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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Low-grade inflammation decreases emotion recognition – Evidence from the vaccination model of inflammation
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“46 However, the measures used in the study have a high validity in measuring the outcomes.”
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Background
The positive and negative emotion functions related to loneliness: a systematic review of behavioural and neuroimaging studies
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“Specifically, lone-liness could make individuals more susceptible to experiencing negative emotions (Heinrich and Gullone, 2006 ; Erzen and Çikrikci 2018 ), and ele v ated le v els of negativ e emotions can r esult in a lac k of interest in social interactions and emotional fatigue, thereby…”
Background
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Background
Reputación social, ajuste psicosocial y victimización entre adolescentes en el contexto escolar
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“January/February 2013 ◆ vol 54 no 1 105 Loneliness has been defined as instances of discontinuity between the ideal inter personal relationships and one’s perceived current interpersonal relationships (Heinrich & Gullone, 2006), often occurring in college students.”
Background
Loneliness – two sides to the story: adolescents’ lived experiences
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“The loneliness literature has called for more subjective examinations of the construct (Heinrich & Gullone, 2006; Mann et al., 2017).”
BackgroundInfluential
Brain Sub/Region-Specific Effects of Olanzapine on c-Fos Expression of Chronically Socially Isolated Rats
Stanisavljević, A., Perić, I., Gass, P., Inta, D., Lang, U. E., Borgwardt, S., & Filipović, D. (2018) · Neuroscience · doi:10.1016/j.neuroscience.2018.11.015 · Cited by 30
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“Conflictual friendships have been associated with higher levels of depressive symptoms (Bagwell et al., 2005) and loneliness (Heinrich & Gullone, 2006) in emerging adulthood.”
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Why loneliness requires a multidimensional approach: a critical narrative review
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“Other studies have shown that romantic relationship status and cohabitation was associated with EL only 14–18 , and that discrepancies between desired and actual relationships play an important role in the severity of EL and SL 19 .”
Multisource assessed social competence as a predictor for children’s and adolescents’ later loneliness, social anxiety, and social phobia
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“To date, many correlations of loneliness have been identified varying from employment to low self-esteem [25, 26, 28], but a limited number of studies focussed on PTE and related symptoms as predictors of loneliness.”
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Friendless Adolescents: Do Perceptions of Social Threat Account for Their Internalizing Difficulties and Continued Friendlessness?
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“In light of research suggesting that chronic social isolation is particularly harmful to psychological health (Heinrich & Gullone, 2006), future studies should examine whether a history of friendlessness helps account for an accumulation of adjustment problems.”
Background
Antidepressant-like effects of pharmacological inhibition of FAAH activity in socially isolated female rats
Carnevali, L., Statello, R., Vacondio, F., Ferlenghi, F., Spadoni, G., Rivara, S., Mor, M., & Sgoifo, A. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2019.12.119 · Cited by 30
“Depressive-like syndrome in socially isolated female rats 293 Psychiatric disorders in humans have been linked prevalently with social stress and/or reduced 294 social interaction (Bjorkqvist, 2001; Heinrich and Gullone, 2006).”
Background
Lockdown Lives: A Longitudinal Study of Inter-Relationships Among Feelings of Loneliness, Social Contacts, and Solidarity During the COVID-19 Lockdown in Early 2020
van Breen, J. A., Kutlaca, M., Koç, Y., Jeronimus, B. F., Reitsema, A. M., Jovanović, V., Agostini, M., Bélanger, J. J., Gützkow, B., Kreienkamp, J., et al. (2021) · Personality and Social Psychology Bulletin · doi:10.1177/01461672211036602 · Cited by 34
Assessing Social Anxiety Through Digital Biomarkers Embedded in a Gaming Task
Dechant, M., Frommel, J., & Mandryk, R. L. (2021) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445238 · Cited by 31
“3445238 risk of developing more severe physical and mental health problems [24, 54, 56].”
Background
The Importance of Modeling Method Effects: Resolving the (Uni)Dimensionality of the Loneliness Questionnaire
Ebesutani, C. K., Drescher, C. F., Reise, S. P., Heiden, L. J., Hight, T. L., Damon, J. D., & Young, J. N. (2012) · Journal of Personality Assessment · doi:10.1080/00223891.2011.627967 · Cited by 29
“A recent review ( Heinrich & Gullone, 2006 ) has highlighted the clinical significance of loneliness, including its relationship to several indexes of poor psychological and physical health.”
Background
Types of Social Connectedness and Loneliness: the Joint Moderating Effects of Age and Gender
Ang, C.-S. (2016) · Applied Research in Quality of Life · doi:10.1007/s11482-015-9428-5 · Cited by 30
Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis
Jong, A., Odoi, C. M., Lau, J., & J.Hollocks, M. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241229096 · Cited by 29
“In young people in the general population, increasing and chronic loneliness trajectories predict increases in depression, anxiety, self-harm, and suicidal ideation (Heinrich & Gullone, 2006; Ladd & Ettekal, 2013; Qualter et al., 2013; Vanhalst et al., 2013).”
BackgroundResult
Difficulties in Emotion Regulation and Problematic Pornography Use: The Mediating Role of Loneliness
Cardoso, J., Ramos, C., Brito, J., & Almeida, T. C. (2023) · International Journal of Sexual Health · doi:10.1080/19317611.2023.2224807 · Cited by 34
“Additionally, people with higher levels of loneliness are more likely to experience other negative emotions (Heinrich & Gullone, 2006), with correspondingly greater emotion regulation efforts.”
Background
Bullying at School, Cyberbullying, and Loneliness: National Representative Study of Adolescents in Denmark
Madsen, K. R., Damsgaard, M. T., Petersen, K. J., Qualter, P., & Holstein, B. E. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21040414 · Cited by 48
“Loneliness is also an important public health problem because it is associated with a range of health problems [1,6,11–14] and risk behaviors [15–17].”
Background
Multidimensional and fluctuating experiences of loneliness from childhood to young adulthood in Northern Finland
Rönkä, A. R., Taanila, A. M., Rautio, A., & Sunnari, V. (2018) · Advances in Life Course Research · doi:10.1016/j.alcr.2018.01.003 · Cited by 35
Motivation for Solitude: A Cross-Cultural Examination of Adolescents from Collectivist and Individualist Cultures in South Africa
van Zyl, C. J. J., Dankaert, E. S., & Guse, T. (2018) · Journal of Child and Family Studies · doi:10.1007/s10826-017-0916-0 · Cited by 36
“Especially, if they would prefer to be in the company of others, but their social fears, anxieties or other-imposed forms of withdrawal result in isolation (Heinrich and Gullone 2006).”
Loneliness and ED Visits in Chronic Obstructive Pulmonary Disease
Marty, P. K., Novotny, P. J., & Benzo, R. P. (2019) · Mayo Clinic Proceedings Innovations Quality & Outcomes · doi:10.1016/j.mayocpiqo.2019.05.002 · Cited by 29
“This subsequently may contribute to a sense of distress(8) and has been linked to adverse outcomes in mortality and mental health.(7,9) Overall, loneliness seems to be increasing in the United States(8) and prevails among older adults.”
Background
The social value of positive autobiographical memory retrieval.
Speer, M. E., & Delgado, M. R. (2019) · Journal of Experimental Psychology General · doi:10.1037/xge0000671 · Cited by 34
“A lack of social ties is linked to reduced selfesteem (Leary, Tambor, Terdal, & Downs, 1995), the onset of mental health disorders such as anxiety and depression (Heinrich & Gullone, 2006), and increased risk of mortality akin to smoking or alcohol abuse (Holt-Lunstad, Smith, & Layton, 2010).”
Background
The Association Between Social Isolation and Health: An Analysis of Parent–Adolescent Dyads from the Family Life, Activity, Sun, Health, and Eating Study
Thompson, T., Rodebaugh, T. L., Bessaha, M. L., & Sabbath, E. L. (2019) · Clinical Social Work Journal · doi:10.1007/s10615-019-00730-2 · Cited by 31
“2018 ), but these issues are also problematic for younger people, including adolescents (Brody 2017; Heinrich and Gullone 2006; Qualter et al.”
Background
Are Aspects of Twitter Use Associated with Reduced Depressive Symptoms? The Moderating Role of In-Person Social Support
Cole, D. A., Nick, E. A., Varga, G., Smith, D. K., Zelkowitz, R. L., Ford, M. A., & Lédeczi, Á. (2019) · Cyberpsychology Behavior and Social Networking · doi:10.1089/cyber.2019.0035 · Cited by 29
Sense of coherence and burnout among school psychologists: The moderating role of loneliness
George‐Levi, S., Schmidt‐Barad, T., Natan, I., & Margalit, M. (2020) · Current Psychology · doi:10.1007/s12144-020-00766-5 · Cited by 29
Adolescents' peer contacts promote life satisfaction in young adulthood — A connection mediated by the subjective experience of not being lonely
Kekkonen, V., Tolmunen, T., Kraav, S., Hintikka, J., Kivimäki, P., Kaarre, O., & Laukkanen, E. (2020) · Personality and Individual Differences · doi:10.1016/j.paid.2020.110264 · Cited by 29
Left‐Behind Children's Grandparent–Child and Parent–Child Relationships and Loneliness: A Multivariable Mediation Model
Song, J., Ma, C., & Ruan, Y. (2020) · Family Relations · doi:10.1111/fare.12480 · Cited by 30
The Rising of the Shield Hero. Development of the Post-Traumatic Symptom Questionnaire (PTSQ) and Assessment of the Protective Effect of Self-Esteem from Trauma-Related Anxiety and Depression
Rossi, A. A., Panzeri, A., Taccini, F., Parola, A., & Mannarini, S. (2022) · Journal of Child & Adolescent Trauma · doi:10.1007/s40653-022-00503-z · Cited by 29
“First, both Study 1 and Study 2 are grounded on well-established theoretical foundations relying on several experimental and longitudinal studies’ support (Brage & Meredith, 1994; Greenberg et al., 1992; Heinrich & Gullone, 2006; Pyszc-zynski et al., 2004).”
Lonely patients in general practice: a call for revealing GPs' emotions? A qualitative study
van der Zwet, J., Loon, M. S. K.-V., & van den Akker, M. (2009) · Family Practice · doi:10.1093/fampra/cmp059 · Cited by 29
Neurological mechanism of Xiaochaihutang's antidepressant-like effects to socially isolated adult rats
Ma, J., Wu, C. F., Wang, F., Yang, J., Dong, Y. X., Su, G. Y., Zhang, K., Wang, Z. Q., Xu, L. W., Pan, X., et al. (2016) · Journal of Pharmacy and Pharmacology · doi:10.1111/jphp.12616 · Cited by 29
“Social isolation is especially stressful for social individuals.([9]) Under laboratory conditions, chronic social isolation stress (CSIS) mimics the psychosocial stress that may effectively model a depressive-like state.”
Background
Associations among shyness, interpersonal relationships, and loneliness in college freshmen: A longitudinal cross‐lagged analysis
Tian, Y., Chen, P., Meng, W., Zhan, X., Wang, J., Wang, P., & Gao, F. (2019) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12588 · Cited by 29
Causes of loneliness
Rokach, A. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-815618-6.00006-0 · Cited by 29
Social Withdrawal during Adolescence and Emerging Adulthood
Bowker, J. C., Nelson, L. J., Markovic, A., & Luster, S. S. (2013) · doi:10.1002/9781118427378.ch10 · Cited by 29
“It is also likely that loneliness will ensue, which is a strong predictor of psychological distress, across cultures, and across the lifespan (e.g., Cacioppo, Hawkley, & Thisted, 2010; Heinrich & Gullone, 2006; see Asher & Weeks, Chapter 16, this volume).”
Background
On failed intersubjectivity: recollections of loneliness experiences in offspring of Holocaust survivors
Wiseman, H. (2008) · American Journal of Orthopsychiatry · doi:10.1037/a0014197 · Cited by 28
A Systematic Review of Intervention Programs Promoting Peer Relationships Among Children and Adolescents: Methods and Targets Used in Effective Programs
Pollak, I., Mitić, M., Birchwood, J., Dörfler, S., Krammer, I., Rogers, J. C., Schek, E. J., Schrank, B., Stiehl, K. A. M., & Woodcock, K. A. (2022) · Adolescent Research Review · doi:10.1007/s40894-022-00195-4 · Cited by 48
“Especially loneliness was found to be strongly associated with mental health (Heinrich & Gullone, 2006) and have bidirectional links with depressive symptoms (Vanhalst et al., 2012).”
Background
Who are the lonely? A typology of loneliness in New Zealand
Hawkins-Elder, H., Milfont, T. L., Hammond, M. D., & Sibley, C. G. (2017) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867417718944 · Cited by 32
“Loneliness has also been linked to other negative mental health outcomes, including social anxiety (Heinrich and Gullone, 2006; Lim et al., 2016; Mahon et al., 2006), obsessive–compulsive disorder (Timpano et al., 2014), cognitive Background: Loneliness has many negative physical and mental health…”
BackgroundInfluential
Why did (some) consumers buy toilet papers? A cross‐cultural examination of panic buying as a maladaptive coping response to COVID ‐19
Im, H., Kim, N. L., & Lee, H. K. (2021) · Journal of Consumer Affairs · doi:10.1111/joca.12426 · Cited by 31
The associations of use of social network sites with perceived social support and loneliness
Caba‐Machado, V., McIlroy, D., Adamuz, F. M. P., Murphy, R., & Palmer-Conn, S. (2022) · Current Psychology · doi:10.1007/s12144-021-02673-9 · Cited by 42
“Loneliness corresponds to a divergence between one’s perceived and desired levels of social connectedness (Heinrich & Gullone, 2006).”
Background
Stop talking about it already! Co-ruminating and social media focused on COVID-19 was associated with heightened state anxiety, depressive symptoms, and perceived changes in health anxiety during Spring 2020
Stone, L. B., & Veksler, A. E. (2022) · BMC Psychology · doi:10.1186/s40359-022-00734-7 · Cited by 32
“In contrast, loneliness increases depression and anxiety risk [13, 14].”
Background
The prevalence, incidence, and risk factors of mental health problems and mental health service use before and 9 months after the COVID-19 outbreak among the general Dutch population. A 3-wave prospective study
van der Velden, P. G., Marchand, M. A. G., Das, M., Muffels, R. J. A., & Bosmans, M. W. G. (2022) · PLoS ONE · doi:10.1371/journal.pone.0276834 · Cited by 28
“How can we, given the outcomes of several studies showing an increase in mental health problems [9–17], understand the contradicting results of the present study [20, 42]? Several elements, other than the resilience of people [3–5], may play a role and may help explain these differences, but future empirical research…”
Result
Repetitive Negative Thinking as a Central Node Between Psychopathological Domains: a Network Analysis
Zagaria, A., Ballesio, A., Vacca, M., & Lombardo, C. (2023) · International Journal of Cognitive Therapy · doi:10.1007/s41811-023-00162-4 · Cited by 28
“…discrepancy between the quality and quantity of relationships that individuals have and the ones they desire (Cacioppo & Cacioppo, 2018), has been considered a transdiagnostic clinical phenomenon that may significantly influence mental health and psychological well-being (Heinrich & Gullone, 2006).”
Background
An investigation of the relationship between subjective sleep quality, loneliness and mood in an Australian sample: Can daily routine explain the links?
Smith, S. S., Kozak, N., & Sullivan, K. A. (2010) · International Journal of Social Psychiatry · doi:10.1177/0020764010387551 · Cited by 28
“Loneliness is important to sleep quality, as sleep complaints are more prevalent among people who are socially alienated or otherwise dissatisfied with their social relations (Carney et al., 2006; Heinrich and Gullone, 2006; Ohayon and Roth, 2001).”
BackgroundMethodInfluential
Associations Between Health-Related Self-Protection, Diurnal Cortisol, and C-Reactive Protein in Lonely Older Adults
Rueggeberg, R., Wrosch, C., Miller, G. E., & McDade, T. W. (2012) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3182732dc6 · Cited by 28
“Feelings of loneliness are increasingly recognized to compromise quality of life (1,2).”
Background
Are adolescents with high self-esteem protected from psychosomatic symptomatology?
Piko, B. F., Varga, S., & Mellor, D. J. (2016) · European Journal of Pediatrics · doi:10.1007/s00431-016-2709-7 · Cited by 28
Associations between school liking, loneliness and social relations among adolescents: Northern Finland Birth Cohort 1986 study
Rönkä, A. R., Sunnari, V., Rautio, A., Koiranen, M., & Taanila, A. M. (2016) · International Journal of Adolescence and Youth · doi:10.1080/02673843.2015.1136659 · Cited by 35
“Loneliness has also been linked with an increased likelihood of school drop-outs (Heinrich & Gullone, 2006), absenteeism (Juvonen, Nishina, & Graham, 2000) and substance use (Page, Dennis, Lindsay, & Merrill, 2010; Stickley, Koyanagi, Koposov, Schwab-Stone, & Ruchkin, 2014).”
The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis
Chau, A. K. C., So, S. H., Sun, X., Zhu, C., Chiu, C., Chan, R. C. K., & Leung, P. W. L. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.931558 · Cited by 30
Evaluating the impact of loneliness and social isolation on health literacy and health-related factors in young adults
Vasan, S., Eikelis, N., Lim, M. H., & Lambert, É. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.996611 · Cited by 42
“Young adulthood is a critical and transitional period marked with psychosocial challenges (e.g., striving for independence, holding increased responsibilities, and moving away from familial relationships and gravitating toward peer-based relationships; Heinrich and Gullone, 2006).”
Background
A framework for understanding adverse adolescent experiences
Pollmann, A., Bates, K. E., & Fuhrmann, D. (2025) · Nature Human Behaviour · doi:10.1038/s41562-024-02098-x · Cited by 36
“Although social isolation is neither necessary nor sufficient for loneliness to occur, adolescents are more vulnerable to loneliness than other age groups 88,89 .”

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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