Is America in the middle of a loneliness epidemic?

Claims of rising loneliness are often part of a larger narrative about fraying social bonds in America. In this framing, loneliness is seen as one symptom among many of a larger set of problems. The Centers for Disease Control and Prevention (CDC) recently reported that between 1999 and 2016, the most recent year for which data are available, suicide rates had increased by almost 30 percent,¹ and some states, such as New Hampshire, Vermont, and Utah, saw their rates increase by over 45 percent. Stories about the perpetually-plugged-in-but-socially-disconnected teen draw wide attention.² Moreover, there is an emerging consensus in the research community that chronic loneliness has a number of negative consequences.³ Some scholars have even recently advanced the argument that it should be a public policy priority.⁴

The worry that loneliness is on the rise in America routinely surfaces in national media. Vivek Murthy, former U.S. Surgeon General, has argued as much across numerous articles, interviews, and television and radio appearances. For example, in the Harvard Business Review he stated: "Loneliness is a growing health epidemic. We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s. Additionally, the number of people who report having a close confidante in their lives has been declining over the past few decades."

In a speech across the Atlantic previewing the report of the 2017 Jo Cox Commission on Loneliness, Rachel Reeves MP noted that "[i]n the last few decades loneliness has escalated from personal misfortune into a social epidemic." In part spurred on by that report, British Prime Minister Theresa May considered it so important that she initiated a variety of efforts to better understand and address the problem, including appointing an under secretary to coordinate those efforts across the government (which was often reported as May's appointment of a "Minister of Loneliness").

Despite claims of a new crisis, one can find similar concern with the problem of loneliness going back many decades in bestselling books, major newspapers, magazines, and television programs. The 1950s brought us The Lonely Crowd: A Study of the Changing American Character, a bestseller; the 1970s brought us The Pursuit of Loneliness: American Culture at the Breaking Point, also a bestseller.⁵ Our rising concern with loneliness appears to extend even further back in time. Although it is certainly an imperfect measure, Google's Ngram Viewer shows below that the word "loneliness" appeared infrequently in books until the early 19th century, when it steadily increased in relative frequency to the late 1960s, shooting way up until the early 1980s, then declining roughly to levels that prevailed between the 1930s and 1960s. Whatever the status of our actual loneliness, we certainly seem preoccupied with it.

What is loneliness and how is it measured?

Defining loneliness is more subtle than it might appear.

The late University of Chicago psychologist John Cacioppo and his co-author Louise Hawkley defined it as "perceived social isolation."⁷ Another slightly more elaborated definition is that loneliness is "the distressing feeling that accompanies discrepancies between one's desired and actual social relationships."⁸

One challenge in studying loneliness is that researchers span multiple disciplines—particularly psychology and sociology—and often rely on different measures of related but distinct phenomena.⁹ As sociologists Erin York Cornwell and Linda J. Waite note, "the relative contributions of subjective aspects of isolation, such as loneliness and perceived support, are rarely considered alongside social disconnectedness and social inactivity."¹⁰ Many people wrongly assume that having relatively few social contacts or infrequent social interaction is strongly related to loneliness (or, conversely, that those with many social contacts and interactions are not lonely), but research on loneliness does not support that view. Many people who have few social contacts and are often alone are not lonely, and many people who have a large number of social contacts and interactions can be subjectively lonely.¹¹ Further, individuals differ a great deal in their propensity to feel lonely.¹²

Loneliness has been measured in a wide variety of ways, from single-item measures to lengthier scales. Since the 1970s, a variety of instruments have been developed to study individual differences in loneliness, but by far the most commonly used is the UCLA Loneliness Scale—first introduced in 1978, revised in 1980, and revised again in 1996; this last version is widely used today.¹³ It is a set of 20 questions about how often (and how intensely) the respondent experiences various aspects of loneliness (e.g. "How often do you feel that there is no one you can turn to?", "How often do you feel isolated from others?", and "How often do you feel that you have a lot in common with the people around you?").

Although there is some disagreement about how many different underlying constructs this scale measures, a factor analysis in the latest published revision indicated that it was plausibly measuring a single underlying factor. Importantly, researchers have found across multiple studies that scores on the UCLA Loneliness Scale showed relatively low correlations with objective features of social networks (e.g. number of various kinds of relationships or quantity of interactions), indicating that their measure was not simply redundant with those relationship characteristics.¹⁴

Is loneliness increasing?

There are a few different but related questions that tend to get lumped into one general story about whether loneliness is on the rise in America, in part because of a lack of good data, and occasionally because of a failure to distinguish the two often distinct lines of psychological and sociological research.

One question is whether Americans are increasingly alone (that is, have fewer social contacts, or have less social interaction). This question, which sociologists tend to study, is about objectively observable social networks or relationship characteristics. It is distinguishable from the second question, regarding the subjective experience of loneliness. This latter question—whether Americans are increasingly experiencing loneliness ("perceived social isolation")—has typically been the research purview of psychologists.

Correlations are lower than we might expect between the most common measures of loneliness and objective measures of social network characteristics, so these two questions are substantially though not wholly distinct from each other.¹⁵

From reading the headlines, one would certainly get the impression that loneliness is increasing. The health insurer Cigna recently released the results of a survey on loneliness—making use of the UCLA Loneliness Scale—that "was created to focus the national conversation on the epidemic."¹⁶ National media covered the survey as such. For example, Washington, D.C.'s National Public Radio station WAMU described an hour-long program on the topic as "The Universal Solitude of Americans: Loneliness on the Rise,"¹⁷ despite the fact that the survey had not shown an increase in loneliness. Late last year, Former Surgeon General Vivek Murthy stated in an article that "[l]oneliness is a growing health epidemic. We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s."¹⁸

However, it is not at all clear that loneliness has increased over the last several decades.

In his 2011 book, Still Connected: Family and Friends in America Since 1970, sociologist Claude Fischer puts a fine point on this question: "For all the interest in loneliness, there appears to be little national survey data that would permit us to draw trends."¹⁹

We looked for the strongest support for the claim that loneliness has risen, and the best we could find comes from polls by FGI. Between 1994 and 2004, the FGI polls indicate that the share of adults saying loneliness was a problem for them rose from roughly 25 percent to 30 percent. It is unclear, however, whether this five-point difference reflects a real shift or arises from chance differences in the people sampled in each year or in survey administration.

The remaining evidence suggests flat trends. In 1985 and 2000, Harris polls found that respondents' experience of loneliness in the past month did not rise over the period, remaining under twenty percent in both years. In 1981 and 1990, Gallup polls showed that rates of loneliness held roughly steady, with 18 to 20 percent of adults indicating they felt "lonely or remote from other people" the past few weeks. Between 1963 and 2001, NORC surveys show a slight decline in reported feelings of loneliness, from 28 to 25 percent.

In interpreting these data, two caveats are in order. First, it is unwise to assess trends using data points from different polling organizations, which have their own distinctive methods. Any comparison between the NORC results and those from Gallup should be used with significant caution.

Second, as Claude Fischer notes, the NORC polls may have been affected by salient current events. The 1963 NORC poll was conducted just after John F. Kennedy's assassination; the 2001 NORC poll shortly after 9/11. These events might bias the percentages (showing temporarily higher or lower rates of loneliness). However, responses to the same question in a 1965 NORC poll also fell in the same 25- to 28-percent range.

These estimates are hardly conclusive evidence that loneliness has been mostly stable since the early 1960s, but they cast significant doubt on the claim that it has risen significantly.

Why, then, all the assertions that loneliness has increased and now constitutes an epidemic? Across a number of interviews and popular articles, the claim that loneliness has doubled since the 1980s is common but hard to pin down. Just one of many examples is this 2016 New York Times article, which states that "[s]ince the 1980s, the percentage of American adults who say they're lonely has doubled from 20 percent to 40 percent."²⁰ The piece links to another article in Slate.com.²¹ The Slate article, in turn, cites "two recent surveys" and links to a frequently cited AARP survey on loneliness conducted in 2010.²² We suspect the second referenced survey is a 2012 analysis of data from the Health and Retirement Study (HRS).

Neither survey supports the claim that loneliness doubled between the 1980s and today. First, the AARP's 2010 survey was limited to adults age 45 and older, not adults generally. It defined as "lonely" anyone who scored 44 or higher on the UCLA scale. About 35 percent of respondents were lonely under this cutoff, not 40 percent.²³ (It is unclear why so many media accounts have cited the 40 percent figure when describing the results of this survey.) The survey report itself does not mention past levels of loneliness, but an article written for the official AARP magazine summarized some of the results of the survey and mentioned that 20 percent were found lonely "in a similar survey a decade ago."²⁴

That "similar survey" is elusive.²⁵ It could refer to the 2000 Harris poll question that asked respondents whether or not "being lonely" "affected you in the last month." That percentage was slightly below 20 percent, but it is completely incomparable to the AARP results using the 20-question UCLA scale. The question from the 2001 NORC survey neither produces a figure of 20 percent nor is comparable to the AARP study. Both results are from the general population of adults, not older adults.

The second survey that Slate cites but does not link to is, we believe, a longitudinal survey whose results were published in 2012, one year prior to the Slate article.²⁶ That study relied on data from the Health and Retirement Study to examine loneliness in subjects older than 60.²⁷ The study defined "loneliness" as reporting 1 of 3 loneliness items "at least some of the time" and found that about 43 percent of the subjects were lonely.

Again, it is unwise to directly compare this figure to the one found by the AARP, not least of which because AARP's loneliness measure is based on a 20-item, 80-point UCLA Loneliness Scale, and with a different researcher-defined cutoff point for who is "lonely." A less imperfect figure to compare to the AARP's might be of HRS respondents who "reported feeling 2 or 3 of these symptoms at least some of the time." This comparison yields a much lower 22 percent, and is more closely aligned to the share found lonely by the AARP using the full 20-item scale for those of similar age ranges (25 percent among those 70 or older and 32 percent for those age 60-69). Coincidentally, that figure is also close to the 20 percent AARP mysteriously cites from "a decade ago."

As for the "1980s" loneliness figure, we are not sure where it came from; there are a number of possibilities cited by Fischer: the two 1981 Gallup polls, the 1985 Harris poll, a 1982 ABC News/Washington Post poll, and a 1982 World Values Survey poll.²⁸ What we do know is that none of these polls of the general population of adults is comparable to the AARP or HRS estimates for older adults (which use different measures of loneliness).

It is possible that earlier estimates of loneliness prevalence were even lower. Psychologist John Cacioppo indicated in a 2016 interview that those "who responded that they regularly or frequently felt lonely was between 11% and 20% in the 1970s and 1980s [the percentage varied depending on the study]." The upper bound he referred to is probably from one of the early 1980s survey results. The lower bound was somewhat harder to track down, and it is unclear if we located the correct source. In a 2015 paper, Cacioppo and colleagues cited an earlier book chapter from the 1970s that showed the "prevalence estimated to be 11%-17%."²⁹ That chapter, in turn, cites only two figures on the prevalence of loneliness, both from the 1960s.³⁰ One is based on a national survey conducted by the National Opinion Research Center in 1965 whose results are reported in a 1969 book by Norman Bradburn, which found that 26 percent of a national sample of 21- to 59-year-olds reported being "very lonely or remote from other people" in the last few weeks (also cited by Fischer).³¹ The second figure cited came from a 1969 study in which respondents in a national sample were asked the same question, but given a timeframe of only one week; 11 percent answered in the affirmative.³²

In short, the claim that loneliness has doubled since the 1980s is difficult to substantiate. The polling questions from around 2000, from the early 1980s, and from the 1960s are all quite different from each other and from the recent loneliness surveys, asking respondents whether they had experienced loneliness across different timeframes ("the past few weeks," "the last month"). This inconsistency raises questions of reliability. Second, the threshold for being "lonely" varies by instrument and study. Earlier surveys used only a single item to gauge loneliness, and some emphasized its intensity ("very lonely"), whereas the UCLA Loneliness Scale used in the AARP study is a 20-item questionnaire that is intended to measure the full range of loneliness. Third, the surveys sample different populations. For example, Bradburn's survey was fielded among a sample of 21- to 59-year-olds, whereas the AARP study was of those 45 and older (including many respondents considerably older than 59). The claim that loneliness has doubled—or even increased—since the 1980s (let alone the late 1960s) is simply unwarranted.

More recently, some media outlets have misinterpreted the results of a 2018 Cigna survey to argue that loneliness has increased. The survey indicated that loneliness was higher for younger Americans than for older ones. A mistaken interpretation of this finding would be that older Americans were less likely to be lonely when they were younger than today's younger Americans are. This interprets life-course changes in loneliness as reflecting a change over time for Americans whatever their stage in the life course. While USA Today reported the age-based results as "surprising," the research on the relationship between age and loneliness suggests that the "[p]revalence and intensity of lonely feelings are greater in adolescence and young adulthood (i.e., 16-25 years of age)," decline with age, and then increase again in the very old.³³ The Cigna survey does not support the claim that loneliness has increased over time, nor is the increased loneliness of adolescents a new revelation.

Finally, there is some longitudinal evidence that various American subpopulations are experiencing declines in loneliness. In a 2015 article, researchers looked at loneliness trends in high school and college students over time.³⁴ In the first analysis, the researchers conducted a meta-analysis of studies that looked at college students who had taken the questionnaire based on the Revised UCLA Loneliness Scale, and found that there was a modest decline in loneliness scores between 1978 and 2009, mostly driven by declining female loneliness. In the second analysis, the researchers found a small but significant decline in loneliness in a representative sample of high school students between 1991 and 2012.

It is entirely possible that loneliness has increased over time, but the available evidence does not appear to support that claim. It is just as possible that loneliness has stayed the same or even declined.

Is alone-ness increasing?

Inspired in part by Robert Putnam's book Bowling Alone, and in particular by his chapter on informal social connections, Fischer's Still Connected is the single best data-intensive look at this question. The Social Capital Project has reviewed some of the relevant evidence in an earlier report, but it is worth briefly summarizing Fischer's takeaway from his exhaustive study, and highlighting one particular study that generated a lot of hand-wringing about increasing loneliness that turned out to be less alarming than it initially appeared.

Fischer separately evaluated trends in connections to family, friends and others, social support, and subjective feelings of connectedness. But his conclusion is that although there has been great change over the last several decades—cultural, demographic, economic, technological—we have adapted to those changes and are probably no less connected today than fifty years ago:

Over the long run—say, the last couple of centuries—Americans' ties to kin have diminished, in number at least, if for no other reason than that families have shrunk in size. In addition, nonkin relationships have probably displaced weaker kinship and local ties—people may now turn to friends instead of cousins, to coworkers instead of neighbors. The friendships that emerge from work, clubs, hobbies, and casual meetings, and that are then sustained by modern affluence and communications, have probably grown in number and kind. In the window of the last forty years, not much has changed, and that continuity probably testifies to the ardor of Americans' ties to their families and friends.³⁵

One study in particular is worth mentioning here. As recounted by Fischer, headlines from major newspapers trumpeted the findings of a 2006 paper: "Friendless in America" (Boston Globe) and "The Lonely American Just Got a Bit Lonelier" (New York Times).³⁶ Over a period of several years, several of the study's major headline-grabbing claims—often used to support a narrative of increasing loneliness—were found less sturdy than they initially seemed.

The study, entitled "Social Isolation in America: Changes in Core Discussion Networks over Two Decades," made use of the General Social Survey (GSS) to look at "the first nationally representative data on the confidants with whom Americans discuss important matters."³⁷ The main findings as reported in the study were that between 1985 and 2004 the number of core discussion partners ("confidants") for the typical American had decreased by nearly one person from about three to two. The study reported that those with no confidants almost tripled, from about 8 percent to about 23 percent. As reported, that was a shockingly large number of people who were reporting that they had not one single person to confide in, and it had apparently increased by quite a lot between 1985 and 2004.

Again, however, there is uncertainty about the numbers. Fischer raised questions about the survey methodology,³⁸ and one of the authors on the original paper later published a reexamination of the GSS data on discussion networks, ultimately finding that although discussion networks did appear to have diminished in size, the initially alarming finding of a large increase in people with no one to confide in did not appear plausible.³⁹ Despite these important caveats, the original paper's findings are still routinely cited in the media as evidence that we are increasingly alone (and lonely).

Conclusion

The discussion of loneliness has suggested to media consumers and policymakers that it is an epidemic—that loneliness has increased substantially in recent years and is a pressing problem in need of urgent attention. These claims, however, are based on a flawed interpretation of the research literature. In fact, there is little evidence that loneliness has increased.

With limited resources for research and interventions, it is essential to use the evidence at our disposal to understand the problems we face. Loneliness is certainly a problem for whom it chronically persists, and it might be a problem in the United States generally, but the first order of business must be understanding the scale and characteristics of the challenge. We will need new data if we want to compare today’s loneliness levels to those of the past. Unless we ask survey respondents the same questions that were asked in past surveys, we will never know whether loneliness is on the rise, and other criteria will be necessary to determine whether we are in an epidemic or experiencing a crisis.

Endnotes

1 Centers for Disease Control and Prevention, "Vital Signs: Trends in State Suicide Rates – United States, 1999-2016 and Circumstances Contributing to Suicide – 27 States, 2015," Suicide Rates Rising Across the U.S.," CDC Morbidity and Mortality Weekly Report, June 8, 2018, https://www.cdc.gov/mmwr/volumes/67/wr/mm6722a1.htm?s_cid=mm6722a1.

2 Jean M. Twenge, "Have Smartphones Destroyed a Generation?" The Atlantic, September 2017, https://www.theatlantic.com/magazine/archive/2017/09/has-the-smartphone-destroyed-a-generation/534198/.

3 See, for example, Nicole K. Valtorta, Mona Kanaan, Simon Gilbody, Sara Ronzi, and Barbara Hanratty, "Loneliness and Social Isolation as Risk Factors for Coronary Heart Disease and Stroke: Systematic Review and Meta-analysis of Longitudinal Observational Studies," Heart 102, no. 13 (2016): 1009-1016; Julianne Holt-Lunstad, Timothy B. Smith, and J. Bradley Layton, "Social Relationships and Mortality Risk: A Meta-analytic Review, PLoS Medicine 7, no. 7 (2010), http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316; Julianne Holt-Lunstad et al., "Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review," Perspectives on Psychological Science 10, no. 2 (2015): 227-337; Andrew Steptoe, Aparna Shankar, Panayotes Demakakos, and Jane Wardle, "Social Isolation, Loneliness, and All-cause Mortality in Older Men and Women," Proceedings of the National Academy of Sciences 110, no. 15 (April 2013): 5797-5801; and Erin York Cornwell and Linda J. Waite, "Social Disconnectedness, Perceived Isolation, and Health among Older Adults," Journal of Health and Social Behavior 50, no. 1 (2009): 31-48.

4 See, for example, Julianne Holt-Lunstad, Theodore F. Robles, and David A Sbarra, "Advancing Social Connection as a Public Health Priority in the United States," American Psychologist 72, no. 6 (2017): 517-530, https://www.apa.org/pubs/journals/releases/amp-amp0000103.pdf; and Julianne Holt-Lunstad, "The Potential Public Health Relevance of Social Isolation and Loneliness: Prevalence, Epidemiology, and Risk Factors," Public Policy & Aging Report 27, no. 4 (2017), 127–130.

5 David Riesman, Nathan Glazer, and Reuel Denney, The Lonely Crowd, Revised edition: A Study of the Changing American Character (New Haven: Yale University Press, 2001); Philip Slater, The Pursuit of Loneliness: American Culture at the Breaking Point (Boston: Beacon Press, 1990).

6 Eric Klinenberg, "Is Loneliness a Health Epidemic?" New York Times, February 9, 2018, 
https://www.nytimes.com/2018/02/09/opinion/sunday/loneliness-health.html.

7 John T. Cacioppo and Louise C. Hawkley, "Perceived Social Isolation and Cognition," Trends in Cognitive Sciences 13, no. 10 (2009): 447–454. They usefully summarize its relevance to a species as social as humans by stating: "Humans, born to the longest period of abject dependency of any species and dependent on conspecifics across the lifespan to survive and prosper, do not fare well, either, whether they live solitary lives or they simply perceive they live in relative isolation." Cacioppo and co-author William Patrick describe its benefits in their book Loneliness: Human Nature and the Need for Social Connection, stating that "[i]n the same way that physical pain serves as a prompt to change behavior—the pain of burning skin tells you to pull your finger away from the frying pan—loneliness developed as a stimulus to get humans to pay more attention to their social connections, and to reach out toward others, to renew frayed or broken bonds."

8 Ye Luo, Louise C. Hawkley, Linda J. Waite, and John T. Cacioppo, "Loneliness, Health, and Mortality in Old Age: A National Longitudinal Study," Social Science Medicine 74, no. 6 (2012): 907-914.

9 For a recent and thorough counterexample, see Julianne Holt-Lunstad, "Why Social Relationships Are Important for Physical Health: A Systems Approach to Understanding and Modifying Risk and Protection," Annual Review of Psychology 69, 437-458; and for elaboration on this measurement typology, see Table 2 of Julianne Holt-Lunstad, Timothy B. Smith, and J. Bradley Layton, "Social Relationships and Mortality Risk: A Meta-analytic Review, PLoS Medicine 7, no. 7 (2010), 
http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316.

10 Erin York Cornwell and Linda J. Waite, "Social Disconnectedness, Perceived Isolation, and Health among Older Adults," Journal of Health and Social Behavior 50, no. 1 (2009): 31-48.

11 John T. Cacioppo and William Patrick, Loneliness: Human Nature and the Need for Social Connection (New York: W.W. Norton & Company, 2008); Kimberley J. Smith and Christina Victor, "Typologies of Loneliness, Living Alone and Social Isolation, and Their Associations with Physical and Mental Health," Aging & Society (2018); Jeannette Golden et al., "Loneliness, Social Support Networks, Mood and Wellbeing in Community-Dwelling Elderly," International Journal of Geriatric Psychiatry 24 (2009): 694-700. An example of this is aptly described in Wilfred M. McClay's retrospective review of The Lonely Crowd where he notes that "the book expressed a worry that, despite the postwar era's exuberant prosperity, the traditional American ethos of self-reliant independence was rapidly atrophying, and, as a result, America was turning into a nation of anxious, oversocialized, and glad-handing personality mongerers, salesmen, trimmers, empty suits, and artful dodgers. Hence the paradox captured in the title: a teeming throng whose individual members nevertheless feel themselves to be achingly alone, empty, devoid of purpose or independent meaning." In Wilfred M. McClay, "Fifty Years of The Lonely Crowd," Wilson Quarterly, Summer 1998, 35.

12 John T. Cacioppo and Louise C. Hawkley, "Loneliness," in Handbook of Individual Differences in Social Behavior, ed. Mark R. Leary & Rick H. Hoyle (New York: Guilford Press, 2009), 227-240.

13 Dan Russell, Letitia Anne Peplau, and Mary Lund Ferguson, "Developing a Measure of Loneliness," Journal of Personality Assessment 42, no. 3 (1978): 290-294; Dan Russell, Letitia A. Peplau, and Carolyn E. Cutrona, "The Revised Loneliness Scale: Concurrent and Discriminant Validity Evidence," Journal of Personality and Social Psychology 39, no. 3 (1980): 472-480; and Daniel W. Russell, "UCLA Loneliness Scale (Version 3): Reliability, Validity, and Factor Structure," Journal of Personality Assessment 66, no. 1 (1996): 20-40. Respondents are instructed to answer on four-point scale (1 = never, 2 = rarely, 3 = sometimes, and 4 = always). The scale goes from 0 to 80 and is reverse scored for positive valence items. A shorter 3-item version of the scale was later developed to enable wider use and measurement of loneliness; see Mary Elizabeth Hughes, Linda J. Waite, Louise C. Hawkley, and John T. Cacioppo, "A Short Scale for Measuring Loneliness in Large Surveys," Research on Aging 26, no. 6 (2004): 655-672.

14 For example, see Table 6 in Daniel W. Russell, "UCLA Loneliness Scale (Version 3): Reliability, Validity, and Factor Structure," Journal of Personality Assessment 66, no. 1 (1996): 20-40, 
https://www.tandfonline.com/doi/abs/10.1207/s15327752jpa6601_2.

15 See, for example, Caitlin E. Coyle and Elizabeth Dugan, "Social Isolation, Loneliness and Health Among Older Adults, Journal of Aging and Health 24, no. 8, 1346-1363; and Carla M. Perissinotto and Kenneth E. Covinsky, "Living Alone, Socially Isolated or Lonely—What are We Measuring?" Journal of General Internal Medicine 29, no. 11 (2014): 1429-1431.

16 "2018 Cigna U.S. Loneliness Index: Survey of 20,000 Americans Examining Behaviors Driving Loneliness in the United States," Cigna, https://www.multivu.com/players/English/8294451-cigna-us-loneliness-
survey/docs/IndexReport_1524069371598-173525450.pdf.

17 "The Universal Solitude of Americans: Loneliness on the Rise," WAMU 88.5, 1A, 
https://wamu.org/story/18/05/02/the-universal-solitude-of-americans-loneliness-on-the-rise/.

18 Vivek Murthy, "Work and the Loneliness Epidemic," Harvard Business Review, September 2017, 
https://hbr.org/cover-story/2017/09/work-and-the-loneliness-epidemic.

19 Claude S. Fischer, Still Connected: Family and Friends in America Since 1970 (New York: Russell Sage Foundation, 2011), 78.

20 Dhruv Khullar, "How Social Isolation is Killing Us," New York Times, December 22, 2016, 
https://www.nytimes.com/2016/12/22/upshot/how-social-isolation-is-killing-us.html.

21 Jessica Olien, "Loneliness is Deadly," Slate.com, August 23, 2013, http://www.slate.com/articles/health_and_science/medical_examiner/2013/08/
dangers_of_loneliness_social_isolation_is_deadlier_than_obesity.html.

22 C. Wilson and B. Moulton, "Loneliness among Older Adults: A National Survey of Adults 45+," 2010, AARP, accessed August 13, 2018, 
https://assets.aarp.org/rgcenter/general/loneliness_2010.pdf.

23 Interestingly, the AARP survey did ask respondents how long they had been lonely in retrospect; of the 35 percent of respondents who were designated "lonely" (a score of UCLA Loneliness Scale of 44 or higher), 45 percent (or about 16 percent of the overall sample) said it had lasted six years or more; 32 percent (or about 11 percent of the overall sample) said it had lasted one to five years; and 24 percent (or about 8 percent of the overall sample) said they had been lonely up to one year. So, at least in 2010 there clearly were a lot of people aged 45 and older who appeared to be persistently lonely, but far fewer than the headlines would suggest.

24 Brad Edmondson, "All the Lonely People," AARP The Magazine, Nov./Dec. 2010, https://www.aarp.org/personal-growth/transitions/info-
09-2010/all_the_lonely_people.html.

25 We reached out to Edmondson over email for clarification, but the study he provided us was about core discussion networks rather than loneliness and did not include any figures from around 2000 that were close to 20 percent. He also referred us to John Cacioppo, whose work we cite below, but Cacioppo died in March of this year.

26 We reached out to Olien, the author of the Slate article, via email for clarification, but we did not receive a response.

27 Carla M. Perissinott, Irena Stijacic Cenzer, and Kenneth E. Covinsky, "Loneliness in Older Persons: A Predictor of Functional Decline and Death," Archives of Internal Medicine 172, no. 14 (July 2012).

28 Fischer, Still Connected, 78-80.

29 Stephanie Cacioppo et al., "Loneliness: Clinical Import and Interventions," Perspectives on Psychological Science 10, no. 2 (2015): 238-249. The authors also note that "[o]ver the past 40 years, loneliness has also become more widespread overseas," but proceed to list survey results for a single point in time demonstrating no trend of increasing loneliness.

30 Letitia Anne Peplau, Dan Russell, and Margaret Heim, "The Experience of Loneliness," in New Approaches to Social Problems: Applications of Attribution Theory, eds. I.H. Frieze, D. Bar-Tal, & J.S. Carrol (San Francisco, CA: Jossey-Bass, 1979), 53-78.

31 Norman M. Bradburn, The Structure of Psychological Well-Being (Chicago: National Opinion Research Center, 1969), 25 and 56, 
http://www.norc.org/PDFs/publications/BradburnN_Struc_Psych_Well_Being.pdf.

32 Richard Maisel, Report of the Continuing Audit of Public Attitudes and Concerns (Harvard Medical School: Laboratory of Community Psychiatry, 1969), mimeographed.

33 John T. Cacioppo and Louise C. Hawkley, "Loneliness," in Handbook of Individual Differences in Social Behavior, ed. Mark R. Leary & Rick H. Hoyle (New York: Guilford Press, 2009), 230.

34 D. Matthew T. Clark, Natalie J. Loxton, and Stephanie J. Tobin, "Declining Loneliness Over Time: Evidence from American Colleges and High Schools," Personality and Social Psychology Bulletin 41, no. 1 (2015): 78-89.

35 Fischer, Still Connected, 100.

36 Ellen Goodman, "Friendless in America," Boston Globe, June 30, 2006; and Henry Fountain, "The Lonely American Just Got a Bit Lonelier," New York Times, July 2, 2006.

37 Miller McPherson, Lynn Smith-Lovin, and Matthew E. Brashears, "Social Isolation in America: Changes in Core Discussion Networks over Two Decades," American Sociological Review 71, no. 3 (2006): 353-375.

38 Claude S. Fischer, "The 2004 GSS Finding of Shrunken Social Networks: An Artifact?" American Sociological Review 74, no. 4 (2009): 657-669.

39 Matthew E. Brashears, "Small Networks and High Isolation? A Reexamination of American Discussion Networks," Social Networks 33 (2011): 331-341.