Loneliness and emotional support helpline use in Spain: a 20-year observational study.

Background: Emotional support helplines provide low-threshold assistance to people experiencing psychological distress, yet long-term evidence on reasons for contact remains limited in Spain. This study aimed to describe the distribution of psychological motives for contacting Teléfono de la Esperanza between 2004 and 2023, with particular attention to loneliness, and to examine temporal, sex-, and age-related patterns. Methods: We conducted a retrospective observational study using anonymized routine registry data from the International Association Teléfono de la Esperanza (ASITES). The dataset included 2,194,175 contact records registered between 2004 and 2023. Descriptive analyses summarized annual volume, caller characteristics, and primary presenting problems. Annual proportions were calculated to examine temporal patterns. Associations between caller characteristics and selected primary presenting motive were examined using multinomial logistic regression, with loneliness/communication difficulties as the reference outcome category and sex, age group, and calendar year entered simultaneously as predictors. Adjusted odds ratios, 95% confidence intervals, and model-based adjusted predicted probabilities were reported. Results: Contact volume increased over time, reaching its highest levels in 2021-2023. Most contacts were by telephone, and most callers were women (67.1%); age distribution was concentrated in midlife. Loneliness/communication difficulties was the most frequent primary presenting problem among the selected motives examined (10.1%), followed by depressed mood (7.2%) and anxiety-related problems (7.0%). In the multinomial model, age group showed the largest contribution to model fit. Adjusted predicted probabilities showed a strong age gradient for loneliness/communication difficulties, increasing from 15.75% among contacts aged ≤18 years to 77.44% among those aged ≥76 years. In contrast, suicidality-related motives were concentrated in younger groups. Men had higher adjusted relative odds of suicidal ideation and suicidal crisis than women, whereas women had higher relative representation of depressed mood and grief/bereavement. Conclusion: Helpline contact records reflect distinct age-, sex-, and time-related patterns of distress. Loneliness emerged as a major reason for contact, particularly in later life, supporting the value of helplines as an accessible public mental health resource and as a potential gateway for targeted prevention and referral strategies.