Using a large national sample, our study has identified significant associations between loneliness and worsening physical and mental health during the COVID-19 pandemic. Over a third (37.2%) of respondents reported feeling lonely in the last week, with groups at increased risk of experiencing loneliness cutting across multiple demographic characteristics, including young people, women, those with pre-existing health conditions, people living in more deprived areas, the unemployed, and those experiencing a negative change in their financial situation. Loneliness was the strongest predictor of reporting worsening mental health, with people who reported having often or always felt lonely in the last week having over an eight-fold increase in odds of self-reporting their mental health to have worsened during the pandemic. This effect was also observed with respect to physical health outcomes, with odds of reporting worsening physical health and physical fitness being over three-fold and two-fold respectively for those always or often lonely.
The relationships identified here between loneliness and worsening physical and mental health are consistent with those found in previous studies conducted prior to the pandemic in effect size [5,6,7]. Our analysis has additionally shown that these relationships are maintained in the context of the COVID-19 pandemic. This is of particular concern during the pandemic due to the reduced ability for people to socialise with friends and family, increasing the number of people experiencing loneliness as a result [10, 11] and potentially translating to a substantial indirect effect on public health.
Our study also highlights the potential for lasting negative health consequences associated with the COVID-19 pandemic, with 40.1% of people reporting increased weight, and 16.9% of people reporting increased alcohol consumption in comparison with pre-pandemic. These poorer health behaviours were more prevalent in people who reported feeling often or always lonely, with a 37% and 29% increase in the odds of reporting increased alcohol consumption and increased weight in comparison with pre-pandemic, respectively. These observations may partially mediate the wider relationship between loneliness and physical health outcomes.
No other factors were found to have as consistent or strong a relation with the odds of all self-reported poor physical, mental and health behaviour outcomes as loneliness, although people who described their financial situation as much worse in comparison with prior to the COVID-19 pandemic were consistently at increased risk of poorer outcomes. For example, people who reported being in a ‘Much worse’ financial situation compared to a year ago were over three times more likely to report worsening mental health and over two times likely to report worse physical health.
Our analysis suggests that the social impact of the COVID-19 pandemic may also have the effect of compounding pre-existing health inequalities present in society. Previous studies have shown the disproportionate direct effect of COVID-19 on people living in more deprived areas and on those from a minority ethnic background [12, 13]. This study has shown that in addition to these direct effects, people from these population groups are also significantly more likely to report feeling often or always lonely, and may be at increased risk of worsening physical, mental and behaviour health outcomes as a result.
The observed relationships in this study may also have a downstream effect on health service use; not only the demand for mental health support services indicated by the increased odds of reporting worse mental health and social isolation, but also the demand for services treating clinical outcomes relating to increased weight, increased alcohol consumption and worse physical health and fitness. In addition, these services are often under increased pre-existing pressure in more deprived areas, potentially further exacerbating health inequities for the most deprived [14, 15].
A primary limitation of this analysis is that all outcomes were based on self-reported data; as such a respondent’s current mental health may affect their perception of their current physical health, and vice versa. The use of a self-rating question to measure loneliness could lead to under-reporting in certain population groups, for example, there is evidence to suggest under-reporting of loneliness in men when using a direct measure (as used in this study) compared to the use of an indirect measure such as the De Jong Gierveld Scale . All data was cross-sectional rather than longitudinal meaning that causative relationships could not be measured between loneliness and the examined outcomes. Loneliness was measured in the past week and changes in health over the past year. It was not possible to account for changes in individuals’ perceptions of their mental or physical health over time. Results may also be confounded by unobserved data. No analysis was undertaken on separate ethnic groups due to the small sample size and only 2.4% of the sample were from a minority ethnic group, which may limit the generalisability of the study findings with respect to ethnic background. There are also limitations based on the administration of the survey; as this analysis is based on a sample of data from respondents who agreed to participate in a telephone survey, results may be subject to selection bias and may not be generalizable to the population as a whole.