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      Loneliness in the Era of COVID-19

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      Frontiers in Psychology
      Frontiers Media S.A.
      COVID-19, social connectedness, loneliness, well-being, mental health

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          Abstract

          COVID-19 is proving to be a particularly cruel disease not just because of its pathophysiology but also due to its potentially devastating consequences for engendering loneliness. From the outset of the pandemic, we have learned of countless individuals having to die alone or loved ones not being able to grieve by providing burial services (Miller, 2020). This disease holds particularly dire consequences for many populations—most notably the elderly and those with compromised health conditions but also minorities and the homeless; these groups have also faced unique difficulties in contending with loneliness well before this crisis (Rokach, 2019). For as much attention that this disease has rightfully focused on the elderly, individuals can experience different developmental challenges with loneliness throughout the lifespan including adolescence and young adulthood (Luhmann and Hawkley, 2016)—and, indeed, there is already evidence of heightened psychological problems amongst Chinese youth in the wake of this pandemic (Liang et al., 2020). Accordingly, it will be important for psychologists to assess how age-based threats to loneliness evolve in the era of COVID-19. Social distancing and isolation are critical to preventing the transmission of this highly contagious virus; yet, these are acts that are intrinsically linked with various adverse psychological effects including loneliness and adherence to these sorts of strategies are likely to decrease over time (Armitage and Nellums, 2020; Galea et al., 2020). Given the great reliance on technology during this time, it has been suggested that devices like smartphones can help combat isolation and loneliness during the pandemic particularly among the elderly (Banskota et al., 2020). However, there is a rather conflicting literature as to how Internet-based and social media usage impacts loneliness (Miller, 2018). For instance, Kim (2020) found that social media discussions about COVID-19 were less likely to feature uncivil comments amongst South Korean users with larger social networks. In short, it would be inaccurate to presume that technology provides an absolute clear means of minimizing feelings of loneliness during this crisis. Even before the pandemic, the World Health Organization declared that social disconnection was a major public health crisis and there is growing concern that the lonely and socially isolated may face heightened morbidity and mortality risks including suicide as a result of this crisis (Courtet et al., 2020). Much more research needs to be done with respect to possible direct or indirect effects from this pandemic that have either created newly found feelings of loneliness or reduced previous such feelings. On one hand, in the wake of this crisis, consistent with basic themes from both terror management theory and attachment theory, a fear of loss of loved ones and love itself should produce a fundamental sense of fear so as to potentially bolster earlier bonds (Steele, 2020). Yet, we are facing what many are terming alarming rises of upwards of 10–20% increased year-to-year rates of domestic violence in select U.S. cities in the immediate aftermath of the crisis (Boserup et al., 2020). More generally, this pandemic may adjust our appraisals of others as they relate to our perceptions of loneliness as it has also served as a reminder of the importance of maintaining health and the fragility of life. Accordingly, it is possible that this crisis may cause individuals to reevaluate aspects of their lives that have contributed to prior perceptions of loneliness. Though, in this era of social distancing and quarantining, quite notably, the sheer act of being alone is not inherently tantamount to producing loneliness (Russell et al., 2012) nor does the physical company of others (such as spouses) inherently prevent loneliness either (Moorman, 2016). This pandemic will also likely cause us to reflect about our physical environments in a more thoughtful way and this too will have significant relevance to the study of loneliness. A classic paper from Milgram (1970) examined the irony of how urban life can actually allow individuals to feel disconnected from others. Indeed, even though much of the industrialized world is largely urban, such environments can pose challenges to loneliness due to their design and the psychological effects of dense living (Imrie, 2018). The need to address these challenges has likely grown given the newfound perils of physical proximity to others that is largely synonymous with urban life. And, though it may not necessarily be tied to loneliness experienced vis-à-vis close others, feeling connected to nature appears to be associated with a larger connection for humanity and others (Moreton et al., 2019). Since the original COVID-19 source almost certainly was a bat and the point of transmission from animal to human likely occurred at the Wuhan Seafood Market, this experience should force us to realize that in our interdependent world, our actions have clear global consequences and it is critical to have health policies with environmental regulations. In doing so, while it is fair to critique governmental policies or responses that may have contributed to this crisis, it is also important to not do so in a way that further foments racism or stigmatization (Ang, 2020) as these conditions are also associated with the promotion of loneliness. Over the course of human history, individuals have borne witness to various atrocities and disasters such as war, genocide, and pandemics—and individuals and society generally adapt to these conditions. However, though there remains some debate whether loneliness should be viewed as a modern epidemic, Alberti (2019) contends that it should be looked at it this way when considered through a historical lens and particularly since in the twenty-first century, it is often intertwined by broader social, economic, and political crises. The COVID-19 pandemic features all of these aforesaid crises (Miller, 2020). Though COVID-19 may hold some unique consequences for perceptions of loneliness, so does the potential for technology to help foster self-care during this crisis (Saltzman et al., 2020). Some of the common reasons why loneliness may occur (such as distance from close others or feeling alienated) or ways we cope with loneliness (such as increased activity) may be hindered due to the nature of the pandemic; likewise, pre-existing mental, and physical health risks of loneliness may be exacerbated too during this pandemic. But, indeed, there are effective techniques (that do not necessarily require an online component) such as increased self-reflection and acceptance that can potentially be utilized during this crisis (Sønderby and Wagoner, 2013). Psychological theory, practice, and research must accordingly work to address what will likely be an ever-burgeoning loneliness crisis in the coming years as a result of this pandemic. Author Contributions The author confirms being the sole contributor of this work and has approved it for publication. Conflict of Interest The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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          The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention

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            COVID-19 and the consequences of isolating the elderly

            As countries are affected by coronavirus disease 2019 (COVID-19), the elderly population will soon be told to self-isolate for “a very long time” in the UK, and elsewhere. 1 This attempt to shield the over-70s, and thereby protect over-burdened health systems, comes as worldwide countries enforce lockdowns, curfews, and social isolation to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems. 2 Santini and colleagues 3 recently demonstrated that social disconnection puts older adults at greater risk of depression and anxiety. If health ministers instruct elderly people to remain home, have groceries and vital medications delivered, and avoid social contact with family and friends, urgent action is needed to mitigate the mental and physical health consequences. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. Online technologies could be harnessed to provide social support networks and a sense of belonging, 4 although there might be disparities in access to or literacy in digital resources. Interventions could simply involve more frequent telephone contact with significant others, close family and friends, voluntary organisations, or health-care professionals, or community outreach projects providing peer support throughout the enforced isolation. Beyond this, cognitive behavioural therapies could be delivered online to decrease loneliness and improve mental wellbeing. 5 Isolating the elderly might reduce transmission, which is most important to delay the peak in cases, and minimise the spread to high-risk groups. However, adherence to isolation strategies is likely to decrease over time. Such mitigation measures must be effectively timed to prevent transmission, but avoid increasing the morbidity of COVID-19 associated with affective disorders. This effect will be felt greatest in more disadvantaged and marginalised populations, which should be urgently targeted for the implementation of preventive strategies.
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              Alarming trends in US domestic violence during the COVID-19 pandemic

              The COVID-19 pandemic caused by the acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused significant destruction worldwide. In the United States (US) as of April 18, 2020 there were 690,714 reported cases and 35,443 deaths [1]. In order to curb the spread of SARS-CoV-2 quarantines, social isolation, travel restrictions and stay-at-home orders have been adopted [2,3]. While many states in the US implement stay-at-home orders differently, in most cases individuals are expected to stay indoors except for essential activities (e.g., obtaining food, medication, medical treatment) or for work in essential businesses (e.g., health care, essential infrastructure operations). Although these measures can be effective to control the spread of disease, they have a profound impact on society leading to social, financial and psychological repercussions. Isolation may expose or worsen vulnerabilities due to a lack of established social support systems. The temporary shutdown of non-essential businesses has led to unemployed and economic strain [4]. Quarantine conditions are associated with alcohol abuse, depression, and post-traumatic stress symptoms [5]. Stay-at-home orders may cause a catastrophic milieu for individuals whose lives are plagued by domestic violence (DV). DV usually occurs in a domestic space when one individual holds power over another. DV is a broad term and typically includes intimate partner violence (IPV) (e.g., usually occurs between current or former intimate partners and includes stalking, psychological, sexual and physical violence) elder abuse (e.g., involves negligent or intentional acts which cause harm) and child abuse (e.g., includes neglect, physical harm, sexual violence, and emotional harm) [6]. However, for the purpose of report we will primarily refer to DV as it pertains to IPV. Forms of DV such as IPV are unfortunately quite common. According to the CDC, approximately 1 in 4 women and 1 in 10 men report experiencing some form of IPV each year [7]. In the wake of the COVID-19 pandemic trends regarding DV are already starting to emerge on a global scale. Reports from local police near the epicenter of the COVID-19 outbreak in China's Hubei province, indicate that DV tripled during February 2020 compared to February 2019 [8]. Also, according to the United Nations entity UN Women, DV reports in France have increased 30% since they initiated a March 17 lockdown. DV calls in Argentina have increased 25% since their March 20 lockdown [9]. The organization also reports a 30% increase in helpline calls in Cyprus and 33% increase in Singapore [9]. However, in the US, the effect of the COVID-19 pandemic on DV is just beginning to be realized via anecdotal reports since there is limited data available to assess how DV has changed following implementation of stay-at-home orders. Data from US police departments provide some early insight into the effect COVID-19 has had on DV in some regions. For instance, in Portland, Oregon public schools closed March 16, 2020 and on March 23 came stay-at-home orders [10]. Following these events, the Portland Police Bureau recorded a 22% increase in arrests related to DV compared to prior weeks [11]. In San Antonio, Texas schools closed March 20, 2020 and stay-at-home orders came March 24 [12]. The San Antonio Police Department subsequently noted they received an 18% increase in calls pertaining to family violence in March 2020 compared to March 2019 [13]. In Jefferson County Alabama, the Sheriff's Office reported a 27% increase in DV calls during March 2020 compared to March 2019 [14]. In New York City schools closed March 16, 2020 and stay-at-home orders started on March 22, 2020 [15]. During the month of March, the New York City Police Department responded to a 10% increase in DV reports compared to March 2019 [16] [Fig. 1A & B]. Fig. 1 (A). Percent increase in US domestic violence in the locations studied in 2020. (B). Percent increase in US domestic violence in the locations studied 2020. Fig. 1 Reports of shootings in Philadelphia have increased since the state enacted its stay-at-home orders on April 01, 2020 [17]. According to data published by the City of Philadelphia, the number of shooting victims has increased approximately 7% during the period of April 01, 2020 to April 15, 2020 compared to the same time last year [18]. This cursory analysis illustrates that stay-at-home orders may create a worst-case scenario for individuals suffering from DV and demonstrates a need for further research. With the apparent rise in DV reports, there is a need for more current and standardized modalities of reporting actionable DV data. First responders, physicians and other healthcare personal need to be made aware of the potential for increased DV during the COVID-19 pandemic so they can respond appropriately. Steps could also be taken on an administrative level to make IPV screening tools more readily available in clinical settings and media outlets should be utilized to raise awareness. Social media should also be leveraged while stay-at-home orders are in place to reach a wider audience and provide support. Overall, it is vital that health care providers do not lose sight of the increased potential for violence while fighting this global pandemic since they may be the first point of contact for survivors. Funding None. Declaration of competing interest Authors declare no competing interests.
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                Author and article information

                Contributors
                Journal
                Front Psychol
                Front. Psychol.
                Frontiers in Psychology
                Frontiers Media S.A.
                1664-1078
                18 September 2020
                2020
                18 September 2020
                : 11
                : 2219
                Affiliations
                Department of Psychology, Kent State University , East Liverpool, OH, United States
                Author notes

                Edited by: Ami Rokach, The Center for Academic Studies, Israel

                Reviewed by: Idit Shalev, Ariel University, Israel

                *Correspondence: Eric D. Miller edmille1@ 123456kent.edu

                This article was submitted to Personality and Social Psychology, a section of the journal Frontiers in Psychology

                Article
                10.3389/fpsyg.2020.02219
                7530332
                33071848
                f00d5ef5-50f9-4f03-83b2-a6dca8421a65
                Copyright © 2020 Miller.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 07 May 2020
                : 07 August 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 3, Words: 1801
                Categories
                Psychology
                Opinion

                Clinical Psychology & Psychiatry
                covid-19,social connectedness,loneliness,well-being,mental health
                Clinical Psychology & Psychiatry
                covid-19, social connectedness, loneliness, well-being, mental health

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