Loneliness and Rurality: Important Risk Factors for Young Australians' Mental Health

We are in the midst of a youth mental health crisis. Internationally, youth mental health is a recognised priority, with global prevalence of adolescent mental health disorders estimated to be 15%, and suicide recognised as the third leading cause of death for 15–29-year-olds (World Health Organisation 2024). Concerningly, in Australia, the reported rates are even higher. The Australian Bureau of Statistics (ABS, 2023) recently reported that in the 2020–2022 period, 38.8% of young people in Australia aged 16–24 years experienced a mental health disorder. In addition, suicide is recognised as the leading cause of death among Australians aged 15–24 years (Australian Institute of Health and Welfare 2024). These statistics are alarming and highlight the need for urgent action to improve mental health outcomes for Australian young people. One recognised risk factor for the mental health outcomes of Australian young people is rurality (Seidler et al. 2020). Young people in rural communities have higher rates of self-harm and suicide, and limited access to specialist psychological care than their counterparts in urban locations (Fitzpatrick et al. 2021). The National Strategic Framework for Rural and Remote Health (Department of Health and Aging 2011) recognised the disadvantage faced by young people in geographical regions where socio-economic and rural risk factors intersect, and relate to poorer health outcomes. Service access and treatment difficulties are recognised structural barriers for rural Australian young people, with challenges of travel, stigma, cost, confidentiality in small communities, waiting lists, and a lack of services contributing to mental health outcomes (Seidler et al. 2020). Novel approaches emphasise the need for discoveries made through psychological science to reach those who will benefit from them (Wiltsey Stirman and Beidas 2020). For rural young people, this means co-developing specific strategies to address their needs, and adopting innovative solutions that overcome the barriers to accessing services. Navigating social relationships is among the key developmental challenges of adolescence. Young people's relationships with their peers are related to their mental health and academic adjustment (Véronneau and Trempe 2022), and relational bullying has been found to predict a range of mental health symptomology (Ferraz de Camargo et al. 2022). Poor relationship experiences, including the experience of relational aggression such as exclusion, gossip and teasing, can take a significant negative emotional toll on young people, as does upward social comparisons when viewing social media (Moore et al. 2014; Samra et al. 2022). Quality friendships and feeling connected have an important role in young people's wellbeing and engagement in school and the community. Despite being digitally connected, young people aged 15–24 years report the highest levels of loneliness of all age groups (Melbourne Institute: Applied Economic and Social Research 2023). It is alarming that 62% of young people aged between 12- and 25-years report feeling socially isolated, lonely, and left out often or some of the time (National Youth Mental Health Survey 2022). Loneliness in Australia is linked to twice the likelihood of having a chronic disease, almost five times the likelihood of clinical depression, more than four times the likelihood of social anxiety, and more than five times the likelihood of poorer wellbeing (Ending Loneliness Together 2023). Thus, loneliness represents an important health symptom and risk that needs attention. The decline in quality friendships and social engagement began well before the COVID-19 pandemic, and the problem is worse in rural areas. In 2023, the first State of the Nation Report—Social Connection in Australia (Ending Loneliness Together 2023) identified loneliness as one of Australia's most pressing public health priorities, with the highest levels of loneliness reported in young people and rural communities. The loneliness epidemic in Australia is being seen around the world, resulting in the World Health Organisation (2023) declaring loneliness a global public health priority. The call to action is to prioritise relationships as a source of healing and wellbeing, a solution that is ‘hiding in plain sight’. Loneliness is a subjective feeling and is differentiated from social isolation. Young people are often embedded in social structures and surrounded by peers, and yet experience a feeling of being alone. This highlights that young people's current peer context and social culture, with online interaction dominant, have limited success in alleviating loneliness. In understanding and addressing loneliness, it is imperative to consider the quality of relationships, where young people feel they can rely on others for understanding and support. Fostering the development of quality friendships may present a sustainable prevention and early intervention strategy to reduce young people's loneliness. A review of 24 studies concluded that friendship interventions have the potential to improve and protect adolescent mental health (Manchanda et al. 2023). However, the authors note that “little is known about this important potential area of mental health intervention” (Manchanda et al. 2023, p.21) and recommend efforts to better understanding the domains of friendship influence. Thus, research is needed to understand how young peoples' friendship experiences shape loneliness, and the impact of youth friendship interventions as an antidote to the current loneliness epidemic. Evidence-based research is needed to enable us to better understand and intervene on this emerging area, and translate evidence into practice and policy, to generate meaningful change (Ending Loneliness Together 2023). To address the social–emotional health needs of rural young people, the mental health system needs to work more efficiently. Providing mental health services for young people requires additional resources for effective collaboration with the young person's parents or carers, primary health care professionals and educators about the young person's needs, treatment, and progress. Young people requiring secondary and tertiary health care often report it is a difficult process to recount all details about their history and repeatedly answer the same questions to various clinicians. Moving forward, there is a need for innovative, high-quality targeted interventions to change the trajectory for rural young people, to reduce loneliness and improve mental health outcomes. Mental health professionals have an important role in addressing this increasingly urgent and important issue. Novel approaches need to be co-developed and evaluated rigorously to identify strategies to help this high-risk group. Friendship interventions may offer a possible direction for prevention, early intervention, and treatment (Manchanda et al. 2023). Without urgent attention, there is risk that young people will continue to feel isolated and unsupported, especially in rural areas, and suicide rates will continue to increase. Action is needed now to break this cycle of disadvantage through the development, implementation, and evaluation of innovative strategies to help young people in rural communities. The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.