Social isolation and loneliness affect large numbers of people across the lifespan and are widely recognised as important public health issues. Although they are understood as distinct conditions, they have both been found to predict a range of physical and mental health problems, such as premature mortality and depression (Holt-Lunstad et al., 2015; Beller & Wagner, 2018). Take a look at Timothy Matthews’ blog Tackling Loneliness in People with Mental Health Problems (Matthews, 2018) for more on the relationship between loneliness and mental health.

High rates of loneliness and social isolation have been found in migrants and people from ethnic minority backgrounds. For example, research in the UK has found that minority elders have high rates of loneliness and new migrants, asylum seekers and refugees have high levels of social isolation (Victor, Burholt & Martin, 2012; Strang & Quinn, 2014). Such populations may face particular risks leaving them vulnerable to experiencing social isolation and loneliness such as limited language skills and exposure to racial discrimination (McCabe et al., 2013; Wallace, Nazroo & Bécares, 2016). From our own clinical experience we’ve seen how the process of applying for settlement in the UK can restrict an individuals’ ability to engage in society, leading to barriers in developing social networks, for example as a result of not being able to work.

Despite these findings there is currently a lack of research exploring effective interventions that reduce social isolation and loneliness in migrants and people from ethnic minority backgrounds. To address this gap in the literature Sarah Salway and colleagues (2020) set out to synthesise the current evidence-base, understand the function and effect of current interventions and explore insights from members of the public and community organisations.

Methods

This review acknowledges that social isolation and loneliness are complex and multifaceted problems. The authors wished to gain a distinct understanding of how and why interventions in particular contexts play out as they do. They also wanted to identify any missed chances to protect against isolation and loneliness.

Twelve comprehensive and inclusive research questions were developed that clearly identified how research into loneliness was to be reviewed. Examples of questions asked include the effectiveness of interventions, the costs associated with interventions, and the health and wellbeing outcomes of interventions.

Literature search

The review appeared to use an inclusion criteria that would result in suitable papers. They used a generalised and specific search of electronic databases. The review used PRISMA guidelines to process the searches. However, it was not clear what types of studies the reviewers wanted to include. Three categories of paper were chosen: i. intervention – evaluation, ii. intervention – descriptive and iii. non-intervention empirical.

The data was extracted and the authors moderated papers based on relevance (articulated in terms of potential contribution to analysis and/or synthesis), rigour (whether or not the method used to generate data is credible and trustworthy) and richness (the extent to which a quantitative or qualitative study contributed to an understanding of the phenomena of interest or to the mechanisms by which intervention achieves its effects). The effectiveness was assessed using the Cochrane Risk of Bias Tool for all Randomised Controlled Trials. Other study designs were simply noted and the design was described.

Consultation panel

Three consultation panels were held with participants who self-identified as a migrant and/or having an ethnic minority identity. These panels provided commentary and critiqued the results yielded by the review.

The data extracted from the literature on intervention papers was coupled with contributions from the consultation panel. This allowed for the development of factors that affect both the risk of loneliness and the operation of loneliness.

Results

Theory development

Loneliness needs careful consideration when thinking about migrant and ethnic minority people. The authors confirmed the failing of existing theories of ‘loneliness’. More attention needs to be paid to the experience of negative social ties and interactions, and low self-worth. Both of these factors increase the likelihood of loneliness in ethnic minority groups.

Intervention effectiveness

Eight different types of intervention were identified that could potentially reduce loneliness. Three were common:

• befriending (a one-to-one supportive relationship),
• shared-identity social support groups (similar people coming together to support each other and engage in meaningful activities) and
• intercultural encounters (people interacting across ethnic or cultural differences).

There was limited evidence to suggest if these interventions worked in practice. UK based research was particularly sparse. However, the research did suggest that shared-identity social support groups can be effective. There is also some evidence to suggest befriending and intercultural encounters were effective.

Data from the literature review and the consultation panel workshops suggest that many factors increase the risk of loneliness. Racism increases the risk of loneliness by interpersonal abuse and organisational processes that increase discrimination. No intervention was found to be successful at tackling racism.

Conclusions

The authors concluded that when considering migrant and ethnic minority loneliness, four additional factors should be recognised:

1. positive social ties and interactions,
2. negative social ties and interactions,
3. self-worth and
4. appraisal of existing ties.

The current study highlighted that a wide range of interventions have been developed to potentially combat loneliness. Of these interventions, befriending, shared-identity social groups and intercultural social groups were most common. However, the UK evidence base was very limited, and there was inadequate quantitative or long-term evidence of effectiveness.

Strengths and limitations

Strengths

• This study focuses on migrant and ethnic minority populations, groups which may be more at risk of experiencing loneliness and social isolation. Currently, there is a lack of research investigating such groups, so it is important to expand the evidence-base in this area.

• The current study utilised consultation panels, giving the researchers the opportunity to draw on real world experiences. The consultation panels were made up of people from diverse backgrounds increasing generalisability of results. A key strength was the valuable insights gained, for example, nuances in barriers to accessing interventions such as the inability to attend both language classes and social groups for those with child care responsibilities, the long unsociable hours worked by Chinese men and the hostile environment towards migrants which discourages them from accessing services.

Limitations

• The consultation panels did not include those over the age of 54. There is a large amount of evidence that loneliness and social isolation is highly prevalent in older adults (Victor & Yang, 2012). Therefore, it is important their experiences and views are taken into account when thinking about interventions.

• The decision not to include religion or religious beliefs as search terms in the literature review may have led to relevant studies being excluded. This is further highlighted by the consultation panels identifying places of worship as important for migrant and ethnic minority populations to feel safe and to connect with others.

Implications for practice

• The conceptualisation of loneliness using the four proximate determinants model is a useful framework for both researchers and practitioners: increase positive social ties and interactions, reduce negative social ties and interactions, increase self-worth, and enhance positive appraisal of existing social ties and interactions. The model is helpful in guiding which interventions future research should focus on, and as the authors of the study mention, for practitioners the model could be used to identify causes of loneliness and tailor subsequent solutions.

• Shared identity and social support groups had the strongest evidence for positive outcomes. Therefore, it is important that research continues to evaluate this type of intervention and that commissioners consider that shared spaces which feel safe and non-judgemental are important in increasing positive social ties and interactions.

• Insights from the consultation panels indicated that racism, both systemic and interpersonal, is a widespread problem, contributing to loneliness and a sense of not belonging, as well as being a barrier in accessing services for migrant and ethnic minority people. Both commissioners and practitioners should be working to put an end to hostile environments and more effort should be given to consulting with migrants and people from ethnic minority backgrounds about how to create safe spaces.

Statement of interests

Hannah Cocker is a member of the Loneliness and Social Isolation in Mental Health Research Network UCL.

Links

Primary paper

Salway, S., Such, E., Preston, L., Booth, A., Zubair, M., Victor, C., & Raghavan, R. (2020). Reducing loneliness among migrant and ethnic minority people: A participatory evidence synthesis. Public Health Research, 8(10), 1-246.

Other references

Beller, J., & Wagner, A. (2018). Disentangling loneliness: Differential effects of subjective loneliness, network quality, network size, and living alone on physical, mental, and cognitive health. J Aging Health, 30(4), 521–539.

Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on psychological science, 10(2), 227-237.

Matthews, T. (2018). Tackling loneliness in people with mental health problems. National Elf Service.

McCabe, A., Gilchrist, A., Harris, K., Afridi, A., & Kyprianou, P. (2013). Making the Links – Poverty, Ethnicity and Social Networks. York: Joseph Rowntree Foundation. 

Wallace, S., Nazroo, J., & Bécares, L. (2016). Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. Am J Public Health, 106 (7), 1294–300.

Strang, A., & Quinn, N. (2014).  Integration or Isolation? Mapping Social Connections and Well-being Amongst Refugees in Glasgow.

Victor, C. R., Burholt, V., & Martin, W. (2012). Loneliness and ethnic minority elders in Great Britain: An exploratory study. J Cross Cult Gerontol, 27, 65–78. DOI 10.1007/s10823-012-9161-6.

Victor, C. R., & Yang, K. (2012). The prevalence of loneliness among adults: A case study of the United Kingdom. The Journal of psychology, 146(1-2), 85-104.

Photo credits

• Photo by diGital Sennin on Unsplash
• Photo by Alexis Brown on Unsplash
• Photo by Vlad Sargu on Unsplash
• Photo by Hudson Hintze on Unsplash
• Photo by Ricardo Gomez Angel on Unsplash