Health Survey for England, 2021 part 2

This report includes findings from the 2021 Health Survey for England (HSE) for adults aged 16 and over. It describes self-reported loneliness and subjective wellbeing, using the short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS).    

Detailed tables accompanying this report can be accessed here.
 

• In 2021, 27% of adults reported that they never felt lonely. However, 22% of adults felt lonely at least some of the time, including 6% who reported that they often or always felt lonely (chronic loneliness). 
• Women (24%) were more likely than men (20%) to feel lonely at least some of the time.
• 62% of adults who reported bad or very bad health reported that they felt lonely at least some of the time, compared to 35% of adults with fair health and 18% of those with good or very good health.
• The proportions of adults who felt lonely at least some of the time higher among adults in lower income households and among those who lived in the most deprived areas. Other characteristics linked with being lonely at least some of the time were obesity, physical inactivity and living alone.
• In 2021, the mean wellbeing score of adults in England was 26.0. Men (26.1) had, on average, higher scores than women (25.8). 
• Wellbeing scores were particularly low among those in bad or very bad health (20.7) and those who often or always felt lonely (19.6).
• Those living in the most deprived areas had lower wellbeing scores than those living in other areas. Lower wellbeing scores were also associated with obesity and physical inactivity. 
   

Persistent and prolonged exposure to feeling lonely has been associated with an adverse impact on wellbeing and health. Research has shown loneliness increases the likelihood of early mortality and poor physical health; it has also been shown to put individuals at greater risk of poor mental health including depression.      

Mental wellbeing is a facet of mental health that includes experiences of positive emotions, a person’s perception of themselves and their lives, and overall life satisfaction. Lower mental wellbeing is associated with poor physical health, higher morbidity, and lower life satisfaction. 
 

Loneliness

The Office for National Statistics (ONS) have developed a number of questions to measure loneliness. 

The HSE in 2021 included the direct measure of loneliness, which asks participants directly about their experience of loneliness: ‘How often do you feel lonely?’. Participants were asked to respond on a five-point scale, with categories ‘Never’, ‘Hardly ever’, ‘Occasionally’, ‘Some of the time’ and ‘Often or always’. This was included in the self-completion questionnaire.

The Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) 

The Warwick-Edinburg Mental Well-Being Scale (WEMWBS) is a 14-item scale that is designed to measure positive mental health, looking at factors like feelings, thoughts, and functioning. In previous years, the HSE included the full 14-item scale. 

In 2021, the HSE used the shortened version of the scale (SWEMWBS) as part of the self-completion questionnaire. This can be found within the Survey Documentation.

SWEMWBS has seven items that mostly cover the functioning aspect of mental wellbeing. The items are scored on a Likert scale, from ‘None of the time (1)’, to ‘All of the time (5)’. All seven items are worded positively, so higher SWEMWBS scores indicate higher positive mental wellbeing. The lowest score possible is 7 and the highest score possible is 35.

Participants were asked how often they felt lonely: 

• 27% of adults said that they never felt lonely
• 31% said that they hardly ever felt lonely
• 20% said they occasionally felt lonely
• 17% said they felt lonely some of the time
• 6% said they often or always felt lonely (chronic loneliness).

Those who felt lonely some of the time and those who often or always felt lonely are collectively described in this report as feeling lonely at least some of the time (22% of adults). 

For more information: Table 1

Men (32%) were more likely than women (22%) to report that they never felt lonely.

Women (24%) were more likely than men (20%) to report that they felt lonely at least some of the time. 

Similar proportions of men (5%) and women (6%) experienced chronic loneliness, defined as feeling lonely often or always.

The experience of loneliness also varied with age. The proportion who said that they never felt lonely increased with age from 22% of those aged 16 to 34 to 36% of those aged between 65 and 74, but was lower (30%) among those aged 75 and over.

For more information: Table 1

Younger adults were more likely to say that they felt lonely some of the time, often or always, and this proportion declined broadly in line with age, from 26% of those aged 16 to 34 to 16% of those aged 65 to 74 and 17% of those aged 75 and over. 

For more information: Table 1

The remainder of this report focuses on the prevalence of loneliness at least some of the time.

Estimates by region are shown in the tables as both observed and age-standardised. Observed estimates show the prevalence of reported loneliness in each region. Comparisons between regions are based on age-standardised data, which take into account different regional age profiles. 

After controlling for age, the proportion of adults who reported feeling lonely at least some of the time varied across regions: ranging from 15% in the East Midlands to 27% in the North East. 

For more information: Table 2

The HSE uses the measure of equivalised household income, which accounts for the number of adults and dependent children in the household as well as overall household income. Households are divided into quintiles (fifths) based on this measure. The age profile of the income quintiles has been age-standardised to account for differences in age profiles between households. For information about how equivalised income is calculated, see the HSE 2021 Methods report.

The proportion of adults feeling lonely at least some of the time was higher in lower income households. 27% in the lowest income quintile and 28% in the second lowest quintile reported that they felt lonely at least some of the time, compared with 18% to 20% in the other, better-off households. 

This pattern is accounted for in part by those who reported feeling chronically lonely (often and always). 7% and 9% of those in the two lowest income quintiles often or always felt lonely, compared with 4% of adults in better-off households.

For more information: Table 3

The English Index of Multiple Deprivation (IMD) is a measure of area deprivation, based on 37 indicators, across seven domains of deprivation. IMD is a measure of the overall deprivation experienced by people living in a neighbourhood, although not everyone who lives in a deprived neighbourhood will be deprived themselves. To enable comparisons, areas are classified into quintiles (fifths). For further information about the IMD, see the HSE 2021 Methods report.

The proportion of adults feeling lonely some of the time or more often varied with area deprivation. In the most deprived IMD quintile, 32% of adults reported feeling lonely at least some of the time compared with between 19% and 24% in other areas. 

Adults living in the most deprived areas were most likely to report experiencing chronic loneliness (10%, compared with between 3% and 6% in other areas). 

For more information: Table 4

For the HSE 2021, Body Mass Index (BMI) was calculated using participants’ self-reported height and weight, adjusted to account for systematic misreporting. More information on height and weight in HSE 2021 can be found in the HSE 2021 report on overweight and obesity. 

BMI scores are grouped into three categories, based on the World Health Organisation’s BMI classification (WHO, 2010), as below.

Obesity was associated with loneliness. 30% of those who were obese reported being lonely some of the time or more often, compared with those who were overweight (20%) and those who were neither overweight nor obese (22%). 

This pattern was similar for chronic loneliness. 8% of adults who were obese reported feeling lonely often or always compared with overweight adults (4%) and adults who were neither overweight nor obese (5%).  

For more information: Table 5

Participants answered a series of detailed questions about the types and amounts of physical activity they had done in the past four weeks. From this data, levels of physical activity were calculated in relation to government recommendations. 

• Meets aerobic guidelines: at least 150 minutes moderately intensive physical activity or 75 minutes vigorous activity per week, or an equivalent combination of these,
• Some/low activity: 30 to 149 minutes moderately intensive activity or 15 to 74 minutes vigorous activity per week, or an equivalent combination of these,
• Inactive: less than 30 minutes moderately intensive activity or less than 15 minutes vigorous activity per week, or an equivalent combination of these.

For more information see the Physical Activity report.

Levels of exercise were linked to feelings of loneliness. Adults who were inactive (29%) or active below recommendations (28%) were more likely to feel lonely some of the time or more often compared with those who met the physical activity recommendations (19%).

There was a similar pattern for the prevalence of often or always feeling lonely.

For more information: Table 6
 

Participants were asked about their general health, with five answer categories ranging from ‘very good’ to ‘very bad’. For analysis the categories ‘very good’ and ‘good’ were grouped, as were the categories ‘bad’ and ‘very bad’. 

The prevalence of feeling lonely some of the time or more often varied with general health status. 18% of those who reported good or very good health reported that they felt lonely at least some of the time, and this proportion increased to 35% of those with fair health and to 62% of those with bad or very bad health. 

The difference was more extreme for men than women. The proportions of men who were lonely at least some of the time varied from 15% of those whose health was good or very good, to 70% of those whose health was bad or very bad. The corresponding difference for women was 20% compared with 57% respectively.

The proportion of those who experienced chronic loneliness was also lower among those in good or very health (4%), compared with 28% of those with bad or very bad health. 

For more information: Table 7

Participants were asked who lived in their household and were categorised based on whether they lived alone or with other people (adults or children). 

Adults living alone were almost twice as likely to feel lonely at least some of the time as were those who lived with other adults or children: 37% of those who lived alone, compared with 19% of those who lived with other people.

There was a similar pattern for feeling lonely often or always (chronic loneliness). 10% of those who lived alone were chronically lonely, compared with 4% of those who lived with other people.

For more information: Table 8

In 2021, the mean wellbeing score of adults in England was 26.0. Men had, on average, higher scores than women (26.1 and 25.8 respectively).

Wellbeing varied with age, with the lowest mean scores amongst those aged 35 to 44 (25.6) and the highest amongst those aged 65 to 74 (26.9).   

For more information: Table 9

Estimates by region are shown in the tables both as observed and age-standardised to account for the different age profiles across different regions. After age-standardisation, mean wellbeing scores were similar across regions.

For more information: Table 10
 

The HSE uses the measure of equivalised household income, which takes into account the number of adults and dependent children in the household as well as overall household income. In this topic report, households are divided into fifths (quintiles) based on this measure. Data reported by income quintiles have been age-standardised to account for difference in age profiles across household incomes.     

Wellbeing scores were at similar levels across income groups.

For more information: Table 11
 

Data reported by Index of Multiple Deprivation (IMD) quintiles have been age-standardised to account for different area age profiles.     

Mean wellbeing scores varied by area deprivation. Those living in the most deprived areas had the lowest average score (24.9), compared with those living in less deprived areas (mean scores between 26.0 and 26.3)    

For more information: Table 12

Adults who were obese had lower average wellbeing scores (25.5) than those who were overweight or neither overweight nor obese (both 26.2). 

For more information: Table 13

Participants who met the aerobic guidelines had the highest mean wellbeing scores (26.5). As physical activity decreased, so did mean wellbeing scores to 25.7 for adults who were active but below recommendations and 24.7 for those classed as inactive.

For more information: Table 14

Participants were asked about their general health, with five answer categories ranging from ‘very good’ to ‘very bad’. For analysis the categories ‘very good’ and ‘good’ were grouped, as were the categories ‘bad’ and ‘very bad’. 

Those who reported their health as good or very good had the highest wellbeing scores (26.7). Wellbeing declined with lower levels of general health, with mean scores of 24.2 among those who reported that their health was fair, and 20.7 among those who reported having bad or very bad health.

For more information: Table 15

Participants self-reported how often they felt lonely on a five-point scale from ‘never feel lonely’ to ‘often or always feel lonely’. 

Those who reported that they never felt lonely had the highest wellbeing scores (28.9). Mean wellbeing scores decreased as self-reported loneliness increased to 19.6 for those who said that they always felt lonely. 

For more information: Table 16

Participants were asked who lived in their household and were categorised based on whether they lived alone or with other people (adults or children). 

Those living alone had lower mean scores than those living with others (24.8 compared to 26.1, respectively). 

For more information: Table 17