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More than half of bisexual and transgender survey respondents reported feeling lonely, and these groups also reported the highest prevalence of stress, frequent mental distress, and history of depression, CDC researchers said.

Among adults in 26 U.S. states surveyed in 2022, 56.7% of bisexual people and 56.4% to 63.9% of transgender people reported feeling lonely always, usually, or sometimes, Katherine Bruss, PsyD, of the CDC's National Center for Chronic Disease Prevention and Health Promotion, and colleagues reported in .

These rates were almost double those reported by their straight (30.3%) and cisgender (32.1%) counterparts.

Bisexual and transgender people also reported the highest prevalence of stress (34.3% and 36.1% to 37.8%, respectively), frequent mental distress (40.5% and 37.2% to 51.8%), and history of depression (54.4% and 47.4% to 67.2%).

"Addressing the threat to mental health among sexual and gender minority groups should include consideration of loneliness and lack of social and emotional support," Bruss and team wrote. "Providing access to health services that are affirming for sexual and gender minority groups and collecting data to address health inequities might help improve the delivery of culturally competent care."

Among all respondents in this analysis, the prevalences of loneliness and lack of social and emotional support, respectively, were highest among those ages 18 to 34 (43.3% and 29.7%), those with less than a high school education (41.1% and 36.3%), those who never married (45.9% and 34.7%), and those with a household income below $25,000 (47.9% and 39.8%).

The prevalences of loneliness and lack of social and emotional support were lowest in white adults (29.6% and 20.1%) and those with two-adult households (27.4% and 19.1%).

Loneliness was significantly more common among women versus men (33.5% and 30.7%), whereas lack of social and emotional support was more common among men versus women (26.1% and 22.3%).

"These findings highlight the importance of integrating standardized measures of social connection into existing data systems and public health frameworks and initiatives," Bruss and colleagues wrote. "Improved surveillance can identify risk factors and help guide interventions to address the impacts of loneliness and lack of social and emotional support."

Surgeon General Vivek Murthy, MD, MBA, as well as other experts, have increasingly drawn attention to the adverse effects of loneliness. Some have called for it to be treated like any other health condition.

Bruss and team noted that loneliness and isolation can indicate social disconnection, which can lead to adverse health outcomes, such as heart disease, stroke, dementia, type 2 diabetes, depression, anxiety, premature mortality, and more.

For this study, the researchers used data on 218,915 people across 26 states from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) Social Determinants and Health Equity module and the BRFSS Sexual Orientation and Gender Identity module.

People who did not have all demographic information available or answered "don't know/not sure" were excluded. However, people with missing information on household income, sexual orientation, and gender identity were still included as an unknown group, since this applied to 15% to 20% of responses.

Loneliness was defined as answering "always/usually/sometimes" to "How often do you feel socially isolated from others?" Stress was defined as answering "always/usually" to "Stress means a situation in which a person feels tense, restless, nervous or anxious, or is unable to sleep at night because their mind is troubled all the time. Within the last 30 days, how often have you felt this kind of stress?"

The authors pointed to several limitations, including that the BRFSS data are self-reported, which can lead to recall and social desirability bias. In addition, only 26 states were represented, so results may not apply to the entire U.S. The 2022 BRFSS measured loneliness by asking about social isolation, which could be misinterpreted as a measure of social isolation. The 2023 BRFSS addresses loneliness more directly.

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