C H A P T E R 2 6

Loneliness and Social Isolation

Jenrry de Jong GierueldTheo uan TilburgPearl A. Dvkstra

Given that all people seek happiness and allpeople desire to be huppy, the feelings ofloneliness as registered among adolescents,young adults (Marcoen, Goossens, & Caes,tg87; Sippola & Bukowski, 1999), midlifeand older adults (see among many others,Lopata, 1996) reveal a major problemin society. Although there is a generalcore to loneliness - the evaluation of adiscrepancy between the desired and theachieved network of relationships as a neg-ative experience - the forms of lonelinessand their antecedents vary enormouslyaccording to personal and contextual deter-minants. Despite the fact that lonelinessis not treated as a specific clinical entity

[Mijuskovic, ryg6), Russell, Peplau, andCutrona [r98o) presented evidence on theuniqueness of loneliness as a phenomenonin its own right. After being largely ignoredby social scientists until the mid-zothcentury, an ever-increasing flow of worksince the r97os amply testifies to the utilityof loneliness as an important concept.This chapter addresses the concepts ofloneliness and social isolation using theo-retical ideas and empirical evidence from

various sources and disciplines includingpsychology, sociology, and anthropology.

The Concepts of Loneliness and

Social Isolation

Loneliness

The oldest publication about loneliness isUbt, die Eínsamkeít (Zímmermann, ry8j-1786). More recent effiorts to conceptual-ize loneliness started in the r95os with thepublication "Loneliness" by Fromm Reich-man (r9;q). Empirical research into loneli-ness was supported by the efforts of Perlmanand Peplau (r98r), who defined lonelinessas "the unpleasant experience that occurswhen a person's network of social relationsis deficient in some important way, eitherquantitatively or qualitatively" [p. ]r). Asecond definition of loneliness, frequentlyused in European countries, is formulatedas follows:

Lonelmess is a situation experienced bythe indiuidual as one where there isan unpbasant or inadmissible lnck "f

+8s

In: Cambridge handbook of personal relationships / A.Vangelisti and D.Perlman, eds. Cambridge: Cambridge University Press, 2006. - p. 485-500.

486

(quality ofl certain relationships. Thisincludes situations, in which the numberof existing relationships is smaller thanis consiàered desirable or admissible, aswell as situations where the intimacy onewishes for has not been realized. (De JongGieruelà, gB7, p. no)

Central to both definitions is that lonelinessis a subjective and negative experience, andthe outcome of a cognitive evaluation of thematch between the quantity and quality ofexisting relationships and relationship stan-dards. The opposite of loneliness is belong-ingness or embeddedness.

Social Isolation

Social isolation concerns the objective char-acteristics of a situation and refers to theabsence of relationships with other people.The central question is this: To what extentis he or she alone? There is a continuumrunning from social isolation at the one endto social participation at the other. Personswith a very small number of meaningful tiesare, by definition, socially isolated. Loneli-ness is not directly connected to objectivesocial isolation; the association is of a morecomplex nature.

The Relationship Behaeen Social Isolationand Lonekness

Loneliness is but one of the possible out-comes of the evaluation of a situationcharacterized by a small number of rela-tionships. Socially isolated persons are notnecessarily lonely, and lonely persons are notnecessarily socially isolated in an objectivesense. An individual who is well positionedin terms of objective social participation canoccupy virtually any position on the subjec-tive continuum. Where a person ends upon the subjective continuum depends onhis or her relationship standards. Some peo-ple with a small number of social contactsmight feel lonely; others might feel sufÊ-ciently embedded. An example of the lattersituation is that of a person who prefers to bealone and opts for privacy as a means towardavoiding undesired social contacts and rela-tionships. Acknowledging the importance ofrelationship standards, Perlman and Peplau

THE CAMBRIDCE HANDBOOK OF PERSONAL RELATIONSHIPS

[r98r) developed a cognitive or cognitivediscrepancy theoretical approach to loneli-ness that focuses on the subjective evalua-tion of relationships in association with thepersonal standards for an optimal network ofsocial relationships. The cognitive approachalso considers the activities a person mightundertake to restore the imbalance betweenthe actual and the ideal situation. Thus,a person's position on the subjective con-tinuum is affected not only by the type,nature and the saliency of the contactsmissed, but also by the time perspectiverequired to "solve" and upgrade problematicrelationships, and the capacities to changethe situation.

Typ"t ofLonekness

Several components of loneliness can be dis-tinguishe d. Zimmerman Q7 8 5 / ry 86) difFer-entiated between a positive and a negativetype of loneliness. The positive type of lone-liness is related to situations such as thevoluntary withdrawal from the daily has-sles of life and is oriented toward hlghergoals: reflection, meditation, and commu-nication with God. Nowadays, the posi-tive type of loneliness is more frequentlyreferred to by a separate concept: privacy.Privacy is voluntary; it concerns a freelychosen situation of [temporary) absence ofcontacts with other people. The negativetype of loneliness is related to an unpleas-ant or inadmissible lack of personal rela-tionships and contacts with important oth-ers, as formulated in the definitions given inthis chapter. This is the concept of loneli-ness that is nowadays used in theories andresearch. Moreover, it is the type of lone-liness that best fits the everyday conceptof loneliness.

Weiss (rW ZJ differentiated between emo-tional loneliness, stemming from the absenceof an intimate figure or a close emotionalattachment [a partner, a best friend), andsocial loneliness stemming from the absenceof a broader group of contacts, or an engag-ing social network [friends, colleagues, andpeople in the neighborhood). Emotionalloneliness arises when a partner relationshipdissolves through widowhood or divorce and

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is characterized by intense feelings of empti-ness, abandonment, and forlornness. Thistype of loneliness is only solvable by start-ing a new intimate relationship. Social sup-port from family and friends cannot com-pensate the loss of the attachment figure(Stroebe, Stroebe, Abakoumkin, & Schut,

ryg6). The social type of loneliness is relatedto the absence of a wider network offriends with common interests. According toWeiss (rgll), social loneliness is frequentlyreported by young homemakers, who havemoved to an area where they are newcom-ers. Their husbands, however supportive andintimate, cannot fill the gap that is causedby the absence of a group of friends andothers with whom to socialize. The distinc-tion between social and emotional lonelinesshas again been gaining attention. In recentyears, researchers have used the two typesto better understand the determinants andexpressions of loneliness. Both the De JongGierveld loneliness scale [De Jong Gierveld& Van Tilburg, r999a, rgggb; Dykstra & DeJong Gierveld, zoo4; Van Baarsen, Snijders,Smit, & Van Duijn, zoor) and the Socialand Emotional Loneliness Scale for Adults(SELSA); [DiTommaso & Spinner; r9g3;Ernst & Cacioppo, 1999) have proved to bevalid and reliable measuring instruments foremotional and social loneliness (see the nextsection for addiUonal information').

Measuring Instruments

Loneliness has a negative connotation.Lonely people carry a social stigma. Forthose reasons it is embarrassing to talk aboutfeelings of loneliness, in particular for men

[Borys & Perlman, 1985), and people withdeficiencies in their relationships do notalways admit to being lonely. The use ofdirect questions including the words "lonely"

or "loneliness" to investigate loneliness islikely to result in underreporting. Someloneliness scales consist of items exclud-ing any reference to loneliness, whereasother scales include one or more such items.In discussing different measuring instru-ments, Shaver and Brennan [r99rJ arguedthat the exclusion of explicit references toloneliness gives rise to disagreements on

content validity. In their view, it is unclearwhether one is measuring relationship sat-isfaction or loneliness. We disagree: Manyinstruments are validated by showing theycorrelate with self-reports of loneliness. Wedescribe two loneliness scales that haveno explicit references to loneliness andhave been used in many research projects

[Pinquart & Sórensen, zoorb].The UCLA Loneliness Scale [Russell,

Peplau, & Cutrona, r98o) has been trans-lated into several languages. In the originalversion, all the items were worded in a neg-ative or "lonely" direction. Because of con-cerns about how the negative wording ofthe items might affect scores [i.e., responsesets), a revised version of the scale was devel-oped that included items worded in a lonelyand a nonlonely direction. The wording ofthe items and the response format havebeen simplified to facilitate administrationof the measure to less educated populations

fRussell, ryg6).De Jong Gierveld and colleagues con-

ducted qualitative research as the first stepin developing a loneliness scale. The r9B5version (De Jong Gierveld & Kamphuis,r9B 5; De Jong Gierveld & Van Tilburg,r999a) consists of rr items. Five items arepositively phrased, and six are negativelyphrased. The reliability and homogeneityof the scale have proven to be satisfac-tory in different Dutch samples adoptingdifterent modes of data collection [VanTilburg & De Leeuru, i99r). Using the scalein self-administered questionnaires resultsin higher scale means than if the scaleis used in face-to-face or telephone inter-views (De Leeuw, rggz). This finding is inline with Sudman and Bradburn's (rgl +)observation that, compared with interviews,the more anonymous the setting in whichselÊadministered surveys are completed,the more the results show self-disclosureand reduce the tendency of respondents topresent themselves in a favorable light. TheDe Jong Gierveld scale was not developedto assess types of loneliness but rather tomeasure the severity of feelings of loneli-ness. Researchers can choose to use the scaleas a one-dimensional measure. As a whole,the scale is moderately, yet sufficiently

4 8 8

homogeneous. The items were, however;developed with Weiss's (tgl1J distinctionbetween social and emotional lonelinessin mind. For that reason, researchers canchoose to use two subscales (one for emo-tional and one for social loneliness) that havemoderate intercorrelations.

Conceptual Approaches toUnderstanding Loneliness

Several theoretical approaches have beenused for analyzing loneliness [Derlega &Margulis, ry82; Perlman & Peplau, r98r).Weiss (rgl+), a leading proponent of theattachment perspective, suggested that thereare different provisions of relationships (e.g.,attachment, sense of worth, etc.), each asso-ciated with a specific type of relationships.He contended that as long as the provideris trustworthy, we can obtain guidance andassistance, often needed during stressful sit-uations, and in alleviating loneliness. Themain approaches to loneliness focus onindividual-level characteristics that predis-pose people to become lonely or to persistin being lonely [Marangoni & Ickes, 1989;Rokach & Brock, ryg6).ln our view, greaterinsight into loneliness will be gained bybringing together individual level character-istics and contextual characteristics. Exam-ples of the latter are sociocultural factors andsociostructural characteristics of the individ-ual's environment. In this section, we startwith a description of the individual levelfactors contributing to loneliness. We con-tinue with the sociocultural factors that con-tribute to loneliness, more specifically, thesocial standards. Finally, the sociostructuralfactors modulating the risks of loneliness areaddressed, particularly the socioeconomiccharacteristics of the contextual setting.

The Cognitiue Approach to Lonekness(Individual Leuel)

Thanks to the efforts of Peplau and Perlman

[1982) who, at the end of the r97os, broughttogether loneliness researchers from theUnited States, Canada, and Europe, mea-

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

suring instruments and research into thedeterminants of loneliness became more orless "standardized."

From that point in time,loneliness research in different regions of theworld has been largely comparable in termsof design and theoretical modeling. Draw-ing on the cognitiue approach to loneliness(Dykstra & De Jong Gierveld, rgg4; Perlman& Peplau, r98rJ, analyses focus on subjec-tive experiences and on cognitive processesthat mediate the association between rela-tionship characteristics and the experienceof loneliness. A shortage of achieved as com-pared with desired relationships does notdirectly and inevitably lead to loneliness butis first perceived and evaluated. Social com-parisons are key to this process. For example,social comparison may affect how large andimportant a social deficit is believed to be(Perlman & Peplau, r98r).

Researchers adopting the cognitiveapproach typically include the followingcharacteristics in their models: [aJ descrip-tive characteristic.s of the social network(intimate relationships as well as the broadergroup of acquaintances, colleagues, neigh-bors, and extended hrJ; ft) relationshipstandards, [.J personality characteristics

[".g., social skills, selÊesteem, shyness,anxiety, introversion); and (d) backgroundcharacteristics (".g., gender and healthJ.First, we address various components of thenetwork of social relationships.

MARITAL AND PARTNER STATUS

From Durkheim onward, marriage hasbeen seen as an avenue toward alleviat-ing social isolation and loneliness. Researchhas repeatedly shown the protective effectof an intimate partner bond on the phys-ical, financial and mental well-being ofboth men and women [Waite & Gallagher,zoooJ. Although, in Western and NorthernEurope "ne\M" partnerships such as consen-sual unions and "living apart and together"relationships are becoming increasingly pop-ular, it is the content and not the form ofthe partner bond that matters (Coleman,Ganong, & Fine, 2ooo; De Jong Gierveld,2oo4; Dykstra, zoo4). A partner does not

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LONELINESS AND SOCIAL ISOLATION +89

always provide protection against loneliness.Persons with a partner who is not theirmost supportive network member tend to bevery lonely 0á" Tilburg, 1988). Generallyspeaking, howeveq persons with a part-ner bond tend to be better protected fromloneliness than persons without a partnerbond [Dannenbeck, r995; Wenger, Davies,Shahtahmasebi, & Scott, r996).

Several mechanisms can explain why theabsence of a partner in the household makespeople more vulnerable to loneliness. First,a key structuring influence in the social net-work is missing: The size and broader com-position of the network are strongly linkedwith the presence of a partner (Pinquart &Sórensen, zoora). Persons living alone havesmaller networks than those living with apartner. Second, when help is needed, thepersons living alone lack in-house supportand, by definition, have to orient themselvestoward others outside the household. Third,living alone is, in many cases, the result of thedissolution of a partner relationship. Thosewho remain alone after the death of thepartner are specifically at risk of loneliness,and the effects on the intensity of lonelinessare recognizable over a long period of time(Lopata, ryg6; Stevens, rg8gJ. The effectsof divorce on loneliness are also known tocontinue over long periods of time: Divorcein middle adulthood continues to affect feel-ings of loneliness even at older ages (Dykstra& De Jong Gierveld, zoo4). Remarriage,unmarried cohabitation, and dating help toresolve loneliness to a certain extent. Find-ings reported by Peters and Liefbroer [1997)show that previous disruptions of partner-ships have an efFect on loneliness over andabove current partner status.

KIN RELATIONSHIPS

Involvement in relationships other than apartner can also help to prevent or alleviateloneliness. Hagestad [r98r, 1998) describedthe socially integrative role of the fam-ily, arguing that communication and histor-ical conversations across generations helpmaintain continuity across life phases andstrengthen a sense of belonging. The central-

ity of the parent-child bond in people's livesis undisputed [Rossi & Rossi, r99o). Adultchildren are an important source of compan-ionship, closeness, and sharing, particularlyfor those who live alone. Dykstra [1993) andPinquart (zoo1J have shown, for example,that contacts with children are more likelyto reduce loneliness among formerly marriedthan among married older adults. Divorceoften impairs the relationship between par-ents and children, especially in the case offathers (Kaufman &Uhlenberg, 1998; Kitson& Morgan, rggo). The low level of contactwith adult children is the reason divorcedfathers tend to be lonelier than divorcedmothers fPinquart, zoo3). Siblings are spe-cial in many ways (Bedford, r989; Cicirelli,rggr; Connidis, 1989; Gold, 1987): Thereis the common blood tie, the shared his-tory of growing up together and of havingthe same background. The loss of a siblinghas been found to contribute to lonelinessamong older persons (Gold, rg8Z). Siblingsserve a particularly important function inalleviating the loneliness of those who lackthe intimate attachment of a partner andhave no children (Pinquart, zooT).

NONKIN RELATIONSHIPS

The importance of friends for psychologi-calwell-being is well documented (Blieszner& Adams, r99z; Rawlins, rgg5): the joy ofspending time together, the compassion evi-dent in keeping up with personal ups anddowns, and the exchange of ideas. Rela-tionships with friends, colleagues, and othernonkin relationships serve to connect peo-ple to circles outside their immediate fam-ily. The benefits of belonging to a set ofinterlocking networks can lower the risks ofsocial loneliness [Connidis & Davies, r99o)Wagner, Schutze, & Lang, r999J. More-ove{, best friends can step in and functionas confidants and in doing so help allevi-ate emotional loneliness, in particulaq, fornever partnered or childless adults [Dykstra,

rgg3; Pinquart, zoq). Involvement informal organizations is another source ofsociability: Church attendance, activities involuntary associations, and volunteer work

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bring people together and are a means offorming attachments [Pilusuk & Minkleqr98oJ and in this way help to prevent orcombat loneliness [Van Tilburg, De JongGierveld, Lecchini, & Marsiglia, r9g8).

SIZE AND COMPOSITION OF THE NETWORK

Generally speaking, as the number of rela-tionships in the social network increasesand as the amount of emotional and socialsupport exchanged increases, the intensityof loneliness decreases fVan Tilburg, r988).The four closest ties in a person's networkprovide the greatest degree of protectionagainst loneliness. The protection providedby additlonal relationships is marginal [VanTilburg, r99o). Diversity across relationshiptypes also serves to protect against loneliness.People with networks composed of bothstrong and weak ties are less prone to loneli-ness than people with strong ties only [VanTilburg, r99o). Moreove4, research (Dykstra,

rygo; Silverstein & Chen, ryg6) has shownthat people with networks that consistprimarily or entirely of kin ties are morevulnerable to loneliness than people withmore heterogeneous networks. Those whoare dependent on family members for socialcontacts because they lack alternatives tendto have the highest levels of loneliness.

RELATIONSHIPS STANDARDS

The cognitive approach to loneliness empha-sizes that people evaluate whether theirrelationships measure up to their standards.Standards might be what a person aims forin relationships [".g., a certain degree of inti-macy, of frequency of contactsJ. Standardsmight also be desires to have specific typesof relationships [".g., an intimate partneq,best friends, supportive colleagues). Stan-dards develop over the course of life. Child-hood experiences shape needs and desiresfor attachment (Bowlby, ry74), which arealtered with new relationship experiences.Standards regarding partner relationshipsare a case in point. Research has shown thatover the course of time, men and womenwho have lost their partner by death startdownplaying the advantages of having a

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

partner and start upgrading the advantagesof being single (Dykstra & De Jong Gierveld,rgg4; Stevens, rgSq). In doing so, they freethe way for other relationships. The lessimportance attached to having a partner, theless lonely the widowed were found to be.

PERSONALITY CHARACTERISTICS

People with poor social skills and psycholog-ical resources are likely to experience diffr-culty developing and maintaining relation-ships, and for that reason might feel lonely

[Windle & Woods, zoo4). Similarly, peoplewith a neurotic or anxious personality mightharbor unrealistic relationship standards,and their unmet social needs might give riseto feelings of loneliness fcf Jones & Carver,199r). Feeling socially uncomfortable, fearof intimacy, being easily intimidated byothers, being unable to communicate ade-quately to others and developmental deficitssuch as childhood neglect and abandonmentare reported by lonely people as the maincauses of their feelings of loneliness (Rokach& Brock, 1996). Characteristics such as lowself-esteem, shyness and low assertivenesscan predispose people to loneliness andmight also make it more difÊcult to recoverfrom loneliness (Peplau & Perlman, r98zJ.

GENDER

Chodorow [rqZ8) described the gender-specific socialization of men and women,arguing that men and women differ in thevalues they ascribe to different types of rela-tionships. Men socialized to be emotion-ally independent prefer undemanding rela-tionships and tend to rely on their wivesand partners for social and emotional sup-port. Women are socialized to have morecomplex affective needs in which an exclu-sive relationship to a man is not enough.Results from a meta-analysis fPinquart &Sórensen, zoon) of roz studies that investi-gated gender difterences in loneliness showthat women report significantly higher lev-els of loneliness than men. This is morepronounced in studies in which loneli-ness is measured with single-item indica-tors than for studies using higher quality

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loneliness measuring instruments. This dif-ference might be related to men's greaterreluctance to report loneliness in response todirect questions [see the measurement sec-tion of this chapter; and Borys & Perlman,rqSS). In multivariate analyses controllingfor marital status, partner history, socioeco-nomic factors, and the functioning of thesocial network, the efFect of gender on lone-liness decreases (Baltes, Freund, & Horgas,1999) and becomes insignificant for those infirst marriages [Dykstra, zoo4).

HEALTH

Loneliness is associated with a variety ofmeasures of physical health. Those whoare in poor health, whether this is mea-sured objectively or subjectively, tend toreport higher levels of loneliness (Havens, &Hall, zoor; Kramer, Kapteyn, Kuik, & Deeg,2ooz; Mullins, Hall Elston, & Gutkowski,g96; Penninx et aI., rggg; Steverink,Westerhof, Bode, & Dittmann-Kohli, zoor).The causal mechanisms underlying the asso-ciation between loneliness and health arenot well understood, although new lines ofresearch on the psychophysiology mecha-nisms and other pathways connecting lone-liness and health outcomes [see Cacioppoet a1., zooz; Hawkley & Cacioppo, zooj)Loving, Heffneq, & Kiecolt-Glaser, this vol-ume). Does Poor health lead to loneli-ness via difficulties in maintaining socialrelationships? Or does poor health lead toan increase in support and a decrease inlonelinessT Penninx et al. frqqq) and VanTilburg and Broese van Groenou (zooz)showed that investing in relationships by giv-ing support might pay off in times of need:Poor health mobilizes network membersand increases support giving. Does loneli-ness produce Poor health? Could they mutu-ally influence each other? Perhaps there isno direct causation but rather an indirectrelationship through a third factor. One pos-sible reason for the loneliness-health asso-ciation involves preventive health behaviors

[see Cacioppo, Hawkley, & Bernston, zoo3).Lonely individuals are less likely to engagein behaviors such as exercise, remember-

ing to take medications or see their doc-tors, good nutrition, and relaxation fAartsen,zooj; Mahon, Yarcheski, & Yarcheski, zoor;Pérodeau & du-Fort, zooo).

Loneliness in Context

Empirical studies have focused onindividual-level determinants of loneli-ness. Much less attention has been paidto the ways in which social isolation andloneliness are patterned socially. A relativelynew area of research concerns [a) the soci-etal patterning of standards for evaluatingone's social network of relationships and

O) the societal patterning of social andeconomic resources contributing to socialintegration. These contextual-level factorsaftect the intensity of loneliness eitherindirectly via the composition and size ofthe individual's network of relationships ordirectly via differences in the evaluation ofa given context. DifFerences between neigh-borhoods in mutual concern for the other'swell-being are an example of societal pat-terning of resources at the contextual level.As Thomése, Van Tilburg, and Knipscheer(zoo3) showed, as mutual concern for theother's well-being and the shared feelingof community embeddedness increase,the risk of loneliness at the individuallevel decreases.

In this section, we first address the out-comes of international comparative researchinto the relationship on socially differen-tiated standards and loneliness. Next wediscuss theoretical ideas on contextual diÊferences in social and economic resourcesand loneliness.

NORMATIVE CLIMATE

People's relationship standards are shapedby the normative climate in which they findthemselves. The normative climate in and ofitself can be conducive to loneliness. Normsand values afFect people's ideas about theoptimal size of the network, and the obliga-tions and duties of family members.

Johnson and Mullins (rq8Z) suggestedthat loneliness is high in collectivist-orientedcommunities where sensitivitv to social

492 THE CAMBRIDGE HANDBOOK OF

exclusion is stronger than in individualis-tic communities. This hypothesis has beentested in a number of studies on differ-ences between North America and Europe.Rokach, Orzeck, Cripps, Lackovic-Grgin,and Penezic [zoor) compared Canadiansand Croatians [from central-south Europe)assuming that North American culture posesa lower loneliness risk than European cul-ture because of its emphasis on individ-ual achievement and impersonal relation-ships. However; their findings revealed thatCanadians experienced more loneliness thanCroatians. Van Tilburg, Havens, and DeJong Gierveld [zoo4) observed, in linewith Johnson and Mullins's hypothesis, thatthe likelihood of being emotionally lonelyamong older adults without a partner andof being socially lonely among all olderadults in the study was highest in Tuscany,Italy, followed by the Netherlands and Man-itoba, Canada. Swedish centenarians weremore often lonely, in contrast to centenar-ians in Georgia, United States, who seldomreported being lonely [Martin, Hagberg, &Poon, rggT). Stack's [rqq8) analysis ofWorldValues Surveys data showed that adults inItaly and Japan reported more lonelinessthan adults in the United States and Canada,whereas adults in a number of Western andNorthern European countries as well as inAustralia reported less loneliness than in theUnited States and Canada [after controllingfor several individual characteristics suchas marital and parental status, self-reportedhealth, socioeconomic status, education, andgender). The assumed dlchotomy of twotypes of cultures might be too simple. Dif-ferences within a cultural system are over-looked. Considerable variability exists withinNorth America, for example, as illustratedby research among immigrants and peopleborn and raised in North America where theexperience of loneliness differed by countryof origin and cultural background [Good-win, Cook, & Yung , zoor; Rokach & Sharma,1996). No one has yet offered a comprehen-sive explanation to account for the range ofcultural differences that have been found.

A set of studies has examined differ-ences in older adult loneliness across Europe

PERSONAL RELATIONSHIPS

(imamoflu, Ktiller, imamoflu, & Kuller,rgg3; Jylha & Jokela, 1990). Findings showedthat although living alone became progres-sively less common from Northern Europeto Southern Europe, experiences of loneli-ness progressively increased. According tothe authors the crossnational differences areattributable to differences in normative cli-mate. Living alone generally gives rise toloneliness, but this is the more so in coun-tries where older adults without a partnerare expected to live with their families [..g.,Greece, Italy) and the less so in countrieswhere older adults without a partner preferto live alone (".g., Finland).

In general, the problems of lonely peo-ple cannot be regarded as individual failuresonly. Characteristics of the societal context,such as prevailing standards concerning mat-rimony and the nuclear family, the emphasison individual fulfillment, and high expec-tations about romantic relationships mightalso be considered loneliness-provoking fac-tors, especially so for those living on theirown and parents without parents [Ernst &Cacioppo, 1999).

SOCIOECONOMIC CONTEXT

Perlman and Peplau (r98r) argued that in anysetting, factors that increase the frequency ofinteraction and foster group cohesiveness arelikely to affect the incidence of loneliness. Inour view, the dimension of socioeconomicequality versus inequality is among these fac-tors. Unfortunately empirical research con-necting socioeconomic inequality [a con-cept at the contextual level) to individualloneliness is virtually nonexistent. Phillipson

[zoo4) has started a program of researchin the United Kingdom that is orientedtoward investigating the consequences of thedeepening social and economic inequalityand the socially deprived circumstances ofgroups of impoverished inhabitants of urbanneighborhoods compared with the affluentsubgroups, taking loneliness as the depen-dent variable [Phillipson, zoo4). Researchby Scharf Phillipson, and Smith [zoo4) insome of the most deprived neighborhoodsof the United Kingdom indicated significant

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LONELINESS AND SOCIAL ISOLATION 497

numbers of people prone to social exclu-sion (".g., from social relations, materialresources, and basic services) and experi-encing neighborhood exclusion. The risk ofbeing affected by multiple forms of socialexclusion and loneliness was greatest forthose belonging to minority ethnic groupsand the age group of 7j years and over.

In our view, the links between socioe-conomic inequality and loneliness are aresearch area worth pursuing. In doing so,one can learn from research that inves-tigates the relationship between socioeco-nomic inequalities and indicators of individ-uals' well-being, such as health, morbidity,and mortality.

O'Rand (zoor) postulated that acrossindustrialized countries, major structuraland demographic changes have generatedpersistent social inequalities and shifts awayfrom social welfare policies toward market-centered strategies for income and healthmaintenance. In her view, the growing eco-nomic and social inequalities within popula-tions form the fundamental social conditionthat yields negative outcomes in health andwell-being. O'Rand's concept of inequalityconsists of economic, social, and psychoso-cial components and operates multilevel:across societal planes, the state, and theneighborhood to the individual. The causalmechanism by which inequality affects well-being operates through people's perceptionsof societal fairness more than directly on itsown. O'Rand distinguished, on one hand,a direct pathway connecting inequality andpersons' well-being via individuals' socioe-conomic resources. On the other hand, thereis an indirect pathway by which contex-tual level inequality and atomizaiíon at thecommunity level reduce trust and increasepersons' perceptions of relative deprivation,leading to negative outcomes.

Within the same paradigm, Wilkinson(rqg+) investigated the relationship betweensocietal characteristics - gross national prod-uct per capita and differences in relativeincome and life expectancy. He con-cluded that the Organization for EconomicCo-operation and Development countrieswith the longest life expectancy are not the

wealthiest but those with the smallest spreadof incomes and the smallest proportion ofthe population in relative poverty. Wilkinson(rgg+) postulated that the link betweensocioeconomic inequalities and health ormortality is mediated by cognitíue processesof social comparison, feelings of deprivationand disadvantage that can leadto depression.Kawachi, Kennedy, Lochner, and Prothow-Stith (rggl) provided evidence for the linkbetween social inequality at the macro-level and perceived fairness and distrust atthe microlevel. Using General Social Sur-vey data from the United States, they foundan inverse relationship between the degreeof income inequality at the state level andthe perceived lack of fairness and mistrust.The perceived lack of fairness was oper-ationalized with the item, "Most peoplewould try to take advantage of you if theygot a chance," and social mistrust with theitem, "Generally speaking, would you saythat most people can be trusted or thatyou can't be too careful in dealing withpeople?" The concept of trust is also centralin Ross, Mirowsky, and Pribesh's [zoor) workon neighborhood disadvantage and pow-edessness. Neighborhood disadvantage wasmeasured as the sum of the percentage ofhouseholds with incomes below the federalpoverty line and the percentage of female-headed households with children. Resultsindicated that when controlled for individ-ual disadvantage, residents of disadvantagedneighborhoods experienced lower levels oftrust. Mistrust and absence of faith in otherpeople promoted and reinforced a sense ofpowerlessness.

The promise of the previously describedtheoretical ideas for research into lonelinessis that contextual and individual determi-nants might be integrated under an over-arching cognitive theory, connecting socialand economic inequality to the cognitiveprocesses of persons' perceptions of soci-etal fairness and trust, which in turn affectpeople's vulnerability to social isolation andloneliness. In the near future, the analy-ses and description of the core mechanismsof the overarching cognitive theory needsattention. Until now this type of multilevel

494

research is scarce. Moreover, some of thecentral theoretical concepts need better def-initions and valid and reliable measuringinstruments. We need to work toward aresearch and sample design that enablesmultilevel research into social isolationand loneliness.

Coping and Interventions

Some individuals recover from loneliness byusing their own strategies, or by letting timedo the healing. Others require outside pro-fessional help. The most obvious approachis to help people develop satisfying personalrelationships (Rook, ry84). This can be doneby improving how they interact with oth-ers through social skills training or forms ofpsychotherapy aimed at changing dysfunc-tional interpersonal dispositions (".g., fear ofrejection). It can also be done by improvingopportunities for interactions through pro-grams aimed at removing barriers for socialinteraction (e.g., providing transportationJor at bringing people together [".g., discus-sion groups). Pilusuk and Minkler [r98o)emphasized the importance of develop-ing programs that have opportunities forso-called unintentional network building,that is, the development of friendships isa by-product of the shared activity, notthe explicit purpose. Nevertheless, programswith an explicit focus on improving personalrelationships have proven to be effective.In the Netherlands, the Friendship Enrich-ment Program [FEP) in which participantsare taught how to nourish friendships and goabout making friends has been successful inalleviating loneliness (Stevens, 2oor; Stevens& Van Tilburg, zooo). The beneficial effectsof the FEP might be limited to specificgroups, however. The authors noted that theparticipants were selÊselected and wantedto learn about friendship. The FEP mightwork best for individuals who actively wantto become less lonely. Moreove4 given thatonly women participated in the evaluationstudy, the question of whether men will alsobenefit from the FEP cannot be answered.

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

Interventions aimed at improving rela-tionships might not always be feasible orappropriate, as in the case of people whohave unrealistically demanding or excessiveneeds for support. Such people are morelikely to benefit from cognitive interven-tions aimed at modifying relationship expec-tations. Individuals with severely limitedphysical mobility are likely to benefit frominterventions aimed at increasing their reper-toire of rewarding solitary activities. Rook

[rq8+) pointed out that although encour-aging lonely individuals to develop enjoy-able solitary activities seems like a last resort,solitary activities relieve people from depen-dence on others and thus may increase theirsense of personal control.

In a recent review of interventions tar-geting social isolation among the elderly,Findlay (zoo3) lamented the lack of evi-dence showing that they work. Few evalu-ative studies on the effectiveness of lone-liness interventions have been carried out.The few studies that have been done areflawed by weak methodologies. Findlay con-cluded that future programs aimed at reduc-ing social isolation should have evaluationbuilt into them at inception. This advice isheeded in a program of research that is cur-rently being carried out under the auspicesof the Sluyterman van Loo Foundation in theNetherlands. This foundation commissionedr7 interventions aimed at reducing lonelinessamong the elderly under the condition thattheir effectiveness would be evaluated by thethree authors of this chapter together withTineke Fokkema of the Netherlands Inter-disciplinary Demographic Institute. Theinterventions are diverse (".g., home vis-its by volunteers, social program for nurs-ing home residents, educational programfor the hearing impaired, Internet usage).Under our supervision, the collection of datahas been standardized as far as possible.Key variables such as loneliness, marital his-tory, social network characteristics, relation-ship standards, and health and personalitycharacteristics are measured the same way ineach of the projects. All but two of the inter-ventions are randomized control trials. Afirst report is scheduled for the end of zoo5.

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LONELINESS AND SOCIAL ISOLATION 495l

An Evaluative Conclusion

It is broadly agreed that loneliness is notdirectly connected to social isolation, thatis, the absence of relationships with otherpeople. Loneliness is defined as the nega-tive outcome of a cognitive evaluation of adiscrepancy between (the quality and quan-tity of) existing relationships and relation-ship standards. An increasing flow of workfrom disciplines such as psychology, sociol-ogy, and anthropology has broadened theunderstanding of the mechanisms behindthe onset and continuation of loneliness. Indoing so, next to background variables suchas age, gender, and health, characteristics ofthe social network of relationships, personal-ity characteristics, and relationship standardshave been addressed. The socially isolatingeffects of deprivations brought by social andeconomic circumstances at the communityor country level require further exploration.Future research should address the ways inwhich people's evaluations of their relation-ship networks are affected by the normativecontext in which thev find themselves.

References

Aartsen, M. (zoo3). On the interrelntionshipsbetween cognitiue and social funaioning in oWerage. Unpublished doctoral dissertation, VrijeUniversiteit, Amsterdam.

Baltes, M. M., Freund, A. M., & Horgas,A. L. (rqqqJ. Men and women in the BerlinAging Study. In P. B. Baltes & K. U. Mayer(Eds.), The Berlin Agt g Study; agxng from 7oto roo [pp. 259*z9t). Cambridge, England:Cambridge University Press.

Bedford, V. H. (rq8qJ. Understanding the valueof siblings in old age: A proposed model. Amer-ican Behauioral Scientist, 33, 3j-44.

Blieszner, R., & Adams, R. (r9gz). Aduh friend-ship. Newbury Park, CA: Sage.

Borys, S., & Perlman, D. [rq8l). Gender differ-ences in loneliness. Personality and Social Psy-cholog Bulletin, n, 63-7 4.

Bowlby, J. (rglà. Anachment and loss Axach-ment: Vol. r. London: Hogart Press and theInstitute of Psycho-Analvsis.

Cacioppo, J. T., Hawkley, L. C., & Bernston, G. G.(zoo3). The anatomy of loneliness. CurrentDireaions in Psychological Science, n,7r-74.

Cacioppo, J. T., Hawkley, L. C., Crawford, E.,Ernst, J. M., Burleson, M. H., Kowalewski,R. B., et al. [zooz). Loneliness and health:Potenti al mech anism s. P sy ch o s o m atic M e dicine,64, 4o7-4r7.

Chodorow, N. (tqZ8). The reproduction "fmothering: Psychoanalysis and the sociolog ofgender. Berkeley: University of California Press.

Cicirelli, V. G. [tqqS). Stblingrelationships acrossthe life span. New York: Plenum Press.

Coleman, M., Ganon1,L., & Fine, M. [zooo).Reinvestigating remarriage: Another decade ofprogress. Iournalof Marnage andthe Famíly,6z ,n9B-r7o7.

Connidis, L A. (r989). Siblings as friends in laterlífe. American Behauioral Scientist, 33, 8r-9J.

Connidis, I. 4., & Davies, L. [r99o). Confidantsand companions in later life: The place of fam-ily and friends. Journal of Gerontologt: SocialScience, 45, r4r-r4g.

Dannenbeck, C. (rqqS). Im alter einsamT Zurstrukturverànderung sozialer beziehungen imalter ILonely in later life? Changing social rela-tionships in later life]. In H. Bertram [Ed.),Das indiuiduum und seine familie (pp. tz5-r56).Opladen, Germany: Leske * Budrich.

De Jong Gierveld, J. (r987J. Developing and test-ing a model of loneliness. Journal of Personalityand Social Psychologt, 53 , n9-r28.

De Jong Gierveld, J. (zoo4). Remarriage, unmar-ried cohabitation, living apart together: Part-ner relationships following bereavement ordivorce. Journal of Maniage and Family, 66,

46-247.De Jong Gierveld, J., & Kamphuis, F. H. [r985).

The development of a Rasch-type loneliness-scale. Applted Psychological Measurement, Q,289-299.

DeJong Gierveld, J., &VanTilburg, T. G. [r999a).Manual of the loneliness scale. Vrije UniversiteitAmsterdam, Department of Social ResearchMethodology.

De Jong Gierveld, J., & Van Tilburg, T. (r999b).Living arrangements of older adults in theNetherlands and Italy: Coresidence values andbehavior and their consequences for loneli-ness. Iournal of Cross-Cuhural Gerontologt, t4,r-24.

De Leeuw, E. D. (rggr-). Data quality in mail,telephone, and face-to -face surueys. Unpublished

496

doctoral dissertation, Vrije UniversiteitAmsterdam.

Derlega, V. J., & Margulis, S. T. [r9Bz).Why lone-liness occurs: The interrelationship of social-psychological and privacy concepts. In L. A.Peplau & D. Perlman [Eds), Loneliness. A source-book, of current theory, research and therapy(pp. r; z-ó5). New York: Wiley.

DiTommaso, E., & Spinner, B. (tqql).The devel-opment and initial validation of the social andemotional loneliness scale for adults ISELSA].Personality and Indiuidual Differences, 11, rz7-1 3 4 .

Dykstra, P. A. (r99o). Next of non-hin. The impor-tance of primary relntionships t'or older adults'w ell-being. Amsterdam/Lisse, the Netherlands :Swets & Zeitlinger.

Dykstra, P. A. (r993). The differential availabilityof relationships and the provision and effective-ness of support to older adults. Jounnl of Socialand Personal Relntionships, ro,35 .--77o.

Dykstra, P. A. (zoo4). Diversity in partner-

ship histories: Implications for older adults'social integration. In C. Phillipson, G. Allan,& D. Morgan (Eds.), Social networks and socialexclusion: Sociological and policy issues (pp. tt7-r4r). London: Ashgate.

Dykstra, P. A., & De Jong Gierveld, J. [1994). Thetheory of mental incongruity, with a specificapplication to loneliness among widowed menand women. In R. Erber & R. Gilmour (Eds.J,

Theoretical framework s for personal relationship s(pp. ,31,-259). Hillsdale NJ: Erlbaum.

Dykstra, P. 4., & De Jong Gierveld, J. (zoo4).

Gender and marital-history differences insocial and emotional loneliness among Dutcholder adults. Canadian Journal on Aging, 23,L4r-rr5.

Ernst, J., & Cacioppo, J. T. (tqqq). Lonelyhearts: Psychological perspectives on loneli-ness. Applied and Preuentiue Psychologt, B , t-zz.

Findlay, R. A. (zoo3). Interventions to reducesocial isolation amongst older people: Where isthe eviden ce? Ageing and Society, z 3 , 647 -658 .

Fromm Reichmann, F. (r959). Loneliness. Pqychi-atry, 22 , r-rr.

Gold, D. T. (1987). Siblings in old age: Somethingspecial. Canadian lournal on Aging, 6, r99-zr; .

Goodwin, R., Cook, O., &Yung, Y. (zoor). Lone-liness and life satisfaction among three culturalgroups. Personal Relationships, B , zz5-23o.

Hagestad, G. O. (r9Br). Problems and promises inthe social psychology of intergenerational rela-

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

tions. In E. Shanas (Ed.), Aging: Stabiltty andchange in the family [pp. rr-46). New York: Aca-demic Press.

Hagestad, G. [rg98, October r). Towards a sociegt

for all ages: New thinking, new language, newconuersations. Keynote address at the Launchofthe International Year of Older Persons 1999,United Nations. New York.

Havens, B., & Hall , M. [zoor). Social isola-tion, loneliness, and the health of older adults.lndian Journal of Gerontologt, t4, r44-r53.

Hawkley, L. C., & Cacioppo, J. T. [zoo3). Lone-liness and pathways to disease. Brain, Behauior,and Immunity, t7, S98-Sro5.

imamoflu, E. O., Ktiller, R., imamoflu, V., &Kiiller, M. (rqqt). The social psychologicalworlds of Swedes and Turks in and aroundretirement. Journal of Cross-Cultural Psychol-o€J/ ,21, z6-4r .

Johnson, D. P., & Mullins, L. C. [r987). Growingold and lonely in different societies: Towarda comparative perspective. Iournal of Cross-Cultural Gerontologt, 2, z j7 -27, .

Jones, W. H., & Carver, M. D. [rqqt).Adjustmentand coping implications of loneliness. In C. R.Snyder & D. R. Forsych [Eds.), Handbook ofsocial and clinicalpsycholog: The heabh perspec-

tiue (pp.395-+5). New York: Pergamon Press.

Jylha, M., & Jokela, J. [r99o). Individual expe-riences as cultural: A cross-cultural study onloneliness among the elderly. Ageing and Soci-e t y , r o , z9 j - 3 r j .

Kaufman, G., & Uhlenberg, P. (1998). Effectsof life course transitions on the quality ofrelationships between adult children and theirparents. Journal of Maniage and Family, 6o,

924-938.Kawachi, L, Kennedy, B. P., Lochner, K., &

Prothrow-Stith, D. [rqqZ). Social capital,income inequality and mortality. AmencanJournal of Public Health, B7 , ry9vt498.

Kitson, G. C., & Morgan, L. A. [r99o). The multi-ple consequences of divorce: A decade review.Journal of Marriage and Family, 52, gr3-g24.

Kramer, S. E., Kapteyn, T. S., Kuik, D. J., & Deeg,D. [zooz). The association of hearing impair-ment and chronic diseases with psychosocialhealth status in older age. Iournal of Aging andHealth, 14, rzz-r37 .

Lopata, H. Z. [rqq6). Cunent widowhood: Mythsand realities. Thousand Oaks, CA: Sage.

Mahon, N., Yarcheski, A., & Yarcheski, T.-J.

[zoor). Mental health variables and positive

heaLical .

Marantheosuretions

MarcoLonE*psioncenc,

Martirdict,stud203 '

MullirS. IVamcGen

MijusldyrtHut

O'RarcoutheiL . Xsoci,Aca

PennirD. lvansupdiffHea

Peplaron(EdoW'wil

Perlmsoci& FPertLor

Pérodchosoc.i n t1 9 '

Petersitalold6 8 ;

health practices in early adolescents. Psycholog-ical Reports, BB, roz 3-ro3 o.

Marangoni, C., & Ickes, W. [1989). Loneliness: Atheoretical review with implications for mea-surement. Journal of Social and Personal ReIa-tionships, 6, 93-t28.

Marcoen, A., Goossens, L., & Caes, P. (1987).Loneliness in pre- through late adolescence:Exploring the contributions of a multidimen-sional approach. Iournal of Youth and Adoles-cence, ó, 56v577 .

Martin, P., Hagberg, B., & Poon, L. W. (1997). Pre-dictors of loneliness in centenarians: A parallelstudy. Joumal of Cross-Cultural Gerontologl, tz ,

Mullins, L. C., Hall Elston, C., & Gutkowski,S. M. [r996J. Social determinants of lonelinessamong older Americans. Genetic, Social, andGeneral Psycholog Monographs, t2 2 , 413-47 7 .

Mijuskovic, B. [1996). The phenomenology anddynamics of loneliness. Psychologt: A Journal ofHuman Behauior, 33, 4r-.-r.

O'Rand, A. M. [zoor). Stratification and the lifecourse; the forms of life-course capital andtheir interrelationships. In R. H. Binstock &L. K. George (Eds.), Handbook of aging and thesocial sciences (5th ed., pp. tg7-23). New York:Academic Press.

Penninx, B. W J. H., van Tilburg, T., Kriegsman,D. M. W., Boeke, A. J. P., Deeg, D. J. H., &van Eijk, J. T. M. (tqqq). Social network, socialsupport, and loneliness in older persons withdifferent chronic diseases. Journal of Aging andHealth, rr, r5 r-168.

Peplau, L. 4., & Perlman, D. (1982). Perspectiveson loneliness. In L. A. Peplau & D. Perlman(Eds.), Loneliness: A sourcebook, of current the-ory, research and therapy [pp. r-r8). New York:Wiley.

Perlman, D., & Peplau, L. A. (r98r). Toward asocial psychology of loneliness. In S. W Duck& R. Gilmour (Eds.J , Personal Relntionships. 3:Personal relntionships in disorder (pp. 3F56).London: Academic Press.

Pérodeau, G.-M., & du-Fort, G.-G. (zooo). Psy-chotropic drug use and the relation betweensocial support, life events, and mental healthin the elderly. Journal of Applled Gerontologr,1 9 , 2 7 - 4 r .

Peters, A., & Liefbroeq, A. C. (rqqZ).Beyondmar-ital status: Partner history and well-being inold age. Journal of Maniage and the Family, 59,687-6s9.

LONELINESS AND SOCIAL ISOLATION 497

Phillipson, C. (zoo4). Review article: Urbanisa-tion and ageing: Towards a new environmentalgerontology. Ageing and Society, 2 5 , 963-97, .

Pilusuk, M., & Minkler, M. (r98o). Supportivenetworks: Life ties for the elderly. Journal ofSocial lssues, 36(t), 95-:n6.

Pinquart, M. (zoo3l. Loneliness in married,widowed, divorced, and never-married olderadults. lournal of Social and Personal Relation-sh ips ,2o ,7 r -53 .

Pinquart, M., & Sórensen, S. [zoora). Gender dif-ferences in self-concept and psychological well-being in old age: A meta-analysis. Journal ofGerontologt: Psychological Sciences, 56 , r95-zr7 .

Pinquart, M., & Sórensen, S. (zoorb). Influenceson loneliness in older adults: A meta-analysis.Basic and Applied Social Pqtchologt, 23, 245-2 6 6 .

Rawlins, W. K. (,ggS). Friendships in later life. InJ. Coupland&J. F. Nussbaum [Eds.), Handbookof communication and aging research (pp. ,r7-257). Mahwah, NJ: Erlbaum.

Rokach, 4., & Brock, H. [tqq6). The causesof loneliness. Psychologt, a Journal of HumanBehauior, 33, r-tr.

Rokach, A., Orzeck, T., Cripps, J., Lackovic-Grgin, K., & Penezic, Z. (zoor). The effectsof culture on the meaning of loneliness. SocialIndicators Research, 53, r7-3r.

Rokach, 4., & Sharma, M. (1996). The loneli-ness experience in a cultural context. Journalof Social Behauior and Personaliry, n,827-839.

Rook, K. S. (r9B4J. Promoting social bonding:Strategies for helping the lonely and sociallyisolated. American Psychologist, 39, r78g-r4o7 .

Ross, C. E., Mirowsky, J., & Pribesh, S. (zoor).Powerlessness and the amplification of threat:Neighborhood disadvantage, disorder, and mis-trust. American Sociological Reuiew, 66, 568-5 9 1 .

Rossi, A. S., & Rossi, P. H. [rqqo). Of humanbonding: Parent-chilà relntions across the lifecourse. New York: Aldine de Grulter.

Russell, D., Peplau, L. A., & Cutrona, C. E.

[r98o). The revised UCLA Loneliness Scale:Concurrent and discriminant validlty evidence.Journal of Personality and Social Psychologt, 3g,472-48o.

Russell, D. W. [rqq6). UCLA Loneliness Scale

fVersion 3): Reliability, validlty, and factorstructure. Journal of Personality Assessment, 66,2o-4o.

498 THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

Scharf T., Phillipson, C., & Smith, A. E. (zoo4).Poverty and social exclusion: Growing older indeprived urban neighbourhoods. In A. Walker& C. Hagan Hennessy [Eds.), Growing Older -

Quality of Lí, in OIà Age (pp. 8r-ro6).Maidenhead, England: Open University Press.

Shaver; P. R., & Brennan, K. A. [rqqr). Measuresof depression and loneliness. In J. P. Robinson,P. R. Shaver, & L. S. Wrightsman (Eds.), Mea-sures of personality and social psychological atti-tudes (pp. rg7-zB9). San Diego, CA: AcademicPress.

Silverstein, M., & Chen, X. (1996). Too much ofa good thing? Intergenerational social supportand the psychological well-being of older per-sons. Jountal of Maniage and Family, 58, g7o-

9 8 2 .Sippola, L. K., & Bukowski, M. (tqqq). Self

other; and loneliness from a developmen-tal perspective. In K. J. Rottenberg & S.Hymel (Eds.), Loneliness in childhood and ado-lescence [pp. z8o-2g5). Cambridge, England:Cambridge University Press.

Stack, S. (1998). Marriage, family and loneliness:A cross-national study. S o ciolo gical Persp e ctiu e s,

4 1 , 4 1 5 - 4 3 2 .Stevens, N. [1989). Well-being in widowhood: A

question of balnnce. Unpublished doctoral dis-sertation, Catholic University of Nijmegen,Nijmegen [the Netherlands).

Stevens, N. (zoor). Combatting loneliness: Afriendship enrichment programme for olderwomen. Ageing and Society, z r, rï3-zoz .

Stevens, N., & Van Tilburg, T. (zooo). Stimulat-ing friendship in later life: A strategy for reduc-ing loneliness among older women. EducationalGerontologt, 26, ry35.

Steverink, N., Westerhof G. J., Bode, C., &Dittmann-Kohli, F. (zoorj. The personal expe-rience of aging, individual resources, and sub-jective well-being. Journal of Gerontologt: Psy-chological Sciences, 6 5 B, 36+-Zl I .

Stroebe, W, Stroebe, M., Abakoumkin, G., &Schut, H. [1996). The role of loneliness andsocial support in adjustment to loss: A testof attachment versus stress theory. lournal ot'Personality and Sonal Psycholog, 70, L24r-1249 .

Sudman, S., & Bradburn, N. M. [tqZ+). Responseeffects in surueys: A reuiew and synthesis.Chicago: Aldine.

Thomese, F., Van Tilburg, T., & Knipscheer;C. P. M. (zoo3). Continuation of exchange

with neighbors in later life: The importanceof the neighborhood context. Personal Relntion-sh ips, to ,575-550.

Van Baarsen, B., Snijders, T. A. B., Smit, J. H.,& Van Duijn, M. A. J. [zoorj. Lonely but notalone: Emotional isolation and social isolationas two distinct dimensions of loneliness in olclerp e ople. E du c atio nal and P sy cholo gic al M e a sur e -

ment, 6r, ng-t35.

Van Tilburg, T. (r988l. Verkregen en gewensteondersteuning in het licht uan eenzaamheidser-uaríngen fObtained and desired social supportin association with loneliness). Unpublisheddoctoral dissertation, Vrije Universiteit, Ams-terdam.

Van Tilburg, T. [rqq"). The size of the support-ive network in association with the degree ofloneliness. In C. P. M. Knipscheer & T. C.Antonucci [Eds.), Social network, research: Sub-stantiue issues and methodologlcal questions

[pp. t;7-r5o). Lisse, the Netherlands: Swets &Zeitlinger.

Van Tilburg, T., De Jong Gierveld, J., Lecchini, L.,& Marsiglia, D. [1998). Social integration andloneliness: A comparative study among olderadults in the Netherlands and Tuscany, Italy.Journal of Social and Personal Relationships, t5,

7 40-7 5+.

Van Tilburg, T. G., & Broese van Groenou, M. I.(zooz). Network and health changes amongolder Dutch adults. Journal of Social Issues, 58,697-7 t3 '

Van Tilburg, T. G., & De Leeuw, E. D. [rgg,).Stabillty of scale quality under different datacollection procedures: A mode comparison onthe "De Jong Gierveld Loneliness Scale." Inter-national Journal of Public Opinion Research, 3,6q-8 s .

Van Tilburg, T. G., Havens, B., & De JongGierveld, J. [zoo4). Loneliness among olderadults in the Netherlands, Italy, and Canada:A multifaceted comparison. Canadian Jountalon Aging, 23, t69-r8o.

Wagner, M., Schutze, Y., & Lang, F. R. [1999).Social relationships in old age. In P. B. Baltes& K. U. Mayer [Eds.], The Berlin AgtngStudy. Agtng from 7o to roo [pp. z8z-3or).Cambridge, England: Cambridge UniversityPress.

Waite, L., & Gallagher, M. [zooo). The case

for maniage: VVlry married people are happier,healthier and bener off financially. New York:Doubleday.

Weissem(MI'

WeisstiorersHa

WengScci n <ing

Weiss, R. S. [1973). Loneliness: The experience ofemotional and social isolation. Cambridge, MA:MIT Press.

Weiss, R. S. (1974). The provisions of social rela-tionships. In Z. Rubin [Ed.), Doing unto oth-ers (pp. 17-26). Englewood Cliffs, NJ: Prentice-Hall.

Wenger, C. G., Davies, R., Shahtahmasebi, S., &Scott, A. [r996). Social isolation and lonelinessin old age: Review and model refinement. Age-ing and Society, ó, 373-58.

LONELINESS AND SOCIAL ISOLATION 499

Wilkinson, R. G. [r9q+). The epidemiologicaltransition: From material scarcity to socialdisadvantage. Daedalus, Journal of Ameri-can Acaderny of Arts and Sciences, n3(4),6v t t .

Windle, G., & Woods, R. T. (zoo4). Variations insubjective wellbeing: The mediating role of apsychological resource. Ageing and Society, 24,

583-6oz.Zimmermann, J. G. [r7B 5/6). Uber díe einsamkeit

fAbout loneliness]. Frankfurt: Thoppau.