The DOI matches its Crossref record; 104 of the 104 references it cites were found in a registry or an index; none of the 160 sources its claims cite is checked for support yet.
An overview of systematic reviews on the public health consequences of social isolation and loneliness
Open accessAbstract
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.
Overview
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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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Claims the paper makes
82 Not checked yet · 18 No basis given · 16 Own result · 11 Own method · 4 Own interpretation
None of the sources cited for this claim have been checked yet.
In the paper
“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”
What the sources say
- Not checked yetcites [19] Holt-Lunstad, 2015, Loneliness and social isolation as risk factors for mortality: a meta-analytic review, Perspect Psychol Sci source
- Not checked yetcites [20] Nyqvist, 2014, Structural and cognitive aspects of social capital and all-cause mortality: a meta-analysis of cohort studies, Soc Indic Res source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § 1. Mortality & General Health · plain
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Those reviews which scored poorly using AMSTAR also tended to have low GRADE scores.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Generally, the meta-analyses were of superior methodological quality to the systematic reviews.”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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”
What the sources say
- Not checked yetcites [20] Nyqvist, 2014, Structural and cognitive aspects of social capital and all-cause mortality: a meta-analysis of cohort studies, Soc Indic Res source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“The impact of gender on the association was unclear as there were mixed findings from subgroup analyses in the above reviews.”
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“significant clinical heterogeneity existed between both the reviews and the primary studies they contained.”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The search process of eight databases identified 90 papers (40 systematic reviews, 47 nonsystematic reviews and 3 metasyntheses) that considered social isolation, loneliness, social relationships or networks (Figure 1).”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In half of the reviews loneliness or social isolation were identified as a factor associated with the variable of interest but a validated scale was not used (Table 1).”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Social isolation and loneliness have been associated with ill health and are common in the developed world.”
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 20
- It may state two separate claims as one. 48
- The quote only partly states this claim. 19
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“For forty-nine measures, information could be sourced which allowed mapping using a two-dimensional framework 18 (Figure 2).”
What the sources say
- Not checked yetcites [18] Valtorta, 2016, Loneliness, social isolation and social relationships: what are we measuring? A novel framework for classifying and comparing tools, BMJ Open
hedged- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the forty systematic reviews included in this overview, ten involved a meta-analysis.”
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Narrative systematic reviews suggest associations with poorer mental health outcomes, with less strong evidence for behavioural and other physical health outcomes.”
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Forty systematic reviews of mainly observational studies were identified, largely from the developed world.”
plain- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
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In the paper
“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”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“One review found that a low sense of belonging was associated with a higher risk of suicidal ideation and suicide attempts”
What the sources say
- Not checked yetcites [52] Hatcher, 2013, Sense of belonging and suicide: a systematic review, Can J Psychiatry Revue Can De Psychiatrie source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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).”
- Also stated in: § Main findings · boosted
“This overview has identified that there is strong evidence that both social isolation and loneliness are associated with increased all-cause mortality.”
boostedcorrelational- Asserted: passes — The authors put it forward as true.
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- Also stated in: § Main findings · boosted
In the paper
“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 .”
What the sources say
- Not checked yetcites [27] Dyal, 2015, A systematic review of loneliness and smoking: small effects, big implications, Subst Use Misuse source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“with individuals with stronger social relationships having a 50% increased likelihood of survival, with no variation between gender 41”
What the sources say
- Not checked yetcites [41] Glozier, 2013, Psychosocial risk factors for coronary heart disease, Med J Aust source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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”
What the sources say
- Not checked yetcites [37] De Freitas, 2013, Vulnerabilities to misinformation in online pharmaceutical marketing, J R Soc Med source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“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 .”
What the sources say
- Not checked yetcites [25] Pinquart, 2000, Influences of socioeconomic status, social network, and competence on subjective well-being in later life: a meta-analysis, Psychol Aging source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“A meta-analysis identified an association between social isolation and social anxiety disorder, though causality was unclear 51 .”
What the sources say
- Not checked yetcites [51] Teo, 2013, The role of social isolation in social anxiety disorder: a systematic review and meta-analysis, J Anxiety Disord source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Two systematic reviews identified that loneliness and low social participation were associated with an increased risk of dementia”
What the sources say
- Not checked yetcites [57] Boss, 2015, Loneliness and cognitive function in the older adult: a systematic review, Int Psychogeriatr source
- Not checked yetcites [58] Kuiper, 2015, Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies, Ageing Res Rev source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Other physical health (Barton et al 2015, Steenstra et al 2005) | + | | + |”
What the sources say
- Not checked yetcites Barton et al 2015
- Not checked yetcites Steenstra et al 2005 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Depression and anxiety (Ouimet et al 2001, Kita et al 2015, Santini et al 2015, Schwarzbach et al 2014, Teo et al 2013) | ++ | | + |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Physical activity (Vancampfort et al 2012a, Vancampfort et al 2012b) | + | | |”
What the sources say
- Not checked yetcites Vancampfort et al 2012a
- Not checked yetcites Vancampfort et al 2012b
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Diet (Van der Pols-Vijlbrief et al 2014) | | + | |”
What the sources say
- Not checked yetcites Van der Pols-Vijlbrief et al 2014 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
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In the paper
“| Other physical health (Barton et al 2015, Steenstra et al 2005) | + | | + |”
What the sources say
- Not checked yetcites Barton et al 2015
- Not checked yetcites Steenstra et al 2005 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“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 .”
What the sources say
- Not checked yetcites [61] Hawkley, 2010, Loneliness matters: a theoretical and empirical review of consequences and mechanisms, Ann Behav Med source
- Not checked yetcites [80] Hawkley, 2003, Loneliness and pathways to disease, Brain Behav Immun source
- Not checked yetcites [96] West, 1986, The effects of loneliness – a review of the literature, Compr Psychiatry source
- Not checked yetcites [102] Cacioppo, 2014, Toward a neurology of loneliness, Psychol Bull source
- Not checked yetcites [103] Cacioppo, 2011, Social isolation
- Not checked yetcites [104] Hawkley, 2012, Effects of social isolation on glucocorticoid regulation in social mammals, Horm Behav source
- Not checked yetcites [105] Knutson, 2013, Sociodemographic and cultural determinants of sleep deficiency: implications for cardiometabolic disease risk, Soc Sci Med source
- Not checked yetcites [106] Local Government Association and Improvement and Development Agency, 2010
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Tobacco use (Barbosa et al 2012, Dyal & Valente 2015, Seo et al 2012) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Sexual health behaviours (Black et al 2000, Herbst et al 2008, Seto & Lalumiere 2010*) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one. The quote only partly states this claim.
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In the paper
“| Tobacco use (Barbosa et al 2012, Dyal & Valente 2015, Seo et al 2012) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| General health & wellbeing (Aminzadeh & Dalziel 2002, Annear et al 2014, Chen et al 2014, Pinquart & Sorensen 2000) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Sexual health behaviours (Black et al 2000, Herbst et al 2008, Seto & Lalumiere 2010*) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“while the other 19 found a stronger effect for individuals aged less than 65 years.”
What the sources say
- Not checked yetcites [19] Holt-Lunstad, 2015, Loneliness and social isolation as risk factors for mortality: a meta-analytic review, Perspect Psychol Sci source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Cardiovascular disease (Bunker et al 2003, Cuffee et al 2015, Glozier et al 2013, Mookadam et al 2004, Steptoe et al 2013) | ++ | | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“| Adherence to treatment (De Freitas et al 2013, Denhaerynck et al 2009) | + | | |”
What the sources say
- Not checked yetcites De Freitas et al 2013 source
- Not checked yetcites Denhaerynck et al 2009
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“| General health & wellbeing (Aminzadeh & Dalziel 2002, Annear et al 2014, Chen et al 2014, Pinquart & Sorensen 2000) | + | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“| All-cause mortality (Holt Lunstad et al 2010*, Holt Lunstad et al 2015*, Nyqvist et al 2013*, Shor & Roelfs 2015) | ++ | ++ | ++ |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“| Behaviour change (Murray et al 2012) | | | + |”
What the sources say
- Not checked yetcites Murray et al 2012 source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“| Depression and anxiety (Ouimet et al 2001, Kita et al 2015, Santini et al 2015, Schwarzbach et al 2014, Teo et al 2013) | ++ | | + |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“| Cancer (Pinquart & Duberstein 2010*) | | | + |”
What the sources say
- Not checked yetcites Pinquart & Duberstein 2010* source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“though social isolation and loneliness of children may be associated with abuse or poorer developmental and educational outcomes 65, 87, 97, 99-101 .”
What the sources say
- Not checked yetcites [65] Public Health England, 2015
- Not checked yetcites [87] Merrick, 2006, A review of suicidality in persons with intellectual disability, Israel J Psychiatry Relat Sci
- Not checked yetcites [97] Anooshian, 2005, Violence and aggression in the lives of homeless children: a review, Aggress Violent Behav source
- Not checked yetcites [99] Vizard, 1995, Child and adolescent sex abuse perpetrators – a review of the research literature, J Child Psychol Psychiatry Allied Discip source
- Not checked yetcites [100] Whittle, 2013, A review of young people's vulnerabilities to online grooming, Aggress Violent Behav source
- Not checked yetcites [101] Normand, 2016, Cybervictimization of young people with an intellectual or developmental disability: risks specific to sexual solicitation, J Appl Res Intellect Disabil source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Less is known on the role of other conditions and wider socio-economic consequences”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“| Dementia (Boss et al 2015, Kuiper et al 2015*) | | + | |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“| Suicide (Fassberg et al 2012, Hatcher et al 2013, Mezuk et al 2014, Mollinson et al 2014, Pompili 2012) | + | + | + |”
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one. The quote only partly states this claim.
In the paper
“While loneliness may be more common in the elderly, it also affects younger age groups 6 .”
What the sources say
- Not checked yetcites [6] Griffin, 2010
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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 .”
What the sources say
- Not checked yetcites [17] GRADE working group, 2011
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Methods · plain
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
What the sources say
- Not checked yetcites [1] Office of National Statistics, 2013
- Not checked yetcites [2] Dykstra, 2009, Older adult loneliness: myths and realities, Eur J Ageing source
- Not checked yetcites [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 yetcites [4] Perissinotto, 2012, Loneliness in older persons: a predictor of functional decline and death, Arch Intern Med source
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Data were extracted from the selected reviews using a pre-designed data extraction sheet to standardise reporting of results across the included reviews.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Differences of opinion were discussed and consensus reached over inclusion or exclusion of the study.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“but determining causality is difficult as much of the research in this area involves observational studies.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Methodology for this overview followed recognised guidance for conducting systematic overviews 14, 15 .”
What the sources say
- Not checked yetcites [14] Becker, 2011
- Not checked yetcites [15] Smith, 2011, Methodology in conducting a systematic review of systematic reviews of healthcare interventions, BMC Med Res Methodol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“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”
What the sources say
- Not checked yetcites [16] Shea, 2007, Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews, BMC Med Res Methodol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Methods · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Methods · plain
In the paper
“with similar figures for China 5 .”
What the sources say
- Not checked yetcites [5] Yang, 2008, The prevalence of and risk factors for loneliness among older people in China, Ageing Soc source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The role of social isolation and loneliness in other conditions and their socio-economic consequences is less clear.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“though causality could not be proven and other variables may have confounded the relationship 29 .”
What the sources say
- Not checked yetcites [29] Seo, 2012, Systematic review of social network analysis in adolescent cigarette smoking behavior, J Sch Health source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“While proof of causality cannot be confirmed, this may be mediated through the cardiovascular system and mental health.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“very few of the reviews contained longitudinal studies so causality cannot be inferred from the associations identified.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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
The cited source says what the claim attributes to it.
In the citing paper
“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].”
In the citing paper
“solitude and prolonged state of physical isolation have been linked to increases in depression, anxiety, and suicidal ideation [35, 36].”
From Mental Health Impact of COVID-19 among Children and College Students: A Systematic Review (2023) · cites this paper as [35]
In the citing paper
“Also considering the worse severity of COVID-19 in hospitalized patients, this observation suggests that less healthcare support could have increased the social isolation and loneliness typical of COVID-19 pandemics, thus inducing more psychopathology after remission (Ozbay et al., 2007, Leigh-Hunt et al., 2017).”
From Anxiety and depression in COVID-19 survivors: role of inflammatory and clinical predictors (2020) · cites this paper as Leigh-Hunt et al., 2017
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“36 studies - 12 quantitative, 15 qualitative, 3 mixed methods, 5 expert”
Reported 36 · recomputed 35
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“12 studies - 4 cohort, 5 retrospective, 2 observational”
Reported 12 · recomputed 11
Citations
Cites
Social Relationships and Mortality Risk: A Meta-analytic Review
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000316 · Cited by 7,272
Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015) · Perspectives on Psychological Science · doi:10.1177/1745691614568352 · Cited by 6,043
Loneliness matters: a theoretical and empirical review of consequences and mechanisms
Hawkley, L. C., & Cacioppo, J. T. (2010) · Annals of Behavioral Medicine · doi:10.1007/s12160-010-9210-8 · Cited by 4,782
Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews
Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson, N., Hamel, C., Porter, A. C., Tugwell, P., Moher, D., & Bouter, L. M. (2007) · BMC Medical Research Methodology · doi:10.1186/1471-2288-7-10 · Cited by 4,374
Rozanski, A., Blumenthal, J. A., & Kaplan, J. (1999) · Circulation · doi:10.1161/01.cir.99.16.2192 · Cited by 2,846
Uchino, B. N., Cacioppo, J. T., & Kiecolt-Glaser, J. K. (1996) · Psychological Bulletin · doi:10.1037/0033-2909.119.3.488 · Cited by 2,727
Perceived social isolation and cognition
Cacioppo, J. T., & Hawkley, L. C. (2009) · Trends in Cognitive Sciences · doi:10.1016/j.tics.2009.06.005 · Cited by 2,144
The clinical significance of loneliness: a literature review
Heinrich, L. M., & Gullone, E. (2006) · Clinical Psychology Review · doi:10.1016/j.cpr.2006.04.002 · Cited by 1,986
Pinquart, M., & Sörensen, S. (2000) · Psychology and Aging · doi:10.1037/0882-7974.15.2.187 · Cited by 1,549
Social contagion theory: examining dynamic social networks and human behavior
Christakis, N. A., & Fowler, J. H. (2013) · Statistics in Medicine · doi:10.1002/sim.5408 · Cited by 1,303
Cited by
Sorted by citations
Items 101–200 of 1,006
Loneliness in the lives of Danish adolescents: Associations with health and sleep
Eccles, A. M., Qualter, P., Madsen, K. R., & Holstein, B. E. (2020) · Scandinavian Journal of Public Health · doi:10.1177/1403494819865429 · Cited by 125
Stress and Symptom Burden in Oncology Patients During the COVID-19 Pandemic
Miaskowski, C. A., Paul, S. M., Snowberg, K. E., Abbott, M., Borno, H. T., Chang, S. M., Chen, L. M., Cohen, B., Hammer, M. J., Kenfield, S. A., et al. (2020) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2020.08.037 · Cited by 122
Noguchi, T., Saito, M., Aida, J., Cable, N., Tsuji, T., Koyama, S., Ikeda, T., Osaka, K., & Kondo, K. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-045834 · Cited by 130
Flett, G. L., Nepon, T. B., Goldberg, J. O., Rose, A. L., Atkey, S. K., & Zaki-Azat, J. (2021) · Journal of Psychoeducational Assessment · doi:10.1177/07342829211050544 · Cited by 126
Ren, Y. L., Savadlou, A., Park, S., Siska, P., Epp, J. R., & Sargin, D. (2023) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2023.101061 · Cited by 137
Loneliness and Risk for Cardiovascular Disease: Mechanisms and Future Directions
Paul, E., Bu, F., & Fancourt, D. E. (2021) · Current Cardiology Reports · doi:10.1007/s11886-021-01495-2 · Cited by 131
Loneliness and mental health: The mediating effect of perceived social support
Hutten, E., Jongen, E. M. M., Vos, A. E. C. C., van den Hout, A. J. H. C., & van Lankveld, J. J. D. M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182211963 · Cited by 117
Creese, J., Byrne, J.-P., Conway, E., Barrett, E., Prihodová, L., & Humphries, N. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18042051 · Cited by 116
Bussolari, C., Currin-McCulloch, J., Packman, W., Kogan, L., & Erdman, P. (2021) · Animals · doi:10.3390/ani11020330 · Cited by 113
Lifestyle factors in the prevention of COVID-19
Lange, K. W., & Nakamura, Y. (2020) · Global Health Journal · doi:10.1016/j.glohj.2020.11.002 · Cited by 119
Goldberg, S. B., Imhoff-Smith, T., Bolt, D. M., Wilson-Mendenhall, C. D., Dahl, C. J., Davidson, R. J., & Rosenkranz, M. A. (2020) · JMIR Mental Health · doi:10.2196/23825 · Cited by 97
“The possibility that social connectedness also plays a role should be explored further, particularly as it has been associated with numerous psychological and physical health outcomes [117,118].”
BackgroundIs living alone a risk factor of frailty? A systematic review and meta-analysis
Kojima, G., Taniguchi, Y., Kitamura, A., & Fujiwara, Y. (2020) · Ageing Research Reviews · doi:10.1016/j.arr.2020.101048 · Cited by 109
Dadvand, P., Hariri, S., Abbasi, B., Heshmat, R., Qorbani, M., Motlagh, M. E., Basagaña, X., & Kelishadi, R. (2018) · Environmental Research · doi:10.1016/j.envres.2018.09.033 · Cited by 113
Nakou, A., Dragioti, E., Bastas, N. S., Ζαγοριανάκου, Ν., Kakaidi, V., Tsartsalis, D., Mantzoukas, S., Tatsis, F., Veronese, N., Solmi, M., et al. (2025) · Aging Clinical and Experimental Research · doi:10.1007/s40520-024-02925-1 · Cited by 140
“Furthermore, these social dynamics is associated with anxiety, psychosis, substance abuse [3, 23], alcoholism [30], depression [31–33], cognitive impairment [23, 26, 34], decreased subjective well-being [3], sleep disorders [23], reduced quality of life [35] and suicidal tendencies [36].”
InfluentialFredriksen‐Goldsen, K. I., Romanelli, M., Hoy‐Ellis, C. P., & Jung, H. H. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.106988 · Cited by 112
Wakefield, J. R. H., Këllezi, B., Stevenson, C., McNamara, N., Bowe, M., Wilson, I., Halder, M., & Mair, E. (2020) · Journal of Health Psychology · doi:10.1177/1359105320944991 · Cited by 116
Welch, V. A., Ghogomu, E. T., Barbeau, V. I., Dowling, S., Doyle, R., Beveridge, E., Boulton, E., Desai, P., Huang, J. X., Elmestekawy, N., et al. (2023) · Campbell Systematic Reviews · doi:10.1002/cl2.1369 · Cited by 127
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Changes in Tinnitus Experiences During the COVID-19 Pandemic
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“Social isolation is an important and well established determinant of health that is consistently linked to all‐cause mortality, morbidity, and negative mental health.(10) In cancer, it is associated with low treatment engagement and mortality.”
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“social requirements, might jeopardize their ability to age healthily and actively by causing social isolation and loneliness (Leigh-Hunt et al. 2017).”
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“However, it may be worth noting that former research also demonstrated the importance of social isolation (generally, not specifically focused on chronic social isolation) for depressive symptoms (Leigh-Hunt et al., 2017).”
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“Additionally, environmental factors such as a history of trauma, social isolation, and access to lethal means have been identified as potential risk factors [24]–[26].”
Background
Metadata
- 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.
- Venue
- Public Health
- Publisher
- Elsevier BV
- Published
- 2017-11
- Volume
- 152
- Pages
- 157-171
- ISSN
- 0033-3506 (ISSN-L)
- 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
- green
- doi.org
- 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
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