Chapter 157
Promoting Mental Health — 5
Figure 11.3. Different types of physical activity and SSRI medications for reduction of depression. The horizontal lines to the left of zero indicate a significant effect; SSRI drugs crossed the line of zero, which means their effect was not significant in this systematic review. Number of people for each activity type or SSRI intake shown in second column. Adapted from Michael Noetel et al., “Effect of exercise for depression: Systematic review and network meta-analysis of randomised controlled trials,” British Medical Journal 384 (February 2024): e075847, https://doi.org/10.1136/bmj-2023-075847.
Although related, loneliness and social isolation are subjectively different. Loneliness, a state of mind, refers to feeling alone and dissatisfied with one’s social relationships; social isolation simply describes a paucity of social contacts. Contributing factors to the perception of loneliness are losses and transitions, but they are generally heterogeneous and individualized. Both loneliness and social isolation have been on a steep rise for decades but defy the need, embedded in our DNA, to connect with people. As we age, our time spent alone increases (fig. 11.4). Also, the proportion of one-person households around the world has markedly increased and is well above 60 percent in many American cities.
My friend Vivek Murthy, a former surgeon general of the United States, wrote the important and inspirational book Together: The Healing Power of Human Connection in a Sometimes Lonely World, which summarized the evidence. Loneliness, a sign of poor social health, is linked to increased risk of depression, anxiety, and suicide. Survivors of cancer who reported loneliness had a higher mortality risk during four-year follow-up compared with those with no or minimal loneliness. Social isolation is associated with a significant risk of premature death of similar magnitude to that of smoking, obesity, and physical inactivity as well as a 50 percent increased risk of dementia. Among over 430,000 UK Biobank participants with a mean age of fifty-seven years and followed for nearly fourteen years, loneliness and social isolation were both associated with a significant increase of lung cancer. This study incorporated genetic evidence (Mendelian randomization) that also showed that not living alone was linked to about an 80 percent reduced risk of lung cancer.
Figure 11.4. How Americans spend time by age groups. Adapted from “Who Americans spend their time with, by age,” Our World in Data, accessed September 5, 2024, https://ourworldindata.org/grapher/time-spent-with-relationships-by-age-us.
You will remember Mrs. L. R., age ninety-eight, from the introduction. At age ninety-four, when her husband died, she was devastated, lonely, and depressed. One of her seven women friends with whom she has played cards and Rummikub every week for decades suggested she relocate to a senior residence. Within a day of moving into that facility, another resident artist contacted her and set up a dinner for her to meet the other artists in the building. A new network of senior women artists evolved, enriching Mrs. L. R.’s social connections, so much so that she now must strike a balance between the solitude she enjoys for painting and doing jigsaw puzzles and the time she plays cards or interacts with her new artist group.