Background: Mental health (MH) is one of the most important resources of human life, particularly during older adulthood. Self-esteem (SE) is related to mental health (MH), and loneliness may serve as a mediator in the relationship between SE and MH. However, the role of loneliness in this relationship is not well understood. This study aims to evaluate the association between SE and MH in older adults, specifically focusing on the mediating role of loneliness in this relationship.
Methods: This cross-sectional correlational study was conducted in 2023 using structural equation modeling. Participants were 357 older adults selected through quota sampling from comprehensive urban healthcare centers in Urmia, Iran. Data collection instruments included a demographic questionnaire, the University of California Los Angeles Loneliness Scale, the General Health Questionnaire, and the Rosenberg Self-Esteem Scale. Data were analyzed using the SPSS (v. 23.0) and the SmartPLS (v. 3.0) software.
Results: SE had a significantly weak positive association with MH (ß = 0.095; P < 0.001) and a significantly weak negative association with loneliness (ß = -0.288; P < 0.001). Additionally, loneliness had a significantly strong negative association with MH (ß = -0.632; P < 0.001). The study confirmed that loneliness acts as a mediator between SE and MH (β = -0.688, 95% CI: 0.1427, 1.2958; P < 0.001).
Conclusion: Health assessments and loneliness screening programs are essential for older adults to identify symptoms early and prevent mental health issues. Governments should strengthen social connections among older adults through services and education. Urban healthcare centers can reduce loneliness by organizing community activities, encouraging pet ownership, and promoting participation in senior centers.
Clinical trial number: Not applicable.
Keywords: Loneliness; Mental health; Older adult; Self-esteem; Structural equation modeling.
© 2025. The Author(s).