The Pathophysiology of Perceived Social Isolation: Effects on Health and Mortality

Perceived social isolation (PSI) is a deficit in normal human social interaction, which has been associated with negative health outcomes. However, the precise mechanisms through which PSI influences human health are not fully known. This review aims at bringing out what is known about these pathways through which social isolation affects human health. We searched PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica dataBASE (EMBASE), Psychological Information Database (PsycINFO), and Cochrane Library in addition to secondary references from primary journal articles for the most relevant and recent information concerning the research topic. The keywords used were perceived social isolation, loneliness, health outcomes, cardiovascular effects, neuroendocrine effects, depression, and cognitive decline, in animal and human populations. There are clear linkages between PSI and the cardiovascular system, neuroendocrine system, and cognitive functioning. PSI also leads to depression, cognitive decline, and sleep problems. The mechanisms through which PSI causes these effects are neural, hormonal, genetic, emotional, and behavioral. The effects of PSI on health are both direct and indirect. There is a complex interconnected network of pathways through which PSI negatively influences health. These hypothetical pathways using which the effects of PSI have been explained form the base on which further analyses can be carried out.

[1]  Luc Goossens,et al.  The development of loneliness from mid- to late adolescence: trajectory classes, personality traits, and psychosocial functioning. , 2013, Journal of adolescence.

[2]  Jameson K. Hirsch,et al.  Social Problem Solving and Suicidal Behavior: Ethnic Differences in the Moderating Effects of Loneliness and Life Stress , 2012, Archives of suicide research : official journal of the International Academy for Suicide Research.

[3]  Deepak L. Bhatt,et al.  Living alone and cardiovascular risk in outpatients at risk of or with atherothrombosis. , 2012, Archives of internal medicine.

[4]  Ian J. Deary,et al.  Which Social Network or Support Factors are Associated with Cognitive Abilities in Old Age? , 2013, Gerontology.

[5]  Andrew Steptoe,et al.  Loneliness, social isolation, and behavioral and biological health indicators in older adults. , 2011, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[6]  A. Steptoe,et al.  Social isolation and loneliness , 2012 .

[7]  Nancy Adler,et al.  Social isolation: a predictor of mortality comparable to traditional clinical risk factors. , 2013, American journal of public health.

[8]  J. Schneider,et al.  Loneliness and risk of Alzheimer disease. , 2007, Archives of general psychiatry.

[9]  Stephanie Cacioppo,et al.  The neuroendocrinology of social isolation. , 2015, Annual review of psychology.

[10]  Gary G Berntson,et al.  Loneliness in everyday life: cardiovascular activity, psychosocial context, and health behaviors. , 2003, Journal of personality and social psychology.

[11]  D. Berman,et al.  Social Network and Coronary Artery Calcification in Asymptomatic Individuals , 2005, Psychosomatic medicine.

[12]  J A Hobson,et al.  Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. , 2000, International journal of psychophysiology : official journal of the International Organization of Psychophysiology.

[13]  J. Sheridan,et al.  Beta adrenergic blockade decreases the immunomodulatory effects of social disruption stress , 2008, Brain, Behavior, and Immunity.

[14]  L. Hawkley,et al.  Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. , 2006, Psychology and aging.

[15]  M Ericson,et al.  Psychosocial factors and heart rate variability in healthy women. , 1999, Psychosomatic medicine.

[16]  Andrew Steptoe,et al.  Social Isolation and Stress-related Cardiovascular, Lipid, and Cortisol Responses , 2009, Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.

[17]  Jacob E. Cheadle,et al.  Adolescent Loneliness and Health in Early Adulthood. , 2013, Sociological inquiry.

[18]  John P. Capitanio,et al.  Perceived social isolation, evolutionary fitness and health outcomes: a lifespan approach , 2015, Philosophical Transactions of the Royal Society B: Biological Sciences.

[19]  J. Silk,et al.  The adaptive value of sociality in mammalian groups , 2007, Philosophical Transactions of the Royal Society B: Biological Sciences.

[20]  Dianne M. Tice,et al.  Giving in to Feel Good: The Place of Emotion Regulation in the Context of General Self-Control , 2000 .

[21]  L. Hawkley,et al.  Perceived social isolation and cognition , 2009, Trends in Cognitive Sciences.

[22]  E. Adam,et al.  Adverse adolescent relationship histories and young adult health: cumulative effects of loneliness, low parental support, relationship instability, intimate partner violence, and loss. , 2011, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[23]  L. Hawkley,et al.  Effects of social isolation on glucocorticoid regulation in social mammals , 2012, Hormones and Behavior.

[24]  C. White,et al.  Social isolation, cognitive decline, and cardiovascular disease risk , 2015 .

[25]  J. Goodson.  Deconstructing sociality, social evolution and relevant nonapeptide functions , 2013, Psychoneuroendocrinology.

[26]  A. Montes-Martínez,et al.  Social network, presence of cardiovascular events and mortality in hypertensive patients , 2014, Journal of Human Hypertension.

[27]  Yang Claire Yang,et al.  Social Isolation and Adult Mortality , 2013, Journal of health and social behavior.

[28]  James H. Wirth,et al.  The consequences of pain: The social and physical pain overlap on psychological responses , 2011 .

[29]  Louise C Hawkley,et al.  Loneliness is a unique predictor of age-related differences in systolic blood pressure. , 2006, Psychology and aging.

[30]  R. Emsley,et al.  Social isolation rearing induces mitochondrial, immunological, neurochemical and behavioural deficits in rats, and is reversed by clozapine or N-acetyl cysteine , 2013, Brain, Behavior, and Immunity.

[31]  Stephen L. Brown,et al.  Childhood loneliness as a predictor of adolescent depressive symptoms: an 8-year longitudinal study , 2010, European Child & Adolescent Psychiatry.

[32]  John T. Cacioppo,et al.  Do Lonely Days Invade the Nights? Potential Social Modulation of Sleep Efficiency , 2002, Psychological science.

[33]  Andrew Steptoe,et al.  Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women , 2004, Psychoneuroendocrinology.

[34]  C E Speicher,et al.  Urinary Cortisol Levels, Cellular Immunocompetency, and Loneliness in Psychiatric Inpatients , 1984, Psychosomatic medicine.

[35]  E. Cornwell,et al.  Social Disconnectedness, Perceived Isolation, and Health among Older Adults∗ , 2009, Journal of health and social behavior.

[36]  J. Wardle,et al.  Social isolation, loneliness, and all-cause mortality in older men and women , 2013, Proceedings of the National Academy of Sciences.

[37]  Kristopher J Preacher,et al.  Loneliness impairs daytime functioning but not sleep duration. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[38]  Louise C Hawkley,et al.  Loneliness predicts reduced physical activity: cross-sectional & longitudinal analyses. , 2009, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[39]  S. Yusuf,et al.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): case-control study , 2004, The Lancet.

[40]  R. Weiss,et al.  Loneliness: The Experience of Emotional and Social Isolation. , 1975 .

[41]  S. Cole.  Social regulation of leukocyte homeostasis: The role of glucocorticoid sensitivity , 2008, Brain, Behavior, and Immunity.

[42]  R. Sacco,et al.  Association between social isolation and left ventricular mass. , 2011, The American journal of medicine.

[43]  J. Cacioppo,et al.  Elevated Macrophage Migration Inhibitory Factor (MIF) is associated with depressive symptoms, blunted cortisol reactivity to acute stress, and lowered morning cortisol , 2010, Brain, Behavior, and Immunity.

[44]  Diego Zavaleta,et al.  Social isolation: A conceptual and measurement proposal , 2014 .

[45]  Keith A. Johnson,et al.  Association of Higher Cortical Amyloid Burden With Loneliness in Cognitively Normal Older Adults. , 2016, JAMA psychiatry.

[46]  R. Baumeister,et al.  The need to belong: desire for interpersonal attachments as a fundamental human motivation. , 1995, Psychological bulletin.

[47]  Y. Oka,et al.  Social isolation affects the development of obesity and type 2 diabetes in mice. , 2007, Endocrinology.

[48]  Timothy B. Smith,et al.  Social Relationships and Mortality Risk: A Meta-analytic Review , 2010, PLoS medicine.

[49]  J. Kiecolt-Glaser,et al.  Psychosocial Modifiers of Immunocompetence in Medical Students , 1984, Psychosomatic medicine.