While society adjusts to the new normal of work, family, social interaction, along with an easing of health and safety protocols post-pandemic, behavioral health leaders say the residual impact on increasing loneliness among all age groups and populations can’t be ignored.

Research has found that social isolation significantly increases a person's risk of premature death from all causes, a risk that may rival those of smoking, obesity, and physical inactivity.

For example, a study, published by Jama Network Open establishes a link between social isolation and blood-clotting protein levels which can contribute to stroke or heart attacks in older women.  Being lonely could trigger flight and fight stress levels of fibrinogen which usually spikes in case of blood loss and injury.

Most of us understand that getting older can mean a loss of friends and a greater feeling of loneliness but in recent years, researchers have found millennials are feeling lonelier than Baby Boomers.

According to a study by Cigna, young adults are twice as likely to be lonely than seniors. Seventy-nine percent of adults aged 18 to 24 report feeling lonely compared to 41% of seniors aged 66 and older. This is consistent with earlier research.

Morgan Hurtado of Bloomington, Illinois is in her early 30s and has three younger boys. She works days. Her husband works second shift. Weekends are spent with her oldest boy’s travel soccer team. But Hurtado lives where she grew up and has longtime friends nearby. However, she says at least one other millennial friend has moved and feels very disconnected.

“I see him a lot on social media just doing things by himself or maybe on Snapchat just sitting at home, watching TV, not really going out and having face-to-face interactions in a large group setting where there, being a metropolitan area, there’s plenty of opportunity to do that,” she shared.

 OSF HealthCare Behavioral Health Director Cheryl Crowe says many millennials are focused on developing and advancing in their careers which often takes them away from their family and friends.

“We’re now a very mobile workforce. Previously the kids who came back home, worked and they were near family, and they still had their high school friends. That dynamic is fading quite a bit,” she suggested.

Crowe points out loneliness is not about being physically alone, but it speaks to a loss of feeling connected through meaningful relationships. Other studies have decisively linked heavy social media and internet use with both loneliness and depression. Crowe says it’s certainly a contributing factor with an age group which tends to spend more time on the internet and social media.

“When you are on social media, a lot of what you’re seeing is not reality. What we post are our best situations, our best self, our best opportunities and often when we look at that, we may not measure up to what our friends are doing or what our acquaintances are doing,” according to Crowe.

As Hurtado began reflecting, the mom realized she mostly relies on her family for intimate discussions and support. She is challenging herself to get out of her comfort zone and make more in-person connections.

“Something I’m trying in my personal life as sort of an experiment if you will, is to limit my social media interactions or just limit my time as a whole on social media, forcing me to have those in-person interactions more often and maybe leading to new relationships, friendships.”

Pandemic effect on older seniors in nursing homes

Newer research from the AARP Foundation  showed the consequences of isolation and loneliness on nursing home residents’ quality of life are alarming: 50% increased risk of developing dementia, a 32% increased risk of stroke and a nearly fourfold increased risk of death among heart failure patients. That study was conducted in 2020, the first full year of the COVID-19 pandemic.

Dr. Denise Dechow (pronounced DECK-oh), DO, a psychiatrist at OSF HealthCare who specializes in geriatric care, says long term care shutdowns left a lasting impact. Patients who had trouble hearing and seeing really struggled with the technology that allowed virtual visits with family, friends or medical providers.

Some nursing homes with COVID-19 outbreaks required patients to remain in their rooms, so residents experienced even more isolation than usual. That, in turn, affected their physical and mental health, Dr. Dechow says.

“Feelings of loneliness can lead to increased risk of depression, anxiety, substance use disorder, aggression, impulsivity and suicidal thoughts.”

AARP Foundation analyzed federal data and found 1 in 8 nursing home residents passed away from COVID-19. At the same time, the pandemic prevented many people from gathering and holding funerals. That was particularly hard on older seniors who saw their fellow long term care residents, or in some cases, lifelong friends pass away.

Dr. Dechow says grieving is more challenging without access to the rituals that might make it more bearable. There is a condition called Prolonged Grief Disorder (PGD). In complicated grief, painful emotions are so long lasting and severe, individuals have trouble recovering from the loss.

“And this has to do with prolonging symptoms of anxiety, depression, sadness and sleep disturbance. What we notice is that we can’t not participate in these rituals. These are important and must take place, even if it’s a year after someone has passed.”

The risk of PGD is higher in older adults and those with a psychiatric history. Dr. Dechow says health care providers are going to have to recognize symptoms of this relatively newly defined disorder and make proper referrals.

Are you at risk for loneliness and social isolation? Check out this National Institutes of Health infographic for a list of risk factors and 5 ways to stay more connected.

OSF Silver Cloud is a free online tool and phone app to help manage the feelings and causes of depression, anxiety or stress. OSF HealthCare also offers free behavioral health navigation services to help understand all resources available to you.

Video clips with Morgan Hurtado 

Video clips with  Cheryl Crowe

Video clips with Dr. Denise Dechow, (pronounced DECK-oh), DO

There is no doubt there is a mental health pandemic in this country – a crisis that was already brewing and then made worse by the COVID-19 pandemic.

That’s from Dr. Kyle Boerke, the director of Behavioral Health Outpatient Services at OSF HealthCare.  He says innovative solutions are needed to meet the exponentially-growing demand for mental health interventions and treatment, particularly among children and teens.

Dr. Boerke cites as evidence, a concerning report from the World Health Organization (WHO) released last month.

“Identifying a 25% increase in anxiety year-over-year and that was on top of a 50% increase from the year prior to that so if you take a look at the numbers, we truly are not just in a COVID-19 pandemic but a behavioral health pandemic as well.”

An average of 16 children are admitted to an OSF hospital every day for a mental, emotional, or behavioral health diagnosis. Last year, nearly 10,000 children sought outpatient behavioral health services from OSF and many more are on waiting lists.

Sister M. Pieta Keller is an innovation biomedical engineer at Jump Simulation, and the project manager and engineer for a new Community Health Advocacy (CHA) grant. She says the project will involve developing an algorithm, using data from school records, to reach students before they are in crisis – ideally before they end up in the emergency department for a suicide attempt or extreme anxiety.

This project is a collaboration between OSF HealthCare and the University of Illinois Chicago (UIC). It’s an attempt to reach students, even those who might not be an OSF patient, where they spend a majority of most days – in school during the school year.   

Researchers will work with select middle and high schools in the Catholic Diocese of Peoria and Chicago archdiocese, along with, potentially, some public schools, to use de-identified student data that national studies reveal are indicators of behavioral health issues. Those include a drop in grades and attendance, behavior marks, and even socio-economic factors that are associated with mental health challenges.

Sister M. Pieta says as OSF and UIC work to develop the algorithm, its criteria would be flagged in the school’s information management system so teachers, counselors, and even coaches can see when kids might need additional support.
“They can decide if those flags, those compassion alerts, apply or if that student just has senioritis, or is just underperforming at this moment for a small reason and not a big deal, or if they were absent because they were doing school activities for so long or whatever the case may be. So they can kind of be a first discerner and say ‘Are these alerts?’ and intervention is appropriate and necessary?”

Approach could help those privately struggling

Many children with anxiety struggle privately. Dr. Boerke, who is also involved in the research, points out a model that can process so much data could be more effective in picking up slight changes over time that signal a student might be suffering.

“The beauty of this early identification and detection is we’re going to be able to see those small slips in grades over time, and a child who would have gone under the radar because they’re so quiet out of fear that the attention will be brought to them – and they don’t want that because of their anxiety – they’re going to be able to be identified and receive the help they need as well.”

Dr. Boerke is excited about this kind of innovation – developed with clinicians, engineers, computer and data scientists, and social workers who understand the dynamics of an urban population, –

which could allow for a proactive approach.

“The older they get, the more ingrained those behaviors and those cognitions become; it’s harder work. So, if we can catch it as early as possible we’re going to be in a better position to provide these kiddos with the care they need.”

Sister M. Pieta says the research team plans to submit a proposal to the Institutional Review Board (IRB), which oversees research involving individuals, to ensure their methods and data collection are aligned with ethical standards, including protections required by federal laws regarding student and health care patient privacy.

Only teachers and others with authorized access to student records would be provided with alerts.  If parental consent is given for the program, digital and in-person resources can be shared with the student.

“Existing resources in all areas of life, whether it’s in mental health, whether it’s in emotional supports, or even physical and spiritual support; we want to connect them to existing, vetted resources that are age-appropriate.”

Sister M. Pieta says the effort will leverage evidence-based interventions, including OSF SilverCloud, a behavioral health app that has proven to reduce symptoms of stress, anxiety and depression in adults.

“So we’ve seen the advantages that it’s brought to adults, and we want to reach our children with that same care, if not more care, because they’re more vulnerable and they’re at a time in their life when they really need that help; that additional support, that additional connection – that heart connection that we’re trying to establish.”

OSF is seeking additional outside funding through a separate innovation challenge that could bring more resources to creating, testing, and fully integrating the algorithm with school information management systems.

Dr. Kyle Boerke, director of Outpatient Behavioral Health Services, OSF HealthCare

Sister M. Pieta Keller, innovation biomedical engineer, OSF Jump Simulation