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Cited by 821Health disparities and outcomesMental Health Treatment and AccessCOVID-19 and Mental Health

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The prevalence of loneliness across 113 countries: systematic review and meta-analysis

Open access
Surkalim, Daniel L, Luo, Mengyun, Eres, Robert, Gebel, Klaus, van Buskirk, Joseph, Bauman, Adrian, Ding, Ding·2022·BMJ
DOI 10.1136/bmj-2021-067068PMC PMC8826180
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Abstract

Objectives: To identify data availability, gaps, and patterns for population level prevalence of loneliness globally, to summarise prevalence estimates within World Health Organization regions when feasible through meta-analysis, and to examine temporal trends of loneliness in countries where data exist. Design: Systematic review and meta-analysis. Data sources: Embase, Medline, PsycINFO, and Scopus for peer reviewed literature, and Google Scholar and Open Grey for grey literature, supplemented by backward reference searching (to 1 September 2021) Eligibility criteria for selecting studies: Observational studies based on nationally representative samples (n≥292), validated instruments, and prevalence data for 2000-19. Two researchers independently extracted data and assessed the risk of bias using the Joanna Briggs Institute checklist. Random effects meta-analysis was conducted in the subset of studies with relatively homogeneous research methods by measurement instrument, age group, and WHO region. Results: Prevalence data were available for 113 countries or territories, according to official WHO nomenclature for regions, from 57 studies. Data were available for adolescents (12-17 years) in 77 countries or territories, young adults (18-29 years) in 30 countries, middle aged adults (30-59 years) in 32 countries, and older adults (≥60 years) in 40 countries. Data for all age groups except adolescents were lacking outside of Europe. Overall, 212 estimates for 106 countries from 24 studies were included in meta-analyses. The pooled prevalence of loneliness for adolescents ranged from 9.2% (95% confidence interval 6.8% to 12.4%) in South-East Asia to 14.4% (12.2% to 17.1%) in the Eastern Mediterranean region. For adults, meta-analysis was conducted for the European region only, and a consistent geographical pattern was shown for all adult age groups. The lowest prevalence of loneliness was consistently observed in northern European countries (2.9%, 1.8% to 4.5% for young adults; 2.7%, 2.4% to 3.0% for middle aged adults; and 5.2%, 4.2% to 6.5% for older adults) and the highest in eastern European countries (7.5%, 5.9% to 9.4% for young adults; 9.6%, 7.7% to 12.0% for middle aged adults; and 21.3%, 18.7% to 24.2% for older adults). Conclusion: Problematic levels of loneliness are experienced by a substantial proportion of the population in many countries. The substantial difference in data coverage between high income countries (particularly Europe) and low and middle income countries raised an important equity issue. Evidence on the temporal trends of loneliness is insufficient. The findings of this meta-analysis are limited by data scarcity and methodological heterogeneity. Loneliness should be incorporated into general health surveillance with broader geographical and age coverage, using standardised and validated measurement tools. Systematic review registration: PROSPERO CRD42019131448.

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Crossref · 10.1136/bmj-2021-067068

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Fig 1 International estimates for prevalence of loneliness by age groups
Fig 1 International estimates for prevalence of loneliness by age groupsCC BY-NC · PubMed Central
Fig 2 Meta-analysis of loneliness prevalence using scale based measures (de Jong Gierveld Loneliness Scale, six item version, and University of California Los Angeles (UCLA) Loneliness Scale, three item version) in older adults (≥60 years). *Thresholds of five or six were applied. Generalised linear mixed effects models with binomial-normal distribution were used. Norway is included as part of western Europe owing to the lack of data from other northern European countries
Fig 2 Meta-analysis of loneliness prevalence using scale based measures (de Jong Gierveld Loneliness Scale, six item version, and University of California Los Angeles (UCLA) Loneliness Scale, three item version) in older adults (≥60 years). *Thresholds of five or six were applied. Generalised linear mixed effects models with binomial-normal distribution were used. Norway is included as part of western Europe owing to the lack of data from other northern European countriesCC BY-NC · PubMed Central
Fig 3 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Africa region. Generalised linear mixed effects models with binomial-normal distribution were used
Fig 3 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Africa region. Generalised linear mixed effects models with binomial-normal distribution were usedCC BY-NC · PubMed Central
Fig 4 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization The Americas region. Generalised linear mixed effects models with binomial-normal distribution were used
Fig 4 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization The Americas region. Generalised linear mixed effects models with binomial-normal distribution were usedCC BY-NC · PubMed Central
Fig 5 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Eastern Mediterrean and South-East Asia regions. Generalised linear mixed effects models with binomial-normal distribution were used
Fig 5 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Eastern Mediterrean and South-East Asia regions. Generalised linear mixed effects models with binomial-normal distribution were usedCC BY-NC · PubMed Central
Fig 6 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Western Pacific region. Generalised linear mixed effects models with binomial-normal distribution were used
Fig 6 Meta-analysis of loneliness prevalence based on single item measures in adolescents (12-17 years) by World Health Organization Western Pacific region. Generalised linear mixed effects models with binomial-normal distribution were usedCC BY-NC · PubMed Central
Fig 7 Meta-analysis of loneliness prevalence based on single item measures in young adults (18-29 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Unspecified recall period; past week otherwise. †Includes Israel. ‡Includes Georgia
Fig 7 Meta-analysis of loneliness prevalence based on single item measures in young adults (18-29 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Unspecified recall period; past week otherwise. †Includes Israel. ‡Includes GeorgiaCC BY-NC · PubMed Central
Fig 8 Meta-analysis of loneliness prevalence based on single item measures in middle aged adults (30-59 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Unspecified recall period; past week otherwise
Fig 8 Meta-analysis of loneliness prevalence based on single item measures in middle aged adults (30-59 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Unspecified recall period; past week otherwiseCC BY-NC · PubMed Central
Fig 9 Meta-analysis of loneliness prevalence based on single item measures in older adults (≥60 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Includes Israel. †Includes Georgia. ‡Unspecified recall period; past week otherwise
Fig 9 Meta-analysis of loneliness prevalence based on single item measures in older adults (≥60 years) in Europe. Generalised linear mixed effects models with binomial-normal distribution were used. *Includes Israel. †Includes Georgia. ‡Unspecified recall period; past week otherwiseCC BY-NC · PubMed Central

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Show all 87 references

Research works printed but not linked: 4

  1. Peplau LA Perlman D . Perspective on loneliness. Loneliness: A sourcebook of current theory, research and therapy. John Wiley and Sons, 1982: 1-18.
  2. 10.1037/0033-2909.117.3.497 · DOI · Paper page
  3. 10.1097/XEB.0000000000000054 · DOI · Paper page
  4. Russell D . The measurement of loneliness. In: Peplau L Perlman D , eds. Loneliness: A Sourcebook of Current Theory, Research and Theory. John Wiley & Sons, 1982: 81-104.

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Metadata

Authors
Surkalim, D. L., Luo, M., Eres, R., Gebel, K., van Buskirk, J., Bauman, A., & Ding, D.
Affiliations
  • The University of Sydney (AU)
  • Royal Children's Hospital (AU)
  • University of Technology Sydney (AU)
  • Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
Corresponding author
Ding, Ding
ORCID
Venue
BMJ
Publisher
BMJ
Published
2022-02-09
Volume
376
Pages
e067068
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj-2021-067068
PMC
PMC8826180
OpenAlex
W4211106541
Cited by
821
References
87
Citations by year
2026: 220 · 2025: 236 · 2024: 183 · 2023: 138 · 2022: 44
FWCI
20.76
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • RMIT Research Repository (RMIT University Library) (acceptedVersion, other-oa)
  • Figshare (submittedVersion, cc-by-nc)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
Topics
  • Social Sciences › Health › Health disparities and outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords
loneliness, prevalence of loneliness, cross-national comparison, adolescents, young adults, middle-aged adults, older adults, temporal trends, WHO regions, loneliness and isolation
MeSH terms
Demography, Humans, Loneliness, Global Health, Prevalence

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