Loneliness may be a transdiagnostic treatment target to reduce suicidal ideation

Targeting and reducing loneliness may work as a transdiagnostic treatment target to arrest the progression of anxiety and depressive symptoms toward suicidal ideation, according to a cross-sectional study conducted using data from the All of Us Research Programme.

Epidemic of loneliness and isolation

About 50 percent of US adults report experiencing loneliness, and rates of loneliness among individuals in the US have increased over the past 5 decades. A 2023 report of the US Surgeon General declared loneliness and isolation as an epidemic, and highlighted the effects of social connection and community. [www.hhs.gov/sites/default/files/surgeon-general-social-connection-advisory.pdf; JAMA Netw Open 2026;9:e260596]

In a recent cross-sectional study, researchers analyzed data from 62,685 adults (mean age, 61.6 years; female, 65 percent) in the National Institutes of Health (NIH) All of Us Research Programme, which reflected the diverse nature of the US population.

Suicidal ideation: 3 reasons why

Results showed that depressive symptoms (r, 0.39; p<0.001), anxiety symptoms (r, 0.33; p<0.001), and loneliness (r, 0.31; p<0.001) correlated with suicidal ideation. “Depressive symptoms held the strongest correlation with suicidal ideation, followed by anxiety symptoms, then loneliness,” pointed out the researchers.

After controlling for gender and race and ethnicity, depressive symptoms (B, 0.017; 95 percent confidence interval [CI], 0.017–0.019), anxiety symptoms (B, 0.004; 95 percent CI, 0.004 –0.006]), and loneliness (B, 0.007; 95 percent CI, 0.007–0.008) accounted for significant variability in suicidal ideation.

Loneliness: Transdiagnostic target

Of note, the associations of anxiety and depressive symptoms with suicidal ideation were in part mediated by loneliness. Loneliness partially mediated the association of anxiety symptoms and suicidal ideation (average causal mediation effect=0.01; proportion mediated, 0.25; total association, 0.03; p<0.001) as well as depressive symptoms and suicidal ideation (average causal mediation effect=0.003; proportion mediated, 0.10; total association, 0.02; p<0.001).

Reducing depressive and anxiety symptoms are two key approaches to preventing suicidal ideation. However, most interventions depend on licensed clinicians, which is unsustainable given nationwide shortages of qualified mental-health professionals and numerous barriers to care.

In contrast, reduction of loneliness likely does not rely on access to licensed mental health clinicians – a scarce resource in today’s healthcare landscape. Targeting and reducing loneliness represents the third and perhaps a more sustainable approach. It may present a transdiagnostic approach to arrest the progression of anxiety and depressive symptoms toward suicidal ideation.

“This is likely a more scalable and person-centred approach in that people experiencing anxiety symptoms, depressive symptoms, or loneliness can engage with people and activities that are consistent with their values, cultures, goals, and preferences,” explained the researchers.