Social Isolation, eHealth Engagement, and Psychological Distress Among U.S. Adults

Perceived social isolation is a major public health concern in the United States and is consistently associated with adverse psychological outcomes. However, the psychological and behavioral pathways through which perceived social isolation is associated with distress remain incompletely understood, particularly in the context of digital health behaviors. Drawing primarily on Social Cognitive Theory, while also considering health anxiety, uncertainty management, and stress-and-coping perspectives, this study examined a serial mediation model in which eHealth engagement and health self-efficacy were specified as ordered mediators linking social isolation to psychological distress among U.S. adults. Data were drawn from the Health Information National Trends Survey, Cycle 7 (HINTS 7; N = 5,533). Social isolation was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation T-score, and psychological distress was assessed with the Patient Health Questionnaire-4 (PHQ-4). Serial mediation was estimated using survey-weighted regression models with jackknife replicate variance estimation, adjusting for age, sex, education, income, race/ethnicity, and chronic condition count. Social isolation was positively associated with PHQ-4 distress. Significant indirect effects were observed through health self-efficacy and through eHealth engagement alone; however, the serial indirect pathway through eHealth engagement and health self-efficacy was not significant. Findings are consistent with health self-efficacy as a theoretically meaningful pathway linking social isolation and psychological distress, whereas eHealth engagement may reflect reactive health information seeking among more isolated or distressed adults. Because the data are cross-sectional, causal interpretation is not warranted.