Written By: Annie Christie, Twila Ternida, & London Murray-Schroer (12)
May 11, 2020
With the rise of the global COVID-19 pandemic came a series of restrictive measures for rigorous social distancing, including mandatory stay-at-home orders and non-essential business closings, meant to limit the spread and impact of the virus. While the mandates for self-quarantine, ranging everywhere from North America to Europe, seem to have had a positive effect in terms of mitigating the spread of the virus, many individuals seem to have been affected negatively in terms of social behavior and psychology, suffering under the effects of extended isolation. This case study will investigate the impact of social distancing on social behavior, determining possible changes in society’s social interactions and behaviors during and after the pandemic, using research from studies and experts in psychology to form conclusions on the effects of quarantine.
COVID-19 was first identified in Wuhan, China (Binghamton). It is caused by the novel coronavirus and is a new type of the coronavirus that is not yet understood by health experts (Holmes). It is a disease in which one will experience a fever, cough, shortness of breath, chills, muscle pain, headache, sore throat, and a loss in taste or smell (CDC). It is possible to recover without requiring special treatment, however those who are older in age and/or have preexisting conditions such as cardiovascular disease, diabetes, chronic respiratory illness, and cancer, are more likely to develop serious illness (WHO). Due to the fast-spreading nature of COVID-19, hospitals around the world are struggling to keep up with the high number of cases and provide for patients (with more severe cases) the treatment necessary in order to recover. For this reason, it has been essential for everyone to practice social distancing.
Social distancing involves “remaining out of congregate settings, avoiding mass gatherings, and maintaining distance” according to the CDC recommendations (Bates). When necessary to leave the house for essential items such as medicine and groceries, as almost every state in the US has ordered, the CDC has also recommended to stay at least 6 feet from others, as the virus is less likely to spread through cough and sneeze droplets with this distance. As a result of these CDC recommendations and state orders to shelter-in-place, everyone who is not an essential worker has no choice but to stay home. In addition, people are avoiding in-person contact with those who do not live in their own home, because of the recommendations to maintain distance. It’s a slippery slope from social distance to social isolation for many people who live by themselves. A healthy social distancing practice while living at home with others may not come with as negative of effects as someone who lives alone and is actually experiencing more of a social isolation.
Negative effects of social distancing on social behavior and psychology
The restrictions on social interaction have taken a toll on many individuals’ mental health. While some remain relatively unaffected, psychiatrist Joshua Morganstein notes that “for some people, a lack of social connectedness feels as impactful as not eating” (Gupta), leading to problems like imbalances in hormones like cortisol, which indicates stress, as well as “insomnia, emotional exhaustion and substance abuse” (Kanter; Gupta). One study comparing non-quarantined individuals with quarantined individuals during an equine influenza outbreak determined that 34% of the 2,760 quarantined individuals were more psychologically distressed as compared with only “12% of non-quarantined individuals” (Kanter; Gupta).
Factors in stress
To compound with the stress of loneliness, other factors associated with social distancing can lead to negative effects in mental health or other psychological problems, including quarantines that lasted longer than 10 days – including the current COVID-19 quarantines – uncertainty over how long the isolation would last, “lack of access to necessary supplies and telecommunication services”, fears of getting the virus, lack of information or transparency from the authorities, and not knowing the different levels of risk of contracting the virus (Brooks; Gupta; Ellis).
Those who were in danger of significant financial loss, including those with lower incomes, uncertain housing conditions, limited health insurance, or temporary employment (Alison Miller: What are the effects of social distancing and coronavirus on mental health?) often experienced psychological effects that lasted months after the quarantines were over, including anger and anxiety (Brooks).
For many, behavioral changes lasted long after the end of quarantine. Many participants in one study during the SARS outbreak in 2003 even continued to use avoidance and mitigation behaviors after the quarantine period ended, such as avoiding “people who were coughing or sneezing… crowded enclosed places… and all public spaces” (Brooks). Others continued to use “vigilant handwashing and avoidance of crowds” for many months after the end of quarantine (Brooks). While this precautionary behavior is not necessarily a negative impact, as it could have a great impact in preventing future outbreaks and promoting greater public health, the changes signalled a delay in the citizens’ willingness to return to normality. Additionally, research has shown that avoidance behaviors may have adverse effects on an individual’s mental health, as they are often linked with anxiety or panic disorders (Star).
Additionally, according to physician researcher Alexander Chouker, the very fact of confinement changes an individual’s body. Chouker notes “radical changes in the bodies of people participating in simulations of manned spaceflight missions like Mars-500” such as hormonal and physiological changes to their “immune, endocrine, and neurocognitive systems,” which in turn led to altered (and for some, disconnected) sleep patterns and overall changes in their bodies’ metabolisms, or chemical processes (Ellis). Others experienced changes in mood and even developed poor mental health conditions, like depression (Mann).
The effects of isolation are also correlated with an increased likelihood of death, heart disease, dementia, and depression (Miller). One study even reported that “the likelihood of dying during the study increased by… 29% for those who were socially isolated.” (Gupta). There have also been indications that loneliness can weaken the immune system, making the body more vulnerable to disease, which is dangerous in the midst of a pandemic; evidence suggests that “lonely college students respond more weakly to influenza vaccinations than do non-lonely students” (Kanter).
Who is susceptible?
Certain people appear to be more susceptible to the ill effects of social distancing, including those suffering under existing mental problems (Miller). Additionally, a report from the National Academy of Sciences suggests that older people may be more vulnerable to negative mental health or health problems, due to “the loss of family or friends, chronic illness, and sensory impairments like hearing loss that can make it harder to interact.” (Miller).
Healthcare workers, especially those who work in high-risk areas, are particularly vulnerable to long-lasting psychological problems. According to one study conducted “3 years after the SARS outbreak… alcohol abuse or dependency symptoms were positively associated with having been quarantined in health-care workers” (Brooks). Additionally, they “continued to engage in avoidance behaviours” following the end of quarantine, “such as minimising direct contact with patients and not reporting to work” in healthcare workers (Brooks). Even now, healthcare workers are experiencing an emotional toll due to COVID-19, with many describing the difficulties of juggling several stressors — overflowing hospitals, dying patients, and fears of contracting the virus themselves (Noguchi). A study conducted on China’s healthcare workers that treated COVID-19 patients revealed that 50% now suffer from depression, with 44.6% dealing with anxiety, and 33% battling insomnia (Noguchi).
Positive effects of social distancing on social behavior and psychology
While almost no mental health/psychological benefits come directly from the practice of social distancing or any kind of isolation, there are inadvertent benefits to those who create them for themselves. During this time where individuals are unable to leave the house, and many are unable to work and go to school, it presents an opportunity to get more sleep, exercise, engage in self-reflection, and find new hobbies/participate in hobbies.
According to the National Heart, Lung, and Blood Institute, sleep deficiency has been linked to depression and suicidal behavior. Therefore, the ability to get extra sleep while in quarantine is beneficial to mental health as it can lead to a decline in these feelings and a better mental health.
Regular exercise can lead to an improved mental health by boosting endorphin levels in the body, which is a chemical in the body that, when released, produces feelings of happiness and euphoria (Walden University).
According to Sara Uzer, there are multiple ways in which taking time to self-reflect, which is easier to have time to do while social distancing, will lead to an improved mental health. 1. It allows people to notice negative patterns in their lives. 2. It keeps them focused on the bigger picture. 3. It prevents them from worrying about things that are out of their control. 4. It helps them face their fears (Uzer).
Finding new hobbies/finding time to participate in hobbies
According to a 2016 study in BMC Public Health, Australian adults that engaged in artistic hobbies for over 100 hours a year had better mental health than those who engaged for less time. Additionally, a 2016 study in the Journal of Positive Psychology found that young adults who spent more time on creative activities had more positive moods (CBHS Health Fund).
Proposed solutions and changes
Coping with stress
According to the CDC, one of the best ways to avoid stress is to take breaks from “watching, reading or listening to news stories” regarding the pandemic. It can be emotionally stressing to repeatedly listen to the news. However, staying informed is equally important, so this coping method should be done in balance with understanding the state of the pandemic for your area, especially if you are living alone.
The CDC recommends meditating, eating healthy foods, exercising, and getting plenty of sleep as ways to take care of your body to help with dealing with stress. Eating healthy may be the hardest of these, considering the potential change in pay for many, as well as the complications with grocery shopping.
A psychological side effect to watch for, according to the APA, is ‘catastrophizing.’ This occurs when a person is experiencing an “irrational thought” such as imagining a catastrophic event in a future situation, typically after having already experienced a stressful event (Grohol). This can lead to a negative spiral and increased anxiety. Understanding what triggers such a reaction is the first step to avoiding the psychological condition; for many during the COVID-19 pandemic, reading the news could be a trigger, so moderating information consumption, as mentioned above, would be key for reducing this form of mental stress.
Those living in social isolation
If you are living alone, connecting with others via technology is highly recommended by the CDC. For those without technology, mailing letters is mentioned as a connection technique as well. Understanding the common reactions to COVID-19 can help with self-compassion and knowing when you need to reach out for help. According to the CDC, the 5 most-common reactions include concern about protecting oneself, concern regarding medical care, feeling isolated and disconnected from community, guilt for those working or helping ensure the continuation of necessities for daily living, and distress over income. The best solution for all of these reactions is connecting with friends or family. For those who do not feel they have a supportive community, there are programs to connect people living in isolation with volunteers over the phone.
Since health organizations have so highly recommended social connections, it is also important to understand how people should be communicating with and supporting one another. For interacting with children and teens, the CDC recommends answering questions in a calm and reassuring manner. Limiting their exposure to news coverage is also recommended, as is keeping a routine, which can help with reducing the natural stress of adjusting to a new lifestyle (CDC).
For those with mental illnesses or previously-existing health conditions, the CDC suggests understanding the symptoms said person faces and being able to recognize the signs of depression, as those with illness are at an increased risk of becoming depressed during social distancing. However, it should be noted that providing mental support for others should not come at the cost of your own mental health, as that could negatively impact your health, home life, and the stress of those you interact with.
Also, if talking through current events benefits your mental wellbeing, be sure that the information being discussed comes from reliable news sources. The spreading of rumors only adds to increased confusion and mental stress.
Considering the potential solutions above, two recommendations can be made: understand your own mental health, and connect with others. Since everyone is dealing with social distancing differently, a broad generalization such as “you should meditate” cannot be made. Complications such as preexisting health also add to the inability for there to be one simple solution. Therefore, being aware of the state of your mental health is the most applicable recommendation. Understanding what triggers anxiety, what helps your mental health, and how interacting with others impacts you would be included under the umbrella of being mentally aware.
That being said, the second-best recommendation would be connecting with others. Talking about stress catalysts, the news, or questions you have can either help your mental health or aid in your understanding of what you need during this pandemic.
To conclude, the COVID-19 pandemic has resulted in social distancing, which has brought on a new lifestyle that has many impacts on mental health. As pointed out by this case study, the impacts can be negative and positive; the lack of social connection and mentally-stressing current events can increase anxiety or depression, causing negative mental health, while the additional time at home has opened up the opportunity for more sleep, exercise, and self-betterment, all of which are beneficial to mental health. To combat these negative psychological impacts, mental awareness and reflection, as well as social connection through technology, can be generally recommended regardless of how one is coping with this pandemic. For Imagine students and families, it is recommended that the grade level communities and inter-grade interactions continue to benefit the mental health of the students and keep the school spirit alive.