Are loneliness and social network size mediators between childhood adversity and depressive symptoms? A cross-sectional replication study in Ethiopia

BMJ Open. 2025 Aug 16;15(8):e088098. doi: 10.1136/bmjopen-2024-088098.

ABSTRACT

INTRODUCTION: Loneliness and adverse childhood experiences (ACEs) constitute significant risk factors for mental disorders, with loneliness emerging as a serious global public health concern. Recent research highlights the role of loneliness as a potential link between early life adversities and current psychopathology. However, most studies have been conducted in high-income, highly individualistic countries. This cross-sectional study explores the interplay between loneliness, social network size, recalled ACEs and depressive symptoms in Ethiopia-a low-income and collectivistic cultural context.

METHODS: The study included 125 psychiatric outpatients at Jimma University Medical Center in Southwest Ethiopia diagnosed with major depressive disorder, bipolar disorder or psychotic disorders, as well as 131 non-clinical participants. Trained interviewers administered the University of California, Los Angeles (UCLA) Loneliness Scale, the Childhood Trauma Questionnaire, the Social Network Index and the WHO-5 Well-Being Index. We used Mann-Whitney U tests, partial correlation and mediation analysis for data analysis.

RESULTS: We found mild-to-moderate correlations between loneliness and ACEs (clinical group: rho=0.29, p<0.001, 95% CI (0.13 to 0.45); non-clinical group: rho=0.42, p<0.001, 95% CI (0.27 to 0.56)). In both groups, loneliness fully mediated the association between ACEs and depressive symptoms (clinical group: indirect effect a₁b₁=0.07, 95% CI (0.02 to 0.13); non-clinical group: indirect effect a₁b₁=0.03, 95% CI (0.01 to 0.07)). In contrast, social network size was neither correlated with ACEs nor did it mediate the association between ACEs and depressive symptoms in either group.

CONCLUSION: This study replicates previous findings that loneliness-rather than social network size-is associated with ACEs and mediates their impact on depressive symptoms. These results support the transcultural and transdiagnostic relevance of loneliness as a universal psychological mechanism, independent of societal structure.

PMID:40819874 | DOI:10.1136/bmjopen-2024-088098