Pandemic Isolation / Loneliness

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trader32176
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Pandemic Isolation / Loneliness

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Pandemic Isolation / Loneliness

https://www.psychiatrictimes.com/view/m ... loneliness


Mental Health in a Pandemic State: The Route From Social Isolation to Loneliness

March 25th, 2020


The COVID-19 pandemic has gained its place on the dark side of world history for a variety of reasons: sudden onset, speed of global transmission, mistakes in recognition and management, politically inspired neglect or minimizations.

The COVID-19 pandemic has already gained its place on the dark side of world history for a variety of reasons: sudden onset, speed of global transmission, mistakes in recognition and management, politically inspired neglect or minimizations. The already dramatic infection and mortality figures have led to seemingly desperate and extreme government decisions in many countries. Its social, economic/financial, and public health impact is very impressive and, obviously, more powerful and damaging among the poor and disadvantaged population segments worldwide.

Not surprisingly, the mental health implications of this crisis were recognized early in the process.
Psychopathological and clinical terms were used from the beginning by the media and social networks to describe attitudes, pronouncements, reactions, and behaviors from individuals and groups in different scenarios: fear, cynicism, lies, or denial moving to anxiety, panic, and hysteria even . The scope of these words quickly broadened and became the subject of administrative, community-oriented measures, including the need to provide mental health or psychological counseling. From the perspective of the mental health professions, it is important to assess the emotional impact of some of those dispositions themselves. One of the most relevant examples is that related to the so-called social distance, later enlarged to social isolation, first as part of preventive health care advice, and then, as a critical component of “shelter in place” or total lockdown decrees.

Every type of adverse situation, particularly in the health field, entails uncertainties and ambiguities. A measure such as “social distance,” for instance, is dictated in the name of social integrity, protection or solidarity; the imposition of “social isolation” invoked individual and group safety as its raison d’être. Social isolation may be just a phrase but, under the present circumstances, it is certainly a public policy order, a commandment, with intimations of punishment if and when not duly followed. It is precisely the type of disposition that can lead to a unique mood state, a multifaceted cognitive/emotional experience, mental feature-loneliness-that in some cases may generate demoralization and well-defined clinical conditions.1 In fact, the sequence of social isolationà loneliness constitutes an excellent example of both an etio-pathogenic route and a source of individual reflections, an opportunity of self-examination leading to a therapeutic pathway.

The many faces of loneliness


The term was first used at the end of the 16th century to define “the condition of being solitary.” In 1677, Milton’s Paradise Lost featured one of the first lonely characters in British literature, Satan, who describes his loneliness in terms of vulnerability. The word acquired its concrete meaning of “feeling of being dejected from want of companionship or sympathy,” only by the start of the 19th century. In an interesting essay, Worsley2 emphasizes “lonely spaces” as places in which one might meet “someone who could do you harm, with no one else around to help.” The term has evolved from being “usually relegated to the space outside the city,” that is, a merely physical condition to “moving inward . . . taking up residence inside minds, even the minds of people living in bustling cities.” The author concludes that by doing this, loneliness has brought “wilderness inside us.”

Thus, loneliness exhibits a complex conceptual journey.
The dictionary definitions of being without company, unfrequented, isolated, or lonesome describe an individual feeling as well as a social experience, a perception of abandonment and/or a desire for company or refuge; the latter can also make of loneliness an existential state, a way of looking at life and people as components of a reality that belongs to others. Still, away from a truly clinical nature but already delineating fragile junctures, loneliness may have solitude as a synonym, a very personal requirement for the exercise of meditation or reflections-a refuge, again.

The feeling of loneliness leads initially to reflections about what is going on at the present time. The uncertainties of a future worst-case scenario (eg, positive coronavirus test, gradual onset of symptoms, hospitalization, complications, etc) may give place, later, to reflections about one’s own life, expectations and hopes, accomplishments and failures, self-criticisms and self-condemnations, a sense of no-return. Missing alternatives in the near or distant past, grateful moments unable to be re-lived, failed job opportunities or attempts to improve or excel, the present (or absent) impact of religion, spirituality, romantic encounters, personal phantasies, or impossible dreams are all material agitated by the apparently quiet psychological surface of loneliness.

Contemporary psychiatry has incorporated loneliness on two diagnostic levels: a personality trait and a clinical symptom. The former, defined by DSM-5 as “a tendency to feel, perceive, behave, and think in relatively consistent ways across time and across situations, would consider loneliness as present in detached, melancholy prone, solitary individuals, with limited interpersonal interactions and restricted affective experience and expression, ie, reduced hedonic capacity. Still, if alone, it would be just a trait, not a pathological entity. On the other hand, as a clinical symptom, loneliness can be part of a nosological entity characterized by abnormalities in different domains (eg, a personality disorder, or accompanied by several additional symptoms to constitute a variety of other diagnoses).

The title of this essay includes the phrase The Route From Social Isolation to Loneliness, to delineate an eventual pathogenic chain that emerges from the forced social isolation ordered to prevent catastrophic events (such as a massive amount of severe COVID-19 cases). The sequence could lead to growing levels of loneliness and end up in specific psychopathological pictures. Even though it has been said that loneliness can also affect individuals living with other people (eg, a spouse, children, other relatives), the most typical setting would be that of a person living alone and forced to stay locked down for weeks or months in a situation like the current viral pandemic.

The necessary but still unusual (or abnormal) lifestyle determined by an obligatory home seclusion affects critical areas of the individual’s daily life, the conduction of his or her interpersonal relationships and, above all, deeply engrained temperamental features. Unquestionably, social isolation can operate as a triggering, exacerbating agent of loneliness, more so if the latter is already an established personality trait: together with other traits (ie, submissiveness, depressivity, anhedonia, distractibility, or impulsivity, to mention a few), a true personality disorder, compromising identity, self-direction, empathy and intimacy may be the critical, regrettable result.5

Moreover, a dramatic cascade effect can take place, more so if the preceding manifestations are not noticed or dealt with.6 In such a context, loneliness can become a core component (or symptom) of a variety of psychiatric disorders through a subtly or grossly declared clinical evolution: it can nourish despair and discouragement ending up in one of several types of depressive disorders and potentially self-destructive acts; it can aggravate fears and precipitate one or several types of anxiety disorders, including a variety of phobic syndromes; it can exacerbate behavioral styles that end up in conditions such as OCD; and last but not least, it can generate painful memories that, later, can make the experience of social isolation, prelude of a potentially invalidating PTSD.6,7

Management options

It is clear that COVID-19 has seriously challenged not only every line of protection and management installed by governments and public health authorities around the globe, but also-and fundamentally-the human, clinical, and practical resources of mental health service agencies. In addition to the fear of contracting the infection, the anguish of obtaining food, medications, hand sanitizers, and even toilette paper, we now also face the testing circumstances of home reclusion with demands of new adaptation strategies and a somber cloud of uncertainties. The emotional impact of being locked down, and the weight of the resulting loneliness generate waves of fear, urgent needs of a sort of family reorganization, different kinds of leadership and communication styles with and between adults, children, the elderly, the healthy, and the sick.

The victims of loneliness who share the physical reclusion as members of a family, must be encouraged by the group leader(s) to examine and verbalize their thoughts and emotions, recognize their strengths and limitations, identify specific fears and concerns, and threats and opportunities. They must discuss and practice new approaches to socialization and interpersonal transactions. By the same token, they must be provided with “free emotional spaces” for self-deliberations, searching for, and proposal of eventual management alternatives.8

On the other hand, if loneliness occurs in a purely individual context, the management is obviously more difficult. There is a need of outside contacts with health care providers and community agencies to elucidate whether the psycho-emotional events are of a clinical nature or not: if the answer is yes, dispositions and interventions, specific for the diagnosed condition(s) must take place. If it is the kind of response that most individuals would show in the face of social isolation, exhorting them to touch base with the outside world is still an indispensable first step. The affected person must, as well, devote diverse time segments to periods of self-exploration (ie, self-analysis), entertainment and humor, formal communications (using technology-based resources), reading/writing exercises, etc. The self-exploration tasks could include biographic remembrances, experiential memories, personal modeling and modulating (ie, identification of resilience cases, examples of adequate use of opportunities), self-teaching and learning, etc.

Conclusion


Facing exceptional experiences such as forced home stay (even if due to entirely justifiable reasons), leads to phenomena such as loneliness, conceived either as a normal effect of isolation or an emotional response with more or less significant clinical dimensions. In both cases, interventions aimed at normalizing the affected individual’s mental health must be implemented. The essential purpose of community mental health providers would be to mobilize resources and mechanisms in a positive, constructive way so that the best features of the person’s identity would reinforce valuable reserves of stamina, resilience, and authenticity in the face of adversity.

Disclosures:

Dr Alarcon is Emeritus Professor of Psychiatry, Mayo Clinic School of Medicine, Rochester, MN, and Honorio Delgado Chair, Universidad Peruana Cayetano Heredia, Lima, Peru.
References:

1. de Figueiredo JM. Depression and demoralization: phenomenological differences and research perspectives. Compr Psychiatry. 1993;34:308-311.

2. Worsley A. A history of loneliness. The Conversation. March 19, 2018.

3. Izenberg G. Identity: The Necessity of a Modern Idea. Philadelphia, PA: University of Pennsylvania Press; 2016.

4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Washington, DC: American Psychiatric Publishing; 2013.

5. Kruger RF, Eaton NR. Personality traits and the classification of mental disorders: toward a more complete integration in DSM-5 and an empirical model of psychopathology. Person Disor. 2010;1:97-118.

6. Alarcón RD, Glover SG, Deering CG. The cascade model: an alternative to comorbidity in the pathogenesis of posttraumatic stress disorder. Psychiatry. 1999;62:114-124.

7. Fulton JJ, Calhoun PS, Beckham JC. Trauma and stressor-related disorders: posttraumatic stress disorder, acute stress disorder, and adjustment disorder. Tasman A, Kay J, Lieberman JA, et al, Eds. Psychiatry, 4th ed. Chichester, W. Sussex, UK: Wiley Blackwell; 2015: 1142-1169.

8. Brown JF. The Gift of Depression. Koloa, HI: Inspire Hope Publishing Corporation; 2001.
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Re: Pandemic Isolation / Loneliness

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How the COVID-19 Pandemic Could Increase Social Isolation, and How Providers and Policymakers Can Keep Us Connected

April 8, 2020


https://www.commonwealthfund.org/blog/2 ... licymakers


As public officials urge people to stay home and maintain social distance to combat the spread of COVID-19, we will likely need policy solutions to address increasing social isolation and loneliness. While social distancing is important for preventing the spread of the virus, it could exacerbate problems for the more than one of four adults ages 50 to 80 who said they felt isolated even before the outbreak and increase the risk of loneliness for others, especially the 35.7 million Americans living alone.

The Consequences of Social Isolation and Loneliness


Social isolation and loneliness have been linked to many physical and mental health problems including heart disease, diabetes, anxiety, and depression
. The health damage caused by isolation and loneliness is estimated to increase the risk of early death by 26 percent, has been equated to smoking 15 cigarettes a day, and is estimated to cumulatively cost Medicare an additional $6.7 billion each year.

What’s particularly concerning is that the Americans most at risk of developing severe cases of COVID-19 are the same ones who report high rates of social isolation: older adults and people with underlying medical conditions. Research has shown that adults with chronic conditions and physical or cognitive limitations are more than two times as likely to report feeling socially isolated (37%) than adults who do not have these health issues (15%).

Addressing Social Isolation During the COVID-19 Pandemic


Providers, payers, and policymakers can play important roles in combating this additional epidemic of social isolation. Digital solutions, like those discussed below, could provide much-needed relief during the COVID-19 pandemic, but in most cases do not replace effective, in-person support in the long run.

Screening for isolation and referring to digital support.


It is critical that providers screen for social isolation, evaluate the impact it could have on the health of their patients, and refer them as needed to appropriate supports, including digital solutions for connection and companionship. Providers can connect isolated patients to technologies like Papa, which links college students and older adults for virtual conversations, and Stitch, a social networking site for seniors. Policymakers also can allocate funding for programs that offer virtual social support.

Expanding access to telehealth for mental health care. Since the federal government significantly expanded Medicare coverage of telehealth services during the COVID-19 pandemic, providers now have greater flexibility to refer Medicare enrollees who feel isolated and lonely to virtual mental health care or “telemental health.” Apps like TalkSpace and Betterhelp connect people to virtual counseling with licensed therapists. States need further guidance from the federal government on what specifically is covered and how providers can use telemental health platforms. In addition, federal law must extend legal protections to mental health providers practicing in alternate work locations. States also can assist in shoring up telemental health access. New York is building a network of volunteer licensed mental health professionals to offer free counseling and support to residents during the crisis. In addition, states can use emergency orders to activate additional master’s-level licensed professional counselors, allowing them to treat patients and bill Medicare.

Increasing access to internet and smartphones.


Policymakers can consider ways to increase access to utilities like internet and smartphones that are critical for staying connected; nearly half of older adults do not have broadband service or smartphones. Medicare and Medicaid already subsidize this in certain cases for people with disabilities.

During this time of national crisis, providers, payers, and policymakers can take these concrete steps to ensure the social distancing we are doing across America does not have the unintended consequence of increasing harmful social isolation — especially for the sickest and most vulnerable among us.
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Re: Pandemic Isolation / Loneliness

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Social isolation in Covid-19: The impact of loneliness

Published April 29, 2020


https://journals.sagepub.com/doi/full/1 ... 4020922269


‘All of humanity’s problems stem from the man’s inability to sit quietly in a room alone’.

We need to revisit this statement by Blaise Pascal time and again to unearth something invaluable, to reinforce something primal, especially in times such as these where the whole world is in a state of lockdown, courtesy the corona virus disease 2019 (COVID-19). This disease caused by SARS-CoV-2, has literally brought the world down to its knees just within last few months.

COVID-19

The world is facing a global public health crisis for the last three months, as the coronavirus disease 2019 (COVID-19) emerges as a menacing pandemic. Besides the rising number of cases and fatalities with this pandemic, there has also been significant socio-economic, political and psycho-social impact. Billions of people are quarantined in their own homes as nations have locked down to implement social distancing as a measure to contain the spread of infection. Those affected and suspicious cases are isolated. This social isolation leads to chronic loneliness and boredom, which if long enough can have detrimental effects on physical and mental well-being. The timelines of the growing pandemic being uncertain, the isolation is compounded by mass panic and anxiety. Crisis often affects the human mind in crucial ways, enhancing threat arousal and snowballing the anxiety. Rational and logical decisions are replaced by biased and faulty decisions based on mere ‘faith and belief’. This important social threat of a pandemic is largely neglected. We look at the impact of COVID-19 on loneliness across different social strata, its implications in the modern digitalized age and outline a way forward with possible solutions to the same.

There is no doubt that national and global economies are suffering, the health systems are under severe pressure, mass hysteria has acquired a frantic pace and people’s hope and aspirations are taking a merciless beating. The uncertainty of a new and relatively unknown infection increases the anxiety, which gets compounded by isolation in lockdown. As global public health agencies like World Health Organization (WHO) and Centre for Disease Control and Prevention (CDC) struggle to contain the outbreak, social distancing is repeatedly suggested as one of the most useful preventive strategies. It has been used successfully in the past to slow or prevent community transmission during pandemics (WHO, 2019). While certain countries like China have just started recovering from their three-month lockdown, countries like Iran, Italy and South Korea have been badly hit irrespective of these measures and those like India have initiated nation-wide shutdown and curfews to prevent the community transmission of COVID-19. Ironically however, the social distancing is a misnomer, which implies physical separation to prevent the viral spread.

The modern world has rarely been so isolated and restricted. Multiple restrictions have been imposed on public movement to contain the spread of the virus. People are forced to stay at home and are burdened with the heft of quarantine. Individuals are waking up every day wrapped in a freezing cauldron of social isolation, sheer boredom and a penetrating feeling of loneliness. The modern man has known little like this, in an age of rapid travel and communication. Though during the earlier outbreaks of Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS), Spanish flu, Ebola and Plague the world was equally shaken with millions of casualties, the dominance of technology was not as much as to make the distancing felt amplified (Smith, 2006). In this era of digitalization, social media, social hangouts, eateries, pubs, bars, malls, movie theatres to keep us distracted creating apparent ‘social ties’. Humankind has always known what to do next, with their lives generally following a regular trail. But this sudden cataclysmic turn of events have brought them face to face with a dire reckoning – how to live with oneself. It is indeed a frightening realization when a whole generation or two knows how to deal with a nuclear fallout but are at their wit’s end on how to spend time with oneself. Ironically, however, it has stranded them with their families (those who are unaffected by the illness) and are expected to strengthen the bonds of relationship. But, as mentioned before, the ‘virtual connectedness’ provided by social media has probably made us forget what proximity in relationships feel like. This can be a double-edged sword, that can either mend or strain relations, based on the pre-existing intimacy and communication patterns. It feels like a monumental task to stay stuck with yourself and your loved ones, while the pandemic looms large over the world.

Loneliness during a pandemic: the impact and social variations

Loneliness is often described as the state of being without any company or in isolation from the community or society. It is considered to be a dark and miserable feeling, a risk factor for many mental disorders like depression, anxiety, adjustment disorder, chronic stress, insomnia or even late-life dementia (Wilson et al., 2007). Loneliness is common in the old-age group, leading to increased depression rates and suicide. It has been well-documented that long periods of isolation in custodial care or quarantine for illness has detrimental effects on mental well-being (Stickley & Koyanagi, 2016). Loneliness is proposed to break this essential construct and disrupt social integration, leading to increase in isolation. This is a vicious cycle which makes the lonely individual more segregated into his own ‘constricted’ space. Loneliness is also one of the prime indicators of social well-being (Cacioppo & Patrick, 2008). Most people cringe at the idea of this social isolation. They will do anything to keep themselves preoccupied or distracted, from acts of outrageous indulgences to preposterous shows of vanity and depravation. Besides, loneliness has also shown to be an independent risk factor for sensory loss, connective tissue and auto-immune disorders, cardio-vascular disorders and obesity. If this self-isolation and lockdown is prolonged, it is likely that chronic loneliness will decrease physical activity leading to increased risk of frailty and fractures (Mushtaq et al., 2014).

This COVID-19 pandemic seems to have brought our frenzied speed of modern society to a grinding halt and has literally crushed the wings of unlimited social interaction. Under these social restrictions, individuals are forced to reconcile with this terrifying reality of isolation which can contribute to domestic inter-personal violence and boredom. Similar trends of increase in isolation and loneliness have been noticed among emergency workers and quarantined population in Wuhan, China. This has increased the prevalence of depression, anxiety, post-traumatic stress disorders and insomnia in the population. It also contributes to fatigue and decreases performance in health-care workers (Torales et al., 2020). But neither life nor the society had probably readied us for this task. The concept of boredom and loneliness leads to anger, frustration on the authorities and can lead for many to defy the quarantine restrictions, which can cause dire public health consequences. Emotional unpreparedness for such biological disasters have detrimental effects, as this situation is unprecedented in all measures. It also makes us take a step back and question: is social distancing only for a specific social class; as millions of migrant labourers, homeless individuals and daily wage workers stay stranded in their workplaces, railway and bus stations and factories with overcrowding and poor hygiene. When basic amenities of life are scarce, it is far-fetched myth to think about distancing or hand sanitization according to the prescribed standards (The Print, 2020; www.theprint.in). Isolation or loneliness for them is thus different. It is being away from their origins, their families and being deprived of basic human rights and self-dignity. Segregation from self-identity can also form the basis for loneliness, just that it reflects differently in different socio-economic strata (Valkenburg & Peter, 2008). It is again ironic, how the construct of loneliness varies based on the social strata giving rise to dimensional psycho-social needs.

The way forward

First step in this journey is to transform this devious loneliness to solitude. Loneliness, which on one hand is an emotion filled with terror and desolation, solitude, its cousin is full of peace and tranquillity.
The primal answer to loneliness has always been in our roots: the ability to be at peace with oneself. This however has been a habit long lost by the humanity in the trends of globalization.

Many great works of art, philosophy, literature have emerged from solitude. This comes with enjoying one’s existence and ability to cherish the bonds with others. This might be a good time to engage in long-forgotten hobbies, neglected passions and unfulfilled dreams. Improving proximal bonds with family and loved ones is another opportunity. Distancing from social media will be beneficial, as during times of pandemic it can contribute to ‘infodemic’ causing information overload. COVID-19 by all means is a ‘digital epidemic’ where the related statistics spread faster than the virus itself. Only relevant and updated information about the situation outside helps relieve anxiety during isolation (Hyvärinen & Vos, 2016). It is vital that the virus does not invade us ‘psychologically’ which can last much beyond the resolution of this pandemic.

As mental health professionals, we need to be sensitive to the personalized needs of those in quarantine and cater to them. Their personal and psychological needs are to be adhered to. Digital communication needs to be maintained with their loved ones. As mentioned, before social connectedness matters. Similar protocols in China during the first stage of outbreak had shown to improve quality of lives of those isolated (Duan & Zhu, 2020). Need for community-based and brief psycho-social interventions have also been stressed upon by Torales et al. (2020) in their recent article, acknowledging the chronic mental health impact of the ongoing pandemic situation. Furthermore, research has shown that as simple as weekly telephonic sessions can help reduce anxiety at the time of pandemics. These sessions need to be brief and solution-focused (Yang et al., 2020). Social integration forms another important aspect, in which involvement of the associated people in life matters. Taking care of the domestic helpers, the vendors, the security personnel, etc. or even a simple exchange of greetings with neighbors or strangers can give a feeling that ‘we are all in this together’. The bonds of humanity turn even more important at such times, when the whole world shares the same threads of anxiety. Similar sensitization needs to be done for the allied specialities to understand and appreciate the mental health needs of a biological disaster. The pandemic will eventually be over giving rise to two important lessons: the emotional preparedness for solitude at times of such crisis and psycho-social well-being forming the cornerstone of public health.
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

Effects of the COVID-19 pandemic on mental well-being amongst individuals in society- A letter to the editor on “The socio-economic implications of the coronavirus and COVID-19 pandemic: A review”

June 2020

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7198428/


Dear Editor,

The insightful article by Nicola et al. regarding the socio-economic implications of the COVID-19 pandemic detailed the response from authorities, impact of the virus on various societal sectors and the social consequences of isolation measures [1].

In this letter, we present key information regarding the impact of protective social isolation policies, on the mental health of individuals in non-healthcare industries, drawing comparisons to the emotional trauma faced by healthcare staff on the frontline.

COVID-19 social isolation measures have had a profound impact on the psychological and mental well-being of individuals across society. Many of the anticipated consequences of isolation measures are themselves key risk factors for mental health issues including suicide, self-harm, substance misuse, and domestic and child abuse. Social interaction has been widely interlinked with psychological well-being, social opportunities and employment; thereby restriction of these measures are suggested to be profoundly distressing to those experiencing strict isolation. Previous epidemics have induced widespread fear, loneliness and psychological sequelae; COVID-19 is inducing similar effects. It has been reported that over 4000 arrests for domestic abuse offences have been made in the United Kingdom (UK) since the 9th of March, equating to roughly 100 a day; highlighting the potentially fatal impact of social isolation policies. The rise in domestic abuse cases are alarming and bring to light concerns surrounding the collateral psychological and mental health impacts of social isolation during the COVID-19 pandemic [2,3].

The implementation of a nationwide lockdown disrupts the day-to-day lives of the general public; the pandemic has caused an unprecedented shrinkage of the UK economy and the closure of businesses across the country. In combat, the UK government has provided financial support for businesses and the self-employed equating to 80% of their monthly wages. Due to the high demand for emergency funding, many self-employed individuals are resorting to short-term bank loans to maintain lines of income. Those in low-paid, self-employed or insecure occupations experience the greatest impact due to loss of work or the temporary closure of their business. There have been reports of heightened feelings of anxiety and depression, with some fearful of post-lockdown anxiety and paranoia; the largest stressor being an overarching feeling of loss (loss of income, routine or social interaction). Other at-risk groups include children and students who have experienced closure of schools and/or universities causing significant disruption to daily routines, with factors such as exam postponement, accommodation expulsion and graduation cancellations contributing. Furthermore, there has been a significant detrimental impact to those suffering from ongoing mental health conditions, due to decreased access to support and resources. The COVID-19 pandemic has seen the incidence of domestic abuse dramatically increase globally because of reduced options for support, increased exposure to exploitative relationships and disaster-related instability within the household. Consequently, there has been a 32–36% increase in domestic abuse incidents in France, 21–35% increase across the USA, 25% increase in UK domestic abuse hotline calls and a 75% increase in Google searches relating to domestic abuse support. The social-distancing and sheltering-in-place measures are essential to minimising the spread of COVID-19; however, they are likely to dramatically increase the risk of domestic and inter-family violence [3,4].

The COVID-19 pandemic is posing unprecedented challenges to the mental well-being of healthcare workers due to various factors including increased societal pressure, lack of adequate safety provisions such as personal protective equipment (PPE) and being in an emotionally strenuous environment with numerous patients dying suddenly, alone and scared. A recent survey from YouGov, an international journal, involving 996 healthcare workers in the UK, for the Institute for Public Policy Research (IPPR), saw 50% of them admitting to being in a deteriorating mental state, with further questioning highlighting 21% of healthcare staff being more likely to quit as a consequence to the COVID-19 outbreak. This could result in the significant loss of approximately 300,000 healthcare workers in England alone [5]. The rise in anxiety, depression and self-reported stress are associated with sleep disturbance which catastrophically impacts the well-being of workers even further, especially whilst on ever-longer, more draining, shifts. Hence, coping strategies must be optimised to support frontline health and social care staff to mitigate symptoms of stress [3].

The COVID-19 pandemic is having far reaching effects into the mental well-being of individuals in society. Authorities must take into account not only the economic effects of social isolation, but the mental impact on the community also, implementing appropriate measures such as expansion of the “safe spaces” model, to help those suffering domestic abuse and the most vulnerable, preventing further detriment.

References


1. Nicola M., Alsafi Z., Sohrabi C., Kerwan A., Al-Jabir A., Iosifidis C., Agha M., Agha R. The socio-economic implications of the coronavirus and COVID-19 pandemic: a review. Int. J. Surg. 2020:71–76. doi: 10.1016/J.IJSU.2020.04.018. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
2. Domestic abuse surge in coronavirus lockdown could have lasting impact. https://www.theguardian.com/society/202 ... impact-mps MPs say | Society | The Guardian, (n.d.)
3. Holmes E.A., O’connor R.C., Perry H., Tracey I., Wessely S., Arseneault L., Ballard C., Christensen H., Cohen Silver R., Everall I., Ford T., John A., Kabir T., King K., Madan I., Michie S., Przybylski A.K., Shafran R., Sweeney A., Worthman C.M., Yardley L., Cowan K., Cope C., Hotopf M., Bullmore E. Position Paper Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. 2019. [PMC free article] [PubMed] [CrossRef]
4. Usher K., Bhullar N., Durkin J., Gyamfi N., Jackson D. Family violence and COVID‐19: increased vulnerability and reduced options for support. Int. J. Ment. Health Nurs. 2020 doi: 10.1111/inm.12735. Accepted Author Manuscript. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5. Half of UK health workers suffering stress because of Covid-19. https://www.theguardian.com/society/202 ... f-covid-19 Society | The Guardian, (n.d.)
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Re: Pandemic Isolation / Loneliness

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Social Isolation and Loneliness: The Silent Pandemic

August 31,2020


https://www.myharrisregional.com/news/s ... t-pandemic


Social Isolation and Loneliness: The Silent Pandemic


During the COVID-19 pandemic, we have been told to shelter in place. For many of us, sheltering in place has been a way of life before COVID-19. The Health Resources & Services Administration states that two in five Americans report they sometimes or always feel their social relationships are not meaningful and one in five say they feel lonely or socially isolated. And according to the U.S. Census Bureau, more than a quarter of the U.S. population (28 percent) of older adults live alone.

World Health Organization reports, social isolation can be as damaging to health as smoking 15 cigarettes a day. The problem worsens as we get older.

Social isolation significantly increased a person’s risk of premature death from all causes. A risk that may rival those of smoking, obesity, and physical inactivity.
Social isolation was associated with about a 50% percent increased risk of dementia.
Poor social relationships (characterized by social isolation or loneliness) was associated with a 29% increased risk of heart disease and a 32% increased risk of stroke.
Loneliness was associated with higher rates of depression, anxiety, and suicide.
Loneliness among heart failure patients was associated with a nearly four times increased risk of death, a 68% increased risk of hospitalization, and a 57% increased risk of emergency department visits.

The late Dr. John Cacioppo, a psychology professor at the University of Chicago, studied the effects of loneliness for two decades before his passing in 2018. After suffering a near-fatal car crash and having what seemed to be a transformative revelation, he concluded that love and social connections are what really matters in life. He equated loneliness with a type of hunger, noting that establishing social connections is essential for human survival. He also believed that chronic loneliness can increase the incidence of early death.

One would think that knowing if we are being affected emotionally or physically from loneliness would be easy for us, loved ones, and our health care providers to recognize; however, this is not always the case. Like chronic depression or pain, over time we start thinking and believing it’s just a normal way of life. In a recent article AARP shares, Kerstin Gerst Emerson, a clinical assistant professor at the Institute of Gerontology at the University of Georgia in Athens. “You can’t give the patient a blood test or an MRI.” Instead, diagnosis depends on asking questions. Living alone isn’t always the problem, although it can be. More important, say, experts, is a subjective feeling of social separation. “We’re all lonely from time to time, but the problems come when someone is chronically lonely, day in and day out,” says Steve Cole, a professor of medicine and genomics researcher at the University of California in Los Angeles.

Here are some Tips to Help with Social Isolation and Loneliness

Take time to talk to family and friends- phone, virtual platform, email and social media
Keep up a healthy lifestyle - eat a balanced diet, exercise and get quality sleep
Take up a new hobby you always wanted to try
Get as much sunlight, fresh air and nature as you can
Practice relaxation, meditation, and mindfulness
If new and social media makes you feel fearful or anxious, unplug
If you are socially distancing and feeling lonely because of Covid-19, remind yourself this is a temporary period of isolation
Confide in family and friends how you are feeling
Take part in an in-person support or virtual support group

If you suspect you are suffering from chronic loneliness, talk with your provider or mental health professional. They can refer you to a mental health professional to see if individual or group therapy in-person or via teletherapy is right for you. Just like a medical condition, it will only get worse if untreated.

If you or someone you know is in an emergency, call 911 immediately. If you are in crisis or are experiencing difficult or suicidal thoughts, call the National Suicide Hotline at 1-800-273 TALK (8255).

Senior Life Solutions is an intensive outpatient group therapy program designed to meet the unique needs of older adults suffering from symptoms of anxiety and depression often related to aging. For more information, or if you know an older loved one experiencing isolation or loneliness and is in need of help, contact us at 828-488-4044.
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Re: Pandemic Isolation / Loneliness

Post by trader32176 »

Effects of Pandemic Isolation on Mental Health

9/4/20


https://www.mibluesperspectives.com/202 ... al-health/


Nearly half of all adults in the U.S. have reported their mental health has suffered due to the pandemic, according to a recent poll. Measures in place to protect public health like closing schools, limited staffing, business closures and social distancing can unfortunately lead to greater isolation and loneliness – which is linked to poor mental health outcomes.

Social isolation affects everyone in different ways, but it is also a risk factor for suicide. Here are some situations to consider in which isolation could be particularly harmful to an individual’s mental health:

Behavioral or Developmental Disorders: People who have impairments with learning, language, physical movement or behavior may have difficulties accessing information, taking preventative measures against the pandemic or communicating their own symptoms if they are sick. They’re also more at risk for anxiety and depression, which could be exacerbated by being isolated from others.
Caregivers: Caring for an older parent or sick child can be especially isolating during the pandemic. Keeping the household safe from exposure to COVID-19 may mean caregivers are taking on more tasks themselves instead of finding relief from outside help.
Children: With the school year disrupted by the pandemic, many children may be missing the social interaction that comes from sports, activities and daily classes. Adolescent children who are already more at risk for depression may experience greater reactions to their new social limits and act out at home.

Grieving a Loss: Losing a family member or friend is difficult regardless of the circumstances, but the pandemic makes grieving even more difficult with restrictions on travel and large gatherings. Many severely ill COVID-19 patients are unable to have loved ones at their side due to hospital visitor restrictions. Not being able to say goodbye or fully grieve the loss of someone can be traumatic.
History of Depression or Anxiety: People who have a history of depression and anxiety diagnoses are at a higher risk for negative effects from isolation during the pandemic.
Seniors: Adults age 65 and over are at a high risk of severe illness from COVID-19, so many must take extra precautions to distance themselves from others during the pandemic. With a higher risk for depression and without in-person support from friends and family, seniors may be particularly isolated.

How to Cope


Managing stress and change during this time can be difficult, especially without the distractions of traditional social schedules. Individuals should prioritize self-care to feel their best and be able to think clearly.

Here are some self-care tips:

Avoid drugs and alcohol
Connect with friends and family through phone calls, chats and video calls
Eat a healthy diet
Establish and keep a routine
Exercise regularly
Get plenty of sleep
Take breaks from the news and social media
Unwind from work with relaxing activities

Signs of Distress

It’s important to recognize when coping mechanisms aren’t working. Anyone who is experiencing these signs of distress consistently or feels unable to carry out normal functions should ask for help:

Anger
Changes in appetite, energy or activity levels
Difficulty concentrating
Feelings of numbness, anxiety or fear
Headaches, body pains, stomach problems or other physical reactions
Increased use of substances like tobacco, drugs or alcohol
Worsening of chronic health problems

Individuals should contact their health care provider to discuss any mental health concerns and potential treatment options. The National Suicide Prevention Lifeline is available at 1-800-273-TALK (8255) for English and 1-888-628-9454 for Spanish.

Dr. Kristyn Gregory, DO, is a medical director of behavioral health at Blue Cross Blue Shield of Michigan.
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Re: Pandemic Isolation / Loneliness

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How Social Isolation Affects the Brain

July / August 2020


https://www.the-scientist.com/features/ ... rain-67701


Absence of human contact is associated with declines in cognitive function. But as the COVID-19 pandemic brings concerns about the potential harms of isolation to the fore, researchers are still hunting for concrete evidence of a causal role as well as possible mechanisms.


Daisy Fancourt was at her home in Surrey in southeast England when the UK government formally announced a nationwide lockdown. Speaking in a televised address on March 23, UK Prime Minister Boris Johnson laid out a suite of measures designed to curb the spread of COVID-19, including closing public spaces and requiring people to stay home except for exercise and essential tasks. For Fancourt, an epidemiologist at University College London (UCL), the announcement meant more than just a change to her daily life. It was the starting gun for a huge study, weeks in the planning, that would investigate the effects of enforced isolation and other pandemic-associated changes on the British public.

In more normal times, Fancourt and her colleagues study how social factors such as isolation influence mental and physical health. Before Johnson’s late-March announcement, the team had been watching as Italy, and subsequently other countries in Europe, began closing down public spaces and enforcing restrictions on people’s movements. They realized it wouldn’t be long before the UK followed suit. “We felt we had to start immediately collecting data,” Fancourt says. She and her colleagues rapidly laid the groundwork for a study that would track some of the effects of lockdown in real time. Between March 24 and the middle of June, the study had recruited more than 70,000 participants to fill out weekly online surveys, and in some cases answer questions in telephone interviews, about wellbeing, mental health, and coping strategies.

This project and others like it underway in Australia, the United States, and elsewhere aim to complement a broader literature on how changes in people’s interactions with those around them influence their biology. Even before COVID-19 began its global spread, millions of people were already what researchers consider to be socially isolated—separated from society, with few personal relationships and little communication with the outside world. According to European Union statistics, more than 7 percent of residents say they meet up with friends or relatives less than once a year. Surveys in the UK, meanwhile, show that half a million people over the age of 60 usually spend every day alone.

These figures are concerning to public health experts, because scientific research has revealed a link between social isolation—along with negative emotions such as loneliness that often accompany it—and poor health. “We are seeing a really growing body of evidence,” says Fancourt, “that’s showing how isolation and loneliness are linked in with incidence of different types of disease [and] with premature mortality.” Alongside myriad connections to poor physical health, including obesity and cardiovascular problems, a range of possible effects on the human brain have now been documented: Social isolation is associated with increased risk of cognitive decline and dementia, as well as mental health consequences such as depression and anxiety.

It’ll be years before researchers understand whether and how measures enacted during the pandemic play into any of these risks. The sort of isolation people are experiencing right now is unprecedented, and is compounded with other pressures, such as fear of disease and financial strain. But now more than ever, it’s important to study the effects of social isolation, and potential means to mitigate it, says Stephanie Cacioppo, a social neuroscientist and cognitive psychologist at the University of Chicago. “We’re a social species,” she says. “We really need others to survive.”

The cognitive effects of prolonged social isolation

In 1972, French adventurer and scientist Michel Siffre famously shut himself in a cave in Texas for more than six months—what still clocks in as one of the longest self-isolation experiments in history. Meticulously documenting the effects on his mind over those 205 days, Siffre wrote that he could “barely string thoughts” together after a couple months. By the five-month mark, he was reportedly so desperate for company that he tried (unsuccessfully) to befriend a mouse.

This kind of experiment, and less extreme isolation periods such as those experienced by spaceship crews or scientists working in remote Antarctic research stations, has offered glimpses of some of the cognitive and mental effects of sensory and social deprivation. People routinely report confusion, changes in personality, and episodes of anxiety and depression. A crueler version of those experiments is continually underway in prisons across the world. In the US alone, tens of thousands of incarcerated people are in long-term solitary confinement, with devastating and lasting effects on cognitive and mental health. (See “Extreme Isolation” below.)

For most of human society, however, social isolation acts in more insidious ways than these “experiments” capture, often disproportionately affecting vulnerable members of the population, such as the elderly, and with effects accumulating slowly such that they may go unnoticed for many years, if not decades. The effects of this subtler sort of social isolation, which some health researchers and psychologists have already described as a public health risk, are better observed in longer-term studies that look for links between a person’s social connections and how the mind functions.

Many studies have found that chronic social isolation is indeed associated with cognitive decline, and that isolation often precedes decline by several years. One 2013 study, for example, measured cognitive function at two time points in a cohort of more than 6,000 older individuals taking part in the English Longitudinal Study of Ageing (ELSA). People who reported having fewer social contacts and activities at the beginning of the study, researchers found, showed greater decline in cognitive function, as measured by verbal fluency and memory recall tasks, after four years.

More-recent studies have added weight to the association. A 2019 study of more than 11,000 people taking part in ELSA found that men who reported higher-than-average social isolation and women who reported increasing social isolation both experienced above-average decline in memory function within two years of being surveyed. However, the results don’t demonstrate that isolation causes deterioration in brain function, cautions ELSA director Andrew Steptoe, a UCL psychologist and epidemiologist who collaborates with Fancourt; it’s also possible that cognitive decline encourages some people to socialize less.

Indeed, the relationship between isolation and cognitive health isn’t entirely clear-cut. A recent meta-analysis of more than 50 studies, carried out by clinical psychologist Linda Clare and colleagues at the University of Exeter, found that while there was reasonably good evidence for an association between social isolation and cognitive decline later in life, the relationship wasn’t as strong as that reported for cognitive decline and some other lifestyle factors such as educational attainment. “We have to acknowledge that there are lots of different measures used and different studies and different ways of approaching this,” says Clare, whose work focuses on ways to help dementia patients and their caregivers in the UK. Different studies assess social isolation and cognition differently, and not all research takes into account potential confounding factors such as isolated people’s frequency of leisure activities, or their participation in voluntary or paid work. Despite all the variability, Clare says, “we did see that there is a reasonably robust association between more engagement in social activity and better cognitive function in later life.”

To add to the challenges in understanding these complex relationships, there’s sometimes confusion in the scientific literature about the distinction between objective and subjective measures of isolation, notes Cacioppo. “We know that there’s a difference between being physically isolated and emotionally isolated,” she says. Not everyone with limited social connections feels lonely, and some people with lots of social connections do. Cacioppo adds that while some people might choose solitude without suffering particularly adverse effects, loneliness is an inherently negative emotion, and when experienced for long periods, is often associated with depressive symptoms. “Loneliness is a discrepancy between what you want and what you have” in your relationships, she says.

A number of studies have tried to parse these subtleties by measuring social isolation and loneliness in parallel, partly aided by a metric known as the University of California, Los Angeles (UCLA) loneliness scale. This scale, developed by UCLA researchers in the 1970s, uses a list of statements to evaluate how connected people feel, in contrast to measures of social isolation, which rely on more-objective measures of social network size or the frequency of contacts with other people. One recent longitudinal study in England found that social isolation and loneliness were each associated with poorer physical and mental health, and the strongest association was seen in the group of people who reported both conditions. A three-year study of adults in Spain published in 2019, meanwhile, found that loneliness and social isolation were independently associated with cognitive decline. Other work has found effects for only one of the two measures: Studies in the Netherlands and the UK, for example, have found that loneliness, but not social isolation, was predictive of the onset of dementia. In contrast to these findings, a preprint published on bioRxiv a few months ago reported that social isolation, but not loneliness, was associated with elevated dementia risk among more than 150,000 adults in the UK when genetic risk factors for dementia were taken into account.

“It’s quite a varied picture,” says Steptoe. “One sometimes finds different patterns.”

Possible mechanisms linking isolation to brain function

By the time the nine-person crew of the Antarctic research station Neumayer III emerged from their 14-month stay a couple of years ago, they’d endured winter temperatures of -50 °C, drastic changes in natural light, and prolonged lack of contact with the outside world. The effects on their brains, it turned out, were substantial.

Structural MRI performed by neuroscientists at the Max Planck Institute for Human Development before and after the trip showed anatomical changes to the dentate gyrus, a region of the brain that feeds information into the hippocampus and is associated with learning and memory; the crew members’ dentate gyruses had shrunk by an average of around 7 percent. The crew members also had reduced blood levels of brain-derived neurotrophic factor (BDNF), a protein involved in stress regulation and memory, and they performed worse on tests of spatial awareness and attention than they had before they left.

The participants in this study were contending with more than just social isolation during their expedition, making it hard to know whether the observed brain changes are linked to lack of social contact as opposed to circadian disruption or some other aspect of their experience. But researchers studying social isolation and loneliness in the general population are also beginning to document differences in brain structure that could help reveal biological mechanisms at play.

Sandra Düzel, a neurobiologist at the same Max Planck Institute (though not a collaborator on the Antarctic study), recently set out to study such differences in more than 300 people participating in a longitudinal project called the Berlin Aging Study. Using MRI to map the volume of the brain’s various regions, Düzel and her colleagues found that, regardless of their level of social contact, people who scored high on the UCLA loneliness scale tended to have smaller gray matter volumes in a handful of regions. Those areas included the hippocampus and the amygdala, known for its role in emotion processing. The findings don’t demonstrate that loneliness causes shrinkage of these brain structures, Düzel writes in an email to The Scientist, but the researchers are considering both a lack of social stimulation and loneliness-induced stress as possible contributing factors.

Recent research in mice, which, like humans, are social organisms, supports a role for social interaction in maintaining normal brain structure and function, and hints at possible molecular mechanisms. One 2018 study, for example, investigated the effects of social isolation on mice’s ability to recognize other individuals—something researchers assess by recording how long mice spend interacting with one another, as an unfamiliar mouse normally elicits more interest than a familiar one. Adult mice that had been kept in isolation for up to a week were worse at discriminating familiar and unfamiliar mice, the researchers found. Returning mice to enclosures containing their colony mates restored their recognition abilities, as did inhibiting a small signaling protein known as Rac1, which has been linked to memory problems in Alzheimer’s disease. Activating Rac1 in mice that had not been isolated caused the animals to show the same forgetfulness exhibited by isolated individuals.

While distinguishing between loneliness and social isolation is impossible in animal studies, these kind of manipulative experiments offer a unique insight into effects of isolation on the brain, says Moriel Zelikowsky, a neuroscientist at the University of Utah School of Medicine. Mouse work she carried out while a postdoc at Caltech, for example, revealed a previously unknown role for Tac2, a signaling neuropeptide implicated in diverse cognitive functions, in mediating the behavioral effects of isolation.

The peptide was highly expressed across broad regions of the brain in mice that had been housed alone for several weeks, the team found, but not in controls kept with two other mice, nor in rodents isolated for just 24 hours. Mice that had spent weeks by themselves also displayed aggression—a typical behavioral effect of isolation—but that behavior was inhibited by a drug that blocks the protein receptor that Tac2 normally binds to. The findings suggest that Tac2 may be involved in regulating some of the effects of long-term isolation, rather than immediate stress induced by separation from companions, Zelikowsky notes. She adds, however, that there’s still a lot about the neuropeptide the team doesn’t know, including how it may interact with hormones involved in the stress response and whether it functions the same way in humans.

One area where animal studies and observational research in humans may be starting to align is the link between isolation and inflammation—a response that can have negative effects on cognitive function as well as on other processes throughout the body. For example, more than a decade of animal work has shown increased circulation of inflammatory signaling molecules such as interleukin-6 in isolated mice, and a recent meta-analysis of more than two dozen human-focused papers on the topic noted that studies of people experiencing loneliness consistently reported increased blood concentrations of this same cytokine. The meta-analysis also found that social isolation was primarily linked to higher levels for C-reactive protein (CRP) and fibrinogen, two molecules involved in inflammatory responses in mice and humans.

Fancourt, a coauthor of one of the studies included in that meta-analysis, says that the picture starting to emerge from this line of research is that social isolation and loneliness have distinct but closely related effects on inflammatory responses. Her study found that social isolation was associated with higher levels of CRP and fibrinogen, while loneliness was associated with lower insulin-like growth factor-1, a molecule that helps inhibit inflammation. “Both isolation and loneliness were linked to inflammation,” she says, “but while social isolation was linked to inflammatory markers themselves, for loneliness it was related to a pathway that involved how much those inflammatory responses are allowed to happen, or are inhibited from happening.”

Like research on any potential health risk, studies of social isolation still struggle to connect the dots between observations and concrete biological outcomes. Human studies can only reveal correlations, and experimental animal research “can show you that pathways can work in principle, but it doesn’t show they operate like that” in practice, says Steptoe. Nevertheless, research so far has helped to flesh out neuroscientists’ understanding of the sorts of factors involved in responses to social isolation—and, perhaps more importantly, has inspired several efforts to mitigate the problems that such isolation may cause.

Protecting cognition in socially isolated people


In recognition of the potential risks of social isolation, whether they be related to brain health or to other, less direct risks of living alone, many countries and health organizations have funded outreach campaigns to improve connections between people most likely to be (or to feel) isolated and the rest of the community. Cohousing organizations in the US and elsewhere, meanwhile, aim to foster social engagement with shared living spaces, although their ability to reduce loneliness has yet to be evaluated.

Where changes in a person’s social life or living arrangement aren’t possible or are unlikely to improve the situation, some researchers argue that pharmacological treatments could help—at least temporarily. Cacioppo and her late husband John, a pioneer in the study of loneliness and social neuroscience, proposed a few years ago that allopregnanolone, a steroid involved in regulation of BDNF as well as various emotional and behavioral responses to stress, might help alleviate loneliness in humans. Since 2017, Cacioppo’s team has been working with lonely patients to test a closely related molecule, pregnanolone, although the work has had to be put on hold because of the pandemic.

Zelikowsky notes that osanetant, the drug that she and her colleagues used to block Tac2 receptors in their mouse experiments, may also have promise as a therapeutic for people experiencing chronic isolation. The drug was originally developed in the 1990s by France-based pharmaceutical company Sanofi-Synthélabo (now Sanofi) as a treatment for schizophrenia, but was discontinued due to lack of efficacy, she says, adding she doesn’t know of clinical work currently underway to investigate its potential for people experiencing isolation or loneliness.

Other researchers, meanwhile, are focusing on behavioral interventions that may help reduce the risk of cognitive decline and other effects associated with social isolation. Fancourt and Steptoe, for example, have shown that boosting cognitive engagement, regardless of a person’s social engagement, may have a protective effect. One recent study found that people who more frequently visited museums, galleries, or exhibitions or attended theater performances, concerts, or operas were less likely to show decreases in memory recall and verbal skills within the next decade. (The relationship didn’t hold for visits to the cinema.) A 2019 study by the same researchers suggests that engaging in these kinds of cultural activities is associated with a lower risk of dementia.

It’s this kind of area in which research from the ongoing pandemic might also really contribute, says Fancourt. During the crisis, millions of people have found themselves isolated without choosing to be that way, and surveys already suggest that many people—particularly women, according to one recent study in the UK—have felt increasing loneliness since the pandemic began.

While some people may appreciate the chance to be alone, others have found new ways to stay connected with their social network—behaviors that could provide critical information about how different people cope with the effects of being physically separated from society. For example, Fancourt says, “if we’re all putting in lots of extra effort to speak to people, have Skype calls, Zoom calls, message people, are we able to offset some of the negative effects of isolation?”

From a research perspective, she adds, it’s an unprecedented opportunity to ask new questions about how a lack of traditional social contact influences human biology. “It might really change the way we think about concepts like loneliness and isolation,” Fancourt says, “and mean that we might actually start to define and research them differently based on what this very unusual natural experiment teaches us.”

Extreme Isolation

Every year in the US, tens of thousands of incarcerated people spend weeks or months at a time alone in small windowless cells, deprived of sensory stimuli and separated from other people. Surveys of people who have experienced this form of extreme isolation point to a range of negative cognitive consequences, including difficulties thinking or remembering information, obsessive thinking, and hallucinations and other psychotic symptoms, as well as longer-term mental illness risks, and increased incidence of suicide. Research on these effects of solitary confinement isn’t new; in the 19th century, observers of incarcerated people began attributing high rates of psychotic illnesses to having been housed alone and deprived of sensory stimulation, while work carried out in the last few decades in countries including Canada, Norway, South Africa, and Switzerland have drawn similar conclusions.

Animal studies that try to mimic the conditions of solitary confinement, meanwhile, indicate numerous potential biological effects on the brain. Studies of mice, for example, show that the stress induced by prolonged isolation can cause changes in brain structure, including reduced hippocampal volume, plus changes in the expression of genes associated with neuroplasticity and chemical signaling.

Neuroscientists face an uphill battle in using this research in legal settings for people who have experienced solitary confinement. Many US courts have rejected evidence of psychological pain on the grounds that, unlike a diagnosed mental illness or physiological harm, it is insufficient evidence of “cruel and unusual punishment,” and therefore doesn’t count as a violation of the US Constitution. Neurobiological research based on animal studies, meanwhile, has been rejected on the grounds that animal-based studies cannot be extrapolated to humans. That said, a landmark settlement between incarcerated people and the governor of California in 2015 was decided partly on the basis on neuroscientific evidence and resulted in the end of indeterminate solitary confinement in the state’s prisons.
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Re: Pandemic Isolation / Loneliness

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In The Midst Of The Pandemic, Loneliness Has Leveled Out

Studies suggest that we are finding ways to connect even amid quarantine


By Kasley Killam on August 18, 2020


https://www.scientificamerican.com/arti ... veled-out/


Before the coronavirus pandemic, there was a loneliness epidemic. By some estimates, two thirds of Americans often or always felt lonely in 2019. So when quarantines and shelter-in-place orders began, I was one of many social scientists who raised concerns that loneliness might worsen in the months to come. Would prolonged isolation trigger a “social recession,” as former U.S. surgeon general Vivek H. Murthy and physician Alice T. Chen put it?

Now, thanks to early research, we are starting to get answers—and the data give us reason to hope. According to several recent studies, loneliness has not only leveled out but, in certain cases, actually improved. Social distancing has made us recognize the importance of our relationships, which influence health and mortality as much as factors such as smoking and excessive drinking.

In a study published in the American Psychologist, researchers surveyed a group of people aged 18 to 98 across the U.S. at three different times: in late January and early February, before the U.S. outbreak; in late March, after social distancing was first recommended; and in late April, after shelter-in-place orders had been underway for a month. Each time, they polled participants using the UCLA Loneliness Scale and asked them to rate the statement, “I receive the social and emotional support that I need.” On average, the researchers found no significant changes in loneliness. In fact, perceived social and emotional support actually increased.

Another study conducted in the U.S., the U.K. and 26 other countries echoed these findings. The researchers surveyed the same individuals both before and during the pandemic, also using the UCLA Loneliness Scale. The responses indicate that, despite social distancing, people’s feelings of loneliness slightly improved.

Both studies stand out in that they followed the same sets of participants starting before the pandemic. In contrast, several papers that have reported a rise in loneliness used cross-sectional data—information from a single point in time—after the pandemic was already underway, meaning we can’t be sure if the individuals they surveyed were more or less lonely before. Other investigations have revealed additional nuances: After monitoring daily experiences of loneliness in the first month of lockdown, a preprint study in Germany reported an initial increase, followed by a decrease. This finding suggests that sudden isolation triggered a spike, but people quickly adapted and found ways to maintain social connection despite the circumstances.

Surprisingly, it seems that levels of loneliness around the world have remained generally stable. How have we avoided a social fallout? First, social isolation does not necessarily cause loneliness. While isolation is the objective state of being alone, loneliness is the subjective experience of disconnection, which means that you can feel lonely while surrounded by people or connected while by yourself. Amid COVID-19, most of us are more isolated, yet that doesn’t mean we are lonelier.

In the past few months, we’ve made a point to prioritize connection. The pandemic has made people more aware and appreciative of their relationships. Researchers have long known that social connection reduces your risk for illness, disease and early death. But only recently has the rest of society caught up. Whether we do so in person or virtually, spending time with friends, family and neighbors can bolster our social health—the dimension of well-being that comes from connection.

Similarly, taking action to support our communities through volunteering, making masks or thanking health care workers can confer a general sense of belonging. Following the September 11 terrorist attacks, researchers observed an influx of kindness, love and teamwork. For many of us, the pandemic has inspired similar solidarity and a spirit that “we are all in this together.”


Technology has also allowed us to avoid a social decline. Local nonprofits and national organizations offer remote programs, such as the Institute on Aging’s Friendship Line for people aged 60 and older and the AARP’s mutual aid groups for people to support each other within their community. Innovation has accelerated in the technology sector, with platforms emerging to better meet our connection needs and existing products launching new features, such as Nextdoor’s Neighbors Helping Neighbors program. Lawmakers are also acknowledging the need for political action to prevent loneliness: In March the House of Representatives passed the Supporting Older Americans Act of 2020, which included provisions to address social isolation.

If these trends continue, the social recession we feared could turn out to be a social revolution. Ironically, the pandemic may catalyze a cultural shift in which neighborhoods and communities band together to build healthy connection habits. In the process of reimagining cities, buildings, schools and workplaces, we have an opportunity to design our spaces and institutions in ways that enhance our social well-being. In short, it’s possible that a symptom of the coronavirus pandemic could become a cure for the loneliness epidemic.

To be sure, these trends don’t mean that everyone has felt connected. Loneliness may not have changed on average, but some groups are more affected than others. In the American Psychologist study, older adults initially felt lonelier, and people who lived alone or had a chronic disease reported more loneliness overall. Other evidence suggests that younger generations, men and residents of individualistic countries are particularly susceptible to loneliness. Meanwhile the digital divide has left older adults especially vulnerable because many lack the means to socialize or seek support remotely.

We still have a long way to go to reduce loneliness at the population level. But at the very least, so far, COVID doesn’t seem to have made it worse. With cases fluctuating and states closing down again, it will take a concerted effort to ensure that we stay socially connected even while physically separated.

We all feel powerless when it comes to the coronavirus, but we still have some control over our social lives and our social health. We can call our loved ones, participate in quarantine pods, reach out to isolated neighbors and organize virtual gatherings. Now is the time to strengthen bonds within families, neighborhoods and communities of all kinds—because by doing so, we will not only endure; we might emerge better off.

Kasley Killam

Kasley Killam is a writer, speaker, consultant, and member of local, state and national coalitions working on loneliness and social well-being. She has a master's from the Harvard T. H. Chan School of Public Health.
Recent Articles

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Re: Pandemic Isolation / Loneliness

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Pastoral care helped to mitigate COVID-19 impact among the elderly

10/21/20


https://www.news-medical.net/news/20201 ... derly.aspx


Volunteers from the Catholic Church in Brazil helped to mitigate the impact of COVID-19 among the elderly, a new study shows.

Peter Kevern, Professor Values in Health and Social Care at Staffordshire University, partnered with The Pontifical Catholic University of São Paulo to carry out the study which looked at the contribution of the Pastoral da Pessoa Idosa (PPI) program in Brazil.

And Professor Kevern suggests that the study findings may well assist the UK whose social care system has been severely tested during the pandemic.

PPI is a volunteer movement that uses the organizational structure of the Catholic Church of Brazil to provide a range of support to isolated elderly people right across the country. Anyone can be a volunteer in their community or in their building to support older people through the scheme.

Last year, approximately 25,000 'Pastoral Agents', provided home visits, personalized practical help and support to 164,000 older people. Pastoral Agents are also trained to measure and report indicators of well-being such as fragility, fluid intake, annual flu vaccination, and to refer people to government agencies.


" Brazil has a fragile social infrastructure so there are many unmet social needs to be addressed. The aim of this research was to estimate the contribution of the PPI program to the health and social support of older people. Almost 4,000 volunteers were interviewed over a one-week period using a 21-item telephone questionnaire to evaluate the impact of its activities during 'normal' times, and how they changed to address the challenge of COVID-19."

- Peter Kevern, Professor Values in Health and Social Care, Staffordshire University

The arrival of COVID-19 led to a temporary stop in visits following recommendations by the World Health Organization but efforts to provide material and immaterial support and remote monitoring by phone calls were encouraged through a campaign.

Professor Kevern added: "The striking thing about PPI was how quickly and flexibly the movement responded to the pandemic. Innumerable initiatives were undertaken by volunteers such as making masks, collecting food and other donations in order to make the lives of the elderly people monitored by the PPI better throughout Brazil. This was especially important for those who live in places far from urban centers, or in peripheries of large cities where access to social and health services is limited."

"I think we have some lessons to learn from PPI. In the UK, our social care system is also very fragile, and the experience of the early days of the lockdown, where older people were sent into care homes from hospital untested and many died from Covid-19, shows that the present system can't cope. Voluntary movements like PPI, supported and trained by the government, may be indispensable at times of population-level stress like a pandemic. There are some challenges coming down the line - possible future pandemics, Brexit, climate change - when again we might need to adjust to an unstable and rapidly-changing situation. Organizations like PPI might be part of the answer."

Source:

Staffordshire University

Journal reference:


Kevern, P., et al. (2020) The Contribution of Church-Based Networks to Social Care in the Coronavirus Pandemic and Beyond: The Case of Pastoral da Pessoa Idosa in Brazil. Religions. doi.org/10.3390/rel11100486.
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Re: Pandemic Isolation / Loneliness

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Seniors form COVID pods to ward off isolation this winter

11/3/20


https://www.news-medical.net/news/20201 ... inter.aspx


Over the past month, Dr. Richard Besdine and his wife have been discussing whether to see family and friends indoors this fall and winter.

He thinks they should, so long as people have been taking strict precautions during the coronavirus pandemic.

She's not convinced it's safe, given the heightened risk of viral transmission in indoor spaces.

Both are well positioned to weigh in on the question. Besdine, 80, was the longtime director of the division of geriatrics and palliative medicine at Brown University's Alpert Medical School. His wife, Terrie Wetle, 73, also an aging specialist, was the founding dean of Brown's School of Public Health.

"We differ, but I respect her hesitancy, so we don't argue," Besdine said.

Older adults in all kinds of circumstances — those living alone and those who are partnered, those in good health and those who are not — are similarly deliberating what to do as days and nights turn chilly and coronavirus cases rise across the country.

Some are forming "bubbles" or "pods": small groups that agree on pandemic precautions and will see one another in person in the months ahead. Others are planning to go it alone.

Judith Rosenmeier, 84, of Boston, a widow who's survived three bouts of breast cancer, doesn't intend to invite friends to her apartment or visit them in theirs.

"My oncologist said when all this started, 'You really have to stay home more than other people because the treatments you've had have destroyed a lot of your immune defenses,'" she said.

Since mid-March, Rosenmeier has been outside only three times: once, in September, to go to the eye doctor and twice since to walk with a few friends. After living in Denmark for most of her adult life, she doesn't have a lot of close contacts. Her son lives in Edinburgh, Scotland.

"There's a good chance I'll be alone on Thanksgiving and on Christmas, but I'll survive," she said.

A friend who lives nearby, Joan Doucette, 82, is determined to maintain in-person social contacts. With her husband, Harry Fisher, 84, she's formed a "pod" with two other couples in her nine-unit apartment building. All are members of Beacon Hill Village, an organization that provides various services to seniors aging in place. Doucette sees her pod almost every day.

"We're always running up and down the stairs or elevator and bringing each other cookies or soup," she said. "I don't think I would have survived this pandemic without that companionship."

About once a week, the couples have dinner together and "we don't wear masks," said Jerry Fielder, 74, who moved to Boston two years ago with his partner, Daniel, 73. But he said he feels safe because "we know where everyone goes and what they do: We're all on the same page. We go out for walks every day, all of us. Otherwise, we're very careful."

Eleanor Weiss, 86, and her husband are also members of the group. "I wear a mask, I socially distance myself, but I don't isolate myself," Weiss said. This winter, she said, she'll see "a few close friends" and three daughters who live in the Boston area.

One daughter is hosting Thanksgiving at her house, and everyone will get tested for the coronavirus beforehand. "We're all careful. We don't hug and kiss. We do the elbow thing," Weiss said.

In Chicago, Arthur Koff, 85, and his wife, Norma, 69, don't yet have plans for Thanksgiving or Christmas. "It's up in the air depending on what's happening with the virus," he said. The couple has a wide circle of friends.

"I think it's going to be a very hard winter," said Koff, who has diabetes and blood cancer. He doesn't plan to go to restaurants but hopes to meet some friends he trusts inside their homes or apartments when the weather turns bad.

Julie Freestone, 75, and her husband, Rudi Raab, 74, are "pretty fanatic" about staying safe during the pandemic. The couple invited six friends over for "Thanksgiving in October" earlier this month — outside, in their backyard in Richmond, California.

"Instead of a seating chart, this year I had a plating chart and I plated everything in advance," Freestone said. "I asked everybody to tell me what they wanted — White or dark meat? Brussels sprouts or broccoli?"

This winter, Freestone isn't planning to see people inside, but she'll visit with people in groups, virtually. One is her monthly women's group, which has been getting together over Zoom. "In some ways, I feel we've reached a new level of intimacy because people are struggling with so many issues — and we're all talking about that," she said.

"I think you need to redefine bubbles," said Freestone, who's on the board of Ashby Village, a Berkeley, California-based organization for seniors aging in place that's hosting lots of virtual groups. "It should be something you feel a part of, but it doesn't have to be people who come into your house."

In the Minneapolis-St. Paul area in Minnesota, two psychologists — Leni de Mik, 79, and Brenda Hartman, 65 — are calling attention to what they call SILOS, an acronym for "single individuals left out of social circles," and their need for dependable social contact this winter and fall.

They recommend that older adults in this situation reach out to others with similar interests — people they may have met at church or in book clubs or art classes, for instance — and try to form a group. Similarly, they recommend that families or friends invite a single older friend into their pods or bubbles.

"Look around at who's in your community. Who used to come to your house that you haven't seen? Reach out," de Mik recommended.

Both psychologists are single and live alone. De Mik's pod will include two friends who are "super careful outside," as she is. Hartman's will include her sister, 67, and her father, 89, who also live alone. Because her daughter works in an elementary school, she'll see her only outside. Also, she'll be walking regularly with two friends over the winter.

"COVID brings life and death right up in front of us," Hartman said, "and when that happens, we have the opportunity to make crucial choices — the opportunity to take care of each other."
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