Family support is important for mitigating the mental health consequences of loneliness among Black Americans at midlife: Results from a longitudinal mediation analysis.

PURPOSE: Social connectedness influences mental health, yet pathways through loneliness versus social isolation remain underexamined among Black Americans. This study examines these mediating pathways. METHODS: We analyzed longitudinal data (between 2005-2006 and 2016-2017) among Black Americans (N = 592) in the Midlife in the United States (MIDUS), Milwaukee, WI. Social connectedness was measured across six dimensions: neighborhood social cohesion, social integration, support from family, support from friends, social contribution, and community contribution. Mediators included loneliness and social isolation (frequency of social contact). Outcomes were psychological distress (Kessler-6 Scale) and depression diagnosis (7-item binary measure assessing the presence of depressive symptoms over a two-week period). We used structural equation modeling with inverse probability weighting to examine both direct and indirect effects. RESULTS: Loneliness significantly predicted both psychological distress (β = 1.76, p < 0.001) and depression (aOR = 2.14, p = 0.010). Social isolation did not significantly predict either outcome. Support from family showed the strongest total protective effects on psychological distress (total β = -2.477, p < 0.05) and depression (total aOR = 0.208, p < 0.01), primarily driven by substantial indirect effects through reduced loneliness (psychological distress: β = -1.244, p < 0.01; depression: aOR = 0.538, p < 0.05). Support from family also showed a significant direct protective effect on depression (aOR = 0.301, p < 0.05), but not on psychological distress. CONCLUSIONS: Support from family reduced both psychological distress and depression primarily through its role in reducing loneliness, with an additional direct protective effect on depression. Programs and policies that strengthen family support are imperative to promote mental health in this population.