Mitigating the psychological effects of social isolation during the covid-19 pandemic
BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1904 (Published 21 May 2020) Cite this as: BMJ 2020;369:m1904Read our latest coverage of the coronavirus pandemic
All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Dear Editor,
I thank Razai et al, for their article on the psychological effects of COVID-19 related public health restrictions. (1)
The effect of self-isolation on the young must not be underestimated. Amongst those aged 12-25, loneliness, psychological distress and mental health conditions were already an epidemic without the effects of COVID-19. The Young Australian Loneliness Survey conducted by Swinburne University and VicHealth found that 1 in 2 young people in Victoria, Australia were lonely some or all of the time with 1 in 4 of those reporting a level of loneliness deemed to be problematic. (2) Similar, albeit less severe, statistics can be found for the United Kingdom. (3) Worldwide, the incidence of any mental health condition amongst young people in their twenties is 19.8% for men and 32.4% for women highlighting the prevalence of these conditions in normal circumstances. (4)
However, the outbreak of COVID-19 is not a normal circumstance. Many young people have found themselves physically split from their social groups. There is evidence to suggest that close in-person relationships with friends and the community are a major protective factor against mental health conditions in young people. (5) The pandemic has taken this away from many worldwide. Non face to face relationships are no substitute for physical connectedness with Hu finding that virtual interactions are less effective at lowering mood loneliness than their real life equivalents. (6)
Not only has the pandemic led to a loss of connectedness but it has also made access to daily activities such as education, employment, healthcare and recreation difficult in many areas. This has wide reaching implications for mental health. Many will face a loss of identity from losing access to a crucial part of their daily routine and may experience a disconnect from reality as a result. (7) Some young people already at risk will have lost access to support that was assisting with alcohol and drug abuse, homelessness and poverty which will lead to more unfavourable mental health outcomes.
The implications of COVID-19 on young people are serious and it is incumbent on all medical practitioners to be cognizant of the multifaceted impacts that public health restrictions can have on young people. In a cohort that is already reticent to seek care, doctors must approach issues of young people’s mental health in a sympathetic and comprehensive manner during this time. Otherwise, the potential exists to compound the harm that COVID-19 has already done to young people.
References
1. Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ. 2020;369(m1904):1–5.
2. Lim MH, Eres R, Peck C. The Young Australian Loneliness Survey: understanding loneliness in adolescence and young adulthood. Victorian Health Promotion Foundation (VicHealth). Melbourne; 2019.
3. Snape D, Manclossi S. Children’s and young people’s experiences of loneliness: 2018. Office for National Statistics. London; 2018.
4. Gustavson K, Knudsen AK, Nesvåg R, Knudsen GP, Vollset SE, Reichborn-Kjennerud T. Prevalence and stability of mental disorders among young adults: Findings from a longitudinal study. BMC Psychiatry. 2018;18(1):1–15.
5. Saeri AK, Cruwys T, Barlow FK, Stronge S, Sibley CG. Social connectedness improves public mental health: Investigating bidirectional relationships in the New Zealand attitudes and values survey. Aust N Z J Psychiatry. 2018;52(4):365–74.
6. Hu M. Will online chat help alleviate mood loneliness? Cyberpsychology Behav. 2009;12(2):219–23.
7. Conroy SA, O’Leary-Kelly AM. Letting go and moving on: Work-related identity loss and recovery. Acad Manag Rev. 2014;39(1):67–87.
Competing interests: No competing interests
Re: Mitigating the psychological effects of social isolation during the covid-19 pandemic
Dear Editor
Now the Clapping Is Over....
and we begin the return to normality, the fantastic work done by the NHS can continue.
Razai and colleagues rightly highlight the issue of social isolation and its impact on people. They specifically reference unemployment and loss of income as risk factors which contribute to social isolation.
Government messages have been stark and many people have been alarmed. The priority was, and is, to protect the NHS with probably less thought into how to move on from such messages in the public psyche as the country returns to its new normal. The public remains anxious and now, some workers lucky enough to have jobs, are facing the challenge of balancing the anxiety of a return to a workplace with the anxiety of staying away with the risk of loss of income and ultimately of loss of job.
We recognise that being worried and anxious is a normal response to the pandemic and that relatively few people who are worried have a diagnosable anxiety disorder. So we should not medicalise this normal response, turning people into patients and risking their further withdrawal and isolation, potential loss of employment and consequent increased consumption of healthcare. We should resist calls for sickness certification based on an inability for the doctor to provide an absolute guarantee of safety on return to work as such guarantees were not possible even before the pandemic. Workers need to keep in touch with managers and discuss their concerns with them, particularly around adjustments that can address their fears. Healthcare professionals can help by suggesting such contacts and by adopting a holistic biopsychosocial rather than medical approach to the concerns raised.
The reality is that we as a country are faced with meeting both the huge economic, emotional and personal cost of the pandemic and the need to generate income to pay for the health and social care, education and public services we want. We have a strong evidence base of the impact of unemployment on the physical and mental health at both individual and societal levels, so what started as “Stay home, Protect the NHS, Save lives” needs to become “Stay safe”, “Earn, learn, spend” and “ Save the economy” if we are to truly recover from the pandemic.
References
1. Razai MS, Oakeshott P, Kankam H, Galea S, Stokes-Lampard H. Mitigating the psychological effects of social isolation during the covid-19 pandemic. BMJ. 2020;369(m1904):1–5.
Dr Nerys Williams, Consultant Occupational Physician. West Midlands.
Writihg in a personal capacity.
Competing interests: No competing interests