Loneliness and Mental Health in 26 States, 2022: Worst for Bisexual and Transgender Adults

Social connection — having the relationships, in number, quality and variety, that make a person feel they belong and are cared for — brings real health benefits. Loneliness and isolation mark its absence, and raise the risk of heart disease, stroke, dementia, type 2 diabetes, depression, anxiety and early death. Yet data are scarce for groups most affected, including people who are not heterosexual or cisgender.

CDC used the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a telephone survey of adults, in the 26 states that asked both its social determinants and sexual orientation and gender identity questions — 218,915 people in the final analysis.

Loneliness goes with poor mental health

Compared with adults who were not lonely, lonely adults were — after allowing for demographic differences —

Who is lonely

Overall, 32.1% reported loneliness and 24.1% a lack of social and emotional support.

By sexual orientation and gender identity:

Mental health

Overall, 13.9% reported stress, 16.0% frequent mental distress and 21.3% a history of depression. These were highest among adults aged 18–34 (21.6%, 23.2%, 26.4%), women (16.0%, 18.8%, 27.0%) and those with household incomes under $25,000 (24.1%, 27.2%, 32.0%), and lowest among non-Hispanic Asian adults (9.5%, 10.8%, 10.7%).

All three were significantly higher among gay, lesbian, bisexual and other non-straight adults than among straight adults — highest among bisexual adults (34.3% stress, 40.5% distress, 54.4% depression) — and among transgender than cisgender adults, with the highest depression of all (67.2%) among transgender, gender nonconforming adults.

What it means

The findings confirm that loneliness and a lack of support go with depression and stress, and show them concentrated among bisexual and transgender people, young adults, most racial and ethnic minority groups, and people with less education and low income.

• Measure social connection routinely in data systems, to find risk factors and guide help.
• Widen access to mental health and social services, especially for sexual and gender minority groups.
• Build safe community spaces for relationships and support.
• In health care — hospitals, clinics, emergency departments — raise awareness, be welcoming, use gender-neutral, inclusive language, and reduce the stigma around loneliness; affirming services and better data on sexual and gender minority people can improve culturally competent care.

Limits

• Answers are self-reported.
• Only 26 states asked both sets of questions, so the results may not apply nationwide.
• Response rates were low in some states (from 36.9% in Delaware to 59.6% in Alaska), and some answers were missing.
• In 2022 the survey measured loneliness indirectly, asking whether people felt socially isolated; from 2023 it asks directly, "How often do you feel lonely?"

Sources

Based on Bruss KV, Seth P, Zhao G, "Loneliness, Lack of Social and Emotional Support, and Mental Health Issues — United States, 2022," MMWR Morbidity and Mortality Weekly Report, volume 73, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's text gives the men's and women's figures for lack of support the wrong way round; the figures here are from its table.