Guest Reachwell blog: Dr Maria Loades, University of Bath.
Loneliness is the painful feeling we experience when our actual social contacts are different from what we desire them to be1. In the COVID context, lockdown loneliness seems to have been a particular problem for young people, more than any other age group 2,3,4. This is most probably due to developmental context. Friendships are where we develop and refine our social skills. Friendships and social life look different and have different functions at different stages of child development. Pre-primary aged children mainly play alongside one another. At primary school age, friends start to become more important and play is the main way through which children connect with others. However, family relationships are still the main influence on development. For teenagers, friendships are very important source of identity and belongingness (much more so than family). At this stage, it is really important to have shared experiences with peers who function as a social group to do new things with, especially things that are different from what families do. This is a key step in transitioning towards becoming an independent adult.
What effects might this burgeoning of loneliness have on mental health in children and young people? To address this question, we set out to systematically find all the studies that have looked at the mental health impacts of social isolation and loneliness5. We found that there was little evidence specific to the pandemic context. We found considerable evidence that loneliness is associated with depression and anxiety, both when measured at the same time, and over time. Loneliness is associated with later depression and anxiety, up to 9 years later. There was some evidence that the duration of loneliness is more strongly associated with unfavourable mental health outcomes than the intensity of loneliness.
What this means in practice is that several years down the line, we might still be seeing the mental health impacts of loneliness now. More than ever, we need children and young people to be resilient. That is, that they can manage stress, cope with changes, bounce back from difficult life experiences and have positive outcomes. And to build this resilience and promote wellbeing, we need to build up their protective factors, and decrease risk factors where possible.
A key risk factor is loneliness. We need to minimise the duration of loneliness where possible. Physical distancing does not have to mean social disconnection. As schools resume, we must prioritise catching up socially and emotionally as much as academically. Reconnecting socially, including through play, is crucial. In future, consideration should be given to how to maintain contact amongst children and young people, including keeping schools open even if local lockdowns are imposed.
To build protective factors, we also need to promote wellbeing. At school, community and national level, public health messages should be sent out about activities that support wellbeing, such as being physically active, socialising, doing enjoyable activities, spending time in nature, and keeping a daily structure/routine. Some children and young people will need more targeted, individualised mental health treatments. We need to make sure that children and families know who they can talk to if they are struggling and that a range of supports are in place. At the lower levels of intensity, this includes parent-led self-help approaches, and computerised Cognitive Behaviour Therapy (CBT) based programmes6. These programmes tend to work best if there is some therapist input. At higher levels of intensity, we need to ensure that more specialist mental health services are prepared to deal with an increase in demand and can provide evidence-based treatments in a timely and accessible manner.
Dr Loades is funded by the National Institute for Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). This report is independent research. The views expressed in this publication are those of the authors(s) and not necessarily those of the NHS, NIHR or the Department of Health and Social Care.