Mental Health
Loneliness in college students: prevalence and associations with substance use outcomes Michelle Flesaker* Michelle Flesaker Christina E. Freibott Travis C. Evans Jaimie L. Gradus Sarah K. Lipson
Background: In 2023, the U.S. Surgeon General issued a report describing loneliness as a critical public health problem. While relationships between loneliness and mental health outcomes have been established, gender-specific associations between loneliness and substance use among young adults are unknown.
Objectives: This study quantified the prevalence of loneliness and associations between loneliness and substance use by gender in a sample of college students.
Methods: Participants were students enrolled in postsecondary institutions throughout the U.S. in the 2021-2022 wave of the Healthy Minds Study (n = 84,481). Data were self-reported. Gender was categorized as male, female, and transgender/nonbinary. Loneliness was measured with the UCLA 3-item loneliness scale and dichotomized as lonely and not lonely. Substance use included alcohol use in the past two weeks and marijuana, prescription stimulant, benzodiazepine, and opioid use in the past 30 days; use was dichotomized as any or no use. We used logistic regression and calculated 95% confidence intervals (CI) to estimate associations.
Results: Loneliness was prevalent overall, but highest among transgender/nonbinary students (79%) as compared to females (59%) and males (54%). Loneliness was associated with reduced odds of alcohol use (odds ratio [OR] = 0.91, CI = 0.87, 0.96) and increased odds of benzodiazepine use (OR = 1.87, CI = 1.29, 2.70) in all genders, and increased odds of marijuana, stimulant, and opioid use in females and males, but not transgender/nonbinary students.
Conclusions: Loneliness was prevalent in a large, national sample of college students, especially in transgender/nonbinary students, and was associated with increased odds of use of most substances examined. Results are limited by the cross-sectional design and use of self-reported measures. Future work should improve interventions to reduce loneliness in this population and integrate substance use prevention as part of these strategies.