Dr Maria Loades is a Senior Lecturer in the Department of Psychology at the University of Bath.
The novel corona virus, SARS-coV-2, also known as COVID-19, has necessitated disease containment measures across the globe. These have primarily involved rapidly instigated ‘lockdowns’, in which populations have been told to stay at home. This has resulted in the curtailment of social interaction and social support, a reduction in physical activity, and a lack of structure, routine and purposeful and/or enjoyable activities. These factors, combined with the heightened anxiety resulting from the threats posed by COVID-19 itself, have inadvertently created the conditions in which mental health problems are likely to escalate.
Within this context, we did a rapid systematic review to collate and synthesise the findings of all the existing studies which have looked at loneliness and social isolation and mental health in children and young people.
Loneliness is the painful feeling we get when there is a discrepancy between our actual social contacts and what we desire them to be. We focused on loneliness as well as social isolation, even though they are not necessarily one and the same, because we hypothesised that social distancing measures, including school closures, would be particularly difficult for children and young people, for whom interacting with and playing with peers is key to social and emotional development and to a sense of connection. Indeed, emerging findings from surveys in the current context are indicating that loneliness is higher in children and young people than in any other age group.
Over 60 studies met our criteria and were included in our review. There is strong evidence that loneliness is linked to depression and anxiety in children, adolescents and young adults, both concurrently and prospectively. Being lonely increases the chances of developing mental health problems up to almost a decade later. Of particular relevance to the COVID-19 context, there is some evidence that the duration of loneliness is more strongly associated with subsequent depression than the intensity of loneliness. Although not everyone will be lonely in the current context, those who are will be particularly vulnerable to developing mental health problems.
We found only one study which had looked at mental health outcomes for children in a pandemic context. This study found increased rates of mental health service use, and increased rates of trauma symptoms in those who had experienced disease containment measures (quarantine or social distancing) compared to those who had not. Children who had experienced disease containment measures were five times more likely to require mental health service input. Therefore, although little is known about the mental health impacts of disease containment in a pandemic context and much more research is needed, there is an initial indication from the literature of a detrimental impact on mental health for children and young people.
This is also consistent with emerging evidence in the COVID-19 context; studies in China have reported early findings that children aged three to 18 are commonly displaying behavioural manifestations of anxiety, and at least one in four young adult students are experiencing mild anxiety symptoms. In the UK, early results from the Co-SPACE (COVID-19 Supporting Parents, Adolescents and Children in Epidemics) online survey of over 8000 parents of four to 16 year olds, suggest high levels of COVID-19-related worries and indicate that over 40% of parents feel that they need help with managing their children’s emotions.
Social distancing measures and widespread chronic loneliness could increase in mental health problems in children and young people. We should try to prevent this where possible. The effects on mental health could be mitigated by promoting wellbeing at school and community level as lockdown eases. Public health messages could be sent out about activities that support wellbeing, such as physical activity, socialising and doing enjoyable activities. Reconnecting socially, including through play, should be prioritised. Although there is evidence that interventions can reduce loneliness in children and young people, including by focusing on social and emotional skills and learning a new hobby, more research is needed in this arena. There are things we can do to reduce the social impact of enforced physical distancing. These include maintaining the structure, quality, and quantity of social networks including through virtual communications, and helping children and young people to experience social rewards, feel part of a group, and know that there are others they can look to for support.
For some children and young people, a more targeted, individualised approach will be needed to ensure that emergent mental health problems do not continue to interfere with their functioning over time. We know, for instance, that psychological distress and exclusion from school are inter-linked. Therefore, we need to ensure that mental health services are prepared to deal with an increase in demand and can provide evidence-based treatments in a timely and accessible manner, including remotely while disease containment measures remain in place.
Computerised Cognitive Behaviour Therapy (CBT) based programmes, generally have small but positive effects on mental health. Although mobile phone applications for mental health are generally acceptable to children and young people, there is a lack of convincing evidence of their effectiveness as few mobile health apps have been thoroughly tested. Importantly, there is evidence that the outcomes of digital interventions are better if there is some therapist input and if parents are involved especially for younger children.
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