Social Isolation

ImportanceAlthough anxiety symptoms and depressive symptoms are linked with increases in suicidal ideation, they leave much of the variance in suicidal ideation unexplained. Loneliness may mediate the links between anxiety symptoms and suicidal ideation as well as depressive symptoms and suicidal ideation.ObjectiveTo analyze the mediating role of loneliness in the association between anxiety symptoms and suicidal ideation as well as in the association between depressive symptoms and suicidal ideation.Design, setting, and participantsThis cross-sectional study used data collected between May 31, 2017, and October 1, 2023, from 62 685 US adults who completed the self-report mental health survey portion of the National Institutes of Health's All of Us Research Program.Main outcomes and measuresSelf-report surveys estimated anxiety symptoms (using the 7-item Generalized Anxiety Disorder scale), depressive symptoms (using the first 8 items of the 9-item Patient Health Questionnaire [PHQ-9]), loneliness (using the UCLA Loneliness Scale), and suicidal ideation (using item 9 of the PHQ-9). Analyses were conducted in August of 2025.ResultsThe analytic sample of 62 685 individuals had a mean (SD) age of 61.8 (16.1) years and included 40 749 women (65.0%). Anxiety symptoms (r = 0.33; P Conclusions and relevanceIn this cross-sectional study of 62 685 participants from the All of Us Research Program, loneliness partially mediated the association between anxiety symptoms and suicidal ideation as well as depressive symptoms and suicidal ideation. Targeting and reducing loneliness may present a transdiagnostic approach to arrest the progression from anxiety and depressive symptoms toward suicidal ideation.

BackgroundSocial isolation is a prevalent issue among older people in long-term care facilities (LTCFs), with profound negative impacts on their quality of life and mental health. However, the authentic experiences and underlying mechanisms of social isolation among older people in LTCFs remain understudied. A nuanced understanding of these experiences is essential for designing targeted nursing interventions.ObjectiveThis study aimed to systematically review and synthesize qualitative evidence to explore the experiences of social isolation among older adults in LTCFs and analyze them in terms of causes, mechanisms, outcomes, and strategies.MethodsA systematic review and qualitative meta-synthesis were conducted. We searched PubMed, Web of Science, Embase, PsycInfo, Cochrane Library, CINAHL, Scopus, Chinese Biomedical Literature Database, CNKI, Wanfang Data, and Weipu (VIP) with no restriction on the start year, up to February 2025. Two reviewers (WL and ZM) independently screened studies, extracted data using a Microsoft Excel spreadsheet, and assessed study quality with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Qualitative data synthesis was performed following Thomas and Harden's thematic and content analysis method, including line-by-line coding of participant quotes, organizing codes into descriptive themes, and developing analytical themes.ResultsA total of 4856 papers were retrieved through systematic searches, and 14 qualitative studies met the inclusion criteria. Four overarching analytical themes were identified: (1) root cause: person-environment mismatch (encompassing 4 interrelated dimensions: imbalance between declining individual capacity and insufficient environmental support, negative self-perception paired with inadequate positive environmental feedback, personal biases conflicting with homogeneous institutional social ecology, and disrupted social roles due to rigid institutional management); (2) overt behavioral patterns: proactive isolation, defensive isolation, and adaptive isolation; (3) inner emotional experiences: feelings of confinement, sorrow, and weariness; and (4) strategies for restoring person-environment match: active engagement in interaction, rational acceptance of coexistence, and passive avoidance and withdrawal. Notably, person-environment mismatch was confirmed as the core mechanism driving the onset and persistence of social isolation in this population.ConclusionsPerson-environment mismatch is the fundamental driver of social isolation among older adults in LTCFs. Interventions should prioritize restoring person-environment alignment-including optimizing physical environments, reconstructing supportive social environments, and enhancing psychological empowerment. Future studies should focus on developing tools to quantify person-environment matching degrees in LTCFs and conduct longitudinal evaluations of targeted interventions to further reduce social isolation and promote active social participation among older people.

BackgroundThe impacts of social isolation on diverse health conditions and how it contributes to health risks remain unclear. We aimed to investigate the associations of social isolation with 59 health conditions among older adults.MethodsParticipants from the UK Biobank without baseline diagnosis of the included diseases were selected. Social isolation was assessed with three questions. The 59 health conditions included all-cause mortality, 5 cause-specific mortalities, and 53 diseases. We used an instrumental variable from multivariable common factor GWAS in Mendelian randomization (MR) to explore causal links of social isolation with diseases. Omics analyses were conducted to assess the roles of Olink plasma proteins and metabolomics, and PERM was calculated to evaluate the influence of other factors.ResultsA total of 489,741 individuals [266,706 (54.5%) women; mean age 56.5 years (SD 8.1)] were included. During a median follow-up of 12.5 years, social isolation was uncorrelated with the majority of 59 health conditions. Significantly, it was associated with increased risks of all-cause [adjusted HR (aHR) 1.28, 95% CI 1.25-1.32], 5 cause-specific mortalities (aHR range, 1.18-1.38), and 11 specific diseases (aHR range, 1.08-1.17). Living alone was the strongest item of isolation in predicting mortality (aHR range, 1.18-1.45) and selected diseases. MR analyses offered little evidence to support a causal link between social isolation and these diseases. The proteins involved in these associations are predominantly related to "response to stimulus". Proteomic signatures (PERM, 36%-49%), health behaviours (32%-59%), and socioeconomic factors (22%-42%) were the main explanatory factors linking social isolation to 8 health outcomes.ConclusionsSocial isolation is associated with elevated risks of 17 out of the 59 examined adverse health outcomes, predominantly mortality-related conditions; however, MR analyses indicate an absence of evidence supporting causality for these associations.