Loneliness is the subjective feeling that you are lacking social connections; the feelings of closeness, affection and trust from friends, close ones and a community.

The past year has seen a surge in individuals experiencing loneliness. A study carried out in June of last year by the University of Malta's Faculty for Social Wellbeing showed that nine in every 10 people experienced loneliness during the Covid-19 pandemic and the 1772 loneliness helpline in Malta received 7,861 calls between March and September of last year.

The Malta Independent spoke with two mental health professionals about how their understanding of loneliness has changed over the past year due to Covid-19. Ian Refalo is a psychotherapist who has worked with adults for over 20 years and Karl Grech is a counsellor and the head of the Suicide Prevention Outreach and Therapeutic Services (SPOT) at Victim Support Malta.

Since the Covid-19 pandemic spread to Malta a year ago, how has your understanding of loneliness changed?

Refalo: The level of loneliness has increased significantly, as have the problems that come with it in terms of depression and the sense of total isolation. Because we don't have a date in sight as to when this pandemic will pass, that creates aspects of anxiety which you wouldn't find when you have a clear prognosis of something. When we have a date in front of us, that keeps us going and the fact that everything is a bit unclear sustains this anxiety and loneliness.

Grech: When you're meeting your friends outside and suddenly no one wants to meet you, you might misperceive and think that you are a burden, rather than realise that it is due to the pandemic. Due to this, suicide rates have also increased since the start of the pandemic and more people have been reaching out to SPOT for help. I was looking at some interesting findings that show how people in long-standing isolation may start to hallucinate in order to create imaginary friends.

Is there one demographic that you noticed has suffered from loneliness more than others?

Refalo: The most noticeable group has been elderly citizens living alone because they are missing out on living the last years of their lives with their children and grandchildren, or simply living their own experiences. Physically, they've also declined, since they're not going out as much and are not moving around like they used to. Another group facing loneliness is children who are not going to school and are suffering socially. People who are already living in anxiety or with some form of mental illness are also affected as their anxiety issues are being shocked to alarming levels and they are seeking a significant amount of support from psychiatrists and therapists. Lastly, for people who are in abusive relationships, being stuck at home has created new realities and new problems.

Grech: The first obvious answer that comes to mind is the elderly, but what about single parents who have to take care of a child by themselves? You are the caregiver, you are exhausted. Isn't that person isolated and lacking adult-to-adult connection? What about front-liners? They're always working, and if they're not, they're burnt out. It's tricky to choose one demographic. We're also living on a tiny island and we haven't gone abroad in a year! For those of us who do go abroad, it's very claustrophobic now. I think we've all experienced loneliness in a very different way and everyone has suffered elements of loneliness over the past year. 

Studies have shown that long-term social isolation is as bad for your health as smoking 15 cigarettes a day. How can loneliness affect one's physical health?

Refalo: Long-term loneliness will affect one's health, both mentally and physically. The sense of isolation can damage your sense of motivation in life and make you feel that you're not valuable to anyone and that, effectively, you're just existing and not living. People have an extra drink when they shouldn't or have an extra cigarette when they shouldn't. Losing interest in one's self-care can kick in when you're feeling lonely and there's no one to live for. That is why building connections with others is so crucial, because it gives you a sense of 'I belong to a community'. It's not a coincidence that people sit, looking out of a window, as seeing people go by reminds them that they still belong.

Grech: According to a 2020 study, long-lasting social isolation in older adults has been linked to a 50% increase risk of dementia, a 29% increase risk of heart disease and 32% increase risk of stroke. This just goes to show that we are social animals and that staying inside for long periods of time means fighting our very nature.

What can we do to minimize loneliness during this time, both at an institutional level and on a personal level?

Refalo: If everyone does something small on a personal level, it will do far more good than anything that can be done at an institutional level. Imagine if everyone had one person they kept in contact with on a regular basis who they know suffers from loneliness. That will be of greater benefit than any other form of institutional intervention. Institutionally, it's about getting this pandemic under control, but I don't think it should be the institutions that should minimise loneliness, it's more about what everyone can do. There's a lot we can do on a personal level and it's relatively insignificant in terms of commitment, but the value in it is great.

Grech: If we had to talk about an ideal state, then there should be more initiatives to help tackle loneliness, but everyone is spread thin at the moment. More internet-based communities can be created, like neighbourhood Whatsapps for example. Ultimately however, as citizens, it falls to us to look after each other. We can't always depend on the state to take care of us. On a personal level, helping another people during Covid can be an incredibly powerful experience. So reach out to your neighbours and anyone in need. It would be beautiful if we could get through this together.