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

Results

From 16 practices, 1,246 patients completed the survey, with 1,235 patients responding to the loneliness items on the questionnaire. The mean age of study respondents was 52 years (SD = 16.5). The majority of respondents were female (63%), white (71%), and lived in an urban setting (77%). About one-half were married (54%) and employed full time (45%). Colorado and Virginia populations were significantly different across every demographic category (Table 1).

Loneliness Prevalence

The overall prevalence of loneliness was 20% (246/1,235). The prevalence varied between states, with 22% of patients from Virginia reporting loneliness compared with 17% of patients from Colorado (P = .04). The mean score on the 3-item UCLA Loneliness Scale was 4.2 (SD = 1.6), with about one-third of respondents "sometimes" or "often" feeling lack of companionship, left out, or isolated from others (Figure 1). The prevalence of loneliness generally decreased with age, as 33% (18/58) of respondents aged <25 years reported loneliness compared with 11% (34/307) of those aged >65 years (P <.01). Similarly, the mean loneliness score linearly declined from 4.7 (standard error [SE] = 0.16) at age 18 years to 2.9 (SE = 0.75) at age 80 years (P = .03) (Figure 2).

Figure 1.

Percentage of responses to the 3-item UCLA Loneliness Scale (N = 1,235).
UCLA = University of California, Los Angeles.

Figure 2.

Predicted loneliness score vs age (18-<90 y) (N = 1,235).
Note: The black line illustrates a linear decrease in loneliness scores with increasing age and the gray area represents the 95% CI.

Loneliness and Demographics

As illustrated in Figure 3, loneliness was significantly associated with relationship status and employment status. Divorced, separated, widowed, and never been married respondents illustrated a significantly higher prevalence of loneliness (P <.01). Additionally, individuals who were unemployed or disabled experienced significantly higher levels of loneliness (P <.01). There was not a significant association between race/ethnicity (P = .57) or respondent sex (P = .08) and loneliness score. Finally, there was no significant association between location and loneliness scores (P = .42), with the loneliness prevalence similar in rural (17%) and urban areas (21%).

Figure 3.

Unadjusted odds ratios for participant characteristics and loneliness (N = 1,246).
Note: Forest plot of the unadjusted odds ratio (black circles) and 95% CI (horizontal lines).

Loneliness, Quality of Life, and Utilization

Loneliness classifications were significantly associated with respondent health classification and health status. Respondents in poor health were more likely to report loneliness (P <.01). As illustrated in Figure 3, there was an inverse relationship with loneliness and respondent health status, from poor to excellent health (P <.01). There was also a significant association between the number of days with poor physical or mental health in the prior month and loneliness (P <.01) (Table 2). This association remained significant when adjusting for all patient characteristics (OR = 1.04; 95% CI, 1.02–1.06) or employment and relationship status (OR = 1.05; 95% CI, 1.03–1.07). A high level of loneliness was positively associated with all 3 utilization measures, including the number of visits to the primary care office, the number of hospitalizations, and the number of emergency department or urgent care visits (Table 2). When adjusting for employment and relationship status, the association of loneliness with primary care visits or emergency department/urgent care visits remained significant (Table 2).

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