Social connection remains an overlooked health factor, research shows

Research confirms that social isolation and loneliness significantly impact health and mortality, even if not listed on death certificates. BYU psychology and neuroscience professor, Julianne Holt-Lunstad, has published extensively on the topic, including a landmark 2010 meta-analysis and a 2023 framework on assessment and treatment. She also served as lead scientist on the 2023 Surgeon General Advisory and is advising the World Health Organization on an upcoming report that addresses the pressing health threat of loneliness and isolation and a global agenda on social connection.

Social connection is now a legitimate health factor, but Holt-Lunstad and doctoral student, Andrew Proctor, recently published two studies showing that most of us-the general population and medical providers-still don't think social connection affects physical health. And even the professionals who recognize the importance report that they don't have time or tools to help patients address social concerns.

Proctor, who authored a study recently published in Springer Nature, explained that before the study, they had been watching how the pandemic was influencing internet searches around the topics of isolation and loneliness.

"I have a marketing background, so I thought that maybe the public perception had changed since COVID. Social distancing, isolation and loneliness were huge buzzwords on the internet as seen through Google Trends and BuzzSumo (an online trend analyzer). Everything around these search terms was super viral during that time, and so we wondered if perceptions about social connection had changed," said Proctor.

With loneliness and isolation trending on the internet, the researchers set up a study. In a nationally representative sample of US adults, as well as samples from the UK and Australia, they surveyed 2,392 people about their perceptions of health risks associated with isolation and loneliness. The data showed that, despite the pandemic and other campaigns, people still underestimate the importance of social connection for physical health. And the underestimation exists equally among the lonely and the socially connected.

The study identified blind spots in medical care. Social connection is like a vital sign. What if we didn't care about high blood pressure? Or what if we never knew smoking was bad for us? Social connection is like a key vital sign. We just don't tend to recognize it."

Andrew Proctor, doctoral student, Brigham Young University

In a closely connected study, Holt-Lunstad and Proctor, along with coauthors from top research medical centers, surveyed 681 healthcare providers (primarily doctors) about perceptions of health risks associated with poor social connection. Similar to the general population from the first study, healthcare providers underestimated social connection as a medically relevant health factor.

The researchers gleaned some unexpected insights due to an unintentional time lag in data collection in the second study.

"We completed the data collection at two different time points because we were waiting for institutional approvals. Our first cohort was healthcare providers through the University of Utah Health System. Slightly later, we had a second major cohort of University of California San Francisco (UCSF) physicians," said Holt-Lunstad. "What was interesting is that the perceived importance of social factors was a bit higher among the UCSF group."

The authors attribute the higher awareness at UCSF to the University's Social Interventions Research and Evaluation Network as well as the publication of the 2023 Surgeon General's Advisory, which came out just before the second cohort was surveyed. This suggests that social initiatives as well as institutional support make a difference in the perceived importance of social connection.

"What I hope is that these studies can spur recognition that there is a body of evidence showing social connection as medically relevant," said Holt-Lunstad. "Together these papers make a really compelling case that not only does the general public underestimate this, but so do healthcare providers who should know this information."

"Awareness can make a difference," says Holt-Lunstad. "It's the first step, but awareness isn't enough."

The research brings to light the need for education and strategies for healthcare providers as well as the need for a revised K-12 healthcare curriculum and public health campaigns. Future research includes how to address perceived barriers to integrated medical treatment and actionable strategies such as "social prescribing."