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EDITORIAL BOARD Irene Anderson, Principal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Freelance Lecturer and Writer Dimitri Beeckman, Professor of Skin Integrity and Clinical Nursing, Ghent University, Belgium Jacqueline Boulton, Lecturer in Adult Nursing, Faculty Lead for Student Mobility, Electives and Global Health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London Beverley Brathwaite, Visiting Senior Lecturer, Middlesex University Nicholas Castle, Head of Professions/ Assistant Executive Director, Hamad Medical Corporation Ambulance Service, Qatar Jothi Clara J Michael, Director of Nursing, IHH Healthcare, India Emma Collins, Nurse Consultant, Sexual Health in Plymouth, University Hospitals Plymouth NHS Trust Alison Coull, Lecturer, Queen Margaret University, Edinburgh Angela Grainger, Senior Lecturer, BPP University Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Barry Hill, Director of Nursing, Midwifery and Health Employability, Northumbria University, Newcastle upon Tyne Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Jacqueline Leigh, Professor, Director Nursing and Midwifery Education, Edge Hill University, Lancashire Joanne McPeake, Acute Specialist Nurse/ Senior Staff Nurse in Critical Care; Honorary Lecturer/Practitioner in Critical Care, University of Glasgow John McKinnon, Senior Lecturer, School of Health and Social Care, University of Lincoln Michelle Mello, Deputy Director: Workforce Development/National Clinical Lead, Personalised Care Group, NHS England/ NHS Improvement Aby Mitchell, Professional Lead for Simulation and Immersive Technologies, and Senior Lecturer, Adult Nursing, University of West London Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Hilary Paniagua, Principal Lecturer/Head of Doctoral Studies Faculty of Health & Well Being at the University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Kendra Schneller, Nurse Practitioner, Health Inclusion Team – Vulnerable Adults and Prevention Services, Guy’s & St Thomas’ NHS Foundation Trust John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Jamie Waterall, Deputy Chief Nurse, Public Health England; Honorary Professor, University of Nottingham Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Research Fellow, Oxford Brookes University

The invisible wound Kimberley Cairns, Wellness Consultant, Eden Wellstyle (kimberley@edenwellnesstherapies.me.uk)

Loneliness, an often neglected but critically important emotional state, was the theme of the 2022 Mental Health Foundation (MHF) awareness week last month (#IveBeenThere).At the beginning of the pandemic, 5% of UK adults reported feeling lonely ‘often’ or ‘always’, or a similar proportion to 2016-2017. By February 2021, this had risen to 7.2%, representing 3.7 million adults (MHF, 2022a).After lockdown, 41% of adults in the UK across all age ranges and communities reported feeling lonelier since lockdown, with one-third feeling that their loneliness will get worse (British Red Cross, 2022).

As part of Mental Health Awareness Week, the MHF (2022b) published a report citing loneliness as a leading public health challenge of our time, with 1 in 4 adults affected.With no single cause or solution, it has been described as the feeling we get when our need for rewarding social contact and relationships is not met. Research shows a clear link between loneliness and mental health issues, and the physical health effects appear to be comparable to smoking 15 cigarettes a day (Dyal and Valente, 2015). Negative health effects of loneliness include high blood pressure, high cholesterol, obesity, poor nutrition, vasoconstriction and an increased inflammatory response in the body.Another effect can be a rise in cortisol levels, which, if present over a prolonged period, can cause anxiety, depression, suicidal ideation, digestive problems, heart disease, sleep problems and weight gain.

Those affected by loneliness can find it harder to enjoy things so they tend to avoid social situations, causing a further decline in mental health and deepening feelings of loneliness. Deficits in motivation, exercise and a general decline in energy and morale have also been noted in those affected, which can seriously impact on self-care, as well as an increase in risk-taking behaviours and lower concordance with medical treatments (Holt-Lunstad, 2018).

One misconception is that loneliness is a choice, but it can be forced on any of us in any circumstances.The stereotypes around who feels lonely can make it harder for people to recognise it in themselves or in others. This leaves gaps in the way we, as a society, can respond. If we are to provide a buffer against the negative effects of loneliness on our mental health, we must challenge the stigma around it and accept that certain life events and factors increase our chances of developing severe and lasting loneliness, which is different to feelings of isolation. Known risk factors include being aged 16-24

years, single, unemployed, being a carer, living alone, living in rented accommodation, being from an ethic minority group and/or being LGBTQ+.

The effects of loneliness can be overlooked, especially among the older population.The data are distressing: 1 in 5 older people in the UK live with depression (British Geriatric Society/Royal College of Psychiatrists, 2019). Explanations for greater loneliness in this age group have included socio-economic factors and challenging life events such as the loss of a loved one or spouse, retirement, relocation or loss of independence due to illness or disability.

As well as being deeply distressing for individuals, loneliness puts enormous pressure on healthcare and public services, given the costs associated with the aforementioned comorbidities, additional GP visits, community nursing, longer hospital stays, and the increased likelihood of requiring residential care.

Social relationships do not solely affect individual emotional wellbeing, they also affect long-term mental health outcomes and communities (Barreto, et al, 2021).A lack of social connection is as a serious risk factor, yet social aspects can often be overlooked in healthcare practice, when in fact this could be the required antidote.The stress-buffering effects of social re-connection must not be underestimated. Social prescribing puts emphasis on building social connections that can be positive for positive mental health, quality of life and longevity. Nurses are uniquely placed to identify, prevent and mitigate the adverse effects of loneliness, and they can offer lifelines by way of personalised care to alleviate this painful experience. It is crucial that we empower nurses, and other health professionals, to be confident to ask themselves, their colleagues, their family, friends and patients one simple question: How often do you feel lonely? BJN

Barreto M,Victor C, Hammond C, Eccles A, Richins MT, Qualter P.

Loneliness around the world: age, gender, and cultural differences in loneliness. Pers Individ Dif. 2021;169:110066. https://doi. org/10.1016/j.paid.2020.110066 British Geriatric Society, Royal College of Psychiatrists. Collaborative approaches to treatment. Depression among older people living in care homes. 2019. https://tinyurl.com/59kr9wkn (accessed 16 June) British Red Cross. Life after lockdown: tackling loneliness. 2022.

https://tinyurl.com/7w7y2ubz (accessed 16 June 2022) Dyal SR,Valente TW.A systematic review of loneliness and smoking:

small effects, big implications. Subst Use Misuse. 2015;50(13):16971716. https://doi.org/10.3109/10826084.2015.1027933 Holt-Lunstad J.Why social relationships are important for physical health: a systems approach to understanding and modifying risk and protection. Annu Rev Psychol. 2018;69:437-458. https://doi. org/10.1146/annurev-psych-122216-011902 Mental Health Foundation. Loneliness England policy briefing. 2022a.

https://tinyurl.com/3bbmdm7v (accessed 14 June 2022) Mental Health Foundation. All the lonely people. 2022b. https://tinyurl.

com/3schvyn5 (accessed 14 June 2022)

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British Journal of Nursing, 2022, Vol 31, No 12

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