https://www.psychiatrictimes.com/view/covid-19-loneliness?utm_source=sfmc&utm_medium=email&utm_campaign=05202021_NEU-21-PSD0297_PT_Ingrezza%20Traffic%20Driver_INTL&eKey=cGhpbGlwcGExOTYxQGdtYWlsLmNvbQ==COVID-19 Loneliness
May 13, 2021
Julian Lagoy, MD
CLINICAL REFLECTIONS
As the world slowly sheds the weight of COVID-19, there is an opportunity for psychiatrists to pause and consider the role they are about to play in the coming months and years. Never before has the entire modern world been subjected to such collective feelings of fear, uncertainty, anxiety, and sorrowâ€â€and loneliness.
Individuals around the world did their part to slow the spread of COVID-19 by staying home. Populations that were not used to being alone, like children and teenagers, were suddenly cut off from their social networks. Family members were often isolated from each other. Many individuals have died from COVID-19, often without family, with little comfort or human contact except hospital staff.
About 36% of Americans reported feeling “serious loneliness†in the wake of the pandemic, according to Loneliness in America, a recent report by Harvard University.1 Of these respondents, 61% were aged 18 to 25 years, and 43% reported increases in loneliness since the pandemic began.
The effects of pandemic-related isolation have been felt in every corner of society. It may take the form of exacerbated symptoms in some patients or freshly developing signs of mental illness in others. Medically, loneliness has been linked to heart disease and stroke.2 It is also linked to increased rates of depression, anxiety, substance abuse, domestic abuse, and suicide.3
Psychiatry often relies on pharmaceuticals to treat mental illness; this pandemic serves as a good reminder that the best cure for loneliness can be as simple as kindness and compassion.
Studying Loneliness
More than any other species, humans are dependent on others for longer periods of time. In fact, the average individual spends about 80% of their waking hours in the company of others.4 Loneliness is a state of mind that is characterized by feeling unwanted, empty, and cut off from other human beings.5 It is also described as a negative reaction to the discrepancy between the relationships we desire versus those we have.
Loneliness is not necessarily the result of being alone. One can easily feel lonely even when surrounded by others. Because loneliness is more often a perception, feelings of isolation can trigger hypervigilance, in which the world appears to be a threatening place.6 Individuals who are lonely tend to be more critical of themselves.7 When these negative expectations are confirmed by the behavior of others, this creates a loneliness loop that is accompanied by feelings of hostility, stress, pessimism, anxiety, and low self-esteem.8
Loneliness apparently loves company, with studies describing it as contagious.9 It appears to spread through friends, rather than family members, and occurs in clusters, extending up to 3 degrees of separation.10 Loneliness can be addressed both as a group and individually. One way to prevent loneliness is to encourage social activity. Obviously, for some people it is very hard to be social; this is where emphasizing resiliency and perseverance is important.
“In loneliness, the lonely one eats himself; in a crowd, the many eat him,†Friedrich Nietzsche once said.11 Culturally, loneliness can be seen as a sign of weakness or self-pity. For instance, 1965 study of rhesus monkeys Found that when a group of socially isolated monkeys were reintroduced to their colony, they were driven off or eliminated.12
In 2018, the United Kingdom’s BBC Radio 4 released results from The Loneliness Experiment, the largest survey ever conducted on the subject.13 They study included more than 55,000 participants, aged 16 to 99 years, hailing from 237 countries, islands, and territories. It found that loneliness was higher in individualistic cultures such as the United States and Western Europe, which placed high value on self-reliance, loose social networks, and chosen relationships. In contrast, cultures with strong collectivist norms, including some Asian countries, are built on interdependence, tighter social networks, and stronger family connections. Some of these countries include Brazil, India, and the Philippines.
The study found young individuals experienced the most loneliness, with 40% of 16- to 24-year-olds feeling lonely often or very often, in comparison with 29% of individuals aged 65 to 75. Young men in particular were more susceptible to feelings of loneliness, and their loneliness was more intense and longer-lasting.
Most of the research on loneliness was conducted before COVID-19 sent us into lockdown, so it is too soon to consider the pandemic’s long-term effects. However, recent studies have tracked the impact of social distancing and quarantine, and they have left an intriguing bread-crumb trail of predictions.
Pandemic Worries
When COVID-19 struck, many experts worried suicide rates would skyrocket.14 A 2020 report from the Centers for Disease Control and Prevention showed a 35% increase in suicide mortality in the US from 1999 to 2018, a trend most people expected to continue.15
A March 2020 rapid review disseminated 24 studies in 10 countries that examined the psychological impact of quarantine.16 It included those affected by SARS, Ebola, H1N1 influenza, Middle East respiratory syndrome, and equine influenza. Common quarantine side effects included posttraumatic stress disorder (PTSD), confusion, and anger. Stressors included the extension of quarantines, fear of infection, frustration, boredom, inadequate supplies and information, financial loss, and stigma.
The review also found health care workers in particular suffered from the loneliness and isolation of quarantine. Theyendured increased severe symptoms of PTSD, felt stigmatized, and reported greater loss of income. Health care workers also reported feeling lonely, guilty, angry, helpless, isolated, nervous, and sad. Many linked their quarantine experience to alcohol abuse and dependency symptoms. They also engaged in avoidance behavior, often not showing up to work or avoiding direct interactions with patients.
Like every facet of society, health and mental health organizations have had to rethink how to serve their patients, especially when they could not be treated in person. Mental health care providers were encouraged to find alternate ways to deliver services, provide clear pathways for those considering suicide, and quickly offer bereavement services when needed. We can assess for loneliness by using the revised University of California, Los Angeles (UCLA) loneliness scale.17 One way to approach the conversation is to ask patients what they are doing during their free time and if they have any friends or family they spend time with. Since the COVID-19 pandemic, it is likely a lot more patients have indicated they are lonely.
