Winter 2025 - Vol. 20, No. 4 Loneliness and social isolation are significant public health concerns. Isolation has been associated with a range of adverse health outcomes, including increased risk of stroke, impaired cognitive functioning, and reduced physical functioning.¹ Similarly, loneliness is linked to poorer mental health outcomes, such as elevated depressive symptoms, anxiety, lower overall ratings of life satisfaction,² and suicidality.³

About one-third of adults in the United States say they feel lonely, and one in four reports not having enough social or emotional support.⁴ Though anyone can experience loneliness or isolation, certain factors — increased age, financial barriers, disability status, mental or physical health concerns, being an LGBTQ+ person, and the personal experience of discrimination or marginalization — may increase vulnerability.¹

While loneliness is normal, it can be positively altered. First, we can attend to whatever shame and anxiety may be associated with isolation by conveying compassion and humanity. We can also reinforce that strong social connections correlate with positive mental health outcomes and an increased likelihood of asking for help when needed.⁵

Social support and connection allow for the development and use of healthy strategies such as emotion expression and regulation.⁶ Thus, to enhance whole-person wellness, clinicians can help patients enhance social connection and community belonging.

One’s community may be a place — a neighborhood or a shared environment — or the bonds that exist with those around us, grounded in mutual understanding and support. Having knowledge of patients’ relationships, sources of support, and community connections can provide essential insight into their overall well-being. Framing inquiry regarding social connection as a means of promoting and protecting health can be a meaningful way to approach the conversation.

Clinicians can help patients understand their sense of belonging by asking thoughtful questions about where they feel supported and comfortable, to be themselves and be valued by others. While some may respond easily, others may report they do not feel this way in any of their current environments. Lack of connection may result from a history of interpersonal trauma or other challenging circumstances. Social drivers of health, such as inadequate finances or childcare, or overwhelming caregiver responsibilities may exacerbate feelings of isolation.

Depending on the patient’s individual situation, a primary care physician may help with problem-solving, yet collaborating with a mental health professional may also be beneficial. This may be especially true if a patient’s isolation is closely connected to a diagnosis of a mental health disorder. Understanding what a patient perceives to be an ideal level of social connection and what are barriers for them is key.

From there, clinicians can help discern how to close gaps by initiating, for example, a referral to a support agency or helping identify opportunities for activity in the community. It is vital that we suggest steps that are reasonable to the patient and agree upon goals that are both motivating and realistic. For instance, a patient who has experienced long-term isolation might be hesitant to immediately join a group activity; it might be best for them to start by trying to leave their home consistently or make phone calls. Listening to patients will help guide recommendations.

It is also possible that a feasible action step would be for the patient to strengthen or revisit former positive friendships or connections. Clinicians who understand that the strength of any relationship can fluctuate over time may appreciate that patients may need encouragement to take the first step.

Once this conversation is initiated, it is important to follow-up at subsequent encounters. When we are more aware of patients’ social goals, it is easier to identify potential steppingstones. Clinicians who understand what is available in the patient’s community are better equipped to help their patients with social isolation. Libraries and other community spaces are often a good place to start because they can feel comfortable. Some patients may have a special interest or piece of their identity that can be supported through connection with specific individuals or organizations. Understanding patient interests and needs helps us make better suggestions. Nevertheless, it may take time for patients to find what feels like their own best fit.

Promoting social connections and community engagement is an important public health objective for medical and mental health professionals. Facilitating discussions with patients about opportunities to enhance social participation and connectedness can contribute to improved psychological and physical well-being. Helping patients strengthen and reinforce social connections can be a process — but one well worth the effort.

REFERENCES
1. Our Epidemic of Loneliness and Isolation: The U.S. Surgeon General’s Advisory on the Healing Effects of Social Connection and Community. U.S. Department of Health and Human Services. 2023. Accessed November 10, 2025. https://www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf
2. Hong JH, Nakamura JS, Berkman LF, et al. Are loneliness and social isolation equal threats to health and well-being? An outcome-wide longitudinal approach. SSM Popul Health. 2023;23:101459.
3. Alothman D, Lewis S, Card T, Tyrrell E, Fogarty AW. The association between living alone, loneliness and suicide mortality and effect modification by age: a case-control study. J Affect Disord. 2024;352:278-280.
4. Risk Factors for Loneliness and Social Isolation. Centers for Disease Control and Prevention. 2024. Accessed November 9, 2025. https://www.cdc.gov/social-connectedness/risk-factors/index.html
5. Ishikawa A, Rickwood D, Bariola E, Bhullar N. Autonomy versus support: self-reliance and help-seeking for mental health problems in young people. Soc Psychiatry Psychiatr Epidemiol. 2023;58(3):489-499.
6. Lopez RB, Courtney AL, Liang D, Swinchoski A, Goodson PN, Denny BT. Social support and adaptive emotion regulation: links between social network measures, emotion regulation strategy use, and health. Emotion. 2024;24(1):130-138.
 

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