Holt-Lunstad, J., Smith, T., Baker, M., Harris, T. and Stephenson, D. (2015). Loneliness and Social Isolation as Risk Factors for Mortality. Perspectives on Psychological Science, 10(2), pp.227-237.
A meta-analysis of studies into the effect of social factors on mortality, with a focus on social isolation. This area has received less interest in research and literature than other factors such as smoking, obesity, and sedentary lifestyles. There have been some studies which suggest that social connections have an impact on mental health, emotional well-being, and physical health.
70 studies were included in the meta-analysis, with participants with a mean age of 66 years at initial contact and a mean length of 7 years as a follow-up. The total sample size was 3,407,134. 63% of the studies involve standard community samples, 37% involved patients with medical conditions.
Measures such as the Social Isolation Scale, the Social Network Index, and Loneliness Scales were used to give measurements on social connectedness and social isolation.
Studies where mortality was the result of suicide or accident, were excluded from this meta-analysis.
- Social Isolation, loneliness, and living alone resulted in a higher likelihood of mortality, regardless of whether the measurement was objective or subjective.
- The statistics reported for increased risk of death were:
- 26% for reported loneliness
- 29% for social isolation
- 32% for living alone
- Those who were social isolated, lonely, or living alone were more likely to be dead by the time of the follow-up than their counterparts, regardless of age or socioeconomic status.
- Middle-aged adults were at greater risk of mortality when lonely or living alone than any other age group in the meta-analysis.
- Fully adjusted models which accounted for health status, or studies which did not include physically ill individuals still found social isolation and loneliness to be predictive of mortality.
The meta-analysis could not confirm causality.
This meta-analysis could not identify any “threshold” for social isolation at which increased mortality risk occurred – given the complexity and individuality of the matter; it is unlikely this threshold could accurately be identified even in future research.
Most of the studies online looked at one of the three factors: social isolation, loneliness, or living alone. Therefore it was not possible to identify one of the three as a greater risk factor than the others.
91% of the studies involved people younger than 50 years of age – future research should include participants from a broader range of age groups.
Why is this relevant to autism? How is it relevant to practice?
The National Autistic Society surveys regularly find that autistic people report being lonely and isolated more than the general population. Some autistic people like to be on their own for long periods of time, others are expected to feel like that because of the stereotypes around autism.
Assumptions should not be made about what friendship or socialising means to an autistic person. Try to find out what they want out of friendship and see if that is possible, or if a compromise can be made.
Being involved in the community can help reduce isolation – too often people with profound or severe learning difficulties are not involved in their community at all.