Topic Suggestion

1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?

Increasingly, loneliness/social isolation is being seen as both a reflection of and contributor to overall poor health and well-being. A recent study by the health plan Cigna reported half of Americans often reported feeling alone or left out.1 Younger persons were especially likely to be impacted. Those who were able to exercise regularly and obtain sufficient sleep tended to be less lonely.

The United Kingdom, for instance, recently appointed a Minister of Loneliness to help lead a cross-governmental effort to address these issues.2 The United Kingdom’s step followed a well-publicized report by a Loneliness Commission supported by such partners as the British Red Cross, the government aging agency, the Alzheimer’s Society and several other partners to evaluate how social isolation impacted health and well-being.3

Strong social connections have been correlated with reduced HIV viral load4; improved cancer survival5; reduced risk of Alzheimer’s disease and dementia6; improved cardiovascular health7 and reduced risk of substance use disorders8. Studies link loneliness in and of itself to increased mortality.9 Studies have shown but, to my knowledge, there has been no recent, thorough systematic review of how loneliness/social isolation impact physical and mental health, how to screen for social connectedness/social isolation and potential interventions in the health care sector to reduce loneliness.

Questions an AHRQ systematic review could examine could include:

• Who is primarily impacted by loneliness/social isolation? While it is clear that all groups can be impacted, are there disparities with respect to age, gender, rural/urban location, income and/or race and ethnicity? How are others such as Veterans, homeless persons, LGBT persons and those with disabilities impacted?
• How do physicians and other health care providers best screen for social connectedness and strong social ties? To what extent is such screening supported by the literature?
• How and to what extent does social connectedness promote health or recovery from behavioral health conditions, cardiovascular disease, cancer?
• What are some cost-effective, evidence-based interventions that can be implemented by local, federal and state governments, community organizations, health care providers, insurers and others to reduce loneliness and social isolation? A recent study in the United Kingdom, reportedly now being submitted for peer review, suggests a 'compassionate community' project aimed at building social relationships helped reduce hospital readmissions.10 What other studies, if any, of this nature have been conducted?

Citations

1. https://www.cigna.com/newsroom/news-releases/2018/new-cigna-study-reveals-loneliness-at-epidemic-levelsin-america
2. UK Appoints a Minister for Loneliness, New York Times, https://www.nytimes.com/2018/01/17/world/europe/uk-britain-loneliness.html
3. https://www.campaigntoendloneliness.org/about-the-campaign/; https://www.jocoxloneliness.org/; https://www.ageuk.org.uk/our-impact/campaigning/jo-cox-commission/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5571899/
5. https://www.cbsnews.com/news/loneliness-may-sabotage-breast-cancer-survival-study-finds/
6. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/482179; https://www.alzinfo.org/articles/feeling-lonely-increases-alzheimers-risk-2/
7. http://heart.bmj.com/content/early/2016/03/15/heartjnl-2015-309242
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295122/
9. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190033; http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4225959/
10. https://www.resurgence.org/magazine/article5039-compassionate-community-project.html
11. https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic
12. https://directorsblog.nih.gov/tag/social-isolation/
13. https://www.cdc.gov/healthyyouth/protective/school_connectedness.htm; https://www.samhsa.gov/safeschools-healthy-students
14. See e.g., https://www.psychiatry.org/news-room/apa-blogs/apa-blog/2017/01/loneliness-a-growing-healthconcern

2. Why are you struggling with this issue?

As noted above, the topic of social isolation/loneliness is important because it appears to directly and indirectly impact morbidity and mortality from a wide range of health conditions. Loneliness also is known to have substantial impact on performance in schools and in the workplace, as noted by former Surgeon General Vivek Murthy in the Harvard Business Review.11

3. What do you want to see changed? How will you know that your issue is improving or has been addressed?

4. When do you need the evidence report?

Not applicable.

5. What will you do with the evidence report?

An evidence review could encourage screening for social connectedness, if warranted, and consideration of interventions to improve social relationships and, potentially, health outcomes.

The information from an AHRQ report could be used as the basis for additional studies or programs within the health sector and by government agencies, particularly if effective, evidence-based interventions and screening strategies can be identified in a review.

I cannot speak for any organization. However, based on the United Kingdom's efforts and the correlation of social isolation with many diseases and health conditions, a wide range of agencies and associations could be interested in this type of report. Such partners could include agencies working on physical and mental health interventions such as CDC, SAMHSA and NIH or the Department of Education. NIH, for instance, has funded research on social media and loneliness.12 CDC and SAMHSA have supported programs to build school connectedness.13 Health care associations such as the American Psychiatric Association, American Medical Association and American Psychological Association also may have interest.14 Organizations and associations working with youth, older adults and persons with such conditions as HIV, cancer and cardiovascular disease also may have strong interest in approaches to enhance social connectedness and health outcomes for those they serve. Health insurers such as Cigna and employers also may have some interest.