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Loneliness is Lethal: Five Strategies to Improve Health Outcomes by Improving Social Connectedness

This blog post was authored by HMA clinicians Margaret Kirkegaard, MD, MPH, and Jeffrey Ring, PhD

While most people would agree that social relationships improve day-to-day quality of life, do social connections actually provide a health benefit? The answer is a resounding yes!

In 1921, a remarkable study began tracking the lives of 1,500 Americans from childhood to death. It sought to track what factors in life — such as faith, marriage, pets and exercise — increased longevity. The most significant finding was that strong social networks mattered the most. The quality of social connections was more significant than the quantity.[1] In an interview with National Public Radio, lead researcher Howard Friedman notes, “We saw that over and above the number of connections and the frequency of interactions that when those connections involved helping other people, reaching out, being actively engaged to do things for others, that was an added bonus on top of what we already see as quite beneficial from the social contacts themselves.”[2]

While Friedman’s study may be the longest running and best known, other researchers have demonstrated the impact of social connectedness on healthcare outcomes. Women with breast cancer who have larger social networks have been shown to have lower mortality rates than women with smaller social networks.[3] This impact is independent of the physical assistance that women may receive through their social networks. Other research has shown that post-myocardial infraction patients who perceive greater social support from friends had significantly lower mortality risk. The researchers conclude by encouraging clinicians “to assess post-MI psychosocial status to identify high-risk patients.”[4]

Overall, loneliness may have as much of an impact on health as smoking[5], yet healthcare providers rarely assess or address loneliness the same way they might address smoking. While we work hard to help healthcare teams develop strong relationships, we also think that it is vitally important for healthcare teams to assist clients in developing strong social relationships outside of relationships with their healthcare teams. Here are some strategies that we recommend:

  1. Assess social connectedness as a routine part of developing a health history or performing a health risk assessment. Find out who lives in the same household—are relationships supportive or stressful? Or both? Assess other relationships such as neighbors, church and social groups. Do not be fooled by vague answers like, “I have lots of friends” or “my family stops by from time to time.”  People are often ashamed of being lonely as it implies some defect about them. Ask for details and let them know that you are interested in all aspects of their health.
  2. Encourage clients to have a friend or family member present during medical appointments and care management phone calls. This not only improves health literacy by increasing the amount of information retained but also helps the patient “share” the medical encounter and feel supported.
  3. Refer appropriate clients to peer support treatment options. For example, many providers participate in group prenatal care, or peer support teams are often available through addiction and recovery centers. Chronic disease self-management support groups can facilitate chronic disease care. Depending on the client’s clinical condition and social circumstances, there may be a variety of options. Find out what is available in your community.
  4. Connect clients to community-based social programs, such as the gym, YMCA, library or senior center. All of these community organizations can provide free or low-cost options for people to connect socially with one another. Encouraging lonely people to volunteer is another great way to foster meaningful social connections. If you are affiliated with a provider organization, there might even be volunteer opportunities within your own organization.
  5. Offer patients with chronic loneliness brief, targeted cognitive behavioral therapy. Patients with chronic loneliness often have maladaptive responses to social cues — assuming people do not like them or others are making fun of them. This misperception, in turn, creates negative social behavior that perpetuates the cycle of loneliness. Making friends is a skill that can be learned at any stage in life. Do not assume that lonely people are happy being alone. Some are but many have just learned to cope with chronic loneliness by projecting satisfaction with their loneliness.

Loneliness is lethal. As we strive to improve health outcomes, these simple steps can reduce stress and improve health outcomes. For more information, click

For more information, click here to access our paper The Case for Relationship-Centered Care and How to Achieve It, or contact us directly at [email protected] and [email protected].

[1] Howard Friedman and Leslie Martin, The Longevity Project (New York: Hudson Street Press, 2011).

[2] “Talk of the Nation,” National Public Radio, March 24, 2011.

[3] C.H. Kroenke, C. Quesenberry, M.L. Kwan, C. Sweeney, A. Castillo, and B.J. Caan, “Social Networks, Social Support, Burden in Relationships, and Mortality after Breast Cancer Diagnosis in the Life After Breast Cancer Epidemiology (LACE) Study,” Breast Cancer Res Treat 137:1 (January 2013): 261-271.

[4] N. Weiss-Faratci, I. Lurie, Y. Neumark, M. Malowany, G. Cohen, Y. Benyamini, U. Goldbourt, and Y. Gerber, “Perceived Social Support at Different Times after Myocardial Infarction and Long-Term Mortality Risk: a Prospective Cohort Study,” Annals of Epidemiology 26:6 (June 2016): 424-428.

[5] Holt-Lunstad J, Smith TB, Layton JB (2010) Social Relationships and Mortality Risk: A Meta-analytic Review. PLoS Med 7(7): e1000316.