Loneliness in spinal cord injury: A systematic review and comparison with the general population.

Abstract

Context: The psychosocial consequences of a Spinal Cord Injury or Disorder (SCI/D) can include increased loneliness. However, differences in the measurement of loneliness confound the available evidence.

Objectives: To compare levels of loneliness between adults with a SCI/D and the general population (Touch Test data) using the UCLA Loneliness Scale (any version). A secondary aim was to explore potential subgroups vulnerable to loneliness.

Methods: Observational studies examining loneliness in SCI/D were identified via CINAHL, PubMed, PsycINFO, MEDLINE, Embase, Web of Science (up until 9th Sept 2025), Google Scholar (first 100 results), and targeted citation searching. Standardized mean group differences (Hedges' g) were pooled using random effects modelling and the methodological quality of included studies evaluated (QualSyst tool). Study characteristics and bivariate correlations of loneliness in SCI/D were additionally examined.

Results: Thirteen observational studies (N = 3029 adults with SCI/D) were included in the analysis. Average UCLA scores (revised Version 3, 20-item and 3-item) for the pooled SCI/D sample and the general population were comparable, with both groups reporting moderate levels of loneliness (g_w = .01; CI: -.43 to .46, P = .951). Individual effect estimates among the SCI/D studies were, however, characterized by imprecision and heterogeneity. Associations between loneliness, demographic and SCI/D characteristics were inconsistent although those who were lonely did report adverse health and social outcomes.

Conclusions: The underlying personal, social and environmental factors which contribute to loneliness in SCI/D should be monitored and addressed. Ongoing research is also needed to develop a more culturally nuanced understanding of loneliness in disability. Protocol registration: https://osf.io/s6723/.