Social disconnectedness and perceived isolation have a bidirectional predictive relationship with depression and anxiety in older adults, according to a longitudinal mediation analysis published in Lancet Public Health. The study looked at both social factors given the often tenuous relationship between a person’s objective social network structure and subjective loneliness.

Ziggi Ivan Santini, PhD, from the Danish National Institute of Public Health, University of Southern Denmark in Copenhagen, and colleagues examined 10-year follow-up data from the National Social Life, Health, and Aging Project (NSHAP), a nationally representative survey of older community-dwelling Americans. The study assessed social disconnectedness, perceived isolation, depressive symptoms, and anxiety.

The investigators identified 3005 adults born between 1920 and 1947 (mean age, 69.3±7.9 years; 51.6% women; 70.5% white) and reviewed data in 3 waves: from 2005 to 2006, 2010 to 2011, and 2015 to 2016. Data were analyzed with structural equation modelling to determine mediation relationships between variables. Researchers also performed maximum likelihood estimation with 5000 bootstrapped iterations.

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The researchers found that social disconnectedness predicted higher perceived isolation (β, 0.09; P <.0001), which in turn predicted higher depression symptoms (β, 0.12; P <.0001) and anxiety symptoms (β, 0.12; P <.0001). The reverse relationship held true, with depression symptoms predicting higher social disconnectedness (β, 0.06; P <.0001) and perceived isolation (β, 0·13; P <.0001). Anxiety, however, only predicted elevated perceived isolation (β, 0.09; P <.0001). Notably, perceived isolation predicted higher social disconnectedness (β, 0.07; P <.0001), with depression symptoms leading to perceived isolation, then social disconnectedness (indirect effect, 0.012; standard error [SE], 0.002; P <.0001). Similarly, anxiety correlated with subsequent perceived isolation, then social disconnectedness (indirect effect, 0.009; SE, 0.002; P <.0001).

The study was limited by the self-reported nature of the data, as well as potential confounders such as stressful life events or genetic profiles.

“Our findings point to perceived isolation as a lynchpin through which social disconnectedness leads to affective disorders, and through which depression and anxiety precipitate social withdrawal,” the study authors noted. They suggested the Act-Belong-Commit mental health promotion campaign as a possible intervention given its focus on staying physically and mentally active and maintaining social connections.

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They concluded, “Public health initiatives could reduce perceived isolation by facilitating social network integration and participation in community activities, thereby protecting against the development of affective disorders.”


Santini ZI, Jose PE, York Cornwell EY, et al. Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among older Americans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. 2020;5(1):e62-e70.