key: cord-0939958-lanet00w authors: Necka, Elizabeth A.; Rowland, Laura M; Evans, Jovier D. title: Social Disconnection in Late Life Mental Illness – Commentary from the National Institute of Mental Health date: 2020-08-26 journal: Am J Geriatr Psychiatry DOI: 10.1016/j.jagp.2020.08.013 sha: bfd32e7f8e2fac097ff8aa5ceb966492f7897b8e doc_id: 939958 cord_uid: lanet00w • Social disconnection – both objective social isolation as well as perceived social isolation (otherwise known as loneliness) – is a prevalent affliction among older adults, with profound effects on mental health. • Mechanistic understanding of how mental illness contributes to, is exacerbated by, or is otherwise linked to social disconnection remains elusive, and therapeutic interventions which leverage social connection to enhance compliance with or efficacy of mental health treatment, though promising, remain scarce. • The National Institute of Mental Health (NIMH) is committed to transforming the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. To translate basic knowledge into new methods for diagnosis, treatment, and prevention of mental illness demands appreciation for the broader milieu of social and environmental factors in which mental illness prevails – of which, social connection or disconnection is one.  Social disconnection -both objective social isolation as well as perceived social isolation (otherwise known as loneliness) -is a prevalent affliction among older adults, with profound effects on mental health.  Mechanistic understanding of how mental illness contributes to, is exacerbated by, or is otherwise linked to social disconnection remains elusive, and therapeutic interventions which leverage social connection to enhance compliance with or efficacy of mental health treatment, though promising, remain scarce.  The National Institute of Mental Health (NIMH) is committed to transforming the understanding and treatment of mental illnesses through basic and clinical research, paving the way for prevention, recovery, and cure. To translate basic knowledge into new methods for diagnosis, treatment, and prevention of mental illness demands appreciation for the broader milieu of social and environmental factors in which mental illness prevails -of which, social connection or disconnection is one. Social disconnection -a term which refers to either objective social isolation, perceived social isolation (otherwise known as loneliness), or the co-presence of both -is a prevalent affliction among older adults. Nearly a quarter of older Americans live alone 1,2 , and surveys suggest that over one third of Americans over the age of 45 are lonely at least some of the time 3 , with levels of loneliness increasing rapidly among those over the age of 70 4 , the same age when objective social isolation is highest 5 . In the midst of the COVID-19 Global Pandemic, which poses disparate mortality risk for older adults 6 , and public health regulations encouraging physical isolation to protect the most vulnerable populations, the prevalence of abject objective social isolation, as well as feelings of loneliness, are likely to rise. These issues highlight the need for effective strategies and solutions to help alleviate the negative health impacts of social isolation. Social disconnection puts individuals at greater risk for all-cause morbidity and mortality 7 at a rate greater than or equivalent to traditional health risk factors such as alcohol consumption, physical activity, and obesity 8 . It also has profound effects on mental health. A commonly reported association exists between loneliness and depression, with some evidence that feelings of loneliness exacerbate later depressive symptoms [9] [10] [11] , though the relationships may be bidirectional [12] [13] [14] . Links also exist between social disconnection and a number of other mental illnesses, including anxiety 13,15,16 , psychosis 17, 18 , obsessive compulsive disorder 19 , borderline personality disorder 20, 21 , and post-traumatic stress disorder (PTSD) 22, 23 . Alarmingly, social disconnection -either real or perceived -is also one of the primary risk factors for a suicidal attempt 24 and is one of the primary motivators of self-harm in older adults 25 . Yet mechanistic understanding of how mental illness contributes to, is exacerbated by, or is otherwise linked to social disconnection remains elusive, and therapeutic interventions which leverage social connection to enhance compliance with or efficacy of mental health treatment, though promising 26,27 , remain scarce. As the US population rapidly ages -within the next fifteen years, the number of US adults over the age of 65 are expected to outnumber US children under the age of 18 for the first time in history 28issues of social disconnection are becoming more pressing public health issues 29 . Older adults are disproportionately likely to encounter bereavement, to exit the workforce (i.e., through retirement or layoffs), to endure decreased physical functioning and mobility which can limit in-person social interactions, and to suffer visual and hearing impairments, making telephone, social media, and other digital means of social interaction difficult or impossible. Together, these factors making them more likely to become objectively socially isolated. This can be accompanied by profound loneliness-the discrepancy between the number or quality of relationships that one desires and those that one has 30 . Yet even in the presence of objective social connection (for instance, when living among family or in an assisted living community), individuals can experience the feeling of loneliness. Indeed, the statistical correlation between loneliness and objective social isolation is relatively weak [31] [32] [33] . Though perceived social isolation (i.e., loneliness) is generally more predictive of individuals' overall assessment of their mental health than objective social isolation 31, 33 , measuring both types of social disconnection concurrently and independently is critical 34 . Objective and perceived social isolation are independently associated with a number of adverse health outcomes, including poor health behaviors 35 , reduced cognitive functioning 36 , Alzheimer's disease 37 , and even mortality 7 . Yet they may also interact to exhibit a synergistic interactive effect, with loneliness being particularly deleterious in the presence of objective isolation and vice versa [38] [39] [40] . In the context of understanding mental illness trajectories, it is particularly important to measure objective and perceived social isolation independently, as many mental health issues are accompanied by symptoms that may differentially increase the odds of objective or perceived social isolation or that may be differentially impacted by into new methods for diagnosis, treatment, and prevention of mental illness demands appreciation for the broader milieu of social and environmental factors in which mental illness prevails -of which, social connection or disconnection is one. As this special issue highlights, the mental health impacts, consequences, and correlates of social isolation are an evolving area of science. Important issues remain to be addressed, and the National Institute of Mental Health is committed to supporting this area of research. The authors declare no conflicts of interest. There are no financial disclosures to report. Author Contributions. All authors (EAN, LMR, JDE) contributed to the writing this commentary and approve of its publication. The Epidemiology of Social Isolation: National Health and Aging Trends Study Are U.S. older adults getting lonelier? 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