What does loneliness actually feel like? It’s not only about being physically alone, but rather a feeling that is silent but hard to bear, even when people are around. For many older adults, this feeling becomes more common with age. But for some groups, it may be more than just common; it may also carry deeper consequences. A recent study sheds light on this issue, suggesting that loneliness may help explain why some older adults are more likely to experience depression than others. And importantly, it highlights something we might be able to change.
Looking beyond the surface of mental health inequalities
As populations around the world continue to age, mental health in old age is becoming an increasing concern. Depression in older adults is both widespread and often underdiagnosed, affecting not just physical health, but also mental health and overall quality of life. Within this broader picture, not everyone is affected equally. Older adults who identify as part of a sexual minority, such as lesbian, gay, or bisexual individuals, consistently show higher rates of depression compared to their heterosexual peers (~ 2 times higher odds). Researchers often explain this using the idea of minority stress, the cumulative impact of stigma, discrimination, and social exclusion over the life course. But knowing such disparity exists is only part of the story. To make a real difference, we need to understand why it exists. This is where loneliness comes in. Loneliness reflects a gap between the relationships people want and the ones they feel they have. In later life, this gap can widen from a number of reasons: retirement, bereavement, or simmering social networks.
That being said, sexual minority older adults are particularly vulnerable to loneliness. They are more likely to live alone, less likely to have children, and may have experienced rejection or loss within family and social circles. Some may also feel unable to fully express their identity freely, leading to a sense of isolation and disconnectedness. This raises an important question: could loneliness be one of the pathways linking life experiences to depression?
Sexual minority older adults face higher rates of depression than their heterosexual peers, yet the mechanisms behind this disparity remain poorly understood.
Methods
To investigate this, researchers analysed data from the English Longitudinal Study of Ageing, a large, national dataset of adults aged 50 and over. The cohort started in 2002, with just over 12,000 participants and a mean age of 65. They followed the participants over time, first measuring orientation and loneliness at one point in time and then looked at depressive symptoms a few years later.
They used two waves: Wave 6, collected in 2010 to 2011, and Wave 7 from 2013 to 2014. The reason for starting at Wave 6 is that this is the first wave where sexual orientation was recorded. Then they included a mediator: loneliness, measured at Wave 6 using a three-item scale asking how often participants felt they lacked companionship, felt left out, or felt isolated. Afterwards, the outcome: Depression was measured approximately three years later, at Wave 7, so the authors could reduce the risk of reverse causation and support the temporal ordering of loneliness before depression, though the authors also adjusted for baseline depression as an intermediate confounder, given that depression and loneliness may mutually influence one another. To minimise bias, confounders were selected based on prior literature and adjusted for across different paths of the model. Age, sex, education, and ethnicity were adjusted for throughout; additional variables, including employment status, self-reported health, and marital status, were adjusted for on the loneliness-to-depression path.
Results
Older adults from sexual minority groups showed higher levels of loneliness and were also more likely to experience depressive symptoms. Loneliness itself was strongly linked to future depression, regardless of other confounding factors. But the most striking finding was this: loneliness explained about 15% of the difference in depression between sexual minority and heterosexual older adults.
At first glance, 15% might not sound like much but in public health terms, it is meaningful and critical. The authors note that even modest reductions in a modifiable risk factor can translate into meaningful population-level impact (Carey et al., 2023). It is also important to note that the remaining 85% of the effect operated through pathways other than loneliness, such as discrimination, health inequalities, and lifelong experiences of minority stress, underscoring that loneliness is not just a side effect of ageing or circumstance. It may be one of the mechanisms through which social inequalities actively affect mental health.
Loneliness accounted for 15% of the elevated risk of depression seen in sexual minority older adults compared with heterosexual peers.
Conclusions
One of the most encouraging aspects of this research is that loneliness is, in principle, modifiable. However, effective interventions must be carefully tailored to the needs of sexual minority older adults, recognising the importance of community, shared identity, and genuine belonging, not just social contact. Community activities, peer support groups, and social prescribing (where healthcare providers connect people to local social resources) are all potential approaches to reducing loneliness. Digital tools, such as video calls or online communities, may also play a role, particularly for those with limited mobility.
Community-based interventions tailored to sexual minority older adults, such as peer support groups and social prescribing, may help reduce loneliness and, in turn, lower depression risk.
Strengths and limitations
At the same time, it’s important not to oversimplify the findings. Loneliness explained part of the difference in depression, but not all of it. Other factors such as discrimination, health inequalities, and lifelong experiences can also play a role in depression in old age, especially those in gender minorities.
The study also has its limitations. For example, sexual orientation was measured based on behaviour rather than identity, which may not fully capture the spectrum of lived experience of their identities. Some groups, particularly transgender and gender-diverse individuals, were also not included. It’s worth noting, however, that the authors conducted sensitivity analyses on the main findings to increase the robustness of the findings. The study raised an important message and paved the way for future research in these groups of older adults.
Sexual orientation is not correctly represented in this research, but plausible since there’s not yet a universal measure for that.
Implications for practice
This research opens up an important pathway to address for policy makers and practitioners. If loneliness contributes to mental health inequalities, then tackling loneliness could be a meaningful step toward reducing those inequalities. But this requires more than generic solutions. Interventions need to be culturally and sexually inclusive. It is important to recognise that meaningful connection goes beyond feeling safe, but also involves being understood and accepted. Future research can build on this by exploring differences within sexual minority groups, including gender-diverse populations, and developing interventions specifically to reduce loneliness in sexually minoritised older adults.
How to define sexuality?
Moving forwards, research should go beyond measuring sexuality as a binary variable based on experience, but instead look at the complex relationships between behaviour, attraction, and identity. This could help increase proportions of people within samples who identify with SGM (Sexual and Gender Minority) groups and improve statistical power for future research on similar topics.
Rethinking loneliness
Loneliness is often seen as an inevitable part of growing older, a reality that simply comes with age. However, this study challenges that assumption. Instead, it suggests that loneliness is not only widespread, but also consequential, and most importantly, changeable. By taking loneliness seriously, we may not only improve individual wellbeing but also begin to address deeper inequalities in mental health. And that makes it more than just a personal issue, it becomes a public responsibility.
Social inclusion and community belonging are central to reducing loneliness, and potentially depression, in sexual minority older adults.
Statement of interests
As MSc Clinical Mental Health Sciences students at UCL, we want to clarify that while some individuals involved in the discussed research are UCL faculty, we have no direct involvement in the study, its review, or publication. This blog was created independently for our coursework and reflects our interpretation. We have no conflicts of interest beyond our academic relationship with the study.
Contributors
Thanks to the UCL Mental Health MSc students who wrote this blog from the Morant Student Group: Li Chun Lam (Kirk), Helen Barrera Lopez, Eirini Dimitriou, Caitlin Morrissey, Aisling O’Neill and Smilte Razanovaite.Â
UCLÂ MSc in Mental Health Studies
This blog has been written by a group of students on the Clinical Mental Health Sciences MSc at University College London. A full list of blogs by UCL MSc students can be found here.
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Edited by
Dr Dafni Katsampa.
Links
Primary paper
Talen Wright, Francesca Solmi, Olesya Ajnakina, Elizabeth Ingram, Aaron Kandola, Stephen Lee, Eleonora Iob, Andrew Steptoe, Ben Thomas and Gemma Lewis (2025). The role of loneliness in the association between sexual orientation and depressive symptoms among older adults: A prospective cohort study. Journal of Affective Disorders, 356, 137 144.
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