Experts said that the frequency and quality of social relationships have a greater effect on mortality than obesity or drinking alcohol, and this commands attention from health systems.
From the moment a child is born, the opportunity to bond, first with its mother and later with friends or a partner, can make or break its mental health, its metabolic and cardiovascular condition, and even determine the length of life. That's what a pair of psychiatrists shared Sunday at the 30th US Psychiatric and Mental Health Congress in New Orleans, Louisiana.
Isolation is becoming more common, but from the perspective of evolution, it’s not normal, said Vladimir Maletic, MD, MS, clinical professor of psychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, South Carolina. He presented, “Love is a Drug: Clinical Relevance of Early-Life Adversity and Relationship Disturbances,” with Bernadette DeMuri, MD, clinical assistant professor of psychiatry at the Medical College of Wisconsin in Milwaukee, Wisconsin.
“Being in a group is safe,” Maletic said, while being alone is dangerous, so those who are lonely respond with higher stress activity and increased hypertension. The brain responds in a way that precisely resembles depression; there’s increased inflammation and reduced neuroplasticity, so antidepressants are less effective.
Early trauma, especially when a child experiences the loss or rejection of a mother, has lifetime effects. The same biological response that helps the child survive the trauma wreaks havoc decades later, Maletic explained.
“We need sugar in the blood stream to respond quickly, so our brain, our heart, and our muscles will be ready to react,” he said. “If we didn’t have inflammatory response, people would have died of infection. Unfortunately, these same mechanisms that in the short term are life-saving in the long term cause us to develop depression or anxiety disorders. That is the trade-off with Mother Nature.”
DeMuri explained there’s a “dose response,” a relationship between the number of traumatic events a child experiences, and the level of inflammation. Studies show that the effects of early trauma are lasting, not only on mental health, but on physical health as well.
Events can cause autoimmune diseases to show up in the third to fifth decade of life, she said. DeMuri reviewed a study that showed a relationship between the number of adverse events in a child’s life and reduced telomere length, which is linked to a shorter life span. It was estimated that childhood trauma shortened the life span by 7 to 12 years.1
Loneliness. So powerful is the effect of loneliness on health, Maletic said, that it dwarfs the impact of well-known risk factors that public health officials scrutinize every day.
“If you had a patient that was a smoker, would you recommend that they stop smoking? If they are drinking 6 drinks a day, would you say it’s probably a good time to do something about it? If they have obesity, you may be concerned for their overall health,” Maletic said. “In terms of the impact on overall mortality, social relationships—evaluated in terms of frequency of social contacts and quality of social contacts—have a greater impact on mortality."
“If you’re concerned about a [body mass index] of 30, loneliness has double the impact. It has triple the impact as going from 6 drinks to zero drinks. It has a greater impact on mortality than if somebody has a heart attack and they have no cardiac rehab,” he said. “This is not something that we can afford to miss.”
A study of women with heart disease with 19 years of follow-up found the women with higher levels of loneliness had 76% more events.2 Other studies they presented showed loneliness associated with higher cortisol levels3 and greater levels of amyloid plaque4; conversely, having 4 to 5 friends reduced the risk of metabolic disturbance.5
“This is hard science,” Maletic said. “This is not fluffy stuff. Relationships are really important.”
At least one health plan is tackling this problem head on. CareMore, a division of Anthem, earlier this year announced an initiative to combat loneliness among seniors, which included the appointment of a Chief Togtherness Officer.
With the knowledge that the inflammation loneliness brings can make medications less effective, what can physicians do? DeMuri said when physicians prescribe atypical antipsychotics, they frequently discuss the need for healthy diets and exercise with their patients, but “we also need to be educating them about the importance of social connectedness.”
Volunteering “had the greatest impact,” DeMuri said. She recommends having patients research a few projects that interest them and pick one. However they get there, the evidence shows having 4 to 5 friends is the “magic number.”
1. Kiecolt-Glaser JK, Gouin JP, Weng NP, Malarkey WB, Beversdorf DQ, Glaser R. Childhood adversity heightens the impact of later-life caregiving stress on telomere length and inflammation. Psychosom Med. 2011;73(1);16-22.
2. Thurston RC, Kubzansky LD. Women, loneliness, and incident coronary heart disease. Psychosom Med. 2009;71(8):836-842.
3. Eisenberger NI, Taylor SE, Gable SL, Hilmert CJ, Leiberman MD. Neural pathways link social support to attenuated neuroendocrine stress responses. Neuroimage. 2007;35(4):1601-1612.
4. Donovan NJ, Okereke OI, Vannini P, et al. Associaton of higher cortical amyloid burden with loneliness in cognitively normal older adults. JAMA Psychiatry. 2016;73(12):1230-1237.