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Source: https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30213-3/fulltext?dgcid=raven_jbs_etoc_email

August 2020


Children are often surrounded by people—other children, teachers, and family—and so the concept of children feeling lonely is not something we might think about. Often considered an issue impacting adults, the first statistics reported by the UK Office of National Statistics (ONS) on loneliness, collected using the Community Life Survey 2016–17, was a surprise. The age group who were the loneliest were those aged 16–24 years. In addition, 11% of children aged 10–15 years and 14% of those aged 10–12 years said they were often lonely.
“Loneliness in children is really interesting because they are often constantly surrounded by other children. And so the idea of being alone or isolated is challenging, as they themselves recognise loneliness doesn't mean that there's no people around. It just means that you don't feel you're connecting with them and that you are not having good relationships with them”, explained Richard Crellin, Policy Manager at The Children's Society.
These results were replicated in the Loneliness experiment; the online survey of 55 000 people found that 40% of 16–24 year olds reported often feeling lonely, compared with 27% of those aged over 75 years. This finding was reported in young people across cultures, countries, and genders.
In terms of which groups of children are more impacted, research points to those with lower socioeconomic status. “Data in England show that [restricted] family financial resources seem to be related to higher levels of loneliness”, explained Pamela Qualter, Professor in Psychology for Education, University of Manchester (Manchester, UK), who headed the Loneliness experiment. “This is likely to be because [low] socioeconomic status stops you from doing some of the things your friends are doing, [such as] going to the cinema or coffee shop. It probably also means you don't have the latest things your friends have, like the latest trainers or video game.”
But Qualter points out that we do not have much evidence on other socioeconomic groups. And we need more data and evidence. The ONS data used children receiving free school meals as an indicator of poor socioeconomic status and found that 27% of these children felt lonely. Crellin said that for The Children's Society report 2019, they decided to look at the link between loneliness and overall household income. The organisation was concerned that focusing on just poverty could be misleading. Their findings were similar in relation to poorer children feeling lonelier, but they also saw a similar pattern in those from high-income households.
“So actually, young people who are in the lowest income and the highest income households are more likely to feel lonely than those in middle-income households”, explained Crellin. “There's something about being very wealthy that is also connected to loneliness, which is interesting to think about.”
The Children's Society report points to the qualitative work into loneliness that highlights the importance young people place on “fitting in”. “Income inequality can be experienced in both subtle and explicit ways by both wealthy and poorer children ”.
Loneliness is also linked to poor physical and mental health and poor personal well-being. The health impact of loneliness has been described as being on par with other public health issues, such as obesity or smoking . A growing body of research indicated that loneliness predicts increased morbidity and mortality. Loneliness has been associated with several health issues including high blood pressure, coronary heart disease, and poor mental health and cognitive functioning. Most of the research has focused on adults or older people, and there is a gap in the evidence for children. But there are clear links between loneliness and poor mental and physical health and between loneliness and lower academic achievement, according to a report by the charity Action for Children.
“There's also evidence linking loneliness with poor sleep among children and adolescents”, said Qualter. “And of course, that's really important for school outcome, engagement, and academic achievements. So if we can offer interventions that help children who are stuck in prolonged loneliness so that they can get out of their loneliness quicker, this would be really important.” And Qualter thinks schools and teachers are key to tackling this problem.
Social prescribing is part of the UK's 2018 loneliness strategy; patients can be connected to groups or services in the community. Social prescribing is something that mostly comes via general practitioners (GPs) and primary care in the UK. “I don't think we have really cracked social prescribing for children and young people in the UK yet. Relationships with GPs are actually the relationship the parent has rather than children themselves”, says Crellin.
Qualter thinks it is important to consider school-based approaches. “The main force of loneliness for adolescents and children is actually school. It's their peers”, explains Qualter. “So for me it seems absolutely appropriate to get them talking about those experiences where they are experiencing them, and where it is more heightened. I think teachers aren't well equipped; we need to work with teachers and adolescents to come up with an intervention that's most appropriate for them.”
Key reasons for loneliness that have been identified involved transitions in life, such as moving from primary to secondary school, going to university, or moving back home after university. Children and adolescents reported embarrassment about admitting to loneliness and saw this as a possible “failing”. Multiples issues could trigger loneliness, such as bullying, disability, and bereavement. Children who are not satisfied with the relationships with their family and friends report experiencing loneliness more often.
Evidence shows that the experience of loneliness is linked with low self-esteem and low levels of trusting other people, and these factors are also predictors of prolonged loneliness, says Qualter. The research on the link between children's loneliness and their families and parents is lacking. If parents interpret relationships negatively (eg, seeing others as untrustworthy) then children may do too, explains Qualter.
Qualter says that a variety of interventions can help with loneliness. Learning a new hobby can be a distraction, but counselling techniques can also help with low self-esteem and manage the typically high levels of mistrust in others.
Social media has been attributed as a significant factor in loneliness in children, with issues of cyberbullying and isolation through social net-working sites like Facebook and Twitter. However, recent research is starting to show that social media and modern communication can also help with loneliness. The report by Action for Children found that “nearly half of 11–16 year olds find it easier to be themselves online than face-to-face and three-in-five said they would be lonely if they couldn't talk to the friends via technology”. And yet, in a 2017 survey of more than 1000 young people aged 11–25 years in the UK, 4% said they had been bullied online in the last month.
Ruth Evans, Associate Professor in Human Geography at the University of Reading (Reading, UK) also said she came across similar findings in her research into loneliness. “Some people with mental health conditions particularly talked about how social media could be a positive thing for loneliness. That they could play games online and interact with people, and have a network, often internationally, with people they did online gaming with.”
In her research, Evans said that young carers of a parent or relative with a disability or mental illness can be vulnerable to loneliness, and they may benefit from online social groups. “They might particularly value social or support groups where they can meet others in similar situations. Even if they are not talking about their particular family issues and caring, but being with others in similar situations can be really helpful.”
Even with the UK Government's strategy on loneliness, experts think a lot of work is still needed to obtain more data and evidence on who is impacted by loneliness. Crellin thinks we are still in the phase of gathering data and are in early days of understanding how and what interventions can help. Loneliness is clearly linked to wellbeing, and those who are dealing with different disadvantages may be more impacted, but he is concerned about missing out on other vulnerable groups, such as people with disability and those from minority ethnic or sexuality groups.
And the situation is becoming more important, set to impact more people, whatever their circumstance, as the world finds itself in the midst a new normal of quarantined life.
New survey results published on June 8, 2020, by the ONS looked at coronavirus and loneliness and described a phenomenon of “lockdown loneliness”. Collecting more than 5000 individual responses during the UK's lockdown period (April 3–May 3, 2020), the survey found that the lockdown affected everyone asked. 31% reported that their well-being had been impacted by loneliness. There was no link between lockdown loneliness and objective indicators such as having a health condition or disability.
Although the ONS survey included adults only, similar findings have been reported in young people. Place2Be, UK-based organisation that provides mental health services in primary and secondary schools, found in a recent survey of over 200 frontline mental health professionals that loneliness and isolation was the most common topic discussed by young people, and by parents and carers during the lockdown.
“Although young people may have stayed digitally connected with each other at this time, they may have missed being part of a bigger class, year group, or school community”, said Niki Cooper, Clinical Director of Place2Be. “There is a large body of research on the central importance of social support and social groups in combatting stress and overcoming adversity.”
Experts think that the momentum of the government's loneliness strategy has slowed down, but they hope that the pandemic will re-engage efforts in tackling loneliness, especially in children and adolescents. Government funds have been made available for interventions for loneliness since lockdown started; however, these have been allocated to adult services, says Qualter. The government's initial engagement with academics to help with the loneliness strategy has now stopped. “I hope they will re-engage us so that suitable interventions can be funded to support the UK population as we come out of lockdown”, says Qualter. “With Brexit, [the government's loneliness strategy] slowed down significantly. I think the current pandemic has refocused the government and I hope that will lead to real change.”
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