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March 23, 2020 – To stop the spread of the COVID-19 coronavirus, the governing bodies of cities and states across the country are ordering people to stay home. But studies have shown that the loneliness and depression that may result from social isolation impacts not only mental health, but physical health as well.

Jena Lee, MD, a board-certified child and adult psychiatrist and clinical instructor at the David Geffen School of Medicine at UCLA, discussed how stay-at-home and shelter-in-place orders may affect emotional and physical wellbeing, and how to counteract those effects.

What are some of the immediate effects of social distancing and isolation on emotional wellbeing, especially for people who live alone?

Isolation may cause loneliness, fear or anxiety. But, if you look a little deeper, these seemingly immediate effects stem from our thoughts around isolation and are not particular to the act of isolation or social distancing, per se. These thoughts can be so fast and implicit that we may not even realize we are having them.  As a result, we often misunderstand the emotional effect of our thoughts and equate them to be the direct effect of external circumstances, such as a stay-at-home order. Ultimately, we end up feeling more helpless. 

Some common thoughts for those who already are alone might be, “Now I’m going to be even more alone,” or “I’ll be alone forever.” My suggestion would be to try to make changes in your thoughts, such as “I am helping to fight this virus by being temporarily isolated” or “There are many ways I can stay socially connected despite being physically distanced.” When you’re better able to recognize what you are thinking, you can better control your emotional wellbeing.

What are some of the things people can do to keep their minds and bodies active while practicing social distancing?

We must be creative while we’re practicing social distancing to stay active in a healthy way. Physically, try new home exercises, including yoga or strength training, and try to minimize use of substances like alcohol.  It takes just as much effort to immerse ourselves with messages of hope, compassion, and calm, as it does to minimize our attention on thoughts of fear and anxiety.  Often fear, depression and anxiety are associated with a mind that is focused on the past or future and not on the present. Practice bringing your attention back into the present, back into gratitude, using exercises such as meditation, prayer or even conversations focused on these topics.  It takes practice, but, like physical exercise, it becomes increasingly beneficial and easier with regular practice.

Are some people more susceptible to feeling anxious, lonely and depressed during times of required distancing?

Yes. People who might be more vulnerable to anxiety and depression include those who have a pre-existing mental disorder, those who struggle with loneliness or low self-esteem, those who may not already be socially connected to friends or family and those who live alone and depend on others for assistance. The more challenging limitations someone has, including physical illness and financial difficulty, the greater the risk for stress and subsequent symptoms of anxiety and depression. The older population is also more vulnerable to risks associated with social isolation.

What can people who are both out of work and feeling socially isolated do to improve their emotional wellbeing?

Make a schedule and allot time to try out new healthy behaviors, even if you haven’t tried them before.  For example, schedule video conferencing time with relatives and old friends, take an online course or update your resume.  Include time for productive activities like cooking, exercise, meditation and journaling, but also for relaxing time to watch a movie, take a bath or play games. Also consider a goal for sleep and wake time. Being able to stick to a schedule itself can feel very productive and really help balance out your activities so you don’t get stuck watching television all day. 

What advice would you give to parents on how to keep children entertained and maintain a regular routine while schools are closed?

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Keeping to a routine schedule for children is especially important because structure often translates into more emotional regulation in children. Despite school being closed, block out time for education and try to get access to online lessons that you can go through with your child. Reading, physical activity and art can be included in the educational part of the day. Then, the evening can be more relaxed. This structure will also help children eventually adjust back to school. Stay engaged in the activities of your child, ask them how they are feeling and thinking and do activities together as a family. For example, instead of telling children to read for 30 minutes, read in parallel and then ask them about what they read.  Regular wake and sleep times are very important to the physical, emotional and cognitive development of children.

Are there long-term consequences of social distancing and isolation on emotional wellbeing?

There is a lot of evidence that does link chronic isolation and loneliness not only to emotional problems like depression, but also to physical problems such as cardiovascular health and even mortality. Research also shows that increased symptoms of depression, anxiety, trauma, confusion and anger can result from quarantine. The good news is that we know about these negative consequences, and by trying to adjust them, we can try to prevent some of these effects. These factors include: inadequate information or supplies, longer duration of quarantine, extent of boredom, financial loss, fear of infection and stigma. So, by actively engaging each other in activities and encouragement, for example, we can mitigate boredom and stigma, which can have significant impact on our emotional wellbeing in this time.

When should people seek help if they are feeling depressed, anxious or increased stress?

You should always consider checking in with a primary care provider when you are struggling, but some of the signals to look for that would warrant help sooner include: depressed or anxious feelings that dominate most of the day; having difficulty enjoying or wanting to do activities you typically like; withdrawing socially from others, even from phone contact; changes in sleep and/or appetite; difficulty getting out of bed or taking care of yourself; and thoughts of suicide.