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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:e067068- Daniel L Surkalim, doctoral student12,
- Mengyun Luo, doctoral student12,
- Robert Eres, postdoctoral research fellow34,
- Klaus Gebel, senior lecturer5,
- Joseph van Buskirk, research fellow1,
- Adrian Bauman, emeritus professor12,
- Ding Ding, associate professor12
- Correspondence to: D Ding melody.ding@sydney.edu.au
- Accepted 15 December 2021
Abstract
Objectives To identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine temporal trends of loneliness in countries where data exist.
Design Systematic review and meta-analysis.
Data sources Embase, Medline, PsycINFO, and Scopus for peer reviewed literature, and Google Scholar and Open Grey for grey literature, supplemented by backward reference searching (to 1 September 2021)
Eligibility criteria for selecting studies Observational studies based on nationally representative samples (n≥292), validated instruments, and prevalence data for 2000-19. Two researchers independently extracted data and assessed the risk of bias using the Joanna Briggs Institute checklist. Random effects meta-analysis was conducted in the subset of studies with relatively homogeneous research methods by measurement instrument, age group, and WHO region.
Results Prevalence data were available for 113 countries or territories, according to official WHO nomenclature for regions, from 57 studies. Data were available for adolescents (12-17 years) in 77 countries or territories, young adults (18-29 years) in 30 countries, middle aged adults (30-59 years) in 32 countries, and older adults (≥60 years) in 40 countries. Data for all age groups except adolescents were lacking outside of Europe. Overall, 212 estimates for 106 countries from 24 studies were included in meta-analyses. The pooled prevalence of loneliness for adolescents ranged from 9.2% (95% confidence interval 6.8% to 12.4%) in South-East Asia to 14.4% (12.2% to 17.1%) in the Eastern Mediterranean region. For adults, meta-analysis was conducted for the European region only, and a consistent geographical pattern was shown for all adult age groups. The lowest prevalence of loneliness was consistently observed in northern European countries (2.9%, 1.8% to 4.5% for young adults; 2.7%, 2.4% to 3.0% for middle aged adults; and 5.2%, 4.2% to 6.5% for older adults) and the highest in eastern European countries (7.5%, 5.9% to 9.4% for young adults; 9.6%, 7.7% to 12.0% for middle aged adults; and 21.3%, 18.7% to 24.2% for older adults).
Conclusion Problematic levels of loneliness are experienced by a substantial proportion of the population in many countries. The substantial difference in data coverage between high income countries (particularly Europe) and low and middle income countries raised an important equity issue. Evidence on the temporal trends of loneliness is insufficient. The findings of this meta-analysis are limited by data scarcity and methodological heterogeneity. Loneliness should be incorporated into general health surveillance with broader geographical and age coverage, using standardised and validated measurement tools.
Systematic review registration PROSPERO CRD42019131448.
Introduction
Humans thrive on meaningful social connections. Feelings of loneliness set in when a discrepancy exists between one’s desired and one’s actual level of social relationships.1 Loneliness is a negative, subjective experience2 closely linked to the quality of social connections.3 Loneliness is similar to, but distinct from, social isolation, which is defined as a lack of social contacts, and being alone, characterised as being physically removed from social connections.4 Transient loneliness is a common experience,5 but chronic or severe loneliness pose threats to health and wellbeing.
Growing evidence has linked loneliness to various adverse health outcomes. Loneliness is associated with unfavourable cardiovascular health indicators, such as increased activation of the hypothalamic-pituitary-adrenal axis,6 high blood pressure, increased cholesterol levels,27 and coronary heart disease.8 Loneliness is associated with sleep disturbance9 and increased risk of mild cognitive impairment and dementia.10 Loneliness may also be detrimental to behavioural, mental, and social health throughout the lifespan,2 influencing outcomes such as substance misuse, suicidal ideation,11 anxiety, depression,12 and poor subjective wellbeing.7 According to a 2015 meta-analysis, people with chronic loneliness had a 26% increased risk of mortality.13 This increased risk is comparable to established risk factors such as physical inactivity14 and grade 1 obesity.15
Culture affects levels of loneliness.16 Individualism-collectivism has been long considered an important cultural determinant of loneliness.17 A recent conceptual model
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