Washington, DC, November 19, 2020 - The COVID-19 pandemic has necessitated widespread social isolation, affecting all ages of global society. A new rapid review in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports on the available evidence about children and young people specifically, stating that loneliness is associated with mental health problems, including depression and anxiety-potentially affecting them years later.
The review, which synthesizes over 60 pre-existing, peer-reviewed studies on topics spanning isolation, loneliness and mental health for young people aged between 4 and 21 years of age, found extensive evidence of an association between loneliness and an increased risk of mental health problems for children and young people.
"As school closures continue, indoor play facilities remain closed and at best, young people can meet outdoors in small groups only, chances are that many are lonely (and continue to be so over time)," said lead author, Maria Loades, DClinPsy, Senior Lecturer in Clinical Psychology at the University of Bath, UK.
"This rapid review of what is known about loneliness and its impact on mental health in children and young people found that loneliness is associated with both depression and anxiety. This occurs when studies measured both loneliness and mental health at the same point in time; when loneliness was measured separately; and when depression and anxiety were measured subsequently, up to 9 years later," Dr. Loades added. "Of relevance to the COVID-19 context, we found some evidence that it is the duration of loneliness that is more strongly associated with later mental health problems."
From the selected studies there was evidence that children and young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health outcomes like depressive symptoms could last for years. There was also evidence that the duration of loneliness may be more important, than the intensity of loneliness, in increasing the risk of future depression among young people.
For many young people, loneliness will decrease as they re-establish social contacts and connections as lockdown eases (e.g., as they return to school or college). For some a sense of loneliness may persist as they struggle to resume social life, particularly for those who were more vulnerable to being socially isolated before lockdown.
"It's key that children and young people are allowed to return to activities such as playing together, even if outdoors, as soon as possible, and that they are able to resume attending school, which gives them a structure for their day, and provides them with opportunities to see peers and to get support from adults outside of the nuclear family," said Dr. Loades. Furthermore, she added "children need more in their strategy for easing lockdown. Alongside this, the government could target children's wellbeing in public health messaging. And meanwhile, we should also continue to embrace technology as a way to keep in touch."
So whilst we do what we can to mitigate the effects of loneliness and re-establish social connections, we also need to prepare for an increase in mental health problems, in part due to loneliness, and also due to the other unintended consequences of lockdown, such as a lack of structure, physical inactivity and social and/separation anxiety that might be triggered when resuming social interactions outside of the home.
There are several levels at which we can prepare for the heightened demand:
- Take a universal approach to promoting wellbeing through public messaging, and by schools doing activities to promote wellbeing in children and young people as they resume normal activities.
- Seek to identify those who are struggling with loneliness as early as possible and do so by targeted interventions to help them overcome their struggles. This may be through the provision of extra support in schools, helping them overcome anxieties about returning to school, or giving them an extra hand with reconnecting socially with peers.
For those who continue to struggle over time, and can't get back to doing the things they normally do as a result of their struggles, we need to ensure that they are made aware that services are open, and can provide specialist help, and to make sure that they know how to access this help and are supported to do so.
Notes for editors
The article is "Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19," by Maria Elizabeth Loades, DClinPsy, Eleanor Chatburn, MA, Nina Higson-Sweeney, BSc, Shirley Reynolds, PhD, Roz Shafran, PhD, Amberly Brigden, MSc, Catherine Linney, MA, Megan Niamh McManus, BSc, Catherine Borwick, MSc, Esther Crawley, PhD (https://doi.org/10.1016/j.jaac.2020.05.009). It currently appears on the JAACAP Articles In Press page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 59, issue 11 (November 2020), published by Elsevier.
Dr Maria Loades is a Senior Lecturer for the Doctorate in Clinical Psychology program at the University of Bath, UK. Maria qualified as a Clinical Psychologist from the University of East Anglia in 2008. Since qualification, she has worked in a variety of mental health settings, including Child and Adolescent Mental Health Services (CAMHS), and completed a post-graduate diploma in cognitive behavior therapy (CBT) for children, young people and families at the Anna Freud Centre/University College London. Dr. Loades holds a Postgraduate Certificate in the Supervision of Applied Psychology Practice at the University of Oxford and secured an NIHR doctoral research fellowship in 2016 to further her research into depression and fatigue in teenagers. Her current research interests also include developing and delivering CBT treatments for children and young people with depression, including those with chronic illnesses; therapist competence in delivering CBT, particularly in the field of child and adolescent mental health; and CBT supervision.
Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at firstname.lastname@example.org or +1 202 587 9674. Journalists wishing to interview the authors may contact Andy Dunne, University of Bath Press Office at email@example.com or +44 79 66 341 431.
Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.
The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and sychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.
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