The COVID-19 pandemic has been the most serious crisis on a global scale in living memory. It was identified by the World Health Organisation as a “Public Health Emergency of International Concern” on 3rd February 2020 and it has affected almost all industries. A frightening increase in confirmed cases and deaths continues to rise since the first cases in the UK at the end of January 2020. The world has gradually come to a halt and, as most other countries around the world, the British government has ordered a period of social isolation.
Social isolation can be defined as the separation of people who may have the virus from those who have not by restricting everyone to their homes, unless absolutely necessary (i.e. collecting medicine, buying food or one outing for exercise per day).
There are several ways in which social isolation can impact a person’s mental health. It is essential for the government, and particularly people exercising social isolation, to be aware of these stressors and their consequences. Since the initial outbreak in Wuhan, China, academics have been putting together scientific papers on how the COVID-19 induced social isolation can impact mental health based on pervious epidemics e.g. SARS (2003). This blog will provide a general review of the evidence.
How Can Social Isolation Impact Psychological Wellbeing?
Disruption of regular routines can be the most prominent stressor. A rapid review published in February 2020  reported that confinement to home and not having the means to work to the same standard reduces social or physical contact with others during working hours, resulting in a sense of boredom, frustration and isolation from the world. Participants of these studies reported psychological distress in response to these changes. Protective behavioural patterns such as sleep, mealtimes and exercise routines can also be disturbed during isolation . Furthermore, working from home can also disrupt the boundaries between work and leisure, which can result in the loss of leisure activities that protect psychological wellbeing in the long term.
Whilst many are able to carry out their professional duties remotely (albeit less efficiently and with diminished social contact), people who work in industries such as entertainment, music and hospitality have lost their jobs due to cancelled events and diminished number of customers, forcing establishments such as night clubs, restaurants and bars to dismiss their employees and put artists out of work. The airline industry is another example of how isolation has caused substantial losses, with Flybe collapsing in early March 2020. It is predicted that 37 million domestic jobs could be lost due to the outbreak .
Financial difficulty during self-isolation has been reported to be one of the longer lasting socio-economic stressors of isolation that can lead to clinical disorders such as anxiety, depression and anger , even several months after the isolation period has ended . Interestingly, a study  showed very low rates of financial hardship in Toronto during the SARS epidemic when employers or governments compensated the financial losses caused by isolation. If you find yourself in financial hardship as a result of the COVID-19 isolation period, it is recommended that you apply for benefits available to prevent socio-economic distress seen in previous outbreaks (e.g. The Department for Work and Pensions or the UK’s government scheme of paying 80% of employee wages who are unable to work during coronavirus pandemic).
Modified parental roles can bring extra stress to family households. Young children who are usually at school in the day now have to be cared for at home, which may bring the burden of more house-hold chores (e.g. extra mealtimes) and provision of extra supplies. The increased consumption of supplies and the subsequent “panic buying” of groceries observed after the initial announcement of a ‘lock down’ in the UK can lead to inadequate supplies such as food and medical supplies.
On a more basic level, parents have previously reported that explaining the situation sensitively without evoking fear in their children was distressing, particularly if parents were health care workers and had to continue working in personal protective equipment (PPE) – an unusual sight for their children . Furthermore, infected spouses sleeping in separate rooms for quarantine reasons may increase pressure on other spouse to take on more family tasks.
Whilst the idea of school closure may be exciting for many adolescents, this demographic is susceptible to a number of specific psychological stressors during isolation. School and college environments provide adolescents social stimulation, which is crucial at this age. The area of the brain known as the prefrontal cortex is very malleable at this age and regulates behaviours and emotions that are evoked by social dynamics such as social identity and a sense of belonging . Isolation may impact the development of these emotions by denying them access to their face-to-face social network.
One conspicuous solution for maintaining an active social network during isolation is technology. Studies have shown that the use of interactive media (i.e. gaming, smart phones and social media applications) is higher than ever before, with the estimated number of teenagers using smart phones rising from 73% to 95% in approximately four years . However, this solution must be approached with caution: prolonged excessive use of technology is associated with social withdrawal, shyness and can lead to excessive time spent alone, even after isolation period has ceased. This can act as an obstacle for teens to developing important social skills needed later in life. An increased use of interactive technology may be a healthy adaption to social isolation, but parents must be weary that its use and can grow into a real addiction.
Fear of the Unknown
As this strain of corona virus is novel, it is rapidly evolving. Inadequate information and constantly changing news updates on the increasing death toll will increase anxiety and depression levels in the average person, as well as those who have pre-existing mental health conditions. Those suffering from obsessive-compulsive disorder and anxiety disorders such as agoraphobia (fear of crowded places) are likely to engage in avoidance behaviours more intensely than usual. Such avoidance behaviours are problematic because it may reduce purchasing and consumption of essential products such as food and cleaning products.
For those enduring isolation away from family, living alone or in a house share, loneliness and boredom set in quickly. Not only is loneliness associated with an increase in anxiety, depression and even suicide, studies have found boredom to be related to an increase in unhealthy and addictive behaviours to pass the time, such as alcohol consumption and smoking . There needs to be transparent risk communication of becoming infected by government officials – anticipation of the isolation vs infection risks will affect the whether the public comply to self-isolation in order to prevent the spread of the deadly virus, despite its potential negative impact on mental health.
Health Care Workers and Their Families
Health care workers (HCWs) and emergency responders are the only ones who are exempt from isolation. The worry and anxiety of HCW’s families in isolation who deem their partner’s work as too risky may cause stigmatisation and intra-family tension. However, HCWs who are quarantined due to infection may become stressed, self-critical and experience guilt at the prospect of failing to support co-workers and creating more work for their colleagues by leaving them understaffed .
There have been studies that report isolated HCWs experiencing rejection, stigmatisation and receiving critical comments from members of their local neighbourhoods, despite their bravery for having worked in such close contact with the infected. Others suggest that HCWs who worked in high risk environments during the SARS epidemic engaged in maladaptive avoidance behaviours (e.g. minimising patient contact, avoiding crowded places and not attending work) and displayed more severe post-traumatic stress symptoms up to three years after the isolation period ended . Having such first-hand experience of death and exposure to people with an infectious disease can have a detrimental effect on the psychological and social wellbeing of HCW and their families.
Tips for Reducing the Negative Effects of Isolation and Increasing Engagement
Social connection is a protective factor of psychological wellbeing that is prevented by self-isolation. In order to mitigate the negative effects of isolation, here are some recommendations:
- Wi-Fi connection: remote access social network is essential, rather than a luxury (to be approached with caution for adolescents). Setting up a properly installed, fast Wi-Fi router is recommended. Various video call applications are available to be part of a community and are essential to stay in touch with friends and family, particularly for those living alone or in a house share. For example, virtual pub quizzes simulate real life interaction and reduce the enforced sense of isolation. This will reduce anger, frustration and long-term distress about reduced autonomy during isolation.
- Maintaining ordinary routines: mealtimes, exercise and sleep are healthy routines that are much easier to maintain if they are time specific, rather than general aspirations – create a daily schedule and stick to regular alarms .
- Online fitness courses: exercise class instructors will also have adapted to this time so take advantage and engage by joining a new exercise class.
- Keep informed and be patient: although there will be a great deal of negative content, this will have a long-term benefit to psychological wellbeing and will reduce stigma towards those who have been infected. Take each day as it comes, as the total period of isolation in still uncertain – be patient and be proactive in your activities e.g. set targets for increasing exercise routines.
- Using resources and help lines available: NHS help line 111 will provide advice on any symptoms and action that needs to be taken. This will provide reassurance and reduce anxiety.
- Altruism: thinking about the how your compromised social interaction is having a positive impact (i.e. saving lives and reducing the strain on the NHS). Ultimately, the long-term outcome will outweigh the short-term psychological impact of self-isolation.
- Time for reflection: this is a unique opportunity to reflect on unhealthy lifestyle choices or unnecessary expenses. The time could also be spent learning a new hobby or something you feel like you never have time to do e.g. mindfulness, yoga, cooking.
- Collective action: young people are less susceptible to becoming critically infected and are therefore more likely to prioritise their self-interest of social interaction than the collective interest of social distancing and protecting older people. Young people complying to the isolation orders are likely to motivate “conditional co-operators” – those who will only cooperate if other fellow young people do so  and will therefore be more content with their social sacrifice.
- Public-spirited behaviour: cooperation is improved by communication. The more people that feel part of a community response, the more likely they are to engage in self-isolation, whilst also reducing the sense of isolation that negatively impacts psychological wellbeing. The recent 8:00pm applauses for NHS workers are a good example of public-spirited behaviours; a display of appreciation and community togetherness. You are not alone!
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- Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L., Wessely, S., Greenberg, N. and Rubin, G.J., 2020. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet.
- Lunn, P.D., Belton, C.A., Lavin, C., McGowan, F.P., Timmons, S. and Robertson, D.A., 2020. Using Behavioral Science to help fight the Coronavirus. Journal of Behavioral Public Administration, 3(1).
- Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M., Sadavoy, J., Verhaeghe, L.M., Steinberg, R. and Mazzulli, T., 2003. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. Cmaj, 168(10), pp.1245-1251.
- Jeong, H., Yim, H.W., Song, Y.J., Ki, M., Min, J.A., Cho, J. and Chae, J.H., 2016. Mental health status of people isolated due to Middle East Respiratory Syndrome. Epidemiology and health, 38.
- Cava, M.A., Fay, K.E., Beanlands, H.J., McCay, E.A. and Wignall, R., 2005. The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing, 22(5), pp.398-406.
- Robertson, E., Hershenfield, K., Grace, S.L. and Stewart, D.E., 2004. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. The Canadian Journal of Psychiatry, 49(6), pp.403-407.
- Gerfo, E.L., Gallucci, A., Morese, R., Vergallito, A., Ottone, S., Ponzano, F., Locatelli, G., Bosco, F. and Lauro, L.J.R., 2019. The role of ventromedial prefrontal cortex and temporo-parietal junction in third-party punishment behavior. NeuroImage, 200, pp.501-510.
- Anderson, M. and Jiang, J., 2018. Teens, social media & technology 2018. Pew Research Center, 31, p.2018.
- Barbisch, D., Koenig, K.L. and Shih, F.Y., 2015. Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster medicine and public health preparedness, 9(5), pp.547-553.
- Maunder R, Hunter J, Vincent L, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ 2003; 168: 1245–51.
- Reynolds, D.L., Garay, J.R., Deamond, S.L., Moran, M.K., Gold, W. and Styra, R., 2008. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology & Infection, 136(7), pp.997-1007.
- Ostrom, E., Walker, J. and Gardner, R., 1992. Covenants with and without a sword: Self-governance is possible. American political science Review, 86(2), pp.404-417.