Loneliness as a predictor of self-rated health: a gendered, cross-national analysis in six European countries

Background: Loneliness is a recognized social determinant of health with substantial physical and psychological implications. Self-rated health (SRH) is a widely used population indicator, with strong predictive validity for morbidity and mortality. Objective: To examine whether loneliness is associated with SRH across six European countries (Germany, Greece, Ireland, Poland, Spain and Sweden), incorporating a gender perspective and the moderating role of sociodemographic factors. Methods: Using a quota-based, cross-sectional sample (N = 4,800), we conducted descriptive analyses by country, sex, and age group, and estimated nested OLS regression models (treating SRH as a 1-5 scale) to examine the association between SRH and loneliness. Results: Higher loneliness was consistently associated with poorer SRH across all models, even after adjusting for sociodemographic and contextual covariates. Women reported lower SRH and higher loneliness, most pronounced at younger ages, while socioeconomic status emerged as the strongest structural correlate of SRH. Conclusion: Loneliness is robustly associated with poorer SRH and exhibits cross-national variation, yet gender gaps remain salient. Findings underline the need for targeted public health interventions addressing loneliness, with particular emphasis on gender equity and protection for the most vulnerable groups.