The association between loneliness, suicidal ideation, and psychological distress considering family compositions: a cross-sectional study in a Japanese rural area

Research on how loneliness, as a subjective experience, affects suicide risk remains insufficient. It also remains unclear whether the effects vary according to family composition. This study aimed to investigate the associations among loneliness, suicidal ideation, and psychological distress in a rural population in Japan. A cross-sectional survey was conducted between August and September 2023 in a rural town in Akita Prefecture. Of the 5,000 surveyed residents, data from 1,842 respondents were analyzed. The exposure variable was loneliness, as assessed by the University of California Los Angeles Loneliness Scale short form. The main outcome was the presence or absence of suicidal ideation, which was measured using a self-reported questionnaire. The secondary outcome was psychological distress, which was measured using the Kessler Psychological Distress Scale (K6). The collected data were analyzed using multivariate logistic regression and stratified analysis based on family composition. Loneliness was strongly associated with suicidal ideation and psychological distress. The loneliness-psychological distress association persisted regardless of family composition. Loneliness independently affected suicidal ideation and psychological distress among rural residents in Japan. To develop effective suicide prevention strategies in rural areas, it is essential to address both social isolation and the subjective experience of loneliness.