Impact of loneliness on depression among cancer survivors: a comparison between adolescents and young adults and other age groups.
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BACKGROUND: Numerous studies have suggested an association between loneliness and depression in cancer survivors, particularly adolescents and young adults (AYAs). This study aimed to develop a causal model linking loneliness to depression using structural equation modeling. METHODS: A cross-sectional web-based survey was conducted to collect demographic information and psychosocial measures, including the UCLA Loneliness Scale, Patient Health Questionnaire-9, EQ-5D-5L, Multidimensional Scale of Perceived Social Support short form, Brief Resilience Scale, Comprehensive Score for Financial Toxicity, and a single item on cancer-related stigma. Structural equation modeling with observed variables was conducted, focusing on the pathway from loneliness to depression. Multiple-group analysis was used to compare AYAs and non-AYAs. RESULTS: The study included 3,565 cancer survivors, of whom 743 (20.8%) were AYAs. The final model showed a significant association between loneliness and depression (standardized coefficient = 0.214; 95% confidence interval = 0.184–0.243; P < 0.001). Perceived social support, resilience, financial toxicity, and stigma were directly or indirectly related to loneliness and depression. Female sex and having a spouse or partner were associated with perceived social support, whereas non-job-related social participation was associated with loneliness. The association between loneliness and depression was significantly stronger among AYAs than non-AYAs. CONCLUSIONS: The results suggested a significant link between loneliness and depression, with a stronger pathway in AYAs. Loneliness may serve as a modifiable mediator for interventions targeting depression prevention among AYA cancer survivors. The psychosocial variables identified could aid in screening high-risk individuals and developing effective interventions.