Loneliness in Primary Care Patients: A Prevalence Study

Rebecca A. Mullen, MD, MPH; Sebastian Tong, MD, MPH; Roy T. Sabo, PhD; Winston R. Liaw, MD, MPH; John Marshall; Donald E. Nease Jr, MD; Alex H. Krist, MD, MPH; John J. Frey III, MD

Disclosures

Ann Fam Med. 2019;17(2):108-115. 

In This Article

Abstract and Introduction

Abstract

Purpose: Loneliness has important health consequences. Little is known, however, about loneliness in primary care patient populations. This study describes the prevalence of loneliness in patients presenting for primary care and associations with self-reported demographic factors, health care utilization, and health-related quality of life.

Methods: We conducted cross-sectional surveys of adults presenting for routine care to outpatient primary care practices in 2 diverse practice-based research networks. The 3-item University of California, Los Angeles Loneliness Scale was utilized to determine loneliness.

Results: The prevalence of loneliness was 20% (246/1,235). Loneliness prevalence was inversely associated with age (P <.01) and less likely in those who were married (P<.01) or employed (P <.01). Loneliness was more common in those with lower health status (P <.01), including when adjusting for employment and relationship status (odds ratio [OR] = 1.05; 95% CI, 1.03–1.07). Primary care visits (OR = 1.07; 95% CI, 1.03–1.10), urgent care/emergency department visits (OR = 1.24; 95% CI, 1.12–1.38), and hospitalizations (OR = 1.15; 95% CI, 1.01–1.31) were associated with loneliness status. There was no significant difference in rates of loneliness between sexes (P = .08), racial categories (P = .57), or rural and urban respondents (P = .42).

Conclusions: Our findings demonstrate that loneliness is common in primary care patients and is associated with adverse health consequences including poorer health status and greater health care utilization. Further work is needed to understand the value of screening for and using interventions to treat loneliness in primary care.

Introduction

Loneliness, defined as the internal perception of inadequacy of personal relationships,[1]has detrimental effects on health and is increasingly acknowledged as a public health crisis. The prevalence of loneliness is recognized to be high, and reports range from 7%[2] to 49%[3] depending on the country of origin, measurements used, age range, and subpopulations queried. In the United States, it has been reported that over one-third of the general population aged over 45 years may experience loneliness.[4]

Loneliness is connected to poor physical and mental health outcomes, including increased risk of hypertension,[5] cardiovascular disease and stroke,[6,7] depression,[8] cognitive decline and Alzheimer's disease,[9] and all-causes of mortality.[10] In fact, loneliness may be as deleterious as smoking 15 cigarettes per day.[6] While much of the literature and popular belief has focused on the relationship between loneliness and the elderly,[11] increasing attention is being paid to the patterns of social relationships that begin earlier in life and persist throughout a lifetime.[12,13] Given the identified health threats, policy makers have called for research on loneliness in diverse settings, increased consideration from the health care community, and novel interventions.[14,15]

While studies contribute to our understanding of the reach of loneliness, less is known about the appropriate clinical response, particularly with respect to primary care. In 2014, the National Academy of Medicine called for clinicians to regularly collect information on social connections and social isolation recognizing the negative implications on quality of life and health.[16] Few clinicians, however, have begun collecting these data. While valid scales for measuring loneliness exist,[17] they are not regularly used in primary care practices. Moreover, the role of primary care in treatingloneliness remains unclear.

Therefore, if the goal is to address loneliness within primary care, it is essential to understand the characteristics and behaviors of lonely individuals in this setting. This study describes the prevalence of loneliness in adults presenting to outpatient primary care practices for routine care and examines associations between loneliness and self-reported demographic factors, health status, and health care utilization.

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