Can loneliness kill?

Former President Joseph Estrada has been reported to be suffering from bouts of depression – aside from bronchitis, arthritis and a heart condition. He is not, of course, alone. There are thousands of people in the Philippines who are also socially isolated and lonely. Many are sick while others are quite healthy. So, who gets affected and who doesn’t? And how do social isolation and loneliness produce stress that can affect physical and mental health? Finally, how should one cope with the frustration, disappointment and sadness that enter everyone’s life from time to time? These are interesting questions begging for answers.

When people recall their happiest memories, they usually think of times when they were surrounded by family or friends or when they felt an intimate connection with another person. Unfortunately, as individuals age, such moments may be increasingly hard to come by, and many older adults find themselves feeling lonely and isolated – because of the death of a loved one, a disease or a disability that makes it difficult to leave the house, a sense of loss that may accompany retirement – or even, incarceration.

Alone on the banks of Walden Pond, Henry David Thoreau enjoyed the simple life. But is the solitary lifestyle healthy for us all? Scientists say "no." Indeed, there is no single type of social support that is right for everyone. There are "social animals," who enjoy having a large network of varied friends and acquaintances, and there are one-on-one people, who are more comfortable cultivating just a few close relationships. Whereas the former might thrive in large group settings, the latter may favor joining a book club or surfing the Internet. And it is known that a person’s social tendencies reflect his or her personality, which remains fairly constant throughout life. In other words, someone who is the life of the party at 35 will be equally outgoing at 65!

Social Support

Indeed, social support is an important, and often overlooked, component of maintaining good physical and mental health. There is evidence indicating that people who have a high degree of support, whether defined as the number of social ties, the satisfaction derived from them, or both, generally live longer than those who don’t. Social support has also been linked to a lower risk of depression, alcoholism and heart disease.

In a 1992 investigation by researchers at Duke University Medical Center, there was a 50 percent five-year mortality rate among patients with atherosclerosis who were isolated (unmarried without a close friend or confidant) compared with a rate of 17 percent for heart patients with a spouse, confidant, or both.

Researchers aren’t sure how social support might mitigate cardiovascular events or confer other health benefits. One theory is that people with close ties are more likely than isolated individuals to seek prompt medical care and to stick to their therapy, because they have assistance and encouragement. Another hypothesis is that those who lack such support are subject to a greater amount of stress – which may play a role in causing some diseases.

Signs Of Depression

It is, however, important to emphasize that prolonged feelings of despair and worthlessness, difficulty sleeping or concentrating, and a preoccupation with death or suicide, are not a normal part of getting older or of living alone: They are signs of depression, which should be treated by a physician.

Classic warning signs of depression include persistent sadness; an inability to experience pleasure; an inability to concentrate; early morning awakenings; feelings of guilt, helplessness, or worthlessness; decreased energy; decreased or increased appetite; and recurrent thoughts of death. A person who suffers from some or all of these symptoms every day for more than two weeks should seek medical treatment. Antidepressant medication, talk therapy, or both, can bring substantial relief.

Family And Social Ties

Recent research underscores the importance of strengthening family and social ties to help maintain mental and physical health. Living alone, or simply feeling alone, can have a negative effect not only on one’s state of mind but also on his or her physical health as well. Here’s how social isolation can affect you:

Nutrition: If you live alone, you’re more likely to deprive yourself of nutrients you need. This is true more so for older men than for women. Living alone can stifle your appetite and leave you uninspired in the kitchen. Skipping meals or eating a limited variety of foods puts you at risk for poor nutrition.

A study published in the Journal of the American Dietetic Association, done on more than 4,400 men and women, confirmed the ill effects of lonely eating. Researchers found that men, 55 and older who lived alone, were more likely than those with a spouse to consume a diet falling below two-thirds the Recommended Dietary Allowance (RDA) for vitamin A, vitamin B-6, vitamin C, calcium and magnesium. The women, aged 55 to 74 and living alone, were more likely than married women to eat diets deficient in vitamin B-6, calcium, magnesium, thiamin and riboflavin.

Heart: Two published studies in the Journal of the American Medical Association (JAMA) showed that isolation is a risk factor for people with heart problems.

The first study looked at the effects of living alone on people who had had one heart attack. Those living alone had a 15.8 percent chance of having a second serious nonfatal heart attack. That figure is much higher when compared to the 8.8 percent for those not living alone.

The second JAMA study looked at people with severe narrowing of at least one major heart vessel. Those who were unmarried and without one close friend or confidant were "over three times more likely to die (of a heart problem) within five years than married patients who did report having a confidant."

Cancer: A long-term study of more than 6,000 adults living in Alameda County, California, showed that people who had no or few social contacts were twice as likely to die of all cancers. These subjects were also found to be more than five times as likely to die of smoking-related cancers.

Suicide: Men who are separated, widowed or divorced are at highest risk for suicide, at least in the United States. Men account for 80 percent of all suicides.

Psychological Stress

The mechanism by which loneliness and social isolation produce psychological stress which can damage one’s health is not known, but speculation abounds. One theory holds that stress stimulates the nervous system in ways that can cause or worsen heart-rhythm abnormalities. Another suggests that stress contributes to the development of hypertension, which is an important risk factor for coronary disease and stroke. A simpler explanation offered for the poorer health of people who live alone is that they may take their medications less often because no one is there to remind them, or they may not receive necessary prodding to seek medical attention when new symptoms appear.

One team who studied heart-attack survivors was struck by the severity of anxiety in those who live by themselves. These patients describe "terror" on returning home alone, particularly at night, when no one is available to calm them about symptoms that may be minor. Stress and frustration can impair the flow of blood through the coronary arteries, and therefore, anxiety could lead to real cardiac complications in these patients.

Although a scientific "smoking gun" linking loneliness to cardiac disease has not been found, experts emphasize that a public health hazard can be recognized without being fully understood. And that seems to be the case with social isolation and loneliness which can cause psychological stress that can adversely affect health.

Social Network

Friends are good medicine, notes Harvey Simon in his book Staying Well (Houghton Miffin, 1992). To counter the frustration, disappointment and sadness that may bedevil our lives from time to time, he recommends developing a repertoire of coping mechanisms, including building friendships, finding ways to express feelings, engaging in physical exercise and pursuing diversions. Future research will determine whether strategies such as these can extend life. But even without any studies, there is no question that these measures can improve the quality of life of all socially-isolated and lonely people, whether they’re young or old, rich or poor, laborer or ex-President!