Loneliness and Mental Health Distress Have a Cyclical Relationship

For many, the pandemic intensified loneliness concerns. A new research study conducted in the United Kingdom (UK) has found a direct link between the impacts of loneliness and greater mental health distress.

Researchers conducted interviews with 59 adults with mental health concerns in the UK, and found that mental health distress can impact chronic loneliness, which refers to feeling lonely often or always.

These findings can better inform government programs to address loneliness and improve mental health among adults.

Understanding the Research

Researchers found that the interviews conducted for the study yielded four themes: what "lonely" means, contributing factors to ongoing loneliness, links between chronic loneliness and mental health, and strategies for reducing loneliness.

In particular, this study found that certain groups are more vulnerable to chronic loneliness, including disabled people and members of the LGBTQIA+ community.

Although this study included a somewhat diverse sample with people of various backgrounds, types of mental health issues, service use, and locations, the researchers note that the context of the pandemic may have influenced accounts of loneliness, and even more diversity in the sample would have been beneficial.

Stigma Impacts Mental Illness and Loneliness

Psychiatrist and behavioral health medical director at Community Health of South Florida Inc., Howard Pratt, DO, says, “Mental health issues such as depression and anxiety for some people are a catalyst for isolation. For these people, it’s like being knocked down before you can even get up.”

"Loneliness and isolation can become a form of self-neglect. Just like we need self-care and time to ourselves, we also need to be engaging our community to have a sense of purpose," he says.

Pratt notes that if not prepared for it, people find that retirement can be hard.

"If a person has their identity wrapped around a job, and you take that away, then that sense of purpose is lost, and can lead to depression," he says.

Pratt highlights, "There is a stigma associated with mental health issues, particularly when it comes to mental health and isolation. This stigma often stems from others misinterpreting that isolation."

Since most may not want to burden others, Pratt notes that they may withdraw. "So, a person can start isolating without realizing they are doing it and without others noticing or knowing why," he says.

Pratt explains that when a person does realize that they have more or less retreated from loved ones, it is important to start the journey back, which may mean communicating that they have been going through a rough time, as well as seeking professional help as needed.

Expecting family and friends to provide sufficient support to promote mental health may strain relationships, according to Pratt.

"These findings are a confirmation of what has already been known by the mental health community as well as the general public," he says.

"The public should know how common the progression to self-isolation is when it comes to one’s mental health, and it can be happening right in front of you. In other words, isolation doesn’t have to be a matter of being physically apart from people."

Social Interaction Is Essential

Julian Lagoy, MD, a psychiatrist with Mindpath Health, says, "Mental health issues do have a significant impact on our social life, and can make it harder for someone to make true friendships." 

"This difficulty can lead to loneliness, which can lead to mental health issues. Human beings are social creatures and we are meant to be around other human beings," he explains.

Loneliness and social isolation increase the risk of mental illness, according to Lagoy.

"When you are lonely and lack social interaction, you are more likely to become depressed," he says.

Lagoy highlights, "There is stigma with loneliness and mental health in our society. To break this cycle, people can be more open with their illness, so those who are suffering realize that they are not alone."

Social interaction is essential to flourishing, as Lagoy notes how a lack of it increases the risk of mental illness.

"Loneliness and its relation to mental health have not been studied much; however, studies like this are showing how important both are and how they are both related," he says.

Lagoy explains, "As was noted in the paper, limitations include not having a diverse enough sample of people; they did not look at variables such as sexual orientation or ethnicity. This is worth noting because sexual orientation and ethnicity do play a crucial part in mental health."

People of certain cultures may be more at risk for loneliness compared to other cultures and ethnicities, according to Lagoy. "I would re-emphasize that we need to destigmatize loneliness and mental health," he says.

While medications can help patients who are lonely, Lagoy notes that connection to others is needed.

"The sooner we recognize the problem, the sooner we can get real solutions. Unfortunately, in our society we do not talk about loneliness much; however, it is a major problem and medications alone are not going to solve it," he says.

Early Intervention Needed for Loneliness

Adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center, David A. Merrill, MD, PhD, says, “The common core of different anxiety disorders is fear-based avoidance.

"If a person has one or more negative social experiences of perceived failure or embarrassment, this may lead them to decline future offers to connect."

In the short-term, Merrill notes that avoidance may successfully allow individuals to prevent the discomfort of a social situation. But this is not without consequences.

"Repeated avoidance of social activities leads to diminishment of our relationships over time. This can evolve into diagnosable and debilitating mental health conditions such as social phobia or agoraphobia," he says.

Merrill explains, "Human well-being is in many ways tied to social interaction-based relationships. We often find these close relationships among family members and similar bonds can form in work settings."

When ties are suddenly severed or dramatically altered by an event like retirement, Merrill notes this can trigger depressive symptoms like low mood, decreased energy, poor focus, and trouble sleeping.

Merrill highlights, "One need look no further than social media platforms to witness the stigma associated with loneliness and mental health issues. In many ways, the antidote to avoidance-based fear is to re-approach the same potentially anxiety-provoking social situations."

Safe and supportive social interactions are key to long-term mental health and well-being, according to Merrill.

"Our relationships are a major source of support, and opportunities for purpose in life," he says.

Similar to prior research, Merrill notes that these findings show that chronic loneliness plays a significant role in mental health distress.

"Early intervention may play a significant role in combating the effects of loneliness on mental health in the short term," he says.

Merrill explains, "The COVID pandemic continues to significantly limit the comfort and safety of social opportunities, especially for those with long-term health conditions at risk of severe COVID. Persistent worry about COVID infection and risk of severe health consequences appears to be driving sustained social isolation in an untold number of individuals."

For those struggling to connect with others, Merrill notes that it can be helpful to schedule structured group activities, such as nature-based experiences like hiking, sports teams, or exercise classes.

"Taking up culture-based activities like music, dance, photography, or art classes and events can be another safe and rewarding way to connect with others. Life-long learning through ongoing course work and also volunteering to help others are reliable ways to keep social experiences in your day to day experiences."

Stigma Can Be a Barrier

Amanda Logid, LMFT, says, "There continues to be a stigma surrounding mental health challenges which can be a barrier to seeking help. In my experience as a therapist, people who are struggling usually see treatment as a last resort and end up spending a lot of time suffering." 

Logid explains how mental health challenges can contribute to isolation from others.

"Negative thoughts can keep people from reaching out to others and magnify the feelings of loneliness," she says.

In her practice, Logid notes that she has seen clients who isolate, then feel that they have neglected their relationships, and then avoid them because of guilt.

"It can be a scary and difficult cycle to break," she says.

Logid highlights, "One of our basic needs as humans is connection with others. It is a huge part of why therapy can be so helpful. Therapy is based on a healthy, consistent, truthful connection with another human."

If someone is not experiencing consistent connection or attachment to a safe person, it can be detrimental to mental health, according to Logid.

"A safe person is someone who provides support and validation," she says.

In her practice, Logid notes a significant increase in depression and anxiety in children and teens who were mandated to attend school virtually and professionals who began and continue working from home.

Logid explains, "People may not even realize how much social interaction affects their mental health. I fear that the impact of these last few years will wreak havoc on the mental well-being of many individuals."

Breaking the cycle of loneliness starts with an awareness of how important social connections are to mental health.

"One of the first things I do as a therapist is assess my client’s social support system," she says. "If their social support is lacking or they are self-isolating, I stress the importance of building community as an important goal. The way we reach that goal is different for each person."

Without social interaction, Logid notes that individuals often do not have a healthy community.

"If you are suffering with loneliness, start with reaching out to someone you trust. Feeling alone in the midst of mental health struggles is part of why it is so difficult. You are not alone, and you are valuable enough to seek and get help, and find your community."