Social connections

Lane Kenworthy, The Good Society
July 2020

For at least 150 years, analysts and pundits have worried that modernity would reduce social connections and ties. Better transportation, greater access to college, and the concentration of jobs in cities increases the incentive for people to move away from family and childhood friends. Cities are crowded, which can make it more difficult to develop lasting bonds. Technological advance provides more sources of distraction and access to individualized entertainment, reducing the time available for friends or family. As more women move into paid work, they have less time to socialize. And as government public insurance programs cushion more of the risks and hardships we face, voluntary organizations, a key source of interaction and community, may diminish in prevalence.

On the other hand, most of these developments could potentially have the opposite effect. Geographic mobility might increase the number of friends we have. Living in a more populous area, such as a city or suburb, boosts the number of potential friends. New technologies — telephones, email, text messaging, social media — enhance our ability to communicate with family and friends. For women, work is a potential source of contacts and friendships. And by reducing deprivation and improving capabilities among the less advantaged, government services and transfers might decrease isolation.

In the late 1800s and early 1900s, sociologists Fernand Tonnies, Max Weber, and Emile Durkheim described the shift from the “gemeinschaft” society of small villages, which emphasizes personal relationships and family, to the individualistic, atomistic “gesellschaft” society common in large cities. In 1950, David Riesman’s The Lonely Crowd portrayed an America in which adults are less and less connected with one another, whether by traditions or traditional institutions. In the 1970s, Vance Packard’s A Nation of Strangers warned that personal connections of all sorts were weakening.

In recent decades pessimistic assessments in this vein have proliferated.1 In Bowling Alone, published in 2000, Robert Putnam examined a host of indicators of social connections. The evidence, he concluded, suggests that “across a very wide range of activities, the last several decades have witnessed a striking diminution of regular contacts with our friends and neighbors. We spend less time in conversation over meals, we exchange visits less often, we engage less often in leisure activities that encourage casual social interaction, we spend more time watching (admittedly, some of it in the presence of others) and less time doing. We know our neighbors less well, and we see old friends less often.”2

Over the ensuing decades, David Brooks, an op-ed writer for the New York Times, penned dozens of columns suggesting that “social fragmentation and social isolation are the fundamental problems afflicting America today.”3

In 2016, Yuval Levin posited, in his book The Fractured Republic, that “As the national government grows more centralized, and takes over the work otherwise performed by mediating institutions — from families and communities to local governments and charities — individuals become increasingly atomized.” The result, according to Levin, is that “We have set loose a scourge of loneliness and isolation.”4

In 2017, Vivek Murthy, a former Surgeon General of the United States, suggested that “Loneliness is a growing health epidemic. We live in the most technologically connected age in the history of civilization, yet rates of loneliness have doubled since the 1980s.”5

That same year, Jean Twenge examined patterns of loneliness and isolation among teenagers since the advent of the smartphone a decade earlier. Her conclusion: “The twin rise of the smartphone and social media has caused an earthquake of a magnitude we’ve not seen in a very long time, if ever. There is compelling evidence that the devices we’ve placed in young people’s hands are having profound effects on their lives — and making them seriously unhappy.”6

A major exception to these pessimistic assessments comes from Claude Fischer. In his 2011 book Still Connected, Fischer undertook the most comprehensive and detailed examination of available data on social connections and ties. He concluded as follows7:

“The question that this book has posed is whether and how Americans’ relationships with family and friends changed between 1970 and 2010. The short answer, based on a canvass of published research and available survey data, is: not much. Some of the ways in which Americans engaged with people in their immediate circles changed, but the intimacy and support of close family and friendship ties stayed about the same. Few Americans were socially isolated, and the percentage of those who were did not increase. The number of family and friends with whom people reported being close stayed about the same. Americans got together with one another in set-aside home activities like dinner parties less often, but they communicated with one another electronically more often. Americans expected to get about as much help from family and friends as they had earlier. And American feelings about their social relationships stayed about the same or became more upbeat.”

What does an updated look at the evidence tell us about social connections, isolation, and loneliness in the United States?

ISOLATION

Let’s begin with the question of how much time Americans spend with family. Figure 1 shows that the share of families who frequently eat dinner together declined in the 1980s but has been fairly constant since then.

Figure 1. Family frequently eats dinner together
Family usually eats dinner together: Share of Americans saying they definitely agree, generally agree, or moderately agree that “Our whole family usually eats dinner together.” Other response options: definitely disagree, generally disagree, moderately disagree. The top line is for households with two or more adults. The lower line is for all households. Data source: Claude Fischer, Still Connected: Family and Friends in America Since 1970, Russell Sage Foundation, 2011, figure 3.1, using data from DDB Needham. Family eats dinner together 6-7 nights a week: Other response options: 0, 1, 2, 3, 4, 5. Data source: Lydia Saad, “Most U.S. Families Still Routinely Dine Together at Home,” Gallup, 2013.

Robert Putnam reported in 2000 that “Beyond mealtime, virtually all forms of family togetherness became less common over the last quarter of the twentieth century. Between 1976 and 1997, according to Roper polls of families with children aged eight to seventeen, vacationing together fell from 53 percent to 38 percent, watching TV together from 54 percent to 41 percent, attending religious services together from 38 percent to 31 percent, and ‘just sitting and talking’ together from 53 percent to 43 percent.”8

On the other hand, the amount of time parents spend with their children — at playdates, sports practices, the grocery store — has increased since 2000.9 And as figure 2 shows, there has been no decline since the mid-1970s in the share of Americans, around 55-60%, who say they spend social evenings several times a month or more with relatives.

Figure 2. Spend a social evening with relatives several times a month or more
Share of US adults. Question: “Would you use this card and tell me which answer comes closest to how often you do the following things: Spend a social evening with relatives.” Response options: almost daily, several times a week, several times a month, once a month, several times a year, once a year, never. Data source: General Social Survey, sda.berkeley.edu, series socrel.

In Still Connected, Claude Fischer concludes that “This pattern of results suggests that Americans were no less committed to their immediate families and other relatives in the 2000s than before….”10

What about time with friends and neighbors? In Bowling Alone, Robert Putnam reported declines in the 1970s, 1980s, and 1990s in playing cards, participating in league bowling, going out to bars and nightclubs, participating in youth sports (boys only), and engaging in informal socializing (visiting with friends, attending parties, informal conversation, and so on).11

The General Social Survey periodically asks Americans how often they spend a social evening out with neighbors. As figure 3 shows, the share who say they do so several times a month or more dropped in the late 1970s and through the 1980s. Since, then, however, there has been no change. The survey asks the same question about friends who live outside the neighborhood. As we see in figure 4, here there has been no decline at all. Data from DDB Needham surveys are consistent with this picture.12

Figure 3. Spend a social evening with neighbors several times a month or more
Share of US adults. Question: “Would you use this card and tell me which answer comes closest to how often you do the following things: Spend a social evening with neighbors.” Response options: almost daily, several times a week, several times a month, once a month, several times a year, once a year, never. Data source: General Social Survey, sda.berkeley.edu, series socommun.

Figure 4. Spend a social evening with friends who live outside the neighborhood several times a month or more
Share of US adults. Question: “Would you use this card and tell me which answer comes closest to how often you do the following things: Spend a social evening with friends who live outside the neighborhood.” Response options: almost daily, several times a week, several times a month, once a month, several times a year, once a year, never. Data source: General Social Survey, sda.berkeley.edu, series socfrend.

Figure 5 shows the share of Americans who say that yesterday they called a friend or relative just to talk. The line is flat, suggesting no decline. We don’t have good data on contact with family and friends via texting or social media, but given that neither existed prior to the late 2000s, there is good reason to suspect they have increased.

Figure 5. Called a friend or relative yesterday just to talk
Share of US adults. Question: “Yesterday did you … call a friend or relative just to talk?” Response options: yes, no. Data source: Pew Research Center.

In his review of the data in 2011, Claude Fischer concluded that there has been no decline in American adults’ overall contact with family and friends.13 That conclusion seems likely to still hold.

What about teenagers? According to data marshaled by Jean Twenge, smartphones and social media have changed the type of contact among American teenagers. As figure 6 shows, we see sharp declines over the past decade in the share of 12th graders (high school seniors) who ever go out on dates, who attend parties once a month or more, and, most revealingly, who say they get together with friends every day or nearly every day. While these forms of face-to-face contact have decreased, they’ve been replaced by contact via texting and social media. As Twenge puts it, “The timing of the recent, severe drop in going out and getting together with friends … occurred right when smartphones became popular and social media use really took off. Time spent with friends in person has been replaced by time spent with friends (and virtual friends) online.”14 Texting and social media were nonexistent prior to 2007. As figure 7 shows, both are now heavily used by 12th graders.

Figure 6. Face-to-face contact among 12th graders
Share of 12th graders. “Go out on dates”: ever go out on dates. “Attend parties”: attend parties once a month or more. “Get together with friends often”: get together with friends every day or nearly every day. Data source: Jean M. Twenge, iGen, 2017, figures 1.2, 3.1, and 3.2, using Monitoring the Future data.

Figure 7. Texting and social media time among 12th graders
Average hours per day. Data source: Jean M. Twenge, iGen, 2017, figure 2.2, using Monitoring the Future data.

Has there been an increase in the share of Americans who don’t have any friends? Since 1976, Gallup has occasionally asked “Not counting your relatives, about how many close friends would you say you have?” And since the mid-1980s the General Social Survey has asked about “close friends.” The trend for average number of friends has been flat. The share saying “zero” has been less than 5%, and it too has been flat.15

In Going Solo, Eric Klinenberg reports that over the past half century the share of Americans who live alone has risen steadily. Most of this is by choice. (Some of it is due to rising life expectancy, which means more elderly persons live alone for lengthy periods after a spouse or partner dies.) Klinenberg concludes that those who live alone aren’t condemned to be isolated or feel lonely: “On the contrary, the evidence suggests that people who live alone compensate by becoming more socially active than those who live with others.”16

LONELINESS

So isolation doesn’t seem to have increased to any appreciable degree. Even so, Americans may have gotten lonelier, because isolation and loneliness aren’t strongly correlated across individuals. Some isolated people are lonely, but others aren’t. Some non-isolated persons aren’t lonely, while some are.17 (The one notable exception is people without a romantic partner/spouse, who tend to feel lonelier than those who do have one.)

Loneliness is “the subjective feeling that you’re lacking the social connections you need.”18 Social scientists measure loneliness via answers to questions such as

  • How often do you feel that you lack companionship?
  • How often do you feel that there are people you can turn to?
  • How often do you feel that there are people who really understand you?
  • Do you have someone with whom you’re comfortable discussing important matters?
  • How satisfied are you with your friendships?
  • Would you like to spend more time with friends?

Reviewing the available data for the period from 1970 to 2010, Claude Fischer finds that fewer than 10% of American adults reported being lonely according to these types of questions, and there was no change through these years.19

What do we find when people are asked more directly about being lonely? One question, asked only a handful of times over the past half century, is “During the past few weeks, did you ever feel very lonely or remote from other people?” Figure 8 shows the share responding yes to this question from the early 1960s to the early 2000s. The data suggest no noteworthy change over this lengthy period, but they don’t, unfortunately, tell us anything about the past two decades. In 2018, a different survey found 11% saying they feel lonely always or often; 22% saying they always or often feel lonely, isolated, left out, or lack companionship; and 34% said they feel lonely always, often, or sometimes.

Figure 8. Lonely
Share of US adults. 1963-2001 data source: National Opinion Research Center and Gallup, via Claude Fischer, Still Connected, Russell Sage Foundation, 2011, figure 6.1. 2018 data source: Kaiser Family Foundation and The Economist, “Topline: Survey on Loneliness and Social Isolation in the United States, the United Kingdom, and Japan,” 2018.

So for adults there is little indication of an increase in loneliness. A 2018 assessment concludes similarly: “The discussion of loneliness has suggested to media consumers and policymakers that it is an epidemic — that loneliness has increased substantially in recent years and is a pressing problem in need of urgent attention. These claims, however, are based on a flawed interpretation of the research literature. In fact, there is little evidence that loneliness has increased.”20

In recent years there has been growing concern about the impact of social media on loneliness among teenagers. The period in which we are likely to observe effects is after 2007, when the first iPhone was released. In her book iGen, Jean Twenge examines data from the Monitoring the Future surveys of American teenagers. As we see in figure 9, there has indeed been a sharp rise since 2007 in the share of 8th, 10th, and 12th graders who say “A lot of times I feel lonely.” Twenge also notes that the increase has been larger among girls than among boys. This, she says, is what we would predict: “Girls use social media more often, giving them additional opportunities to feel excluded and lonely when they see their friends or classmates getting together without them.”21

Figure 9. Feel lonely a lot of times
Share of 8th, 10th, and 12th graders who agree or mostly agree. Question: “How much do you agree or disagree with each of the following statements? A lot of times I feel lonely.” Other response options: neither, mostly disagree, disagree. Data source: Jean M. Twenge, iGen, 2017, figure 4.3, using Monitoring the Future data.

On the other hand, the Monitoring the Future survey asks additional questions that tap loneliness. If we take these into account, loneliness seems clearly to have decreased, as we see in figure 10.

Figure 10. Loneliness
Average score on 6 questions: (1) A lot of the time I feel lonely. (2) There is always someone I can turn to if I need help. (3) I often feel left out of things. (4) There is usually someone I can talk to if I need to. (5) I often wish I had more good friends. (6) I usually have a few friends around I can get together with. Response options: Agree-disagree scale of 1 to 5. Data source: D. Matthew, T. Clark, Natalie J. Loxton, and Stephanie J. Tobin, “Declining Loneliness Over Time: Evidence From American Colleges and High Schools,” Personality and Social Psychology Bulletin, 2015, figure 4, using Monitoring the Future data.

And unhappiness doesn’t seem to have increased among teenagers. Figure 11 shows the share of 12th graders who say they are “not too happy,” as opposed to “very happy” or “pretty happy,” in recent decades. There is no rise over time. Nor, as figure 12 shows, is there any association between the amount of time teenagers spend on social media and their likelihood of being unhappy.

Figure 11. Unhappiness among 12th graders
Share responding “not too happy.” Other response options: very happy, pretty happy. Data source: Alexandra Samuel, “Yes, Smartphones Are Destroying a Generation, But Not of Kids,” JSTOR Daily, 2017, figure 1, using Monitoring the Future data.

Figure 12. Social media use and unhappiness among 12th graders
Share of 12th graders responding “not too happy” to the question “Taking all things together, how would you say things are these days — would you say you’re very happy, pretty happy, or not too happy these days?” Data source: Alexandra Samuel, “Yes, Smartphones Are Destroying a Generation, But Not of Kids,” JSTOR Daily, 2017, figure 3, using Monitoring the Future data.

Two recent meta-analyses find no compelling evidence that teenagers’ use of digital technology or social media significantly worsens their subjective well-being.22

Teenage suicide has increased since 2007. Figure 13 shows the suicide rate over time for three age groups. Among 15-to-19-year-olds there was a rapid rise after 2007. The rate of increase was faster among this group than among 25-to-44-year-olds. However, it wasn’t more rapid than among 45-to-64-year-olds.23 And contrary to what Twenge concludes about loneliness, the teen suicide rate has risen more rapidly among boys than among girls. So it isn’t clear how strongly suicide trends support the hypothesis that smartphones and social media have increased problematic loneliness among American teenagers.

Figure 13. Suicides
Per 100,000 persons. Data source: National Center for Health Statistics, Health, United States, 2018, table 9.

There is good reason to suspect that smartphones and social media have increased perceptions of exclusion and loneliness among some American teens. But it’s too soon to tell how large this effect is, how long it will last, and what impact it has on well-being.

CONSEQUENCES OF LONELINESS AND ISOLATION

The evidence gives us little reason to conclude that isolation or loneliness have increased significantly in the United States. But that doesn’t mean they aren’t a big problem. David Brooks suggests that isolation tends to reduce happiness even people choose it intentionally: “Nations where a fifth of the people live alone, like Denmark and Finland, are a lot richer than nations where almost no one lives alone, like the ones in Latin America or Africa…. When people who are raised in developed countries get money, they buy privacy. For the privileged, this sort of works. The arrangement enables the affluent to dedicate more hours to work and email, unencumbered by family commitments. They can afford to hire people who will do the work that extended family used to do. But a lingering sadness lurks, an awareness that life is emotionally vacant when family and close friends aren’t physically present, when neighbors aren’t geographically or metaphorically close enough for you to lean on them, or for them to lean on you.”24

For evolutionary reasons, isolation and loneliness may produce a subconscious search for threat, and this can increase anxiety and depression, worsen physical health, and shorten lives.25 A 2015 meta-analysis of 70 studies concludes that “Substantial evidence now indicates that individuals lacking social connections (both objective and subjective social isolation) are at risk for premature mortality. The risk associated with social isolation and loneliness is comparable with well-established risk factors for mortality, including those identified by the U.S. Department of Health and Human Services (physical activity, obesity, substance abuse, responsible sexual behavior, mental health, injury and violence, environmental quality, immunization, and access to health care).”26 According to Vivek Murthy, “the impact of lacking social connection on reducing life span is equal to the risk of smoking 15 cigarettes a day.”27 And Dean Ornish and Anne Ornish suggest that “Our supportive connections are sufficient when we can answer ‘Yes’ to questions such as: Do you have anyone who really cares for you? Who feels close to you? Who loves you? Who wants to help you? In whom you can confide and be vulnerable? … If you cannot answer yes to any of these questions, you may have a three to ten times higher risk of premature death and diseases from all causes.”28 Others contend that these conclusions are stronger than the existing evidence allows.29

What can we learn by comparing across nations? Figure 14 includes three charts. On the horizontal axis in each chart is that share of adults who don’t live alone — that is, who live with one or more other persons. In the first chart, the vertical axis has a measure of happiness. In the second chart it is suicides; in the third it is life expectancy. Life satisfaction tends to be lower, not higher, in countries where which fewer people live alone. On the other hand, the suicide rate tends to be lower in such countries, although the difference is modest. There is no apparent association between living alone and life expectancy.

Figure 14. Living with others, happiness, and health
Life satisfaction: average response to the question “Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?” 2015-2017. Data source: Gallup World Poll, via the World Happiness Report. Suicides: per 100,000 population. 2014-2016. South Korea is omitted as an outlier. Data source: OECD. Life expectancy: years of life expectancy at birth. 2014-2017. Data source: OECD. Don’t live alone: share of adults who live with one or more other persons, family or non-family. Data source: Pew Research Center, “Religion and Living Arrangements Around the World,” appendix C, 2019, using national data sources. “Aus” is Austria. The lines are linear regression lines.

Figure 15 has three analogous charts, but with the horizontal axes showing the share of adults who say they get together with friends several times a month or more. Here we see a positive association with happiness. There again is a negative association with suicides, and this association is fairly strong. These first two charts suggest a beneficial impact of social connections. Once again, however, there is no apparent relationship with life expectancy.

Figure 15. Getting together with friends frequently, happiness, and health
Life satisfaction: average response to the question “Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?” 2015-2017. Data source: Gallup World Poll, via the World Happiness Report. Suicides: per 100,000 population. 2014-2016. South Korea is omitted as an outlier. Data source: OECD. Life expectancy: years of life expectancy at birth. 2014-2017. Data source: OECD. Get together with friends frequently: share of adults who say they get together with friends several times a month or more. Question: “How often do you do each of the following activities in your free time? Get together with friends.” Response options: daily, several times a week, several times a month, several times a year or less, never. Data source: International Social Survey Program (ISSP), “Leisure Time and Sports” module, 2007. “Asl” is Australia. The lines are linear regression lines.

In figure 16, the horizontal axes have a third indicator of social connections: the share of adults who say yes in response to the question “If you were in trouble, do you have relatives or friends you can count on to help you whenever you need them, or not?” Here the first chart suggests a beneficial effect, but the other two don’t.

Figure 16. Social support, happiness, and health
Life satisfaction: average response to the question “Please imagine a ladder, with steps numbered from 0 at the bottom to 10 at the top. The top of the ladder represents the best possible life for you and the bottom of the ladder represents the worst possible life for you. On which step of the ladder would you say you personally feel you stand at this time?” 2015-2017. Data source: Gallup World Poll, via the World Happiness Report. Suicides: per 100,000 population. 2014-2016. Data source: OECD. Life expectancy: years of life expectancy at birth. 2014-2017. Data source: OECD. Social support: share of adults responding yes to the question: “If you were in trouble, do you have relatives or friends you can count on to help you whenever you need them, or not?” Data source: Gallup World Poll, via the World Happiness Report. South Korea is omitted as an outlier. “Asl” is Australia; “Aus” is Austria. The lines are linear regression lines.

On the whole, the cross-country patterns suggest that isolation may be bad for happiness and suicides. Two of the three measures of social connectedness are associated with these outcomes in the predicted way. There is no indication of an effect on life expectancy.

SUMMARY

Since the onset of industrialization, societal observers have predicted a rise in isolation and loneliness, and in recent decades this view seems to have become increasingly prominent. However, in his thorough examination of the data in 2011, Claude Fischer concluded that over the past half century “Americans’ relationships with family and friends were — perhaps surprisingly to some commentators — robust and lasting.”30 With the possible exception of the recent impact of smartphones and social media on teen loneliness, that assessment continues to hold.

Even so, isolation and loneliness affect a significant share of Americans, with seemingly malign consequences for happiness and mental health.

But that’s a stronger conclusion than the existing evidence allows. Murthy, Together, p. 13; Esteban Ortiz-Ospina, “How Important Are Social Relations for Our Health and Well-Being?,” Our World in Data, 2019.


  1. In addition to those cited in this and the ensuing paragraphs, see Lynn Smith-Lovin, Matthew Brashears, and Miller McPherson, “The Ties That Bind Are Fraying,” Contexts, 2008. These researchers looked at responses at two points in time to a public opinion survey question that asked “Think back over the last six months and the people with whom you discussed the things most important to you. How many were there?” According to the researchers, in 2004 “Americans had one-third fewer confidants than two decades earlier. In 2004, many more people said they don’t discuss matters of importance with anyone.” It turns out, however, that these data may have been misleading. See Claude Fischer, Still Connected: Family and Friends in America Since 1970, Russell Sage Foundation, 2011. 
  2. Robert D. Putnam, Bowling Alone: The Collapse and Revival of American Community, Simon and Schuster, 2000, p. 115. 
  3. David Brooks, “How American Renewal Begins,” New York Times, 2018. 
  4. Yuval Levin, The Fractured Republic, Basic Books, 2015, pp. 45, 88. 
  5. Vivek Murthy, “Work and the Loneliness Epidemic,” Harvard Business Review, 2017. 
  6. Jean M. Twenge, “Have Smartphones Destroyed a Generation?,” The Atlantic, 2017. See also Twenge, iGen: Why Today’s Super-Connected Kids Are Growing Up Less Rebellious, More Tolerant, Less Happy — and Completely Unprepared for Adulthood, Atria Books, 2017. 
  7. Fischer, Still Connected, ch. 7. 
  8. Putnam, Bowling Alone, p. 101. See also Fischer, Still Connected, ch. 3. 
  9. Fischer, Still Connected, ch. 3. 
  10. Fischer, Still Connected, ch. 3. 
  11. Putnam, Bowling Alone, ch. 6. 
  12. Fischer, Still Connected, figure 4.8. 
  13. Fischer, Still Connected, ch. 4. 
  14. Twenge, iGen, ch. 3. 
  15. Fischer, Still Connected, ch. 4. 
  16. Eric Klinenberg, Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone, Penguin, 2012. 
  17. Fischer, Still Connected. 
  18. Vivek H. Murthy, Together, HarperCollins, 2020, p. 8. 
  19. Fischer, Still Connected, chs. 5-6. Other analysts come up with a different number. Vivek Murthy estimates that about 20% of Americans are lonely, while a Cigna report drawing on surveys in 2018 and 2019 puts the share at approximately 50%. Murthy, Together, p. 10; Cigna, “Loneliness and the Workplace: 2020 US Report,” p. 4. 
  20. Social Capital Project, Joint Economic Committee, “All the Lonely Americans?,” Report 2-18, 2018. 
  21. Twenge, “Have Smartphones Destroyed a Generation?” 
  22. Candice L. Odgers and Michaeline R. Jensen, “Annual Research Review: Adolescent Mental Health in the Digital Age: Facts, Fears, and Future Directions,” Journal of Child Psychology and Psychiatry, 2020; Amy Orben, “Teenagers, Screens, and Social Media: A Narrative Review of Reviews and Key Studies,” Social Psychiatry and Psychiatric Epidemiology, 2020. 
  23. See also Mike Males, “The Truth about Teen Suicide,” Washington Monthly, 2018. 
  24. David Brooks, “The Nuclear Family Was a Mistake,” The Atlantic, 2020. 
  25. L.C. Hawkley and J.T. Cacioppo, “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms,” Annals of Behavioral Medicine, 2010; Julianne Holt-Lunstad, Timothy B. Smith, Mark Baker, Tyler Harris, and David Stephenson, “Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review,” Perspectives on Psychological Science, 2015; Murthy, Together, ch. 2. 
  26. Holt-Lunstad et al, “Loneliness and Social Isolation as Risk Factors for Mortality.” 
  27. Murthy, Together, p. 13. 
  28. Dean Ornish and Anne Ornish, Undo It!, Random House, 2018, p. 236. 
  29. Esteban Ortiz-Ospina, “How Important Are Social Relations for Our Health and Well-Being?,” Our World in Data, 2019. 
  30. Fischer, Still Connected, Preface.