The bidirectional relationship between loneliness and common mental disorders in adults: findings from a longitudinal population-based cohort study

  • Jasper NuyenEmail author
  • Marlous Tuithof
  • Ron de Graaf
  • Saskia van Dorsselaer
  • Marloes Kleinjan
  • Margreet ten Have
Original Paper



Limited longitudinal population-based research exists on the bidirectional association between loneliness and common mental disorders (CMDs). Using 3-year follow-up data, this study examined whether loneliness among adults increases the risk for onset and persistence of mild–moderate or severe CMD; and whether mild–moderate or severe CMD is a risk factor for onset and persistence of loneliness.


Data were used from the second (‘baseline’) and third (3-year follow-up) waves of the Netherlands Mental Health Survey and Incidence Study-2, a prospective study of a representative cohort of adults aged 18–64 years. Twelve-month CMDs and their severity were assessed with the Composite International Diagnostic Interview 3.0, and current loneliness using the De Jong Gierveld Loneliness Scale. Multivariate analyses were controlled for several potential confounders.


Loneliness predicted onset of severe CMD at follow-up in adults without CMDs at baseline, and increased risk for persistent severe CMD at follow-up in those with CMD at baseline. Conversely, severe CMD predicted onset of loneliness at follow-up in non-lonely adults at baseline, but was not associated with persistent loneliness at follow-up in lonely adults at baseline. Observed associations remained significant after controlling for perceived social support at baseline, except for the relationship between loneliness and persistent severe CMD. No longitudinal relationships were observed between loneliness and mild–moderate CMD.


Attention should be paid to loneliness, both in adults with and without CMD. Further research is needed to better understand the mechanisms underlying the observed associations between loneliness and CMDs to develop successful interventions.


Loneliness Common mental disorder Adult general population Prospective cohort study 



NEMESIS-2 is conducted by The Netherlands Institute of Mental Health and Addiction (Trimbos Institute) in Utrecht. Financial support has been received from the Ministry of Health, Welfare and Sport, with supplementary support from The Netherlands Organization for Health Research and Development (ZonMw) and the Genetic Risk and Outcome of Psychosis (GROUP) investigators.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

NEMESIS-2 was approved by the Medical Ethics Review Committee for Institutions on Mental Health Care. After having been informed about the study aims, respondents provided written informed consent at each wave.

Supplementary material

127_2019_1778_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)


  1. 1.
    de Gierveld J (1998) A review of loneliness: concept and definitions, determinants and consequences. Rev Clin Gerontol 8:S0959259898008090. CrossRefGoogle Scholar
  2. 2.
    Yang K, Victor C (2011) Age and loneliness in 25 European nations. Ageing Soc 31:1368–1388. CrossRefGoogle Scholar
  3. 3.
    Victor CR, Yang K (2012) The prevalence of loneliness among adults: a case study of the United Kingdom. J Psychol Interdiscip Appl 146:85–104. CrossRefGoogle Scholar
  4. 4.
    Nicolaisen M, Thorsen K (2014) Who are lonely? Loneliness in different age groups (18–81 years old), using two measures of loneliness. Int J Aging Hum Dev 78:229–257. CrossRefPubMedGoogle Scholar
  5. 5.
    Lasgaard M, Friis K, Shevlin M (2016) “Where are all the lonely people?” A population-based study of high-risk groups across the life span. Soc Psychiatry Psychiatr Epidemiol 51:1373–1384. CrossRefPubMedGoogle Scholar
  6. 6.
    Richard A, Rohrmann S, Vandeleur CL et al (2017) Loneliness is adversely associated with physical and mental health and lifestyle factors: results from a Swiss national survey. PLoS One 12:1–18. CrossRefGoogle Scholar
  7. 7.
    Thurston RC, Kubzansky LD (2009) Women, loneliness, and incident coronary heart disease. Psychosom Med 71:836–842. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Boss L, Kang DH, Branson S (2015) Loneliness and cognitive function in the older adult: a systematic review. Int Psychogeriatr 27:541–553. CrossRefPubMedGoogle Scholar
  9. 9.
    Kuiper JS, Zuidersma M, Oude Voshaar RC et al (2015) Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 22:39–57. CrossRefPubMedGoogle Scholar
  10. 10.
    Valtorta NK, Kanaan M, Gilbody S et al (2016) Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart 102:1009–1016. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Holt-Lunstad J, Smith TB, Baker M et al (2015) Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci 10:227–237. CrossRefPubMedGoogle Scholar
  12. 12.
    Leigh-Hunt N, Bagguley D, Bash K et al (2017) An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health 152:157–171. CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Meltzer H, Bebbington P, Dennis MS et al (2013) Feelings of loneliness among adults with mental disorder. Soc Psychiatry Psychiatr Epidemiol 48:5–13. CrossRefPubMedGoogle Scholar
  14. 14.
    Barger SD, Messerli-Bürgy N, Barth J (2014) Social relationship correlates of major depressive disorder and depressive symptoms in Switzerland: nationally representative cross sectional study. BMC Public Health. CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Stickley A, Koyanagi A (2016) Loneliness, common mental disorders and suicidal behavior: findings from a general population survey. J Affect Disord 197:81–87. CrossRefPubMedGoogle Scholar
  16. 16.
    Teo AR, Lerrigo R, Rogers MAM (2013) The role of social isolation in social anxiety disorder: a systematic review and meta-analysis. J Anxiety Disord 27:353–364. CrossRefPubMedGoogle Scholar
  17. 17.
    Matthews T, Danese A, Caspi A et al (2018) Lonely young adults in modern Britain: findings from an epidemiological cohort study. Psychol Med. CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Steel Z, Marnane C, Iranpour C et al (2014) The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 43:476–493. CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Flensborg-Madsen T, Tolstrup J, Sørensen HJ, Mortensen EL (2012) Social and psychological predictors of onset of anxiety disorders: results from a large prospective cohort study. Soc Psychiatry Psychiatr Epidemiol 47:711–721. CrossRefPubMedGoogle Scholar
  20. 20.
    Green BH, Copeland JR, Dewey ME et al (1992) Risk factors for depression in elderly people: a prospective study. Acta Psychiatr Scand 86:213–217CrossRefPubMedGoogle Scholar
  21. 21.
    Beekman ATF, Deeg DJH, Geerlings SW et al (2001) Emergence and persistence of late life depression: a 3-year follow-up of the Longitudinal Aging Study Amsterdam. J Affect Disord 65:131–138. CrossRefPubMedGoogle Scholar
  22. 22.
    Conde-Sala JL, Garre-Olmo J, Calvó-Perxas L et al (2019) Course of depressive symptoms and associated factors in people aged 65 + in Europe: a two-year follow-up. J Affect Disord 245:440–450. CrossRefPubMedGoogle Scholar
  23. 23.
    Harris T, Cook DG, Victor C et al (2006) Onset and persistence of depression in older people—results from a 2-year community follow-up study. Age Ageing 35:25–32. CrossRefPubMedGoogle Scholar
  24. 24.
    Holvast F, Burger H, De Waal MMW et al (2015) Loneliness is associated with poor prognosis in late-life depression: longitudinal analysis of the Netherlands study of depression in older persons. J Affect Disord 185:1–7. CrossRefPubMedGoogle Scholar
  25. 25.
    Jeuring HW, Stek ML, Huisman M et al (2018) A six-year prospective study of the prognosis and predictors in patients with late-life depression. Am J Geriatr Psychiatry 26:985–997. CrossRefPubMedGoogle Scholar
  26. 26.
    Van Den Brink RHS, Schutter N, Hanssen DJC et al (2018) Prognostic significance of social network, social support and loneliness for course of major depressive disorder in adulthood and old age. Epidemiol Psychiatr Sci 27:266–277. CrossRefPubMedGoogle Scholar
  27. 27.
    van Beljouw IMJ, Verhaak PFM, Cuijpers P et al (2010) The course of untreated anxiety and depression, and determinants of poor one-year outcome: a one-year cohort study. BMC Psychiatry 10:86. CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    De Graaf R, Ten Have M, Van Gool C, Van Dorsselaer S (2012) Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 47:203–213. CrossRefPubMedGoogle Scholar
  29. 29.
    Kessler RC, Chiu WT, Demler O et al (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Alonso J, Angermeyer MC, Bernert S et al (2004) Disability and quality of life impact of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand 109:38–46. CrossRefGoogle Scholar
  31. 31.
    Kessler RC, Berglund P, Demler O et al (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105. CrossRefPubMedGoogle Scholar
  32. 32.
    ten Have M, de Graaf R, van Dorsselaer S et al (2018) Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort. Acta Psychiatr Scand 137:503–515. CrossRefPubMedGoogle Scholar
  33. 33.
    Demyttenaere K, Bruffaerts R, Posada-Villa J et al (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291:2581–2590. CrossRefPubMedGoogle Scholar
  34. 34.
    Ten Have M, Nuyen J, Beekman A, De Graaf R (2013) Common mental disorder severity and its association with treatment contact and treatment intensity for mental health problems. Psychol Med 43:2203–2213. CrossRefPubMedGoogle Scholar
  35. 35.
    Andrade LH, Alonso J, Mneimneh Z et al (2014) Barriers to mental health treatment: results from the WHO World Mental Health surveys. Psychol Med 44:1303–1317. CrossRefPubMedGoogle Scholar
  36. 36.
    Aartsen M, Jylhä M (2011) Onset of loneliness in older adults: results of a 28 year prospective study. Eur J Ageing 8:31–38. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Cacioppo JT, Hawkley LC, Thisted RA (2010) Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago Health, Aging, and Social Relations Study. Psychol Aging 25:453–463. CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Luo Y, Hawkley LC, Waite LJ, Cacioppo JT (2012) Loneliness, health, and mortality in old age: a national longitudinal study. Soc Sci Med 74:907–914. CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Tiikkainen P, Heikkinen RL (2005) Associations between loneliness, depressive symptoms and perceived togetherness in older people. Aging Ment Health 9:526–534. CrossRefPubMedGoogle Scholar
  40. 40.
    Cacioppo JT, Hughes ME, Waite LJ et al (2006) Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychol Aging 21:140–151. CrossRefPubMedGoogle Scholar
  41. 41.
    Dahlberg L, Andersson L, McKee KJ, Lennartsson C (2015) Predictors of loneliness among older women and men in Sweden: a national longitudinal study. Aging Ment Health 19:409–417. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Beller J, Wagner A (2018) Disentangling loneliness: differential effects of subjective loneliness, network quality, network size, and living alone on physical, mental, and cognitive health. J Aging Health 30:521–539. CrossRefPubMedGoogle Scholar
  43. 43.
    de Graaf R, Ten Have M, van Dorsselaer S (2010) The Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): design and methods. Int J Methods Psychiatr Res 19:125–141. CrossRefGoogle Scholar
  44. 44.
    de Jong-Gierveld J, Kamphuls F (1985) The development of a Rasch-Type Loneliness Scale. Appl Psychol Meas 9:289–299. CrossRefGoogle Scholar
  45. 45.
    de Jong Gierveld J, van Tilburg T (1999) Manual loneliness scale. (Updated from the printed version: 15-6-2017). Accessed 8 Aug 2019
  46. 46.
    van Tilburg TG, de Jong Gierveld J (1999) Reference standards for the loneliness scale. Tijdschr Gerontol Geriatr 30:158–163PubMedGoogle Scholar
  47. 47.
    Kessler RC, Ustün TB (2004) The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121CrossRefGoogle Scholar
  48. 48.
    Haro JM, Arbabzadeh-Bouchez S, Brugha TS et al (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15:167–180CrossRefGoogle Scholar
  49. 49.
    Medina-Mora ME, Borges G, Lara C et al (2005) Prevalence, service use, and demographic correlates of 12-month DSM-IV psychiatric disorders in Mexico: results from the Mexican National Comorbidity Survey. Psychol Med 35:1773–1783. CrossRefPubMedGoogle Scholar
  50. 50.
    Leon AC, Olfson M, Portera L et al (1997) Assessing psychiatric impairment in primary care with the Sheehan Disability Scale. Int J Psychiatry Med 27:93–105. CrossRefPubMedGoogle Scholar
  51. 51.
    Brugha T, Bebbington P, Tennant C, Hurry J (1985) The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med 15:189–194CrossRefGoogle Scholar
  52. 52.
    Wang J, Mann F, Lloyd-Evans B et al (2018) Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry 18:1–16. CrossRefGoogle Scholar
  53. 53.
    Hawkley LC, Cacioppo JT (2010) Loneliness matters: a theoretical and empirical review of consequences and mechanisms. Ann Behav Med 40:218–227. CrossRefPubMedGoogle Scholar
  54. 54.
    Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L (2004) Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology 29:593–611. CrossRefPubMedGoogle Scholar
  55. 55.
    Mann F, Bone JK, Lloyd-Evans B et al (2017) A life less lonely: the state of the art in interventions to reduce loneliness in people with mental health problems. Soc Psychiatry Psychiatr Epidemiol 52:627–638. CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Cacioppo JT, Cacioppo S, Capitanio JP, Cole S (2015) The neuroendocrinology of social isolation. SSRN. CrossRefGoogle Scholar
  57. 57.
    Cohen-Mansfield J, Parpura-Gill A (2007) Loneliness in older persons: a theoretical model and empirical findings. Int Psychogeriatr 19:279–294. CrossRefPubMedGoogle Scholar
  58. 58.
    Houtjes W, Van Meijel B, Van De Ven PM et al (2014) The impact of an unfavorable depression course on network size and loneliness in older people: a longitudinal study in the community. Int J Geriatr Psychiatry 29:1010–1017. CrossRefPubMedGoogle Scholar
  59. 59.
    Tuithof M, Ten Have M, van den Brink W et al (2013) Predicting persistency of DSM-5 alcohol use disorder and examining drinking patterns of recently remitted individuals: a prospective general population study. Addiction 108:2091–2099. CrossRefPubMedGoogle Scholar
  60. 60.
    Markkula N, Härkänen T, Nieminen T et al (2016) Prognosis of depressive disorders in the general population- results from the longitudinal Finnish Health 2011 Study. J Affect Disord 190:687–696. CrossRefPubMedGoogle Scholar
  61. 61.
    Cabello M, Miret M, Caballero FF et al (2017) The role of unhealthy lifestyles in the incidence and persistence of depression: a longitudinal general population study in four emerging countries. Global Health 13:18. CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Gardiner C, Geldenhuys G, Gott M (2018) Interventions to reduce social isolation and loneliness among older people: an integrative review. Health Soc Care Community 26:147–157. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Netherlands Institute of Mental Health and AddictionUtrechtThe Netherlands
  2. 2.Department of Interdisciplinary Social SciencesUtrecht UniversityUtrechtThe Netherlands

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