Loneliness and social isolation have been recognised as important public health issues in many countries. While these conditions have similar negative health impacts, it is unclear who is more likely to experience chronic loneliness and social isolation. This study is the first to distinguish episodic from chronic experiences of loneliness and social isolation with the use of longitudinal population data, and to identify who is most vulnerable.
It was noteworthy that the cumulative prevalence rates of loneliness (overall 34%; 21% episodic, 13% chronic) far exceeded the prevalence rates of social isolation (overall 17%; 13% episodic, 4% chronic) in Australia, yet many existing policies and programs have focussed on reducing social isolation and less so on reducing loneliness. Examples are strategies that increase social contact (i.e., reduce social isolation) but do not promote the development and maintenance of meaningful connections, which could reduce loneliness. Several factors may be driving this, including a gap in research translation to practice (e.g., community and health practitioners not measuring loneliness severity) to poor community awareness about what loneliness is (e.g., confusion with social isolation or stigma associated with loneliness).48
Being male was protective of any type (episodic or chronic) of loneliness, consistent with previous study which report women are more predisposed to loneliness,49 including older women.50 Men, however, were more likely to be socially isolated than women, which is consistent with sex differences in reporting subjective versus objective social isolation.51,52 Although men were more socially isolated, they may be either less vulnerable or more reluctant to report loneliness.
Our results indicate that age differences were only present in those that reported chronic, as opposed to episodic, loneliness. Much of the research to date does not make the distinction between these sub-types, but most point to a U-shaped distribution where younger and older people are more vulnerable to problematic levels of loneliness.16,53 After accounting for all possible confounding variables, those aged 75 years and older, followed by those aged 60–74 years, and those 15–29 years were all less likely to experience chronic loneliness than those aged 30–44 years. One plausible reason for the greater vulnerability of individuals aged 30–44 years could include a lack of time to nurture and maintain meaningful social relationships.
Interestingly, the only age-related differences in social isolation was the higher prevalence among those aged 45–59 years of either subtype. While there is a strong focus upon social isolation in older adults in both research and public policy, our findings indicate there is a need to assist individuals in the middle-aged, pre-retirement phase of life. Those aged 45–59 years were also less likely to experience any episodic or chronic loneliness, which demonstrates that these constructs are likely to be independent. More research is needed to understand the specific factors that may drive this age group’s social vulnerability.
Our findings indicate that single parents with young children have an elevated risk of chronic loneliness, almost equivalent to those who live alone. Similarly, an earlier study using the HILDA sample also indicate that single fathers with children were at risk of loneliness.43 While there no known studies examining the impact of loneliness in single parents, the detrimental impact is consistent with reports of poor health status54 and increased mortality risk in this population group.55 It was noteworthy that couples without children were less likely to experience chronic loneliness when compared with couples with children. Further, compared with those without children, almost all groups reported higher levels of episodic social isolation but only those who lived alone and who lived with non-family members were more likely to experience chronic social isolation.
We found no differences between by country of birth (Australia, other English speaking, or non-English speaking) for episodic or chronic social isolation. On the other hand, people from non-English speaking countries were at more risk of episodic loneliness, while tending to have lower risk of chronic loneliness. This may signal that individuals from non-English speaking backgrounds are able to build meaningful social relationships as their duration of residence lengthens. Further research needs to be done comparing loneliness and social isolation between specific cultural groups with appropriate assessment tools, especially in light of research showing that loneliness is a significant predictor of lower self-reported health, greater risk of posttraumatic stress, and higher incidence of mental illness in migrant groups.56
Household income was found to have an inverse relationship with the risk of both episodic and chronic loneliness, that is, the lower the income the higher likelihood of reporting each sub-type of loneliness. Similar patterns were found for episodic social isolation, but only those who had the lowest income (<$80,000) reported higher likelihood of chronic social isolation. Plausible reasons for these trends include having fewer resources (i.e., time or money) to invest in developing and maintaining meaningful social connection (i.e., reducing their risk of loneliness and social isolation).51 It was also found that those who were unemployed showed the highest risk of both episodic and chronic loneliness, but compared with those in full-time employment, people engaged in home duties and non-working students showed the highest risk of episodic and chronic social isolation. This highlights the opportunities that employment can offer for building and developing social connection.
Consistent with previous research,57–59 those living in more disadvantaged neighbourhoods reported more loneliness and social isolation compared with people living in more advantaged neighbourhoods. More advantaged neighbourhoods may offer more physical spaces and environmental resources (such as green spaces) that can be conducive to promoting social connection.60 A similar clear trend was seen for episodic social isolation, with those in the most more disadvantaged neighbourhoods (SEIFA IRSAD 1–2) having the highest risk of episodic social isolation, whereas all groups (SEIFA IRSAD 1–4) were at greater risk of chronic social isolation than those on the most advantaged quintile (SEIFA IRSAD 5).
People who had a long-term health condition were consistently more likely to experience both loneliness and socially isolation, with this sub-group reporting approximately double the risk of chronic loneliness and isolation compared to those without a long-term health condition. Approximately, one in four (24%) individuals with a long-term health condition reported episodic loneliness and one in five (20%) met the criteria for chronic loneliness. While there is a plethora of research on how individual health characteristics (i.e., physical health, BMI),61,62 and poor health regulation behaviours (i.e., smoking, alcohol use, physical activity)63,64 influence loneliness and social isolation in specific demographic cohorts, there is a lack of clarity on how these factors influence the onset of chronic loneliness. Our findings nevertheless highlight the importance of preventing loneliness in these vulnerable groups, and the need to equip health care practitioners and community agencies to better support people with long-term health conditions to manage their psychosocial well-being.65 This may be in the form of building linkages with others who have a shared experience and to facilitate greater participation with their existing social networks.
While the sample used in analysis was weighted to match the profile of the Australian population, it is possible that individuals taking part in the HILDA longitudinal study are unrepresentative in selected characteristics (social and psychological) that are of importance to this study and cannot be mitigated by means of demographic weighting. Further, these issues may be magnified by the fact participants under 18 were primarily recruited via their parents, who are themselves HILDA participants and this recruitment method may skew our results on loneliness and social isolation reported by young people under 18.
This study enabled examination of how loneliness and social isolation of differing levels of duration affect particular population groups, using psychometrically validated scales but the categorical classification did not enable investigation of the severity (i.e., intensity) of these experiences. Further, our study does not show the factors predicting a transition from episodic loneliness and social isolation to the chronic forms of these conditions, which remains an evidence-gap.66
This study did not examine more closely differences in how loneliness and social isolation influence different chronic health conditions,67 as there is evidence that the pathway to disease could differ for loneliness and social isolation (e.g., loneliness better predicted poorer mental health; social isolation better predicted poorer physical and cognitive health).68 Previous relationships have been established between specific health conditions and loneliness and social isolation, for example, cardiovascular disease and Type 2 diabetes were associated with loneliness and social isolation, but the same effect was not found for other disorders including chronic obstructive pulmonary disease and cancer.27