Male Loneliness: Four studies that shifted my perspective
OPINION
Dr John Ratcliffe is a Research Fellow in the School of Healthcare. As part of Men's Health Month, he discusses his research into the complex issue of loneliness in men. In this piece, he reflects on how loneliness intersects with masculinity, mental health, and social worth, and why tackling it requires more than just improving social relationships.
Loneliness is a difficult enough condition to deal with by itself, but as if that wasn’t enough, it is also statistically associated with all kinds of negative health outcomes, including cardiovascular disorder, dementia, and even death.
As it’s Men’s Health Month, I thought I would summarise the research I’ve done on loneliness in men - why I did it, what I found, and why tackling it isn’t just about social relationships, but a multifaceted issue in which pride, purpose, social justice, and even neurological mechanisms have their part to play.
Mental health has long been important to me, and older research suggesting men may be less inclined to admit or seek help for mental health problems, or linking alcoholism and drug abuse to masculinities and mental health, influenced me deeply and personally.
Back in 2016, I worked part-time on a small report evaluating a care programme for Age UK, and it struck me that loneliness was absent from the research on men’s mental health, whilst men were marginal in studies of ageing and loneliness. So, through 2017-18, I conducted interviews with men aged 65+, and had a colleague look through some older interviews. In these, the men we spoke to often understood loneliness as a subordinating stereotype of ageing that was incompatible with masculine ideals of responsibility and caring for others. Doing something about loneliness, then, was about two things: spaces where men felt comfortable being emotionally tactile; and opportunities to rejuvenate a sense of ‘social worth’.
"Studies have tended to define loneliness as a subjective perception of insufficient relationships, distinct from isolation which is an objective lack of social contact."
This work threw up several questions more suited to big data. After all, we might think men are reticent to say they are lonely, but is this actually true en masse? To find out this and more, I conducted a statistical study looking at sex differences in loneliness using the English Longitudinal Study of Ageing, a large dataset of nearly 7000 men and women aged 50+. This uncovered five striking findings:
One, older men were less likely to state they were lonely as a response to a question using the word ‘lonely’ than when responding to a scale measure that did not use the word [1]. It seems, then, that these men were more reticent to state they are lonely.
Two, lonely older men drank more alcohol than older men who were not lonely, whereas lonely older women drank less than their not-lonely counterparts [2]. Men, perhaps, turn to alcohol to deal with loneliness, whereas women’s drinking is more associated with positive socialising.
Three, older men who cohabited with a partner were less lonely than cohabiting older women, whereas previously married but not cohabiting older men were lonelier than women in this situation. Evidence therefore suggested that men tend to be more reliant on spouses/partners for preventing loneliness.
Four, some evidence was found to suggest older men’s worse friendships mediated this association. In other words, men’s greater reliance on partners can partly be attributed to the fact that their friendships aren’t as good.
Fifth, severely isolated older women were 758% more likely to show a score of lonely than other women, whereas severely isolated older men were zero % more likely to attain a score of lonely. Either older men are more comfortable alone, or their distress isn’t being captured by the measures we used.
[1] The direct question asked how often a person felt lonely (rarely – sometimes – often) and the indirect questions consisted of the 3-item UCLA loneliness scale.
[2] This statistic used a measure of alcohol consumed in the last 7 days, therefore a measure of loneliness in the last 7 days was used. This used the word ‘lonely’.
Questions remained. Why would men act in ways that harm themselves, such as drinking or not seeking help? Why be reticent to state loneliness on a confidential survey? Why were men’s friendships worse? We conducted another set of interviews, this time with a diverse group of men of different ages, ethnicities, sexualities, and physical abilities. Following these, we concluded that men often understood loneliness as a combination of social worth and positive occupation (i.e., positive mental stimulation from a task or activity). These resulted from social connections, and all were impacted by masculine norms and values (see figure below).
Turning back to the questions, then, if social worth is vital to non-loneliness, and loneliness is itself not ‘worthy’, then it makes sense that men would present themselves as not lonely regardless of their emotional state (even on a confidential survey). If invulnerability is perceived as the norm, it is no wonder intimate friendships are harder to attain and alcohol is more appealing. And if masculine roles include building a classic family setup, as it did for many of the men interviewed, a tendency to rely on spouses/partners is equally unsurprising.
This is also where we realised a shift in our perspectives was necessary to understand and combat loneliness. Studies have tended to define loneliness as a subjective perception of insufficient relationships, distinct from isolation which is an objective lack of social contact.
In this study, though, being positively occupied wasn’t just about distraction, it was an arbiter of non-loneliness, such that loneliness was almost synonymous with boredom.
It is for this reason I say that neurological mechanisms matter – without positive stimulation, loneliness occurred, and this makes sense if you consider loneliness to be an evolved signal to improve social connections (as many do). Nevertheless, this does not mean that loneliness all comes down to biology. Rather, it is about ensuring that sense of social worth I’ve been banging on about, and enough positive stimulation to avoid the loneliness that arises from isolation. And this means social justice – without a fair and respected role within society, and the means to form connections that facilitate positive occupation, loneliness will occur.
"Doing something about loneliness, then, was about two things: spaces where men felt comfortable being emotionally tactile; and opportunities to rejuvenate a sense of ‘social worth’."
Of course, just because the research was with and about men, it doesn’t mean the conclusions always and only relate to men. Indeed, social worth and positive mental stimulation are surely relevant to everyone. Eventually, this led me to where I am now – at the very beginnings of research into combatting loneliness in care homes. This remains a population vulnerable to loneliness, yet much of the research focuses on activities intending to build relationships or change those cognitive perceptions. As the above work with men suggests, this may not get to the nub of the matter. We intend to conduct a review and consultation, leading to the design of a new intervention/strategy. But this is a way off. In the meantime, I leave you with a valuable lesson my research exploring loneliness has taught me. It is always just about the individual, but it is never just about the individual.