Exploring the Link Between Loneliness and Multimorbidity

The Impact of Multimorbidity

Research conducted in England has investigated the relationship between loneliness and multimorbidity, defined as the presence of two or more chronic or acute illnesses. This condition affects a significant portion of the population and is linked to various adverse outcomes, including diminished quality of life and an increased risk of premature mortality. Despite its prevalence, the connection between multimorbidity and loneliness remains under-explored.

Understanding Loneliness

Loneliness is a common experience, affecting approximately 5-15% of the healthy population who report frequent feelings of isolation. This emotional state has been associated with numerous negative health outcomes, including a higher risk of premature death. Previous research has indicated a link between chronic illness and feelings of loneliness, particularly in specific patient groups such as those with Alzheimer’s or stroke survivors. However, this association varies across different diseases and demographic groups, with limited studies focusing on the relationship between comorbidity and loneliness, particularly in populations younger than 45.

Study Overview: Does Multimorbidity Increase Loneliness?

Published in PLoS ONE, a recent study from the UK aimed to explore the association between multimorbidity and loneliness, while also identifying potential influencing factors. For this study, loneliness was defined as the uncomfortable feeling arising from a deficiency in one’s social relationships, either in quantity or quality.

Methodology

The researchers surveyed 7,461 participants, categorizing them based on their chronic disease status, from none to five or more chronic conditions. They collected data on potential covariates, such as smoking, drug use, obesity, and life stressors occurring before or after the age of 16. This approach aimed to identify any significant mediators or confounders in the relationship between multimorbidity and loneliness.

Findings: Loneliness and Multimorbidity Correlation

The study revealed a significant association between loneliness and various negative health factors. Notably, the prevalence of loneliness increased with the number of physical diseases reported: 16.5% of individuals without chronic illnesses experienced loneliness, compared to 30.7% among those with five or more diseases. After controlling for socio-demographic variables, highly multimorbid patients exhibited notably higher levels of loneliness compared to those with just one physical condition, with this trend being particularly pronounced among younger participants aged 16-44.

Mediating Factors: The Role of Stressful Life Events

The research also indicated a significant link between multimorbidity, loneliness, and stressful life events occurring before and after the age of 16. These stressful experiences included anxiety, depression, and disordered eating. While factors like smoking, substance abuse, and social support did not show substantial effects, stressful life events in adulthood emerged as the strongest mediator for younger individuals. For middle-aged participants (45-64 years), anxiety was identified as the primary mediator, whereas for older adults (65 and above), stressful life events in adulthood were the only significant mediators.

Understanding the Mechanism

Despite these findings, the exact mechanism behind the association between multimorbidity and loneliness remains unclear. It is hypothesized that mental health issues stemming from multimorbidity may lead to feelings of inadequacy and dependency, contributing to loneliness. Additionally, depression in older adults has been linked to reduced social engagement, further exacerbating feelings of isolation. Stressful life events earlier in life could elevate the risk of developing multimorbidity later on, potentially due to physiological changes or issues with trust and social bonding.

Confounding Variables or Mediators?

The evidence raises the question of whether these factors act as confounders, suggesting no direct link between loneliness and multimorbidity, or if they serve as mediators. Stressful life events could incapacitate individuals, leading to isolation and loneliness. The study’s design, which did not assess variables over time, limits the ability to determine the causal relationship between loneliness and comorbidity. Distorted thought patterns associated with loneliness may also produce physiological and behavioral changes, heightening the risk of chronic diseases, including hypertension and metabolic syndrome.

Unexpected Findings in Younger Populations

Interestingly, younger participants reported higher levels of loneliness compared to older groups. This may be attributed to the societal expectation for young individuals to engage socially and remain active, making the experience of multimorbidity particularly isolating. In contrast, older adults may possess greater resilience and have fewer societal role expectations, potentially reducing their feelings of loneliness.

Study Limitations

The study does have limitations, notably that the reported physical illnesses were self-reported, which may not always be accurate. Additionally, the response rate was moderate, with only about half of the surveyed individuals participating. Previous research suggests that lonely individuals may be less trustworthy and more apprehensive about confidentiality, which could skew the sample. Furthermore, the loneliness measure included aspects of isolation, making it challenging to separate these two concepts.

Implications for Future Research

Future studies should focus on long-term investigations of these phenomena and their underlying processes. Nonetheless, the current study highlights a strong correlation between multimorbidity and loneliness, emphasizing the importance of recognizing this relationship in both prevention and treatment strategies for various physical and mental health conditions. Clinicians should remain cognizant of this association when treating patients with multiple medical issues.

Reference

Stickley A, Koyanagi A (2018). Physical multimorbidity and loneliness: A population-based study. PLoS ONE 13(1): e0191651. https://doi.org/10.1371/journal.pone.0191651