Are lonely adolescents more prone to mental health problems in later life? In a recent study published in BJPsych Open, researchers investigated whether loneliness during adolescence can predict mental health problems in adulthood. Their findings suggest that lonely adolescents are at higher risk of developing severe mental health issues, including depression and psychosis, later in life, as indicated by their use of psychotropic medications.
Loneliness is a distressing feeling that arises from a perceived lack of social connections. Previous research has shown that loneliness is linked to various health problems, such as weakened cognitive function, impaired immune response, and increased inflammation. Additionally, loneliness has been found to elevate stress hormone levels and contribute to functional disabilities.
Importantly, loneliness is associated with a significant risk of premature death, even greater than that posed by smoking. Despite this, most studies have focused on loneliness in adults, leaving a gap in understanding how loneliness during adolescence impacts mental health in adulthood.
The researchers utilized data from the “Young in Norway” study, a longitudinal project that began in 1992. Initially, the study involved 12,655 students, aged around 15 years, from 67 junior and senior high schools across Norway. These participants were surveyed multiple times over a span of 14 years, with follow-up assessments conducted in 1994, 1999, and 2005-2006. By the final follow-up, about 2,602 participants had their data linked to the Norwegian Prescription Database, which provided comprehensive records of all prescription medications dispensed to individuals in Norway.
To measure loneliness, the researchers used a five-item scale adapted from the UCLA Loneliness Scale, which included statements such as “I feel in tune with the people around me” and “I feel lonely.” Participants rated these statements on a scale from 1 (never) to 4 (often). This scale was administered at each of the four time points to track changes in loneliness over time.
In addition to loneliness, the study collected data on several other factors that could influence mental health outcomes. These included demographic characteristics like age, gender, and parental education; behavioral factors such as conduct problems and substance use (alcohol, cigarettes, cannabis); and mental health issues, including symptoms of depression and anxiety. This comprehensive data collection allowed the researchers to control for these variables in their analyses.
The primary outcome measure was the prescription of psychotropic drugs, which are medications used to treat mental health conditions like depression, anxiety, and psychosis. The researchers categorized these prescriptions into several groups: antipsychotics, mood stabilizers, antidepressants, benzodiazepines, and other psychotropic medications. They then used statistical models to examine the relationships between loneliness at different ages, changes in loneliness over time, and the likelihood of receiving these medications in adulthood.
The study revealed significant associations between loneliness during adolescence and the likelihood of receiving prescriptions for psychotropic drugs in adulthood. Specifically, adolescents who reported higher levels of loneliness were more likely to be prescribed medications for conditions such as psychosis, mood disorders, and depression later in life.
One of the key findings was that high levels of loneliness during adolescence were associated with a higher likelihood of receiving prescriptions for antipsychotics, mood stabilizers, and antidepressants in adulthood. For example, adolescents with high loneliness had an increased risk of being prescribed antipsychotics and mood stabilizers, which are often used to treat severe mental health conditions like schizophrenia and bipolar disorder. This association persisted even after controlling for other factors such as demographic characteristics, conduct problems, substance use, and prior mental health issues.
Additionally, the researchers found that an increase in loneliness from adolescence to adulthood was a strong predictor of future psychotropic drug prescriptions. Participants who experienced a greater rise in loneliness over time were more likely to receive prescriptions for antipsychotics, mood stabilizers, and antidepressants. This suggests that not only the level of loneliness during adolescence but also the trajectory of loneliness over time plays a critical role in the development of mental health issues.
Interestingly, the study did not find a significant relationship between loneliness and the prescription of benzodiazepines, which are commonly used to treat anxiety disorders. This finding suggests that loneliness may be more closely linked to conditions like depression and psychosis rather than anxiety.
But the study has some limitations. The use of prescription data as a proxy for mental health disorders may not perfectly reflect the underlying conditions. For example, some medications can be prescribed for multiple indications, making it challenging to pinpoint specific disorders. Additionally, the study’s findings are based on a Norwegian population, which may limit their generalizability to other cultural contexts.
Future research should aim to explore the causal relationships between loneliness and mental health disorders more deeply. Investigating whether loneliness directly contributes to the development of mental disorders or whether it exacerbates pre-existing conditions is crucial. Moreover, studies should examine the effectiveness of interventions aimed at reducing loneliness in adolescents, such as social skills training or structural changes like changing schools.
The researchers concluded that “this study extends findings from previous studies. We used one of the broadest age ranges for the measurement of loneliness and mental health outcome (23 years), including an age span from adolescence to adulthood, an objective measure of prescription of psychotropic drug medications (data from national patient registries) and indicators of a broad range of mental disorders (including psychotic and bipolar disorders).”
“Nevertheless, to better comprehend the relationship between loneliness and mental disorders, we need more research on the potential role of loneliness in the aetiology of mental disorders. The study results provide first indications that early monitoring of loneliness and interventions aimed at reducing loneliness (e.g. social skill training or structural interventions such as change of school) may benefit those at risk of developing mental disorders, particularly those who experience loneliness over an extended period of time in adolescence and early adulthood.”
The study, “Loneliness in adolescence and prescription of psychotropic drugs in adulthood: 23-year longitudinal population-based and registry study,” was authored by Rubén Rodríguez-Cano, Karianne Lotre, Tilmann von Soest, Eline Borger Rognli, and Jørgen Gustav Bramness.
