What causes loneliness among household heads: a study based in primary setting in Mumbai, India

Urbanization is considered a new avenue of prosperity as it continuously attracts people to a better life. Nevertheless, gradually, it was realized that urbanization is like a two-edged sword [1]; on one side, it provides better opportunities for standard life and health care to the population through better urban services [2]. However, on the other side, the fruits of city life such as privacy and seclusion have led to many physical and psychological problems among people living in urban areas [2]. In this context, it has been anticipated that with the pace of urbanization, symptoms of loneliness emerge as one of the most devastating mental illnesses among city dwellers in the modern age [3]–[5].

Currently, around 30% of the India’s population live in urban areas. It also appraised that by 2025, the share of people living in urban areas is going to be higher by 46% [6]. Previous studies asserted that Indian society passes through the transitional phase of culture [7]. The traditional family system underwent structural and functional changes, which weakened the family ties [8], causing migration and individual disconnection with family. Additionally, hectic city lives leave little time for socializing or leisure living. Therefore, one may find isolation even while living in a big family or a big condominium with several neighbours[9, 10]. Social media has a profound role in compounding the problem by making people connect virtually, diminishing the importance of real face-to-face interaction [11]. This anonymity of living in a big city can end in a scarcity of trust, making it harder to attach. In this way, people are paying a high price for its stretched emphasis on privacy and individuality that many people have no friends and close ones [12]. Also, reaching a threshold point of virtual contacts, isolation backfires probably too when this threshold has been crossed [13]. In this scenario, emotional seclusion may be a tricky thing that strikes different people for different reasons. So, there is no rule or set method to beat loneliness. The lonely person continues to suffer from numerous problems in life.

Empirically loneliness is defined in several ways. It is a natural human feeling triggered by an unpleasant experience of life that occurs when a person's social relationship network is deficient in some significant way, either quantitatively or qualitatively [14]. Sadler (1975) describes “loneliness is caused not by being alone but by being without some needed relationship or set of relationships [15].” He divided loneliness into two types: emotional loneliness: characterized by the lack of an attachment; and social isolation which is manifested through the absence of a social network [15]. Besides, Tiwari (2013) categorized loneliness circumstances into three parts 1) situational loneliness: it arises as a result of adverse socio-economic and cultural situations such as unpleasant experiences due to the disagreement of needs, loss of social contact, migration of distress, interpersonal conflicts, accidents, disasters or emptiness [16]. 2) Developmental loneliness: It appears when individuals are unable to balance, for example, personal inadequacies, separation, poverty, living arrangements, and disability, between innate desire and need [16]. 3) Internal loneliness: it appears to be due to certain inferior personality characteristics such as low self-esteem, feelings of guilt or worthlessness, and poor situational coping skills [16]. In addition, every city dweller values privacy, and therefore the terms of urban living encourage it; hence, loneliness is more often voluntary than imposed. However, when loneliness becomes chronic, it can severely affect both health and well-being; unfortunately, it is continuously emerging as a modern urban life problem [17]. It is a hidden killer that can trigger many problems, including biological dysfunction, psychological distress, and behavioural problems [16, 18]. It is a common stereotype that it mainly affects older people, but previous studies have shown that even younger people suffer from it [19]. Typically, the progression of loneliness has a nonlinear U-shaped distributional curve with people under 25 years of age and people over 65 years of age [20]. Likewise, the magnitude of loneliness shows variations across all ages [21]. In this context, Singh (1991) stated that everyone has to suffer from their ravages at one time or another [22]. Despite this, in India, very little comprehensive research has been done to capture the growing phenomenon of loneliness. However, most related studies concentrated on the elderly population [17].

Thus, there is a greater need for comprehensive studies to fill this research gap, particularly in urban India. Many of these studies lack sound individual loneliness information in an urban locality and data on potential confounders, such as socio-economic status, the role of social capital, and information on substance use. Therefore, this study aimed to examine the pattern and correlates of loneliness among household heads in primary setting in Mumbai, India.

Loneliness is a growing health epidemic, particularly among city dwellers due to changed lifestyles and social adversities. The present study reinforced and extends the previous findings on loneliness, particularly in city dwellers of India. The salient findings are: first, the dwellers of the SRH locality perceived a comparatively higher level of loneliness than other localities. Second, those household heads who suffer from multiple morbidities also suffer from loneliness. Third, the prevalence of loneliness was more prominent among females than in males. Fourth, those household heads having a high level of personal relationships have more likelihood to suffer from loneliness. Fifth, civic engagement, and trust and cooperation show a negative association with loneliness. The data used for this study was collected five years ago, and given the current pandemic situation, how reliable and useful are the estimates are worth probing? Despite data being a bit old, the comprehensiveness and usefulness of the study findings cannot be ruled out completely. However, it is true that with the advent of coronavirus, the study findings may not hold by large in the current context. As this study explored the prevalence and correlates of loneliness among household heads, it is expected that the prevalence of loneliness might have increased after coronavirus. On a similar note, the factors linked to loneliness might have been not the same due to coronavirus. Accordingly, a new study exploring loneliness among household heads in the same study area may provide better estimates.

The study finds that more than one-fourth (28%) of people in Mumbai suffer from loneliness. However, its percentage was varying by locality type. The unadjusted and adjusted OR value shows that SRH followed by old colony residents strongly associate with loneliness. Previous studies also asserted that SRH residents complain about the unfavourable built environment, which reduces the sensory connectedness and restricts traditional flows with other neighbours due to random allocation of flats [31]. It eventually hampers their collective identity, weakened their social support network, and significantly leads to loneliness. Hence, they want to go back to the horizontal slum again; this willingness considers as a rebound phenomenon [32]. On the other hand, old colonies comprised mainly of old-age Parsi and Sindhi populations. The present study asserted that factors like disability and health, loss of a spouse, living alone, and ageing were significantly associated with their perceived loneliness. There is no direct empirical evidence on this issue. However, some previous studies indicate about declining demographic trend of these communities, particularly Parsis. Those studies gave reasoning such as never married, late marriage, and migration about their declining population, etc. [33].

Physical multimorbidity (≥ 2 physical diseases) was associated with increased odds for loneliness. It might be happening due to a greater number of chronic diseases creating hindrance to engage in social activities and roles such as spouse, parent, and worker. This finding is consistent with the previous studies [34, 35]. Multimorbidity leads to social isolation which can be a cause of loneliness [36]. Furthermore, Barlow et al. (2015) demonstrated that multimorbidity affects physical functioning, which can further affect loneliness [37]. Another plausible explanation was provided by Kristensen et al. (2019), where they associated loneliness with quality of the relationships and not with the quantity of the relationships [34]. They suggested that multimorbidity may affect loneliness by reducing the quality in relationship [34]. Furthermore, Jessen et al. (2018) also provided a plausible explanation for the relationship between multimorbidity and loneliness and stated that household head with multimorbidity have to deal with health care system on a regular basis, thereby restricting their social participation leading to loneliness [38]. To add more, people with multimorbidity may have to leave labour market thereby reducing the everyday contact with colleagues, which could also be a plausible factor of loneliness among them [38].

Gender is an important determinant in the context of perceived loneliness; and in agreement with previous research results indicate that females were lonelier than their male counterpart [39, 40]. In contrast, few studies have also noted an otherwise outcome where men were more likely to experience loneliness than their female counterparts [41, 42].The likelihood of odds was also significantly three times more among females after adjusting all other factors. This situation occurs because females are not highly interconnected or have cohesive sets of friends compared to their counterparts. Moreover, women are also more likely to precise and share their emotions with, and be more responsive to the emotions of others [43]. However, the stigma related to loneliness, mainly among men, is different; men are less likely to interact and intimate closure than women; but relational connectedness is more important for ladies than men [44].

In concordant with previous studies[45, 46], this study noticed higher odds of loneliness among older adults who belonged to other category of marital status than the older adults who were married. In a marital union, protection from social loneliness come from involvement with spouse, thereby reducing loneliness [45]. Women not in marital union may perceive loneliness due to the adjustment in a new role of singlehood [46]. Another plausible explanation suggest that with increasing age, friendship ties become weak and the spouse is the only person with whom older adult feel attached; thereby reducing loneliness among them [47].

Previous studies found an inverse relationship between social capital with loneliness and asserted that strong relations with relatives and friends lower stress [48]. Although different dimensions of social capital attribute, unlike personal characteristics. Results show that a high level of personal relationships leads to a high level of loneliness. This positive, strong relationship considers as a dark side of close personal relation [49]. Fafchamps (2006) argues that sometimes an excessive amount of social bonding and connection results in pressure and tension, and it becomes negative, creating conformity instead of variety[50]. In contrast, a high level of trust and cooperation and civic engagement reduces loneliness by three quarters. It is evident that the quality of social engagement and trust is protective against loneliness and a key factor to achieve personal and social desired goals [9, 20].

The findings of this study shall be interpreted in line of some noteworthy limitations. The study acknowledges that the physical illness was self-reported and was not verified against other data sources such as medical records. This might have resulted in misreporting in some instances, especially as evidence suggests that while self-reports of physical illness mostly accord with doctor’s reports, not all diseases are reported with equal accuracy, and there might also be age-related differences in the reliability of reports for some diseases. Nonetheless, the cross-sectional nature of the present study restricts the claims of causal inferences; hence we cannot conclude that an increase in loneliness is caused by any particular factor or vice-versa. As this study was cross-sectional, we could not establish causality or determine the direction of the observed association. Also, the information on loneliness was self-reported and was assessed using one item only. Furthermore, the study findings shall not be generalized to a larger set of population as purposive sampling was done in a metropolitan region only.

It has long been noted that life style of urban dwellers adversely affects their health not only physically but mentally too. In this context, loneliness rapidly emerged as a public health concerns in urban part. Hence, current study tried to examined the level of loneliness and its significant factors. Finding reveals that level of loneliness symptomatology in urban dwellers may be attributed significantly by individual (i.e., morbidity status and sex of respondent), social (i.e., personal relation) and residing locality characteristics. On the other hand, some factors (i.e., civic engagement, and trust and cooperation) identified as inversely associated with loneliness. In nutshell, study concludes that that there is a significant effect of locality in the subjective feeling of loneliness. Slum rehabilitees were found to be significantly lonelier than their counterpart localities. Furthermore, many identified the risk factors of loneliness could be avoided if timely preventive measures could be taken along with adequate care. Improvement in aesthetic design of future slum rehabilitation projects can promote socially cohesive environment.