Loneliness as an Emerging Global Public Health Priority: Nursing Perspectives

Fifty years ago, loneliness was largely viewed by theorists as a psychological or sociological phenomenon. Today, it is increasingly recognised as a critical and emerging global public health concern, mainly due to the enormous impact it has on health and social well-being (Smith et al. 2025). Termed as an ‘epidemic in modern society’ within the Journal of Advanced Nursing (Killean 1998), loneliness has been compared to other major public health challenges, like obesity and smoking, mainly due to its elevated risks of mental illness, cognitive decline, cardiovascular disease, functional impairment and premature mortality. In this commentary paper to celebrate the 50th Anniversary of the Journal of Advanced Nursing, the evolution of loneliness, as an emerging global health priority, will be examined from a nursing perspective. Attention will be given to the evolution of loneliness in nursing science over the last 50 years, followed by an exploration of how emerging trends may influence nursing perspectives in the next half-century, considering the preparedness of our profession to meet the demands posed by this increasingly important health determinant. Specific attention will be given to the conceptual understanding of loneliness, causes of loneliness, cultural and diversity considerations, multifaceted assessment methodologies and evidence-based loneliness interventions within nursing practice. Taken together, these factors will highlight the crucial role that nurses currently play and will continue to play in mitigating loneliness with recommendations for the importance of integrating loneliness assessment and culturally sensitive interventions into nursing practice. Earlier this year, the World Health Organization (WHO) published its global report on loneliness and social isolation, underscoring loneliness as a widespread public health issue which affects one in six people of all ages around the world. The health-related impact of loneliness is both substantial and complex, contributing to over 871,000 deaths annually and significantly increasing the risk for chronic diseases, mental health disorders and healthcare usage (WHO 2025). Loneliness is a multifaceted phenomenon with determinants that go beyond personal circumstances; it is shaped by complex interactions between health, social structure and culture. Loneliness can manifest among individuals of all ages and social backgrounds, highlighting an urgent need for evidence-based, integrated approaches to address loneliness in healthcare settings. It is well established that the burden of loneliness disproportionately affects those in vulnerable populations, increasing the magnitude of health inequities. Young adults, minority groups and people in low- and middle-income countries have been identified as especially vulnerable to loneliness (Barreto et al. 2021). Older people are also at increased risk of loneliness due to a range of interrelated physical, psychological and social factors (Smith et al. 2025). Across society, other drivers of loneliness include poor health status, low income or education, living alone and inadequate social infrastructure (Salari et al. 2025). Globally, the COVID-19 pandemic led to an upward trend in loneliness rates, most markedly among low-income and vulnerable populations and these rates do not appear to have returned to pre-pandemic levels. During COVID-enforced social restrictions, increases in loneliness were observed across all age groups; however, the most pronounced impact was experienced by younger adults, particularly those aged 18 to 25, with significant ramifications for psychosocial and emotional health. The rapid disappearance of face-to-face peer interaction and the loss of regular routines led many young people around the world to feel socially disconnected and isolated. In the Journal of Advanced Nursing, Rodney et al. (2021) reported the heightened impact of loneliness on older adults during COVID restrictions, identifying links to negative health-related outcomes and recommending the importance of nursing initiatives to counter the public health impact of loneliness. Defining loneliness can be challenging, mainly due to its complex, multidimensional and subjective character. It has been viewed as a distressing feeling that arises when there is a perceived gap between someone's desired social connections and actual social relationships or belonging (Cacioppo and Hawkley 2009). There are many examples in the literature where the terms loneliness and social isolation have been used interchangeably. However, it is important to see the difference between these concepts: social isolation is an objective condition arising from the structure of a person's social network. In contrast, loneliness is a subjective experience arising from qualitative and quantitative deficits in a person's social relationships. As loneliness traverses emotional, social and professional needs, it is difficult to capture this concept in a single universally accepted definition, due also to its diverse manifestations. As social, cultural and contextual dynamics shape both how loneliness is experienced and expressed, it is important for contemporary definitions to account for these complexities, rather than applying narrow or overly rigid conceptualizations of loneliness. To some extent, the absence of a clear and unified definition has impeded the development of consistency in loneliness-related research. Papers in the Journal of Advanced Nursing that focused on loneliness-related issues first began to appear in the mid-1990s, marking the start of the journal's engagement with loneliness as a key nursing research and conceptual issue, framing it as a critical yet underexplored nursing issue. Over the last 50 years the theoretical position of loneliness in relation to health has shifted substantially, moving from primarily psychological and interpersonal explanations to multi-level models that integrate biological mechanisms, health outcomes and social determinants. This shift has reshaped how loneliness has been studied, measured and linked to health and nursing. Early models primarily focused on psychological and interpersonal dimensions, often distinguishing loneliness in relatively basic terms, such as emotional and social loneliness and only focusing on interpersonal deficits. These foundational models, such as Weiss's (1973) typology, provided a useful framework by categorising loneliness and identifying cognitive gaps between expected and actual social connection, central to the experience of loneliness. From a nursing perspective, Donaldson and Watson (1996) conceptualised loneliness using Weiss's (1973) distinction between emotional and social loneliness and emphasised that loneliness negatively affects older people's quality of life, calling for targeted nursing research and interventions in this area. This theme reappeared in the journal 2 years later, further establishing loneliness as a sociopsychological and important nursing concern (Killeen 1998). In a conceptual paper, Killeen (1998) explored the social origins, psychological impacts and public health implications of loneliness in older people, characterising loneliness as a ‘modern epidemic’. Notably, this widely cited Journal of Advanced Nursing paper broadened the discourse in nursing science on loneliness in older people, moving it beyond a traditional association with ageing to emphasise its relevance within a wider societal context, underscoring the significant role that nursing can play in addressing the complexity of loneliness, highlighting the importance of holistic and multidisciplinary approaches in both nursing research and practice. In more recent times, perspectives of loneliness have expanded into multilevel models that consider biological, psychological and social dimensions. More modern frameworks have increasingly integrated the roles of social determinants, cultural context and environmental influences, viewing loneliness as a multifaceted biopsychosocial phenomenon that both influences and is shaped by broader social systems (Hawkley and Cacioppo 2010). Culture can profoundly influence how loneliness is experienced, expressed and managed, mainly shaped by how different cultures value independence versus social harmony. In individualistic cultures, common in Western societies, autonomy, personal achievement and voluntary relationships are highly valued. In contrast, in collectivist cultures, such as those found in Asia, parts of Africa and Latin America, interdependence and familial or community ties are emphasized. In general, evidence suggests that people from individualistic cultures report higher levels of loneliness, mainly due to weaker embeddedness within social networks. However, there may be other risk factors for loneliness within collectivist cultures, including sensitivity to being alone and the inability to fulfill cultural expectations. In particular, culture can strongly influence how older adults experience, express and cope with loneliness, especially when social expectations, family structures, stigma, coping strategies and community resources vary across cultures (Rokach 2024). As a resident of Hong Kong, the experience and stigma of loneliness are closely linked to cultural values, social image and the need for belonging, potentially influencing the likelihood that older people who are lonely will seek support. For the nursing profession, recognising loneliness as a culturally shaped construct highlights the need for culturally sensitive definitions, assessments and interventions. This suggests that a universal approach to loneliness may be insufficient for nurses and that effective nursing and public health practices must consider cultural values, norms and relational expectations to address loneliness meaningfully across diverse cultural populations. To provide culturally sensitive nursing, it is important to continually recognise cultural aspects of loneliness and to engage in communication strategies that are respectful of cultural beliefs. Today, taking all of these factors into account is essential for the provision of culturally sensitive nursing care for loneliness (Cai and Wilson 2025). Loneliness intersects with various dimensions of diversity, including age, ethnicity, gender identity, sexual orientation and socioeconomic status, all of which can influence individuals' vulnerability to loneliness. Marginalised groups frequently encounter heightened risks of loneliness due to factors such as social exclusion, discrimination and linguistic or cultural barriers. Research consistently suggests that loneliness disproportionately affects vulnerable populations, including older adults, individuals with chronic illness or disability, migrants, those experiencing poverty and others who face systemic discrimination (Barreto et al. 2021). Marginalised groups often face compounded risks due to social exclusion, discrimination or linguistic and cultural barriers. Nurses are uniquely positioned to address the adverse consequences of loneliness through comprehensive, empathetic, person-centred care (Smith et al. 2025). Tackling loneliness, the nursing role is multifaceted, encompassing assessment, intervention, advocacy, education and research across the lifespan. From childhood to older adulthood, effective nursing care for loneliness-related issues involves the integration of social factors into assessments and developing individualised care plans that meet diverse patient needs. Nurses facilitate social interaction, establish therapeutic relationships and can be instrumental in making referrals for lonely people to appropriate mental health and community resources (Yu et al. 2023). They also deliver individual and group-based interventions, including mindfulness-based approaches, promoting public awareness and coordinating interdisciplinary loneliness-related care. However, it is important to recognise that in nursing care, seemingly minor gestures, such as attentive listening, brief conversations or offering a warm smile, can play a vital role in the care of lonely people (Nordin et al. 2023). In nurse education, there is significant scope for developing programs to strengthen nurses' competencies in identifying loneliness and implementing culturally competent interventions worldwide. Advocacy for integrating loneliness recognition and intervention into nursing curricula, healthcare policy and interdisciplinary care frameworks is merited. As loneliness intersects with psychological, social and physical health domains, it can provide an attractive option for nursing research, offering deeper insights into holistic care, health disparities and the impact of nursing practice across the lifespan (Yu et al. 2023). Ongoing nurse-led research continues to identify effective, culturally relevant strategies that connect clinical care with public health priorities. In a recent systematic review and meta-analysis in the Journal of Advanced Nursing, Szeto et al. (2025) highlighted the importance of psychosocial interventions for older people in residential care. Addressing loneliness and health among nursing professionals has become increasingly important; loneliness now represents a significant occupational issue within our discipline. From a system-level perspective, loneliness among nurses is recognised as a psychosocial hazard. During the COVID-19 pandemic, nurses working with affected patient populations reported notably elevated levels of loneliness, closely associated with increased social isolation and emotional distress (Smith et al. 2020). Although nursing is fundamentally a relationship-centred profession, evidence indicates that nurses are vulnerable to occupational loneliness. This vulnerability is often attributed to emotional strain in clinical practice, excessive workloads and dysfunctional team environments. Faced with these occupational circumstances can negatively affect nurses' mental health and retention in the profession, as well as reducing the quality of patient care. Notably, nurses experiencing workplace loneliness are at higher risk for compassion fatigue, emotional exhaustion and professional burnout. One qualitative study published in the Journal of Advanced Nursing offers insight into these dynamics, highlighting the impact of loneliness experienced by nurses delivering end-of-life care in the emergency department during the pandemic (Cowley et al. 2025). Collectively, these findings highlight the ethical and organisational responsibility of health and social care institutions to actively address the issue of organisational loneliness among nurses. Effective approaches for addressing organisational loneliness include cultivating supportive working environments, promotion of work-life balance and ensuring access to mental health resources. Other community-level approaches, like social prescribing programs, have the potential to link individuals to social resources, whilst public health policies that foster inclusive, age-friendly environments can reduce systemic barriers to social participation. Additional interventions, such as structured nursing mentorship programs, peer-support groups and targeted team-building initiatives have shown some promise. Nevertheless, further empirical research is warranted to determine the long-term effectiveness for these approaches. Addressing the issue of organisational loneliness within our profession requires effective nursing leadership that actively fosters a sense of belonging and facilitates peer connection for nurses within the workplace. If nurses feel genuinely supported in the workplace, nursing leaders can empower them to sustain compassion and maintain high standards of nursing care. Loneliness offers an attractive avenue of inquiry for nurse researchers, as it sits at the intersection of psychological, social and physical health domains. Investigating loneliness not only provides important insights into holistic models of nursing care and health disparities, but also elucidates the multifaceted impact that nursing practice can have across the lifespan (Smith et al. 2025). Assessment of loneliness in nursing practice is fundamental for the early identification of individuals who may be at risk of loneliness or vulnerable to social isolation, enabling prompt and targeted interventions that enhance patient outcomes, particularly in younger and older adults and those living with health problems (Hauger et al. 2025). By routinely assessing for loneliness, nurses can quickly implement supportive interventions, such as referral to appropriate health and social services to prevent worsening of a situation. Measuring loneliness can be challenging; nursing researchers need to navigate issues related to definition, cultural sensitivity and subjectivity, requiring methodological rigour and contextual adaptation to ensure findings are robust and actionable (Ell et al. 2025). Accurate loneliness assessment is critical for identifying those at risk to enable timely interventions; the most widely used measurement scales are The UCLA Loneliness Scale and its associated short-form versions and the De Jong Gierveld Loneliness Scale, both of which aim to capture emotional and social loneliness dimensions. The widespread validation, adaptability and brief options of the UCLA Loneliness Scale make it an attractive option for nursing assessment of lonely people. The original UCLA Loneliness Scale contained 20 items; although a three-item version has been developed and validated, it provided a valuable tool for general population surveys and clinical studies, when brevity and comparability may be required (Gosling et al. 2024). There are two versions of the De Jong Gierveld Loneliness Scale, an original 11-item scale and now a shorter, more widely used and validated 6-item scale. The 11-item scale measures both emotional and social loneliness, whilst the 6-item version is for emotional and social loneliness and This scale can enable nurses to identify not only the of loneliness but also its emotional or on Weiss's theoretical distinction between social and emotional loneliness, the and Loneliness Scale for is widely used which has been to loneliness. This multidimensional scale provides insights to relational insights of loneliness, including family loneliness. 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