Friends, loneliness and a long life
Loneliness raises the risk of dying early by about as much as smoking does — and the number of Americans with no close friends has quadrupled since 1990.
In May 2023 the Surgeon General of the United States, the country’s chief public-health doctor, issued an advisory about something that is not a disease: loneliness. Advisories are usually reserved for things like tobacco and drunk driving. The decision to issue one about social connection was a statement about how large the evidence had become.
What the advisory found
About half of American adults said they had experienced loneliness. The advisory pulled together decades of research on what that does to health and concluded that a lack of social connection is linked to a roughly 30% higher risk of dying early. It compared the effect on mortality to smoking up to fifteen cigarettes a day.
The same body of research links poor social connection to a higher risk of heart disease and stroke, to depression and anxiety, and in older adults to dementia. People who are socially connected, by contrast, tend to recover from illness better and live longer.
It is worth being careful about what this means. These are associations found across many studies, and loneliness often travels with other problems such as illness, poverty and the loss of a partner. But the link holds up after those are taken into account, and there are plausible reasons for it: lonely people sleep worse, are more stressed, see doctors less and have nobody to notice when something is wrong.
Fewer close friends
A separate survey shows how the shape of friendship has changed. In 1990, 3% of Americans said they had no close friends. In 2021, the Survey Center on American Life found that 12% did. Over the same period, the share with ten or more close friends fell from 33% to 13%.
The researchers pointed to several causes: the pandemic, people marrying later and moving more often, parents spending more time with their children, and longer working hours. None of these is a bad thing on its own. Together they mean that many adults reach their forties with fewer friends than they had at twenty, without having decided that.
What keeps friendships alive
Friendship research comes back to a few simple ingredients:
- Time. Friendships are built from hours spent together, and they fade without them. Adults who keep old friends tend to have a standing arrangement: a weekly call, a yearly trip, a shared activity.
- Showing up when it costs something. The friendships people value most are often the ones where somebody came when it was inconvenient — to the hospital, the funeral, the move.
- Repair. Long friendships survive arguments, distance and neglect because somebody makes the first call afterwards.
The decisions that wear friendships down are rarely dramatic. They are the skipped birthday, the move that was never followed up, the years when work came first every time. Each one is small; together they decide who is still around at sixty.
Questions people ask
Is being alone the same as being lonely? No. Loneliness is the feeling that one’s relationships are not enough; social isolation is having few relationships or little contact. Some people live alone and are not lonely, and some people are lonely in a crowded house or a marriage. Both are linked to poorer health, and the advisory treats both as forms of social disconnection.
Who is most likely to be lonely? The advisory found high rates among young adults, which surprises many people, as well as among older adults living alone, people with low incomes and people in poor health.
How many friends does a person need? There is no magic number. Research consistently finds that having a few close relationships, people one can call in a crisis, matters more than having a large network. Quality and regular contact matter more than the total.
In One Life
Friends in One Life are people, not a number. They have names, histories and needs of their own; they remember what you did for them and what you did not. The friendship Life Questions follow a life the way real friendships do: “Who becomes important?” early on, “Do you maintain the friendship?” when life starts pulling people apart, and later, sometimes, “Can you repair a broken friendship?”
How connected a life is counts toward how long it lasts and how it is scored at the end, and the people from a childhood can come back decades later. The game does not reward having the most friends. It notices who stayed, and why.