Between 50% and 80% of adolescents and adults report feeling lonely. Loneliness, isolation, and lack of human connection are associated with low health-related quality of life. At the foot of the COVID-19 pandemic and the stay-at-home and social distancing orders, health advocates warn that social isolation and loneliness in certain populations may even be the next public health crisis.
This article describes the different types of loneliness, reviews the research on the health impacts of loneliness and social isolation, and provides suggestions for ways health coaches can support clients who are at risk for loneliness.
The 3 Types of Loneliness
Grouping together experiences of loneliness can be useful for health professionals to support clients and patients, as it can be useful for health policymakers to make improvements to health and social policies to prevent loneliness and social isolation.
It is important to highlight that loneliness refers to a distressing awareness of feeling alone or isolated, whereas social isolation is the lack of social contact of an individual due to various circumstances (physical separation, speaking a different language, social and cultural gaps in understanding, living arrangements, economic differences, and others). They are related but not necessarily present together.
Mental health professionals and sociologists categorize loneliness in different ways. Researcher Sarvada Tiwari’s categorization of loneliness is useful for understanding the causes of loneliness.
Tiwari divides loneliness into three categories, the definitions of which are included verbatim from his article Loneliness: A Disease? below:
- Situational Loneliness: Socio-economic and cultural milieu contributes to situational loneliness.
Various environmental factors like unpleasant experiences, the discrepancy between the levels of his/her needs and social contacts, and migration of population, interpersonal conflicts, accidents, disasters or emptiness syndrome, etc., lead to loneliness in old age. The increased life expectancy and feminization of the elderly population is a significant factor in developing situational loneliness in females.
- Developmental loneliness: Every one of us has an innate desire of intimacy or a need to be related to others. This need is essential for our development as a human being.
Apart from this need, a higher level of need for individualism also exists, which is related to knowing and developing our own real self that requires some solitude too. For optimum development, there should be a balance between the two. When a person is not able to balance these needs properly, it results in loss of meaning from their life, which in turn leads to emptiness and loneliness in that person. Personal inadequacies, developmental deficits, significant separations, social marginality, poverty, living arrangements, and physical/psychological disabilities often lead to developmental loneliness.
- Internal loneliness: Being alone does not essentially make a person lonely. It is the perception of being alone which makes the person lonely. People with low self-esteem and less self-worth are seen to feel lonelier than their counterparts. Reasons for this type of loneliness are personality factors, locus of control, mental distress, low self-esteem, feeling of guilt or worthlessness, and poor coping strategies with situations.
It is important to note that social isolation is not the same as privacy. Privacy is something that is desired by the individual; privacy makes them feel safe and comfortable. On the other hand, social isolation is unwanted. People who are socially isolated feel lonely and desire companionship.
Causes of Social Isolation
Some of the causes of social isolation are as follows:
- Physical illness and disease: Autoimmune diseases and chronic diseases can lead to social isolation in many ways. Limited mobility, the feeling of being misunderstood or overlooked, and the lack of access people with chronic illnesses have to environments and opportunities to build community due to infrastructural, social, and economic reasons can lead to social isolation.
- Mental health conditions: that are strongly associated with loneliness and social isolation include depression, Alzheimer’s disease, alcoholism, and personality disorders.
- Immigration and cultural and linguistic differences: People who belong to cultural and linguistic minorities often have to navigate differences without support and with limited abilities to communicate. This can easily lead to isolation and a sense of loneliness.
- Social and cultural norms: Misogynist, racist, homophobic, classist, and agest norms can lead people to feel insecure and lonely.
Public policies: Researchers have identified public policies that can support populations vulnerable to social isolation. These include: 1) opportunities for vulnerable populations to network and be part of the social fabric; 2) initiatives promoting inclusive community development; 3) programs that promote education related to social isolation; 4) develop services that place an emphasis on partnerships/collaborations; 5) services that are sustainable over the longer term.
People Most at Risk of Social Isolation and Loneliness
Those who are most at risk of social isolation and loneliness include:
- Older adults
- Quarantined populations
- People living alone
- People living in rural areas
- Widows and widowers
- People with a low level of education
- People with low incomes
- Unemployed people
- People with disabilities
- People who are victims of abuse
- Minoritized populations (In the US, some minoritized populations include Black, Latino, LGBTQ+, Immigrants, Indigenous, and Asian populations)
- Socially and economically disadvantaged populations
- People with mental health conditions
- People with chronic and autoimmune diseases
Health Impacts of Social Isolation and Loneliness
Humans have evolved to thrive in communities. This is because, in terms of the survival of the species, there is strength in numbers. In other words, humans need other humans to survive. Thus, the lack of social support and isolation have imposed stress on our minds and bodies. Loneliness and isolation are not only social and psychological problems; they have a direct effect on all dimensions of health and wellness, including physical wellness. In the short term, loneliness causes behavioral symptoms like:
- Sleep disturbances
- Depressive symptoms
For example, social isolation and loneliness are associated with impaired immune function. The chemical changes in the body that occur when someone is socially isolated increase systemic inflammation much like they might if they were fighting an infection. In fact, loneliness can have the same deleterious health effects as smoking 15 cigarettes per day.
Concretely, research-based cause-effect relationships between social isolation and health are summarized as follows:
- Socially isolated men (not married, fewer than six friends or relatives, no memberships in religious or social organizations) had a 90% increased risk of cardiovascular death and more than double the risk of death from an accident or suicide.
- Loneliness in older adults is shown to significantly increase the risk of functional decline and death.
- Older adults who report loneliness are at higher risk for both functional decline (such as reduced mobility) and death.
- Poor social relationships in general (social isolation and loneliness) were associated with a 29% increase in the risk of coronary heart disease and a 32% increase in stroke risk.
Just as loneliness can trigger or worsen mental health and chronic diseases, health conditions can also be a cause of loneliness. Living with chronic stress, anxiety, depression, and demands from autoimmune diseases can lead to isolation.
How Health Coaches Can Support People Who Feel Lonely or are Socially Isolated
If social isolation is a systemic problem, then what can health coaches do to support their clients?
Research and identify social support resources for clients
Be a Source of Support for Clients
Health, nutrition, and fitness coaches understand the nuances and complexities of health experiences. Even if, at face value, health coaches appear to be service providers with clear-cut objectives, the way in which you provide your service to clients can make all of the difference.
In fact, many of the qualities of top health coaches reflect clients’ need for empathy, care, and validation. According to studies, the top qualities of health coaches include:
- Outstanding communication skills
- Personality and demeanor
- High-quality coaching with up-to-date knowledge about the individuals’ conditions and needs
- Care continuity between coaching sessions
Encourage Clients to Engage in Activities That Promote Community and Connection
Where appropriate and realistic, encourage clients to:
- Make a conscious and intentional effort to form and nurture true friendships. Remind them that making new friends via support groups and recreational activities with people with similar experiences is one way to form bonds and connections.
- Make it a priority to engage in hobbies and recreational activities online or in person. If your client is living with a disability or disease that can make accessing or engaging in hobbies difficult, make an effort to identify adaptive and accessibility tools and techniques.
- Practice self-empathy. Remind your client that their experiences and feelings are valid.
- Volunteer for a cause they care about. It is a great way to make friends, engage with the community, and put their skills to action.
- Practice stress-reduction techniques. You can find some suggestions in the article about 6 Ways to Help Clients Cope With Stress & Anxiety
- Seek out psychotherapy from a mental health professional, especially if their loneliness and isolation are causing or worsening feelings of depression or self-harm.
- Look into adopting a pet. Pets can be vital sources of emotional support and companionship for some people.
These are general suggestions, but they may not be relevant or realistic for your clients. As a coach, it is important to carefully select information and recommendations that are relevant to your client.
Offer to Let Them Bring Friends and Family to Sessions
Caregivers, close friends, and family members may have a true desire to be of support to your client, but they may not fully understand how to do so. When you open the opportunity for your client’s friend, partner, or family member to come to sessions as a support to you, your client may feel less vulnerable, and it will give your client’s company an opportunity to better understand your client’s struggles and appreciate their qualities.
If your client is experiencing loneliness related to a health experience or diagnosis, you may want to suggest that your client’s companion seek out a support or respite group for caregivers and family members with that condition. These groups can help companions be a better support to your client.
Offer Group and Community Sessions
As part of your coaching business model, you can offer group and community sessions in addition to one-on-one sessions. The group and community sessions can be based on similar goals, similar experiences, or age groups. These sessions not only offer a great opportunity for your clients to make friends and build a sense of community, but they may also offer an opportunity to grow your business.
Offer Virtual and In-Person Options
Some of your clients may feel fatigued by a digital work-from-home environment. You can offer in-person individual and group sessions for your clients to foster opportunities for greater personal connections and companionship.
At the same time, digital options may be a social outlet for other people. People who live in remote areas or who are unable to commute due to physical limitations may long for connection and support through digital means. By offering virtual coaching services, you may be able to meet their coaching needs while supporting their desire for connection.
Loneliness and social isolation are worrisome experiences that have worsened in the current health crisis. Humans are naturally a social species, so a lack of social bonds and human contact leads to distressing feelings and, eventually, negative health impacts on the human mind and body.
There are various reasons why a person may feel lonely and socially isolated. As a health coach, whether your clients have expressed that they feel lonely or not, you can implement practices that can be beneficial for letting them know that you care and are there for them while also providing suggestions for ways to improve their social wellbeing.