Cited by 1,986Health disparities and outcomesAttachment and Relationship DynamicsDeath Anxiety and Social Exclusion

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The clinical significance of loneliness: A literature review

Heinrich, Liesl M., Gullone, Eleonora·2006·Clinical Psychology Review

DOI 10.1016/j.cpr.2006.04.002

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Abstract

Satisfying social relationships are vital for good mental and physical health. Accordingly, we recommend that the alleviation and prevention of social relationship deficits be a key focus of clinicians. In this review, we focus on loneliness as a crucial marker of social relationship deficits and contend that loneliness should command clinicians' attention in its own right--not just as an adjunct to the treatment of other problems such as depression. With a particular focus on the adolescent developmental period, this review is organized into five sections: Drawing on developmental and evolutionary psychology theories, the nature of social relationships and the function they serve is first discussed. In the second section, loneliness is introduced as an exemplar of social relationship deficits. Here a definition of loneliness is provided, as well as an explanation of why it may pose a situation of concern. This is followed by a review of the prototypic features of loneliness through examination of its affective, cognitive, and behavioral correlates. The fourth section includes a review of theories related to the antecedent and maintenance factors involved in loneliness. Finally, methodological and theoretical considerations are addressed, and conclusions and proposals for future research directions are put forth.

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Macdonald, S. J., Deacon, L., Nixon, J., Akintola, A. R., Gillingham, A., Kent, J., Ellis, G., Mathews, D., Ismail, A., Sullivan, S., et al. (2018) · Disability & Society · doi:10.1080/09687599.2018.1476224 · Cited by 224
“by Heinrich and Gullone (2006) in Australia explored the effect that loneliness”
BackgroundMethodInfluential
Loneliness and Facebook motives in adolescence: A longitudinal inquiry into directionality of effect
Teppers, E., Luyckx, K., A. Klimstra, T., & Goossens, L. (2014) · Journal of Adolescence · doi:10.1016/j.adolescence.2013.11.003 · Cited by 217
“Loneliness is particularly relevant to investigate in adolescence (Heinrich & Gullone, 2006).”
Background
Prevalence of loneliness amongst older people in high-income countries: A systematic review and meta-analysis
Chawla, K., Kunonga, P., Stow, D., Barker, R., Craig, D., & Hanratty, B. (2021) · PLoS ONE · doi:10.1371/journal.pone.0255088 · Cited by 245
“In addition, published prevalence rates have been most consistent for very frequent or severe loneliness amongst the older population, at between 5 and 13% [77].”
Background
The Interplay of Loneliness and Depressive Symptoms Across Adolescence: Exploring the Role of Personality Traits
Vanhalst, J., Klimstra, T. A., Luyckx, K., Scholte, R. H. J., Engels, R. C. M. E., & Goossens, L. (2012) · Journal of Youth and Adolescence · doi:10.1007/s10964-011-9726-7 · Cited by 208
Experiences of Loneliness Associated with Being an Informal Caregiver: A Qualitative Investigation
Vasileiou, K., Barnett, J. C., Barreto, M., Vines, J., Atkinson, M., Lawson, S. W., & Wilson, M. L. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.00585 · Cited by 224
“Loneliness is also related to poor mental health outcomes (for a review see Heinrich and Gullone, 2006), such as depression (Cacioppo et al., 2010; Teo et al., 2013), deliberate self-harm (Rönkä et al., 2013), increased risk of dementia (Holwerda et al., 2014), and Alzheimer’s disease (Wilson et…”
Loneliness among people with substance use problems: A narrative systematic review
Ingram, I., Kelly, P. J., Deane, F. P., Baker, A. L., Goh, M. C. W., Raftery, D. K., & Dingle, G. A. (2020) · Drug and Alcohol Review · doi:10.1111/dar.13064 · Cited by 206
Loneliness and social anxiety across childhood and adolescence: Multilevel meta-analyses of cross-sectional and longitudinal associations.
Maes, M., Nelemans, S. A., Danneel, S., Fernández-Castilla, B., Van den Noortgate, W., Goossens, L., & Vanhalst, J. (2019) · Developmental Psychology · doi:10.1037/dev0000719 · Cited by 207
Vulnerability to Loneliness in People with Intellectual Disability: An Explanatory Model
Gilmore, L., & Cuskelly, M. (2014) · Journal of Policy and Practice in Intellectual Disabilities · doi:10.1111/jppi.12089 · Cited by 243
“Compared with around 15–30% of people in the general population (Heinrich & Gullone, 2006), it is estimated that up to half of those with intellectual disability are chronically lonely (Stancliffe et al., 2010).”
Background
Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence ☆
Schinka, K. C., van Dulmen, M. H. M., Mata, A. D., Bossarte, R., & Swahn, M. (2013) · Journal of Adolescence · doi:10.1016/j.adolescence.2013.08.002 · Cited by 199
Adolescent Loneliness and Health in Early Adulthood
Goosby, B. J., Bellatorre, A., Walsemann, K. M., & Cheadle, J. E. (2013) · Sociological Inquiry · doi:10.1111/soin.12018 · Cited by 231
Chatbots and mental health: Insights into the safety of generative AI
De Freitas, J., Uğuralp, A. K., Oğuz‐Uğuralp, Z., & Puntoni, S. (2024) · Journal of Consumer Psychology · doi:10.1002/jcpy.1393 · Cited by 211
Gender differences in the behavioral associates of loneliness and social dissatisfaction in kindergarten
Coplan, R. J., Closson, L. M., & Arbeau, K. A. (2007) · Journal of Child Psychology and Psychiatry · doi:10.1111/j.1469-7610.2007.01804.x · Cited by 198
The burden of loneliness: Implications of the social determinants of health during COVID-19
McQuaid, R. J., Cox, S. M. L., Ogunlana, A., & Jaworska, N. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113648 · Cited by 216
Loneliness across time and space
Luhmann, M., Buecker, S., & Rüsberg, M. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00124-1 · Cited by 197
Characterization of depression in children with autism spectrum disorders
Magnuson, K. M., & Constantino, J. N. (2011) · Journal of Developmental & Behavioral Pediatrics · doi:10.1097/dbp.0b013e318213f56c · Cited by 193
The importance of belonging and the avoidance of social risk taking in adolescence
Tomova, L., Andrews, J. L., & Blakemore, S.-J. (2021) · Developmental Review · doi:10.1016/j.dr.2021.100981 · Cited by 196
“It has been suggested that increased substance use might serve as a form of self-medication to cope with loneliness (Heinrich & Gullone, 2006), or as a way to affiliate with others if substance use is known to be endorsed by the peer group (DeWall & Pond, 2011).”
Background
A prospective study of social isolation, loneliness, and mortality in Finland
Tanskanen, J., & Anttila, T. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303431 · Cited by 189
Problem-focused and emotion-focused coping options and loneliness: how are they related?
Schoenmakers, E., van Tilburg, T. G., & Fokkema, T. (2015) · European Journal of Ageing · doi:10.1007/s10433-015-0336-1 · Cited by 244
“…1998; Peplau and Perlman 1982) observed to be related to negative effects on well-being (De Jong Gierveld 1998) and physical and mental health (Hawkley and Cacioppo 2010; Heinrich and Gullone 2006; Holwerda et al. 2012; Ó Luanaigh and Lawlor 2008; Routasalo and Pitkala 2003; Shankar et al. 2013).”
Background
The Psychological Impact of ‘Mild Lockdown’ in Japan during the COVID-19 Pandemic: A Nationwide Survey under a Declared State of Emergency
Yamamoto, T., Uchiumi, C., Suzuki, N., Yoshimoto, J., & Murillo‐Rodríguez, E. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17249382 · Cited by 203
Loneliness, social relations and health and well-being in deprived communities
Kearns, A., Whitley, E., Tannahill, C., & Ellaway, A. (2014) · Psychology Health & Medicine · doi:10.1080/13548506.2014.940354 · Cited by 187
“The associations between social contact, social support and loneliness throw light on what have been termed the “situational determinants of loneliness” (Heinrich & Gullone, 2006) for people in deprived areas.”
Sociodemographic and Health-Related Risks for Loneliness and Outcome Differences by Loneliness Status in a Sample of U.S. Older Adults
Theeke, L. A. (2010) · Research in Gerontological Nursing · doi:10.3928/19404921-20091103-99 · Cited by 186
“One most recent literature review regarding the clinical significance of loneliness concluded that self-report may be the most "tenable method of data collection" (Heinrich & Gullone, 2006).”
Method
Low Self-Esteem as a Risk Factor for Loneliness in Adolescence: Perceived - but not Actual - Social Acceptance as an Underlying Mechanism
Vanhalst, J., Luyckx, K., Scholte, R. H. J., Engels, R. C. M. E., & Goossens, L. (2013) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-013-9751-y · Cited by 216
“Similarly, literature reviews have indicated that loneliness is not only related to psychopathology in adolescence (e.g., depression and anxiety; Heinrich and Gullone 2006), but also marks an increased risk for morbidity and mortality”
Background
Would the Real Loneliness Please Stand Up? The Validity of Loneliness Scores and the Reliability of Single-Item Scores
Mund, M., Maes, M., Drewke, P. M., Gutzeit, A., Jaki, I., & Qualter, P. (2023) · Assessment · doi:10.1177/10731911221077227 · Cited by 192
“…on health-related outcomes (for reviews, see Cacioppo et al., 2015; Ernst & Cacioppo, 1999; Hawkley & Cacioppo, 2010; Hawkley & Capitanio, 2015; Heinrich & Gullone, 2006; Holt-Lunstad et al., 2015) and interpersonal outcomes (Cacioppo et al., 2017; Lodder et al., 2017; Mund et al., 2022; Mund…”
Loneliness, social isolation, their synergistic interaction, and mortality.
Beller, J., & Wagner, A. (2018) · Health Psychology · doi:10.1037/hea0000605 · Cited by 217
“Not surprisingly, loneliness and social isolation are thus also associated with mortality (e.g., Coyle & Dugan, 2012; Elovainio et al., 2017; Hawkley & Cacioppo, 2010; Heinrich & Gullone, 2006; Pantell et al., 2013).”
Background
Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study
Stickley, A., Koyanagi, A., Koposov, R. A., Schwab‐Stone, M., & Ruchkin, V. V. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-366 · Cited by 206
Grief literacy: A call to action for compassionate communities
Breen, L. J., 川島, 大., Joy, K., Cadell, S., Roth, D., Chow, A. Y. M., & Macdonald, M. E. (2020) · Death Studies · doi:10.1080/07481187.2020.1739780 · Cited by 209
The development of loneliness from mid‐ to late adolescence: Trajectory classes, personality traits, and psychosocial functioning
Vanhalst, J., Goossens, L., Luyckx, K., Scholte, R. H. J., & Engels, R. C. M. E. (2013) · Journal of Adolescence · doi:10.1016/j.adolescence.2012.04.002 · Cited by 177
“Finally, the experience of loneliness has been shown to relate to more depressive symptoms, lower self-esteem, higher anxiety, and greater perceived stress (Ernst & Cacioppo,1999; Heinrich & Gullone, 2006).”
Background
Internet-Based Cognitive Behavior Therapy for Loneliness: A Pilot Randomized Controlled Trial
Käll, A., Jägholm, S., Hesser, H., Andersson, F., Mathaldi, A., Norkvist, B. T., Shafran, R., & Andersson, G. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.05.001 · Cited by 176
Social networks and support in first-episode psychosis: exploring the role of loneliness and anxiety
Sündermann, O., Onwumere, J., Kane, F., Morgan, C., & Kuipers, E. (2013) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-013-0754-3 · Cited by 189
“This is also in line with research showing that loneliness is more influenced by subjective appraisals of the social relationships than by its objective features [12].”
BackgroundResult
Mental Health of Elders in Retirement Communities: Is Loneliness a Key Factor?
Bekhet, A. K., & Zauszniewski, J. A. (2011) · Archives of Psychiatric Nursing · doi:10.1016/j.apnu.2011.09.007 · Cited by 188
“The causes of loneliness are multidimensional and may include poor coping strategies, insecure attachments, failure expectations, and relationships that lack intimacy (Heinrich & Gullone, 2006; Seapersad, 2010).”
Background
Do the socially rich get richer? A nuanced perspective on social network site use and online social capital accrual.
Cheng, C., Wang, H., Sigerson, L., & Chau, C.-L. (2019) · Psychological Bulletin · doi:10.1037/bul0000198 · Cited by 197
“Loneliness is characterized by negative thoughts and feelings of inadequacy in social relations (e.g., de Jong Gierveld, van Tilburg, & Dykstra, 2006; Heinrich & Gullone, 2006).”
Background
Does loneliness mediate the relation between social support and cognitive functioning in later life
Ellwardt, L., Aartsen, M., Deeg, D., & Steverink, N. (2013) · Social Science & Medicine · doi:10.1016/j.socscimed.2013.09.002 · Cited by 167
“A crucial marker of unfavorably evaluated support and deficits in social relationships is loneliness (Heinrich & Gullone, 2006; O’Donovan & Hughes, 2007; Pinquart & Sörensen, 2001), defined as a “distressing feeling that accompanies the perception that one’s social needs are not being met by the…”
Background
Adolescents' longitudinal trajectories of mental health and loneliness: The impact of COVID‐19 school closures
Houghton, S., Kyron, M., Hunter, S. C., Lawrence, D., Hattie, J., Carroll, A., & Zadow, C. (2022) · Journal of Adolescence · doi:10.1002/jad.12017 · Cited by 185
Loneliness and social isolation causal association with health-related lifestyle risk in older adults: a systematic review and meta-analysis protocol
Malcolm, M., Frost, H., & Cowie, J. (2019) · Systematic Reviews · doi:10.1186/s13643-019-0968-x · Cited by 194
The Anxiety-Buffer Hypothesis in the Time of COVID-19: When Self-Esteem Protects From the Impact of Loneliness and Fear on Anxiety and Depression
Rossi, A., Panzeri, A., Pietrabissa, G., Manzoni, G. M., Castelnuovo, G., & Mannarini, S. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02177 · Cited by 166
Does Mode of Contact with Different Types of Social Relationships Predict Depression in Older Adults? Evidence from a Nationally Representative Survey
Teo, A. R., Choi, H., Andrea, S. B., Valenstein, M. M., Newsom, J. T., Dobscha, S. K., & Zivin, K. (2015) · Journal of the American Geriatrics Society · doi:10.1111/jgs.13667 · Cited by 184
Feeling Lonely Versus Being Alone: Loneliness and Social Support Among Recently Bereaved Persons
Utz, R., Swenson, K. L., Caserta, M. S., Lund, D., & deVries, B. (2013) · The Journals of Gerontology Series B · doi:10.1093/geronb/gbt075 · Cited by 169
“Greater social support was associated with lower levels of loneliness overall, but the receipt of social support did not modify one’s expression of loneliness over time.”
Loneliness in psychotic disorders and its association with cognitive function and symptom profile
Badcock, J. C., Shah, S., Mackinnon, A., Stain, H. J., Galletly, C., Jablensky, A., & Morgan, V. A. (2015) · Schizophrenia Research · doi:10.1016/j.schres.2015.10.027 · Cited by 168
“…ourna l homepage: www.e lsev ie r .com/ locate /schres Australia indicate that around 7–11% of adults describe themselves currently as often or very lonely (Griffin, 2010; Hawthorne, 2008), with roughly 30% indicating that loneliness is an enduring part of life (Heinrich and Gullone, 2006).”
Background

Authors: Heinrich, L. M., & Gullone, E.
Affiliations: Monash University (AU)
Corresponding author: Heinrich, Liesl M.
ORCID: Heinrich, Liesl M.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2006-10
Volume: 26
Issue: 6
Pages: 695-718
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2006.04.002
OpenAlex: W1974322420
Cited by: 1,986
References: 221
Citations by year: 2026: 135 · 2025: 158 · 2024: 183 · 2023: 201 · 2022: 198 · 2021: 170 · 2020: 132 · 2019: 113 · 2018: 106 · 2017: 100 · 2016: 83 · 2015: 91 · 2014: 75 · 2013: 69 · 2012: 54
FWCI: 2.96
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Health › Health disparities and outcomes
Social Sciences › Psychology › Social Psychology › Attachment and Relationship Dynamics
Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
Keywords: loneliness, interpersonal relationships, adolescents, evolutionary psychology, developmental psychology, mental health, physical health
MeSH terms: Adolescent, Affect, Anxiety Disorders, Depressive Disorder, Biological Evolution, Health Services, Health Services Needs and Demand, Health Status, Humans, Interpersonal Relations, Loneliness, Motivation, Psychophysiologic Disorders, Self Concept, Social Behavior, Prevalence

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The clinical significance of loneliness: A literature review

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