Evidence
Alert

Lonely young people have an increased risk of mental health problems years later: research suggests lockdown could have a long term effect

Loneliness and social isolation increase the long-term risk of depression and anxiety in children and teenagers, a recent review of research suggests. It included studies carried out before the current pandemic and found that negative impacts on mental health were evident up to nine years later.

Children and teenagers rely on close friendships more than adults and are more likely to develop mental health problems. But little is known about how isolation and the associated feeling of loneliness affects them.

Researchers wanted to find out more about the possible impact of COVID-19 containment measures on the mental health of this vulnerable group. They hope their work will raise awareness of the likely rise in mental health issues and encourage clinical services to provide targeted help and support for young people.

What’s the issue?

Tackling the COVID-19 pandemic has involved extensive physical isolation measures such as school closures, social distancing, and quarantine at home.

Closing schools and social distancing are likely to cause feelings of loneliness in children and young people. Early reports suggest that more than one in three teenagers and almost half of 18 to 24-year-olds are experiencing high levels of loneliness during lockdown. This is important as teenagers develop their identity and sense of belonging through friendships. Sharing experiences with people outside their family helps them to become independent adults.

In adults, loneliness is linked to mental health problems, and quarantine is known to have negative psychological effects, including confusion, anger, and anxiety. These effects are compounded by other pandemic-related issues such as fear of infection, boredom, frustration, and financial loss.

We know that children and young people are more likely to develop mental health problems than adults. We know less about the impact of quarantine and social distancing measures on them, at a time when they may also be anxious about threats to health and family income.

Researchers wanted to find out more about the potential impact of quarantine and social isolation on the mental health of this vulnerable group.

What’s new?

The team analysed research completed before the current pandemic. Researchers reviewed work that explored the impact of loneliness or quarantine on the mental health of healthy children and teenagers. Because they wanted fast results to inform discussions about the COVID-19 pandemic, this was a ‘rapid review’. They sped up and simplified the review processes while retaining scientific rigour.

The researchers analysed 63 studies including a total of 51,576 school or university students. Most studies focused on adolescents but six focused on children under the age of ten.

Loneliness and social isolation increased the risk of depression and anxiety in young people across all age groups. These effects began at the time and were present up to nine years later. There is some evidence that the duration of loneliness had more impact on mental health symptoms than its intensity.

One of the studies investigated the after-effects of previous pandemics: H1N1, severe acute respiratory syndrome (SARS) and avian flu. It found that those who had experienced quarantine or social distancing had higher levels of post-traumatic stress and were five times more likely to use mental health services compared to those who had not. One in three parents whose children had been subjected to disease containment measures said that their child had needed mental health service input as a result. Grief and stress-related disorders were the most common problems.

Why is this important?

This research amplifies concerns that COVID-19 containment measures harm young peoples’ mental health. The suggestion that the duration of loneliness has more impact than its intensity is important, given that COVID-19 measures have lasted for over a year.

The research suggests that there could be a rise in depression and anxiety lasting long after the end of quarantine and social isolation. These results are in line with data from China during the COVID-19 pandemic, which reported an increase in anxiety including clinginess, distraction, fear and irritability among young people aged three to 18 years.

In the UK, the Co-SPACE study seeks to understand the ongoing needs of children, young people, and their families in the current pandemic. Participants complete regular online questionnaires to offer a snapshot of how they are coping. The Co-SPACE study has found high levels of worries and fears, especially in children under 10 years.

Mental health services will need to be prepared to meet increased need.

What’s next?

Clinical services should be aiming to minimise the long-term effects on mental health. The researchers say that children and young people struggling with their mental health will need targeted help to prevent mental health problems developing and to allow early intervention.

They suggest practical strategies to promote mental health among children and adolescents. These include:

  • ensuring that young people know who to turn to for support
  • enabling social connection between children and young people so that they feel part of a group
  • helping young people to find activities, structure and purpose during lockdown
  • prioritising social reconnection, including through play, as lockdown eases
  • messaging in schools and communities about how to promote mental health and wellbeing.

The researchers have developed a Loneliness Toolkit based on this study for parents, teachers, and practitioners. It can help them to spot loneliness and tackle it by facilitating conversations, challenging misconceptions, increasing resilience, and reducing the stigma attached to loneliness.

This review included healthy young people. There remains an urgent need for more research into the impacts of lockdown on particular groups, such as those with pre-existing mental health problems and those from racially minoritised communities. Analysing the relative impact of the duration and intensity of lockdown measures is vital.

Most of the studies included in this review assessed feelings of loneliness when isolation was not enforced and was not common. By contrast, during COVID-19, isolation has been almost universal, affecting young people, their peers and whole communities. The researchers say that loneliness involves comparison with others and that the shared experience of social isolation might lessen its negative effects. This will need further study.

The team is exploring the impact of lockdown during the current pandemic on teenagers in South Africa by interviewing young people, parents, teachers, and counsellors. The findings will be published soon.

You may be interested to read

The full paper: Loades ME, and others. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;59:1218–1239

Emerging Minds, a research network addressing the mental health of children and young people

A list of general and COVID-19-specific resources on children’s mental health and wellbeing put together by the Department for Education, for children, parents, carers, and school staff

Living through Lockdown, an Emerging Minds webinar, in which author Maria Loades discusses this study and the impact of social isolation on young people.

Podcast on Loneliness for Children & Young People During the Pandemic in which Maria Loades discusses the place for Cognitive Behavioural Therapy (CBT) in tackling loneliness

 

Funding: This research was supported by Maria Loades’ NIHR Doctoral Research Fellowship. One of the rapid review authors was supported by the NIHR Great Ormond Street Hospital Biomedical Research Centre.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

Study author

In most of the studies we looked at, young people rated and reported their loneliness. But their feelings of loneliness may not have been obvious to those around them. It’s important to ask young people about whether they are feeling lonely, whether they are feeling left out, and whether they have people they can turn to.

Approaches like Cognitive Behaviour Therapy (CBT) can help young people manage their thoughts and try out different ways of doing things to help them to feel better. There is also some tentative evidence that taking up a new hobby can help young people to feel less lonely.

It’s also important, in the current pandemic context, to find creative ways of investigating how families who cannot access the internet or may not be motivated to take part in online surveys are managing.

Maria Loades, Clinical Psychologist, Lecturer and Researcher, Department of Psychology, University of Bath

Mental health advocate

I have three young people living with me who have been affected by lockdown. I think most people are aware of the ramifications of COVID-19 on children and young peoples’ mental health. So, while these findings do not offer new information, they do provide a source for extrapolating numbers to inform commissioning.

Commissioners need to prepare for the increased numbers of children and young people with mental health problems. Child and Adolescent Mental Health Services (CAMHS), Targeted Mental Health in Schools (TaMHS) and in-school mental health resources were overwhelmed before COVID-19, so another pathway or offer may be needed to support children and young people who have been negatively affected.

Professionals need to come together, using information from this study to create an accessible pathway for families as an early intervention.

Colette O’Sullivan, Independent Mental Health Advocate (IMHA) working with children and young people, Swindon

Young person

I don’t have mental health problems but I’ve found this year hard. I’m 15 and I’ve hated not being able to socialise, to see friends at school, or to go anywhere. Everything I was looking forward to was cancelled. I’ve kept in touch with close friends online but it’s not great. You have to arrange to chat, there’s no spontaneity and you don’t get to know new people.

I’m quite excited about going back to school, seeing people and going to classes. My school has been good with online learning but my education is not what it would have been. I love rowing and have kept training all through lockdown, which has given me something regular to do and it has helped. But online sessions are not as much fun as when we’re all together and there’s a really good atmosphere. Lots of other people have become demotivated and left the club during lockdown. Even when we get back to normal and can go out on the river, I’m not sure it will ever be the same again.

Clara Sayers, Public contributor, Oxford