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Impact of self-stigma of loneliness on psychological distress in older adults: mediation effect of relative deprivation and moderation effect of positive solitude

BMC Geriatrics volume 25, Article number: 309 (2025) Cite this article

Abstract

Background

Self-stigma of loneliness is a major predictor of psychological distress among older adults, but its mechanism has not been further discussed. Drawing on classical relative deprivation theory and conceptualizing stigma model, this study aimed to examine the relationship between self-stigma of loneliness and psychological distress among older people and analyzed the mediation effect of relative deprivation and the moderation effect of positive solitude.

Methods

The study applied a cross-sectional study design to conduct questionnaire survey by administrating the Stigma of Loneliness Scale (SLS), 6-item Kessler Psychological Distress Scale (K6), Relative Deprivation Questionnaire, and Positive Solitude Scale (PS) among 1179 Chinese older adults. The Pearson correlation analysis explored the correlation between variables and Model 4 in PROCESS examined the mediating effect of relative deprivation. The moderating effect of positive solitude in the mediation model was tested through Model 59.

Results

The correlation analysis shows a significant and positive correlation between the stigma of loneliness, relative deprivation, and psychological distress (r = 0.530 ~ 0.714); while positive solitude is significantly and negatively correlated with the stigma of loneliness, relative deprivation, and psychological distress (r = -0.128 ~ -0.179). Additionally, relative deprivation plays a mediating role in the relationship between self-stigma of loneliness and psychological distress. Meanwhile, it is invalid of the moderating effect of positive solitude in the direct path, first half of and second half of the path in the mediation model.

Conclusions

Self-stigma of loneliness could both directly affect psychological distress in older people and indirectly through the role of relative deprivation. Furthermore, positive solitude does not significantly buffer the impact of self-stigma of loneliness on relative deprivation and psychological distress. As research findings suggested, it is conducive to reducing psychological distress in older adults by adopting appropriate interventions to diminish self-stigma of loneliness and relative deprivation.

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Introduction

Life expectancy has seen a steady increase, but the underlying problem of aging is gradually exacerbated as socioeconomic development and medical technology advances [1]. China has the largest older adult population in the world, and its aging process is accelerating [2]. Mental health issues stand out as a core topic in dealing with the aging phenomenon. Aging is associated with impaired cognitive function, restricted physical activity, declined health conditions, and accumulated negative life events (e.g., death of a spouse or friend), which can lead to psychological distress such as anxiety, depression, and stress [3]. A review study noted that globally, more than one-third of older adults experience varying degrees of psychological distress [4].

Exploring the influencing factors of psychological distress in older adults can provide theoretical references for early prevention and psychological intervention. Ko et al. highlighted that the stigma of loneliness was significantly and positively associated with psychological distress [5]. Existing literature has provided important insights into the relationship between stigma of loneliness and mental health [5]. However, the mechanisms through which stigma of loneliness affects psychological distress fail to be fully explained, and most such studies are conducted among college students. To this end, the present study aimed to analyze the relationship between stigma of loneliness and psychological distress among older adults and its mechanisms, providing empirical evidence for the development of intervention studies.

The relationship between stigma of loneliness and psychological distress

Psychological distress refers to negative emotional experiences that emerge when an individual lacks the ability to cope with the stress of daily life, such as depression, anxiety, and agony [6]. Currently, a significant body of research suggests the impact of loneliness on mental health in older adults [7, 8]. However, only a few studies have noticed the relationship between stigma of loneliness and psychological distress. Loneliness and stigma of loneliness are different concepts and differ in their impact on psychological distress. Stigma is a demeaning and insulting belief toward a group or a particular attribute [9]. Stigma of loneliness mainly reflects one’s cognitive evaluation of loneliness, which is a kind of negative stereotype and label attached to loneliness [10]. For instance, older adults may perceive those experiencing loneliness as individuals who have failed to achieve social success and who are resistant to social engagement, which may lead older individuals to conceal their own experiences of loneliness from their social circle [11]. Results of a follow-up study showed that people tend to attribute loneliness to a characteristic of older adults and that individuals' age stereotypes can aggravate the experience of loneliness in old age [12].

There is evidence that stigma manifests itself as an adverse factor in affecting the mental health of older adults [13]. For instance, Ko et al. found that stigma of loneliness can potentially decrease one’s social connectedness, self-esteem, and self-disclosure of distress, and lead to the escalation of self-concealment and depression [5]. Similarly, Fan and colleagues discovered that as stigma of loneliness increases, an individual’s psychological distress is correspondingly elevated [14]. Moreover, Barreto et al. noted that individuals high in loneliness were inclined to adopt an internal attribution approach to interpret their loneliness, perceiving higher levels of stigma during loneliness experience with an active intention to conceal loneliness [15]. Concretely, individuals high in loneliness usually possess a higher stigma of loneliness, which can, in turn, further worsen loneliness. Notably, loneliness is considered to be a direct contributor to psychological distress [16]. Therefore, it is fairly speculated that stigma of loneliness may exert a potential influence on psychological distress.

Moreover, individuals tend to have a ‘two-folded stigma’ for loneliness, meaning that individuals with a high stigma of loneliness tend to both reject and avoid people who are lonely (public stigma of loneliness), and deny and dismiss their loneliness feelings (self-stigma of loneliness) [17]. The public stigma of older adults and their perception of stigma information are the prerequisites for the formation of self-stigma of loneliness, which can lead to negative coping styles [18]. Individuals high in self-stigma of loneliness engage in more frequent negative self-evaluations, and more likely to conceal their loneliness and seek help less often when experiencing loneliness [15]. In parallel, self-stigma of loneliness undermines an individual's sense of belonging, reduces perceptions of interpersonal support, and leads to feelings of isolation and marginalization [19]. Therefore, self-stigma of loneliness can exacerbate the experience of loneliness and trigger psychological distress in older adults.

The mediating role of relative deprivation

The sense of relative deprivation is one’s or a group’s feeling of disadvantageous status during the comparison with the reference group [20]. Such perception does not originate from one’s objective inferior status but the result of comparison with other cohorts. It is possible for older adults who feel lonely to maintain a sense of relative deprivation compared to those who are not lonely. For instance, Neves et al. uncovered that loneliness is not only seen as personal trouble but also a public issue. Older people who are lonely may be subject to a sense of devaluation, inequality, and declining social status, leading to relative deprivation [21]. According to Classical Relative Deprivation Theory, it can be inferred that relative deprivation may play a mediating role in the relationship between the two [22]. The theory noted that if an individual or one's ingroup perceives itself to be in a disadvantageous position in the horizontal or vertical comparison with the reference group, the experience of fundamental rights deprivation and the sense of injustice will emerge with negative emotions of anger, dissatisfaction, and resentment [23].

The feeling of relative deprivation not only results in individuals losing plenty of opportunities in everyday life but also has a negative impact on their mental health and social adjustment [24]. The relative deprivation increases an individual's attention bias toward threatening information which leads to anxiety [25]. When coping with emotional problems, individuals high in relative deprivation are inclined to resort to negative cognitive styles and poor adjustment strategies, which can contribute to the accumulation of negative emotions and an increase in psychological problems [24]. The relationship between feelings of relative deprivation and psychological distress is supported by some empirical evidence. Qin et al. found that relative deprivation can increase the level of depression and negatively affect medication adherence and health conditions [26]. In addition to evidence from cross-sectional studies, results from follow-up studies have similarly found that relative deprivation is associated with deterioration in depressive symptoms, functional capacity, and subjective health [27]. Liu et al.’s follow-up study of rural Chinese older adults showed that relative deprivation has a negative and continuous predictive effect on individual physical and mental health, and its impact on older adults is higher than that on the middle-aged [28]. Furthermore, a meta-analytic review indicated that relative deprivation is a threat to individual mental health [29].

Feelings of relative deprivation are primarily derived from social comparisons between individuals and reference groups, while stigma is similarly related to negative social comparisons [30, 31]. Therefore, stigma and relative deprivation may be closely related. The conceptualizing stigma model holds that stigma is the result of social classification [32]. Stigma occurs through four phases, which are (a) identifying and marking group differences; (b) associating stigmatized people with negative stereotypes; (c) social segregation, and (d) labeling people who experience loss of status and discrimination with underlying inequality outcomes [33]. Power plays a key role in the stigmatization process, which is embodied in the labeling process of the majority or those in a dominant position towards a group [34]. The immediate aftermath triggered by stigmatization may involve discrimination, a decline in social status, and the denial of legitimate rights [33].

Stigmatized people are conscripted to endure numerous headwinds, such as misunderstanding, interpersonal rejection, and diminished educational and employment opportunities [35, 36]. For the individuals being stigmatized, cognitive appraisal of their disadvantaged position and subsequent negative emotional experience can exacerbate relative deprivation. Xiong et al. found that stigma is associated with the decline of external locus of control and an increase in relative deprivation [37]. In addition, Paterson et al. stated that stigma is closely associated with negative social comparison and low self-esteem [38]. According to Classical Relative Deprivation Theory, the sense of unfairness from negative social comparison is the main contributor to relative deprivation [23, 39]. Moreover, as depicted in previous studies, stigma and relative deprivation are seen to be predictors of psychological distress [14, 29]. Therefore, relative deprivation may play a mediating role in the effect of stigma on psychological distress.

The moderating effect of positive solitude

Previous studies have found that positive solitude may be an important moderating variable in the relationship between stigma of loneliness and psychological distress [40]. Older adults' social networks will narrow as they age, and the time spent in solitude is much more than that of other age groups [41]. Solitude is generally a double-edged sword for older adults, encompassing both positive and negative effects [42]. Unlike loneliness, isolation, or involuntary solitude, positive solitude is a pivotal psychological resource that helps to buffer the hazards underlying adversity situations against mental health [43]. Positive solitude refers to a meaningful and enjoyable activity or experience an individual engages in at a time or place of conscious choice without essential interaction with others [44]. For example, a person alone enjoys a cup of coffee, indulges in sunbathing, and reads a book in an undisturbed environment. Compared to middle-aged adults, older counterparts are more likely to embrace solitude and benefit from being alone [45].

Stigma of loneliness mainly reflects the individual's cognitive evaluation of loneliness, while positive solitude is a behavioral choice and motivational preference. The two terms differ significantly in conceptual meaning [46, 47]. The development of the stigma of loneliness is closely associated with one's interpersonal relationships, while positive solitude corresponds to the special explanations and reactions towards being alone with less influence caused by real interpersonal relationships or expectations towards personal relationships [48]. As Palgi et al. mentioned, the concept of positive solitude derives from positive psychology, which is a status rather than a stable trait and could develop itself under appropriate interventions [49]. When people encounter obstacles or adverse events, positive solitude as a distinct resourceful experience and skill can facilitate older adults in redefining sense of loneliness [44]. Those older adults with high positive solitude focusing more on the positive value maintained in being alone to better adapt to the changes in social networks with the expectation of reducing negative effects along with stigma of loneliness [50]. In other words, positive solitude exists commonly, even though older adults with high stigma of loneliness can still gain broad and potential benefits through positive solitude.

Positive solitude provides individuals with opportunities for self-reflection and self-growth, which helps to deepen their understanding of self and improve their perception of the meaning and value of life [44, 51]. Moreover, positive solitude enables individuals to rid themselves of complex interpersonal relationships and have an access to engage in positive thinking or meaningful introspection, thereby enhancing authenticity and psychological well-being [52]. Individuals with high positive solitude intend to distance themselves physically and mentally from others and are attentive to internal needs and autonomous choices [53]. Moreover, positive solitude can encourage older adults to better adapt to social networks that are diminishing day by day [54]. For instance, Jiang et al. addressed that positive solitude can reduce the negative impact of interpersonal conflict and potentially enhance positive emotional experiences [40]. As a diary study pointed out, on days when more time was spent in positive solitude, individuals felt less stress and greater autonomy satisfaction (volitional, authentic, and free from pressure) [55].

Therefore, individuals who enjoy highly positive solitude are less reliant on relationships and report higher levels of self-acceptance and authenticity, which facilitates buffering the effects of stigma of loneliness on the sense of relative deprivation. In addition, a review study noted that older adults who are high in positive solitude are prone to employ adaptive emotional regulation strategies, inhibiting the rise of negative emotion [42]. Ost-Mor and colleagues found that positive solitude plays a moderating role in the effects of loneliness on depression [56]. Therefore, positive solitude may reduce excessive worry in older adults pertaining to the negative consequences of loneliness by adopting adaptive emotional regulation strategies, which in turn diminishes the effects of stigma of loneliness on psychological distress.

Furthermore, positive solitude also moderately affects the relationship between relative deprivation and psychological distress. Interpersonal exclusion, rejection, or upward social comparison are important resources in escalating relative deprivation among older adults, which may threaten their health, happiness, and life satisfaction [57, 58]. In this process, positive solitude could promote older adults meeting basic psychological needs of autonomy, competence, and relatedness, which in turn make up for the shortcomings of environment, improve sense of control, achieve emotional calmness, and maintain and develop interpersonal relationships [59]. When older adults perceive relative deprivation, resorting to positive solitude contributes to higher concentration on their own actual needs, less social comparison, and more active self-adaption to rejuvenate, therefore leveling down the negative effects of relative deprivation on mental health [41, 60].

To summarize, the current study constructs a moderated mediation model (see Fig. 1) based on Conceptualizing Stigma Model and Classical Relative Deprivation Theory, which aims to provide empirical evidence to explain the relationship between self-stigma of loneliness and psychological distress in older adults and its mechanisms. Conceptualizing Stigma Model, the most used theory in the field of stigma, focuses on explaining the process of stigma formation and its harms from the perspective of social classification and power differences. The Classical Relative Deprivation Theory, as an important theory of psychology emphasizes that the individual’s social comparison is a prerequisite for the formation of a sense of relative deprivation. The current study applied the Conceptualizing Stigma Model and Classical Relative Deprivation Theory as theoretical frameworks, which facilitates revealing the role of social interaction in the effect of stigma on mental health in social contexts.

Fig. 1
figure 1

Conceptual hypothesis model diagram

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Meanwhile, stigma manifests certain cultural differences as a cultural phenomenon [61]. China is a typical collectivist country strongly and deeply influenced by Confucianism, which may lead to distinct understandings and attitudes towards relationships compared to Western countries. Barreto et al. stated that people living in collectivist countries, compared with those from individualist countries, are more inclined to attribute loneliness to controllable factors and perceive more stigma in their community [15]. In collectivist societies, a strong emphasis is placed on group cohesion, which can lead to lower tolerance or more negative attitudes towards individuals who are perceived as socially deviant such as those experiencing loneliness. Previous studies on stigma of loneliness have been based on populations in North America or Europe, rarely in Asia. The study intends to investigate the effects of self-stigma of loneliness on psychological distress among older adults in Chinese social context, as well as the mediating role of relative deprivation and the moderating role of positive solitude. To this end, the study proposes the following hypotheses:

  • Hypothesis H1: Self-stigma of loneliness is positively associated with psychological distress in older adults;

  • Hypothesis H2: Relative deprivation plays a mediating role in the effect of self-stigma of loneliness on psychological distress among older adults;

  • Hypothesis H3: Positive solitude plays a moderating role in the effect of self-stigma of loneliness on relative deprivation among older adults; Specifically, compared to older adults with low positive solitude, there is a high tendency that the effect of self-stigma of loneliness on the relative deprivation of those with high positive solitude is weaker.

  • Hypothesis H4: Positive solitude plays a moderating role in the effect of self-stigma of loneliness on psychological distress among older adults. Specifically, compared to older adults with low positive solitude, there is a high tendency that the effect of self-stigma of loneliness on the psychological distress of those with high positive solitude is weaker.

  • Hypothesis H5: Positive solitude plays a moderating role in the effect of relative deprivation on psychological distress. In other words, older adults who are high in positive solitude, compared to those with low positive solitude, experience less effect of relative deprivation on psychological distress.

Methods

Study design and participants

This research involved a cross-sectional survey carried out in February 2024. Prior to the survey, the required sample size was calculated using G* power 3.1.9.7. In the moderated mediation model, it is necessary to construct two multiple regression equations. In the first multiple regression equation, the dependent variable is relative deprivation, while the independent variables include self-stigma of loneliness, positive solitude, and their interaction term. In the second multiple regression equation, the dependent variable is psychological distress, with the independent variables comprising self-stigma of loneliness, relative deprivation, positive solitude, the interaction term between self-stigma of loneliness and positive solitude, and the interaction term between relative deprivation and positive solitude. It is assumed that the effect size of the two multiple regressions is small effect (i.e., ƒ2 = 0.02). To achieve an overall power of 0.80, it is necessary to maintain a power level equivalent to the square root of 0.80 for each individual effect within the analysis. Based on the calculation, the statistical power (1-β) is determined to be 0.8944 (i.e., 0.8944 × 0.8944 = 0.80). Accordingly, for the first multiple regression equation, the parameters are set as follows: ƒ2 = 0.02, 1-β = 0.8944, α = 0.05, and the number of predictors = 3. In the second multiple regression equation, the number of predictors was adjusted to 5. After calculation, the minimum required sample size was determined to be 518. However, considering the simplifying assumptions involved in this power calculation (e.g., independence of both effects and the absence of bootstrapping methodology), it is necessary to increase the sample size by an additional 10% (n = 52) to account for potential statistical uncertainties and enhance the robustness of the analysis. Consequently, the minimum sample size required for this study should be 570 participants.

Currently, there are 34 first-level administrative regions in China. Participants in this study come from 25 provinces, municipalities, and autonomous regions, covering most areas of China, which is representative to a certain extent. The researchers recruited 183 college students as investigators at 2 universities in China. During the winter holidays, the investigators conducted face-to-face surveys with older adults living in rural and community settings within their hometowns. All investigators received special training, getting familiar with the content of the questionnaire, the survey process, and the guidelines.

We obtained informed consent from participants before the survey. Subsequently, the investigators issued QR codes to the participants, who scanned the QR codes and answered independently. They would feel free to ask the investigators if they have any questions during the answering process. The research mainly chose the method of online survey for three reasons: First, it can improve the anonymity of the research. Investigators who were in direct contact with the participants had no access to view the results of the participants' surveys. All data was processed and analyzed by the experimenter. Second, the questionnaire was adapted to the older adults’ capabilities and needs. The older participants could adjust the font size according to their actual needs, and use the voice assist function, which can reduce the reading pressure. Third, it would be useful to reduce the pressure of data entry in the later stage. Due to the large number of older participants in this survey, it would take a lot of time to enter data in the form of paper questionnaires as well as making entry errors easily. However, online investigation investigators present a challenge in verifying the authenticity of survey results. At the end of the survey, the researchers checked all the questionnaires one by one. A questionnaire was considered invalid if it had the following problems: (a) the same option was selected for all items; (b) demographic information was inconsistent with the facts, e.g. age 36 or 328. A total of 1,298 questionnaires were distributed and 1,179 valid questionnaires were recollected, with a validity rate of 90.83%. The inclusion criteria for the participants were:(a) voluntary participation in this survey, (b) aged 60 years and above, (c) being able to read, write, and speak Chinese. The exclusion criteria were: (a) having a serious mental illness; (b) having cognitive disorders or dementia.

Measurements

Independent variable

The independent variable in this study was the Stigma of Loneliness Scale (SLS). Fan et al.'s study examined that the Chinese version of SLS has good reliability and validity [14]. The SLS consists of 10 items on a 5-level scoring system: "strongly disagree", "disagree", "uncertain, "agree", and "strongly agree". The scale is divided into Self-Stigma of Loneliness (SSL) and Public Stigma of Loneliness (PSL) dimensions. In the current study, we applied Self-Stigma of Loneliness subscale as research tool. An example item is “I would judge myself negatively if I were lonely”. Higher total scores indicate a higher individual's stigma of loneliness. In this study, Cronbach's α coefficients of SSL was 0.93.

Dependent variable

The dependent variable in this study was the 6-item Kessler Psychological Distress Scale (K6), the most used instrument for measuring individuals’ psychological distress [61]. The validity of the Chinese version of K6 has been validated in the Chinese older population [62]. The K6 consists of 6 items and is scored on a 5-point scale: "none of the time" (0 points), "a little of the time" (1 point), "some of the time" (2 points), "most of the time" (3 points), and "all of the time" (4 points). The item example is “During the last 30 days, about how often did you feel restless or fidgety?”. The higher the total score, the higher the individual's level of psychological distress and the higher the likelihood of developing psychological problems. In this study, Cronbach's α coefficient of K6 was 0.80.

Mediator variable

The mediating variable in this study was the Relative Deprivation Questionnaire, which was developed based on Chinese residents of different ages [63]. The Relative Deprivation Questionnaire consists of 4 items and is scored on a 6-point scale. The item example is “Considering the effort and dedication I made, my life should have been better than it is now.” The higher the total score, the stronger the sense of relative deprivation experienced by individuals when compared with the reference group. In this study, Cronbach's α coefficient of the questionnaire was 0.84.

Moderator variable

The moderating variable in this study was Positive Solitude Scale (PS). PS can be used to measure older adults' attitudes and solitude propensity [49]. The Chinese version of PS has shown favorable psychometric characteristics [50]. The scale consists of 9 items and has no reverse scoring item. Items are scored on a 5-point scale, with a choice from "not at all" to "most of the time". The item example is “When I am by myself, I can achieve the high level of focus that I need”. The higher the total score, the more positive the individual's attitude towards solitude. In this study, Cronbach's α coefficient of the scale was 0.93.

Control variables

The Control variables in this study were mainly demographic information, including age, gender, place of residence, marital status, education level, and physical disability. Among them, gender was categorized as male and female; residence was categorized as urban and rural; marital status was categorized as unmarried, married, remarried, divorced, and widowed; and education was categorized as elementary school and below, junior high school, high school or secondary school, junior college, bachelor's degree, and master’s degree and above.

Statistical analysis

The research adopted SPSS 20.0 to analyze the data. The descriptive statistical analysis calculated the frequency, mean, and standard deviation of demographic characteristics. Pearson's correlation analysis concluded the correlations between variables. All the data were standardized before the analysis of mediating and moderating effects. Previous studies have found that the demographic characteristics of advanced age, female, uneducated, rural residence, divorced or widowed, and poor health are predictors of mental health in older adults [64, 65]. Therefore, the current study included age, gender, place of residence, marital status, education, and physical disability as control variables in the model analysis. In the model analysis, categorical variables such as gender (male as reference), place of residence (city as reference), marital status (unmarried as reference), education (elementary school and below as reference), and physical disability (non-disability as reference) were set as dummy variables. The mediating role of relative deprivation was tested using Model 4 in PROCESS [66]. Using the bootstrap method, the sample was repeated 5,000 times to test the significance of the mediating effect. If the lower and upper limits of the 95% confidence interval did not include 0, then the mediation effect was valid [67]. Subsequently, the moderating effect of Positive Solitude was analyzed using Model 59. If the interaction was significant, a further simple slope test was performed. One standard deviation above or below the mean of the moderating variable was used as the basis for high and low groupings, respectively [68]. The current study regarded p < 0.05 as the standard for statistical significance.

Results

Participants’ characteristics

The participants were aged between 60 and 92 years old, with an average age of 69.04 ± 6.73. The total number of participants was 1179, of which 529 were males, accounting for 44.87% and 650 were females, accounting for 55.13%. The results of detailed descriptive statistical analysis are shown in Table 1.

Table 1 Socio-demographic characteristics (n = 1179)
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The results of the correlation analysis

The mean and standard deviation of each variable are presented in Table 2. As shown in the results of correlation analysis, the self-stigma of loneliness positively and significantly correlates with relative deprivation (r = 0.577, ps < 0.01) and psychological distress (r = 0.673, ps < 0.01); positive solitude is significantly negatively correlated with self-stigma of loneliness, relative deprivation, and psychological distress with correlation coefficient ranging between -0.132 and -0.179 (ps < 0.001).

Table 2 The results of correlation analysis between variables (n = 1179)
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Analysis of the mediating effect of relative deprivation

The multicollinearity test showed that the tolerances of all predictors were 0.689, 0.679, and 0.966, and the variance inflation factor (VIF) was 1.452, 1.474, and 1.035, respectively. Since the correlation coefficients of each variable are less than 0.80 and the VIF is less than 3, it indicates that there is no multicollinearity problem among the predictors [69].

Model 4 was applied to test the mediation model after standardizing independent variables, dependent variables, and mediating variables. The result shows that the self-stigma of loneliness significantly and positively predicts psychological distress (β = 0.662, t = 30.567, p < 0.001) (see Table 3 and Fig. 2). The positive predictive effect of self-stigma of loneliness on psychological distress after the addition of mediators persists significantly (β = 0.537, t = 21.446, p < 0.001) and can predict relative deprivation positively (β = 0.551, t = 22.404, p < 0.001). Moreover, the positive predictive effect of relative deprivation on psychological distress is significant as well (β = 0.227, t = 9.078, p < 0.001). Further Bootstrap analysis showed a 95% confidence interval of [0.620, 0.705], excluding 0. The total effect value of self-stigma of loneliness on psychological distress was 0.662, the direct effect value was 0.537, and the indirect effect value was 0.125.

Table 3 The test results of mediating effects (n = 1179)
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Fig. 2
figure 2

The mediating effect of relative deprivation in the relationship between the stigma of loneliness and psychological distress

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The analysis of the moderating effect of positive solitude

The current study used Model 59 in PROCESS to test the moderating effect of positive solitude on the first half of the pathway and the direct pathway of the mediation model. The results showed that the interaction terms of self-stigma of loneliness and positive solitude predicted relative deprivation significantly (β = 0.081, t = 3.737, p < 0.001). The results of further simple effects analysis (as illustrated in Fig. 3) revealed significant differences in relative deprivation scores across different levels of positive solitude. Specifically, under conditions of low positive solitude (one standard deviation below the mean), older adults with high self-stigma of loneliness (M = 12.875, SD = 3.83) demonstrated significantly higher levels of relative deprivation compared to those with low self-stigma of loneliness (M = 7.200, SD = 2.285), with this difference being statistically significant (F(1,135) = 41.029, p < 0.001, η2 = 0.233). Similarly, under conditions of high positive solitude (one standard deviation above the mean), older adults with high self-stigma of loneliness (M = 12.00, SD = 3.514) continued to exhibit significantly higher levels of relative deprivation than their counterparts with low self-stigma of loneliness (M = 5.719, SD = 2.644), with this difference also reaching statistical significance (F(1,135) = 80.256, p < 0.001, η2 = 0.373). The interaction terms of self-stigma of loneliness and positive solitude did not significantly predict psychological distress (β = 0.037, t = 1.704, p = 0.089); the interaction terms of relative deprivation and positive solitude also insignificantly predict psychological distress (β = 0.030, t = 1.481, p = 0.139).

Fig. 3
figure 3

The mediating effect of positive solitude. Note: The vertical axis values are standardized

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Discussion

Currently, the mental health of older people has become an increasingly serious public health concern [70]. To disclose the relationship between the stigma of loneliness and psychological distress and its mechanism in Chinese cultural context, the current study took older Chinese adults as survey subjects and built a moderated mediation model. The research discovered that the self-stigma of loneliness exerts a direct effect on psychological distress (Hypothesis 1) and an indirect effect on psychological distress through the mediation of relative deprivation (Hypothesis 2). Furthermore, positive solitude moderates the impact of self-stigma of loneliness on relative deprivation (Hypothesis 3). In summary, the research outcomes highlighted that the self-stigma of loneliness and relative deprivation are factors associated with the changes in the psychological distress of older adults, while positive solitude has moderate effects in the mediation model.

Relationship between self-stigma of loneliness and psychological distress

This study found that self-stigma of loneliness was significantly and positively associated with psychological distress in older adults. This finding is consistent with previous research studies, which indicate that self-stigma of loneliness is a significant factor in psychological distress among older adults [5, 14]. As shown in the conceptualizing stigma model, perceived discrimination is regarded as a standard to evaluate self-stigma. Suppose one believes the negative social stereotypes can apply to one’s own. In that case, it may lead to the recognition and internalization of stigma information, therefore restricting opportunities in life aspects of employment, education, income, and social societies [71, 72]. As emphasized in the conceptualizing stigma model, psychological distress is one of the typical outcomes triggered by the self-stigma of loneliness [73]. In the previous studies, some examined the relationships between types of stigma (i.e., occupational stigma, disabled stigma, and mental illness stigma) and the mental health of specific populations [74,75,76]. The current study, compared with others, centers on the topic of self-stigma of loneliness, examining the function mechanism of psychological distress triggered by negative evaluations older adults had towards their sense of loneliness. The research results can enrich existential literature related to the detrimental impacts of self-stigma of loneliness, facilitating understanding of how stigma affects one’s mental health in social contexts.

The mediating effect of relative deprivation

The study revealed that relative deprivation mediates the effect of self-stigma of loneliness on psychological distress in older adults. Classical Relative Deprivation Theory posits that compared to structurally advantaged groups, individuals in disadvantaged positions experience a heightened sense of relative deprivation, with more pronounced effects on behaviors, attitudes, and psychological well-being [29]. Stigma is associated with a range of unfavorable outcomes, notably a decline in status and denial of legitimate rights for stigmatized people [77]. According to the conceptualizing stigma model, stigma can lead to demeaning discrimination, loss of status, and unfair treatment of individuals [78]. Stigma arises as a result of the stigmatizing group having greater power and status, imposing negative labels on a particular group of people, and exacerbating the stigmatized group's perception of their inferior status [79].

In addition, individuals high in self-stigma of loneliness tend to adopt active distancing and self-concealment strategies to avoid discrimination and ridicule, which can undermine or impede access to various types of resources and lead to a rise in relative deprivation [80]. Therefore, self-stigma of loneliness may make individuals feel an inferior position and aggravate feelings of relative deprivation. Relative deprivation has been found to be a threatening factor to the mental health of older adults in previous cross-sectional or longitudinal studies [28, 81]. Evidence from meta-analysis suggests that the typical consequences of relative deprivation are psychological stress and negative emotions [22]. The present study also draws consistent conclusions that relative deprivation is significantly and positively associated with psychological distress in older adults. In the course of social comparison, individuals who perceive unfulfilled expectations or deprivation of resources to which they are entitled are subjected to feelings of unease, anger, and dissatisfaction [82].

The moderating effect of positive solitude

As found in the study, the interaction term of self-stigma of loneliness and positive solitude, as well as the interaction term of relative deprivation and positive solitude, have insignificant prediction effects on psychological distress. It means that the moderation effects of positive solitude in the mediation model’s direct path and second half path are invalid. In other words, hypotheses H4 and H5 are not verified. Moreover, though the predictive effect of the interaction term of self-stigma of loneliness and positive solitude on relative deprivation is significant, the difference in relative deprivation between older adults with high and low levels of positive solitude decreases as self-stigma of loneliness increases. Therefore, the moderating effect of positive solitude in the mediation model’s first half path is also invalid (Hypothesis H3 is invalid). Ost-Mor et al. found that positive solitude buffered the effects of loneliness on depressive symptoms [56]. The present study has not achieved similar results. The role of positive solitude corresponds to the ‘protective-reactive model’ that the beneficial side of positive solitude declines at high-risk conditions [83].

Positive solitude refers to a state in which individuals feel positively connected with themselves and are less influenced by the reality of their relationships or their expectations of others [49]. Individuals high in positive solitude possess a more heightened sense of control and are more likely to enjoy relaxation, calmness, intimacy, and freedom, thus diminishing psychological distress [84]. However, older adults with high self-stigma of loneliness may endure excessive anxiety and fear of the negative consequences of loneliness. As the level of self-stigma of loneliness rises, their need to have relationships is heightened, as does the level of fear of rejection, isolation, and ostracism [5]. Being affected by health status, older people may present a high dependence on family members and friends, resulting in more sensitivity to cues of loneliness and isolation [85]. Therefore, in older adults characterized by elevated levels of self-stigma of loneliness, the positive influence of solitude is insufficient to adequately support mental well-being.

Implications

First, this research takes the initiative to explore the relationship between the stigma of loneliness and psychological distress among older adults. Previous studies on the stigma of loneliness and psychological distress have been mainly conducted among college students. Several pieces of evidence pointed out that young people experience a higher stigma of loneliness than older groups, presenting different characteristics from other adults [15, 86]. This study examined the relationship between self-stigma of loneliness and psychological distress for the first time, focusing on older adults who are most deeply influenced by traditional attitudes. The results of this study can not only provide broader insights into understanding the relationship between older adults’ self-stigma of loneliness and psychological distress and its mechanisms but also shed light on cross-cultural research on stigma of loneliness.

Second, this study is the first to present and analyze the relationship between self-stigma of loneliness and relative deprivation based on Classical Relative Deprivation. It is found that relative deprivation has a mediating effect on the relationship between self-stigma of loneliness and older adults’ mental health. Additionally, previous studies underscored that positive solitude is double-edged for the mental health of the old, bringing positive as well as negative effects [87]. The research nuances in the results of different studies may be due to conceptual differences, inconsistent theories or diverse solitude motivations. This study explores the mediating effect of positive solitude. The results of this study can provide a theoretical reference for the formulation of interventions for the discussion of the relationship between specific types of solitude and mental health.

Third, research on psychological well-being is essential to develop effective interventions that address culturally relevant stigma and discrimination. While paying attention to the harm caused by loneliness to the mental health of older people, we should also set store by their cognitive evaluation of loneliness. When self-stigma of loneliness levels up, older people are more sensitive to their relationships and more concerned about the negative consequences of loneliness, which leads to a potential increase in psychological distress. Therefore, interventions should be implemented to diminish the overemphasis on the negative outcomes of loneliness, regarding loneliness as a universal and normal emotional experience.

Moreover, the findings suggest that intervention against self-stigma of loneliness and relative deprivation may be an effective way to improve the mental health of older adults. For example, it is promoted to have more direct contact between older adults and people who feel lonely, or to adopt the form of short videos and educational lectures, to increase indirect contact between older adults and people who feel lonely and to advocate objective and inclusive perception of loneliness, so as to reduce the stigma of loneliness [88]. Besides, relative deprivation, unlike absolute deprivation, is a subjective psychological feeling, and it is feasible to intervene in it. Relative deprivation mainly stems from the choice of the reference group, and there is no direct connection with the satisfaction of their basic needs. It can promote reduced relative deprivation by instructing older adults to adopt a downward social comparison strategy.

Limitations and future research directions

Some limitations in this study need to be addressed in prospective studies. First, the study adopted a cross-sectional design, and the explanatory power of causality was relatively weak. In future studies, longitudinal studies or experimental design can be conducted to make it more prudent to verify the causal relationship between variables. Second, the self-report method for assessing the variables may be affected by the social expectation effect, reducing the reliability of the conclusions. Further research can carry on multiple methods to collect data, such as examiner-rating scales or interviews.

Third, studies only explored the mediating role of relative deprivation and the moderating role of positive solitude in the effects of self-stigma of loneliness on psychological distress. However, self-stigma of loneliness can affect multiple aspects of individuals, such as social interaction, loneliness, willingness to seek help, and pain disclosure [23]. Moreover, the psychological distress of older adults is also the result of multiple factors combined [89]. Therefore, the relationship between self-stigma of loneliness and psychological distress may be mediated and moderated by other variables. Fourth, though participants were from 25 provinces in China, covering the major regions in China, the utilization of non-random sampling may potentially compromise the sample representativeness. It is expected to include more rigorous sampling to conduct large-scale surveys among older adults. Furthermore, the mobile population, the low-income, the widowed, people with chronic disease and physical disability, and older people from rural backgrounds also experience heightened feelings of relative deprivation and psychological distress. Therefore, in future studies, the mechanisms of self-stigma of loneliness on psychological distress can be further analyzed in specific types of older populations.

Conclusions

This study discussed the relationship between self-stigma of loneliness and psychological distress. We found that self-stigma of loneliness positively predicted psychological distress, with relative deprivation playing a mediating role between the two. However, the analysis revealed that positive solitude did not demonstrate a significant moderating effect within this mediation model. The results suggest that the amelioration of older people’s stigma and negative evaluation of loneliness can facilitate the decrease of relative deprivation and psychological distress. In summary, this study contributes to shedding light on better comprehension of how the stigma of loneliness impacts psychological distress in older adults, which may provide new insights into the development of more effective mental health interventions for older adults.

Data availability

The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

SLS:

Stigma of Loneliness Scale

SSL:

Self-Stigma of Loneliness

PSL:

Public Stigma of Loneliness

K6:

6-Item Kessler Psychological Distress Scale

PS:

Positive Solitude Scale

M:

Mean

SD:

Standard deviation

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Acknowledgements

We appreciate all participants for supporting this study.

Funding

This study was under the Jilin Province Science and Technology Department key research and development project (No. 20230203104SF) and the Jilin Provincial Education Science "14th Five-Year Plan" 2022 General Project (GH22473).

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Authors and Affiliations

  1. Department of Psychology, School of Teacher Education, Shaoxing University, Shaoxing, 312000, People’s Republic of China

    Zhiguang Fan & Xinchang Lu

  2. Department of Psychology, University of Exeter, Exeter, EX4 4QJ, UK

    Xiaoli Shi

  3. Wuhan Jiangxia District No. 1 Middle School, Wuhan, 430000, People’s Republic of China

    Jing Zhang

  4. Rural Revitalization Research Institute, Jilin Engineering Normal University, Changchun, 130052, People’s Republic of China

    Li Li

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Contributions

Fan, Shi, Lu, Zhang, and Li conceived and designed the study. Fan, Shi, and Lu helped with data collection. Fan, Zhang, Shi, and Lu provided statistical advice on study design and performed data analysis. Fan, Shi, Lu, Zhang, and Li contributed to the manuscript preparation and revision. All authors read and approved the final manuscript.

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Correspondence to Li Li.

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Fan, Z., Shi, X., Lu, X. et al. Impact of self-stigma of loneliness on psychological distress in older adults: mediation effect of relative deprivation and moderation effect of positive solitude. BMC Geriatr 25, 309 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12877-025-05904-x

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