The study was published on July 9, 2025 in the journal PLOS One.

“Our study highlights that loneliness is not just an emotional state—it has measurable consequences for both mental and physical health,” the authors said. “Addressing loneliness may be a critical public health priority to reduce depression and improve overall well-being.”

The investigators analyzed data from the (U.S.) Behavioral Risk Factor Surveillance System (BRFSS), recorded from 2016 to 2023.

They measured loneliness by asking the question, “How often do you feel lonely?” They categorized the answers into five levels: Always, Usually, Sometimes, Rarely, and Never.

They acquired data on 47,318 subjects, predominantly White (73.3%), female (62.1%), and aged 18–64 years (72.1%).

Over 80% of the subjects reported some loneliness.

Compared to those who reported “Never” being lonely, the subjects who reported “Always” being lonely had a significantly higher predicted probabil¬ity of depression (50.2% vs. 9.7%, p < 0.001), 10.9 more poor mental health days per month, and 5.0 more poor physical health days per month (all statistically significant at p < 0.001).

Differences in outcomes appeared across differences in gender, race/ethnicity, and age. Women reported more poor mental health days than men across most levels of loneliness. Black subjects reporting loneliness showed significantly lower probabilities of depression and fewer poor mental health days than White peers. Older adults (>64) experienced more poor physical health days than younger adults for all of the loneli¬ness categories.

The authors concluded, “Loneliness is a strong and independent predictor of depression and poor health outcomes. Public health interventions aimed at addressing loneliness—especially among high-risk subgroups—are critical to improving mental and physical well-being at the population level.”

They added, “Conducting this research allowed us to explore the lived experiences of many individuals in vulnerable situations. What stood out most was how strongly loneliness affected every aspect of health—underscoring the urgency of tackling this hidden epidemic.”

Nearly identical percentages believe mental health is handled either “much” (38%) or “somewhat” worse (37%) than physical health ailments, while 15% say they are dealt with “about the same.” Just 5% think mental health is treated “somewhat” (4%) or “much” better (1%). This negative assessment of mental healthcare comes as 4 in 5 Americans perceive an increase in conditions such as depression or anxiety over the past five years, including 42% who think they have increased a lot.

These latest findings may explain why 57% of Americans give poor to failing grades to the nation’s healthcare system for its handling of mental health conditions — 32% give it a “D” and 25% give it an “F.” Only 1% awarded the top grade of “A”, with 8% giving it a “B” and 27% a “C.”

“Many Americans struggle with mental and behavioral health conditions that often go unaddressed in the context of treating and managing other medical conditions,” said Timothy Lash, President, West Health, a nonprofit focused on aging and healthcare in America. “Health systems, providers, caregivers and patients themselves need to pay just as much attention to mental health as they grow older as they do their physical health. The two are inextricably linked and critical to overall health, aging successfully and quality of life.”

According to the CDC, depression is more common in people who have other illnesses. About 80% of older adults have at least one chronic health condition, and 50% have two or more. Notably, the West Health-Gallup survey finds a higher percentage of older adults than the general population (82% vs. 75%) feel mental health issues are not treated as they should. This is a particularly important finding in that come 2030, people 65 and older will outnumber children for the first time in the U.S. and increase the demand for mental health services.

The survey finds 51% of Americans say they have experienced depression, anxiety or some other mental or emotional condition in the past 12 months. This group includes 22% who say their condition was so significant that it disrupted their normal activities, such as going to work or taking care of their household.

Over half of Americans see psychological counseling (53%) as an effective treatment and 35% say the same of prescription medication. But two potential barriers including lack of affordability (52%) and difficulty in accessing a provider (42%) may be preventing people from seeking care. Other barriers or reasons include a belief that the individual can deal with their condition on their own (28%), shame or embarrassment (27%) or not thinking treatment would help (24%).

Seven in 10 Americans report societal stigma around mental illness, which also played a role in keeping people from getting professional help. The belief is strongest among those who say they have dealt with a mental health condition in the past year (74%) and older adults (75%).

“Effectively meeting the behavioral health needs of Americans and their families throughout the different stages of life requires providers, caregivers, policymakers, payers and patients themselves work together to reduce barriers to care,” said Lash. “There are still sizable numbers of people not getting the treatment they need – a situation that may only worsen as the population ages. Effective approaches, including integrated and person-centered models of behavioral health that deliver services through clinics or community-based organizations, should be more fully leveraged to ensure people are able to get the care they need when and where they need it.”

Since 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) called for health plans to cover mental health benefits to the same level they cover general healthcare. But according to the White House, “too many Americans still struggle to find and afford the care they need.” In 2020, the government reported less than half of those with a mental illness received care for it.

Last year, the Biden administration highlighted mental health as a priority with a “comprehensive national strategy to transform how mental health is understood, accessed, treated, and integrated in and out of health care settings,” which includes expanding access to mental health services from Medicare.

Methodology
Results for this Gallup poll are based on self-administered web surveys conducted Feb. 2-14, 2024 with a random sample of 2,266 adults, aged 18 and older, and are members of the Gallup Panel. Gallup uses probability-based, random sampling methods to recruit its Panel members. For results based on the sample of U.S. adults, the margin of sampling error is ±3 percentage points at the 95% confidence level.

About Gallup
Gallup delivers analytics and advice to help leaders and organizations solve their most pressing problems. Combining more than 80 years of experience with its global reach, Gallup knows more about the attitudes and behaviors of employees, customers, students and citizens than any other organization in the world.

About West Health
Solely funded by philanthropists Gary and Mary West, West Health is a family of nonprofit and nonpartisan organizations that include the Gary and Mary West Foundation and West Health Institute in San Diego, and the West Health Policy Center in Washington, D.C. West Health is dedicated to lowering healthcare costs to enable seniors to successfully age in place with access to high-quality, affordable health and support services that preserve and protect their dignity, quality of life and independence. Learn more at westhealth.org and follow @westhealth.

IMAGE: OVER HALF OF AMERICANS SEE PSYCHOLOGICAL COUNSELING (53%) AS AN EFFECTIVE TREATMENT AND 35% SAY THE SAME OF PRESCRIPTION MEDICATION. BUT TWO POTENTIAL BARRIERS INCLUDING LACK OF AFFORDABILITY (52%) AND DIFFICULTY IN ACCESSING A PROVIDER (42%) MAY BE PREVENTING PEOPLE FROM SEEKING CARE. OTHER BARRIERS OR REASONS INCLUDE A BELIEF THAT THE INDIVIDUAL CAN DEAL WITH THEIR CONDITION ON THEIR OWN (28%), SHAME OR EMBARRASSMENT (27%) OR NOT THINKING TREATMENT WOULD HELP (24%). view more CREDIT: WEST HEALTH-GALLUP

The research group based its work on the  Trøndelag Health Study (HUNT). Since 1984, 250,000 Trøndelag residents have voluntarily contributed their health data to this comprehensive research project. The data are available to researchers, who can use the data to estimate people’s fitness levels, among other things.

The figures were taken from the third data collection round, called HUNT3, which was conducted from 2006 to 2008.

The research group compared the data from HUNT3 with data from the Norwegian Prescribed Drug Registry, which provides an overview of medications that have been dispensed in Norway.

Reduces the need for medication

“Being in better physical shape appears to reduce the need for anxiolytic drugs and antidepressants,” Ernstsen said.

In a previous study, Ernstsen and her co-authors found that people who were in good physical shape during the second HUNT study had a lower prevalence of depressive symptoms when they were participants in HUNT3 ten years later. However, at the time, the researchers found no correlation between good physical shape and anxiety.

But the new study design, which allows the researchers to look at what kinds of medication HUNT3 participants obtained from pharmacies as late as 2018, allowed the researchers to find the correlation.

However, the study does have a theoretical catch. The researchers can only see what kinds of medication were dispensed to people by pharmacies. They cannot see whether people actually took the medication — there’s no way to monitor people at their medicine cabinets.

“Nevertheless, there is reason to believe that people who are prescribed medication have more symptoms than those who do not see a doctor,” according to first author Audun Havnen, an associate professor at the Department of Psychology at NTNU.

Greatest effect for men and young people

Being in good physical shape helps all age groups and both genders. However, some people get greater benefits from exercise and being in good physical shape than others.

“We find that men experience a greater effect from exercise than women. The correlations are also less clear for the elderly,” Ernstsen says.

But that doesn’t mean that it isn’t important for women and the elderly to exercise.

What came first?

We can, of course, ask what triggers what. Is it actually the case that good physical health helps prevent anxiety and depression? Or is it the case that people who suffer from anxiety and depression exercise less and are therefore in poorer shape?

In order to not include anyone who was already experiencing anxiety or depression at the start of the study, the researchers excluded anyone who had filled prescriptions for these conditions before participating in HUNT3, as well as for three months afterwards.

“We also adjusted for symptoms of anxiety and depression in statistical analyses. To the extent that the figures can be believed, we also feel fairly confident that we started with a relatively anxiety and depression-free cohort in HUNT3,” Ernstsen said.

In other words, the subjects were unlikely to have suffered from anxiety or depression beforehand.

Unfortunately there are no shortcuts for people who can’t be bothered to exercise. We simply have to get started — unless we decide to give up. But is there really no other alternative?

“The results indicate that you can achieve a protective effect by improving your physical shape from poor to moderate, so any activity is beneficial,”  Havnen says.

You should be physically active in a way that leaves you breathless and sweaty if you want to improve or maintain your physical condition. The Norwegian health authorities recommend that adults be physically active for at least 150 to 300 minutes at moderate intensity each week.

However, one option for people who are short on time is to aim for 75 minutes of high-intensity training each week or a combination of moderate and high-intensity training.

“Research reinforces the finding that each minute of physical activity counts,” Ernstsen said.

Reference: Audun Havnen, Ekaterina Zotcheva, Ottar Bjerkeset, Xuemei Sui, Linda Ernstsen, Cardiorespiratory fitness and incident use of anxiolytics and antidepressants in adults. A linkage study between HUNT and the Norwegian Prescription Database Journal of Affective Disorders, Volume 339, 2023, Pages 111-117, ISSN 0165-0327, https://doi.org/10.1016/j.jad.2023.07.029  

Worry about contracting the virus and anxiety related to restrictions on social interactions are known to have taken a toll on the well-being of people of all ages. However, some fared better than others, prompting scientists to explore the factors that can protect against serious mental health issue. The work may also help health professionals to identify those who may be at higher risk during times of crisis.

Researchers at Bar-Ilan University in Israel found that people with more relaxed heart rate and respiratory function in the 2-3 years prior to the SARS-CoV-2 outbreak reported greater mental well-being during the pandemic.

The study, led by Prof. Ilanit Gordon of Bar-Ilan’s Department of Psychology, asked 185 Israeli adults to complete online questionnaires assessing their mood regulation since COVID-19 began, and their well-being during lockdown in mid-2020.

The same individuals participated in a lab study 2-3 years prior to the pandemic in which physiological measures were taken during physical activity and during rest. These measures included respiratory sinus arrhythmia (RSA), which shows how one’s heart rate fluctuates according to one’s respiration, and skin conductance level (SCL), which measures activity of sweat glands in the palms.

Both of these measures are controlled by the autonomic nervous system, which regulates involuntary physiological processes including heart rate, arousal, blood pressure, and digestion. The results were assessed to determine individuals’ mental well-being and their ability to regulate negative emotions during the pandemic.

Individuals who had higher RSA in the lab (2-3 years ago) reported better expectations to be able to regulate their negative mood during the pandemic, and thus reported higher mental well-being. Individuals with higher SCL did not exhibit the same effect.

Those with higher SCL most likely experienced an increased sense of distress or vigilance in these times of uncertainty, and for these reasons, higher RSA (which is an indicator of a more “relaxed” mode of physiological regulation) no longer directly relates to better mental well-being.

‘Physiological data assessed during rest, from heart rate, respiration, or sweat activity that was collected in unrelated lab studies 2-3 years ago is predictive of how individuals are coping psychologically today during the COVID-19 pandemic,’ says Prof. Gordon, ‘This information can help us determine which individuals may be at risk for heightened mental distress and enable us to better locate and treat them.’

Prof. Danny Horesh, of the Department of Psychology, a co-author of the paper, says that these findings illustrate how physiological information has the potential to deepen our understanding about resilience and risk factors in the face of distress.The team hope to be able to conduct similar studies in other countries, where stress levels differ from Israel.