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COVID-19: The public health emergency and the disproportionately disadvantaged
Flattening the curve has its costs: understanding the mental health and psychosocial impact of social distancing
Johanna Badcock highlights some of the possible unintended consequences of social distancing, quarantine and self-isolation for the mental health of the broader population and, in particular, for those who are already experiencing higher levels of loneliness.
The emergence of the coronavirus pandemic has been disorienting.
Government responses, in Australia and overseas, have centred on a range of measures to decrease the rate of spread of COVID-19, including self-isolation (of those known or reasonably believed to be infected), quarantine (of those reasonably believed to have been exposed, but not yet symptomatic) and social distancing for nearly everyone else (e.g. avoiding mass gatherings, working from home, social-density controls and maintaining a safe distance from others when possible).
It’s important to be clear that loneliness is not a disorder: it’s part of the human condition. However, evidence shows that loneliness is a common response to the social turmoil and restrictions arising from pandemics.
In the absence of a vaccine, our ability to contain and control transmission of the virus is critical. There has been substantial variation across countries in the stringency and timing of social responses to COVID-19, generating debate amongst policymakers, and rapid accumulation of data, about which measures are effective (and which are not) in preventing transmission. Emerging evidence suggests that social distancing measures will be effective in reducing the spread of COVID-19, which in turn will help to lower the pressure on the healthcare system.
However, the unintended psychological effects of social distancing, quarantine and self-isolation are now rapidly taking hold and seem likely to become more serious over time. Put simply, social distancing measures are highly disruptive; they deeply challenge our usual ways of interacting and connecting with others.
Previous studies of viral epidemics indicate that the psychosocial impact can be substantial, pervasive and long-lasting, with frontline workers being at increased risk. The wide-scale implementation of social restrictions, including ‘lockdown’, across the Australian community will need to be accompanied by a range of well-coordinated, evidence-based strategies to reduce, as much as possible, the negative effects on mental health and wellbeing.
Public health systems also need consistent and robust data-collection strategies that capture the psychological as well as the medical impact of pandemics, so appropriate help can be provided in a timely and effective way.
In fact, there has already been a marked increase in the levels of stress and anxiety being reported in the Australian community, leading mental-health organisation Beyond Blue warn that the global pandemic could result in a rise in suicides. Unsurprisingly, the need for longer periods of social distancing may result in lower levels of compliance, and the current uncertainty surrounding the duration for which social-distancing measures will be applied seems likely to further fuel anxiety. Consequently, public messaging may now need to change from explaining why social distancing is needed, to emphasising what the benefits of complying are for stopping the pandemic in the shortest possible time.
Many people are also struggling with feelings of loneliness.
It’s important to highlight the distinction between social isolation – the objective state of being alone – and loneliness, which is the distressing feeling we experience when the quantity, and especially the quality, of our social relationships is less than we desire. These are two separate issues, which means that social isolation (e.g. when managing COVID-19) doesn’t inevitably mean you will feel lonely.
However, the coronavirus pandemic has come at a time when loneliness is a widespread problem both in Australia and overseas. Those who were already experiencing loneliness are likely to be disproportionately affected by the social-distancing, quarantine and social-isolation measures required to manage the current crisis, since they do not take into account individual differences in social needs.
This pre-existing level of loneliness cannot be separated from the necessary government response to COVID-19. However, it highlights the need for government and public-health responses to be grounded in the context, including pre-existing issues in the community. That is, to provide effective interventions for loneliness in the context of the pandemic, we need to understand the needs of specific and vulnerable groups who might experience difficulties accessing information, care and support, or who might be at higher risk of infection.
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