A smaller social network increases loneliness more drastically for those with depression

A study in Germany found that people reporting greater loneliness tend to have fewer social relationships. This association was present both in depressed individuals and in those without depression, but the correlation was notably stronger in depressed individuals. The paper was published in BMC Psychiatry.

Loneliness is a feeling of sadness or distress that happens when a person feels socially or emotionally disconnected. It is not the same as simply being alone, because someone can be alone without feeling lonely. A person can also feel lonely even when surrounded by other people.

Loneliness usually reflects a gap between the relationships a person wants and the relationships they actually have. It can be temporary, such as after moving to a new place or losing contact with friends. It can also become chronic when the feeling lasts for a long time. Chronic loneliness is linked to poorer mental health, including depression and anxiety. It can also affect physical health by increasing stress and harming sleep and overall well-being.

Study author Valeria Koppert and her colleagues wanted to explore the relationship between the number of social relationships a person has and their feelings of loneliness. In particular, they wanted to compare the strength of this association in people suffering from depression and in those without depression. They noted that depressed individuals tend to feel lonelier than healthy people and wanted to know whether they also have fewer actual social relationships compared to nondepressed individuals.

The authors of this study analyzed data from the German Depression Barometer, an annual national survey of people aged 18-69 in Germany. This survey is conducted by the German Foundation for Depression and Suicide Prevention. Data were collected from the end of August to early September 2023.

The analyses were based on a total of 4,042 participants. Of these, 1,221 reported a lifetime diagnosis of depression, while 2,821 were considered healthy. Women comprised 61% of the depressed group and 46% of the healthy participants.

The survey included questions asking participants whether they had ever been diagnosed with depression and how severe their symptoms were at the moment. Participants also completed an assessment of loneliness (the 11-item De Jong Gierveld Loneliness Scale) and reported their number of social contacts. The item about social contacts asked for the average number of personal daily interactions with other people on a normal weekday.

Results showed that, in both groups, more pronounced feelings of loneliness were associated with a lower number of social contacts. However, this inverse correlation was significantly stronger in the depression group than in the group of healthy participants.

Confirming previous research, people with a history of depression experienced significantly higher overall levels of subjective loneliness and reported having fewer social contacts than healthy individuals.

When analyzing the different phases of episodic depression, researchers noticed an interesting pattern. They found that a patient’s subjective feeling of loneliness fluctuated wildly depending on their current state, spiking during an active depressive episode. However, their actual number of social relationships remained relatively stable across the different phases of the illness.

“Our research indicates a negative correlation between feelings of loneliness and the number of social relationships among people with depression,” the study authors concluded. “With respect to the current state of depression, we find greater variation in feelings of loneliness than in the number of social relationships.”

Because the study proves that the actual number of social relationships heavily impacts the internal feeling of loneliness for depressed people, the authors suggest that clinical interventions should actively focus on helping patients rebuild objective social networks, rather than treating loneliness as just an internal chemical symptom.

The study contributes to the scientific understanding of the links between contacts with other people and feelings of loneliness in depressed individuals. However, it should be noted that the design of the study does not allow any causal inferences to be derived from these results. Furthermore, the study relied entirely on self-reported online surveys, meaning the depression diagnoses were not clinically verified by the researchers.

The paper, “The association between feelings of loneliness and the number of social relationships in depression: a cross-sectional study of German adults,” was authored by Valeria Koppert, Andreas Czaplicki, and Ulrich Hegerl.