on perception of the difference between the relationship you'd like and the relationship that you have with others.”
Younger people are feeling lonelier
“Loneliness was already an epidemic of its own, but the global COVID-19 pandemic caused loneliness to increase substantially over the past few years,” said Dr. Bell Washington, who took a course during the last year of her MPH program at Harvard T.H. Chan School of Public Medicine where she learned the serious complications of loneliness.
“A 2021 online survey found that 36% of all Americans—which includes 61% of young adults and 51% of mothers with young children—feel ’serious loneliness,’” she said.
Additionally, the Centers for Disease Control and Prevention “found 63% of young adults also suffer significant symptoms of anxiety or depression,” Dr. Bell Washington said. “That means we have a generation of young people hungry for deeper connection who often do not have the skills or opportunities to achieve it.”
“One’s 20s are filled with countless social expectations including separating from one’s nuclear family, finding a partner, developing a career and finding a ‘tribe,’” she said. “For many this time is complicated by unrealistic social media lives which are often unattainable. That only amplifies the loneliness that young adults feel.”
Social isolation can play a role
“An individual experiencing loneliness will often describe feeling alone. This is distinct from social isolation where there is a paucity of social connectedness,” said Dr. Clark. “Social isolation can be a sequela of loneliness, but there are plenty of individuals who experience loneliness and are still socially connected.”
Additionally, “there are some people who I would consider socially isolated, but they feel perfectly fine with it,” said Dr. Bell Washington. “The pandemic revealed that though some people considered themselves loners, when they truly had to be alone all of the time (due to quarantine or isolation), they found out that they actually do value social connection and would have preferred to be with other people.”
Social media affects loneliness
“We get these dopamine surges when someone likes our status,” said Dr. Clark, referring to a social media posting. Many, conversely, feel “sad or upset when they do not receive a certain number of likes or have over 1 million followers on their social media accounts.
“And if you’re having an identity crisis—and if you’re letting social media dictate who you are—that can create some loneliness,” he added. “We must be mindful of the psychiatric sequelae of loneliness. These include depression and anxiety.”
Everyone is at risk for loneliness
“We’re all at risk for loneliness in our lives,” said Dr. Clark. “There was a report that came out from the National Academies of Science, Engineering and Medicine. It revealed that more than one-third of adults 45 or older reported feeling lonely and about a quarter of adults 65 or older were considered to be socially isolated.
“Social isolation in itself was associated with a 50% increased risk of developing a neurocognitive disorder and other serious medical conditions,” he added. “No one is immune to loneliness and social isolation, but there are certain groups who are at increased risk.”
“When we think about historically marginalized groups in terms of immigrants—as well as the LGBTQ+ community—those are groups that have been shown to be at high risk for loneliness and social isolation,” Dr. Clark said.
“Anyone can suffer from loneliness and the highest risk is for those who are not able to remedy the loneliness when they feel it,” Dr. Bell Washington echoed. She added, “The fear of being alone in your loneliness only makes the isolation worse. It is easy to feel you’re the only one who needs social connectedness, but that is not true. There is no shame in being lonely. We were built for connection.”
It’s linked to health complications
“There is some evidence to note that people who are experiencing social isolation and loneliness are at increased risk for premature death,” said Dr. Clark, adding that “social isolation and loneliness were associated with a 29% increased risk of heart disease and a 32% risk of stroke.”
“Now, I’m a romantic and a poet, and there’s something to be said about the broken heart—literally and figuratively speaking,” he said. “If you’re already feeling lonely, that’s going to impact your heart. If you’re feeling socially isolated, that’s going to impact your heart.”