Suicidal ideation is a broad term that encompasses a variety of thoughts and wishes relating to both suicide and death more broadly (Harmer et al., 2021). As one of the strongest risk factors for death by suicide (Franklin et al., 2017), suicidal ideation, and specifically understanding the factors that contribute to it, has become an important research subject in the wider context of suicide prevention strategies (Jobes & Joiner, 2019).

Loneliness has regularly been examined in relation to both suicidal ideation and behaviour, and a consistent relationship has been demonstrated between these phenomena (McClelland et al., 2020). Theories of suicidal behaviour, such as the Interpersonal Theory of Suicide (Van Orden et al., 2010) and the Integrated Motivational Volitional model of suicide (O’Connor & Kirtley, 2018) underline the likely role that loneliness, and its associated psychological impact, may play in motivating suicidal thoughts and actions.

However, both loneliness and suicidal ideation are complex and varied issues, which are likely to be influenced by a wide range of factors. Two such factors comprise gender and age, both of which have been demonstrated to influence loneliness and suicidal ideation respectively (Qualter et al., 2017; Barreto et al., 2021; Alessi et al, 2019; Dennis et al., 2007). It is therefore important to consider how gender and age may also impact the relationship between loneliness and suicidal ideation. The current study aimed to do this, by first examining whether loneliness was related to higher levels of suicidal ideation, and then by assessing whether this relationship changed based on participant gender and age.

Methods

This research used cross-sectional data from a 2014 study conducted with a nationally representative sample of 2,450 German adults. Suicidal ideation was measured using the Beck Scale for Suicide Ideation (BSS), loneliness was assessed using a three-item version of the R-UCLA Loneliness scale, and mental distress was recorded using a four-item form of the Patient Health Questionnaire (PHQ-4). Sociodemographic information was also included in the analyses, comprising participant gender, age, and income.

The authors constructed a multiple linear regression model of suicidal ideation, in which loneliness, gender, and age were entered as predictor variables. They also included four interaction terms as predictors (loneliness X gender, loneliness X age, gender X age, and loneliness X gender X age), and controlled for the potential confounders of household income, mental distress, and whether participants lived alone.

Results

Analyses included data from 1,130 men and 1,320 women.

Mean scores of loneliness and mental distress were higher in women than in men, while mean level of suicidal ideation and reported previous suicide attempts did not differ across genders.

Loneliness was shown to be positively correlated with suicidal ideation, even when controlling for income, whether someone lived alone, and levels of mental distress. This association was however moderated by age and gender, with a stronger association among both male and younger participants.

The authors carried out further analyses by gender, finding that while loneliness was significantly associated with suicidal ideation regardless of gender, this relationship was stronger in men. Living with others was linked with lower suicidal ideation only in men. There was also a significant interaction between loneliness and age in the male group, with the association between loneliness and suicidal ideation shown to be stronger in younger men.

Conclusions

The results demonstrate an important link between loneliness and suicidal ideation, irrespective of mental distress, whether someone lives alone, and household income. The authors note that such an association corroborates the view that suicidality has a considerable interpersonal component. This may be especially true for young men, as the stronger association between loneliness and suicidal ideation in this group may indicate loneliness as a particularly important indicator of possible suicidality for this cohort. This is further underlined by the male-only association between living with others and reduced suicidal ideation, which the authors highlight as a further indication of possible gender-specific risk and protective factors for suicidal ideation.

Strengths and limitations

This study benefits from using a large, representative sample to address a timely research question. However, a primary limitation of this study is its cross-sectional design. Because of this, robust conclusions cannot be drawn regarding the direction of the association between loneliness and suicidal ideation. This, in turn, limits the useful clinical implications that can be gained from this study, as further research will be necessary to fully understand this relationship and how it can inform practice. The authors also acknowledge that their model, within which only 13.1% of variance was explained, likely does not sufficiently account for other major risk factors for suicidal ideation.

The data that the authors used in these analyses should also be considered in light of certain limitations. The response rate when collecting this data originally was 55%, indicating that findings may be biased by the individuals who chose to participate in the study, and may neglect relevant insights from those who did not. Similarly, data was exclusively collected via self-report questionnaires, the results of which may be biased by factors of social desirability (Huang et al., 1998). Furthermore, only responses from male and female identifying participants were included. The findings, therefore, likely neglect valuable insights from minority genders, who, as a group, are at a significantly greater risk of suicidal ideation and suicide attempts (Horwitz et al., 2020).

Implications for practice

This study comes at a particularly important time with respect to the COVID-19 pandemic. Research conducted during the pandemic indicates that the young adult population were at heightened risk of loneliness during this time (Bu et al., 2020). This is especially concerning given that those aged 16-24 years old reported higher rates of frequent loneliness than any other age group in the population, even before the impact of the COVID-19 pandemic (Office for National Statistics, 2018).

Therefore, the findings in this study, of a particularly strong association between loneliness and suicidal ideation among younger people, indicate a timely signal that this already vulnerable group may need additional psychological support in the current climate, to mitigate against serious, negative consequences for their mental health. The findings also demonstrate the potential gravity of loneliness as an issue. The authors suggest that for young people who really struggle with loneliness, especially young men, strategies to combat this problem should be recognised as an important priority, and a focus on suicide prevention may also be warranted. In tandem with additional research, it may also be important to consider targeting features of loneliness in people who report suicidal ideation.

The study highlights the need for future, non-cross-sectional research to further examine gender-specific risk and protective factors for suicidal ideation, as well as how loneliness and distress may present divergently in differently gendered groups. This should include a focus on a more diverse range of gender identities, such as non-binary and transgender individuals. A more nuanced understanding of these relationships may lead, in the future, to effective screening and intervention targets for individuals who are vulnerable to suicidal ideation.

Statement of interests

No conflicting interests.

Links

Primary paper

Ernst, M., Klein, E. M., Beutel, M. E., & Brähler, E. (2021). Gender-specific associations of loneliness and suicidal ideation in a representative population sample: young, lonely men are particularly at risk. Journal of affective disorders, 294, 63-70.

Other references

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