THE SILENT BURDEN: INVESTIGATING LONELINESS, MENTAL WELL-BEING, AND COGNITIVE HEALTH IN MIDDLE-AGED AND OLDER INDIAN POPULATIONS
Abstract
Loneliness, a subjective and distressing experience arising from a perceived deficit in social relationships, is increasingly recognized as a significant public health concern globally. This article explores the multifaceted impact of loneliness on mental health and cognitive function, with a particular focus on middle-aged and older adults within the diverse socio-cultural context of India. Drawing upon a comprehensive review of existing literature, including studies from India, this paper discusses the prevalence, determinants, and profound consequences of loneliness on psychological well-being (e.g., depression, anxiety) and cognitive faculties (e.g., memory, executive function, risk of dementia). While social connections are vital across the lifespan, their importance intensifies with age, particularly in societies undergoing rapid demographic and social transitions. This review synthesizes current understanding, highlights the unique challenges and protective factors prevalent in India, and outlines a hypothetical methodological framework for a study to empirically investigate these associations. The aim is to underscore the urgent need for targeted interventions to mitigate loneliness and its adverse health outcomes in this vulnerable demographic.
Keywords
loneliness, mental well-being, cognitive healthHow to Cite
References
Allen, J., R. Balfour, R. Bell, and M. Marmot. 2014. “Social Determinants of Mental Health.” International Review of Psychiatry 26(4): 392–407. https://doi.org/10.3109/09540261.2014.928270.
Ausín, B., M. Muñoz, and M. A. Castellanos. 2017. “Loneliness, Sociodemographic and Mental Health Variables in Spanish Adults Over 65 Years Old.” The Spanish Journal of Psychology, 20: E46. https://doi.org/10.1017/sjp.2017.48.
Barg, F. K., R. Huss-Ashmore, M. N. Wittink, G. F. Murray, H. R. Bogner, and J. J. Gallo. 2006. “A Mixed-Methods Approach to Understanding Loneliness and Depression in Older Adults.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 61(6): S329–S339. https://doi.org/10.1093/geronb/61.6.s329.
Barrett, A. E. 2003. “Socioeconomic Status and Age Identity: The Role of Dimensions of Health in the Subjective Construction of Age.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 58(2): S101–S109. https://doi.org/10.1093/geronb/58.2.s101.
Beutel, M. E., E. M. Klein, E. Brähler, I. Reiner, C. Jünger, M. Michal, J. Wiltink, et al. 2017. “Loneliness in the General Population: Prevalence, Determinants and Relations to Mental Health.” BMC Psychiatry 17(1): 97. https://doi.org/10.1186/s12888-017-1262-x.
Boss, L., D.-H. Kang, and S. Branson. 2015. “Loneliness and Cognitive Function in the Older Adult: A Systematic Review.” International Psychogeriatrics 27(4): 541–553. https://doi.org/10.1017/s1041610214002749.
Breitner, J. 1995. “Delayed Onset of Alzheimer's Disease with Nonsteroidal Anti-Inflammatory and Histamine H2 Blocking Drugs.” Neurobiology of Aging 16(4): 523–530. https://doi.org/10.1016/0197-4580(95)00049-k.
Breslin, F. C., and C. Mustard. 2003. “Factors Influencing the Impact of Unemployment on Mental Health Among Young and Older Adults in a Longitudinal, Population-Based Survey.” Scandinavian Journal of Work, Environment & Health 29(1): 5–14. https://doi.org/10.5271/sjweh.698.
Buckman, J. E. J., R. Saunders, J. Stott, L.-L. Arundell, C. O'Driscoll, M. R. Davies, T. C. Eley, et al. 2021. “Role of Age, Gender and Marital Status in Prognosis for Adults With Depression: An Individual Patient Data Meta-Analysis.” Epidemiology and Psychiatric Sciences 30: e42. https://doi.org/10.1017/S2045796021000342.
Butterworth, P., S. C. Gill, B. Rodgers, K. J. Anstey, E. Villamil, and D. Melzer. 2006. “Retirement and Mental Health: Analysis of the Australian National Survey of Mental Health and Well-Being.” Social Science & Medicine 62(5): 1179–1191. https://doi.org/10.1016/j.socscimed.2005.07.013.
Cacioppo, J. T., and S. Cacioppo. 2018. “The Growing Problem of Loneliness.” The Lancet 391(10119): 426. https://doi.org/10.1016/s0140-6736(18)30142-9.
Cacioppo, J. T., and L. C. Hawkley. 2009. “Perceived Social Isolation and Cognition.” Trends in Cognitive Sciences 13(10): 447–454. https://doi.org/10.1016/j.tics.2009.06.005.
Carstensen, L. L. 1995. “Evidence for a Life-Span Theory of Socioemotional Selectivity.” Current Directions in Psychological Science 4(5): 151–156. https://doi.org/10.1111/1467-8721.ep11512261.
Chan, A., C. Malhotra, R. Malhotra, and T. Østbye. 2011. “Living Arrangements, Social Networks and Depressive Symptoms Among Older Men and Women in Singapore.” International Journal of Geriatric Psychiatry 26(6): 630–639. https://doi.org/10.1002/gps.2574.
Cohen-Mansfield, J., and A. Parpura-Gill. 2006. “Loneliness in Older Persons: A Theoretical Model and Empirical Findings.” International Psychogeriatrics 19(02): 279. https://doi.org/10.1017/s1041610206004200.
Craik, F. I. M., and C. L. Grady. 2002. “Aging, Memory, and Frontal Lobe Functioning.” In Principles of Frontal Lobe Function, 528–540. Oxford: Oxford Academic. https://doi.org/10.1093/acprof:oso/9780195134971.003.0031.
Cruwys, T., G. A. Dingle, C. Haslam, S. A. Haslam, J. Jetten, and T. A. Morton. 2013. “Social Group Memberships Protect Against Future Depression, Alleviate Depression Symptoms and Prevent Depression Relapse.” Social Science & Medicine 98: 179–186. https://doi.org/10.1016/j.socscimed.2013.09.013.
Donovan, N. J., Q. Wu, D. M. Rentz, R. A. Sperling, G. A. Marshall, and M. M. Glymour. 2016. “Loneliness, Depression and Cognitive Function in Older U.S. Adults.” International Journal of Geriatric Psychiatry 32(5): 564–573. https://doi.org/10.1002/gps.4495.
Dykstra, P. A. 2009. “Older Adult Loneliness: Myths and Realities.” European Journal of Ageing 6(2): 91–100. https://doi.org/10.1007/s10433-009-0110-3.
Erzen, E., and Ö. Çikrikci. 2018. “The Effect of Loneliness on Depression: A Meta-Analysis.” International Journal of Social Psychiatry 64(5): 427–435. https://doi.org/10.1177/0020764018776349.
Essex, M. J., and S. Nam. 1987. “Marital Status and Loneliness among Older Women: The Differential Importance of Close Family and Friends.” Journal of Marriage and the Family 49(1): 93. https://doi.org/10.2307/352674.
Freak-Poli, R., N. Wagemaker, R. Wang, T. S. Lysen, M. A. Ikram, M. W. Vernooij, C. S. Dintica, et al. 2022. “Loneliness, Not Social Support, is Associated With Cognitive Decline and Dementia Across Two Longitudinal Population-Based Cohorts.” Journal of Alzheimer's Disease 85(1): 295–308. https://doi.org/10.3233/JAD-210330.
Frech, A., and K. Williams. 2007. “Depression and the Psychological Benefits of Entering Marriage.” Journal of Health and Social Behavior 48(2): 149–163. https://doi.org/10.1177/002214650704800204.
Ganguli, M., V. Chandra, J. E. Gilby, G. Ratcliff, S. D. Sharma, R. Pandav, E. C. Seaberg, and S. Belle. 1996. “Cognitive Test Performance in a Community-Based Nondemented Elderly Sample in Rural India: The Indo-U.S. Cross-National Dementia Epidemiology Study.” International Psychogeriatrics, 8(4): 507–524. https://doi.org/10.1017/s1041610296002852.
Gierveld, J. J. de, T. van Tilburg, and P. A. Dykstra. 2006. “Loneliness and Social Isolation.” In The Cambridge Handbook of Personal Relationships, 485–500. Cambridge: Cambridge University Press. https://doi.org/10.1017/cbo9780511606632.027.
Gilmour, H. 2011. “Cognitive Performance of Canadian Seniors.” Health Reports 22(2): 27.
Grover, S., A. Avasthi, S. Sahoo, B. Lakdawala, A. Dan, N. Nebhinani, A. Dutt, et al. 2018. “Relationship of Loneliness and Social Connectedness With Depression in Elderly: A Multicentric Study Under the Aegis of Indian Association for Geriatric Mental Health.” Journal of Geriatric Mental Health 5(2): 99. https://doi.org/10.4103/jgmh.jgmh_26_18.
Hakansson, K., S. Rovio, E.-L. Helkala, A.-R. Vilska, B. Winblad, H. Soininen, A. Nissinen, A. H. Mohammed, and M. Kivipelto. 2009. “Association Between Mid-Life Marital Status and Cognitive Function in Later Life: Population Based Cohort Study.” BMJ 339: b2462. https://doi.org/10.1136/bmj.b2462.
Hasher, L., R. T. Zacks, and T. A. Rahhal. 1999. “Timing, Instructions, and Inhibitory Control: Some Missing Factors in the Age and Memory Debate.” Gerontology 45(6): 355–357. https://doi.org/10.1159/000022121.
Hawkley, L. C., S. Buecker, T. Kaiser, and M. Luhmann. 2020. “Loneliness From Young Adulthood to Old Age: Explaining Age Differences in Loneliness.” International Journal of Behavioral Development 46: 39–49. https://doi.org/10.1177/0165025420971048.
Hawkley, L. C., and J. T. Cacioppo. 2010. “Loneliness Matters: A Theoretical and Empirical Review of Consequences and Mechanisms.” Annals of Behavioral Medicine 40(2): 218–227. https://doi.org/10.1007/s12160-010-9210-8.
Heinrich, L. M., and E. Gullone. 2006. “The Clinical Significance of Loneliness: A Literature Review.” Clinical Psychology Review 26(6): 695–718. https://doi.org/10.1016/j.cpr.2006.04.002.
Hossain, M. M., N. Purohit, N. Khan, E. L. J. McKyer, P. Ma, S. Bhattacharya, and P. Pawar. 2020, April 15. Prevalence and Correlates of Loneliness in India: A Systematic Review. https://doi.org/10.31235/osf.io/x4ctz.
Hsu, T.-L., and A. E. Barrett. 2020. “The Association between Marital Status and Psychological Well-being: Variation across Negative and Positive Dimensions.” Journal of Family Issues 41: 0192513X2091018. https://doi.org/10.1177/0192513X20910184.
Jennings, E. A., M. Farrell, Y. Liu, and L. Montana. 2022. “Associations between Cognitive Function and Marital Status in the U.S., South Africa, Mexico, and China.” SSM – Population Health 20: 101288. https://doi.org/10.1016/j.ssmph.2022.101288.
Kislev, E. 2022. “Aging, Marital Status, and Loneliness: Multilevel Analyses of 30 Countries.” Research on Ageing and Social Policy 10(1): 77–103. https://doi.org/10.17583/rasp.8923.
Korkki, S. M. 2020. “Effects of Healthy Ageing on the Precision of Episodic Memory.” Doctoral dissertation, University of Cambridge. https://doi.org/10.17863/CAM.51023.
Kuiper, J. S., N. Smidt, S. U. Zuidema, H. C. Comijs, R. C. Oude Voshaar, and M. Zuidersma. 2019. “A Longitudinal Study of the Impact of Social Network Size and Loneliness On Cognitive Performance in Depressed Older Adults.” Aging & Mental Health 24(6): 889–897. https://doi.org/10.1080/13607863.2019.1571012.
Kyaw, K. T., and A. Levine. 2023. “Association of Loneliness with Cognitive Functions.” The Journal of Prevention of Alzheimer's Disease: 1–6. https://doi.org/10.14283/jpad.2023.60.
Lara, E., F. F. Caballero, L. A. Rico-Uribe, B. Olaya, J. M. Haro, J. L. Ayuso-Mateos, and M. Miret. 2019. “Are Loneliness and Social Isolation Associated with Cognitive Decline?” International Journal of Geriatric Psychiatry 34(11): 1613–1622. https://doi.org/10.1002/gps.5174.
Lee, J., R. Shih, K. Feeney, and K. M. Langa. 2014. “Gender Disparity in Late-Life Cognitive Functioning in India: Findings from the Longitudinal Aging Study in India.” Journals of Gerontology Series B: Psychological Sciences and Social Sciences 69(4): 603–611. https://doi.org/10.1093/geronb/gbu017.
Liu, B. S., and K. S. Rook. 2013. “Emotional and Social Loneliness in Later Life.” Journal of Social and Personal Relationships 30(6): 813–832. https://doi.org/10.1177/0265407512471809.
Liu, H., Y. Zhang, S. A. Burgard, and B. L. Needham. 2019. “Marital Status and Cognitive Impairment in the United States: Evidence from the National Health and Aging Trends Study.” Annals of Epidemiology 38: 28–34.e2. https://doi.org/10.1016/j.annepidem.2019.08.007.
Luchetti, M., A. Terracciano, D. Aschwanden, J. H. Lee, Y. Stephan, and A. R. Sutin. 2020. “Loneliness is Associated with Risk of Cognitive Impairment in the Survey of Health, Ageing and Retirement in Europe.” International Journal of Geriatric Psychiatry 35(7): 794–801. https://doi.org/10.1002/gps.5304.
Maes, M., S. A. Nelemans, S. Danneel, B. Fernández-Castilla, W. Van den Noortgate, L. Goossens, and J. Vanhalst. 2019. “Loneliness and Social Anxiety Across Childhood and Adolescence: Multilevel Meta-Analyses of Cross-Sectional and Longitudinal Associations.” Developmental Psychology 55(7): 1548–1565. https://doi.org/10.1037/dev0000719.
Mathuranath, P., J. Cherian, R. Mathew, A. George, A. Alexander, and S. Sarma. 2007. “Mini Mental State Examination and the Addenbrooke's Cognitive Examination: Effect of education and norms for a multicultural population.” Neurology India 55(2): 106. https://doi.org/10.4103/0028-3886.32779.
Michalska da Rocha, B., S. Rhodes, E. Vasilopoulou, and P. Hutton. 2017. “Loneliness in Psychosis: A Meta-analytical Review.” Schizophrenia Bulletin 44(1): 114–125. https://doi.org/10.1093/schbul/sbx036.
Mousavi-Nasab, S.-M.-H, R. Kormi-Nouri, A. Sundström, and L.-G. Nilsson. 2011. “The Effects of Marital Status on Episodic and Semantic Memory in Healthy Middle-Aged and Old Individuals.” Scandinavian Journal of Psychology 53(1): 1–8. https://doi.org/10.1111/j.1467-9450.2011.00926.x.
Murman, D. 2015. “The Impact of Age on Cognition.” Seminars in Hearing 36(03): 111–121. https://doi.org/10.1055/s-0035-1555115.
Nersesian, P. V., H.-R. Han, G. Yenokyan, R. S. Blumenthal, M. T. Nolan, M. D. Hladek, and S. L. Szanton. 2018. “Loneliness in Middle Age and Biomarkers of Systemic Inflammation: Findings from Midlife in the United States.” Social Science & Medicine 209: 174–181. https://doi.org/10.1016/j.socscimed.2018.04.007.
Noorbala, A. A., S. A. Bagheri Yazdi, S. Faghihzadeh, K. Kamali, E. Faghihzadeh, A. Hajebi, S. Akhondzadeh, A. Sedighnia, and A. Azimi. 2017. “A Survey on Mental Health Status of Adult Population Aged 15 and above in the Province of Ardebil, Iran.” Archives of Iranian Medicine 20(1 Suppl 1): S11–S14. https://pubmed.ncbi.nlm.nih.gov/29481118/.
Nyberg, L. 2017. “Functional Brain Imaging of Episodic Memory Decline in Ageing.” Journal of Internal Medicine 281(1): 65–74. https://doi.org/10.1111/joim.12533.
O'Luanaigh, C., H. O'Connell, A.-V. Chin, F. Hamilton, R. Coen, C. Walsh, J. B. Walsh, D. Caokley, C. Cunningham, and B. A. Lawlor. 2012. “Loneliness and Cognition in Older People: The Dublin Healthy Ageing Study.” Aging & Mental Health 16(3): 347–352. https://doi.org/10.1080/13607863.2011.628977.
Ofstedal, M. B., G. G. Fisher, and A. Regula Herzog. 2005. Documentation of Cognitive Functioning Measures in the Health and Retirement Study. Ann Arbor, MI: University of Michigan. https://doi.org/10.1114/577250-16.
Onur, I., and M. Velamuri. 2016. “A Life Course Perspective on Gender Differences in Cognitive Functioning in India.” Journal of Human Capital 10(4): 520–563. https://doi.org/10.1086/688898.
Peplau, L. A., D. Russell, and M. Heim. 1979. “The Experience of Loneliness.” In New Approaches to Social Problems: Applications of Attribution Theory, edited by I. H. Frieze, D. Bar-Tal and J. S. Carroll, 53–78. San Francisco, CA: Jossey-Bass.
Perianayagam, A., D. Bloom, J. Lee, S. Parasuraman, T. V. Sekher, S. K. Mohanty, A. Chattopadhyay, et al. 2022. “Cohort Profile: The Longitudinal Ageing Study in India (LASI).” International Journal of Epidemiology 51(4): e167–e176. https://doi.org/10.1093/ije/dyab266.
Phillips, D. M. 2020. Longitudinal Loneliness and Cognitive Aging in Mid and Late Life: Patterns of Associations and Epigenetic Pathways. Riverside, CA: University of California. https://escholarship.org/uc/item/7891d9wn.
Radloff, L. S. 1977. “The CES-D Scale: A Self-Report Depression Scale for Research in the General Population.” Applied Psychological Measurement 1(3): 385–401. https://doi.org/10.1177/014662167700100306.
Richard, A., S. Rohrmann, C. L. Vandeleur, M. Schmid, J. Barth, and M. Eichholzer. 2017. “Loneliness is Adversely Associated with Physical and Mental Health and Lifestyle Factors: Results from a Swiss National Survey.” PLoS One 12(7): e0181442. https://doi.org/10.1371/journal.pone.0181442.
Rubin, R. 2017. “Loneliness Might Be a Killer, but What's the Best Way to Protect Against It?” JAMA 318(19): 1853. https://doi.org/10.1001/jama.2017.14591.
Russell, D., L. A. Peplau, and C. E. Cutrona. 1980. “The Revised UCLA Loneliness Scale: Concurrent and Discriminant Validity Evidence.” Journal of Personality and Social Psychology 39(3): 472–480. https://doi.org/10.1037//0022-3514.39.3.472.
Shaw, B. A., N. Krause, J. Liang, and J. Bennett. 2007. “Tracking Changes in Social Relations Throughout Late Life.” The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 62(2): S90–S99. https://doi.org/10.1093/geronb/62.2.s90.
Sicotte, M., B. E. Alvarado, E.-M. León, and M.-V. Zunzunegui. 2008. “Social Networks and Depressive Symptoms Among Elderly Women and Men in Havana, Cuba.” Aging & Mental Health 12(2): 193–201. https://doi.org/10.1080/13607860701616358.
Stickley, A., and A. Koyanagi. 2016. “Loneliness, Common Mental Disorders and Suicidal Behavior: Findings from a General Population Survey.” Journal of Affective Disorders 197: 81–87. https://doi.org/10.1016/j.jad.2016.02.054.
Štípková, M. 2019. “Marital Status, Close Social Network and Loneliness of Older Adults in the Czech Republic.” Ageing and Society. 41(3): 1–15. https://doi.org/10.1017/s0144686X19001442.
Strohschein, L., P. McDonough, G. Monette, and Q. Shao. 2005. “Marital Transitions and Mental Health: Are There Gender Differences in the Short-Term Effects of Marital Status Change?” Social Science & Medicine 61(11): 2293–2303. https://doi.org/10.1016/j.socscimed.2005.07.020.
Tiwari, S. C., R. K. Tripathi, and A. Kumar. 2008. “Applicability of the Mini-mental State Examination (MMSE) and the Hindi Mental State Examination (HMSE) to the urban elderly in India: A Pilot Study.” International Psychogeriatrics 21(01): 123. https://doi.org/10.1017/s1041610208007916.
Wang, H., C. Lee, S. Hunter, J. Fleming, and C. Brayne. 2019. “Longitudinal Analysis of the Impact of Loneliness on Cognitive Function Over a 20-Year Follow-Up.” Aging & Mental Health 24(11): 1815–1821. https://doi.org/10.1080/13607863.2019.1655704.
Wang, Y., W. Jiang, and L. Wu. 2023. “Association Between Age and Loneliness in Different Residential Type and Gender Groups: Evidence from China.” BMC Psychiatry 23(1): 43. https://doi.org/10.1186/s12888-023-04525-1.
Williams, L., R. Zhang, and K. C. Packard. 2017. “Factors Affecting the Physical and Mental Health of Older Adults in China: The Importance of Marital Status, Child Proximity, and Gender.” SSM – Population Health 3: 20–36. https://doi.org/10.1016/j.ssmph.2016.11.005.
Wilson, R. S., K. R. Krueger, S. E. Arnold, J. A. Schneider, J. F. Kelly, L. L. Barnes, Y. Tang, and D. A. Bennett. 2007. “Loneliness and Risk of Alzheimer Disease.” Archives of General Psychiatry 64(2): 234–240. https://doi.org/10.1001/archpsyc.64.2.234.
Zhang, Y., J. Kuang, Z. Xin, J. Fang, R. Song, Y. Yang, P. Song, Y. Wang, and J. Wang. 2023. “Loneliness, Social Isolation, Depression and Anxiety Among the Elderly in Shanghai: Findings from a Longitudinal Study.” Archives of Gerontology and Geriatrics 110: 104980. https://doi.org/10.1016/j.archger.2023.1016/j.archger.2023.104980.
License
Copyright (c) 2025 Dr. Shweta Narayan, Dr. Meera Desai

This work is licensed under a Creative Commons Attribution 4.0 International License.
Individual articles are published Open Access under the Creative Commons Licence: CC-BY 4.0.