Bidirectional relationship found between post-traumatic stress and loneliness in teens

In a study published in the Journal of Affective Disorders, researchers discovered a bidirectional relationship between loneliness and posttraumatic stress among U.S. adolescents.

Adolescence is a pivotal stage of development, often marked by increased vulnerability to both loneliness and mental health challenges such as posttraumatic stress (PTS). Research indicates that loneliness, a distressing experience stemming from perceived deficiencies in social relationships, is particularly common during adolescence and linked to adverse outcomes, including emotional distress and health risk behaviors.

Similarly, exposure to traumatic events is widespread among adolescents, with many experiencing symptoms of PTS, which can disrupt emotional and social functioning. While studies have examined these phenomena independently, there has been little exploration of how they influence one another over time.

Motivated by the lack of longitudinal research on this link, Andrew Stickley and colleagues sought to uncover whether loneliness and PTS are interconnected in adolescents.

The study was conducted as part of a broader longitudinal project designed to explore mental health factors among adolescents in the New Haven, Connecticut public school system. Surveys were administered to students across 17 public middle and high schools, including alternative and bilingual programs, during regular school hours in two waves separated by one year.

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Loneliness was assessed using a single-item question adapted from the Center for Epidemiologic Studies Depression Scale (CES-D), asking students to rate how often they felt lonely in the past 30 days. Responses ranged from “not true” to “certainly true,” and those answering “certainly true” were categorized as lonely. PTS symptoms were measured using the Child Post-Traumatic Stress Reaction Index (CPTS-RI), a validated 20-item self-report scale that evaluates the frequency of PTS symptoms on a scale from 0 (“never”) to 4 (“most of the time”). The CPTS-RI generates a total score reflecting symptom severity, ranging from mild to very severe.

The surveys were available in both English and Spanish. Demographic data, including socioeconomic status (SES) and gender, were also collected, with SES measured by eligibility for free or reduced-cost lunch programs.

The findings revealed a bidirectional association between loneliness and PTS in adolescents. At baseline, nearly one-third of participants reported some degree of loneliness, with females significantly more likely than males to report feelings of loneliness. Similarly, most students exhibited PTS symptoms in the “mild” range, with a smaller proportion experiencing moderate to severe symptoms. Girls consistently reported higher PTS scores than boys at both time points.

The path analysis showed that loneliness at baseline predicted increased PTS symptoms one year later, even after controlling for initial PTS levels and other covariates. This association, while statistically significant, was modest (β = 0.06). Conversely, PTS symptoms at baseline more strongly predicted loneliness one year later (β = 0.19), suggesting that the influence of PTS on subsequent loneliness was greater than the reverse. An additional analysis revealed gender differences, with girls who had higher baseline PTS scores experiencing a more pronounced increase in loneliness over time compared to boys.

A notable limitation is the use of a single-item measure for loneliness, which might have underestimated its prevalence, especially among boys.

The research, titled “Loneliness and Posttraumatic Stress in U.S. Adolescents: A Longitudinal Study,” was authored by Andrew Stickley, Johan Isaksson, Roman Koposov, Mary Schwab-Stone, Tomiki Sumiyoshi, and Vladislav Ruchkin.