Thursday, June 4, 2020

Health Challenges of Social Distancing

Excerpted from the Dana Foundation, March 30, 2020.)

We are social creatures by nature, wired to connect with friends, family, and with other people within their communities (See In Sync: How Humans are Wired for Social Relationships). Yet, according to the U.S. Resources and Services Administration (HRSA), a large number of Americans report feeling lonely or socially isolated from others – so much so that many experts are calling it a “loneliness epidemic.” In response to the COVID-19 pandemic, many communities are facing work and school closures and shelter-in-place orders, which may be further isolating vulnerable populations from the social interactions that are so vital to mental health and well-being.

Here, Myrna Weissman, Ph.D., the Diane Goldman Kemper Family Professor of Epidemiology in Psychiatry at Columbia University’s College of Physicians and Surgeons, discusses the impact of loneliness on mental health, as well as ways to stay connected when circumstances dictate you must stay at home.

What do we know about the effect of social isolation on mental health?

Human attachments are a basic need. That’s why we live in families and communities where we can be connected to other people. It’s just part of the human condition. There is vast data to document that when these kind of attachments are disrupted in early life, like when a mother suffers from post-partum depression, which often disrupts the mother-infant bond, it can have long-term health consequences, ranging from low-birth weight to increased risk of depression, anxiety, substance abuse, or suicidal behavior later in life. Unfortunately, the studies also show that poor bonds early in life can also lead to more social isolation when you are older, as well as feelings of extreme loneliness.

We understand that attachments to others are very important. In fact, a lot of talk therapy focuses on dealing with disruptions to those attachments. You don’t need a lot of friends, but you need to have some people in your life that you can talk to and share your life with.

One of the things psychiatrists were seeing long before the COVID-19 pandemic is that loneliness and social isolation are huge factors in depression. Sometimes, a person has depression and they will avoid other people and become more isolated as their symptoms worsen. Other times, people are depressed because they are isolated from others and they don’t have people they can rely on. Maybe they are lonely because something has changed in their lives. Maybe something bad has happened and they’ve lost someone special. Maybe they don’t get along with their families or the people who should be closest to them. There are, unfortunately, many paths to loneliness....

Does it influence only depression?

No, it influences everything – including chronic medical illnesses like hypertension and diabetes. It’s also now been linked to dementia. People don’t just wake up one day with dementia, unless they’ve had a stroke. Rather, the lack of social interaction, the ability to talk and cooperate with others, leads to a graduate mental decline over time. These social interactions are an important part to health in general.

That said, some people have the opposite experience. They are living with people with whom they don’t get along. Being stuck at home makes things even more stressful as they no longer can do the activities that take them out during the day that can compensate for the underlying discord in the family. That’s of concern.

Then there are the people who live alone. They may be more used to a lowered level of social contact in general. But, on the other hand, many people who live alone have a large number of friends and family members who they see on a regular basis to compensate for that alone time. They could be made more vulnerable by what’s going on, too.

How can people best cope with this sort of forced isolation?

The good news is that human beings, in general, are very flexible and adaptable. There’s good evidence that when you can find ways to connect, it helps to reduce symptoms associated with isolation. Anecdotally, I’ve seen some very creative solutions over the past few weeks....

How can people recognize when the isolation may be becoming too much?

It may not always be easy to recognize it in yourself. It may be easier to see in others. From my experience over the past 10 days, I’d say to watch out for the following situations. First, if there’s someone in your life that you are never hearing from – you send an email or call them and they don’t answer, that’s worrisome. That may be the kind of person who requires more attention during this time. Keep reaching out. Make sure they are okay.

The other kind of situation that may be of concern is a friend or family member who are hyper-focused on the disasters. They are on social media or sending out emails about the number of people who are dying, who are in the hospitals, or the lack of respirators. They are dwelling on the bad things. There, too, it is worthwhile to reach out to them and try to help them focus on something else, to help them see the positives in the situation.

Is there anything we can learn from this period of isolation that can help our mental health and well-being once the isolation from COVID-19 lifts so we can better connect with others in the future?

I’ve been thinking a lot about how the world might change after this is all over. What you take away from this experience will largely depend on your circumstances. Hopefully, you’ll learn something new about yourself. You’ll take stock of what is most vital to your wellbeing during this extraordinary period – both the things you need to be at your best and the things you need to avoid. My hope is that it will help people to reorder their priorities, examine what is important, and discover new ways to foster connections with others.

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