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Cited by 2,158Health disparities and outcomesCOVID-19 and Mental HealthDeath Anxiety and Social Exclusion

An overview of systematic reviews on the public health consequences of social isolation and loneliness

Open access
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., Caan, W.·2017·Public Health
DOI 10.1016/j.puhe.2017.07.035
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Abstract

OBJECTIVES Social isolation and loneliness have been associated with ill health and are common in the developed world. A clear understanding of their implications for morbidity and mortality is needed to gauge the extent of the associated public health challenge and the potential benefit of intervention. STUDY DESIGN A systematic review of systematic reviews (systematic overview) was undertaken to determine the wider consequences of social isolation and loneliness, identify any differences between the two, determine differences from findings of non-systematic reviews and to clarify the direction of causality. METHODS Eight databases were searched from 1950 to 2016 for English language reviews covering social isolation and loneliness but not solely social support. Suitability for inclusion was determined by two or more reviewers, the methodological quality of included systematic reviews assessed using the a measurement tool to assess systematic reviews (AMSTAR) checklist and the quality of evidence within these reviews using the grading of recommendations, assessment, development and evaluations (GRADE) approach. Non-systematic reviews were sought for a comparison of findings but not included in the primary narrative synthesis. RESULTS Forty systematic reviews of mainly observational studies were identified, largely from the developed world. Meta-analyses have identified a significant association between social isolation and loneliness with increased all-cause mortality and social isolation with cardiovascular disease. Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes. No reviews were identified for wider socio-economic or developmental outcomes. CONCLUSIONS This systematic overview highlights that there is consistent evidence linking social isolation and loneliness to worse cardiovascular and mental health outcomes. The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear. More research is needed on associations with cancer, health behaviours, and the impact across the life course and wider socio-economic consequences. Policy makers and health and local government commissioners should consider social isolation and loneliness as important upstream factors impacting on morbidity and mortality due to their effects on cardiovascular and mental health. Prevention strategies should therefore be developed across the public and voluntary sectors, using an asset-based approach.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic overview of 40 systematic reviews found consistent evidence linking social isolation and loneliness to increased all-cause mortality and worse cardiovascular and mental health outcomes. Evidence for other physical health, behavioural, developmental, and socio-economic outcomes was limited or absent.

Key findings

  • Meta-analyses found significant associations with all-cause mortality: social isolation OR 1.29 (95% CI 1.06–1.56; excluding suicide), loneliness OR 1.26 (95% CI 1.04–1.53), and living alone OR 1.32 (95% CI 1.14–1.53); greater social participation HR 0.87 (95% CI 0.82–0.91) and better social networks HR 0.91 (95% CI 0.86–0.97).
  • High social isolation was associated with increased cardiovascular relative risk of 1.5 (95% CI 1.2–1.9); largest social network size was associated with reduced cancer mortality RR 0.80 (95% CI 0.72–0.89).
  • Strong evidence was found for social isolation and loneliness with all-cause mortality, and social isolation with cardiovascular disease and depression; evidence was less strong for behavioural and other physical health outcomes.
  • No systematic reviews were identified for wider socio-economic or developmental outcomes; more research is needed on cancer, health behaviours, the life course, and wider socio-economic consequences.

Methods

  • Systematic overview of systematic reviews; eight databases were searched from 1950 to March 2016 for English-language reviews covering social isolation and loneliness but not solely social support; non-systematic reviews were sought for comparison but not included in the primary narrative synthesis.
  • Forty systematic reviews were identified, ten involving meta-analysis, largely of observational studies and mainly from the developed world; inclusion was confirmed by two or more reviewers.
  • Methodological quality of included reviews was assessed using AMSTAR, and quality of evidence within reviews using GRADE; findings were synthesised narratively.

Limitations

  • Stated: most research came from developed countries and only English-language publications were considered; no reviews considered health economic considerations; age was not analysed in most reviews, with two meta-analyses showing no age effect versus a stronger effect for individuals aged less than 65 years; ethnicity was infrequently recorded; most reviews were of moderate quality and none were high quality; few reviews contained longitudinal studies so causality cannot be inferred; all tools were self-report measures.
  • Evident from the text: significant clinical heterogeneity existed between both the reviews and the primary studies they contained.

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Integrity signals

Registry

Crossref · 10.1016/j.puhe.2017.07.035

Cites

104 of 104 references verified0 citation errors · 0 not checkable

Statistics

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Claims the paper makes

0 of 160 cited sources checked · 0 supported · 0 flagged

  • Findingcitation
    § Copyright:

    Meta-analyses identified a significant association between social isolation and loneliness and increased all-cause mortality.

    “Meta-analyses have identified a significant association between social isolation and loneliness with increased all-cause mortality”
    • Also stated in: § 1. Mortality & General Health · plain
      “Two meta-analyses of cohort studies identified a significant association between social isolation, loneliness and social network size with all-cause mortality”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [19] Holt-Lunstad, 2015, Loneliness and social isolation as risk factors for mortality: a meta-analytic review, Perspect Psychol Sci source

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    • cites [20] Nyqvist, 2014, Structural and cognitive aspects of social capital and all-cause mortality: a meta-analysis of cohort studies, Soc Indic Res source

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  • Findingnone given
    § Results

    Reviews which scored poorly using AMSTAR also tended to have low GRADE scores.

    “Those reviews which scored poorly using AMSTAR also tended to have low GRADE scores.”
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  • Findingown data
    § Results

    Generally, the meta-analyses were of superior methodological quality to the systematic reviews.

    “Generally, the meta-analyses were of superior methodological quality to the systematic reviews.”
    Quote in the paperNot a substantial claim
  • Findingcitation
    § 1. Mortality & General Health

    Greater social participation is associated with lower all-cause mortality, hazard ratio 0.87 (95% CI 0.82, 0.91).

    “hazard ratios for all-cause mortality for greater social participation of 0.87 (95 % CI 0.82, 0.91) and for better social networks of 0.91 (95 % CI 0.86, 0.97) 20”
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    • cites [20] Nyqvist, 2014, Structural and cognitive aspects of social capital and all-cause mortality: a meta-analysis of cohort studies, Soc Indic Res source

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  • Findingnone given
    § 1. Mortality & General Health

    An association between loneliness and fewer social relationships with poor health and wellbeing was suggested in three systematic reviews of worldwide studies using different methodologies and assessment measures in individuals aged over 50-55 years.

    “An association between loneliness and fewer social relationships with poor health and wellbeing was suggested in three systematic reviews of worldwide studies using different methodologies and assessment measures in individuals aged over 50-55 years.”
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  • Classified as probably not a substantial claim. 20
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  • The quote only partly states this claim. 19

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    Findingown data
    § Results

    Eight reviews were undertaken in two or more countries, while the rest were carried out by teams from single countries, all from the developed world except one.

    “Eight reviews were undertaken in two or more countries, while the rest were carried out by teams from single countries, all from the developed world except one.”
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    § Results

    Seven of the meta-analyses were of moderate or high quality (score 8-10); the majority were also assessed as containing evidence of moderate GRADE quality.

    “Seven of the metaanalyses were of moderate or high quality (score 8-10); the majority were also assessed as containing evidence of moderate GRADE quality (Table 3).”
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    Findingcitation
    § Results

    For forty-nine measures, information could be sourced which allowed mapping using a two-dimensional framework.

    “For forty-nine measures, information could be sourced which allowed mapping using a two-dimensional framework 18 (Figure 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Valtorta, 2016, Loneliness, social isolation and social relationships: what are we measuring? A novel framework for classifying and comparing tools, BMJ Open

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    Findingown data
    § Results

    When assessed using the AMSTAR checklist, seventeen of the systematic reviews were of moderate quality (score 5-7) and thirteen of low quality (score 0-4).

    “When assessed using the AMSTAR checklist, seventeen of the systematic reviews were of moderate quality (score 5-7) and thirteen of low quality (score 0-4).”
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    Findingown data
    § Results

    Of the forty systematic reviews included in this overview, ten involved a meta-analysis.

    “Of the forty systematic reviews included in this overview, ten involved a meta-analysis.”
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    Findingown data
    § Copyright:

    Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes.

    “Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes.”
    Quote in the paperSubstantial claim

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    Findingown data
    § Copyright:

    Forty systematic reviews of mainly observational studies were identified, largely from the developed world.

    “Forty systematic reviews of mainly observational studies were identified, largely from the developed world.”
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    Findingcitation
    § 2. Health Behaviours

    Loneliness of parents and social isolation of adolescent sex offenders have been associated with child abuse.

    “Loneliness of parents and social isolation of adolescent sex offenders have been associated with child abuse in another systematic review and a meta-analysis 35, 36”
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    • cites [35] Black, 2001, Risk factors for child physical abuse, Aggress Violent Behav source

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    • cites [36] Seto, 2010, What is so special about male adolescent sexual offending? A review and test of explanations through meta-analysis, Psychol Bull source

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    Findingcitation
    § 4. Mental Health

    A low sense of belonging is associated with a higher risk of suicidal ideation and suicide attempts.

    “One review found that a low sense of belonging was associated with a higher risk of suicidal ideation and suicide attempts”
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    • cites [52] Hatcher, 2013, Sense of belonging and suicide: a systematic review, Can J Psychiatry Revue Can De Psychiatrie source

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    § 5. Summary of evidence

    There is strong evidence that both social isolation and loneliness are associated with increased all-cause mortality.

    “shows that there is strong evidence that both social isolation and loneliness are associated with increased all-cause mortality, and social isolation with cardiovascular disease and depression (Table 4).”
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      “This overview has identified that there is strong evidence that both social isolation and loneliness are associated with increased all-cause mortality.”
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    Findingcitation
    § 2. Health Behaviours

    In one review, a positive association between loneliness and tobacco use was reported in half of the included studies, whereas the other half reported no association or a negative association.

    “in one of these reviews a positive association between loneliness and tobacco use was reported in half of the included studies, whereas the other half reported no association or a negative association 27 .”
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    • cites [27] Dyal, 2015, A systematic review of loneliness and smoking: small effects, big implications, Subst Use Misuse source

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    § 3. Physical Health

    Individuals with stronger social relationships have a 50% increased likelihood of survival, with no variation between gender.

    “with individuals with stronger social relationships having a 50% increased likelihood of survival, with no variation between gender 41”
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    • cites [41] Glozier, 2013, Psychosocial risk factors for coronary heart disease, Med J Aust source

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    Findingcitation
    § 2. Health Behaviours

    Social isolation may lead to reduced interaction and increased use of online sources of advice, potentially leading to sub-optimal adherence to treatments.

    “one suggested that social isolation may lead to reduced interaction and increased use of online sources of advice, potentially leading to sub-optimal adherence to treatments 37”
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    • cites [37] De Freitas, 2013, Vulnerabilities to misinformation in online pharmaceutical marketing, J R Soc Med source

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    § 4. Mental Health

    There is an association between subjective mental wellbeing and social relationships, with the quality of relationships more important than the quantity.

    “One meta-analysis found an association between subjective mental wellbeing and social relationships, with the quality of relationships more important than the quantity of them 25 .”
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    • cites [25] Pinquart, 2000, Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis, Psychol Aging source

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    § 4. Mental Health

    There is an association between social isolation and social anxiety disorder, though causality is unclear.

    “A meta-analysis identified an association between social isolation and social anxiety disorder, though causality was unclear 51 .”
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    • cites [51] Teo, 2013, The role of social isolation in social anxiety disorder: a systematic review and meta-analysis, J Anxiety Disord source

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    Findingcitation
    § 4. Mental Health

    Loneliness and low social participation are associated with an increased risk of dementia.

    “Two systematic reviews identified that loneliness and low social participation were associated with an increased risk of dementia”
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    • cites [57] Boss, 2015, Loneliness and cognitive function in the older adult: a systematic review, Int Psychogeriatr source

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    • cites [58] Kuiper, 2015, Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies, Ageing Res Rev source

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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and suicide, supported by one review or multiple lower quality reviews.

    “| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social networks and relationships and other physical health, supported by one review or multiple lower quality reviews.

    “| Other physical health (Barton et al 2015, Steenstra et al 2005) | + | | + |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social networks and relationships and depression and anxiety, supported by one review or multiple lower quality reviews.

    “| Depression and anxiety (Ouimet et al 2001, Kita et al 2015, Santini et al 2015, Schwarzbach et al 2014, Teo et al 2013) | ++ | | + |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and physical activity, supported by one review or multiple lower quality reviews.

    “| Physical activity (Vancampfort et al 2012a, Vancampfort et al 2012b) | + | | |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and diet, supported by one review or multiple lower quality reviews.

    “| Diet (Van der Pols-Vijlbrief et al 2014) | | + | |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and other physical health, supported by one review or multiple lower quality reviews.

    “| Other physical health (Barton et al 2015, Steenstra et al 2005) | + | | + |”
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    § What is already known

    Non-systematic reviews have identified associations between social isolation/loneliness and changes to brain structure and processes, sympathetic neural tone, vascular stress responses, altered sleep and reduced sleep quality, cortisol secretion patterns, impaired cellular and humoral immunity, and reduced inflammatory responses.

    “a number of non-systematic reviews have identified associations with changes to brain structure and processes, sympathetic neural tone, vascular stress responses, altered sleep and reduced sleep quality, cortisol secretion patterns, impaired cellular and humoral immunity, and reduced inflammatory responses 61, 80, 96, 102-106 .”
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    • cites [61] Hawkley, 2010, Loneliness matters: a theoretical and empirical review of consequences and mechanisms, Ann Behav Med source

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    • cites [80] Hawkley, 2003, Loneliness and pathways to disease, Brain Behav Immun source

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    • cites [96] West, 1986, The effects of loneliness – a review of the literature, Compr Psychiatry source

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    • cites [102] Cacioppo, 2014, Toward a neurology of loneliness, Psychol Bull source

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    • cites [103] Cacioppo, 2011, Social isolation

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    • cites [104] Hawkley, 2012, Effects of social isolation on glucocorticoid regulation in social mammals, Horm Behav source

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    • cites [105] Knutson, 2013, Sociodemographic and cultural determinants of sleep deficiency: implications for cardiometabolic disease risk, Soc Sci Med source

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    • cites [106] Local Government Association and Improvement and Development Agency, 2010

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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and tobacco use, supported by one review or multiple lower quality reviews.

    “| Tobacco use (Barbosa et al 2012, Dyal & Valente 2015, Seo et al 2012) | + | + | |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and sexual health behaviours, supported by one review or multiple lower quality reviews.

    “| Sexual health behaviours (Black et al 2000, Herbst et al 2008, Seto & Lalumiere 2010*) | + | + | |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and tobacco use, supported by one review or multiple lower quality reviews.

    “| Tobacco use (Barbosa et al 2012, Dyal & Valente 2015, Seo et al 2012) | + | + | |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and general health and wellbeing, supported by one review or multiple lower quality reviews.

    “| General health & wellbeing (Aminzadeh & Dalziel 2002, Annear et al 2014, Chen et al 2014, Pinquart & Sorensen 2000) | + | + | |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and sexual health behaviours, supported by one review or multiple lower quality reviews.

    “| Sexual health behaviours (Black et al 2000, Herbst et al 2008, Seto & Lalumiere 2010*) | + | + | |”
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    § Limitations

    One meta-analysis found a stronger effect for individuals aged less than 65 years.

    “while the other 19 found a stronger effect for individuals aged less than 65 years.”
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    • cites [19] Holt-Lunstad, 2015, Loneliness and social isolation as risk factors for mortality: a meta-analytic review, Perspect Psychol Sci source

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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (++) between social isolation and cardiovascular disease, supported by one or more higher quality reviews.

    “| Cardiovascular disease (Bunker et al 2003, Cuffee et al 2015, Glozier et al 2013, Mookadam et al 2004, Steptoe et al 2013) | ++ | | |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (++) between social networks and relationships and all-cause mortality, supported by one or more higher quality reviews.

    “| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and adherence to treatment, supported by one review or multiple lower quality reviews.

    “| Adherence to treatment (De Freitas et al 2013, Denhaerynck et al 2009) | + | | |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (++) between social isolation and all-cause mortality, supported by one or more higher quality reviews.

    “| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social isolation and general health and wellbeing, supported by one review or multiple lower quality reviews.

    “| General health & wellbeing (Aminzadeh & Dalziel 2002, Annear et al 2014, Chen et al 2014, Pinquart & Sorensen 2000) | + | + | |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (++) between loneliness and all-cause mortality, supported by one or more higher quality reviews.

    “| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
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    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social networks and relationships and behaviour change, supported by one review or multiple lower quality reviews.

    “| Behaviour change (Murray et al 2012) | | | + |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (++) between social isolation and depression and anxiety, supported by one or more higher quality reviews.

    “| Depression and anxiety (Ouimet et al 2001, Kita et al 2015, Santini et al 2015, Schwarzbach et al 2014, Teo et al 2013) | ++ | | + |”
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    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social networks and relationships and cancer, supported by one review or multiple lower quality reviews.

    “| Cancer (Pinquart & Duberstein 2010*) | | | + |”
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    § What is already known

    Social isolation and loneliness of children may be associated with abuse or poorer developmental and educational outcomes.

    “though social isolation and loneliness of children may be associated with abuse or poorer developmental and educational outcomes 65, 87, 97, 99-101 .”
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    • cites [65] Public Health England, 2015

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    • cites [87] Merrick, 2006, A review of suicidality in persons with intellectual disability, Israel J Psychiatry Relat Sci

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    • cites [97] Anooshian, 2005, Violence and aggression in the lives of homeless children: a review, Aggress Violent Behav source

      Not checked in the free run.

    • cites [99] Vizard, 1995, Child and adolescent sex abuse perpetrators – a review of the research literature, J Child Psychol Psychiatry Allied Discip source

      Not checked in the free run.

    • cites [100] Whittle, 2013, A review of young people's vulnerabilities to online grooming, Aggress Violent Behav source

      Not checked in the free run.

    • cites [101] Normand, 2016, Cybervictimization of young people with an intellectual or developmental disability: risks specific to sexual solicitation, J Appl Res Intellect Disabil source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between social networks and relationships and suicide, supported by one review or multiple lower quality reviews.

    “| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Fassberg et al 2012 source

      Not checked in the free run.

    • cites Hatcher et al 2013 source

      Not checked in the free run.

    • cites Mezuk et al 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Findingnone given
    § Highlights

    Less is known on the role of other conditions and wider socio-economic consequences.

    “Less is known on the role of other conditions and wider socio-economic consequences”
    Quote in the paperNot a substantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and dementia, supported by one review or multiple lower quality reviews.

    “| Dementia (Boss et al 2015, Kuiper et al 2015*) | | + | |”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Boss et al 2015 source

      Not checked in the free run.

    • cites Kuiper et al 2015* source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingcitation
    § Table 2: Key to measurement scales used in Table 1

    The overview found an association (+) between loneliness and suicide, supported by one review or multiple lower quality reviews.

    “| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Fassberg et al 2012 source

      Not checked in the free run.

    • cites Hatcher et al 2013 source

      Not checked in the free run.

    • cites Mezuk et al 2014 source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Loneliness also affects younger age groups.

    “While loneliness may be more common in the elderly, it also affects younger age groups 6 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [6] Griffin, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § Copyright:

    The quality of evidence within included reviews was assessed using the GRADE approach.

    “the quality of evidence within these reviews using the GRADE approach”
    • Also stated in: § Methods · plain
      “the quality of the evidence in these reviews was assessed using the GRADE approach 17 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] GRADE working group, 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Surveys in Europe and the USA estimate the prevalence of loneliness ranges from 5% to 43% in the elderly.

    “Surveys in Europe and the USA estimate the prevalence of loneliness ranges from 5% to 43% in the elderly 1-4 , with similar figures for China 5 .”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [1] Office of National Statistics, 2013

      Not checked in the free run.

    • cites [2] Dykstra, 2009, Older adult loneliness: myths and realities, Eur J Ageing source

      Not checked in the free run.

    • cites [3] Sörensen, 2000, Vulnerability and access to resources as predictors of preparation for future care needs in the elderly, J Aging Health source

      Not checked in the free run.

    • cites [4] Perissinotto, 2012, Loneliness in older persons: a predictor of functional decline and death, Arch Intern Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § Methods

    Data were extracted from selected reviews using a pre-designed data extraction sheet to standardise reporting of results.

    “Data were extracted from the selected reviews using a pre-designed data extraction sheet to standardise reporting of results across the included reviews.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Methods

    Differences of opinion were discussed and consensus reached over inclusion or exclusion of studies.

    “Differences of opinion were discussed and consensus reached over inclusion or exclusion of the study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisereasoning
    § Introduction

    Determining causality is difficult because much of the research in this area involves observational studies.

    “but determining causality is difficult as much of the research in this area involves observational studies.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation
    § Methods

    Methodology for this overview followed recognised guidance for conducting systematic overviews.

    “Methodology for this overview followed recognised guidance for conducting systematic overviews 14, 15 .”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [14] Becker, 2011

      Not checked in the free run.

    • cites [15] Smith, 2011, Methodology in conducting a systematic review of systematic reviews of healthcare interventions, BMC Med Res Methodol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data
    § Copyright:

    The methodological quality of included systematic reviews was assessed by two reviewers using the AMSTAR checklist.

    “the methodological quality of included systematic reviews assessed using the AMSTAR checklist”
    • Also stated in: § Methods · plain
      “The methodological quality of the reviews selected for inclusion was also assessed by two reviewers for each review, using the AMSTAR checklist 16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Shea, 2007, Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews, BMC Med Res Methodol source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § Copyright:

    Suitability for inclusion was determined by two or more reviewers, with a second reviewer confirming the process to ensure validity of inclusion.

    “Suitability for inclusion was determined by two or more reviewers”
    • Also stated in: § Methods · plain
      “The process was confirmed by a second reviewer to ensure validity of inclusion.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Introduction

    Similar prevalence figures for loneliness are found in China.

    “with similar figures for China 5 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] Yang, 2008, The prevalence of and risk factors for loneliness among older people in China, Ageing Soc source

      Not checked in the free run.

  • May combine two claims.

    Interpretationown data
    § Copyright:

    The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear.

    “The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationcitation
    § 2. Health Behaviours

    Causality could not be proven and other variables may have confounded the relationship between social isolation and tobacco use in adolescents.

    “though causality could not be proven and other variables may have confounded the relationship 29 .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [29] Seo, 2012, Systematic review of social network analysis in adolescent cigarette smoking behavior, J Sch Health source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning
    § Main findings

    The association between social isolation/loneliness and mortality may be mediated through the cardiovascular system and mental health, though proof of causality cannot be confirmed.

    “While proof of causality cannot be confirmed, this may be mediated through the cardiovascular system and mental health.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data
    § Limitations

    Most of the research in this overview came from developed countries and only English language publications were considered, which may limit applicability of findings elsewhere.

    “Most of the research in this overview came from developed countries and only English language publications were considered, so this may limit applicability of findings elsewhere.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Limitations

    Very few of the reviews contained longitudinal studies so causality cannot be inferred from the associations identified.

    “very few of the reviews contained longitudinal studies so causality cannot be inferred from the associations identified.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Limitations

    All of the tools used in the reviews were self-report measures which depend on the degree of subjectivity from respondents, so findings should be considered with caution.

    “As all of the tools used in the reviews were self-report measures which depend on the degree of subjectivity from respondents, findings should also be considered with caution.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Limitations

    No reviews considered health economic considerations, so this review cannot give insight into wider socio-economic consequences of social isolation and loneliness.

    “No reviews considered health economic considerations, so this review is not able to give insight into wider socio-economic consequences of social isolation and loneliness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning
    § Limitations

    Most of the systematic reviews were of moderate quality but none were of high quality.

    “Most of the systematic reviews were of moderate quality but none were of high quality, which most likely is a reflection of them containing predominantly observational studies”
    Quote in the paperSubstantial claim
61 of 61

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Socially restrictive measures, quarantines and lockdowns have been associated with reduced social interaction and increased loneliness that may lead to a rise in mental health problems such as symptoms of depression and anxiety.

    “Socially restrictive measures, quarantines and lockdowns have been associated with reduced social interaction and increased loneliness that may lead to a rise in mental health problems such as symptoms of depression and anxiety.”

    From A Longitudinal Study of Loneliness Before the End of the COVID-19 Pandemic: Trajectories, Predictors, and Impact on Chinese Adolescent Mental Health (2024) · cites this paper as [7]

    The paper’s “4. Mental Health” section reports associations between social networks and depression, and between social isolation and some anxiety-related outcomes; it notes that causality is unclear for social anxiety disorder. It does not examine quarantines, lockdowns, or other socially restrictive measures, so it does not support the claim that those measures reduced interaction or increased loneliness. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Social distancing has been proven to trigger negative mental health consequences, including intensified anxiety and depression and/or apathy and hypersensitivity, and can exacerbate mental illness.

    “social distancing has been proven to trigger negative mental health consequences, including intensified anxiety and depression [9,10] and/or apathy and hypersensitivity; it is especially worrisome that it can also exacerbate mental illness [11,12].”

    From Examining the associations between psychological flexibility, mindfulness, psychosomatic functioning, and anxiety during the covid-19 pandemic: A path analysis (2020) · cites this paper as [12]

    The Mental Health section reports associations between social isolation or social networks and depression and anxiety. The Introduction cautions that causality is difficult to determine, so the paper does not establish that social distancing has been proven to trigger these outcomes. The cited passages also do not support the claims about apathy, hypersensitivity, or exacerbation of existing mental illness. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • The independent effects of loneliness and social isolation on physical health conditions are less consistent, and their independent effects on socioeconomic outcomes have not been investigated.

    “Although existing evidence indicates that loneliness and social isolation are independently associated with mental health conditions and mortality (Holt-Lunstad et al., 2015;Matthews et al., 2016), their independent effects on physical health conditions are less consistent and their independent effects on socioeconomic outcomes have not been investigated (Leigh-Hunt et al., 2017).”

    From Investigating the interplay of loneliness and social isolation across adolescence: Findings from a nationally representative longitudinal study (2026) · cites this paper as Leigh-Hunt et al., 2017

    The Physical Health section reports weaker evidence for conditions other than cardiovascular disease, and the Conclusions say the socio-economic consequences are less clear. The Limitations specify that no included reviews considered health economics; they do not establish that socio-economic outcomes have never been investigated. The paper also does not consistently assess the separate, independent effects of loneliness and social isolation on those outcomes. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Loneliness predicts both mental and physical health challenges.

    “Because loneliness has been shown to predict both mental and physical health challenges (Cacioppo et al., 2011, Leigh-Hunt et al., 2017), these findings also provide new insights for interventions.”

    From Young Adult Adaptability to the Social Challenges of the COVID-19 Pandemic: The Protective Role of Friendships (2022) · cites this paper as Leigh-Hunt et al., 2017

  • Social isolation and loneliness have negative mental and physical health consequences.

    “Social isolation and loneliness have been studied extensively over the past four decades, with numerous studies showing that both have negative mental and physical health consequences [1–5].”

    From Examining social isolation and loneliness in combination in relation to social support and psychological distress using Canadian Longitudinal Study of Aging (CLSA) data (2020) · cites this paper as [4]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Kita review study-type counts total 35, not 36

    Minor

    The four study-type counts in Table 1 add to 35, one fewer than the stated total of 36 studies.

    Reported 36 · recomputed 35

  • Pompili review study-type counts total 11, not 12

    Minor

    Table 1 lists 4 cohort, 5 retrospective, and 2 observational studies, totaling 11 rather than the stated 12.

    Reported 12 · recomputed 11

2 of 2

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Related

Authors
Leigh-Hunt, N., Bagguley, D., Bash, K., Turner, V., Turnbull, S., Valtorta, N., & Caan, W.
Affiliations
  • University of Leeds (GB)
  • Newcastle University (GB)
Corresponding author
Leigh-Hunt, N.
ORCID
Venue
Public Health
Publisher
Elsevier BV
Published
2017-11
Volume
152
Pages
157-171
ISSN
0033-3506 (ISSN-L)
DOI
10.1016/j.puhe.2017.07.035
OpenAlex
W2755781951
Semantic Scholar
21c42f9f38cacdbbc11267fdf596908fb10793ba
Cited by
2,158
References
102
Citations by year
2026: 222 · 2025: 254 · 2024: 311 · 2023: 311 · 2022: 349 · 2021: 366 · 2020: 246 · 2019: 74 · 2018: 21 · 2017: 2
FWCI
16.19
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Public Health (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity)
Funders
  • National Institute for Health and Care Research (DRF-2013-06-074)
  • Solar Energy Technologies Office
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
  • Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
Keywords
social isolation, loneliness, public health impact, all-cause mortality, cardiovascular disease, mental health, morbidity and mortality, social determinants of health, social support, prevention, asset-based approach
MeSH terms
Mental Disorders, Cardiovascular Diseases, Humans, Loneliness, Public Health, Review Literature as Topic, Social Isolation, Socioeconomic Factors, Randomized Controlled Trials as Topic

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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