What are the mental health impacts on the public from isolation during the pandemic?

Summary

The following is a short summary of the available evidence on the mental health impacts on the public from isolation during the pandemic. Six reviews, three guidance documents, and three single studies were found to answer this question and were used in this REAL summary. For additional information about each of the sources, see the Table below.

The authors of three reviews and several guidelines and one single study state that the pandemic, and resulting economic recession and physical distancing has increased prevalence of psychological distress including emotional disturbance, depression, stress, low mood, irritability, boredom, insomnia, post-traumatic stress symptoms, anger, emotional exhaustion, increases in alcohol consumption or substance use and worsening chronic conditions [1,4,8,9,11,12]. In its Taking care of your mental and physical health during the COVID-19 pandemic guidance (November 2020), the Government of Canada further states that these feelings can stem from: 1) thinking that you are being socially excluded or judged by others for displaying symptoms of COVID-19; 2) having concerns about children’s education and well-being; 3) being afraid of contracting the disease or spreading it;  4) having concerns about the future including job and financial security; 5) fear of being apart from family and friends due to quarantine; and 6) having a sense of helplessness, boredom, loneliness, and depression [8]. The authors of the Mental health effects of school closures during COVID-19 (April 2020) study state that adolescents with pre-existing mental health needs may lose an anchor in their life due to social isolation, which may result in symptom relapse [10]. Children with special education needs, such as those with autism spectrum disorder, are also at increased risk of psychological distress due to increased frustration and short temper as their daily routines are disrupted [10]. This study also states that high anxiety exists among post-secondary students, especially those with high financial burdens, as they transition out of their college lives in an uncertain job market [10]. The Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 (November 2020) found that social isolation and loneliness increased the risk of depression, and possibly anxiety, which could continue for 0.25 to 9 years following their period of isolation [2]. In addition, Negative Impacts of Community-based Public Health Measures on Children, Adolescents and Families During the COVID-19 Pandemic: Update (Jan 2021) reported that children’s mental health and behaviour have been overall negatively impacted by the COVID-19 public health measures. Importantly, parental stress was a mediator in the association between exposure to COVID-19 public health measures and negative child outcomes [6]. 
 
The authors of Impact of COVID-19 pandemic on mental health in the general population: A systematic review (December 2020), state that high rates of anxiety, depression, post-traumatic stress disorder, psychological distress, and stress are being reported globally [3]. Risk factors associated with distress included female gender, younger age group (≤40 years), presence of chronic/psychiatric illnesses, unemployment, student status, and frequent exposure to social media/news concerning COVID-19 [3].   
 
Various solutions have been proposed to alleviate the impacts of isolation. The City of Toronto (December 2020), Government of Canada (November 2020), and the Centre for Addiction and Mental Health (2020) recommend the following: 1) staying informed with credible and appropriate information about the pandemic; 2) limiting the news about COVID-19 that cause feelings of anxiety or distress; 3) engaging in meaningful activities and designing schedules (i.e., eating, exercising and sleeping at the same time each day); 4) practicing meditation and mindfulness; 5) staying physically healthy and active; and 6) staying connected with others through electronic devices and applications [7-9]. These guidelines also state that being kind and compassionate to yourself and others may also help with improving your mental health, while creating solidarity and boosting the morale of the community [7-9]. The How does physical distancing impact mental health? review also states that the following is recommended to mitigate the negative effects of physical distancing: 1) quarantine should be no longer than required; 2) clear rationale and information should be provided; 3) sufficient supplies should be ensured; and 4) the benefits of quarantine should be emphasized [4].  If you need help, there are several resources you can reach out to, such as: family physicians, registered psychologists, the Kids Help Phone, Hope for Wellness Help Line, and Crisis Services Canada [6]. A rapid review of mental and physical health effects of working at home: how do we optimise health? (Nov 2020) investigated the impacts of working at home (WAH) on physical and mental health outcomes. This study suggested that WAH policies should consider the following: work-home boundary management support, role clarity, workload, performance indicators, technical support, facilitation of co-worker networking, and training for managers [5]. 

Evidence

What‘s Trending on Social Media and Media

This Toronto Star article (January 2021) describes an updated report from the Sick Kids Hospital that highlights the importance of school, social interaction and mental health support for children. The article also cites a study from the hospital which found that seventy per cent of children and adolescents self-report worsening mental health since the pandemic began. 
 
As part of CBC’s Out of the Dark digital series (January 2021), Quebec youth describe their experiences navigating the challenges of COVID-19, including isolation and the strain that it has placed on their lives and social networks.   

Organizational Scan

The Ontario Hospital Association has compiled a list of easily accessible mental health initiatives from various leading and local resources. Ontario resources listed include Big White Wall (a free peer-to-peer community offering anonymous conversation), ECHO Coping with COVID (CAMH), Ementalhealth.ca (a non-profit initiative of the Children’s Hospital of Eastern Ontario), Ontario Psychological Association’s Guide to Wellness Workbook, as well as many other hospitals across Ontario (e.g., Sunnybrook, St. Joseph’s Healthcare Hamilton, Mt. Sinai, etc.) [22].  
 
Ottawa Public Health has outlined a list of measures accessible to individuals who are working from home to help support their mental health. Some measures include maintaining a routine, setting up a designated workspace at home, staying connected with loved ones, learning a new skill and limiting excessive exposure to COVID-19 related media. They also recommend exercising patience with household members as the pandemic has impacted a variety of populations to some effect. They additionally provided contact information for distress centres and counselling services available in Ottawa [23].  
 
HealthLink BC (May, 2020) develops, operates and maintains a comprehensive non-emergency health information and advice service to the residents of British Columbia. They provide Virtual Mental Health Supports for COVID-19 that are available for youth, adults, seniors and health care workers in British Columbia, across a variety of platforms. Services include virtual counselling, senior volunteer services, and crisis support, aimed to assist people struggling with mental health or experiencing a crisis. The organization also provides a list of existing and expanded mental health programs currently running, and programs that are launching in the near future [24].  
 
Mental Health Research Canada (December 2020) has released the results from their fourth and most recent national poll of a thirteen-part series “How COVID-19 is impacting Canadians”, which includes responses from 2,761 Canadians from December 10-18th. Notably, Canadians reported the highest rates of anxiety and depression during the pandemic; even higher than during the first wave. However, 65% of respondents reported feeling resilient to challenges and most remain optimistic about recovery post-COVID [25].  

Review of Evidence

Resource	Type/Source of Evidence	Last Updated
Psychological and Behavioural Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis — Panda et al.	Systematic Review & Meta-Analysis	Methods: searched databases for articles describing psychological complications in children/adolescents and their caregivers from the COVID-19 pandemic. Pooled estimates of psychological/behavioural problems were calculated.   Anxiety, depression, irritability, boredom, inattention, and fear of COVID-19 are predominant new-onset psychological problems in children during the COVID-19 pandemic.  Children with pre-existing behavioral problems like autism and ADHD have a high probability for worsening of their behavioral symptoms.  There is an urgent need for public health authorities to provide appropriate educational and recreational measures as well as psychological interventions through telephonic review.  Last Updated: December 26, 2020
Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19 — Maria Elizabeth Loades et al.	Rapid Review	Methods: searched MEDLINE, PsycInfo and Web of Science for articles relevant to the mental health impact of quarantine and social isolation on children/adolescents.  Children and adolescents are more likely to experience high rates of depression and anxiety during and after enforced isolation end and may increase as enforced isolation continues.  Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time at which loneliness was measured and between 0.25 and 9 years later.  Reducing the impact of enforced physical distancing by maintaining the structure, quality, and quantity of social networks, and helping children and adolescents to experience social rewards, to feel part of a group, and to know that there are others to whom they can look for support is likely to be important.  Last Updated: November 9, 2020
Impact of COVID-19 pandemic on mental health in the general population: A systematic review — Jiaqi Xiong et al.	Systematic Review	Methods: searched PubMed, Embase, Medline, Web of Science, Scopus, and Google Scholar up to May 17, 2020. Articles were selected from predetermined eligibility criteria.   The COVID-19 pandemic is associated with highly significant levels of psychological distress that, in many cases, would meet the threshold for clinical relevance.   Relatively high rates of symptoms of anxiety (6.33% to 50.9%), depression (14.6% to 48.3%), post-traumatic stress disorder (7% to 53.8%), psychological distress (34.43% to 38%), and stress (8.1% to 81.9%) are reported in the general population during the COVID-19 pandemic in China, Spain, Italy, Iran, the US, Turkey, Nepal, and Denmark.  Mitigating the hazardous effects of COVID-19 on mental health is an international public health priority.  Risk factors associated with distress measures include female gender, younger age group (≤40 years), presence of chronic/psychiatric illnesses, unemployment, student status, and frequent exposure to social media/news concerning COVID-19.  Last Updated: November 30, 2020
How does physical distancing impact mental health? — National Collaborating Centre for Methods and Tools	Rapid Review	Methods: searched 13 databases for evidence on the impact of quarantine on mental health. Grey literature was excluded.   The negative effects of quarantine were exacerbated by longer quarantine duration, fear of infection, frustration, boredom, inadequate supplies or information, financial loss and stigma.   The following is recommended to mitigate the negative effects of physical distancing: 1) quarantine should be no longer than required; 2) clear rationale and information should be provided; 3) sufficient supplies should be ensured; and 4) emphasizing the benefits of quarantine.   Last Updated: May 14, 2020
A rapid review of mental and physical health effects of working at home: how do we optimise health? — Oakman et al.	Rapid Review	Methods: searched PsychInfo, ProQuest, and Web of Science, from 2007 to May 2020.  This study suggests that working at home (WAH) policies should consider the following: work-home boundary management support, role clarity, workload, performance indicators, technical support, facilitation of co-worker networking, and training for managers  There was limited research on physical impacts of WAH which reported decrease in self-reported health  At a minimum, opportunity for regular communication between managers and their team and between colleagues are important and help to reduce the negative impacts associated with feeling isolated whilst WAH.  Last Updated: November 29, 2020
Negative Impacts of Community-based Public Health Measures on Children, Adolescents and Families During the COVID-19 Pandemic: Update — Public Health Ontario	Rapid Review	Methods: searched MEDLINE, Embase, PSYCHINFO, SOCINDEX and CHILD DEVELOPMENT 7 ADOLESCENT STUDIES, and relevant grey literature.  Children’s mental health and behaviour have been overall negatively impacted by the COVID-19 public health measures.  Parental stress was a mediator in the association between exposure to COVID-19 public health measures and negative child outcomes.  Health service utilization for mental health reasons increased in the later weeks of the pandemic.  Last Updated: January 10, 2021
COVID-19: Mental Health General Coping & Specific Stressors — City of Toronto	Municipal Guidance	Individuals are encouraged to keep up their routine, call or virtually connect with others, have regular exercise/dance and stay informed.  There are free online mental health programs and interactive tools that can support healthy coping during COVID-19.  Last Updated: December 17, 2020
Taking care of your mental and physical health during the COVID-19 pandemic — Government of Canada	National Guidance	Isolation can result in feelings of sadness, stress, confusion, fear, or worry.   These feelings can stem from thinking that you are being socially excluded or judged, concerns about your children's education and well-being, fear of contracting the disease or spreading it, concerns about job security and your finances, fear of being apart from family and friends to isolation, and a sense of helplessness, boredom, loneliness, and depression due to isolation or physical distancing.   Recommend minimizing the intake of COVID-19 news, practice mindfulness and meditation, stay socially connected, eating healthy and exercising, being kind and compassionate to yourself and others and limiting your use of substances.  Last Updated: November 26, 2020
Quarantine and Isolation — CAMH: Centre for Addictions and Mental Health	Professional Organization	People placed in quarantine or self-isolation may experience a wide range of feelings, including fear, anger, sadness, irritability, guilt, confusion, and insomnia.   CAMH recommends that the public can stay engaged by creating schedules to keep themselves busy throughout the day.   If you are unemployed during the pandemic, try to catch up on other tasks or projects at home and enjoy your leisure time by doing what you do normally on your days off. They also recommend staying connected with others by videoconference, phone, chat, or text.   The report emphasizes asking for help from others when you are feeling overwhelmed.   Staying physically active and ensuring that the basic supplies (i.e., food, water, and medical supplies) are available.  Last Updated: June 16, 2020
Mental health effects of school closures during COVID-19 — Lee, Joyce	Single Study	Adolescents with pre-existing mental health needs may lose an anchor in their life due to the social isolation and resulting in their symptoms to relapse.  Children with special education needs, such as those with autism spectrum disorder, are also at risk due to increased frustration and short temper among these children as their daily routines are disrupted. This study suggests creating a schedule for these children to create a sense of structure in their life.   High anxiety exists among post-secondary students, especially those with high financial burdens, as they transition out of their college lives among the uncertain times in the job market brought about by the pandemic.  Last Updated: April 13, 2020
Associations between periods of COVID-19 quarantine and mental health in Canada — Daly et al.	Single Study	This study analyzed responses from 3,000 Canadian adults surveyed about the mental health impacts of COVID-19 quarantine, distributed from May 14-29, 2020.  37.4% of respondents reported worse mental health at time of survey compared to before pandemic restrictions.  5.9% of respondents reported thoughts/feelings of suicide and 1.6% reported deliberate self-harm in the previous two weeks.  Participants who had quarantined due to symptoms of, or exposure to, COVID-19 were more likely to have worse mental health outcomes than those who had not.   Quarantine due to travel did not significantly impact mental health outcomes.   This study describes a need for proactive mental health supports to be built into surveillance measures (e.g., include mental health checks when calling to check adherence to quarantine measures).  Last Updated: December 4, 2020
The Implications of COVID-19 for Mental Health and Substance Use — Panchal et al.	Single Study	The pandemic and economic recession has negatively affected many people’s mental health.   During the pandemic about 4 in 10 adults have reported symptoms of anxiety or depressive disorder in comparison to 1 in 10 adults pre-pandemic.   Many people have experienced difficulty sleeping or eating, increases in alcohol consumption or substance use and worsening chronic conditions.   Last Updated: February 9, 2021
Strengthening Mental Health and Wellness During COVID-19 — OHA: Ontario Hospital Association	Organizational Scan	Last Updated: June 10, 2020
Protecting Your Mental Health — Ottawa Public Health	Organizational Scan	Last Updated: June 10, 2020
Mental Health and COVID-19 — HealthLinkBC	Organizational Scan	Last Updated: May 5, 2020
Mental Health during COVID-19 Outbreak: Poll #4 of 13 in a Series — Mental Health Research Canada	Organizational Scan	Last Updated: November 30, 2020
Disclaimer: The summaries provided are distillations of reviews that have synthesized many individual studies. As such, summarized information may not always be applicable to every context. Each piece of evidence is hyperlinked to the original source.