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C H A P T E R 2 6

Loneliness and Social Isolation

Jenrry de Jong Gierueld Theo uan Tilburg Pearl A. Dvkstra

Given that all people seek happiness and all people desire to be huppy, the feelings of loneliness as registered among adolescents, young adults (Marcoen, Goossens, & Caes, tg87; Sippola & Bukowski, 1999), midlife and older adults (see among many others, Lopata, 1996) reveal a major problem in society. Although there is a general core to loneliness - the evaluation of a discrepancy between the desired and the achieved network of relationships as a neg- ative experience - the forms of loneliness and their antecedents vary enormously according to personal and contextual deter- minants. Despite the fact that loneliness is not treated as a specific clinical entity

[Mijuskovic, ryg6), Russell, Peplau, and Cutrona [r98o) presented evidence on the uniqueness of loneliness as a phenomenon in its own right. After being largely ignored by social scientists until the mid-zoth century, an ever-increasing flow of work since the r97os amply testifies to the utility of loneliness as an important concept. This chapter addresses the concepts of loneliness and social isolation using theo- retical ideas and empirical evidence from

various sources and disciplines including psychology, sociology, and anthropology.

The Concepts of Loneliness and

Social Isolation

Loneliness

The oldest publication about loneliness is Ubt, die Eínsamkeít (Zímmermann, ry8j- 1786). More recent effiorts to conceptual- ize loneliness started in the r95os with the publication "Loneliness" by Fromm Reich- man (r9;q). Empirical research into loneli- ness was supported by the efforts of Perlman and Peplau (r98r), who defined loneliness as "the unpleasant experience that occurs when a person's network of social relations is deficient in some important way, either quantitatively or qualitatively" [p. ]r). A second definition of loneliness, frequently used in European countries, is formulated as follows:

Lonelmess is a situation experienced by the indiuidual as one where there is an unpbasant or inadmissible lnck "f

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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. This includes situations, in which the number of existing relationships is smaller than is consiàered desirable or admissible, as well as situations where the intimacy one wishes for has not been realized. (De Jong Gieruelà, gB7, p. no)

Central to both definitions is that loneliness is a subjective and negative experience, and the outcome of a cognitive evaluation of the match between the quantity and quality of existing 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 the absence of relationships with other people. The central question is this: To what extent is he or she alone? There is a continuum running from social isolation at the one end to social participation at the other. Persons with a very small number of meaningful ties are, by definition, socially isolated. Loneli- ness is not directly connected to objective social isolation; the association is of a more complex nature.

The Relationship Behaeen Social Isolation and Lonekness

Loneliness is but one of the possible out- comes of the evaluation of a situation characterized by a small number of rela- tionships. Socially isolated persons are not necessarily lonely, and lonely persons are not necessarily socially isolated in an objective sense. An individual who is well positioned in terms of objective social participation can occupy virtually any position on the subjec- tive continuum. Where a person ends up on the subjective continuum depends on his or her relationship standards. Some peo- ple with a small number of social contacts might feel lonely; others might feel sufÊ- ciently embedded. An example of the latter situation is that of a person who prefers to be alone and opts for privacy as a means toward avoiding undesired social contacts and rela- tionships. Acknowledging the importance of relationship standards, Perlman and Peplau

THE CAMBRIDCE HANDBOOK OF PERSONAL RELATIONSHIPS

[r98r) developed a cognitive or cognitive discrepancy theoretical approach to loneli- ness that focuses on the subjective evalua- tion of relationships in association with the personal standards for an optimal network of social relationships. The cognitive approach also considers the activities a person might undertake to restore the imbalance between the 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 contacts missed, but also by the time perspective required to "solve" and upgrade problematic relationships, and the capacities to change the 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 negative type of loneliness. The positive type of lone- liness is related to situations such as the voluntary withdrawal from the daily has- sles of life and is oriented toward hlgher goals: reflection, meditation, and commu- nication with God. Nowadays, the posi- tive type of loneliness is more frequently referred to by a separate concept: privacy. Privacy is voluntary; it concerns a freely chosen situation of [temporary) absence of contacts with other people. The negative type 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 in this chapter. This is the concept of loneli- ness that is nowadays used in theories and research. Moreover, it is the type of lone- liness that best fits the everyday concept of loneliness.

Weiss (rW ZJ differentiated between emo- tional loneliness, stemming from the absence of an intimate figure or a close emotional attachment [a partner, a best friend), and social loneliness stemming from the absence of a broader group of contacts, or an engag- ing social network [friends, colleagues, and people in the neighborhood). Emotional loneliness arises when a partner relationship dissolves through widowhood or divorce and

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is characterized by intense feelings of empti- ness, abandonment, and forlornness. This type 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 related to the absence of a wider network of friends with common interests. According to Weiss (rgll), social loneliness is frequently reported by young homemakers, who have moved to an area where they are newcom- ers. Their husbands, however supportive and intimate, cannot fill the gap that is caused by the absence of a group of friends and others with whom to socialize. The distinc- tion between social and emotional loneliness has again been gaining attention. In recent years, researchers have used the two types to better understand the determinants and expressions of loneliness. Both the De Jong Gierveld loneliness scale [De Jong Gierveld & Van Tilburg, r999a, rgggb; Dykstra & De Jong Gierveld, zoo4; Van Baarsen, Snijders, Smit, & Van Duijn, zoor) and the Social and Emotional Loneliness Scale for Adults (SELSA); [DiTommaso & Spinner; r9g3; Ernst & Cacioppo, 1999) have proved to be valid and reliable measuring instruments for emotional and social loneliness (see the next section for addiUonal information').

Measuring Instruments

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

[Borys & Perlman, 1985), and people with deficiencies in their relationships do not always admit to being lonely. The use of direct questions including the words "lonely"

or "loneliness" to investigate loneliness is likely to result in underreporting. Some loneliness scales consist of items exclud- ing any reference to loneliness, whereas other scales include one or more such items. In discussing different measuring instru- ments, Shaver and Brennan [r99rJ argued that the exclusion of explicit references to loneliness gives rise to disagreements on

content validity. In their view, it is unclear whether one is measuring relationship sat- isfaction or loneliness. We disagree: Many instruments are validated by showing they correlate with self-reports of loneliness. We describe two loneliness scales that have no explicit references to loneliness and have 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 original version, all the items were worded in a neg- ative or "lonely" direction. Because of con- cerns about how the negative wording of the items might affect scores [i.e., response sets), a revised version of the scale was devel- oped that included items worded in a lonely and a nonlonely direction. The wording of the items and the response format have been simplified to facilitate administration of the measure to less educated populations

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

ducted qualitative research as the first step in developing a loneliness scale. The r9B5 version (De Jong Gierveld & Kamphuis, r9B 5; De Jong Gierveld & Van Tilburg, r999a) consists of rr items. Five items are positively phrased, and six are negatively phrased. The reliability and homogeneity of the scale have proven to be satisfac- tory in different Dutch samples adopting difterent modes of data collection [Van Tilburg & De Leeuru, i99r). Using the scale in self-administered questionnaires results in higher scale means than if the scale is used in face-to-face or telephone inter- views (De Leeuw, rggz). This finding is in line with Sudman and Bradburn's (rgl +) observation that, compared with interviews, the more anonymous the setting in which selÊadministered surveys are completed, the more the results show self-disclosure and reduce the tendency of respondents to present themselves in a favorable light. The De Jong Gierveld scale was not developed to assess types of loneliness but rather to measure the severity of feelings of loneli- ness. Researchers can choose to use the scale as 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 distinction between social and emotional loneliness in mind. For that reason, researchers can choose to use two subscales (one for emo- tional and one for social loneliness) that have moderate intercorrelations.

Conceptual Approaches to Understanding Loneliness

Several theoretical approaches have been used for analyzing loneliness [Derlega & Margulis, ry82; Perlman & Peplau, r98r). Weiss (rgl+), a leading proponent of the attachment perspective, suggested that there are 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 provider is trustworthy, we can obtain guidance and assistance, often needed during stressful sit- uations, and in alleviating loneliness. The main approaches to loneliness focus on individual-level characteristics that predis- pose people to become lonely or to persist in being lonely [Marangoni & Ickes, 1989; Rokach & Brock, ryg6).ln our view, greater insight into loneliness will be gained by bringing together individual level character- istics and contextual characteristics. Exam- ples of the latter are sociocultural factors and sociostructural characteristics of the individ- ual's environment. In this section, we start with a description of the individual level factors contributing to loneliness. We con- tinue with the sociocultural factors that con- tribute to loneliness, more specifically, the social standards. Finally, the sociostructural factors modulating the risks of loneliness are addressed, particularly the socioeconomic characteristics 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, brought together loneliness researchers from the United States, Canada, and Europe, mea-

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

suring instruments and research into the determinants of loneliness became more or less "standardized."

From that point in time, loneliness research in different regions of the world has been largely comparable in terms of 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 processes that mediate the association between rela- tionship characteristics and the experience of loneliness. A shortage of achieved as com- pared with desired relationships does not directly and inevitably lead to loneliness but is first perceived and evaluated. Social com- parisons are key to this process. For example, social comparison may affect how large and important a social deficit is believed to be (Perlman & Peplau, r98r).

Researchers adopting the cognitive approach typically include the following characteristics in their models: [aJ descrip- tive characteristic.s of the social network (intimate relationships as well as the broader group of acquaintances, colleagues, neigh- bors, and extended hrJ; ft) relationship standards, [.J personality characteristics

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

MARITAL AND PARTNER STATUS

From Durkheim onward, marriage has been seen as an avenue toward alleviat- ing social isolation and loneliness. Research has repeatedly shown the protective effect of an intimate partner bond on the phys- ical, financial and mental well-being of both men and women [Waite & Gallagher, zoooJ. Although, in Western and Northern Europe "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 of the 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 their most supportive network member tend to be very lonely 0á" Tilburg, 1988). Generally speaking, howeveq persons with a part- ner bond tend to be better protected from loneliness than persons without a partner bond [Dannenbeck, r995; Wenger, Davies, Shahtahmasebi, & Scott, r996).

Several mechanisms can explain why the absence of a partner in the household makes people 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 linked with the presence of a partner (Pinquart & Sórensen, zoora). Persons living alone have smaller networks than those living with a partner. Second, when help is needed, the persons living alone lack in-house support and, by definition, have to orient themselves toward others outside the household. Third, living alone is, in many cases, the result of the dissolution of a partner relationship. Those who remain alone after the death of the partner are specifically at risk of loneliness, and the effects on the intensity of loneliness are recognizable over a long period of time (Lopata, ryg6; Stevens, rg8gJ. The effects of divorce on loneliness are also known to continue over long periods of time: Divorce in middle adulthood continues to affect feel- ings of loneliness even at older ages (Dykstra & De Jong Gierveld, zoo4). Remarriage, unmarried cohabitation, and dating help to resolve 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 and above current partner status.

KIN RELATIONSHIPS

Involvement in relationships other than a partner can also help to prevent or alleviate loneliness. Hagestad [r98r, 1998) described the socially integrative role of the fam- ily, arguing that communication and histor- ical conversations across generations help maintain continuity across life phases and strengthen a sense of belonging. The central-

ity of the parent-child bond in people's lives is undisputed [Rossi & Rossi, r99o). Adult children are an important source of compan- ionship, closeness, and sharing, particularly for those who live alone. Dykstra [1993) and Pinquart (zoo1J have shown, for example, that contacts with children are more likely to reduce loneliness among formerly married than among married older adults. Divorce often impairs the relationship between par- ents and children, especially in the case of fathers (Kaufman &Uhlenberg, 1998; Kitson & Morgan, rggo). The low level of contact with adult children is the reason divorced fathers tend to be lonelier than divorced mothers fPinquart, zoo3). Siblings are spe- cial in many ways (Bedford, r989; Cicirelli, rggr; Connidis, 1989; Gold, 1987): There is the common blood tie, the shared his- tory of growing up together and of having the same background. The loss of a sibling has been found to contribute to loneliness among older persons (Gold, rg8Z). Siblings serve a particularly important function in alleviating the loneliness of those who lack the intimate attachment of a partner and have no children (Pinquart, zooT).

NONKIN RELATIONSHIPS

The importance of friends for psychologi- calwell-being is well documented (Blieszner & Adams, r99z; Rawlins, rgg5): the joy of spending time together, the compassion evi- dent in keeping up with personal ups and downs, and the exchange of ideas. Rela- tionships with friends, colleagues, and other nonkin relationships serve to connect peo- ple to circles outside their immediate fam- ily. The benefits of belonging to a set of interlocking networks can lower the risks of social loneliness [Connidis & Davies, r99o) Wagner, Schutze, & Lang, r999J. More- ove{, best friends can step in and function as confidants and in doing so help allevi- ate emotional loneliness, in particulaq, for never partnered or childless adults [Dykstra,

rgg3; Pinquart, zoq). Involvement in formal organizations is another source of sociability: Church attendance, activities in voluntary associations, and volunteer work

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bring people together and are a means of forming attachments [Pilusuk & Minkleq r98oJ and in this way help to prevent or combat loneliness [Van Tilburg, De Jong Gierveld, Lecchini, & Marsiglia, r9g8).

SIZE AND COMPOSITION OF THE NETWORK

Generally speaking, as the number of rela- tionships in the social network increases and as the amount of emotional and social support exchanged increases, the intensity of loneliness decreases fVan Tilburg, r988). The four closest ties in a person's network provide the greatest degree of protection against loneliness. The protection provided by additlonal relationships is marginal [Van Tilburg, r99o). Diversity across relationship types also serves to protect against loneliness. People with networks composed of both strong and weak ties are less prone to loneli- ness than people with strong ties only [Van Tilburg, r99o). Moreove4, research (Dykstra,

rygo; Silverstein & Chen, ryg6) has shown that people with networks that consist primarily or entirely of kin ties are more vulnerable to loneliness than people with more heterogeneous networks. Those who are dependent on family members for social contacts because they lack alternatives tend to have the highest levels of loneliness.

RELATIONSHIPS STANDARDS

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

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

partner and start upgrading the advantages of being single (Dykstra & De Jong Gierveld, rgg4; Stevens, rgSq). In doing so, they free the way for other relationships. The less importance attached to having a partner, the less 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, people with a neurotic or anxious personality might harbor unrealistic relationship standards, and their unmet social needs might give rise to feelings of loneliness fcf Jones & Carver, 199r). Feeling socially uncomfortable, fear of intimacy, being easily intimidated by others, being unable to communicate ade- quately to others and developmental deficits such as childhood neglect and abandonment are reported by lonely people as the main causes of their feelings of loneliness (Rokach & Brock, 1996). Characteristics such as low self-esteem, shyness and low assertiveness can predispose people to loneliness and might also make it more difÊcult to recover from loneliness (Peplau & Perlman, r98zJ.

GENDER

Chodorow [rqZ8) described the gender- specific socialization of men and women, arguing that men and women differ in the values 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 wives and partners for social and emotional sup- port. Women are socialized to have more complex 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 show that women report significantly higher lev- els of loneliness than men. This is more pronounced in studies in which loneli- ness is measured with single-item indica- tors than for studies using higher quality

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LONELINESS AND SOCIAL ISOLATION 4gr

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

HEALTH

Loneliness is associated with a variety of measures of physical health. Those who are in poor health, whether this is mea- sured objectively or subjectively, tend to report 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 are not well understood, although new lines of research on the psychophysiology mecha- nisms and other pathways connecting lone- liness and health outcomes [see Cacioppo et a1., zooz; Hawkley & Cacioppo, zooj) Loving, Heffneq, & Kiecolt-Glaser, this vol- ume). Does Poor health lead to loneli- ness via difficulties in maintaining social relationships? Or does poor health lead to an increase in support and a decrease in lonelinessT Penninx et al. frqqq) and Van Tilburg 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 members and increases support giving. Does loneli- ness produce Poor health? Could they mutu- ally influence each other? Perhaps there is no direct causation but rather an indirect relationship 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 engage in 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 on individual-level determinants of loneli- ness. Much less attention has been paid to the ways in which social isolation and loneliness are patterned socially. A relatively new area of research concerns [a) the soci- etal patterning of standards for evaluating one's social network of relationships and

O) the societal patterning of social and economic resources contributing to social integration. These contextual-level factors aftect the intensity of loneliness either indirectly via the composition and size of the individual's network of relationships or directly via differences in the evaluation of a given context. DifFerences between neigh- borhoods in mutual concern for the other's well-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 the other's well-being and the shared feeling of community embeddedness increase, the risk of loneliness at the individual level decreases.

In this section, we first address the out- comes of international comparative research into the relationship on socially differen- tiated standards and loneliness. Next we discuss theoretical ideas on contextual diÊ ferences in social and economic resources and loneliness.

NORMATIVE CLIMATE

People's relationship standards are shaped by the normative climate in which they find themselves. The normative climate in and of itself can be conducive to loneliness. Norms and values afFect people's ideas about the optimal size of the network, and the obliga- tions and duties of family members.

Johnson and Mullins (rq8Z) suggested that loneliness is high in collectivist-oriented communities where sensitivitv to social

492 THE CAMBRIDGE HANDBOOK OF

exclusion is stronger than in individualis- tic communities. This hypothesis has been tested in a number of studies on differ- ences between North America and Europe. Rokach, Orzeck, Cripps, Lackovic-Grgin, and Penezic [zoor) compared Canadians and Croatians [from central-south Europe) assuming that North American culture poses a lower loneliness risk than European cul- ture because of its emphasis on individ- ual achievement and impersonal relation- ships. However; their findings revealed that Canadians experienced more loneliness than Croatians. Van Tilburg, Havens, and De Jong Gierveld [zoo4) observed, in line with Johnson and Mullins's hypothesis, that the likelihood of being emotionally lonely among older adults without a partner and of being socially lonely among all older adults in the study was highest in Tuscany, Italy, followed by the Netherlands and Man- itoba, Canada. Swedish centenarians were more often lonely, in contrast to centenar- ians in Georgia, United States, who seldom reported being lonely [Martin, Hagberg, & Poon, rggT). Stack's [rqq8) analysis ofWorld Values Surveys data showed that adults in Italy and Japan reported more loneliness than adults in the United States and Canada, whereas adults in a number of Western and Northern European countries as well as in Australia reported less loneliness than in the United States and Canada [after controlling for several individual characteristics such as marital and parental status, self-reported health, socioeconomic status, education, and gender). The assumed dlchotomy of two types of cultures might be too simple. Dif- ferences within a cultural system are over- looked. Considerable variability exists within North America, for example, as illustrated by research among immigrants and people born and raised in North America where the experience of loneliness differed by country of 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 of cultural 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 showed that although living alone became progres- sively less common from Northern Europe to Southern Europe, experiences of loneli- ness progressively increased. According to the authors the crossnational differences are attributable to differences in normative cli- mate. Living alone generally gives rise to loneliness, but this is the more so in coun- tries where older adults without a partner are expected to live with their families [..g., Greece, Italy) and the less so in countries where older adults without a partner prefer to live alone (".g., Finland).

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

SOCIOECONOMIC CONTEXT

Perlman and Peplau (r98r) argued that in any setting, factors that increase the frequency of interaction and foster group cohesiveness are likely to affect the incidence of loneliness. In our view, the dimension of socioeconomic equality versus inequality is among these fac- tors. Unfortunately empirical research con- necting socioeconomic inequality [a con- cept at the contextual level) to individual loneliness is virtually nonexistent. Phillipson

[zoo4) has started a program of research in the United Kingdom that is oriented toward investigating the consequences of the deepening social and economic inequality and the socially deprived circumstances of groups of impoverished inhabitants of urban neighborhoods compared with the affluent subgroups, taking loneliness as the depen- dent variable [Phillipson, zoo4). Research by Scharf Phillipson, and Smith [zoo4) in some of the most deprived neighborhoods of 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, material resources, and basic services) and experi- encing neighborhood exclusion. The risk of being affected by multiple forms of social exclusion and loneliness was greatest for those belonging to minority ethnic groups and the age group of 7j years and over.

In our view, the links between socioe- conomic inequality and loneliness are a research 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 across industrialized countries, major structural and demographic changes have generated persistent social inequalities and shifts away from social welfare policies toward market- centered strategies for income and health maintenance. In her view, the growing eco- nomic and social inequalities within popula- tions form the fundamental social condition that yields negative outcomes in health and well-being. O'Rand's concept of inequality consists of economic, social, and psychoso- cial components and operates multilevel: across societal planes, the state, and the neighborhood to the individual. The causal mechanism by which inequality affects well- being operates through people's perceptions of societal fairness more than directly on its own. O'Rand distinguished, on one hand, a direct pathway connecting inequality and persons' well-being via individuals' socioe- conomic resources. On the other hand, there is an indirect pathway by which contex- tual level inequality and atomizaiíon at the community level reduce trust and increase persons' perceptions of relative deprivation, leading to negative outcomes.

Within the same paradigm, Wilkinson (rqg+) investigated the relationship between societal characteristics - gross national prod- uct per capita and differences in relative income and life expectancy. He con- cluded that the Organization for Economic Co-operation and Development countries with the longest life expectancy are not the

wealthiest but those with the smallest spread of incomes and the smallest proportion of the population in relative poverty. Wilkinson (rgg+) postulated that the link between socioeconomic inequalities and health or mortality is mediated by cognitíue processes of social comparison, feelings of deprivation and disadvantage that can leadto depression. Kawachi, Kennedy, Lochner, and Prothow- Stith (rggl) provided evidence for the link between social inequality at the macro- level and perceived fairness and distrust at the microlevel. Using General Social Sur- vey data from the United States, they found an inverse relationship between the degree of income inequality at the state level and the perceived lack of fairness and mistrust. The perceived lack of fairness was oper- ationalized with the item, "Most people would try to take advantage of you if they got a chance," and social mistrust with the item, "Generally speaking, would you say that most people can be trusted or that you can't be too careful in dealing with people?" The concept of trust is also central in Ross, Mirowsky, and Pribesh's [zoor) work on neighborhood disadvantage and pow- edessness. Neighborhood disadvantage was measured as the sum of the percentage of households with incomes below the federal poverty line and the percentage of female- headed households with children. Results indicated that when controlled for individ- ual disadvantage, residents of disadvantaged neighborhoods experienced lower levels of trust. Mistrust and absence of faith in other people promoted and reinforced a sense of powerlessness.

The promise of the previously described theoretical ideas for research into loneliness is that contextual and individual determi- nants might be integrated under an over- arching cognitive theory, connecting social and economic inequality to the cognitive processes of persons' perceptions of soci- etal fairness and trust, which in turn affect people's vulnerability to social isolation and loneliness. In the near future, the analy- ses and description of the core mechanisms of the overarching cognitive theory needs attention. Until now this type of multilevel

494

research is scarce. Moreover, some of the central theoretical concepts need better def- initions and valid and reliable measuring instruments. We need to work toward a research and sample design that enables multilevel research into social isolation and loneliness.

Coping and Interventions

Some individuals recover from loneliness by using their own strategies, or by letting time do the healing. Others require outside pro- fessional help. The most obvious approach is to help people develop satisfying personal relationships (Rook, ry84). This can be done by improving how they interact with oth- ers through social skills training or forms of psychotherapy aimed at changing dysfunc- tional interpersonal dispositions (".g., fear of rejection). It can also be done by improving opportunities for interactions through pro- grams aimed at removing barriers for social interaction (e.g., providing transportationJ or at bringing people together [".g., discus- sion groups). Pilusuk and Minkler [r98o) emphasized the importance of develop- ing programs that have opportunities for so-called unintentional network building, that is, the development of friendships is a by-product of the shared activity, not the explicit purpose. Nevertheless, programs with an explicit focus on improving personal relationships have proven to be effective. In the Netherlands, the Friendship Enrich- ment Program [FEP) in which participants are taught how to nourish friendships and go about making friends has been successful in alleviating loneliness (Stevens, 2oor; Stevens & Van Tilburg, zooo). The beneficial effects of the FEP might be limited to specific groups, however. The authors noted that the participants were selÊselected and wanted to learn about friendship. The FEP might work best for individuals who actively want to become less lonely. Moreove4 given that only women participated in the evaluation study, the question of whether men will also benefit from the FEP cannot be answered.

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

Interventions aimed at improving rela- tionships might not always be feasible or appropriate, as in the case of people who have unrealistically demanding or excessive needs for support. Such people are more likely to benefit from cognitive interven- tions aimed at modifying relationship expec- tations. Individuals with severely limited physical mobility are likely to benefit from interventions 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 their sense 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 are flawed by weak methodologies. Findlay con- cluded that future programs aimed at reduc- ing social isolation should have evaluation built into them at inception. This advice is heeded in a program of research that is cur- rently being carried out under the auspices of the Sluyterman van Loo Foundation in the Netherlands. This foundation commissioned r7 interventions aimed at reducing loneliness among the elderly under the condition that their effectiveness would be evaluated by the three authors of this chapter together with Tineke Fokkema of the Netherlands Inter- disciplinary Demographic Institute. The interventions are diverse (".g., home vis- its by volunteers, social program for nurs- ing home residents, educational program for the hearing impaired, Internet usage). Under our supervision, the collection of data has been standardized as far as possible. Key variables such as loneliness, marital his- tory, social network characteristics, relation- ship standards, and health and personality characteristics are measured the same way in each of the projects. All but two of the inter- ventions are randomized control trials. A first 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 not directly connected to social isolation, that is, the absence of relationships with other people. Loneliness is defined as the nega- tive outcome of a cognitive evaluation of a discrepancy between (the quality and quan- tity of) existing relationships and relation- ship standards. An increasing flow of work from disciplines such as psychology, sociol- ogy, and anthropology has broadened the understanding of the mechanisms behind the onset and continuation of loneliness. In doing so, next to background variables such as age, gender, and health, characteristics of the social network of relationships, personal- ity characteristics, and relationship standards have been addressed. The socially isolating effects of deprivations brought by social and economic circumstances at the community or country level require further exploration. Future research should address the ways in which people's evaluations of their relation- ship networks are affected by the normative context in which thev find themselves.

References

Aartsen, M. (zoo3). On the interrelntionships between cognitiue and social funaioning in oWer age. Unpublished doctoral dissertation, Vrije Universiteit, Amsterdam.

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

Bedford, V. H. (rq8qJ. Understanding the value of 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 the Institute of Psycho-Analvsis.

Cacioppo, J. T., Hawkley, L. C., & Bernston, G. G. (zoo3). The anatomy of loneliness. Current Direaions 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 "f mothering: Psychoanalysis and the sociolog of gender. Berkeley: University of California Press.

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

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

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

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

Dannenbeck, C. (rqqS). Im alter einsamT Zur strukturverànderung sozialer beziehungen im alter 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 Personality and Social Psychologt, 53 , n9-r28.

De Jong Gierveld, J. (zoo4). Remarriage, unmar- ried cohabitation, living apart together: Part- ner relationships following bereavement or divorce. 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 Universiteit Amsterdam, Department of Social Research Methodology.

De Jong Gierveld, J., & Van Tilburg, T. (r999b). Living arrangements of older adults in the Netherlands and Italy: Coresidence values and behavior 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 Universiteit Amsterdam.

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 and emotional 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 availability of relationships and the provision and effective- ness of support to older adults. Jounnl of Social and 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 social exclusion: Sociological and policy issues (pp. tt7- r4r). London: Ashgate.

Dykstra, P. A., & De Jong Gierveld, J. [1994). The theory of mental incongruity, with a specific application to loneliness among widowed men and 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 in social and emotional loneliness among Dutch older adults. Canadian Journal on Aging, 23, L4r-rr5.

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

Findlay, R. A. (zoo3). Interventions to reduce social isolation amongst older people: Where is the 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: Something special. Canadian lournal on Aging, 6, r99-zr; .

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

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

THE CAMBRIDGE HANDBOOK OF PERSONAL RELATIONSHIPS

tions. In E. Shanas (Ed.), Aging: Stabiltty and change 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, new conuersations. Keynote address at the Launch ofthe 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 psychological worlds of Swedes and Turks in and around retirement. Journal of Cross-Cultural Psychol- o€J/ ,21, z6-4r .

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

Jones, W. H., & Carver, M. D. [rqqt).Adjustment and coping implications of loneliness. In C. R. Snyder & D. R. Forsych [Eds.), Handbook of social 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 on loneliness among the elderly. Ageing and Soci- e t y , r o , z9 j - 3 r j .

Kaufman, G., & Uhlenberg, P. (1998). Effects of life course transitions on the quality of relationships between adult children and their parents. 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. Amencan Journal 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 psychosocial health status in older age. Iournal of Aging and Health, 14, rzz-r37 .

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

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

[zoor). Mental health variables and positive

heaL ical .

Maran theo sure tions

Marco Lon E*p sion cenc,

Martir dict, stud 203 '

Mullir S. IV amc Gen

Mijusl dyrt Hut

O'Rar cou thei L . X soci, Aca

Pennir D. l van sup diff Hea

Peplar on (Ed oW' wil

Perlm soci & F Pert Lor

Pérod cho soc. i n t 1 9 '

Peters ital old 6 8 ;

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

Marangoni, C., & Ickes, W. [1989). Loneliness: A theoretical 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 parallel study. Joumal of Cross-Cultural Gerontologl, tz ,

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

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

O'Rand, A. M. [zoor). Stratification and the life course; the forms of life-course capital and their interrelationships. In R. H. Binstock & L. K. George (Eds.), Handbook of aging and the social 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, social support, and loneliness in older persons with different chronic diseases. Journal of Aging and Health, rr, r5 r-168.

Peplau, L. 4., & Perlman, D. (1982). Perspectives on 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 a social 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 between social support, life events, and mental health in 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 in old 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 environmental gerontology. Ageing and Society, 2 5 , 963-97, .

Pilusuk, M., & Minkler, M. (r98o). Supportive networks: Life ties for the elderly. Journal of Social lssues, 36(t), 95-:n6.

Pinquart, M. (zoo3l. Loneliness in married, widowed, divorced, and never-married older adults. 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 of Gerontologt: Psychological Sciences, 56 , r95-zr7 .

Pinquart, M., & Sórensen, S. (zoorb). Influences on 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. In J. Coupland&J. F. Nussbaum [Eds.), Handbook of communication and aging research (pp. ,r7- 257). Mahwah, NJ: Erlbaum.

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

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

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

Rook, K. S. (r9B4J. Promoting social bonding: Strategies for helping the lonely and socially isolated. 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 human bonding: Parent-chilà relntions across the life course. 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 factor structure. 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 in deprived 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). Measures of 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: Academic Press.

Silverstein, M., & Chen, X. (1996). Too much of a good thing? Intergenerational social support and 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: A friendship enrichment programme for older women. 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. Educational Gerontologt, 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 and social support in adjustment to loss: A test of attachment versus stress theory. lournal ot' Personality and Sonal Psycholog, 70, L24r- 1249 .

Sudman, S., & Bradburn, N. M. [tqZ+). Response effects 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 importance of 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 not alone: Emotional isolation and social isolation as two distinct dimensions of loneliness in olcler p 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 gewenste ondersteuning in het licht uan eenzaamheidser- uaríngen fObtained and desired social support in association with loneliness). Unpublished doctoral dissertation, Vrije Universiteit, Ams- terdam.

Van Tilburg, T. [rqq"). The size of the support- ive network in association with the degree of loneliness. 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 and loneliness: A comparative study among older adults 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 among older 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 data collection procedures: A mode comparison on the "De Jong Gierveld Loneliness Scale." Inter- national Journal of Public Opinion Research, 3, 6q-8 s .

Van Tilburg, T. G., Havens, B., & De Jong Gierveld, J. [zoo4). Loneliness among older adults in the Netherlands, Italy, and Canada: A multifaceted comparison. Canadian Jountal on 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 Agtng Study. Agtng from 7o to roo [pp. z8z-3or). Cambridge, England: Cambridge University Press.

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

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

Weiss em( MI'

Weiss tior ers Ha

Weng Scc i n < ing

Weiss, R. S. [1973). Loneliness: The experience of emotional 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 loneliness in old age: Review and model refinement. Age- ing and Society, ó, 373-58.

LONELINESS AND SOCIAL ISOLATION 499

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

Windle, G., & Woods, R. T. (zoo4). Variations in subjective wellbeing: The mediating role of a psychological resource. Ageing and Society, 24,

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

fAbout loneliness]. Frankfurt: Thoppau.