Addressing Loneliness Among Refugees

Loneliness is increasingly recognized as a serious health issue—linked to higher risks of heart disease, substance use, and premature mortality. Its effects span all ages and regions, but refugees face especially severe and often overlooked consequences. For those fleeing conflict, persecution, or disaster, loneliness is intensified by physical and psychological trauma, dislocation, and the loss of social and cultural support.

In a recent Lancet commentary, Frederick Altice, MD, professor of medicine (infectious diseases) at Yale School of Medicine and of epidemiology (microbial diseases) at Yale School of Public Health, and colleagues call for scalable innovations to address loneliness among refugees. Drawing on decades of work across Eastern Europe and Central Asia, Altice is rethinking how mental health care can be delivered in low-resource, high-mobility settings.

In a Q&A, Altice explains why loneliness is so harmful, where current interventions fall short, and how digital tools could help fill the gap.

My background is in infectious diseases and addiction medicine, and I’ve worked with vulnerable populations in Ukraine and Eastern Europe for over two decades. When Russia invaded Ukraine in 2022 and war broke out, everything shifted. Millions fled to other European countries (and to other regions of Ukraine)—often alone, without family, social contacts, or knowledge of the local language or alphabet. Many were stranded in unfamiliar settings, unable to navigate daily life. What we saw wasn’t just trauma, but deep, pervasive loneliness. Ukraine already had high loneliness rates before the conflict; displacement only intensified it, increasing risks for substance use, chronic illness, and disengagement from care. To truly support refugee health, we realized we had to address loneliness directly.

We often think of loneliness as a byproduct of something else—aging, stress, displacement—but it actually plays a central role in worsening health. Lonely individuals tend to be more sedentary, eat poorly, smoke or drink more, and disengage from social structures. Over time, this contributes to weight gain, hypertension, diabetes, and mental health decline. It’s a cascade: someone feels disconnected, so they withdraw, which leads to unhealthy behaviors, which in turn reinforce that disconnection. If we only address the downstream effects, we’re missing a chance to intervene earlier and more effectively. Reframing loneliness as a driver lets us rethink prevention and care strategies from the ground up.

Two things stand out currently: cognitive reappraisal and movement-based interventions. Cognitive reappraisal helps people reframe emotional experiences—it's a core part of cognitive behavioral therapy , but it can be adapted for digital delivery. That’s key for refugee settings, where trained therapists and language-specific care may not be available. Additionally, movement-based prompts are also incredibly effective. Just encouraging someone to stretch, walk, or engage physically can boost mood and reduce stress. These tools don’t require much infrastructure. They’re scalable, adaptable, and can meet people where they are—on their phones, in shelters, or on the move.

The potential is enormous—especially if we tailor interventions to where people are in their lives. A 22-year-old scrolling Instagram experiences loneliness differently than a 75-year-old living alone with distant family. What works for one may not work for the other, so personalization by age, lifestyle, and context is essential. Smartphones already track patterns like movement, screen time, and texting. With digital phenotyping and AI, we can turn those signals into just-in-time nudges: a prompt to engage in bursts of exercise, call someone, or reframe a thought. These tools are scalable, culturally agnostic, and nonjudgmental, but they must be designed thoughtfully. For younger users, that might mean a self-directed prompt; for older adults, it might involve triggering a message to a neighbor or loved one. The technology is here—it’s about using it in ways that truly meet people where they are.

Infectious Diseases, one of 10 sections in the Yale Department of Internal Medicine, engages in comprehensive and innovative patient care, research, and educational activities for a broad range of infectious diseases. To learn more, visit Infectious Diseases.