Shared from the 5/5/2023 San Francisco Chronicle eEdition

Surgeon general report tackles loneliness

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“Our Epidemic of Loneliness and Isolation,” a new surgeon general’s advisory, signals that top U.S. health officials view loneliness and isolation as a critical public health concern.

U.S. Surgeon General Dr. Vivek Murthy on Tuesday released a federal advisory, “Our Epidemic of Loneliness and Isolation” — one of the clearest signals yet that top U.S. health officials view loneliness as a critical public health concern and are mapping out ways to fight it. This step follows action by a number of other countries, including the United Kingdom and Japan, that have appointed ministers of loneliness in the last few years.

Here are four takeaways from the report, including local researchers’ suggestions for resources if you need help seeking connection:

Loneliness and social isolation have major physical and mental health consequences

Social isolation can increase your risk of early death as much as smoking 15 cigarettes a day, according to the advisory, citing previous research. Poor or insufficient social connection is linked to a 29% increased risk of heart disease and a 32% higher risk of stroke. It is also associated with increased risk for obesity, high blood pressure, high cholesterol, anxiety, depression and dementia.

While researchers have known this for years, the U.S. health care system has long tended to treat disease and social factors as separate matters.

“We have never considered social health a core part of our health, so it’s been left to the individual to figure out,” said Dr. Carla Perissinotto, a UCSF geriatrician who helped review the advisory as part of a panel of experts. “The advisory puts more urgency and a critical eye on the need to shift this framework. We cannot continue to just say that loneliness affects only our mental health. It affects our complete health and all our lives across the age spectrum.”

Loneliness and social isolation are prevalent among all age groups —especially young adults — and had been on the rise for years even before the pandemic

Half of U.S. adults reported feeling lonely in 2021, according to recent national surveys, with some of the highest rates among young adults in their late teens and early 20s.

Between 2003 and 2019, social isolation — measured by the amount of time people spent alone — rose from an average of 285 minutes a day to 309 minutes a day, and that grew further to 333 minutes a day in 2020, the first year of the COVID-19 pandemic, the advisory said, citing a 2022 study.

At the same time, the amount of time people spent with friends in person fell from 60 minutes a day in 2003 to 20 minutes a day in 2020. This decline was steepest among those aged 15 to 24, whose time spent in-person with friends dropped about 70% from 150 minutes a day in 2003 to 40 minutes a day in 2020.

It’s not clear exactly why teens and young adults are struggling more. Research has historically focused more on loneliness and isolation among older adults than younger adults, so less is known about the latter, said UCSF pediatrician Dr. Matthew Pantell, who studies the relationship between social isolation, loneliness and health outcomes.

The pandemic forced many teens and young adults to be separated from friends and peers at a time they’d typically build social connections at school, which may contribute to more pronounced social isolation. And the use of social media may also have an impact, though the effects there are mixed — it can boost feelings of connectedness in some instances, but harm users’ mental health in other instances.

Loneliness doesn’t have to be a permanent state, and there are science-backed ways to combat it

The federal report emphasizes the importance of having local infrastructure and community-based programs that help people struggling with isolation and loneliness.

“Here in the Bay Area we have amazing organizations working in this space,” Perissinotto said.

Many but not all are geared toward older adults, and offer free services. The Curry Senior Center in San Francisco’s Tenderloin neighborhood runs a program that connects seniors with peers. It has been found to reduce participants’ feelings of loneliness, depression and barriers to socialization after one year.

San Francisco’s Institute on Aging operates a 24-hour phone line, the Friendship Line, a suicide prevention line for older adults that is manned by trained staff and volunteers.

Outside of structured programs, experts urge people to seek and welcome connections with friends in simple ways: “Answer that phone call from a friend. Make time to share a meal. Listen without the distraction of your phone,” Murthy wrote in the advisory.

“We have a lot of prescribed steps for other kinds of health promotion, like exercising every day and eating a healthy diet,” said Dr. David Spiegel, a professor of psychiatry and behavioral sciences at Stanford. “We think about food as medicine, that eating better is good for your health. Being with people is good for your health, too. Try it, you’ll like it.”

The health care system is talking about how best to intervene

A recent study showed that among 250 U.S. patients, just 13% said their clinicians asked them about loneliness in the past year, even though the vast majority of the patients said they’d be comfortable discussing it, said UCSF’s Pantell.

“We’ve been talking about how important social isolation and loneliness are to health, but haven’t done a great job in the health sector with talking to patients about it,” he said.

Pantell said bringing up the topic during patient visits and trying to root out the cause of social isolation can, in some cases, lead to simple fixes. A patient who’s having trouble hearing may be avoiding contact with friends and family and need a hearing aid. A patient who recently has been injured and can’t drive to see friends and family may benefit from transportation assistance.

“There’s not a silver bullet to address social isolation in everyone,” he said. “So as clinicians, we need to be trained on what’s driving social isolation and loneliness, and what tools we need to mobilize to address both of those.”

Reach Catherine Ho:

“We cannot continue to just say that loneliness affects only our mental health. It affects our complete health and all our lives across the age spectrum.”
Dr. Carla Perissinotto, a UCSF geriatrician on a panel of experts

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