The prevalence of loneliness across 113 countries: systematic review and meta-analysis
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-067068 (Published 09 February 2022) Cite this as: BMJ 2022;376:e067068Linked Editorial
We need a public health approach to loneliness
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Dear Editor,
The systematic review on the prevalence of loneliness by Surklim et al frames loneliness not only as an individual feeling, but as a social and public health issue, whose management remains currently unanswered.
As for patients, one of the determinants of loneliness is the mismatch between what they really need and what researchers investigate (1).
Dr. Cagliano's reference to Alessandro Liberati (2) is appropriate: whenever we respond to our patients’ questions with low quality studies, we do not help them to make a decision, and much less an informed decision; this way, people are abandoned to the loneliness of the absence of answers or, even worse, to the uncertainty arising from answers of little value and no help.
Earlier as a researcher and later as a patient, Alessandro knew that the primary goal of scientific research should be to provide useful answers to people, and not to ease academic curricula or commercial profits (3); he also knew that these answers should try to define those complex entities that escape measurement - but are not less important to patients - such as loneliness.
During last week’s meeting at the Italian Ministry of Health in Rome, that was meant to remember Alessandro's contribution to health research, we realized, once again, that Alessandro used to ask himself crucial questions, but he did not leave us alone and without answers. Even when we feel the loneliness of his absence, his values continue to be close to us: the path he traced and that the Association Alessandro Liberati is trying to carry forward is clear.
We’re not alone, but standing on the shoulders of a giant.
References
1) Liberati A. Need to realign patient-oriented and commercial and academic research. Lancet 2011;378:1777-8.
2) Cagliano S. Rapid Response to “The prevalence of loneliness across 113 countries: systematic review and meta-analysis”. BMJ Rapid Response, 13 February 2022.
3) Liberati A. An unfinished trip through uncertainties. BMJ, 2004;328(7438):531.
Competing interests: No competing interests
Dear Editor
Reading The BMJ always gives cause for reflection. The systematic review by Surkalim et al. explains that loneliness is not a trivial matter (1). Loneliness has no market and affects many people. The paper also tells us that we are not alone and that the research work of those who preceded us continues to support us. In fact, the article makes us also reflect on the importance of the work of some charismatic researchers. Among the references, the one co-signed in 2009 by Alessandro Liberati, David Moher, Jennifer Tetzlaff, and Doug Altman for the PRISMA Group helps us remember two giants of research methodology : Doug Altman and Alessandro Liberati. Paul Glasziou (Bond University, Australia), Giuseppe Ippolito (chair of Research, Italian Ministry of Health), Marina Davoli (Alcohol and Drug Cochrane Group) contributed to a conference held in Rome, Italy, on 11 February at the Ministry of Health to celebrate Alessandro Liberati ten years after his death.
In conclusion, this attention testifies how the work of some great researchers is never lost and this too can help alleviate our loneliness..
References
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009;339:b2535.
Competing interests: No competing interests
Dear Editor,
It's paradoxical, but in the world of social networks we are increasingly more alone. It's an epidemic in Western society, and if loneliness is combined with the pain of an incurable disease and advanced age, the trauma can become very difficult (1).
Most people seeking assisted suicide and euthanasia suffer from depression or other mental illnesses, physical illness, or simply loneliness.
Canada's 2020 MAID report (2) found almost 1412 people (18.6%) died because of loneliness and isolation .
In Belgium 2016 and 2017 (3):
• 77 people suffering from mental health issues; and
• 173 people with no physical suffering but afflicted by conditions such as addiction, loneliness and despair were euthanised.
Researchers at The Irish Longitudinal Study on Ageing (TILDA) (4) in Trinity College Dublin propose that an enhanced focus on improving access to mental health care is needed. Addressing social isolation in older people should therefore be a public health priority. This is particularly pertinent in the context of the research article " The prevalence of loneliness across 113 countries: systematic review and meta-analysis".
Public discussion often treats loneliness as a kind of medical condition or disorder.
Medicalised discourse barely touches on the real social determinants of health conditions and vulnerabilities of the aged, those who are vulnerable and those at a vulnerable time in their lives.
This ignores the root of many societal problems.
"In The Loneliness of the Dying, the sociologist Norbert Elias argues that in contemporary society, older persons are “pushed more and more behind the scenes of social life,” a process that intensifies their devaluation, emotional seclusion, and loss of social significance. A physical and institutional sequestering and a pervasive cultural tendency to “conceal the irrevocable finitude of human existence” have made it harder for them and those around them to relate to, understand, and interact with one another. The aged and dying are less likely to receive the help and affection they need, and they are more prone to different forms of loneliness and painful feelings of irrelevance. “Never before,” Elias writes, “have people died as noiselessly and hygienically as today in [more developed] societies, and never in social conditions so much fostering solitude " (5).
Will euthanasia and assisted suicide be offered as the societal response to devaluation, emotional seclusion, and loss of social significance experienced by our fellow human beings who experience loneliness?
Will help and human affection be replaced by the offer of planned death?
Is this a civilised response?
Yours,
Bernadette Flood PhD MPSI
.
References:
1. https://www.romereports.com/en/2018/03/04/vatican-the-issue-with-euthana...
2. https://www.canada.ca/en/health-canada/services/medical-assistance-dying...
3. https://organesdeconcertation.sante.belglque.be/sltes/defau1Ufiles/docum...
4. https://academic.oup.com/ageing/article/50/4/1321/6133225
5.https://www.psychologytoday.com/us/blog/our-new-discontents/202111/the-e...
Competing interests: No competing interests
Re-emphasizing the strengths and limitations of this study. Re: The prevalence of loneliness across 113 countries: systematic review and meta-analysis
Dear Editor,
I would like to re-emphasize the strengths and limitations of this study.
Strengths of this study:
1) Comprehensive approach: The study utilized a systematic review and meta-analysis, including data from 113 countries or territories, to provide a comprehensive understanding of the global prevalence of loneliness. It focused on nationally representative samples and validated instruments, enhancing the validity and generalizability of the findings.
2) Awareness of data gaps: The study acknowledges the limited data availability in low and middle income countries and highlights the importance of addressing these gaps for equitable representation. It emphasizes the need for ongoing surveillance efforts to monitor trends and inform policy decisions.
3) Transparent assessment of limitations: The study openly discusses the limitations associated with heterogeneity in study design, sampling procedures, and measurement instruments. It provides a clear understanding of the challenges in comparing prevalence estimates and emphasizes the need for standardized and validated instruments in future research.
Limitations of this study:
1) Heterogeneity in study design and measurement: The study acknowledges that despite attempts to maximize comparability, there was still considerable heterogeneity within and across regions due to differences in study design, sampling procedures, and measurement instruments. This may limit the generalizability and interpretability of the pooled estimates.
2) Limited temporal trends analysis: The study highlights the lack of repeated measurements, which limits the conclusions about temporal trends in loneliness prevalence. The data mainly cover the period from 2000 to 2019, and the impact of the COVID-19 pandemic on loneliness is not explicitly examined.
3) Potential reporting biases: Different interpretations and operationalization of loneliness across countries may lead to differential reporting biases. Additionally, the lack of co-design elements with the intended communities and potential limitations in cross-cultural adaptations of the measurement instruments could affect the validity and comparability of the data.
4) Age group and geographical coverage limitations: The study acknowledges the differences in age groups and survey time frames across studies, which may introduce complications and limit comparability. Geographically, the study primarily focuses on Europe, with limited data coverage in other regions, particularly low and middle income countries.
Overall, while the study provides valuable insights into the global prevalence of loneliness, its strengths lie in its comprehensive approach and awareness of data gaps. However, limitations in study design, heterogeneity, limited temporal analysis, potential reporting biases, and geographical and age group limitations should be considered when interpreting the findings. Future research should aim to address these limitations and improve comparability and standardization in loneliness measurement.
Competing interests: No competing interests