The psychological fallout of prolonged social distancing

Living under a shelter-in-place order for weeks has been a brand-new concept for practically all Americans. Everyone admits they are starting to feel restless and tired of social distancing and isolation and of the ongoing uncertainty of the future.

Yet, few deny that the measures taken to crack down on social gatherings, closing schools, and shutdowns of nonessential business have likely significantly reduced not only the spread of COVID-19 but also avoiding overloading many of our hospitals. 

However, as Americans, we’re used to and enjoy our freedom of movement. To go where we want and do what we want with few questions asked. We miss and need human contact.  We’re social creatures hard-wired to thrive and crave close interaction with others. We’re getting “itchy” to once again attend sporting events, weddings, birthday parties, concerts, take a vacation, or simply to go out to eat and see a movie.

While the nonstop news media coverage of coronavirus has primarily focused on steps preventing the spread of it, there needs to be a balance.  A balance of bringing awareness of a growing concern - the impact it’s having on our mental, emotional, and physical health.

After weeks and weeks of hunkering down, we’re finally realizing the profoundly damaging effect of COVID-19 both psychologically and physically on many individuals both young and old.  And this matter could very well outlast the virus for years.

What social isolation does to the mind and body

It’s not good for people to be or to feel isolated. That’s why solitary confinement works so well as a disciplinary action on incarcerated prisoners. No physical harm is used but instead it erodes what makes us human, destroying our psyche. A lengthy report from the North Carolina School of Law, found solitary confinement very similar to a form of torture causing anxiety, depression, mental illness, and panic.

Another more recent review of past databases evaluated the psychological outcomes of people who were quarantined during the outbreaks of SARS, H1N1 flu, Ebola, and other infectious diseases in the early 2000s. Study after study in the review found participants who were quarantined suffered from both short- and long-term mental health problems including stress, insomnia, anxiety, emotional exhaustion, and substance abuse.

Even though social distancing is not even close to the extreme as solitary confinement in a prison or requiring everyone to be quarantined (only intended for those already infected or possibly infected with COVID-19), the day-to-day practice of keeping your distance from others can still take its toll. This is a legitimate concern of psychologists and doctors – what effect will long-term isolation and social distancing do to our physical and mental health?

·      The elderly

Without a doubt, the age group most vulnerable to social isolation is our seniors. Not only are they more likely to become severely ill with the threat of dying of COVID-19, but by being forced to stay inside, isolated away from family and friends, exacerbates loneliness. The withdrawal may be keeping them physically healthy from the virus, but being cut off from society comes with a high mental price tag. Before social distancing was imposed, up to a quarter of Americans age 65 and older, already experienced few social relationships or infrequent contact with others.   In addition, 43 percent of adults age 60 and older already feel lonely. Loneliness and social isolation has been shown to increase the risk of dying, according to a seven year meta-analysis of 70 studies involving more than 3.4 million adults.

Now more than ever, it’s vital to help keep our elders connected. They need and want to feel someone cares and is thinking of them, even if they can’t be together at this time.

Keep connected with the elderly with the following suggestions:

·      Check-in daily with phone calls or text messages

·      Connect with video chats such as Facetime or Skype

·      Write letters or send notes

·      Offer assistance of picking up medication, groceries, walking their dog, or other errands

·      Young to middle-aged adults

Even if you have not been infected with the virus, every single person across the country has still felt the effect of COVID-19. With more than 22 million Americans filing jobless claims last week, the long-term financial hardships and economic situation looks dire and uncertain. Other concerns for this age group include the precarious job market for college students graduating, disappointment of cancelled graduations, weddings, and funerals, putting off “nonessential” surgeries such as joint replacements, or having to work from home while at the same time monitoring your children’s schooling, are just a sampling of the heartache and heavy loads all of us are carrying.

On top of that, you’ve been told to socially isolate. For those who already prefer solitude, social isolation may have little effect on them. But if you flourish best from interaction with others in close proximity, not only can it crumble you emotionally but may harm your physical health too. Research has shown that perceived social isolation is associated with cognitive decline, heart troubles, and a weakened immune system. Another study found that loneliness may lead to a 30% increase in the risk of coronary heart disease and stroke. Part of this is likely due to higher levels of stress, poor sleep, and unhealthy lifestyle habits such as consuming more alcohol or poor food choices.  

Living under social isolation is especially hard on anyone with alcoholism, depression, suicidal thoughts, drug abuse or mental illness issues such as obsessive compulsive disorders or hoarding. Surveys show help lines are flooded with callers who are panicked and stressed to the limit as their mental health takes a nosedive.

One of the most troubling public health concerns though, is the disturbing and dramatic rise in domestic violence in the wake of the coronavirus outbreak. Disasters – whether hurricanes, earthquakes, or pandemics like the coronavirus – cause social upheaval within a family unit.  For example, after Hurricane Katrina, emotional abuse rose by one-third while physical abuse practically doubled among women experiencing domestic violence. As social distancing lockdowns have been implemented, this same pattern is being observed, not just in the U.S. but around the world. The stress of confinement with the abused and their abuser spending more time together alone along with financial constraints, is a recipe for disaster that can rapidly escalate into a ticking time bomb in homes where there’s already a history of emotional or physical abuse. Unfortunately, children in these household have likely witnessed the mistreatment or may become victims themselves of abuse, neglect, or exploitation.  

To protect your mental health during social isolation, here are a few ideas that can help:

·      Use technology like video chats to communicate with family and friends

·      Exercise daily – it’s a well-documented stress reliever

·      Meditate – Research shows meditation can reduce anxiety helping reduce depression

·      Connect with nature – Calming nature sounds and sights have a soothing effect helping distract your mind from negative thinking reducing worry and anxiety.

·      For anyone in an abusive relationship, call the National Domestic Violence Hotline at 1-800-799-SAFE (7233).

·      Children and adolescents

Social distancing presents a particularly challenging situation for our kids. Children and teenagers especially, thrive on social connections. And now that the school year for thousands has come to a halt, they are missing out on important milestones – graduation, prom, sports, field trips, end-of-year parties – once in a lifetime events that are gone.

Currently, over 850 million children worldwide form 191 countries have been forced to social distance and home school. Social development is important at all ages of childhood but children who are likely to suffer the most from long-term social distancing, are those 12 years of age and older. Early social development mainly takes place in the home with family but with older kids, their peer group is vital for learning how to navigate the complexity of social norms.

This is new territory. We do not know the mental health effects of long-term, large-scale disease outbreaks on children and adolescents. No one can predict the impact on their wellbeing of prolonged school closures, strict social distancing measures and the pandemic itself. What we do know is children are often quite resilient but still need an abundance of our support, love, and guidance more than ever.

To help kids cope with the COVID-19 shelter-in-place, here’s a few suggestions:

·      Stick to a school schedule. Set a start and end time each day to keep a sense of normalcy.

·      Let them use technology to connect with friends but also be mindful of the amount of time spent on devices and what platforms are being used.

·      Get kids outdoors at least 30-60 minutes each day. Outside activity helps regulate day and night cycles for better sleep.

·      Teach children altruism by helping others in need during the pandemic - pick up groceries for an elderly neighbor or write letters to residents in a long-term care facility.

·      Watch for signs of depression – changes in eating or sleeping patterns, withdrawal, or lack of energy are a few signs to be aware of.

In conclusion

We’re living in unprecedented times. Our lives look very different and we are facing difficulties we never imagined. Many things remain uncertain as we navigate these rough waters. But when we work together in times of tragedy and apprehension, great things can happen by rising to face these challenges together as a nation.  For now, take care of yourself but also take care of others too.

Dr. David Samadi is the Director of Men’s Health and Urologic Oncology at St. Francis Hospital in Long Island. He is a renowned and highly successful board certified Urologic Oncologist Expert and Robotic Surgeon in New York City. He is regarded as one of the leading prostate surgeons in the U.S., trained in oncology, open, laparoscopic, and robotic surgery. He has a vast expertise in prostate cancer treatment and Robotic-Assisted Laparoscopic Prostatectomy.