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Loneliness in Mental Health




By Thapelo Mabale, Master of International Health, Uppsala University


Most scholars would make you tread carefully when mentioning “loneliness” and “mental illness” in the same sentence, for the mere fact that there has been a huge misconception and misunderstandings of both these terms in the past. The definition of loneliness has been said to be “a complex set of feelings encompassing reactions to the absence of intimate and social needs”, this definition encompasses the rudimentary definition of what loneliness should be defined as (1). Loneliness has been identified as one of the factors that yielded many mental health issues (2,3), some of the findings observed are social withdrawal (4), a lack of self-confidence or trust (4), the inability to take control of any situation (4,1) or the inability to sustain or make relationships (5,6). Some differences seen in individuals are signs of depression (2,5), aggression and hostility (4), low positive perception and pessimism (7). Strangely; some of the findings of the loneliness are similar to some found in clinically diagnosed mental illnesses such as depression, borderline personality disorders and schizophrenia (8,9). This does not necessarily mean that loneliness should be deemed as a mental illness or should it rather be recognised as such and this is not the aim of this article.

loneliness mental health SNIH

The BBC in 2011 identified loneliness as a ‘hidden killer’ (10). Loneliness has been ranked amongst mortifying health issues like smoking, suicide, dementia, immune and cardiovascular system deterioration (11). Which is alarming, especially as it is seen in the elderly. Loneliness is unfortunately evident in everyone whether we admit it or not. How we deal or process it varies from one individual to the next. There is even evidence illustrating that loneliness has a neurological effect; observed in the brain, it yields a smaller grey matter in lonely individuals (12,13). Strangely, there hasn’t been any other attempts or studies to confirm the findings or counter the findings, to elude out the falseness or repeatability of the findings, which is concerning. There still isn’t any current evidence present on what mental health care worker’s perceptions are on loneliness and whether loneliness should be even accounted for under mental health illness. This is understandable due to a lack of scientific evidence and data. It is not entirely that there aren’t any methodologies established to measure loneliness in a quantitative or qualitative method, Dahlberg and McKee in 2014 wrote an article that identified numerous methodologies that have been used over the years to measure loneliness (14). Therefore it is questionable why loneliness is still an entity within the mental health sector that has been, for a lack of a better word, overlooked and its intensities.

A documentary released in Sweden, namely; “The Swedish Theory of Love”, expounded the complex independent and a more individualistic lifestyle Sweden has. This may look as though it is fictitious, but it is entirely substantiated with evidence. There you get to visualise the extent that Sweden has taken the concept of individualism. A few studies have been conducted illustrating that individualistic societies are more prone to be lonely when reaching adult ages and even older (14). Sweden has been one of the countries labelled as having the loneliest people in the world (15) and there has also been literature published to propose this (16–19). All the literature referred to in this article deduces that loneliness has had a bad effect on the individual’s physical and mental health. Holmén and Furukawa did a follow-up study to see if any interventions permeated and found that friendship and a person to converse with, has made an impact on the previously elder people (7). The literature mentioned in this article may only be about the elderly; but what about the young as there could be an obscured perception and arguments that they’re exempted from loneliness. A study in Atlanta in the US deduced that adults who used social media were significantly lonelier than those who didn’t use social media; more specifically Facebook (20). It might be a social platform in media but it doesn’t necessarily mean it can equip individuals with the needed satisfaction or social skills to initiate relationships with other people. Thus they’re not entirely exempt.

Although loneliness has been identified as a problem in Sweden and its various negative impacts; there are very few studies investigating the effectiveness of implemented or even studies attempting to implement interventions for the alleviation of loneliness in our young, elderly and even already clinically diagnosed mentally ill patients. There are some studies that have tried to implement interventions for loneliness but there is a lack of the appropriate comparison or zero samples to compare with and this could be the reason why some of the interventions are doubted and rarely taken seriously. Sweden will need to adjust or implement certain policies to alleviate this ‘hidden killer’. Some Correlational studies have endorsed that having a friend, company, a companion or spouse is actually enough to counteract the feeling of loneliness (1), but this is also very suggestive and not tested. With the backdrop of the ‘Midsommar’ festival lurking in the back of our minds, a few days ago, it is time to question truly if the love endorsed by this festival or the infamous ‘Fika’ that is part of the Swedish culture, is adequate to equip Swedes with social skills or satisfaction, to alleviate loneliness in Sweden. Another question to ponder on is if love is truly what it is supposed to be or is a more individualistic society more selfish, or does it even consider love, family and friends. Does love even fit in within science and should it be documented as an intervention or is this preposterous to even consider. With so many perceptions and contexts of love, where do we even begin to problematize the word and seek a comprehensive definition? Or do we begin with the Bible, considering the Church of Sweden has played a big role in the governance of the country but regarding history do we still go back? Is love truly what the Bible says in 1 Corinthians 13: 4-8

“4) Love endures with patience and serenity, love is kind and thoughtful, and is not jealous or envious; love does not brag and is not proud or arrogant. 5) It is not rude; it is not self-seeking, it is not provoked [nor overly sensitive and easily angered]; it does not take into account a wrong endured. 6) It does not rejoice at injustice, but rejoices with the truth [when right and truth prevail]. 7) Love bears all things [regardless of what comes], believes all things [looking for the best in each one], hopes all things [remaining steadfast during difficult times], endures all things [without weakening].8) Love never fails [it never fades nor ends]……”



  1. Ernst JM, Cacioppo JT. Lonely hearts: Psychological perspectives on loneliness. Appl Prev Psychol [Internet]. 1999 Dec [cited 2017 Jun 20];8(1):1–22. Available from:
  2. Choenarom C, Williams RA, Hagerty BM. The Role of Sense of Belonging and Social Support on Stress and Depression in Individuals With Depression. Arch Psychiatr Nurs [Internet]. 2005 Feb [cited 2017 Jun 20];19(1):18–29. Available from:
  3. Hagerty BMK, Lynch-Sauer J, Patusky KL, Bouwsema M, Collier P. Sense of belonging: A vital mental health concept. Arch Psychiatr Nurs [Internet]. 1992 Jun [cited 2017 Jun 21];6(3):172–7. Available from:
  4. Hawkley LC, Cacioppo JT. Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms. Ann Behav Med [Internet]. NIH Public Access; 2010 [cited 2017 Jun 20];40(2). Available from:
  5. VanderWeele TJ, Hawkley LC, Cacioppo JT. On the Reciprocal Association Between Loneliness and Subjective Well-being. Am J Epidemiol [Internet]. 2012 Nov 1 [cited 2017 Jun 21];176(9):777–84. Available from:
  6. Savikko N, Routasalo P, Tilvis RS, Strandberg TE, Pitkälä KH. Predictors and subjective causes of loneliness in an aged population. Arch Gerontol Geriatr [Internet]. 2005 Nov [cited 2017 Jun 20];41(3):223–33. Available from:
  7. Holm?n K, Furukawa H. Loneliness, health and social network among elderly people?a follow-up study. Arch Gerontol Geriatr [Internet]. 2002 Nov [cited 2017 Jun 21];35(3):261–74. Available from:
  8. Mushtaq R, Shoib S, Shah T, Mushtaq S. Relationship between loneliness, psychiatric disorders and physical health ? A review on the psychological aspects of loneliness. J Clin Diagn Res [Internet]. JCDR Research & Publications Private Limited; 2014 Sep [cited 2017 Jun 22];8(9):WE01-4. Available from:
  9. Golden J, Conroy RM, Bruce I, Denihan A, Greene E, Kirby M, et al. Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. Int J Geriatr Psychiatry [Internet]. John Wiley & Sons, Ltd.; 2009 Jul 1 [cited 2017 Jun 21];24(7):694–700. Available from:
  10. Coughlan S. Loneliness is “hidden killer” of elderly – BBC News [Internet]. BBC News. 2011 [cited 2017 Jun 20]. Available from:
  11. Tiwari SC. Loneliness: A disease? Indian J Psychiatry [Internet]. Medknow Publications; 2013 Oct [cited 2017 Jun 20];55(4):320–2. Available from:
  12. Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness. Psychol Bull [Internet]. NIH Public Access; 2014 Nov [cited 2017 Jun 21];140(6):1464–504. Available from:
  13. Kanai R, Bahrami B, Duchaine B, Janik A, Banissy MJ, Rees G. Brain Structure Links Loneliness to Social Perception. Curr Biol [Internet]. 2012 Oct [cited 2017 Jun 21];22(20):1975–9. Available from:
  14. Dahlberg L, McKee KJ. Correlates of social and emotional loneliness in older people: evidence from an English community study. Aging Ment Health [Internet]. Taylor & Francis; 2014 May [cited 2017 Jun 22];18(4):504–14. Available from:
  15. Perez M. 8 Loneliest Countries In The World [Internet]. 2014 [cited 2017 Jun 21]. Available from:
  16. Berg S, Mellstrom D, Persson G, Svanborg A. Loneliness in the Swedish Aged. J Gerontol [Internet]. Oxford University Press; 1981 May 1 [cited 2017 Jun 22];36(3):342–9. Available from:
  17. Holm?n K, Ericsson K, Andersson L, Winblad B. Loneliness among elderly people living in Stockholm: a population study. J Adv Nurs [Internet]. Blackwell Publishing Ltd; 1992 Jan 1 [cited 2017 Jun 22];17(1):43–51. Available from:
  18. Jakobsson U, Hallberg IR. Loneliness, fear, and quality of life among elderly in Sweden: a  general perspective. Aging Clin Exp Res [Internet]. [cited 2017 Jun 22];17(6):494–501. Available from:
  19. Mullins LC, Sheppard HL, Andersson L. A study of loneliness among a national sample of Swedish elderly. Compr Gerontol B [Internet]. 1988 Apr [cited 2017 Jun 22];2(1):36–43. Available from:
  20. Bell C, Fausset C, Farmer S, Nguyen J, Harley L, Fain WB. Examining social media use among older adults. In: Proceedings of the 24th ACM Conference on Hypertext and Social Media – HT ’13 [Internet]. New York, New York, USA: ACM Press; 2013 [cited 2017 Jun 23]. p. 158–63. Available from:




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