[paraknight]

I haven't dug into all the sources, but I think there's a potential confounder here, or maybe even reverse causality. The author seems to assume causation when the studies only indicate correlation. E.g. the first link says "chronic loneliness increases mortality risk" but the actual source says "actual and perceived social isolation are both associated with increased risk for early mortality".

So for example, it's possible that if you already have chronic illness, a disability, or any other kind of health issues, you're more likely to have higher social isolation and therefore be more lonely, in addition to having a higher mortality risk. There's an outside variable (your health) that is correlated with both (loneliness and mortality), but that doesn't necessarily mean that loneliness causes mortality. If this were the case, we could defend claims like "autism increases mortality", because we already know that autism increases social isolation.

[vharuck]

Poor health increasing social isolation isn't even a hard casual path to argue. Common health problems can physically restrict how often and how long one leaves the house: people on oxygen can only travel as far as their supply and weakened lungs can take them, or people with bowel disorders might be reluctant to be do anything without easy and discrete bathroom use, people with visible symptoms might be embarrassed and avoid socializing.

The loneliness-associated protein study linked in TFA doesn't seem to control for health status. So preexisting conditions may have affected the correlations.

[oncallthrow]

Yes, this seems blindingly obvious to me. Maybe because I have chronic health problems myself. Perhaps those blessed with good health are blissfully ignorant.

When you are chronically ill, socializing falls pretty rapidly down your list of priorities.

[observationist]

That said, it seems pretty clear that incentivizing healthy socialization can significantly improve quality of life, reducing perceived suffering and quite possibly improving outcomes through reinforcement of the various social needs we have.

We are fundamentally social primates; there are prior studies demonstrating the overt harms of isolation and ostracization in humans, primates, and other mammals. Our immune systems, metabolism, and cardiovascular health are all tied intimately to things like stress and hormones, with feedback effects that can amplify disorder, or suppress it, depending on the directionality of the inputs.

I see the "just so" element of explanation to this study, but I think that even if the underlying causal factors are more complex, it is so directionally correct that I have no problem with the conclusion of the study, even if it's not correctly justified scientifically.

[ken47]

And don't forget that physical loneliness, that is, actually being alone, eliminates one major feedback source that something could be wrong with your health, or a source of immediate aid if e.g. you go into cardiac arrest.

Maybe the researcher above touches on these things, but more generally, there should be a standardized probability and statistics exam for ALL aspiring scientific researchers, and a high score should be the minimum cutoff. The influence that a statistically flawed study can have over our collective futures is too dangerous.

[fn-mote]

> The influence that a statistically flawed study can have over our collective futures is too dangerous.

An even bigger danger: with all of the flawed / p-hacked / over-hyped studies, the public (and the legislature) will start to believe that NO science is real.

It worries me how much argument there is over things I consider to be facts. And how much effort goes into undermining science when it is not in the corporate interest (eg cigarette manufacturers funding “inconclusive” studies).

[ramblingrain]

The first source I clicked into was a meta-analysis of randomized clinical trials.

What you say sounds true about chronic illness and isolation. These researchers are looking at research done using actual interventions and real results.

What should they do to analyze this more than RCTs and then meta-analysis of RCTs?

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s... Tackling social disconnection: an umbrella review of RCT-based interventions targeting social isolation and loneliness

[citizenpaul]

Another huge factor is probably lack of feedback loop. Its surprisingly easy to press on by yourself through various health issues until its too late. However someone around you might say you look pale recently you should see doctor as an obviously contrived example.

[vasco]

My dismissive but practical take is "well yeah there's nobody in the room to call an ambulance when you have the heart attack you'll most likely have", which mindfulness classes and support groups don't help with. There's practical benefits to having people around.

[JackFr]

There was a funny statistical artifact I read once (well, for some value of 'funny') that home was a terrible place to have a heart attack, because people are willing to 'just lie down and see how I feel' rather than in a restaurant or movie theater where an ambulance will be called.

[arandr0x]

It would be interesting then for similar studies to add a dimension in addition to self-reported loneliness on self-reported time spent outside the home. While it's likely that sedentary elders are lonelier, it's not a 100% overlap (some elders live with close family and some lonely people are still very physically active/outside). You would expect lonely, active people to have lower death rates than lonely, sedentary people with similar pre-existing conditions under your hypothesis, and it would be a powerful thing to prove because it's a lot easier to make people go out than to make them make friends.

[stackbutterflow]

Then what about work from home? Does it increase mortality?

[Qem]

I bet any change in mortality due to increased isolation is offset by decreased deaths due to traffic acidents.

[IMSAI8080]

Or related: there's no one to nag you about going to get that funny ache checked out. Men particularly are notoriously reluctant to go to a doctor for various reasons but a worried partner might persuade them.

[AnimalMuppet]

When this happens to us, my wife says, "This is another reason why married men live longer."

She's not wrong...

[AndrewKemendo]

By these statistics there aren’t enough healthy people to provide care for those that are less healthy

The challenge here is that healthy people don’t desire to be around unhealthy people.

Society provides no incentive or social benefit for otherwise healthy people to be around the unwell to call the ambulances. Even as a nurse, hospice worker or caregiver, the pay/benefits are non existent for the amount of emotional and physical labor needed for care.

[Y_Y]

You don't have to be that healthy to call an ambulance! As long as not everyone in the sick-and-poor commune has a heart attack at the same time this should be a safe enough system.

[e_y_]

Ambulances are expensive enough that people are hesitant to call them, sometimes even in life threatening situations.

And if the person is unsure whether the situation is critical, they might try to "sleep it off" rather than driving or getting a ride, because ER is also kind of expensive and you could be stuck there all day.

[Qem]

In US. But there are places with proper socialized health systems, where one must not be afraid of bankruptcy by calling an ambulance.

[hhmc]

I once did a course with a paramedic on basic aid. We were discussing choking, which is a condition that really needs a 2nd party to intervene. Someone asked what to do if you live alone (with no close neighbours) - the answer was essentially ‘good luck’

[magneticnorth]

The idea of the heimlich is to put sudden force on the diaphragm and force air upward. You can do that alone by pushing your upper abdomen against a chair back, counter, railing, whatever. Not something I've ever tried, but good to know about in case.

[inciampati]

And if you're alone it's worth running with a chair into the street to do it as visibly as possible.

[hhmc]

Sure theoretically. Outcomes are dramatically better if someone else is around

[vkou]

Most people don't know how to do a self-heimlich.

[mh-]

I know how to in theory, and I think I'm probably "above average" at calm-in-crisis, but my confidence that I'd calmly rescue myself via self-heimlich while unable to breathe is not high.

[nh23423fefe]

Dying of natural causes is ok though.

[AnimalMuppet]

Preventably dying of natural causes is kind of a waste, though.

[biophysboy]

>Recent meta-analyses examining 2.2 million individuals across 90 cohort studies reveal that social isolation and loneliness trigger measurable biological cascades comparable to traditional disease risk factors.

Its frustrating, because cohort study experimental designs like these can in principle chip away at reverse causality (i.e. observe loneliness exposure before a cardiovascular disease prognosis, compare difference-in-difference between treatment/control), but the meta-analysis doesnt clearly state whether this constraint was applied. But even a study like this would have issues with medical participation, so that would need to be controlled, preferably with a prospective design.

[lanstin]

Having a spouse or friend nag you into going to the doctor is undoubtably a part of the effect, both for the practical side and for the feeling that someone would care if you were ill. (Assuming this is what you mean by "issues with medical participation.")

[rawgabbit]

As an anecdote, I have a couple of elderly family members who did not mellow with age. Instead they became even more toxic and abusive as they approached their 80s. (I have another who was the complete opposite.). The abusive ones hurled curse words as soon as you entered the door; then they "switched" personalities and acted as if nothing happened. I also know of an acquaintance whose son had the similar personality traits even though he's only in his 40s. The son needed a 24 hour a day caregiver because he's mentally challenged. In short there are a whole host of physical and/or mental problems that confound the situation.

[fsckboy]

>The author seems to assume causation when the studies only indicate correlation.

once I heard Feynmann say in a youtube video that (paraphrasal) "we don't know what causes gravity, we just know that it exists, it's a property of matter"

then I realized, our experiments never show causation, they only show correlation. gravity has 100% (in our experience) correlation to matter. admittedly, that's a pretty good correlation, but for all we know, gravity causes matter. energy too, apparently.

[schoen]

Philosophers have worried for a long time about whether we can actually observe causation.

David Hume was famous for arguing in An Enquiry Concerning Human Understanding that we can't observe it and we instead have a "custom" or habit of expecting effects to follow causes.

> After the constant conjunction of two objects—heat and flame, for instance, weight and solidity—we are determined by custom to expect the one from the appearance of the other.

Religious philosophers have sometimes gone to the extreme of occasionalism, where they've maintained that patterns and regularities in nature were just habits or customs that God chooses to follow:

https://en.wikipedia.org/wiki/Occasionalism

[bluebarbet]

Skipping punctuation makes your writing harder to parse. It's a false economy.

[fsckboy]

i didn't skip any punctuation

[codedokode]

You skip uppercase letters though.

[andsoitis]

> If this were the case, we could defend claims like "autism increases mortality", because we already know that autism increases social isolation.

Are you aware that life expectancy is much lower for peel with autism than the general public?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6713622/

[paraknight]

I was not aware of this, but this actually supports my point, since the reasons in that study seem to be correlated physical comorbidities, so that makes the claim "autism increases mortality due social isolation" both easier to make (as you can misinterpret the stats) as well as less defensible.

[dfxm12]

Social isolation is also not the same thing as loneliness. The paper recognizes this and gives different outcomes for three distinct categories (social isolation, loneliness and living alone). The blog post mistakenly cites the outcome for living alone as the outcome for loneliness.

[mgh2]

https://www.pbs.org/newshour/health/loneliness-poses-health-...

[ivape]

If you think things through like that then you can only ever attribute physical, material, biological factors as the only things involved in mapping the causation. In other words, every time we attempt to draw the line to mortality, it gets hacked down as we keep reducing the argument.

We cannot explore the possibilities of truth if we do that, but I can appreciate the due diligence. It’s a tricky subject, but life experience informs many of us that there is something more going on than “I materially feel like shit”.

There is a taboo element to loneliness that isn’t often discussed, and that is “I feel hurt that I can be left alone, or that anyone can be left alone or isolated”. So, while the source of the isolation could be material, the feeling that manifests from it is an actual hurt that one feels from the actual thing (isolation). For example, we may be killing our elders when we isolate them in care facilities.

I can’t say if we have the sense as a society to accept data that suggests this pain can be linked to mortality. Isolation in itself isn’t the killer, it’s the pain of “well how could any society leave anyone alone”, and such a phenomenon can be witnessed in the macro outside of yourself (how can we leave people on the street? Etc).

Loneliness and isolation is often in sequence, after abandonment, or negligence, or unforgivingness (if the person “deserved” the isolating). A phantom, immeasurable pain. And even more painful, to deny it afterwards.

[mr_toad]

There is considerable evidence that people who live alone are at greater risk of hospital re-admission, probably because they are less able to care for themselves properly.

[FuriouslyAdrift]

https://en.wikipedia.org/wiki/Comorbidity

[blablabla123]

The myth of the lonely hero (and probably risk taker) has been mentioned as a problematic factor before

[bjourne]

Of course there is no direct causation between loneliness and death. You don't directly die from lack of social interaction, but you do directly die from lack of food. However, there is a clear causal link between loneliness and habits that increase mortality.

[Taek]

No I believe its reasonably well established that being lonely itself takes a toll on your health. Stress goes up etc.

The problem is that this article is overstating the effect on mortality because its not controlling for confounding factors very well.

[lynx97]

> Of course there is no direct causation between loneliness and death.

Of course there is. If you are alone at home, who calls an ambulance if you have a heart attack or similar condition? If you are living together with someone, the chance they are arund while it happens is all thats needed to skew the statistics.

[mrkickling]

Do you not believe that mental well being is affected by loneliness? And that mental well being could affect mortality?