Loneliness as a Downstream Concern in a Pandemic (and Post-Pandemic) World

While the implementation of physical distancing practices and renewed awareness of our ability to spread communicable diseases to one another were (and remain) important in mitigating the spread of infection, a downstream effect of the pandemic that is still not fully appreciated may be the long-term impact of these changes on mental health, specifically as a contributing factor to loneliness.1 Even as the world begins to emerge from the worst of the pandemic in terms of immediate danger to life and physical well-being, a full understanding of the overall impact of the last year on our mental health and wellness is just beginning. The negative effects of loneliness and social isolation are not limited to mental health issues, such as depression and anxiety, but also include physical maladies such as heart disease, stroke, type 2 diabetes, and even higher overall mortality.5-7 The risk of a person developing one or more of these illnesses because of loneliness is comparable to that incurred from other, more well-known factors such as smoking and obesity, and in many studies, loneliness has been shown to be independently associated with the outcome.8,9 Especially important for the pharmacy student population, young people (ages 18-30 years) and students are at greater risk of experiencing loneliness, both prior to and during the pandemic, with the incidence of loneliness higher in these groups than in other demographic populations.10 Cross-sectional studies of different age groups have shown that upwards of 60% of older adults have never reported feeling lonely, whereas the rates of severe loneliness among young adults range from 20%-48%.11 Researchers theorize that, because loneliness is the distress experienced when there is a discrepancy between the expected and perceived quantity and quality of an individual's social interactions, loneliness may not be as closely tied to social isolation in older adults who have more fully developed and mature brains as it is in adolescents and young adults.12 Former US Surgeon General Vivek Murthy's book, Together: The Healing Power ofConnection in a Sometimes Lonely World, published in April 2020, details his experience in learning about the wide-ranging effects of loneliness on mental as well as physical health and its pervasive and growing presence in society, even prior to the pandemic.13 As he traveled across the United States speaking to different groups about public health issues such as cancer, smoking, and opioid use disorder, Murthy was surprised at the numbers of people across demographic groups and geographic areas who discussed with him their struggles with loneliness and feeling alone. In addition to disenfranchised grief over the loss of normal life, there can be a natural tendency to compare our own plight to that of others and employ the idea that "things could be worse," an act known as comparative suffering}1 As discussed by author Brene Brown on her podcast Unlocking Us in the early stages of the pandemic, comparative suffering was a natural coping mechanism employed by many individuals in a noble attempt to encourage gratefulness both internally and externally.18 However well-intentioned, the challenge with comparative suffering over the long term is that it devalues and underappreciates the impact of our own emotions and suffering and buries or pushes them away to be dealt with at another time. Whether intentional or not, the message sent and received is that our feelings are wrong, causing some to even experience shame for feeling them. Because clinical loneliness can stem from the subjective experience of our social connections being inadequate to our needs, it is understandable how the pandemic and its aftermath may have set us up to experience loneliness.