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Different kinds of loneliness – Having poor quality relationships is associated with greater distress than having too few
According to a new study, there are 4 different types of loneliness.
Loneliness not only feels bad, experts have characterised it as a disease that increases the risk of a range of physical and psychological disorders. Some national prevalence estimates for loneliness are alarming. Although they can be as low as 4.4 per cent (in Azerbaijan), in other countries (such as Denmark) as many as 20 per cent of adults report being either moderately or severely lonely.
However, there's no established way of identifying loneliness. Most diagnostic methods treat it as a one-dimensional construct: though it can vary in degrees, someone is either "lonely", or they're not. A new approach, outlined in a paper published recently in Social Psychiatry and Psychiatric Epidemiology, suggests that loneliness should in fact be divided into three sub-types, two of which are associated with poor mental health.
Philip Hyland at Trinity College Dublin and colleagues studied a nationally representative sample of 1,839 US adults aged between 18 and 70, all of whom had experienced at least one traumatic event in their lifetime. (This allowed the team to also look for associations between childhood or adult trauma and loneliness.) Most were married or living with a partner.
Participants completed a six-item scale that measured feelings of "social loneliness" (focusing on perceptions of the quantity of one's social relationships) and "emotional loneliness" (which focused on perceptions of the quality of one's relationships). They also completed questionnaires assessing levels of childhood and adult trauma, depression and anxiety, and their psychological wellbeing.
Following convention, the 17.1 per cent of participants who scored a certain amount above the average loneliness score for the sample (by more than one standard deviation) were classified as "lonely" – a figure comparable to that found previously in many other countries.
However, the researchers also used a statistical technique to look for qualitative differences between the participants' loneliness responses, and this revealed four distinct classes.
The first class – which they called "low loneliness" – was characterised by low scores on both types of loneliness, social and emotional. Just over half the participants fell into this category. The second class – "social loneliness" – making up 8.2 per cent of the sample, comprised people low on emotional loneliness, but high on social loneliness. The third class – "emotional loneliness" – made up just over a quarter of the total sample and was characterised by the opposite pattern of high emotional loneliness but low levels of social loneliness. People in the fourth and final "social and emotional loneliness" class, accounting for 12.4 per cent of the sample, scored high for both types of loneliness.
The researchers found a clear gradient of psychological distress across the classes. People in the low loneliness class were, predictably, least distressed, followed by people in the "social loneliness" class, then the "emotional loneliness" class, and finally the "social and emotional loneliness" class. In fact, people in both these last two classes had levels of symptoms of depression, anxiety and negative psychological wellbeing that were reflective of a psychiatric disorder.
In other words, quality of relationships appears more important to mental health than the sheer number of them."These results indicate that while the experience of social loneliness is associated with slight diminutions in overall mental health, relative to the low loneliness class, the experience of emotional loneliness has a substantially greater, and more negative impact on overall mental health status," the researchers write. "The combination of social and emotional loneliness is associated with the poorest mental health status," they note.
People who belonged to the emotional loneliness class were more likely to be female, younger than average for the group, not in a relationship and to have suffered an increased number of childhood traumas. (Every childhood traumatic experience increased the odds of belonging to the emotional loneliness class by 28 per cent.) The same associations were true for the "social and emotional" loneliness class – except they were also characterised by a greater number of adult traumas.
At 39.0 per cent, the total percentage of participants who fell into the two loneliness classes characterised by clinically relevant levels of psychological distress was much higher than the 17.1 per cent loneliness figure obtained using the conventional one-dimensional approach. "This finding indicates that by recognising naturally occurring subtypes of loneliness, the number of people experiencing a form… that is likely to be of clinical relevance is more than double the number identified when loneliness is conceptualised as a unidimensional construct," the researchers note.
The work suggests that in assessing loneliness, whether in an individual or at a national level, it's important to recognise there are various subtypes. It also supports findings from some other studies that it's the quality, not quantity, of your relationships that really matters. As the researchers conclude: "From a societal perspective, and in the interests of reducing the burden of psychological distress, efforts should be made to enhance the quality of social connections as opposed to promoting the virtues of larger social networks."
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
COVID-19 deepens U.S. health disparities<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.
Working to close the health gap<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />
Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
Philosopher Nick Bostrom's "singleton hypothesis" predicts the future of human societies.
- Nick Bostrom's "singleton hypothesis" says that intelligent life on Earth will eventually form a "singleton".
- The "singleton" could be a single government or an artificial intelligence that runs everything.
- Whether the singleton will be positive or negative depends on numerous factors and is not certain.
Want to Retain American Jobs? Stop Blaming Globalization<div class="rm-shortcode" data-media_id="oxK8j1xN" data-player_id="FvQKszTI" data-rm-shortcode-id="2cf425d7b91ed2a6fc4fe19d065f3408"> <div id="botr_oxK8j1xN_FvQKszTI_div" class="jwplayer-media" data-jwplayer-video-src="https://content.jwplatform.com/players/oxK8j1xN-FvQKszTI.js"> <img src="https://cdn.jwplayer.com/thumbs/oxK8j1xN-1920.jpg" class="jwplayer-media-preview" /> </div> <script src="https://content.jwplatform.com/players/oxK8j1xN-FvQKszTI.js"></script> </div>
Shannon Lee shares lessons from her father in her new book, "Be Water, My Friend: The Teachings of Bruce Lee."
- Bruce Lee would have turned 80 years old on November 27, 2020. The legendary actor and martial artist's daughter, Shannon Lee, shares some of his wisdom and his philosophy on self help in a new book titled "Be Water, My Friend: The Teachings of Bruce Lee."
- In this video, Shannon shares a story of the fight that led to her father beginning a deeper philosophical journey, and how that informed his unique expression of martial arts called Jeet Kune Do.
- One lesson passed down from Bruce Lee was his use and placement of physical symbols as a way to help "cement for yourself this new way of being, or this new lesson you've learned." By working on ourselves (with the right tools), we can develop the skills necessary to rise and conquer new challenges.
How to deal with "epistemic exhaustion."