The silent pandemic: Social isolation and loneliness
OVER 700,000 Covid cases and 10,500 deaths and one year later, we are about to see another prolonged lockdown in Bangladesh. This means further social isolation associated with quarantine measures and added uncertainty at an already precarious moment in our lives. That being said, there seems to be little or no discussion about the mental health pandemic that is hitting young people at an all-time high. As Prothom Alo reported earlier this year, Bangladesh had recorded 70 percent more deaths from suicide than from the pandemic in the first year of the coronavirus outbreak. Almost half of the deceased were aged 20-35 years old, while 35 percent were aged 5-19, and 16 percent were aged 36-80.
Researchers are yet to claim that the restrictive measures taken as a safety precaution and the rate at which mental health problems are increasing are directly related. However, according to the Directorate General of Health Services (DGHS), 8,462 people died from Covid-19 in the 365 days after the first coronavirus cases were detected in Bangladesh on March 8, 2020, while data collected by Aanchal Foundation found that 14,436 people committed suicide over the same period. Hence, this much should be acknowledged that the deterioration of mental health among younger individuals and social isolation due to lockdown measures may at least fall on the same spectrum.
In a recent survey conducted by the United States Centers for Disease Control and Prevention, 63 percent of 18 to 24-year-olds reported symptoms of anxiety or depression, with 25 percent reporting increased substance use to deal with that stress and 25 percent saying they would seriously consider suicide. In a report published by Mental Health America, researchers found that between April and September of last year, 70 percent of people reported that loneliness or isolation was the top contributing factor to these mental health issues. This means that the coronavirus pandemic has caused another kind of pervasive affliction—loneliness. The World Health Organization further reported that poor social relationship (characterised by social isolation or loneliness) was associated with a 29 percent increase in the risk of heart disease and a 32 percent increase in the risk of stroke. Given its association with reduced lifespan and greater risk of both mental and physical illnesses, the widespread experience of loneliness became a public health concern even before the pandemic.
To make matters worse, many young people are constantly suffering from a gnawing feeling that they are wasting valuable time in their peak years as a result of a restricted social life. "For the people between the ages of 21 and 25, this is a time of expansion in their life," Dr. Sarah Lipson, an assistant professor at the Boston University School of Public Health, told ABC News. "I think this is a hard time for parts of life to stand still when there is normally just this fast-paced developmental time where so much is happening socially and professionally."
In Bangladesh, it is difficult to measure the impact of the mental health pandemic as there still remains a stigma surrounding mental health. Hence, the increase in anxiety, depression, sleep disruptions, thoughts of suicide and substance use is, in part, due to the shortage of mental health professionals and community-level intervention and prevention efforts.
So what can we do to combat loneliness? Unlike in past pandemics, many of those now social-distancing at home have the benefit of technology to stay connected. Though physical presence can't be entirely replicated, Robert Waldinger, a professor of psychiatry at Harvard Medical School and Massachusetts General Hospital, said that videoconferencing platforms such as Zoom provide ways to stay in touch and approximate to in-person connectedness. It appears plausible that these options can reduce feelings of social isolation or loneliness (e.g. when seeing their grandparents on the monitor of their devices). However, although interactive meetings and family calls have proven to be a blessing for many during this pandemic, Waldinger is worried that it will become the old scenario of "the rich becoming richer," with some who are better off and more comfortable with technology thriving, while others struggle in silence.
It is also probable that limited access to digital modes of social contact and networking—a common problem in developing countries like Bangladesh—may have contributed to increasing loneliness among some young adults. Alternatively, heavy reliance on digital technology for social contact could have, paradoxically, amplified the sense of social disconnection, thereby aggravating loneliness.
Moreover, losing a loved one can be particularly difficult now, as the normal comfort of family coming together to grieve and support each other may be postponed or foregone entirely due to social distancing concerns. The impact of grief compounded by isolation may be particularly hard for young people, and lack of social support can make it harder to move forward. Under such circumstances, mental health professionals can be critical in helping move on from grief, rather than get stuck in it. As the work of psychologist Dr James Pennebaker at the University of Texas has shown, writing about emotional upheavals and expanded use of telehealth can improve both physical and mental health (Perspectives on Psychological Science, Vol. 13, No. 2, 2018).
So, whilst we do all we can to alleviate the effects of isolation and re-establish social ties, we must still brace for a rise in mental health issues that might be triggered when resuming social interactions. There are several levels at which we can prepare for this: 1) Recognise those who are experiencing loneliness as early as possible to have tailored approaches to assist them in overcoming their difficulties. This may be accomplished by providing additional assistance in school/workplaces, assisting them in overcoming their fears of returning to school/work, or assisting them in socially reconnecting with their peers; and 2) Doctors should talk about depression and connect patients who are struggling with social support and Covid fatalities among their friends and family; and businesses should check in with workers and see if they are depressed and have opportunities to help them connect. To further reduce the stigma associated with loneliness, it's imperative to create national and local campaigns that reassure those suffering that it's OK to seek help.
Social isolation associated with quarantine can be the catalyst for many mental health sequelae, even in people who were previously well. Throughout this global pandemic, it is important to continue to advocate for those who are vulnerable, especially the younger population. If there is a benefit to these quarantined days, said Jeremy Nobel of the Center for Primary Care at Harvard Medical School, it is that with everyone physically isolated, the stigma of admitting to loneliness has decreased, which may make it easier to reach out. Hence, while governments have appropriately concentrated on reducing infection transmission rates, there is also an imperative to address the wider social impact of Covid-19.
We need to know what kind of support is needed right now in Bangladesh, as well as what kind of support organisations, programmes, and communities should offer in order to prepare beyond this point of the pandemic. Governments across the world will increasingly need to focus on both the short-term and long-term implications of loneliness and social isolation as public health priorities, and recognise that these are not just issues facing individuals but also society as a whole.
Zaha Chowdhury is a graduate of the University of Manchester, UK.