Two types, two impacts, and what they mean for mental health

Not all loneliness is the same—new research shows that emotional loneliness is more harmful than social loneliness, affecting mental health and even increasing mortality risk. Understanding this distinction can transform interventions and public health strategies.

Why loneliness requires a multidimensional approach: a critical narrative review. Image Credit: New Africa / Shutterstock

In a recent review published in the journal Nature Mental Health, a group of authors assessed the limitations of a unidimensional loneliness framework and advocated for a multidimensional model to enhance understanding, interventions, and public health strategies.

Background

Imagine sitting in a crowded room yet feeling profoundly alone. You are not alone in this experience; globally, nearly 33% of adults report feeling lonely. Loneliness is a growing global health crisis, recognized by the World Health Organization as a major public health concern. Studies link loneliness to higher risks of heart disease, depression, substance use, and even premature mortality. Longitudinal studies indicate that loneliness can significantly increase the risk of mortality, with emotional loneliness (EL) being particularly detrimental due to its association with chronic stress and immune dysfunction.

While loneliness is often perceived as a singular experience, it actually consists of distinct dimensions—emotional loneliness (EL) (a perceived absence of deep, intimate relationships) and social loneliness (SL) (a lack of broader social networks and integration). EL has stronger links to mental distress, whereas SL reflects broader social disconnection. The prevailing unidimensional model limits our ability to develop effective interventions. Decades of psychological research, dating back to Weiss (1973), have supported this two-dimensional approach, yet it remains underutilized in policy and clinical settings. Further research is needed to refine this distinction and its implications.

Empirical Support for the Multidimensional Approach

Research consistently differentiates EL and SL based on their unique antecedents and psychological impacts. EL is closely associated with emotional distress, depression, and anxiety, whereas SL is more linked to deficits in social support and instrumental help. For instance, empirical studies using the UCLA Loneliness Scale and the Rasch-Type Loneliness Scale (RTLS) consistently find that EL correlates strongly with feelings of abandonment and attachment-related distress, while SL is associated with life transitions such as relocation or job loss. Additionally, EL is more likely to predict psychological disorders, while SL is often mitigated through increased social interaction.

Demographic Variations in Loneliness

Loneliness is not uniform across populations; it varies by gender and age. Women tend to report higher levels of EL, while men report higher levels of SL. This discrepancy may be influenced by societal norms, where women generally prioritize deep emotional bonds, whereas men may engage more in surface-level social interactions. In terms of age, EL is most prevalent among young adults and older people, whereas SL peaks in middle age and decreases in later life. Interestingly, recent studies suggest that EL in young adults may be linked to social media overuse, reinforcing the idea that online connections do not necessarily alleviate deeper feelings of emotional loneliness. These patterns suggest that EL is driven by changes in intimate relationships, while SL is more influenced by social participation and life roles.

Clinical Implications of EL and SL

Understanding loneliness as multidimensional has significant implications for clinical practice. EL is more strongly associated with mental health conditions such as depression and anxiety. In contrast, SL is less directly linked to psychological distress but remains an indicator of social disconnection. Meta-analyses of loneliness interventions have shown that generic approaches often fail because they do not differentiate between EL and SL, leading to inconsistent results. Cross-sectional studies indicate that EL contributes to depressive symptoms more than SL, and longitudinal research suggests that EL has a stronger predictive value for long-term mental health deterioration. In contrast, SL can often be addressed through social interventions that encourage group participation and community engagement.

Loneliness and Health Outcomes

Loneliness has profound implications for physical health and mortality risk. Longitudinal studies show that EL, in particular, is associated with increased mortality rates, even after controlling for medical conditions and demographic factors. One explanation is that EL triggers chronic stress responses, leading to adverse physiological effects such as inflammation and weakened immune function. For example, a five-year study of nursing home residents found that EL, but not SL, was a significant predictor of earlier mortality, reinforcing its unique impact on health. While SL also presents health risks, its impact on mortality appears to be less severe than that of EL.

Interventions and Treatment Strategies

Effective interventions for loneliness should be tailored based on whether an individual is experiencing EL or SL. Addressing EL requires therapy focusing on deepening emotional connections, cognitive restructuring, and attachment-based interventions. Programs that foster meaningful relationships, such as peer support groups, may help alleviate EL. Addressing SL necessitates social integration programs, community engagement, and behavioral activation techniques. Encouraging participation in structured group activities can enhance social connectivity and reduce perceived isolation.

However, studies indicate that many existing interventions do not make this distinction, which may explain why broad loneliness-reduction programs have had limited success. For instance, behavioral activation techniques work well for SL but do little to alleviate EL, which requires interventions targeting deeper relational security. Despite these approaches, current interventions often fail to differentiate between EL and SL, limiting their effectiveness.

Public Health Implications

From a public health perspective, loneliness should be addressed at multiple levels—individual, community, and societal. The COVID-19 pandemic provided a real-world test case, demonstrating how lockdowns disproportionately increased EL by severing deep emotional connections, whereas SL effects were less pronounced in certain populations. The pandemic highlighted the urgent need for targeted public health initiatives.

Public health initiatives, such as social prescribing and community-based programs, may help mitigate the effects of loneliness. Efforts should also be made to improve screening and early detection of loneliness in clinical and primary healthcare settings. A growing number of researchers advocate for routine loneliness assessments in healthcare settings, similar to depression screenings, to identify at-risk individuals early.

Conclusions

To summarize, this review highlights the inadequacies of a unidimensional approach to loneliness and underscores the importance of distinguishing between emotional and social loneliness. Emotional loneliness presents a greater risk for mental health disorders, substance misuse, and mortality, whereas social loneliness primarily affects social integration. Future research should prioritize the development of psychometrically validated measures that distinguish between EL and SL, ensuring that interventions are scientifically tailored rather than broadly applied.

Interventions should be tailored accordingly, with deep relational support for emotional loneliness and broader community engagement for social loneliness. Future research should refine loneliness assessments, ensuring interventions are evidence-based and personalized. Recognizing the multidimensional nature of loneliness is crucial for developing effective public health policies and improving individual and societal well-being.