Associations between loneliness severity and depression and suicidal ideation among older adults during the COVID-19 pandemic

OBJECTIVES: The COVID-19 pandemic has exacerbated loneliness among older adults. This study evaluates the relationship between loneliness, depression, and suicidal ideation in this population during the early pandemic by utilizing data from the All of Us (AoU) Research Program. METHOD: We analyzed cross-sectional data from 17,084 individuals aged ≥65 enrolled in the AoU Research Program who completed a COVID-19 related survey in May 2020. Participants were categorized into loneliness quartiles based on their UCLA Loneliness Scale Short Form-8 scores. Descriptive statistics and chi-square tests assessed demographic differences. Poisson regression models with robust standard errors tested associations between loneliness quartiles and both depression and suicidal ideation, adjusting for age, gender, race, ethnicity, education, marital status, employment status, housing status, health insurance status, and social support. RESULTS: Among 17,084 participants (mean age 72.0 years [SD 5.3], 55% female, 89% White), we found a clear stepwise pattern: as loneliness increased, so did the risk of depression and suicidal ideation. Compared to the lowest loneliness quartile, those in the highest loneliness quartile were approximately 25 times more likely to experience moderate-to-severe depression (adjusted relative risk [aRR] = 25.09, 95% CI: 16.63-37.84) and 44 times more likely to report suicidal ideation (aRR = 44.31, 95% CI: 19.69-99.71). Intermediate loneliness levels (quartiles 2-3) also showed elevated risks (depression aRRs: 2.45, 7.33; suicidal ideation aRRs: 4.03, 11.87). CONCLUSION: Increasing levels of loneliness were associated with greater risk of depression and suicidal ideation among older adults during the early pandemic, underscoring the need for targeted loneliness interventions for this vulnerable population.