Loneliness in the time of COVID-19

The real impact of coronavirus (COVID-19) on society will only be fully understood in the years to come. This global pandemic is beyond most of our lived experiences. As a country we have never encountered widely implemented social restrictions. While all human beings are vulnerable to experiencing loneliness, social restrictions posed upon the community to flatten and bend the curve of infections increase our risk of social isolation. What is unknown is the impact of these social isolation measures on loneliness in our community, particularly during the time of a public health crisis.

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the subsequent development of coronavirus (COVID-19) have affected everyone across the globe (World Health Organization, 2020). Critical steps to implement public health measures were quickly introduced to curb infection. Central to these measures are social distancing, quarantine and self-isolation. We undertook the necessary public health precautions, restricting our social interactions and managing them within the recommended health guidelines (Smith & Lim, 2020). As the urgency of COVID-19 became manageable, mental health professionals now expect that COVID-19 stressors which range from economic to social factors, as well as the ongoing threat of the pandemic over the next year will exponentially increase our vulnerability to mental ill-health. For many with existing mental health issues, COVID-19 related stressors can heighten fear, anxiety and potentially contribute to increased rates of suicide.

Loneliness in context

Loneliness is different from social isolation in that it is a subjective experience of social isolation. Loneliness was already identified as an emerging problem in Australia. In large-scale national surveys, one in four Australians aged 12 to 89 report problematic levels of loneliness (Lim, 2018; Lim et al., 2019). It is plausible to expect that those who did not report problems with loneliness before or those who live alone may feel the sting of loneliness during the course of the pandemic, especially when their social routines are disrupted.

“Consistent with the idea of a lonely paradox we may be more connected than ever digitally, but this does not mean we are meaningfully connected”

Loneliness is not just a social issue – it is a health issue. Feeling lonely is detrimental to our physical health and recent studies have shown that loneliness increases our risk of a multitude of physical health problems including acute myocardial infarction (AMI) and stroke (Hakulinen et al., 2018). There is now robust evidence that feeling lonely will lead to poorer mental health in the future, in particular more depression, social anxiety and paranoia (Lim et al., 2016).

It is no surprise that higher levels of loneliness are related to clinical mental disorders. Large population studies indicate that loneliness increases the odds of all mental disorders, especially phobias, depression and obsessive-compulsive disorder (Meltzer et al., 2013). Worryingly, findings from longitudinal and cross-sectional studies have shown a positive association between feelings of loneliness and, suicidal behaviour and suicide risk, across older and younger age groups, even after controlling for demographic and other mental health variables (Bennardi et al., 2019; Chang et al., 2019; Niu et al., 2018; Solmi et al., 2020).

Loneliness is an important issue for people with a lived experience of poor mental health. Loneliness was identified as the top challenge by people with complex mental health issues (Stain et al., 2012) and yet mental health services continue to neglect the social needs of vulnerable groups. It is treated like an epiphenomenon of mental health problems, and not seen as a potential target for preventative mental health care or an issue taken seriously within mental health care services.

Digitising our social connections

In a COVID-19 environment, however, we have no choice but to review our social relationships. To maintain personal and work connections, many of us have made a rapid shift towards digital communication. For psychologists, the use of telehealth to receive and deliver health care took a prominent stage quickly. While many of us are adapting to receiving and, or giving care via telehealth, it is important to note that telehealth has long been utilised in phone counselling services and mental health services.

Online web-based platforms have been developed and trialed to increase accessibility and reduce costs in mental health. Youth mental health services have used accessible online platforms to engage otherwise difficult to engage young people, providing them a safe way to either receive mental health care, to augment face-to-face care, or to promote recovery. Comprehensive digital tools can also tie large groups of social networks together, provide skill-based training, and clinician care. Those that have been rigorously evaluated can be modified and rolled out for wider implementation.

However, while these digital programs may reduce mental health symptoms, increase social functioning, and/or reduce social isolation, they may not effectively reduce loneliness. More work needs to be done to understand how we can build and facilitate a sense of meaningful connection between people. Because loneliness is related to the quality of relationships rather than quantity, a change in the way we relate to others may influence how connected we feel to others. That is to say, having access to social networking may not lead to reduced loneliness (Ludwig et al., 2020).

Consistent with the idea of a lonely paradox we may be more connected than ever digitally, but this does not mean we are meaningfully connected (i.e., satisfies our social needs). This is not to say that digital technology is ineffective in mitigating loneliness for some people. But what is needed is rigorous research around how digital technology can reduce loneliness effectively given this new evolving social environment of COVID-19.

Assessing loneliness during COVID-19

So what is the impact of loneliness on Australians during the COVID-19 pandemic? An Australian Bureau of Statistics study looked at the overall household impact of the pandemic throughout a four-week period (April to May 2020), with 19,385,000 respondents. Results indicated that one in every five (22%) Australians reported suffering from loneliness (Australian Bureau of Statistics, 2020). There was also a gender difference where one in every three females (34%) and one in every five males (20%) reported suffering from loneliness while working from home during the COVID-19 social restrictions period. However, the question posed was if someone was suffering from loneliness in a ‘Yes’ or ‘No’ response format.

While this survey attempts to provide a litmus test about the state of our nation during COVID-19, these sorts of responses only provide a partial snapshot of the nation’s loneliness. First, loneliness itself isn’t a pathological condition, but rather normal feelings that arise because of a fundamental need to belong. In fact, we should expect people, especially during a time of crisis, to report more loneliness due to a sudden change of social circumstances. Furthermore, we can better understand loneliness by using a measure that captures severity as opposed to a simple presence/absence. We do so more generally in research with validated psychometric instruments, which will allow us to capture severity levels. Second, because there is stigma around feeling lonely and asking someone if they are lonely often this leads to underreporting. Previous studies have noted that older men for example are more likely to deny loneliness but may be more ready to say they prefer companionship (Cohen-Mansfield et al., 2009; Lau & Gruen, 1992; Nicolaisen & Thorsen, 2014; Pinquart & Sorensen, 2001). Third, the individual who feels lonely may not be readily acknowledged or recognised even during a COVID-19 period marked with social distancing and increased social isolation.

More generally, people who are distressed by their loneliness do not readily verbalise their need to connect, possibly due to their own misconceptions of what loneliness is. Many people think that living with others will mean they do not have a reason to feel lonely.

Lonely people may also feel like they pose a burden to others if they reach out, that their social needs are not important, or hold a general mistrust of others. Therefore, it is likely that lonely people may be less cooperative, show weaker attempts to connect, or generally avoid others. These self-defeating behaviours signal to others a lack of interest to connect (Cacioppo & Hawkley, 2009).

We do not know that increased social isolation will lead to an increase in loneliness. In having fewer face-to-face social interactions, do we assume that we are lonelier? Are those who live alone more predisposed to feeling lonely because they are more socially isolated? There are important factors that could influence whether someone feels lonely in the pandemic such as: economic stressors, the meaningfulness of their existing social relationships, individual factors such as personality, existing mental health or physical health status, and competency in utilising digital technology.

We know for example, that there is a reciprocal relationship between loneliness and social anxiety (Lim et al., 2016). So without measuring confounding factors such as social anxiety, how do we know that people are indeed feeling lonelier and not more socially anxious? Understanding loneliness within a more complex framework will allow us to more effectively address this important issue (Lim, Eres, & Vasan, 2020).

A national problem

So what can Australia do to mitigate the emerging concern around loneliness? Right now, many solutions designed to reduce social isolation may not target loneliness. Some who do attempt to reduce loneliness do not provide any evidence of effectiveness within rigorous study designs. Furthermore, there is no national coordinated approach in the way we measure and target loneliness in our programs, and there are many missed opportunities to expand and build on knowledge within scientific and other industries from health to social services. As mental health professionals we need to consider how we can effectively address loneliness to prevent future mental health issues, and to improve the quality of life in those with mental ill health.

Loneliness is on everyone’s minds and in a new COVID-19 world, we have no choice but to better understand how to meet our social needs. Loneliness was already an issue for Australians before COVID-19. Are these emerging surveys simply identifying an old problem in a different social environment? Loneliness is at risk of being a trendy topic and is treated as a simplistic phenomenon. Not understanding the multiple factors that contribute to problematic levels of loneliness will trivialise the detrimental impact of loneliness on our health, relationships and community wellbeing.

The author can be contacted at [email protected]