Review
Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

https://doi.org/10.1016/j.jaac.2020.05.009Get rights and content

Objective

Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents.

Method

For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance.

Results

A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time at which loneliness was measured and between 0.25 and 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness.

Conclusion

Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.

Key words

loneliness
pandemic
COVID-19
disease containment
mental health

Cited by (0)

The authors have reported no funding for this work. All research at Great Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street Institute of Child Health is made possible by the NIHR Great Ormond Street Hospital Biomedical Research Centre. This report is independent research. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.

Author Contributions Conceptualization: Loades, Chatburn, Reynolds, Shafran, Borwick, Crawley

Data curation: Loades, Chatburn, Higson-Sweeney, Brigden, Linney, McManus

Formal analysis: Loades, Chatburn, Reynolds

Methodology: Loades, Chatburn, Reynolds

Project administration: Loades, Chatburn, Higson-Sweeney, Borwick

Supervision: Reynolds, Shafran, Crawley

Writing – original draft: Loades

Writing – review and editing: Loades, Chatburn, Higson-Sweeney, Reynolds, Shafran, Brigden, Linney, McManus, Borwick, Crawley

ORCID

Maria Elizabeth Loades, DClinPsy: https://orcid.org/0000-0002-0839-3190

Eleanor Chatburn, MA: https://orcid.org/0000-0002-6745-6737

Nina Higson-Sweeney, BSc: https://orcid.org/0000-0002-6926-0463

Shirley Reynolds, PhD: https://orcid.org/0000-0001-9975-2023

Roz Shafran, PhD: https://orcid.org/0000-0003-2729-4961

Amberly Brigden, MSc: https://orcid.org/0000-0002-7958-7881

Catherine Linney, MA: https://orcid.org/0000-0002-3873-3686

Megan Niamh McManus, BSc candidate: https://orcid.org/0000-0002-7206-3444

Catherine Borwick, MSc: https://orcid.org/0000-0002-5423-7279

Esther Crawley, PhD: https://orcid.org/0000-0002-2521-0747

Disclosure: Dr. Loades has received funding from the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). Ms. Brigden has received funding from the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2017-10-169). Profs. Reynolds, Shafran, Crawley and Mss. Chatburn, Higson-Sweeney, Linney, McManus, and Borwick have reported no biomedical financial interests or potential conflicts of interest.

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