Being by yourself may be hazardous to your health, researchers say

January 07, 2001|By A.M. Chaplin | A.M. Chaplin,Sun Staff

Are you lonely tonight?

Are you sleepless in Seattle, friendless in Frisco or bereft in Baltimore?

If so, your health could be in danger, medical research suggests, and not just your mental health. Evidence has been mounting that the lack of social support -- what most people would probably feel as loneliness -- is as bad for your heart as physical inactivity, smoking and obesity.

In a study at Duke University, for example, a sobering 50 percent of heart-disease patients who had neither spouse nor confidant were dead within five years of their evaluation at Duke. But only 17 percent or 18 percent of married or befriended peers had died within the same time frame.

From this and other research, it's clear that the lack of social support is associated with "earlier onset and worse outcome of heart disease," says Dr. Redford Williams, director of the Duke research.

This represents a shift in medical thinking. Song writers have been telling us since the guitar was invented that achy-breaky hearts lead to untimely ends, but physicians are a more literal-minded crew and would rather talk about angina than heartache. Trained in the hard sciences, for a long time they "viewed with skepticism" a relationship between psychosocial factors and disease, Williams says.

But the stack of studies demonstrating a relationship has mounted so high that even "hard-nosed medical types are becoming more accepting," he says, "though there'll always be some die-hards who resist."

And while the die-hards keep resisting, the accepters have moved on. Now that they don't have to prove a relationship between psychosocial factors and heart disease, they are beginning to look for how the relationship does its damage, and what they can do about it.

Within the last few years, researchers have turned their focus to mechanisms and interventions, says Lisa Berkman, chair and professor of the department of health and social behavior and professor of epidemiology at the Harvard School of Public Health.

Mechanisms are the biological "how" by which the psychosocial facts of isolation and loneliness are translated into the physical fact of heart disease.

Stress hormones, for example, have been implicated in the development of heart disease, so researchers looked to see if social support has an effect on the levels of those hormones. Sure enough, greater social support was found to be associated with lower -- and safer -- levels of those hormones in a study headed by Teresa Seeman, professor of medicine and epidemiology at the UCLA School of Medicine.

Altered immune function is another mechanism that may mediate between social isolation and heart disease, and blood pressure is one more. Study results presented to the American Psychological Association in August suggested that the way the cardiovascular systems of lonely college students react to stress was likely to lead to high blood pressure in later life.

The study also found that lonely people, young and old, don't sleep as well as the nonlonely, another way in which loneliness can damage health.

The study was small, but its director sees it as part of a very big picture.

"By the end of the current decade, the number of people living alone is projected to reach almost 31,000,000--- a 40 percent increase since 1980," writes John Cacioppo, the Tiffany and Margaret Blake Distinguished Service Professor in Psychology at the University of Chicago.

This is a result of demographic changes such as an aging population and a high divorce rate -- and of underlying cultural attitudes. Ours is a nation famously dedicated to self-reliance and individualism, and as a result "we are very supportive of loneliness," Berkman says, in contrast to the cultures of, say, Japan and France, which have higher levels of social cohesion and lower levels of heart disease.

Americans should be worrying about the cultural forces causing this epidemic of loneliness just as much as they worry about viruses and bacteria, writes James J. Lynch, author of "A Cry Unheard: New Insights Into the Medical Consequences of Loneliness." Lynch, director of the Life Care Health Associates in Towson, believes those cultural forces are just as much a threat to public health as any communicable disease.

Social isolation

Which brings us to the other new field of lonely-studies research: interventions, or what can be done about it all.

Berkman calls intervention studies a "startling new area," because it goes beyond medical and surgical treatments for heart disease and addresses psychosocial causes as well as physical manifestations.

She sees one level of intervention research looking at overarching factors: at how society affects health and what kinds of social policies might improve things. The other level of intervention research focuses on smaller, more poignant issues: patients, and what can be done about the psychosocial aspects of their suffering.

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