The lockdown and stay-at-home orders that have been implemented in many countries to manage the covid-19 pandemic have led to a wave of commentaries and editorials on the likely adverse effects on mental health. [1] Many of these have discussed the implications of social isolation during the pandemic. 

Social isolation is commonly defined as the state of complete or near-complete lack of interactions, contact, and relationships between an individual and others. While it is a phenomenon that is unique to each individual in its experience, it has typical hallmarks: it is socially patterned, typically affecting older adults or people with chronic health conditions. It evolves gradually over time as contacts and connections disappear, and involves a withdrawal from all types of social interaction. Social isolation has been linked to a range of adverse mental health effects including anxiety, stress, depression, suicidal ideation, and low wellbeing. [2]  The volume of studies on this topic could lead to the assumption that we have an understanding of the potential impact that social isolation during the covid-19 pandemic will have on mental health. But is the current phenomenon of physical distancing brought about by recent lockdown and stay-at-home orders actually “social isolation”?

A comparison of features shows there is in fact little similarity between the features of “social isolation” and the type of isolation being brought about by government orders due to covid-19. Covid-19 is massive and global rather than small-scale and dispersed; abrupt in onset rather than slow in developing; access to leisure and services is strictly curtailed rather than being unimpeded; fears of physical illness or death are higher; and society has been seriously disrupted. But alongside this, there is the solace that this state is temporary, while “social isolation” typically has no time horizon. Covid-19 is also different from “social isolation” in the heterogeneity of experiences people are having. For some, this is a period of little communication; for others contact and companionship are hard to escape. Online and home-based leisure opportunities and community support are plentiful, but uptake is varying. Some people remain active and busy; others are sedentary and bored. All of these features mean that it remains unclear how much we can predict the mental health consequences of this pandemic using previous “social isolation” research.

Literature on other types of isolation could broaden our understanding of the potential effects on mental health. Quarantine during previous epidemics, incarceration, and expeditions (whether over-wintering in Antarctica, space missions, submarine voyages, long-term sailing, or work on oil rigs) all share some features with isolation measures due to covid-19. All suggest adverse effects on mental health. [3-5]  But all also suggest specific nuances. Quarantine can trigger specific stressors around inadequate supplies and information, financial loss, and stigma relating to illness, which are already being noted during covid-19. [5]

Quarantine literature also warns about disproportionate mental health experiences among young people and people from disadvantaged backgrounds, and the continuation of mental health consequences beyond the end of enforced isolation. [5] Already, there are concerns that lockdowns during covid-19 will have lasting psychological effects on individuals. [1]  Expedition literature similarly highlights specific challenges already being noted during covid-19, such as increased interpersonal conflict and irritability, which mirrors reports of relationship strain being experienced in many households. [6] This literature also suggests that baseline social and demographical characteristics may be less important predictors of mental health outcomes than individuals’ own coping resources. [7] Studies of incarceration suggest mental health can improve over several months of incarceration as adaptation and new coping strategies emerge. [8] But this literature might warn us more about the mental health impact of release from isolation as individuals have to re-adjust to routines, re-establish coping strategies, and develop new socialising behaviours, and about the effects of multiple spells of incarceration. [8,9] Early data are suggesting that mental health may be relatively stable during lockdowns, but may in fact worsen more in periods of uncertainty such as when lockdown orders are lifted, and raises questions about how we will be affected by potential second waves of isolation measures. [10]

But even drawing together the literature on these different types of isolation, some features of covid-19 isolation remain unique to the present situation. The presence of fear about the existential threat of the virus may itself stimulate anxiety and depression, although this may be mitigated by the belief that isolation will reduce infection risk. The forecasted societal disruption and anticipated recessions could lead to increasing adversities and mental health problems in the months following the end of lockdown, as well as increased rates of suicide. But it is also possible that the scale of community-wide support being offered, potential increases in community cohesion in the aftermath, along with the active development and encouragement of home-based leisure activities could act as buffers against the worst outcomes, as shown in studies of other global shocks such as natural disasters. [11] Further, due to the heterogeneity of experiences of isolation during covid-19, it may be that what is being experienced is not a single unified concept, but a multiplicity of different types of new isolation experiences that will require nuanced research to identify how their specific features relate to the impact they have on individuals.

The covid-19 outbreak is defining a whole new type of isolation; one that draws on previous experiences and conceptualisations, but one that is unique and largely unpredictable in terms of what its effects on mental health will be. Understanding these effects will be vital not just to how we respond to support people during and after this pandemic, but also to how we plan for future pandemics to try and reduce the harm people may experience. Moreover, research into types and experiences of isolation during covid-19 may fundamentally alter our theoretical conceptualisation of “social isolation” and our understanding of its effects on health.

Daisy Fancourt is Associate Professor of Psychobiology & Epidemiology at University College London and leading the UK COVID-19 Social Study. Twitter @daisy_fancourt 

Andrew Steptoe is Professor of Psychology and Epidemiology at University College London and co-leading the UK COVID-19 Social Study. Twitter @andrewp_steptoe

Conflict of interest: None declared

 

References

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