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, Eleanor Chatburn, Nina Higson-Sweeney, Shirley Reynolds, Roz Shafran, Amberly Brigden, Catherine Linney, Megan Niamh McManus, Catherine Borwick, Esther Crawley, Maria Elizabeth Loades, Eleanor Chatburn, Nina Higson-Sweeney, Shirley Reynolds, Roz Shafran, Amberly Brigden, Catherine Linney, Megan Niamh McManus, Catherine Borwick, Esther Crawley

Abstract

Objective: Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents.

Method: For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29, 2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance.

Results: A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n = 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better methodological quality. 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. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness.

Conclusion: Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where possible and be prepared for an increase in mental health problems.

Keywords: COVID-19; disease containment; loneliness; mental health; pandemic.

Copyright © 2020 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

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Figure 1
PRISMA Flow Diagram Showing Search Results

References

    1. Brooks S.K., Webster R.K., Smith L.E. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–920.
    1. Hossain M.M., Sultana A., Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: a systematic umbrella review of the global evidence. Available at: Published 2020. Accessed April 10, 2020.
    1. Deighton J., Lereya S.T., Casey P., Patalay P., Humphrey N., Wolpert M. Prevalence of mental health problems in schools: poverty and other risk factors among 28 000 adolescents in England. Br J Psychiatry. 2019;215:565–567.
    1. Perlman D., Peplau L.A. Toward a social psychology of loneliness. Pers Relat. 1981;3:31–56.
    1. Oxford ARC Study. Achieving resilience during COVID-19 weekly report 2. 2020. Available at: . Accessed May 22, 2020.
    1. Young Minds. Coronavirus report March 2020. 2020. Available at: . Accessed May 24, 2020.
    1. Mental Health Foundation. Loneliness during Corona-virus. 2020. Available at: . Accessed May 22, 2020.
    1. Wang J., Lloyd-Evans B., Giacco D. Social isolation in mental health: a conceptual and methodological review. Soc Psychiatry Psychiatr Epidemiol. 2017;52:1451–1461.
    1. World Health Organization . World Health Organization; Geneva: 2017. Rapid reviews to strengthen health policy and systems: a practical guide.
    1. Garritty C.G., G, Kamel C. Cochrane Rapid Reviews. Interim guidance from the Cochrane Rapid Review Methods Group. 2020. Available at:
    1. Ganann R., Ciliska D., Thomas H. Expediting systematic reviews: methods and implications of rapid reviews. Implement Sci. 2010;5:56.
    1. Tricco A.C., Antony J., Zarin W. A scoping review of rapid review methods. BMC Med. 2015;13:224.
    1. Manuell M.E., Cukor J. Mother Nature versus human nature: public compliance with evacuation and quarantine. Disasters. 2011;35:417–442.
    1. National Institutes of Health. Study Assessment Tools. 2018. Available at: . Accessed May 22, 2020.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G., PRISMA Group Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med. 2009;6
    1. Westfall J., Yarkoni T. Statistically controlling for confounding constructs is harder than you think. PLoS One. 2016;11 e0152719-e0152719.
    1. Alpaslan A.H., Kocak U., Avci K. Gender-related factors for depressive symptoms in Turkish adolescents. J Child Adolesc Psychiatr Nurs. 2016;29:23–29.
    1. Arslan G. School belongingness, well-being, and mental health among adolescents: exploring the role of loneliness, Aust J Psychol. 2020:1–10.
    1. Baskin T.W., Wampold B.E., Quintana S.M., Enright R.D. Belongingness as a protective factor against loneliness and potential depression in a multicultural middle school. Couns Psychol. 2010;38:626–651.
    1. Brage D., Meredith W., Woodward J. Correlates of loneliness among midwestern adolescents. Adolescence. 1993;28:685–693.
    1. Brage D., Campbell-Grossman C., Dunkel J. Psychological correlates of adolescent depression. J Child Adolesc Psychiatr Nurs. 1995;8:23–30.
    1. Chang E.C., Wan L., Li P. Loneliness and suicidal risk in young adults: does believing in a changeable future help minimize suicidal risk among the lonely? J Psychol. 2017;151:453–463.
    1. Doman L.C.H., Le Roux A. The relationship between loneliness and psychological well-being among third-year students: a cross-cultural investigation. Int J Culture Ment Health. 2012;5:153–168.
    1. Erdur-Baker O., Bugay A. Mediator and moderator role of loneliness in the relationship between peer victimization and depressive symptoms. Aust J Guidance Counsel. 2011;21:175–185.
    1. Ginter E.J., Lufi D., Dwinell P.L. Loneliness, perceived social support, and anxiety among Israeli adolescents. Psychol Rep. 1996;79(1):335–341.
    1. Heredia D. Jr, Sanchez Gonzalez M.L., Rosner C.M. The influence of loneliness and interpersonal relations on Latina/o Middle School Students’ Wellbeing. J Latinos Educ. 2017;16:338–348.
    1. Houghton S.H., Carroll J.A., Wood L., Baffour B. It hurts to be lonely! Loneliness and positive mental wellbeing in Australian rural and urban adolescents. Journal Psychol Counsel Sch. 2016;26:52–67.
    1. Hudson D.B., Elek S.M., Campbell-Grossman C. Depression, self-esteem, loneliness, and social support among adolescent mothers participating in the new parents project. Adolescence. 2000;35:445–453.
    1. Hutcherson S.T., Epkins C.C. Differentiating parent- and peer-related interpersonal correlates of depressive symptoms and social anxiety in preadolescent girls. J Soc Pers Relat. 2009;26:875–897.
    1. Jackson J., Cochran S.D. Loneliness and psychological distress. J Psychol. 1991;125:257–262.
    1. Johnson H.D., Lavoie J.C., Mahoney M. Interparental conflict and family cohesion: predictors of loneliness, social anxiety, and social avoidance in late adolescence. 2001. Available at: Accessed September 29, 2020.
    1. Kim O. Sex differences in social support, loneliness, and depression among Korean college students. Psychol Rep. 2001;88:521–526.
    1. Koenig L.J., Isaacs A.M., Schwartz J.A. Sex differences in adolescent depression and loneliness: why are boys lonelier if girls are more depressed? J Res Personal. 1994;28:27–43.
    1. Lasgaard M.G., L, Bramsen R.H., Trillingsgaarf T., Elklit A. Different sources of loneliness are associated with different forms of psychopathology in adolescence. J Res Personal. 2011;45:233–237.
    1. Lau S., Chan D.W., Lau P.S. Facets of loneliness and depression among Chinese children and adolescents. J Soc Psychol. 1999;139:713–729.
    1. Majd Ara E., Talepasand S., Rezaei A.M. A structural model of depression based on interpersonal relationships: the mediating role of coping strategies and loneliness. Noro Psikiyatr Ars. 2017;54:125–130.
    1. Mahon N.E., Yarcheski A., Yarcheski T.J. Mental health variables and positive health practices in early adolescents. Psychol Rep. 2001;88:1023–1030.
    1. Markovic A., Bowker J.C. Social surrogacy and adjustment: exploring the correlates of having a "social helper" for shy and non-shy young adolescents. J Genet Psychol. 2015;176:110–129.
    1. Matthews T., Danese A., Wertz J. Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis. Soc Psychiatry Psychiatr Epidemiol. 2016;51:339–348.
    1. Mclntyre J.C.W., J, Corcoran R., Harrison Woods P., Bentall R.P. Academic and non-academic predictors of student psychological distress: the role of social identity and loneliness. J Ment Health. 2018;27:230–239.
    1. Moore D., Schultz N.R., Jr. Loneliness at adolescence: correlates, attributions, and coping. J Youth Adolesc. 1983;12:95–100.
    1. Mounts N.S., Valentiner D.P., Anderson K.L., Boswell M.K. Shyness, sociability, and parental support for the college transition: relation to adolescents’ adjustment. J Youth Adolesc. 2006;35:68–77.
    1. Neto F., Barros J. Psychosocial concomitants of loneliness among students of Cape Verde and Portugal. J Psychol. 2000;134:503–514.
    1. Purwono U., French D.C. Depression and its relation to loneliness and religiosity in Indonesian Muslim adolescents. Mental Health Religion Culture. 2016;19:218–228.
    1. Richardson C., Oar E., Fardouly J. The moderating role of sleep in the relationship between social isolation and internalising problems in early adolescence. Child Psychiatry Hum Dev. 2019;50:1011–1020.
    1. Roberts R.E., Chen Y.W. Depressive symptoms and suicidal ideation among Mexican-origin and Anglo adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:81–90.
    1. Singhvi M.K., Sehgal S.R., Kumari N. Psychological correlates of loneliness among adolescents. Indian J Psychol Sci. 2011;2:8.
    1. Spithoven A.W., Lodder G.M., Goossens L. Adolescents' loneliness and depression associated with friendship experiences and well-being: a person-centered approach. J Youth Adolesc. 2017;46:429–441.
    1. Stednitz J.N., Epkins C.C. Girls' and mothers' social anxiety, social skills, and loneliness: associations after accounting for depressive symptoms. J Clin Child Adolesc Psychol. 2006;35:148–154.
    1. Stacciarini J.M., Smith R., Garvan C.W., Wiens B., Cottler L.B. Rural Latinos' mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors. Community Ment Health J. 2015;51:404–413.
    1. Stickley A., Koyanagi A., Koposov R. Loneliness and its association with psychological and somatic health problems among Czech, Russian and U.S. adolescents. BMC Psychiatry. 2016;16:128.
    1. Swami V., Chamorro-Premuzic T., Sinniah D. General health mediates the relationship between loneliness, life satisfaction and depression. A study with Malaysian medical students. Soc Psychiatry Psychiatr Epidemiol. 2007;42:161–166.
    1. Thomas K.K., Bowker J.C. Rejection sensitivity and adjustment during adolescence: do friendship self-silencing and parent support matter? J Child Family Stud. 2013;24:608–616.
    1. Tu Y., Zhang S. Loneliness and subjective well-being among Chinese undergraduates: the mediating role of self-efficacy. Soc Indic Res. 2014;124:963–980.
    1. Uba I., Yaacob S.N., Juhari R., Talib M.A. Does self-esteem mediate the relationship between loneliness and depression among Malaysian teenagers? Pertanika J Soc Sci Humanit. 2012;20:179–188.
    1. Vanhalst J., Luyckx K., Raes F., Goossens L. Loneliness and depressive symptoms: the mediating and moderating role of uncontrollable ruminative thoughts. J Psychol. 2012;146:259–276.
    1. Wang L., Yao J. Life satisfaction and social anxiety among left-behind children in rural China: the mediating role of loneliness. J Community Psychol. 2020;48:258–266.
    1. Xu J., Chen P. The rural children's loneliness and depression in Henan, China: the mediation effect of self-concept. Soc Psychiatry Psychiatr Epidemiol. 2019;54:1101–1109.
    1. Yadegarfard M., Meinhold-Bergmann M.E., Ho R. Family rejection, social isolation, and loneliness as predictors of negative health outcomes (depression, suicidal ideation, and sexual risk behaviour) among Thai male-to-female transgender adolescents. J LGBT Youth. 2014;11:347–363.
    1. Sprang G., Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7:105–110.
    1. Boivin M.H., S, Bukowski W.M. The roles of social withdrawal, peer rejection, and victimization by peers in predicting loneliness and depressed mood in childhood. Dev Psychopathol. 1995;7:765–785.
    1. Christ S.L., Kwak Y.Y., Lu T. The joint impact of parental psychological neglect and peer isolation on adolescents' depression. Child Abuse Negl. 2017;69:151–162.
    1. Danneel S., Nelemans S., Spithoven A. Internalizing problems in adolescence: linking loneliness, social anxiety symptoms, and depressive symptoms over time. J Abnorm Child Psychol. 2019;47:1691–1705.
    1. Fontaine R.G., Yang C., Burks V.S. Loneliness as a partial mediator of the relation between low social preference in childhood and anxious/depressed symptoms in adolescence. Dev Psychopathol. 2009;21:479–491.
    1. Jones A.C., Schinka K.C., van Dulmen M.H., Bossarte R.M., Swahn M.H. Changes in loneliness during middle childhood predict risk for adolescent suicidality indirectly through mental health problems. J Clin Child Adolesc Psychol. 2011;40:818–824.
    1. Ladd G.W., Ettekal I. Peer-related loneliness across early to late adolescence: normative trends, intra-individual trajectories, and links with depressive symptoms. J Adolesc. 2013;36:1269–1282.
    1. Lalayants M., Prince J.D. Loneliness and depression or depression-related factors among child welfare-involved adolescent females. Child Adolesc Soc Work J. 2015;32:167–176.
    1. Lapierre M.A., Zhao P., Custer B.E. Short-term longitudinal relationships between smartphone use/dependency and psychological well-being among late adolescents. J Adolesc Health. 2019;65:607–612.
    1. Lasgaard M., Goossens L., Elklit A. Loneliness, depressive symptomatology, and suicide ideation in adolescence: cross-sectional and longitudinal analyses. J Abnorm Child Psychol. 2011;39:137–150.
    1. Liu H., Zhang M., Yang Q., Yu B. Gender differences in the influence of social isolation and loneliness on depressive symptoms in college students: a longitudinal study. Soc Psychiatry Psychiatr Epidemiol. 2020;55:251–257.
    1. Mak H.W., Fosco G.M., Feinberg M.E. The role of family for youth friendships: examining a social anxiety mechanism. J Youth Adolesc. 2018;47:306–320.
    1. Matthews T., Danese A., Wertz J. Social isolation and mental health at primary and secondary school entry: a longitudinal cohort study. J Am Acad Child Adolesc Psychiatry. 2015;54:225–232.
    1. Qualter P., Brown S.L., Munn P., Rotenberg K.J. Childhood loneliness as a predictor of adolescent depressive symptoms: an 8-year longitudinal study. Eur Child Adolesc Psychiatry. 2010;19:493–501.
    1. Schinka K.C., van Dulmen M.H., Mata A.D., Bossarte R., Swahn M. Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence. J Adolesc. 2013;36:1251–1260.
    1. Vanhalst J., Goossens L., Luyckx K., Scholte R.H., Engels R.C. The development of loneliness from mid- to late adolescence: trajectory classes, personality traits, and psychosocial functioning. J Adolesc. 2013;36:1305–1312.
    1. Vanhalst J., Klimstra T.A., Luyckx K., Scholte R.H., Engels R.C., Goossens L. The interplay of loneliness and depressive symptoms across adolescence: exploring the role of personality traits. J Youth Adolesc. 2012;41:776–787.
    1. Vanhalst J., Luyckx K., Teppers E., Goossens L. Disentangling the longitudinal relation between loneliness and depressive symptoms: prospective effects and the intervening role of coping. J Soc Clin Psychol. 2012;31:810–834.
    1. Wang Y.T., L, Guo L., Huebner S.E. Family dysfunction and adolescents' anxiety and depression: a multiple mediation model. J Appl Dev Psychol. 2020;66
    1. Zhou J., Li X., Tian L., Huebner E.S. Longitudinal association between low self-esteem and depression in early adolescents: the role of rejection sensitivity and loneliness. Psychol Psychother. 2020;93:54–71.
    1. Wang G., Zhang Y., Zhao J., Zhang J., Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020;395:945–947.
    1. King C.A., Gipson P.Y., Arango A. LET's CONNECT community mentorship program for youths with peer social problems: preliminary findings from a randomized effectiveness trial. J Community Psychol. 2018;46:885–902.
    1. Larsen T.B., Urke H., Tobro M. Promoting mental health and preventing loneliness in upper secondary school in norway: effects of a randomized controlled trial. Scand J Educ Res. 2019:1–14.
    1. Jiao W.Y., Wang L.N., Liu J. Behavioral and emotional disorders in children during the COVID-19 epidemic. J Pediatr. 2020;221:264–266.
    1. Cao W., Fang Z., Hou G. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res. 2020;287:112934.
    1. University of Oxford COVID-19’s impact on youth mental health the focus of new research. 2020. Available at:
    1. Weale S. Fifth of primary children afraid to leave house over COVID-19, survey finds. 2020. Available at:
    1. Brown B.B., Eicher S.A., Petrie S. The importance of peer group ('crowd') affiliation in adolescence. J Adolescence. 1986;9:73–96.
    1. Meeus W., Dekoviic M. Identity development, parental and peer support in adolescence: results of a national Dutch survey. Adolescence. 1995;30(120):931–944.
    1. Beck A.T.C., Clark D.A. Anxiety and depression: an information processing perspective. Anxiety Research. 1988;88:23–36.
    1. Leary M.R. Responses to social exclusion: social anxiety, jealousy, loneliness, depression and low self-esteem. J Soc Clin Psychology. 1990;9:8.
    1. Wiseman H. On failed intersubjectivity: recollections of loneliness experiences in offspring of Holocaust survivors. Am J Orthopsychiatry. 2008;78:350.
    1. Przybylski A.K., Orben A., Weinstein N. How much is too much? Examining the relationship between digital screen engagement and psychosocial functioning in a confirmatory cohort study. 2019. Available at:
    1. Pass L., Lejuez C.W., Reynolds S. Brief Behavioural Activation (Brief BA) for adolescent depression: a pilot study. Behav Cogn Psychother. 2018;46:182–194.
    1. Masi C.M., Chen H.Y., Hawkley L.C., Cacioppo J.T. A meta-analysis of interventions to reduce loneliness. 2011. Available at:
    1. Moor S., Williman J., Drummond S. 'E' therapy in the community: examination of the uptake and effectiveness of BRAVE (a self-help computer programme for anxiety in children and adolescents) in primary care. Internet Interv. 2019;18:100249.
    1. Pennant M.E., Loucas C.E., Whittington C. Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis. Behav Res Ther. 2015;67:1–18.
    1. Grist R., Croker A., Denne M., Stallard P. Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis. Clin Child Fam Psychol Rev. 2019;22:147–171.
    1. Grist R., Porter J., Stallard P. Mental health mobile apps for preadolescents and adolescents: a systematic review. J Med Internet Res. 2017;19:e176.
    1. Creswell C., Violato M., Fairbanks H. Clinical outcomes and cost-effectiveness of brief guided parent-delivered cognitive behavioural therapy and solution-focused brief therapy for treatment of childhood anxiety disorders: a randomised controlled trial. Lancet Psychiatry. 2017;4:529–539.
    1. Lillevoll K.R., Vangberg H.C., Griffiths K.M., Waterloo K., Eisemann M.R. Uptake and adherence of a self-directed internet-based mental health intervention with tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry. 2014;14:14.
    1. Bennett S.D., Cuijpers P., Ebert D.D. Practitioner review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis. J Child Psychol Psychiatry Allied Discip. 2019;60:828–847.

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