Isolation and loneliness

Proposed and experimental methods

Methods that are proposed, under trial, approved in some places, or tried and then failed. Each shows a stage label and an evidence rating. A stage label shows how far a method has progressed, not whether it works. The stage labels are explained on the social factor page.

• Structured telephone support calls (Large trial, B). Trained lay callers or support workers phone isolated people on a set schedule. In a trial of 240 homebound Meals on Wheels clients in Texas, four weeks of empathy-focused calls from 16 briefly trained callers aged 17 to 23 improved loneliness by 1.1 points on the 3-item UCLA Loneliness Scale (Cohen d 0.48) but not significantly on a second loneliness scale (P = .06), and also improved depression and anxiety (Kahlon et al., 2021). A pragmatic trial of 435 socially isolated adults aged 65 and over in England and Wales found that up to eight telephone behavioral activation sessions lowered depression scores at 3 months (adjusted mean difference -1.65 on the PHQ-9) and reduced emotional loneliness in the short term (Gilbody et al., 2024). Both trials followed people for weeks to months, so lasting effects are unknown.
• Ministers and national laws for loneliness (Approved but not scaled, B for program facts only). In January 2018 the UK named a minister to lead cross-government work on loneliness after the Jo Cox Commission, citing more than 9 million people who always or often feel lonely (UK Government, 2018). Japan created a Minister in charge of measures for loneliness and isolation in February 2021 and passed a law to advance these measures in May 2023, with a Cabinet Office headquarters headed by the Prime Minister (Cabinet Office of Japan, 2025). No evaluation was found showing that either structure has reduced loneliness.
• Social prescribing through link workers (In wide use, contested, C). A doctor refers a patient to a link worker, who connects the patient to community groups and activities. A systematic review of UK social prescribing for mental health found 17 studies, of which 15 were uncontrolled before-and-after designs and one was a randomized trial, and concluded that robust conclusions on effectiveness cannot be made (Cooper et al., 2022). See also "Social determinants of health" in the societal factors.
• AI companions (Early trial, contested, C). Builds on "Fear, anxiety, and depression" in the psychological factors (generative AI therapy chatbots). In online experiments, one conversation with an AI companion reduced loneliness about as much as talking with a person (d = 0.25 versus 0.24, 296 people analyzed across five groups), and over a week loneliness fell from before to after each daily session (d = 0.20) (De Freitas et al., 2024). A four-week randomized study of 981 people found no significant effects of chatbot voice or conversation type, but people who chose to use the chatbot more had consistently worse outcomes across loneliness, socializing with real people, emotional dependence, and problematic use (Fang et al., 2025). Neither study is peer reviewed. California's SB 243, in force from January 1, 2026, requires companion chatbot operators to remind minors that they are talking to AI and to follow a protocol for suicidal ideation and self-harm (Padilla, 2025), and in January 2026 Character.AI and Google agreed to settle lawsuits by families alleging chatbot harm to teenagers, including a suicide (Associated Press, 2026).

Sources cited on this page

1. Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine, 7(7), e1000316. DOI B Moderate
2. Putnam, R. D. (2000). Bowling Alone. New York: Simon and Schuster. B Moderate
3. WHO: Social connection Q and A (2025) B Moderate: for prevalence, C for the deaths figure
4. Cooper, M., Avery, L., Scott, J., Ashley, K., Jordan, C., Errington, L., & Flynn, D. (2022). Effectiveness and active ingredients of social prescribing interventions targeting mental health: A systematic review. BMJ Open, 12(7), e060214. link C Limited
5. De Freitas, J., Uguralp, A. K., Uguralp, Z. O., & Puntoni, S. (2024). AI companions reduce loneliness (arXiv:2407.19096). arXiv. link C Limited
6. Fang, C. M., Liu, A. R., Danry, V., Lee, E., Chan, S. W. T., Pataranutaporn, P., et al. (2025). How AI and human behaviors shape psychosocial effects of extended chatbot use: A longitudinal randomized controlled study (arXiv:2503.17473, version 2). arXiv. link C Limited
7. Gilbody, S., Littlewood, E., McMillan, D., Atha, L., Bailey, D., Baird, K., et al. (2024). Behavioural activation to mitigate the psychological impacts of COVID-19 restrictions on older people in England and Wales (BASIL+): A pragmatic randomised controlled trial. The Lancet Healthy Longevity, 5(2), e97-e107. link B Moderate
8. Kahlon, M. K., Aksan, N., Aubrey, R., Clark, N., Cowley-Morillo, M., Jacobs, E. A., et al. (2021). Effect of layperson-delivered, empathy-focused program of telephone calls on loneliness, depression, and anxiety among adults during the COVID-19 pandemic: A randomized clinical trial. JAMA Psychiatry, 78(6), 616-622. link B Moderate
9. Padilla, S. (2025, October 13). First-in-nation AI chatbot safeguards signed into law [Press release]. California State Senate. link B Moderate

Every source for this factor is listed on the social factor page.