It is difficult to put a number on all the lonely people in the world. An estimate comes from the World Health Organisation, which approximates that at least 10% of adolescents, and 25% of older people are lonely. The Global State of Connections report says at least a quarter of 4.5 billion people felt ‘lonely’ or ‘very lonely’ this year. Both are an underestimation of the real scale of loneliness, which the WHO declared a pressing, albeit underappreciated, global health threat last month. The health impact has been likened to smoking 15 cigarettes, or a feeling of hunger or thirst “the body sends us when something we need for survival is missing.” The pandemic years have calcified loneliness as a feature of daily life, with implications on people’s long-term mental and physical health, longevity and well-being, the American Psychological Association noted. Wars, climate change and social inequality have only accelerated this ‘silent’ threat.
“The fact that WHO has put an identification mark to it emphasises a lot more that going through loneliness is serious — and needs to be dealt with urgent attention,” says Nidhi Thakore, a clinical psychologist. The Indian experience of loneliness, however, is relatively understudied and unacknowledged. In a collectivistic country with more than 140 billion people —almost twice the number of people living in Europe — loneliness as a public health and social concern fails to receive the targeted attention it needs, she notes. The Hindu examines the ‘loneliness epidemic’, the challenges of documenting loneliness in India and why experts think India needs to address loneliness as a structural problem.
What does data show?
Loneliness data in India can be cleaved into before and after the pandemic. For research, loneliness is largely understood to be “the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way, either quantitatively or qualitatively,” and is computed as an experience other than ‘social isolation.’
Among the first statistical measures of loneliness in India comes from a 2004 study conducted by the National Sample Survey Office (NSSO): about 49.1 lakh people (12.3 lakh men and 36.8 lakh women) were living alone and suffered from loneliness. Two studies before this (1991 and 1994) analysed the experiences of adolescents and adults, and male students separately, and found deficient friendships and family relationships to be correlated with loneliness — but the sample size for both was less than 200 people. In 2012, self-reported loneliness was found to be 17.3% and 9.5% in urban and rural adolescents, respectively. The Centre for the Study of Developing Societies (CSDS) in 2017 studied 6,000 people aged 15-34 years across 19 States, and found that 12% of India’s youth reported feeling depressed often, and about 8% frequently felt lonely. Between 2017-18, the first wave of the Longitudinal Ageing Study in India (LASI) studied close to 72,000 people from 35 States and Union Territories — 20.5% of adults aged 45 years and above reported moderate loneliness, and 13.3% were severely lonely. It showed for the first time that the elderly have social well-being issues that need to be addressed, ICMR director general Dr. Rajiv Bahl said at a function earlier this year.
A pattern stands out: the burden of loneliness appears to be higher among older demographics. India is a rapidly ageing society, and “accompanied by rapid urbanisation, changing family structure and lifestyles, interpersonal relationship patterns, and power structures, reducing social cohesion and support, eroding kinship ties (relationship strain, support, family cohesion),“ the risk for loneliness is elevated, a 2022 study argued. Other researchers also agreed there was a dearth of reliable statistics on loneliness in India, but anecdotal evidence indicated that it was a growing health concern.
Since the pandemic and subsequent lockdowns, the researcher’s gaze has expanded to look at the experiences of young people, finding loneliness and anxiety to be on the rise. These are studies with smaller sample sizes; some conducted online, telephonically and a few face-to-face, of people living alone during the pandemic years or confined within homes with family members. One peer-reviewed study published in 2022 averred younger students seem to have dealt with the pandemic’s stress more poorly, partly due to their less-developed academic skills and greater need for social contact.
Two caveats persist in this dataset. One being that the findings were specific to a context and the “prevalence of loneliness might have increased after coronavirus,” as per a study published last year in BMC Public Health, which was conducted across Mumbai in 2016. Moreover, a research gap on loneliness is evident, averred a 2022 Aspen Institute report, as studies overlooked the experiences of marginalised identities.
“Earlier, loneliness was called out as a ‘state of mind’ or ‘just a phase’, now it’s becoming more evident that the definition of it goes beyond the standard means of it. ”Nidhi Thakore, clinical psychologist
Loneliness as a public health concern in India
Loneliness is a “fertiliser of other diseases,” explained researcher Steve Cole in 2021. The biology of loneliness shows it can “accelerate the buildup of plaque in arteries, help cancer cells grow and spread, and promote inflammation in the brain leading to Alzheimer’s disease.” People without strong social connections are at a higher risk of sleep disorders, diabetes, rheumatoid arthritis, lupus, coronary heart disease, hypertension, and obesity, among a crop of other health issues. Loneliness, then, may inflame India’s rising communicable and non-communicable disease burden. Experts have flagged that diseases like cancer and diabetes are a ‘ticking time bomb’, and that health infrastructure should prepare for an ‘emerging dementia epidemic’. Mental health disorders — including depression, anxiety disorders, bipolar disorder, schizophrenia, and substance use disorders — too have risen steadily over the last few years.
Chronic illnesses may in turn exacerbate loneliness among people. The BMC Public Health study, conducted across Mumbai’s Chembur, Dadar and Bandra, found the level of loneliness increased threefold among household heads with two or more chronic diseases, in comparison to those without. Moreover, the odds of loneliness were almost three times higher among females as compared to males. The 2017 LASI found that loneliness also increased the odds of major depressive disorder and insomnia symptoms.
The need to address the loneliness epidemic also comes from institutional deficiencies: India lags with inadequate staff, medical infrastructure and budgetary allocation, a Standing Committee on Health and Family Welfare flagged in September. A 2019 Mariwala Foundation report found nearly 70%-92% of persons with mental illness who require care either do not have access to services, or — if receiving services — cannot access quality care that is affordable, available, and satisfactory. This jumble poses a “daunting challenge to contemporary Indian psychiatry,” researchers wrote in a 2017 paper.
India’s unique ‘loneliness epidemic’
Despite their public health burden, India and other low- and middle-income countries (LMICs) are seen as unlikely members of the loneliness cohort. Most global data on loneliness comes from studies conducted in industrialised nations where ageing and many socioeconomic stressors affect social networks. The social networks of LMICs are relatively unexplored exclaves, researchers concur. WHO last month clarified: “Contrary to the perception that isolation and loneliness primarily affect older people in high-income countries, they impact the health and well-being of all age groups across the world.”
Common trends between India and Western countries are demographic and medium: the burden is higher among older people, and social media has uniformly been linked to rising loneliness. A meta-analysis of 26 articles, with a sample size of 16,496 subjects, found “a moderate positive association” between internet addiction and loneliness. Indian parents are already concerned their children are spending too much time looking at digital screens as learning, entertainment, and social interactions have shifted ground to occupy digital spaces.
Divergent trends emerge when accounting for cultural and economic barriers. “Talking or even acknowledging loneliness has always been a taboo point in our society. The assumption is that because we are a collectivistic society and more ingrained in the community, loneliness is out of the question. But in fact, it is the opposite,” Dr. Thakore says. “For some of us, the feeling of community can bring its fears of judgement and question, if we express we are feeling lonely.” A 2023 study of mental health literacy in urban, rural and tribal parts of Kerala found people were likely to see poor mental health as a “collective problem” that reflects badly on the family, even impairing one’s marriage eligibility.
As with other low- and middle-income nations, loneliness is not equally distributed. A 2013 study connected loneliness with socioeconomic challenges like high poverty, income inequality, low education, high dependency ratio, lack of transportation, unplanned urbanisation, rapid industrialisation, and a deterioration in social capital. Different metrics show the COVID-19 pandemic has worsened income inequalities, adding to socioeconomic challenges. “Is loneliness a product of the systems around us, which can be exclusionary to so many people?” asked Shrinidhi Deshmukh, Program Associate of Disability and Mental Health at the Raintree Foundation in the Aspen report. “And if loneliness is also about skills, for example understanding how to deal with concerns around mental health and how to cope, then are these skills also built as a part of or as a result of access to the privileges that we have?”
Inequality fuels stigma too: anecdotal evidence illustrates the sentiment that loneliness is seen as a malady of the elite, and the priority for most Indians is to address basic needs, not the individual issues of mental health. “An increase in understanding the specific causes of why loneliness is occurring to us, for all our unique reasons is needed,” says Dr. Thakore.
Stigma, social inequality and the methodology of scientific research may also mean the surface of India’s experience of loneliness has barely been scraped. The scale is limited; a 2020 preprint review of loneliness research conducted in India included 12 papers which in total had a sample size of less than 4,000 people. The review precluded more than 1,200 research papers published online, excluding those that were non-empirical and did not appear in peer-reviewed journals; it also did not include papers outside of the English language. Longitudinal (which follows people over some time) or cross-sectional (across different sub-groups) surveys are few and far between. Without a national-level survey conducted in local languages, and questions modified to match people’s cultural context (‘mental health’ or ‘depression’ has no direction translation in India’s 22 regional languages), almost 60% of India which lives offline remains beyond the purview of research paradigms.
What should India focus on?
The WHO has established a Commission on Social Connection (2024–2026) with the intent of addressing loneliness from a public health lens. The Commission, among other things, will propose a global agenda on social connection and work to develop solutions targeting loneliness as a medical and social condition.
India’s response to the ‘loneliness epidemic’ has to first contend with two realities. Firstly, “India sees loneliness more as a symptom and a state of mind — rather than a condition itself, (in its own) of its right,” says Dr. Thakore. There is a need to study and treat loneliness with the same nuance one would apply while treating a migraine differently from a seasonal flu. India has launched suicide and mental health helplines and scaled up its digital mental health programming infrastructure; it is investing in mental healthcare facilities, training doctors and setting up health provisions in AIIMS too, a Union Minister told Parliament earlier this year. There are specific targets and measures of progress: by 2030, India wants to reduce suicide mortality by 10% under the National Suicide Prevention Strategy (NSPS). Dr. Thakore argues India needs to work on being more proactive and encouraging, because “when it comes to mental health, a direct dialogue and emphasis does not work...Suggestions such as physical exercise and spending time can help; at the same time, sometimes the root cause of loneliness needs to be found out and worked on.”
Thinking of loneliness as a distinct social and medical condition can help develop targeted interventions specific to people’s cultural context. An oft-cited intervention for loneliness is to spend time with family or loved ones, but in a society that sees loneliness or poor mental health as a ‘weakness’ or ‘laziness,’ family may offer limited respite. A study from August 2022 of 1023 female students of various universities/colleges across India, who lived at home during the lockdown, found “living with family members is not enough to deal with loneliness...Rather it requires a good relationship with family members, self-control, and a positive self-image.” Moreover, despite India’s fast-growing elderly population and reported accounts of loneliness among elder people, there is no prescribed framework — such as old age homes, community centres or affordable healthcare — dedicated to individually addressing loneliness.
Policymakers will also have to answer why India is lonely, tracing the lack of social connectedness to the roots of social inequity. “The problem is with social inequity,” Alok Sarin, Psychiatrist at Sitaram Bhartiya Hospital, says in the Aspen Institute report. Experts highlight the connection between rising farmer suicides due to the burden of seasonal droughts, or the suicides of daily wage or migrant workers who find themselves in distress. Surinder Jodhka, a professor of Sociology at JNU explained in an article that “their feeling of loneliness is more pronounced because of their disintegration at their village home as well as the lack of any family structure in the urban setting,” and may thus need a more tailored and targeted approach.
“It’s an unspoken truth that people belonging to communities who haven’t had their voices heard enough in the mainstream, go through loneliness intensely, and have higher, interconnected social care needs,” says Dr. Thakore.
The 2022 study of loneliness in Mumbai studied slum rehabilitated dwellers and found people’s loneliness was partly brought about by the “unfavourable built environment, which reduces the sensory connectedness and restricts traditional flows with other neighbours due to random allocation of flats.” It hampered their collective identity, weakened their social support network, and significantly led to loneliness. Eventually, they wanted to go back to living in horizontal slums again. The researchers recommended community psychological intervention along with enhanced civic engagement. Put differently, the study underscored that India’s loneliness strategy may have to heal the community by responding to structural inequities, rather than trying to fix the individual through clinical means only.
Activists, including the Campaign to End Loneliness, endorse a dual model -- complementing solutions focused on addressing individual deficits, like psychological therapy and befriending services, “with interventions that address deficits in communities.” The latter pertains to investing in social connections: building safe spaces such as LGBTQ+ venues, community facilities, co-housing design, green spaces, effecting anti-discrimination and equality laws, and “tackling the causes and consequences of poverty.”
Given the stigma and healthcare inequities, India will have to engage in “a dynamic process to continuously figure out what can and cannot work” as loneliness comes into public health’s view, says Dr. Thakore. A helpful start: to reiterate, over and over, that “loneliness is real, and not just a state of mind.”
“Young people are not immune to loneliness. Social isolation can affect anyone, of any age, anywhere...Investments in social connection are critical to creating productive, resilient and stable economies that promote the well-being of current and future generations.”Chido Mpemba, African Union Youth Envoy.
