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Updated: June 26, 2020

What are the mental health impacts on the public from isolation during the pandemic?

Summary

The following is a summary of evidence sources that provide high quality information on the impacts of COVID-19 isolation on the mental health of the public. For additional information about each of the sources, see the Table below.

The authors of two reviews and several guidelines state that individuals quarantined and in isolation present high prevalence of psychological distress including emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger, and emotional exhaustion [1,3,4,5,8]. In its Taking care of your mental and physical health during the COVID-19 pandemic guidance, the Government of Canada further states that these feelings can stem from: 1) individuals thinking they are being socially excluded or judged by others for displaying symptoms of COVID-19; 2) concerns about children’s education and well-being; 3) fear of contracting the disease or spreading it; 4) concerns about the future including job and financial security; 5) fear of being apart from family and friends due to quarantine; and 6) a sense of helplessness, boredom, loneliness, and depression [4].
 
Children and youth that have to stay at home due to COVID-19 are also experiencing high levels of stress and anxiety due to the uncertainty regarding their education and social life. Students, who relied on structure that their attendance in school and homework provided, are therefore being negatively impacted. The authors of a study on the mental health effects of school closures during COVID-19 state that for adolescents with pre-existing mental health needs, school closures and the requisite social isolation may present the loss of an important aspect of stability and structure in their life, that could contribute to symptom relapse [6]. The study also noted that children with special education needs, such as those with autism spectrum disorder, are also at increased risk of psychological distress resulting from increased frustration and shortened tempers as their daily routines are disrupted [6]. The study also states that high anxiety may exist among post-secondary students, especially those with high financial burdens, as they transition out of their college lives among the uncertain times in the job market brought about by the pandemic [6]. Finally, one study, on gender differences in the influence of social isolation on mental health, states that with college students, females in isolation are more likely to develop depressive symptoms than men, though both may develop depressive symptoms due to isolation [7].
 
The impact of isolation can be alleviated through the following proposed solutions and strategies. The World Health Organization, Government of Canada, and the Centre for Addiction and Mental Health recommend: 1) staying informed with credible and appropriate information about the pandemic; 2) limiting the news about COVID-19 that causes anxious or distressed feelings; 3) engaging in meaningful activities and designing schedules (i.e. daily to-do lists); 4) practicing meditation and mindfulness; 5) staying physically healthy and active; and 6) staying connected with others through electronic devices and applications [3,4,5]. These three guidelines also state that self-kindness and having compassion towards others may also help with improving individuals’ mental health, while creating solidarity and boosting the morale of the community [3,4,5]. Virtual care can offer some home-based mental health services (through telehealth, videoconference, or mental health apps) during the pandemic to mitigate the clinical implications of isolation and provide social support to increase the sense of connectedness [2].

Evidence

What‘s Trending on Social Media and Media

This Business Insider article highlights 13 potential long-term impacts on mental health from the coronavirus pandemic. The authors spoke to psychologists and experts about how they think the pandemic will influence the mental health of people in future. They report that the stress resulting from social distances can lead to anxiety and depression for the general population.
 
A Global News YouTube video reports that experts warn that the COVID-19 pandemic would have ‘serious’ mental health consequences. An interview with mental health strategist and speaker Mark Henick says the pandemic may cause trauma for people and could have an effect on people when the isolation measures are lifted.
 
The Centre for Mental Health’s tweet states that at least half a million more people in UK may experience mental illness as a result of COVID-19.
 
Global News YouTube video reports that expert warns that the COVID-19 pandemic would have ‘serious’ mental health consequences. Interview with mental health strategist and speaker Mark Henick says the pandemic may cause trauma for people and could have an effect on people when the measurements lifted.
 
Centre for Mental Health’s tweet states that as a result of COVID-19, at least half a million more people in UK may experience mental illness.

Organizational Scan

The Ontario Hospital Association has compiled a list of easily accessible mental health initiatives from various national organizations and local resources. Ontario resources listed include Big White Wall (i.e., a free peer-to-peer community offering anonymous conversation), ECHO Coping with COVID (CAMH), Ementalhealth.ca (a non-profit initiative of the Children’s Hospital of Eastern Ontario), Ontario Psychological Association’s Guide to Wellness Workbook, as well as many other hospitals across Ontario (Sunnybrook, St. Joseph’s Healthcare Hamilton, Mt. Sinai, etc.) [9].
 
Ottawa Public Health has outlined a list of measures accessible to individuals who are working from home to help support their mental health. Some measures include maintaining a routine, setting up a designated workspace at home, staying connected with loved ones, learning a new skill and limiting excessive exposure to COVID-19 related media. They also recommend exercising patience with household members as the pandemic has impacted a variety of populations to some effect. They also provide contact information for distress centres and counselling services available in Ottawa [10].

HealthLink BC develops, operates and maintains a comprehensive non-emergency health information and advice service to the residents of British Columbia. They provide Virtual Mental Health Supports for COVID-19 that are available for youth, adults, seniors and health care workers in British Columbia, across a variety of platforms. Services include virtual counselling, senior volunteer services, and crisis support, aimed to assist people struggling with mental health or experiencing a crisis. The organization also provides a list of existing and expanded mental health programs currently running, and programs that are launching in the future [11].

Review of Evidence

Resource Type/Source of Evidence Last Updated
The psychological impact of quarantine and how to reduce it: rapid review of the evidence
— Brooks et al.
Rapid Review

This review states that quarantined individuals present a higher prevalence of psychological distress including emotional disturbance, depression, stress, low mood, irritability, insomnia, post-traumatic stress symptoms, anger and emotional exhaustion. The review also reports that research conducted, on previous outbreaks of SARS, showed a range of psychological and behaviour changes including alcohol abuse or dependency symptoms.   This review suggests that the general public can work on reducing burden on your mental health by staying informed with relevant and appropriate information about what is happening and why, engaging in meaningful activities while in quarantine, ensuring that the basic supplies (such as food, water, and medical supplies) are available, and understanding that being quarantine is having a positive impact on the lives of others.

Last Updated: February 25, 2020
Additional Clinical Benefits of Home-Based Telemental Health Treatments
— Pruitt et al.
Rapid Review

This review states that patients are able to access mental health services from home via the use of telecommunications technology. These technologies include but are not limited to videoconference, e-mail, telephone, or smartphone apps. These services are able to provide treatment, including cognitive–behavioral therapies (commonly termed CBT), to provide treatments for several psychological conditions.   The benefits of telehealth listed in this review include reduced travel, having to take less time off work, shorter wait-times for appointment(s), bridging gaps between caregivers to promote social support, and greater personal control on the services taken reducing chances of missing appointments and allowing greater flexibility to seeking care. These forms of communication with patients have shown to be useful methods of monitoring and delivering mental health care while remaining contact free.

Last Updated: September 30, 2014
Mental health and psychosocial considerations during the COVID-19 outbreak
— WHO: World Health Organization
International Guidance

This guidance by the World Health Organization recommends minimizing watching, reading, or listening to news about COVID-19 that causes you to feel anxious or distressed. It also recommends seeking information only from trusted sources, such as the WHO or other trusted organizations, to mainly help you avoid getting COVID-19.   The WHO states that the sudden and near-constant stream of news reports about an outbreak result in feelings of worry. This report states that helping others in their time of need can benefit yourself and the person in need, creating solidarity and boosting the morale of the community during the pandemic.

Last Updated: March 17, 2020
Taking care of your mental and physical health during the COVID-19 pandemic
— Government of Canada
National Guidance

The Government of Canada guidelines state that isolation can result in feelings of sadness, stress, confusion, fear, or worry. These feelings can stem from thinking that you are being socially excluded or judged, concerns about your children's education and well-being, fear of contracting the disease or spreading it, concerns about job security and your finances, fear of being apart from family and friends to isolation, and a sense of helplessness, boredom, loneliness and depression due to isolation or physical distancing.   The Government of Canada guidelines recommend you minimize the intake of COVID-19 news, but still stay informed, practice mindfulness and meditation, stay socially connected, and stay physically healthy and active by eating healthy and exercising. The guidelines also state that the being kind and compassionate to yourself and others may also help with improving your mental health alongside limiting your use of substances.

Last Updated: May 9, 2020
Quarantine and Isolation
— CAMH: Centre for Addictions and Mental Health
Professional Organization

This guideline by the Centre for Addictions and Mental Health states that people placed in quarantine or self-isolation may experience a wide range of feelings, including fear, anger, sadness, irritability, guilt, confusion, and insomnia.   CAMH recommends that the public can stay engaged by creating schedules to keep themselves busy throughout the day. If you are unemployed during the pandemic, try to catch up on other tasks or projects at home and enjoy your leisure time by doing what you do normally on your days off. They also recommend staying connected with others by videoconference, phone, chat or text. The report emphasizes asking for help from others when you are feeling overwhelmed. Staying physically active and ensuring that the basic supplies (i.e. Food, water, and medical supplies) are available.

Last Updated: June 16, 2020
Mental health effects of school closures during COVID-19
— Lee, Joyce
Single Study

This study states that adolescents with pre-existing mental health needs may lose an anchor in their life due to the social isolation and resulting in their symptoms to relapse. Children with special education needs, such as those with autism spectrum disorder, are also at risk due to increased frustration and short temper among these children as their daily routines are disrupted. This study suggests creating a schedule for these children to create a sense of structure in their life. The study also states that high anxiety exists among post-secondary students, especially those with high financial burdens, as they transition out of their college lives among the uncertain times in the job market brought about by the pandemic.

Last Updated: April 13, 2020
Gender differences in the influence of social isolation and loneliness on depressive symptoms in college students: a longitudinal study
— Liu et al.
Single Study

This study states that social isolation is associated with depressive symptoms. The study notes that the rate of depression varies based on gender across various age groups. Females in isolation are more likely to develop depressive symptoms than men, though both may develop depressive symptoms due to isolation.

Last Updated: May 20, 2020
Life in the pandemic: Social isolation and mental health
— Usher et al.
Background Information

This review notes that isolation is known to cause psychosocial problems, especially for vulnerable populations (defined as those with pre-existing mental health conditions and/or are part of a marginalized community). Social isolation can result in feelings of anxiety making you feel anxious and unsafe. Sources of anxiety and feeling unsafe may stem from not knowing the cause of the disease, how long it may last, rumours and misinformation that can lead to discrimination against, or marginalism of people of specific descent. Furthermore, these issues may manifest in the form of acute stress disorders, irritability, insomnia, emotional distress and mood disorders, including depressive symptoms, fear and panic, anxiety and stress due to financial concerns, frustration and boredom, loneliness, lack of supplies and poor communication.

Last Updated: April 5, 2020
Strengthening Mental Health and Wellness During COVID-19
— Ontario Hospital Association
Organizational Scan Last Updated: June 10, 2020
Protecting Your Mental Health
— Ottawa Public Health
Organizational Scan Last Updated: June 10, 2020
Mental Health and COVID-19
— HealthLinkBC
Organizational Scan Last Updated: May 5, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.

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