Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

In the paper

“Seven studies stated that they measured the impact of social isolation39 , 45 , 50 , 59 , 69 , 70 , 72 on mental health, but the social isolation measures used were either subscales or questions from loneliness scales, or strongly overlapped with the construct of loneliness. Therefore, we have considered them together with studies that measured loneliness.”

What the sources say

• Disputed

  Split into 2 atoms — 1 confirmed, 0 partially supported, 1 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Checked by a reasoning model — may be wrong.

  cites [39] Matthews, 2016, Social isolation, loneliness and depression in young adulthood: a behavioural genetic analysis, Soc Psychiatry Psychiatr Epidemiol sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [45] Richardson, 2019, The moderating role of sleep in the relationship between social isolation and internalising problems in early adolescence, Child Psychiatry Hum Dev source
• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [50] Stacciarini, 2015, Rural Latinos' mental wellbeing: a mixed-methods pilot study of family, environment and social isolation factors, Community Ment Health J source

In the paper

“Self-help interventions including bibliotherapy99 and computerized therapy100 have shown a moderate positive effect size when compared to control groups although they are generally less effective than face to face therapies.101”

What the sources say

• Disputed

  Citation 101 is attached to the claim that self-help interventions are generally less effective than face-to-face therapies. The Introduction says brief guided parent-delivered CBT, which uses a self-help book, had similar outcomes to more intensive traditional CBT; the Discussion likewise describes outcomes as similar to more intensive child-focused CBT. The paper does not establish the broader comparison for computerized therapy. (LLM, conf=0.85)

  Checked by a reasoning model — may be wrong.

  cites [99] Creswell, 2017, 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 sourceExperimental — accuracy not yet measured
• Partly supported

  The Background (page unavailable) says therapist-supported internet-based CBT has larger effect sizes than fully automated, unguided interventions. That supports a narrower comparison, but it does not establish the cited claim that self-help interventions are generally less effective than face-to-face therapies. (LLM, conf=0.78)

  cites [100] Lillevoll, 2014, 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 sourceExperimental — accuracy not yet measured
• Supported

  The forest plot in the Discussion reports an overall effect of g = 0.49 for self-help versus controls. The 'Self-help versus face-to-face therapy' section reports a smaller effect in favour of face-to-face therapy (g = −0.17). These findings support the claim for the children and adolescents studied in this review. (LLM, conf=0.92)

  cites [101] Bennett, 2019, 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 source

In the paper

“Duration of quarantine, fear of infection, boredom, frustration, lack of necessary supplies, lack of information, financial loss, and stigma appear to increase the risk of negative psychological outcomes.1”

What the sources say

• Supported

  The Abstract lists all eight factors in the claim as stressors associated with the negative psychological effects of quarantine. The Duration of quarantine section also reports that longer quarantine was associated with poorer mental health. (LLM, conf=0.94)

  cites [1] Brooks, 2020, The psychological impact of quarantine and how to reduce it: rapid review of the evidence, Lancet source

In the paper

“Furthermore, a large survey of young adult students in China has reported that around one in four are experiencing at least mild anxiety symptoms.84”

What the sources say

• Supported

  The Results section (‘Levels of anxiety among college students during the epidemic’) reports a survey of 7,143 college students: 21.3% had mild anxiety, 2.7% moderate anxiety, and 0.9% severe anxiety. Together, 24.9% had at least mild symptoms—around one in four. The paper places the survey during the COVID-19 outbreak. (LLM, conf=0.94)

  cites [84] Cao, 2020, The psychological impact of the COVID-19 epidemic on college students in China, Psychiatry Res source

In the paper

“Duration of peer loneliness rather than intensity of peer loneliness was associated with depression 8 years later (ie, from age 5 to age 13 years); in contrast, family-related loneliness was not independently associated with subsequent depression.73”

What the sources say

• Supported

  The Results (page not provided) report that consistently high peer loneliness in childhood predicted depressive symptoms at age 13. The abstract in the Footnotes (page not provided) identifies an eight-year study beginning at age 5 and says that loneliness at individual time points and the duration of parent-related loneliness did not predict depression. (LLM, conf=0.92)

  cites [73] Qualter, 2010, Childhood loneliness as a predictor of adolescent depressive symptoms: an 8-year longitudinal study, Eur Child Adolesc Psychiatry source

In the paper

“There may also be sex differences, with some research indicating that loneliness was more strongly associated with elevated depression symptoms in girls and with elevated social anxiety in boys.70 , 71”

What the sources say

• ?Not checked — no full text of the sourcecites [70] Liu, 2020, Gender differences in the influence of social isolation and loneliness on depressive symptoms in college students: a longitudinal study, Soc Psychiatry Psychiatr Epidemiol source
• Partly supported

  The Results and Discussion (page unavailable) report that loneliness predicted increased social anxiety for boys but not girls. They do not report that loneliness was more strongly associated with depressive symptoms in girls; the reported gender difference involving internalizing symptoms instead runs from those symptoms to later loneliness and is stronger in boys. (LLM, conf=0.88)

  cites [71] Mak, 2018, The role of family for youth friendships: examining a social anxiety mechanism, J Youth Adolesc sourceExperimental — accuracy not yet measured

In the paper

“Although mobile applications for mental health have been found to be generally acceptable to children and adolescents, there is a lack of convincing evidence of effectiveness on intended mental health outcomes98 and few mobile health apps have been thoroughly tested.97”

What the sources say

• Supported

  Split into 2 atoms — 2 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [98] Grist, 2017, Mental health mobile apps for preadolescents and adolescents: a systematic review, J Med Internet Res source
• Partly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  cites [97] Grist, 2019, Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis, Clin Child Fam Psychol Rev sourceExperimental — accuracy not yet measured

In the paper

“Importantly, reviews have tended to conclude that effects are better if there is some therapist input97 , 101 and if parents are involved especially for younger children.96 , 97”

What the sources say

• Partly supported

  The Results sections on Therapist Support and Parental Involvement report larger effect sizes for therapist-supported and parent-supported interventions, respectively. But the Discussion (Comparison with Previous Work; page not supplied) says evidence for children under 12 is limited and calls for further research on the level of parental support that may benefit them. It does not establish that parental involvement is especially beneficial for younger children. (LLM, conf=0.88)

  cites [97] Grist, 2019, Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis, Clin Child Fam Psychol Rev sourceExperimental — accuracy not yet measured
• Partly supported

  The Meta-analysis section reports larger effects for guided than unguided self-help, although the difference was not significant when restricted to low-risk-of-bias studies. The Discussion suggests parental involvement may matter, particularly for younger children, but says the review could not test whether it was associated with effect size. No page numbers are available in our copy. (LLM, conf=0.88)

  cites [101] Bennett, 2019, 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 sourceExperimental — accuracy not yet measured
• Partly supported

  In “Moderators of effectiveness” (page unavailable), the review says therapist input may be important and parental input may be valuable for children. But its therapist-input subgroup analysis found no significant difference, and it says evidence for computerised parent-focused treatments is limited. The cited review therefore does not establish that either form of input produces better effects. (LLM, conf=0.88)

  cites [96] Pennant, 2015, Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis, Behav Res Ther sourceExperimental — accuracy not yet measured

In the paper

“Two studies evaluated interventions.”

In the paper

“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.”

In the paper

“In all, 61 studies were observational, 18 were longitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents.”

In the paper

“One of these studies was a retrospective investigation after a pandemic.”

In the paper

“We located 4,531 articles (Figure 1 ), of which 83 articles (80 studies) met the inclusion criteria.”

In the paper

“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 the paper

“Of these, 18 articles (17 studies) reported on the impact of loneliness in individuals with a variety of health conditions, including mental health problems (12 studies), physical health problems (one study) and neurodevelopmental conditions (4 studies).”

In the paper

“Furthermore, in the one study that examined mental health problems after enforced isolation and quarantine in previous pandemics, children who had experienced enforced isolation or quarantine were five times more likely to require mental health service input and experienced higher levels of posttraumatic stress.”

In the paper

“On the PTSD Checklist Civilian Version, 28% of children who had experienced isolation/quarantine scored about the cut-off for PTSD, compared to 5.8% of those who had not experienced isolation/quarantine.”

In the paper

“One study found a small association between panic and loneliness (r = 0.13).75 , 76”

What the sources say

• ?Not checked — no full text of the sourcecites [75] Vanhalst, 2013, The development of loneliness from mid- to late adolescence: trajectory classes, personality traits, and psychosocial functioning, J Adolesc source
• ?Not checked — no full text of the sourcecites [76] Vanhalst, 2012, The interplay of loneliness and depressive symptoms across adolescence: exploring the role of personality traits, J Youth Adolesc source

In the paper

“The most frequently reported diagnoses were acute stress disorder (16.7%), adjustment disorder (16.7%), grief (16.7%), and posttraumatic stress disorder (PTSD) (6.2%).”

In the paper

“This retrospective study included 398 parents of exposed children from the United States, Canada, and Mexico, of whom 20.9% experienced social isolation and a further 3.8% had been quarantined.”

In the paper

“Neither intervention specifically addressed mental health problems that had developed in the context of loneliness; therefore, we are unable to answer our second review question, which was what interventions are effective for individuals who have developed mental health problems as a result of social isolation or loneliness.”

In the paper

“There were mixed findings in another large study of adolescents (n = 541), which found a significant association between loneliness and subsequent depression, although this did not hold in a cross-lagged model,69 suggesting a possible bidirectional relationship between the variables.”

What the sources say

• ?Not checked — no full text of the sourcecites [69] Lasgaard, 2011, Loneliness, depressive symptomatology, and suicide ideation in adolescence: cross-sectional and longitudinal analyses, J Abnorm Child Psychol source

In the paper

“Positive associations were also reported between social isolation/loneliness and suicidal ideation,20 , 21 , 34 self-harm,34 and eating disorder risk behavior.34”

What the sources say

• ?Not checked — no full text of the sourcecites [20] Brage, 1993, Correlates of loneliness among midwestern adolescents, Adolescence
• ?Not checked — no full text of the sourcecites [21] Brage, 1995, Psychological correlates of adolescent depression, J Child Adolesc Psychiatr Nurs source
• ?Not checked — no full text of the sourcecites [34] Lasgaard, 2011, Different sources of loneliness are associated with different forms of psychopathology in adolescence, J Res Personal source

In the paper

“The associations were stronger in older participants35 and in female participants.47”

What the sources say

• ?Not checked — no full text of the sourcecites [35] Lau, 1999, Facets of loneliness and depression among Chinese children and adolescents, J Soc Psychol source
• Not checked yetcites [47] Singhvi, 2011, Psychological correlates of loneliness among adolescents, Indian J Psychol Sci

In the paper

“Fewer studies (N = 23) examined symptoms of anxiety.”

In the paper

“More studies have examined the relationship between loneliness and depression than between loneliness and anxiety.”

In the paper

“There is little evidence pertaining to interventions.”

In the paper

“Social isolation was not enforced upon the participants, nor was social isolation almost ubiquitous across their peer groups and across the communities in which they lived.”

In the paper

“A truncated quality assessment was conducted by one author (SR) using criteria adapted from the National Institutes of Health (NIH)14 (Table 1 ).”

What the sources say

• Not checked yetcites [14] National Institutes of Health. Study Assessment Tools. 2018. Available at: https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed May 22, 2020.

In the paper

“Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after enforced isolation ends.”

In the paper

“A random 20% of the data was double-entered to ensure accuracy.”

In the paper

“We checked 20% of all study eligibility results (both included and excluded) to ensure adherence to the eligibility criteria.”

In the paper

“Studies had a high risk of bias, although longitudinal studies were of better methodological quality.”

In the paper

“This suggests that the current social distancing measures enforced on children because of COVID-19 could lead to an increase in mental health problems, as well as possible posttraumatic stress.”

In the paper

“Importantly, they typically assessed and controlled for confounds and could assess the most plausible direction of causality between loneliness/social isolation and mental health.”

In the paper

“In the United Kingdom, early results from the Co-SPACE (COVID-19 Supporting Parents, Adolescents and Children in Epidemics) online survey of more than 1,500 parents suggest high levels of COVID-19−related worries and fears, with younger children (aged 4−10 years) significantly more worried than older children and adolescents (aged 11−16 years).85 , 86”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [85]
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [86] Weale

In the paper

“This propensity to experience loneliness may make young people particularly vulnerable to loneliness in the COVID-19 context, which, based on our findings, may further exacerbate the mental health impacts of the disease containment measures.”

In the paper

“Furthermore, the studies were mainly observational and did not consistently control for potential confounders.”

In the paper

“Most studies were cross-sectional, and therefore the direction of the association cannot be inferred.”

In the paper

“Few studies used independent (ie, not self-report) measures of mental health or social isolation/loneliness, thereby increasing the risk of bias.”

In the paper

“However, the postpandemic study has several limitations in that the sample was self-selecting, and the demographics of the children and the time elapsed since the experience were not reported.”

In the paper

“As loneliness involves social comparison,91 it is possible that the shared experience of social isolation imposed by disease containment measures may mitigate the negative effects.”

What the sources say

• ?Not checked — no full text of the sourcecites [91] Wiseman, 2008, On failed intersubjectivity: recollections of loneliness experiences in offspring of Holocaust survivors, Am J Orthopsychiatry source

In the paper

“The results are also consistent with one study investigating mental health problems in children60 after pandemics, improving our confidence in the results.”

What the sources say

• ?Not checked — no full text of the sourcecites [60] Sprang, 2013, Posttraumatic stress disorder in parents and youth after health-related disasters, Disaster Med Public Health Prep source

In the paper

“In line with Cochrane rapid review guidance,10 gray literature, and trial registry databases were not searched, hand-search strategies were not used, and only English-language publications were included, meaning that some relevant studies may have been missed.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [10] Garritty

In the paper

“The results were consistent across all study methodology for depression (but less so for anxiety), suggesting that these results are reliable.”

In the paper

“During the rapid data extraction phase, there was no scope to contact authors to request any missing information.”