Cited by 983Stress Responses and CortisolNeuroendocrine regulation and behaviorHealth disparities and outcomes

The DOI matches its Crossref record; 129 of the 129 references it cites were found in a registry or an index; none of the 148 sources its claims cite is checked for support yet.

The Neuroendocrinology of Social Isolation

Open access
Cacioppo, John T., Cacioppo, Stephanie, Capitanio, John P., Cole, Steven W.·2015·Annual Review of Psychology

Abstract

Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter of a century. Although the focus of research has been on objective social roles and health behavior, the brain is the key organ for forming, monitoring, maintaining, repairing, and replacing salutary connections with others. Accordingly, population-based longitudinal research indicates that perceived social isolation (loneliness) is a risk factor for morbidity and mortality independent of objective social isolation and health behavior. Human and animal investigations of neuroendocrine stress mechanisms that may be involved suggest that (a) chronic social isolation increases the activation of the hypothalamic pituitary adrenocortical axis, and (b) these effects are more dependent on the disruption of a social bond between a significant pair than objective isolation per se. The relational factors and neuroendocrine, neurobiological, and genetic mechanisms that may contribute to the association between perceived isolation and mortality are reviewed.

Overview

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TL;DR

This review argues that perceived social isolation (loneliness), more than objective isolation, is linked to morbidity and mortality through neuroendocrine stress mechanisms, especially increased HPA-axis activity. It synthesizes human and animal evidence indicating that chronic isolation from a meaningful social bond elevates glucocorticoids and may promote glucocorticoid resistance and inflammation, whereas SAM catecholamine findings are less consistent.

Key findings

  • Human studies generally link loneliness to higher HPA activity: chronic loneliness was positively correlated with salivary cortisol, and loneliness predicted a larger cortisol awakening response the following day independent of demographic factors, nervousness, or perceived stress, whereas the cortisol awakening response did not predict later loneliness; this was replicated in high school students. The paper notes the cortisol awakening response typically increases 50% to 60% in the first 30 to 45 minutes after awakening.
  • Loneliness has been associated with glucocorticoid resistance and proinflammatory gene expression: in a nationally representative sample of adults ages 54 and older from Taiwan, loneliness was associated with smaller neutrophil:lymphocyte and neutrophil:monocyte ratios, consistent with leukocyte glucocorticoid resistance; genome-wide microarray analyses showed reduced expression of glucocorticoid receptor–response genes, upregulated proinflammatory transcripts, and downregulated anti-inflammatory markers in middle- and older-age lonely adults.
  • Animal experiments suggest chronic social isolation increases HPA activity more when it disrupts a significant pair bond than from isolation per se: titi monkeys isolated from a pair mate showed a significant increase in plasma cortisol, whereas polygynous squirrel monkeys did not; prairie voles chronically isolated from a pair-bonded partner showed increased corticosterone, but those isolated from a same-sex sibling did not.
  • Across human and animal work, chronic social isolation is associated with relatively consistent increases in HPA-axis activity but little alteration in SAM catecholamine activity, and effects appear more dependent on disruption of a social bond between a significant pair than on objective isolation alone.

Methods

  • Narrative review of human and animal literature on the SAM and HPA neuroendocrine stress axes and social isolation/loneliness, focusing on adult mammals and adults.
  • Human evidence includes population-based longitudinal, cross-sectional, experience-sampling, fMRI, eye-tracking, immune, and gene-expression studies; animal evidence includes experimental assignment to normal versus socially isolated housing, acute and chronic isolation, and pair-bond disruption.
  • Main analysis is qualitative synthesis; no new data or formal meta-analysis are reported.

Limitations

  • Stated: the causal role of loneliness on neural and neuroendocrine mechanisms is difficult to test conclusively in humans; animal studies often use small sample sizes due to cost and animal-welfare concerns, reducing statistical power and producing inconsistent results; SAM findings are less numerous and consistent and may reflect perceived stress rather than perceived isolation per se; the oxytocinergic system is beyond the article’s scope.
  • Evident: as a narrative review, it does not report a systematic search, quality appraisal, or meta-analysis; heterogeneity in species, sex, isolation duration, relationship type, assayed tissue, measurement timing, and HPA parameters limits comparability across studies.

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Integrity signals

Registry

Crossref · 10.1146/annurev-psych-010814-015240

Cites

129 of 129 references verified0 citation errors · 0 not checkable

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  • It may state two separate claims as one. 49
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55 of 55
  • The paper relies on this without support.

    In many contexts across human history, a chief threat to a person’s reproductive success and survival has come from other humans.

    “In many contexts across human history, a chief threat to a person’s reproductive success and survival has come from other humans.”
  • The paper relies on this without support.

    The human brain categorizes, abstracts, interprets, and evaluates incoming stimuli in light of current states and goals as well as prior knowledge and predispositions.

    “The human brain does not simply respond to stimuli (including people) in an invariant fashion, but rather it categorizes, abstracts, interprets, and evaluates incoming stimuli in light of current states and goals as well as prior knowledge and predispositions.”
  • The paper relies on this without support.

    The HPA axis includes a negative feedback mechanism to limit its circulating hormonal outputs.

    “Unlike the adrenal medulla of the SAM axis, the adrenal cortex of the HPA axis is necessary for survival, and the HPA axis includes a negative feedback mechanism to limit its circulating hormonal outputs.”
  • The paper relies on this without support.

    The brain is the key organ of social connections and processes, and this should be true for other species for which sociality has been a central feature of life for millions of years.

    “The idea that the brain is the key organ of social connections and processes should be true for other species for which sociality has been a central feature of life for millions of years.”
  • The paper relies on this without support.

    The extent to which glucocorticoid receptors become insensitive to glucocorticoid signals is reflected in an attenuation of the established positive correlation between cortisol levels and the circulating neutrophil:lymphocyte and neutrophil:monocyte ratios.

    “The rationale is that the extent to which the glucocorticoid receptors become insensitive (resistant) to glucocorticoid signals should be reflected in an attenuation of the established positive correlation between cortisol levels and the circulating neutrophil:lymphocyte and neutrophil:monocyte ratios.”
  • The paper relies on this without support.

    Cortisol acts on glucocorticoid receptors in leukocytes, leading to a suppression of proinflammatory gene networks.

    “cortisol acts on the glucocorticoid receptors in leukocytes, leading to a suppression of proinflammatory gene networks”
  • The paper relies on this without support.

    The brain is the key organ of social connections and processes.

    “The brain is the key organ of social connections and processes”
  • The paper relies on this without support.

    The same objective social relationship can be experienced as caring and protective or as exploitive and isolating.

    “the same objective social relationship can be experienced as caring and protective or as exploitive and isolating”
  • The paper relies on this without support.

    Social isolation has been a recognized major risk factor for morbidity and mortality in humans for more than a quarter of a century.

    “Social isolation has been recognized as a major risk factor for morbidity and mortality in humans for more than a quarter of a century.”
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Metadata

Authors
Cacioppo, J. T., Cacioppo, S., Capitanio, J. P., & Cole, S. W.
Affiliations
  • University of Chicago (US)
  • University of California, Davis (US)
  • David Geffen School of Medicine, University of California, Los Angeles, California 90095;
Venue
Annual Review of Psychology
Published
2015-01-03
Volume
66
Issue
1
Pages
733-767
ISSN
  • 0066-4308 (ISSN-L)
  • 1545-2085
OpenAlex
W2133556218
Cited by
977
References
126
Citations by year
2026: 103 · 2025: 117 · 2024: 99 · 2023: 106 · 2022: 125 · 2021: 107 · 2020: 86 · 2019: 89 · 2018: 59 · 2017: 35 · 2016: 31 · 2015: 19
FWCI
2.36
Type
journal article
Language
en
Open access
Locations
  • Annual Review of Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (P51OD011107)
  • National Institute on Aging (R37AG033590)
Topics
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
  • Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Neuroendocrine regulation and behavior
  • Social Sciences › Health › Health disparities and outcomes
Keywords
social isolation, loneliness, neuroendocrinology, hypothalamic-pituitary-adrenal axis, chronic stress, mortality risk, social bonds, perceived social isolation, genetic mechanisms, neurobiological mechanisms
MeSH terms
Animals, Brain, Humans, Loneliness, Social Isolation

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