Tackling Loneliness with Holistic Interventions.

We need a holistic approach to loneliness with a robust evidence base.
By Professor Andrea Wigfield

Loneliness is being debated in contemporary society more than at any other time in our history. Most of us will feel lonely at some point in our lives, and this feeling can be triggered by personal characteristics (e.g. age, disability, gender), as well as life transition points (e,g, being diagnosed with a health condition or becoming a carer). Wider societal influences such as the design of cities and towns, the culture of workplaces, and the role of technology also play a critical role, having the potential to prevent, exacerbate or ameliorate loneliness. Given the estimated cost of loneliness to individual health and well-being, the health and social care system, businesses and the economy, it is essential that we take a holistic approach to both understanding and remedying loneliness.

The Impact of COVID-19 on Loneliness

Evidence suggests that loneliness might be on the increase, transcending all population groups, and across the life course. This has arguably escalated even further since Covid-19, as everyday activities such as working, learning, and shopping have moved online, making it more difficult for people to form and maintain meaningful relationships outside of the home and immediate neighbourhood.

Young adults in the UK (age 16-24) are the most lonely group, often triggered by social media usage, with older people, and their declining health and loss of friends and family, the next most lonely. Those in mid-life (age 45-65) are increasingly experiencing loneliness, and are more lonely than their counterparts in past generations, thus emphasising the potential escalation of loneliness. This ‘sandwich generation’ are finding it increasingly difficult to maintain social relationships, whilst balancing paid work and caring for both elderly parents and grandchildren.

A Global Phenomenon: Loneliness Worldwide

Interest in loneliness is becoming a global phenomenon. The USA and Australia report similar levels of loneliness to the UK (with around half the population feeling lonely). Levels are reported to be even higher in countries such as Brazil and Turkey. No wonder then, that many suggest that there is a loneliness ‘epidemic’.

Responses vary internationally with some countries leading the way with a national approach. The UK government appointed a minister for loneliness in 2018, followed by Japan in 2021. In the US, Surgeon General Vivek Murphy set up a loneliness advisory in 2023, and the UK and Denmark have both developed a national strategy to tackle loneliness. However, beneath these overarching strategies, and elsewhere in the world, loneliness is being tackled in a piecemeal way, often by charitable organisations in local communities and predominately targeted at the individual rather than wider societal and structural changes.

Success Stories: Individual-Based Interventions

Examples of successful individual based interventions, which have been robustly evaluated, include mindfulness programmes which help participants to accept, understand and control their feelings. One study of mindfulness for young adults, for example, suggests that it helps participants to feel better equipped to manage future instances of loneliness. Interventions based around activities which people enjoy are particularly effective, as they are able to draw in and connect like-minded people who can then go on to forge meaningful relationships with each other beyond the specific intervention.

A study of a horticultural activity programme, involving an eight week gardening activity for older nursing home residents in Taiwan, for example, found that those who participated demonstrated statistically significant reductions in loneliness and depression, compared to the control group. Intergenerational initiatives can also be effective bringing together old and young to participate together in bonding activities, art being a particularly effective tool.

A randomised controlled trial of an Intergenerational Arts and Heritage-Based Intervention in Singapore called Project ARTISAN found that there were significant positive effects in the treatment group in comparison with the waitlisted control group in terms of promoting life satisfaction, quality of life and reducing loneliness. The initiative involved young people and older adults meeting each week for three hours, over a five week period, in a local museum to engage in storytelling and creative art-making activities.

Such individual based interventions can certainly help bring people together and foster opportunities for meaningful relationships, however wider societal and structural approaches are arguably required for more socially connected communities.

Intergenerational living through co-housing, pioneered in Denmark, is one promising strategy, a combination of individual low and densely built properties, usually built on the outer edges of cities, provide accommodation for all ages, for individuals, groups and families. The design incorporates common shared facilities, where everyday living activities, such as cooking and eating together take place, creating a community to encourage social contact.

Marmalade Lane in Cambridgeshire provides an example of co-housing in the UK, offering private properties, supported by a flexible ‘Common House’ with playroom, guest bedrooms, meeting space, and a large hall and kitchen.

On a wider wide scale, the 15 minute city, whereby most daily necessities and services are to be located within a 15 minute walk, bike, or public transport ride from any point in the city, is a revival of a past urban planning concept. The model is being adopted in a number of cities worldwide, including Paris, Barcelona, Vancouver, Seattle, and Melbourne and has the potential to make in-roads into loneliness by fostering stronger community ties and promoting social interaction.

Barriers to Tackling Loneliness Effectively

Despite many endeavours to remedy loneliness across the globe, it remains a difficult policy area. Challenges in finding a solution to loneliness primarily stem from its focus on relationships, feelings, and emotions.

To remedy loneliness, individuals need to have meaningful relationships, with themselves; with others; with the places and spaces where they inhabit (in other words a sense of belonging). This requires a holistic approach to loneliness which cuts across many policy and service areas – housing, health, crime and safety, transport, education.

A further complication relates to the challenges of evaluating and measuring the impact of interventions which touch on so many aspects of our lives and are subjective in nature. These include: difficulty in implementing randomised controlled trials, the inappropriateness of existing loneliness measurement scales for evaluating changes in loneliness as a direct result of interventions, and the piecemeal approach to loneliness services which are often run by voluntary sector organisations with limited financial resources.

A recent Cochrane Campbell review by the World Health Organization confirms the lack of a robust evidence base, reporting inconsistent findings on the effectiveness of loneliness interventions across all ages and groups, and most reviews classified as critically low quality.

Charting the Path Ahead: Strengthening Our Understanding of Loneliness

Although we have some way to go in gaining a full understanding of which kinds of loneliness interventions work best, for which groups, the World Health Organisation has already made some inroads creating a database of in-person interventions for reducing social isolation and loneliness, and this is a good starting point for anyone wishing to tackle loneliness.