Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review
Open accessAbstract
Actual and perceived social isolation are both associated with increased risk for early mortality. In this meta-analytic review, our objective is to establish the overall and relative magnitude of social isolation and loneliness and to examine possible moderators. We conducted a literature search of studies (January 1980 to February 2014) using MEDLINE, CINAHL, PsycINFO, Social Work Abstracts, and Google Scholar. The included studies provided quantitative data on mortality as affected by loneliness, social isolation, or living alone. Across studies in which several possible confounds were statistically controlled for, the weighted average effect sizes were as follows: social isolation odds ratio (OR) = 1.29, loneliness OR = 1.26, and living alone OR = 1.32, corresponding to an average of 29%, 26%, and 32% increased likelihood of mortality, respectively. We found no differences between measures of objective and subjective social isolation. Results remain consistent across gender, length of follow-up, and world region, but initial health status has an influence on the findings. Results also differ across participant age, with social deficits being more predictive of death in samples with an average age younger than 65 years. Overall, the influence of both objective and subjective social isolation on risk for mortality is comparable with well-established risk factors for mortality.
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Loneliness is a major detrimental factor for older adults' wellbeing, linked to poor mental health, quality of life, cognitive decline, and increased mortality.
“Together with e.g. smoking and alcohol consumption, it has been shown to be a hugely detrimental factor, imposing threats leading to poor mental health, quality of life (Holt-Lunstad et al., 2015), declining cognitive function (Zhong et al., 2017) and increased mortality (Luo et al., 2012).”
From Filial Piety, Generativity and Older Adults’ Wellbeing and Loneliness in Denmark and China (2022) · cites this paper as Holt-Lunstad et al., 2015
The Introduction links social connectedness to psychological and emotional well-being, and Isolation and Aging reports a study linking loneliness after retirement to anxiety and depression. These passages support the mental-health portion, but our copy does not establish the claimed effect on quality of life. The cognitive-decline and mortality clauses are attached to different citations in the citing sentence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSocial isolation is linked to poor health and low wellbeing.
“Recent empirical evidence largely supports this view by documenting relationships linking social isolation, poor health, and low wellbeing (e.g., Larson, 1990; Holt-Lunstad et al., 2015; Liu et al., 2018).”
From Emotional processes, collective behavior, and social movements: A meta-analytic review of collective effervescence outcomes during collective gatherings and demonstrations (2022) · cites this paper as Holt-Lunstad et al., 2015
The Introduction links social isolation to poorer health behaviors and biological risk factors, and the Conclusion links it to poorer health and premature mortality (page numbers unavailable in our copy). These passages support the poor-health link, but they do not establish a relationship with low wellbeing. (LLM, conf=0.86)
Experimental — accuracy not yet measuredLoneliness and social isolation in young people contribute to psychological distress and increase risk of premature mortality, rivaling traditional risk factors.
“The effects of loneliness and social isolation associated with being young can contribute to psychological distress, increasing risk of premature mortality, and such risk rivals that associated with traditional risk factors including smoking, obesity, excessive alcohol consumption and lack of physical activity.4 5”
From Novel ACT-based eHealth psychoeducational intervention for students with mental distress: A study protocol for a mixed-methodology pilot trial (2019) · cites this paper as [4]
The Conclusion (page not specified) reports that loneliness and social isolation are associated with premature mortality at a risk comparable to established factors, including obesity, physical inactivity and substance abuse. The Isolation and Aging section reports a stronger mortality association in adults under 65, particularly middle-aged adults, but does not establish the claim for young people specifically. The paper discusses psychological pathways but does not show that psychological distress mediates the mortality risk. (LLM, conf=0.87)
Experimental — accuracy not yet measuredExisting evidence indicates that loneliness and social isolation are independently associated with mental health conditions and mortality.
“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 Holt-Lunstad et al., 2015
The Discussion reports that loneliness and social isolation each predicted mortality after adjustment for covariates. The Introduction links a lack of social connections to psychological and emotional well-being, but the passages do not establish independent associations of loneliness and social isolation with mental health conditions; they also note that few studies examined the two concurrently. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSocial 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 [3]
The Introduction links both loneliness and social isolation to poorer health behaviors and biological risk factors, and the Conclusion links them to poorer health and premature mortality. The Introduction also says social connection benefits psychological and emotional well-being, but the paper does not directly establish negative mental-health consequences for both loneliness and social isolation. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Loneliness is a powerful emotional state that urges consumers to seek social connections.
“First, research in psychology indicates that loneliness is a powerful emotional state that urges consumers to seek social connections (Hawkley and Cacioppo 2010; Holt-Lunstad et al. 2015).”
From AI Companions Reduce Loneliness (2024) · cites this paper as Holt-Lunstad et al. 2015
Loneliness is increasingly recognized as a critical public health issue.
“Loneliness is increasingly acknowledged as a serious public health issue.”
From Psychological correlates of perceived loneliness in college students before and during the COVID-19 stay-at-home period: a longitudinal study (2023) · cites this paper as [1]
Perceived loneliness plays a role on health outcomes and academic outcomes.
“Given the role played by perceived loneliness on health outcomes [1] and academic outcomes [94, 95], further longitudinal studies are needed to ascertain the medium to long term effects of loneliness, depression, and alexithymia.”
From Psychological correlates of perceived loneliness in college students before and during the COVID-19 stay-at-home period: a longitudinal study (2023) · cites this paper as [1]
Those individuals are also more at risk for serious health conditions.
“Those individuals are also more at risk for serious health conditions [42, 43].”
From Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland (2020) · cites this paper as [43]
Loneliness predicts earlier mortality.
“For example, loneliness predicts earlier mortality (Holt-Lunstad et al., 2015), and is associated with less salutary profiles of cortisol and inflammatory responses to acute stress (Cacioppo et al., 2015; Eisenberger et al., 2017; Hawkley and Cacioppo, 2010).”
From More than a feeling: A unified view of stress measurement for population science (2018) · cites this paper as Holt-Lunstad et al., 2015
Social relationships improve mental health.
“Social relationships buffer people from stress, improve their mental health [1,5,6], and provide meaningful roles that increase self-esteem and purpose in life [7,8].”
From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [6]
Loneliness is associated with mortality.
“Loneliness has also been shown to be associated with a wide range of physical and mental health outcomes, such as reduced cognitive function [23], depression [24–26], and mortality [3].”
Social relationships buffer people from stress.
“Social relationships buffer people from stress, improve their mental health [1,5,6], and provide meaningful roles that increase self-esteem and purpose in life [7,8].”
From A Randomized Pilot Study of Acceptance and Commitment Therapy to Improve Social Support for Veterans with PTSD (2022) · cites this paper as [6]
The Introduction (page unavailable) says social connection benefits psychological and emotional well-being, and the Discussion links it to survival. Neither passage says that social relationships buffer people from stress; searches for stress buffering and physiological stress responses found no such passage in our copy. (LLM, conf=0.72)
Experimental — accuracy not yet measuredLoneliness has been linked to increased risk for several mental disorders and somatic diseases in general.
“Especially loneliness has been associated with an increased risk for several mental disorders and somatic diseases in general (Beutel et al., 2017; Holt-Lunstad et al., 2015; Valtorta et al., 2018; Luhmann and Hawkley, 2016) and during the current pandemic (Palgi et al., 2020; González-Sanguino et al., 2020; Luchetti et al., 2020).”
From Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany (2020) · cites this paper as Holt-Lunstad et al., 2015
Loneliness and social isolation are as dangerous to health as smoking and obesity.
“Loneliness and social isolation are as dangerous to health as smoking and obesity 23 ,”
From Mental health care for older adults: recent advances and new directions in clinical practice and research (2022) · cites this paper as [23]
Adults who have few social contacts (socially isolated) or feel unhappy about their social relationships (lonely) are at increased risk of premature mortality.
“Adults who have few social contacts (ie, who are socially isolated) or feel unhappy about their social relationships (ie, who are lonely) are at increased risk of premature mortality.1”
Earlier reviews reported that cardiovascular disease prognosis is worse among people with poorer social relationships.
“Earlier reviews reported that cardiovascular disease (CVD) prognosis is worse among people with poorer social relationships.1 2”
Prospective studies investigating the relationship between loneliness and SIB are scarce.
“To date, prospective studies investigating the relationship between loneliness and SIB are scarce”
From Loneliness as a predictor of suicidal ideation and behaviour: a systematic review and meta-analysis of prospective studies (2020) · cites this paper as Holt-Lunstad et al., 2015
A meta-analysis of 70 prospective studies reported that social isolation was linked to a 29% higher risk of premature death from any cause, while loneliness was linked to a 26% higher risk.
“For example, one meta-analysis of 70 prospective studies found that social isolation was associated with 29% and loneliness a 26% increased risk for premature mortality from all causes [23].”
From Social isolation: an underappreciated determinant of physical health (2022) · cites this paper as [23]
The overall effect sizes for isolation and loneliness on mortality did not differ statistically, indicating they may predict death risk equally well.
“Despite these relative differences, the aggregate effect sizes were not statistically different, suggesting both social isolation and loneliness may equivalently predict mortality risk.”
From Social isolation: an underappreciated determinant of physical health (2022) · cites this paper as [23]
Social isolation was assessed with a multi-item scale that previous studies refer to as having the best predictive validity for mortality.
“We used a multi-item assessment of social isolation, which is referred to in previous studies as the best predictive validity for such a measurement strategy in relation to mortality.4”
From Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study (2017) · cites this paper as [4]
Loneliness is associated with increased likelihood of mortality, odds ratio 1.26 (95% CI 1.04, 1.53).
“identifying odds ratios of increased likelihood of mortality for social isolation (excluding suicide) of 1.29 (95 % CI 1.06, 1.56), for loneliness 1.26 (95 % CI 1.04, 1.53) and living alone 1.32 (95 % CI 1.14, 1.53) 19”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
The similar odds ratios for loneliness and social isolation suggest no difference between subjective or objective measures of social isolation.
“The similar odds ratios for loneliness and social isolation 19 suggest no difference between subjective or objective measures of social isolation.”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
Social isolation (excluding suicide) is associated with increased likelihood of mortality, odds ratio 1.29 (95% CI 1.06, 1.56).
“identifying odds ratios of increased likelihood of mortality for social isolation (excluding suicide) of 1.29 (95 % CI 1.06, 1.56), for loneliness 1.26 (95 % CI 1.04, 1.53) and living alone 1.32 (95 % CI 1.14, 1.53) 19”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
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”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
Living alone is associated with increased likelihood of mortality, odds ratio 1.32 (95% CI 1.14, 1.53).
“identifying odds ratios of increased likelihood of mortality for social isolation (excluding suicide) of 1.29 (95 % CI 1.06, 1.56), for loneliness 1.26 (95 % CI 1.04, 1.53) and living alone 1.32 (95 % CI 1.14, 1.53) 19”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
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) | ++ | ++ | ++ |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Holt Lunstad et al 2015*
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) | ++ | ++ | ++ |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Holt Lunstad et al 2015*
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) | ++ | ++ | ++ |”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as Holt Lunstad et al 2015*
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.”
From An overview of systematic reviews on the public health consequences of social isolation and loneliness (2017) · cites this paper as [19]
Loneliness or the perceived absence of positive social relationships is linked to diminished longevity, particularly among older individuals.
“By contrast, loneliness or the perceived absence of positive social relationships has been linked to diminished longevity [4]. particularly among older individuals in whom declining economic resources, illness, widowhood, and impaired mobility may result in increased risk for social isolation [5].”
From Loneliness and health in older adults: a mini-review and synthesis (2016) · cites this paper as [4]
Loneliness or perceived social isolation is a major risk factor for physical and mental illness in later life.
“Increasing evidence suggests that perceived social isolation or loneliness is a major risk factor for physical and mental illness in later life.”
From Loneliness and health in older adults: a mini-review and synthesis (2016) · cites this paper as [4]
The data indicated no difference between objective and subjective measures of social isolation when predicting elevated risk for early mortality.
“Of note, the data indicated no difference between objective and subjective measures of social isolation when predicting elevated risk for early mortality.”
From Loneliness and health in older adults: a mini-review and synthesis (2016) · cites this paper as [4]
A meta-analytic review of 70 independent prospective studies conducted between 1980 and 2014, with 3,407,134 participants, found that after accounting for multiple covariates, the increased likelihood of premature mortality was 26% for reported loneliness, 29% for social isolation, and 32% for living alone.
“a recent meta-analytic review of 70 independent prospective studies conducted between 1980 and 2014 – featuring a total of 3,407,134 participants – found that after accounting for multiple covariates (e.g., age, gender, socioeconomic status, health status, physical activity, smoking), the increased likelihood of premature mortality was 26% for reported loneliness, 29% for social isolation, and 32%”
From Loneliness and health in older adults: a mini-review and synthesis (2016) · cites this paper as [4]
Loneliness is associated with worse physical and mental health and increases mortality risk.
“Loneliness is associated with worse physical and mental health [5–8] and increases mortality risk [9,10].”
From Loneliness in the UK during the COVID-19 pandemic: Cross-sectional results from the COVID-19 Psychological Wellbeing Study (2020) · cites this paper as [9]
Loneliness and poor social support are associated with higher mortality rates, with an effect comparable to obesity, physical inactivity, and smoking.
“two meta-analytic reviews have reported that loneliness and poor social support are associated with higher mortality rates, and that the effect is comparable with some well-established risk factors such as obesity, physical inactivity, and smoking [5, 6].”
From Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review (2018) · cites this paper as [5]
Creating and maintaining positive social relationships is essential for human physical and mental health and well-being.
“Creating and maintaining positive social relationships is essential for human physical and mental health and well-being (e.g. [1–4]).”
From The ice-breaker effect: Singing mediates fast social bonding (2015) · cites this paper as [2]
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Loneliness from young adulthood to old age: explaining age differences in loneliness
Hawkley, L. C., Buecker, S., Kaiser, T., & Luhmann, M. (2022) · International Journal of Behavioral Development · doi:10.1177/0165025420971048 · Cited by 281 · see citing works
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- Authors
- Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D.
- Affiliations
- Department of Psychology
- Brigham Young University (US)
- ORCID
- Smith, Timothy B.
- Venue
- Perspectives on Psychological Science
- Publisher
- SAGE Publications
- Published
- 2015-03
- Volume
- 10
- Issue
- 2
- Pages
- 227-237
- ISSN
- 1745-6916 (ISSN-L)
- 1745-6924
- OpenAlex
- W2165243546
- Cited by
- 6,043
- References
- 57
- Citations by year
- 2026: 811 · 2025: 759 · 2024: 702 · 2023: 668 · 2022: 723 · 2021: 728 · 2020: 717 · 2019: 394 · 2018: 251 · 2017: 163 · 2016: 95 · 2015: 29
- FWCI
- 222.69
- Type
- journal article
- Language
- en
- Open access
- Locations
- Perspectives on Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- ScholarsArchive (Brigham Young University) (submittedVersion)
- Funders
- Brigham Young University
- Topics
- Social Sciences › Health › Health disparities and outcomes
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- loneliness, social isolation, mortality risk, living alone, objective social isolation, health risk factors, age differences, effect size comparison
- MeSH terms
- Humans, Loneliness, Mortality, Risk Factors, Social Isolation
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