Akinyemi Oluwasegun, Abdulrazaq Waliah, Fasokun Mojisola, Ogunyankin Fadeke, Ikugbayigbe Seun, Nwosu Uzoamaka, Michael Miriam, Hughes Kakra, Ogundare Temitope
The Clive O Callender Outcomes Research Center, Howard University College of Medicine, Washington, District of Columbia, United States of America.
Department of Psychiatry and Behavioral Sciences, Howard University College of Medicine, Washington, District of Columbia, USA.
PLoS One. 2025 Jul 9;20(7):e0319311. doi: 10.1371/journal.pone.0319311. eCollection 2025.
Loneliness is a growing public health concern, with substantial implications for mental and physical health. Despite increasing attention, it remains an underrecognized determinant of health outcomes in population-based research.
This study evaluates the association between loneliness and key health outcomes, including depression diagnosis, poor mental health days, and poor physical health days, using a nationally representative sample.
We analyzed Behavioral Risk Factor Surveillance System (BRFSS) data from 2016 to 2023. Loneliness was measured with the question, "How often do you feel lonely?" and categorized into five levels: Always, Usually, Sometimes, Rarely, and Never. We estimated average treatment effects (ATE) using inverse probability weighting (IPW), adjusting for sociodemographic characteristics and incorporating BRFSS sampling weights and fixed effects for state, and year.
The study included 47,318 individuals, predominantly White (73.3%), female (62.1%), and aged 18-64 years (72.1%). Over 80% of participants reported some degree of loneliness. Compared to those who reported "Never" being lonely, individuals who reported being "Always" lonely had a significantly higher predicted probability of depression (50.2% vs. 9.7%, ATE = +40.5 percentage points, p < 0.001), 10.9 more poor mental health days, and 5.0 more poor physical health days per month (all p < 0.001). Disparities were evident across sex, race/ethnicity, and age. Women consistently reported more poor mental health days than men across most loneliness levels. Black individuals reporting loneliness had significantly lower probabilities of depression and fewer poor mental health days than White peers. Older adults (>64) experienced more poor physical health days than younger adults across all loneliness categories.
Loneliness is a strong and independent predictor of depression and poor health outcomes. Public health interventions aimed at addressing loneliness-especially among high-risk subgroups-are critical to improving mental and physical well-being at the population level.
孤独是一个日益受到公众健康关注的问题，对身心健康有着重大影响。尽管关注度不断提高，但在基于人群的研究中，它仍然是一个未得到充分认识的健康结果决定因素。
本研究使用具有全国代表性的样本，评估孤独与关键健康结果之间的关联，包括抑郁症诊断、心理健康不佳天数和身体健康不佳天数。
我们分析了2016年至2023年行为危险因素监测系统（BRFSS）的数据。孤独感通过“你多久感到一次孤独？”这一问题进行测量，并分为五个等级：总是、通常、有时、很少、从不。我们使用逆概率加权（IPW）估计平均治疗效果（ATE），调整社会人口学特征，并纳入BRFSS抽样权重以及州和年份的固定效应。
该研究纳入了47318名个体，主要为白人（73.3%）、女性（62.1%），年龄在18 - 64岁之间（72.1%）。超过80%的参与者报告有一定程度的孤独感。与报告“从不”感到孤独的人相比，报告“总是”感到孤独的人抑郁症预测概率显著更高（50.2%对9.7%，ATE = +40.5个百分点，p < 0.001），每月心理健康不佳天数多10.9天，身体健康不佳天数多5.0天（所有p < 0.001）。在性别、种族/族裔和年龄方面存在明显差异。在大多数孤独程度水平上，女性报告的心理健康不佳天数始终多于男性。报告孤独的黑人个体患抑郁症的概率显著低于白人同龄人，心理健康不佳天数也更少。在所有孤独类别中，老年人（>64岁）比年轻人身体健康不佳天数更多。
孤独是抑郁症和不良健康结果的一个强大且独立的预测因素。旨在解决孤独问题的公共卫生干预措施——尤其是在高危亚组中——对于提高人群层面的身心健康至关重要。
