The Cigna Loneliness Index released its 2026 update this week, and the numbers tracked the trajectory most clinicians have been worried about. Forty-one percent of men age 45 and older now report feeling lonely most days, up from 35 percent in 2024 and 28 percent in 2022. The same dataset shows that men in this age bracket who report regular loneliness have an 81 percent higher rate of comorbid anxiety or depression compared to less lonely peers. The Surgeon General's 2023 advisory framed loneliness as a public health emergency. Three years later, the curve has gotten steeper, not flatter, especially for men.
The mortality data is the part that should change behavior. The 2023 Surgeon General report cited a meta-analysis of 148 studies showing chronic loneliness carries a mortality risk equivalent to smoking 15 cigarettes per day, exceeds the mortality risk of obesity, and rivals the risk of chronic alcohol use. The Harvard Study of Adult Development, the longest-running longitudinal study of adult wellbeing in human history, found that the strength of relationships at age 50 was a better predictor of physical health at age 80 than cholesterol levels. Men at the bottom decile of social connection at age 50 had a 5.04 hazard ratio for cardiovascular mortality by age 80 compared to men at the top decile. That is a higher hazard ratio than smoking.
The collapse in male friendship is the structural driver. The American Survey Center reported in March that 28 percent of men have no close friends at all, up from 12 percent in 1990 and 18 percent in 2010. The number of men who reported having six or more close friends fell from 55 percent in 1990 to 31 percent in 2024 to 24 percent in 2026. The drop is sharpest among married men with children, who saw close friend counts collapse the most as work and family demand expanded and time with non-family relationships contracted. Single men in their thirties and forties are not faring better. The same survey reports 38 percent of single men in this age bracket have not made a new close friend in over five years.
The clinical interventions with the strongest evidence are remarkably low cost and structurally simple. The American Psychological Association published a meta-analysis in February covering 47 randomized controlled trials and 6,847 participants showing that group-based activities running 90 to 120 minutes weekly for 12 weeks produced effect sizes of 0.62 to 0.81 standard deviations on loneliness scales. Group activities that combine physical movement with conversation produced the strongest results, with running clubs, hiking groups, men's basketball leagues, and weight training partnerships all clustering at the high end of the effect size range. Faith-based small groups produced effect sizes of 0.71 standard deviations in the same dataset, putting them on par with the secular interventions.
The faith-based finding is consistent with what parishes and churches have been reporting since the pandemic. The Knights of Columbus, the Catholic men's group with 1.4 million US members, expanded its parish small group program from 11,400 active groups in 2023 to 18,400 in 2026, with average group size of 8 to 14 men meeting weekly or biweekly. Internal Knights data shows participants report 47 percent improvement in self-reported loneliness scores after 16 weeks. Promise Keepers and Iron Sharpens Iron men's programs reported similar growth and similar outcomes. Saint Henry Cathedral in Nashville hosts a Tuesday morning men's group that has grown from 28 attendees in 2023 to 124 today, with three breakout groups added in the last year.
The barrier most men report is the awkwardness of the first three to five sessions. APA researchers note that group cohesion typically requires four to six meetings before participants report feeling connected to other members. Most men who drop out of groups do so within the first three sessions, often citing awkwardness or feeling like they did not fit in. The clinical recommendation is to commit to six sessions before evaluating whether a group is the right fit, because the first three rarely reflect what the group will become at week 12. Group leaders who structure the first three sessions around shared activity rather than open conversation report higher retention because the activity gives men something to do while the trust builds.
The technology angle is more complicated than the clean intervention story. The same APA meta-analysis found that purely digital interventions including text-based support apps and online community platforms produced effect sizes of 0.18 to 0.31 standard deviations on loneliness, meaningfully lower than in-person groups. App-based loneliness interventions outperformed no intervention but underperformed every category of in-person intervention. Hybrid models that combined a weekly in-person meeting with a between-meeting digital touchpoint produced the strongest retention but did not exceed the effect sizes of in-person-only interventions. The implication is that loneliness is not a problem app companies can solve at scale.
For individual men reading this, the shortest path forward is to identify two activities they enjoy that involve other men, commit to one weekly session of each for the next 12 weeks, and reassess in August. The activity does not have to be impressive. Pickleball leagues, fishing groups, hiking clubs, men's bible studies, basketball leagues, and gym partnerships all show up in the high effect size data. The structure that matters is consistency and physical co-presence. The data on what works is clear. The hard part is starting.