Psychological Medicine

Original Articles

Increased risk of mortality associated with social isolation in older men: only when feeling lonely? Results from the Amsterdam Study of the Elderly (AMSTEL)

T. J. Holwerdaa1a2 c1, A. T. F. Beekmana2a3, D. J. H. Deega2, M. L. Steka2a3, T. G. van Tilburga2a4, P. J. Vissera2, B. Schmanda5, C. Jonkera2 and R. A. Schoeversa1a2a6

a1 Department of Psychiatry, ARKIN Institute of Mental Health Care, Amsterdam, The Netherlands

a2 EMGO Institute, Vrije Universiteit Medisch Centrum Amsterdam (VUMC), Amsterdam Study of the Elderly (AMSTEL), Amsterdam, The Netherlands

a3 Department of Psychiatry, INGEEST Institute of Mental Health Care, Amsterdam, The Netherlands

a4 Department of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands

a5 Department of Psychology, Universiteit van Amsterdam, Amsterdam, The Netherlands

a6 Department of Psychiatry, Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands


Background Loneliness has a significant influence on both physical and mental health. Few studies have investigated the possible associations of loneliness with mortality risk, impact on men and women and whether this impact concerns the situation of being alone (social isolation), experiencing loneliness (feeling lonely) or both. The current study investigated whether social isolation and feelings of loneliness in older men and women were associated with increased mortality risk, controlling for depression and other potentially confounding factors.

Method In our prospective cohort study of 4004 older persons aged 65–84 years with a 10-year follow-up of mortality data a Cox proportional hazard regression analysis was used to test whether social isolation factors and feelings of loneliness predicted an increased risk of mortality, controlling for psychiatric disorders and medical conditions, cognitive functioning, functional status and sociodemographic factors.

Results At 10 years follow-up, significantly more men than women with feelings of loneliness at baseline had died. After adjustment for explanatory variables including social isolation, the mortality hazard ratio for feelings of loneliness was 1.30 [95% confidence interval (CI) 1.04–1.63] in men and 1.04 (95% CI 0.90–1.24) in women. No higher risk of mortality was found for social isolation.

Conclusions Feelings of loneliness rather than social isolation factors were found to be a major risk factor for increasing mortality in older men. Developing a better understanding of the nature of this association may help us to improve quality of life and longevity, especially in older men.

(Received December 16 2010)

(Revised July 13 2011)

(Accepted August 04 2011)

(Online publication September 06 2011)


c1 Address for correspondence: T. J. Holwerda, M.D., Vrije Universiteit Medisch Centrum Amsterdam, AMTEL-LASA, room A 515, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. (Email: