Lack of Social and Emotional Support*
About
Percentage of adults reporting that they sometimes, rarely, or never get the social and emotional support they need. The 2025 Annual Data Release used data from 2022 for this measure.
Much of our health depends on trusting relationships that provide us with comfort, guidance, and the information needed to navigate a society. Our relationships are a source of emotional and social support critical to thriving.1-3 Lack of Social and Emotional Support is measured as the percentage of adults in a county who say they sometimes, rarely or never get the social and emotional support they need.
People who report a lack of social and emotional support report higher rates of stress, frequent mental distress, and depression, as well as heart disease, stroke, dementia, type 2 diabetes, anxiety and premature death.4,5 A lack of support is associated with lower self-rated physical health, especially in older adults.6 About one in four US adults report a lack of social and emotional support.7
Societies that promote prejudice or make laws erasing the existence of de-valued groups of people create conditions where fewer people are willing to provide social or emotional support to people suspected of holding these devalued identities. In much of the Western world, this disproportionally harms people of color, recent immigrants, people living with disabilities, the elderly, and people who do not conform to the expectations of heterosexuality or traditional gender norms.4 A 2024 study by the CDC found that this lack of support was highest among individuals who identified as transgender female, gender nonconforming, members of racialized groups, those living in low-income households (earning less than $25,000) and those without a high school education.5
Find strategies to address Lack of Social and Emotional Support*
Data and methods
Data Source
Behavioral Risk Factor Surveillance System
The Behavioral Risk Factor Surveillance System (BRFSS) is a state-based random digit dial (RDD) telephone survey that is conducted annually in all states, the District of Columbia, and United States territories. Data obtained from the BRFSS are representative of each state’s total non-institutionalized population over 18 years of age and have included more than 400,000 annual respondents with landline telephones or cellphones since 2011. Data are weighted using iterative proportional fitting (also called "raking") methods to reflect population distributions. Data from the BRFSS are used to measure various health behaviors and health-related quality of life (HRQoL) indicators in the Health Snapshots and downloadable datasets. HRQoL measures are age-adjusted to the 2000 U.S. standard population.
Prior to the 2016 Annual Data Release, up to seven survey years of landline only BRFSS data were aggregated to produce county estimates. However, even with multiple years of data, these did not provide reliable estimates for all counties, particularly those with smaller respondent samples. For the 2016 Annual Data Release and beyond, the CDC produced county estimates using single-year BRFSS data and a multilevel modeling approach based on respondent answers and their age, sex, and race/ethnicity, combined with county-level poverty, as well as county- and state-level contextual effects.1 To produce estimates for those counties where there were no or limited data, the modeling approach borrowed information from the entire BRFSS sample as well as Census Vintage population estimates. CDC used a parametric bootstrapping method to produce standard errors and confidence intervals for those point estimates. This estimation methodology was validated for all U.S. counties, including those with no or small (< 50 respondents) samples.2 This same method was used in constructing the 500 cities study, which includes BRFSS data for the 500 largest cities in the U.S.
For the 2021 Annual Data Release, the CDC has updated their modeling procedure for producing small-area estimates. With the PLACES project, a multilevel statistical modeling framework using multilevel regression and poststratification (MRP) is performed for small-area estimation that links BRFSS data with high spatial resolution population demographic and socioeconomic data from the Census’ American Community Survey (ACS). The CDC has performed internal and external validation studies, which confirm strong consistency between their model-based estimates and the direct BRFSS survey estimates at both the state and county levels. For more technical information on the PLACES modeling procedure, please see their website.3
1Zhang X, Holt JB, Lu H, Wheaton AG, Ford ES, Greenlund K, Croft JB. Multilevel regression and poststratification for small-area estimation of population health outcomes: a case study of chronic obstructive pulmonary disease prevalence using the Behavioral Risk Factor Surveillance System. American Journal of Epidemiology 2014;179(8):1025–1033.
2Zhang X, Holt JB, Yun, S, Lu H, Greenlund K, Croft JB. Validation of multilevel regression and poststratification methodology for small area estimation of health outcomes. American Journal of Epidemiology 2015;182(2):127-137.
3PLACES Project. Centers for Disease Control and Prevention. Accessed March 9, 2021. https://www.cdc.gov/places.
Key Measure Methods
Lack of Social And Emotional Support is a percentage
Lack of Social and Emotional Support is the percentage of adults in a county reporting that they sometimes, rarely, or never get the social and emotional support they need.
Lack of Social And Emotional Support estimates are age-adjusted
We report an age-adjusted rate in order to fairly compare counties with differing age structures.
Lack of Social And Emotional Support estimates are created using statistical modeling
Surveys collect information about a limited portion of a population. Statistical modeling can be used to predict how people who share certain characteristics with those surveyed may have responded to the survey. Modeling can increase the power of survey data by generating more stable estimates for places with small numbers of residents or survey responses. The Lack of Social and Emotional Support estimates are produced from one year of survey data and are created using complex statistical modeling. For more technical information on PLACES modeling using BRFSS data, please see their methodology.
There are also drawbacks to using modeled data. The smaller the population or sample size of a county, the more the estimates are derived from the model itself and the less they are based on survey responses. Models make assumptions about statistical relationships that may not apply in all cases. Finally, there is no perfect model and each model generally has limitations specific to its methods.
Caution should be used when comparing these estimates across states
BRFSS survey data are collected independently by each state, which could result in data collection differences.
Caution should be used when comparing these estimates across years
Estimates may not be comparable across years because of methodological changes in PLACES.
Measure limitations
Generally, a lack of social and emotional support is viewed as the objective absence of meaningful social connections, whereas loneliness is the subjective experience that arises from a lack of support. Subjective survey measures like the BFRSS question used to estimate social and emotional support can be limited by differences in individual interpretation, situational context, mood or culture. These limitations can make meaningful data interpretation difficult, especially across demographic and contextual differences.
These data are only available for counties within states that offered the optional Social Determinants and Health Equity module of the BRFSS. Eleven states are missing these data in the 2025 Data Release including Arkansas, Colorado, Hawaii, Illinois, Louisiana, New York, North Dakota, Oregon, Pennsylvania, South Dakota and Virgina.
Numerator
The numerator is the number of respondents who answered “sometimes,” “rarely” or “never” to the question: “How often do you get the social and emotional support that you need?”
Denominator
The denominator is the total number of adult respondents in a county.
Can This Measure Be Used to Track Progress
Modeled estimates have specific drawbacks with their usefulness in tracking progress in communities. Modeled data may not capture the effects of local conditions, such as health promotion policies. To better understand and validate modeled estimates, it is helpful to supplement estimates with additional local data.
Additionally, methodological changes limit the ability to track progress across years using this measure. For more information on methodological changes, see above.
Finding More Data
Stratified estimates by age, gender, race/ethnicity or poverty are not available.
References
- Powell A. How social isolation, loneliness can shorten your life. The Harvard Gazette. 2023.
- Hutten, E, Jongen EMM, Vos AECC, van den Hout AJHC, van Lankveld JJDM. Loneliness and mental health: The mediating effect of perceived social support. International Journal of Environmental Research and Public Health. 2021;18(22):11963.
- National Institute on Aging. Loneliness and social isolation — Tips for staying connected. National Institute on Aging. 2024.
- Bruss KV, Seth P, Zhao G. Loneliness, lack of social and emotional support, and mental health issues — United States, 2022. Morbidity and Mortality Weekly Report. 2024;73(24):539–545.
- Centers for Disease Control and Prevention. Loneliness, lack of social and Emotional support, and mental health Issues - United States, 2022. Centers for Disease Control and Prevention. 2024.
- Cornwell EY, Waite LJ. Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior. 2009;50(1):31–48.
- Centers for Disease Control and Prevention. Health effects of social isolation and loneliness. Social Connection. Centers for Disease Control and Prevention. 2024.