MAGALHÃES, Ricardo Antonio. GARCIA, July Mesquita Mendes. Psychological Effects of Social Isolation in Brazil during the COVID-19 Pandemic. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 06, Ed. 01, Vol. 01, p. 18-33. January 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/psychology/social-isolation
In this study, the impacts of Covid-19 on mental health were raised. Specifically the mental illnesses observed during the social isolation caused by the pandemic. The study aimed to answer the following question: what are the psychological affects observed in the current literature on the social isolation caused by COVID-19? As for the nature of this research is characterized as applied, in relation to its form of approach as qualitative, with regard to its objectives the research is classified as descriptive and in terms of technical procedures as a survey. As a result, it was observed that Covid-19 provides changes in the mental health of the population with an increase in the number of symptoms of Post Traumatic Stress Disorder, anxiety disorders and negative affects after the end of social isolation. Physical distancing has reduced the availability of many family, social and psychiatric supports. People with severe mental illness and associated socioeconomic disadvantages are particularly at risk from the direct and indirect affects of the pandemic. However, it is concluded that COVID-19 not only causes physical health problems but also results in a number of psychological disorders. The spread of COVID-19 can impact the mental health of people in different communities.
Keywords: Covid-19, Social Isolation, Mental Health.
In December 2019, China informed the World Health Organization (WHO) of an outbreak of a new disease, similar to pneumonia. This disease, transmitted by the new coronavirus, later identified as Sars-Cov-2, was called COVID-19. In January 2020, new cases of COVID-19 were reported outside of China, prompting the WHO to declare an international public health emergency. In Latin America, the first case recorded was in São Paulo, Brazil, on February 25, 2020. According to the situation report 115, issued by the WHO, until May 14, 2020, 4,248,389 cases were confirmed and 292,046 deaths from the disease worldwide. In Brazil, on the same date, 177,589 cases and 12,400 deaths were confirmed, according to the WHO daily bulletin (WHO, 2020). In this situation, the status of the disease has changed, due to the high rate of transmission of the virus and its spread worldwide, passing to the classification of a pandemic, according to situation report nº 114, issued by the WHO.
More than 180 countries around the world have registered the presence of COVID-19, and through the spread of this virus, several government authorities have adopted different strategies, aiming to reduce the pace of its progression (KRAEMER et al., 2020). Being identified as a predominantly respiratory disease, COVID-19 can be transmitted from person to person through droplets of saliva, sneezing, coughing and phlegm, as well as close contact with the mouth, nose, eyes, or contaminated objects and surfaces (TEIXEIRA , 2020).
The rapidly evolving situation has drastically altered people’s lives as well as various aspects of the global economy, both public and private. Declines in tourism, aviation, agriculture and the finance industry, due to the COVID-19 pandemic, are reported as massive reductions in both the supply and demand aspects of the economy that have become inevitable consequences and that have depended on the adoption of strategies by governments internationally.
Among the necessary strategies, it appears that social distancing was the first preventive measure adopted with the purpose of avoiding agglomerations, in order to maintain at least one and a half meters of distance between people, as well as the prohibition of events that bring together a large number of individuals (schools, universities, concerts, shopping malls, sports academies, sporting events, among others) (REIS et al., 2020).
From this perspective, it is observed that together with the COVID-19 pandemic, a state of social panic arises at a global level and the feeling of social isolation triggers feelings (of anguish, insecurity and fear), which can extend even after the virus control (HOSSAIN et al., 2020).
In this sense, despite the fact that social isolation is a measure widely used in the field of public health aimed at preserving the physical health of the individual, it is essential to think about the mental health and well-being of people subjected to this period of social isolation. Emphasizing this fact, this study aimed to carry out an analysis of the consequences caused in mental health, following the period of social isolation during the COVID-19 pandemic, pronouncing, in the end, coping strategies to minimize them.
In Brazil, it appears that the great social and regional inequality has hampered the isolation process, since the population of poor and extremely poor people, who make up more than 66 million Brazilians, need to leave home in search of their subsistence and the family, thus increasing the risk of infection and transmission of the new Coronavirus (OLIVEIRA et al., 2020).
In this context, the practicability of social isolation during the pandemic results in the exposure of the suffering of a large part of the population, caused by exacerbated concerns such as: problems related to the economy and the explosion of news, as well as other issues related to the reality of each of the people who have relationships on a daily basis. Factors such as these can cause the manifestation or worsening of psychological symptoms such as anxiety, stress and depression (ORNELL et al., 2020). It is worth mentioning that there is not just one specific group that will suffer from the effects of social isolation, so all people are subject to the psychological effects caused during this pandemic period, regardless of their age or social groups (MARTINS et al., 2020).
The uncertainties and fears associated with the Coronavirus pandemic, together with the mass lockdowns and economic recession, have shown to have the potential to increase the incidence of suicide, as well as the mental disorders associated with suicide (MAVROUDEAS, 2020).
At different levels, the process of social isolation has had many impacts on people’s lives. In this sense, this research sought to understand the main effects of social isolation, analyzing the factors that cooperate or hinder this process, also correlating some socioeconomic characteristics of the population with factors related to social isolation.
The purpose of this article tends to the field of Psychology and deals with the perspective of the production of informative materials aimed at the mental health of the population present in a very delicate scenario regarding the confrontation of COVID-19. Talking about mental health in times of a pandemic is crucial, because the removal and/or social isolation is present among the preventive measures, which is considered one of the most impactful, since it can lead people to develop various emotional disorders, such as such as stress, anxiety, panic among others (RIBEIRO, 2020).
To obtain the results, we opted for the method of systematic literature review with a qualitative and exploratory approach, in which the authors aimed to: better understand the impacts on the daily life of the population in the face of social isolation by coronavirus, making it more explicit.
As for the nature, this research is characterized as applied, in relation to its approach as qualitative, with regard to its objectives the research is classified as descriptive and in terms of technical procedures as a survey.
Data collection was processed from a bibliographic survey by consultation, carried out by accessing digital platforms such as Estácio’s Virtual Library, EBSCO-Estácio Periodicals Portal, DynaMed Periodicals, Meu Pergamum e collection, SciELO, PubMed, Lilacs, Bireme, Google academic and Capes Journal.
The words: “COVID-19”, “pandemic”, “mental health”, “mental illnesses”, “social isolation” were used as descriptors in order to delimit the research. Publications in Portuguese, English and Spanish, published in indexed journals from 2004 to 2020, were considered.
The inclusion criterion was the admission of bibliographies that answered the guiding question linked to the general objective of this article: What are the psychological effects observed in the current literature on the social isolation caused by COVID-19? Then, the abstracts of the publications were read and those that did not meet criteria such as, for example, the mention of cases on Brazilian territory, or the presentation of cultural characteristics different from the Brazilian reality, were excluded.
Of the 110 publications raised using the descriptors, 60 were discarded for not meeting the inclusion criteria, finally, the last step referring to the full reading of the 50 remaining publications, made it possible to use 38 for the final production of this article and that fit the inclusion and exclusion criteria.
Table 1 – Selection of publications by theme, authors and year.
|Psychological effects of social isolation||Brooks et al.;
Zanon et al.;
|Mental health and the COVID-19 pandemic
DE MORAES, et al.;
YAO et al.;
HAO et al.;
KOZLOFF et al.;
FERNÁNDEZ-ARANDA et al.;
|Psychopathologies related to social isolation||MARTINS et al.;
BROOKS et al.;
RUBIN et al.;
NERIA et al.;
LIM et al.;
HOLMES et al..
|Strategies for monitoring psychopathologies arising from social isolation||BONANNO;
BONANNO et al.;
BONANNO, et al.;
|Impacts of COVID-19 in Brazil||AQUINO et al.;
GANEM et al..
There were authors who were used in more than one theme.
Next, the main observed effects of Covid-19 on mental health will be presented through the survey of the psychological effects of social isolation, the relationship between mental health and COVID-19, the main psychopathologies observed in social isolation and the strategies used in the follow-up of these psychopathologies.
3.1 PSYCHOLOGICAL EFFECTS OF SOCIAL ISOLATION
Brooks et al., (2020) conducted a review of recent literature on the psychological effects of social isolation on participants from ten countries who were subjected to isolation because they were exposed to Ebola, H1N1 Influenza, SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome), among other viruses from previous epidemics/pandemics, in which some predictive factors of psychological distress were observed.
Indicators about demonstrating a history of previous psychiatric disorder and being a health professional, for example, predicted lasting negative emotions. Health professionals, in addition to demonstrating a variety of negative emotions after social isolation (sadness, nervousness, guilt), indicated that they suffered greater stigma compared to other professionals. These data point to a greater availability to mental suffering and, consequently, a greater need for intervention.
Other factors observed as predecessors of greater mental suffering were the duration of the period of social isolation for more than ten days, fear of being infected or infecting others, frustration, boredom, lack of supplies and inadequate information about the disease (Brooks et al., 2020). Some of these indicators were linked to a greater number of symptoms of Post Traumatic Stress Disorder (PTSD), anxiety disorders and negative effects after the end of social isolation. Thus, financial losses and stigma, as well as other adverse conditions caused by social isolation, were identified as risk factors for the development of mental disorders and prolonged negative effects.
It was also identified that financial losses are the greatest risk factor in the development of mental disorders linked to families of low socioeconomic status, due to the representation of this income to these families and the impact of the loss of it (Brooks et al., 2020). Evidence shows that 30% of the sample of some studies on participants submitted to social isolation had criteria for the diagnosis of PTSD (ZANON et al., 2020).
The continuous prevalence of trauma symptoms in individuals who were exposed to pandemics, subject to periods of social isolation, can possibly be explained by the fact that fear and risk perception work as amplifiers of unclear information, which are common in initial periods of outbreaks (JOHAL, 2009). As well as the lack of knowledge about the disease and the absence of vaccines and medicines represent other relevant factors. In this sense, the coverage of pandemics by authentic news sources is a triggering factor for fear, as they report something important and, perhaps, the existence of a possible threat to the population, which is difficult to control.
3.2 MENTAL HEALTH AND THE COVID-19 PANDEMIC
Public health emergencies can affect the health, safety and well-being of individuals and communities through economic losses, job and school closures, inappropriate use of health care resources, and poor distribution of necessities. These effects can translate into a range of perceived emotional reactions through suffering or psychiatric conditions, unhealthy behaviors such as substance abuse, and non-compliance with public health guidelines (such as home confinement and vaccination) in people who contract the disease, and in the general population. Disaster mental health research has established that emotional distress is frequent in affected populations – a finding that is sure to resonate with populations affected by the Covid-19 pandemic (WHO, 2020a).
The Covid-19 pandemic has alarming implications for individual and collective health and for emotional and social functioning. Health care providers, already overburdened, in addition to providing health care services, have an important role in monitoring psychosocial needs and providing psychosocial support to their patients, health professionals and the public – activities that must be integrated into care general medical care for a pandemic (DE MORAES et al., 2020).
People with pre-existing mental disorders have reported increased symptoms and worse access to services and support since the beginning of the COVID-19 pandemic (YAO et al., 2020). Early discharge from psychiatric units and interruption of face-to-face psychiatric care have become common, with negative consequences which can include relapses, suicidal behavior, lack of access to medical care and social isolation. Quarantine and lockdown can particularly affect people with pre-existing mental health issues: increased symptoms of anxiety and depression and high rates of post-traumatic stress disorder and insomnia have been reported. (HAO et al., 2020).
At the same time, physical distancing has reduced the availability of many family, social and psychiatric supports. People with severe mental illness and associated socioeconomic disadvantages are particularly at risk from the direct and indirect effects of the pandemic. (KOZLOFF et al., 2020). Likewise, increased symptoms and vulnerability have been reported during the COVID-19 pandemic in people with eating disorders, autism spectrum disorder, dementia, and intellectual and developmental disabilities. (FERNÁNDEZ-ARANDA et al., 2020). Home confinement, disruption of daily routine and physical distancing can all exacerbate these conditions and pose a challenge for service users and caregivers.
Many countries have dedicated teams to provide mental health support for health professionals and psychiatric liaison services. The support needed depends on the stage of the pandemic. Many questions remain about how to mitigate the effects of the COVID-19 pandemic on mental health. Mental health professionals with experience in the social sciences and community services should also advise regulators to develop, implement and evaluate strategies for dealing with the pandemic and its aftermath.
For people in acute distress who are at risk of developing long-term illness and those who do not trust or engage with conventional mental health services, facilitating diverse and flexible access to mental health care is particularly important. Community-led organizations, local users and families, and small, independent peer-support initiatives mobilized quickly to provide immediate help and guidance during the pandemic. These community support services have proactively responded to COVID-19 differently from conventional clinical services and could cost-effectively expand to support an expected increase in demand for services (CARR, 2020). However, they may not be appropriate or sufficient for everyone and therefore should complement, but not replace, conventional mental health care.
3.3 PSYCHOPATHOLOGIES RELATED TO SOCIAL ISOLATION
Much of the news published on COVID-19 is distressing and sometimes the news is associated with rumors, which is why anxiety levels rise when a person is constantly exposed to COVID-19 news. Misinformation and fabricated reports about COVID-19 can exacerbate depressive symptoms in the general population.
Emerging research on the psychological effects of COVID-19 has primarily focused on understanding excessive fear or anxiety reactions. An equally important but neglected phenomenon concerns the absence of fear and anxiety in the face of COVID-19; in fact, people with low levels of anxiety about an infectious outbreak are less likely to adhere to public health recommendations (eg, social distance).
In underdeveloped and developing countries, which includes Brazil, the epidemic conditions of COVID-19 impose greater psychological effects on the population, since these countries are also affected by many other infectious diseases such as endemic diseases that are transmitted by vectors and that even today it still has a high incidence in these populations. Uncertainty about health status, patient follow-up, treatment care, and inefficiency in these communities can also increase the vulnerability of these communities to the psychological effects of COVID-19 (MARTINS et al., 2020).
Nervousness and anxiety in a society affect everyone to a great extent. Recent evidence suggests that people who are kept in isolation and quarantine experience significant levels of anxiety, anger, confusion and stress (BROOKS et al., 2020). In general, all studies that have examined psychological disorders during the COVID-19 pandemic have reported that affected individuals experience various symptoms of mental trauma, such as emotional distress, depression, stress, mood swings, irritability, insomnia, attention deficit disorder, of hyperactivity, post-traumatic stress and anger (RUBIN et al., 2020).
Research has also shown that frequent exposure to the media can cause distress (NERIA et al., 2011). However, in the current situation, it is challenging to accurately predict the psychological and emotional consequences of COVID-19. Results from epidemiological studies show that women are at a higher risk of depression. Women are more vulnerable to stress and post-traumatic stress disorder than men (LIM et al., 2018).
Recent studies have revealed an association between medical history and increased anxiety and depression caused by the spread of COVID-19. Previous research work has shown that medical history and chronic illness are associated with increased levels of psychiatric distress. People with a history of medical problems and with poor health may feel more vulnerable to a new disease (HOLMES et al., 2020).
3.4 STRATEGIES FOR MONITORING PSYCHOPATHOLOGIES ARISING FROM SOCIAL ISOLATION
The main psychological task for most people during the pandemic is to keep suffering to a minimum. However, in the face of the uncertainty caused by the pandemic, questions abound. How common will resilience be? What can individuals do in the face of the COVID-19 pandemic to maintain resilience? COVID-19-specific studies that can answer these questions are just beginning. However, previous research related to disease outbreaks and natural disasters has provided important information that can provide guidelines to help us overcome the pandemic. In this commentary, we address these important questions and suggest some important research directions.
Studies on exposure to extreme stress, such as disease outbreaks, reported a higher prevalence of psychopathology and a lower rate of resilience compared to studies that examined only moderately aversive events. Across all types of studies and modeling approaches, the proportion of resilient individuals averaged around two-thirds (BONANNO, 2004).
For those infected with COVID-19, it may be especially important to mobilize social support, increase help-seeking behaviors, and maintain ongoing physical care to maintain resilience (BONANNO et al., 2008).
At the family level, studies have identified some resilience factors, such as adaptability, family cohesion, good communication and adequate financial management (BLACK; LOBO, 2008). While these studies contribute to our understanding of individual trajectories, few studies have specifically examined resilient outcomes at the household level (BONANNO et al., 2015). Given that many individuals are quarantined with family members, it is important to consider pathways to resilience at the family level.
At the community level, resilient outcomes are more likely to occur in communities with greater social cohesion, lower crime rates and less exposure to disasters. Other important factors include the possible negative impact of health disparities such as access to health care and socioeconomic status on fear and anxiety (BONANNO et al., 2015). Research aimed at better understanding the origins of health disparities in the context of COVID-19, the effects of perceived health inequality on psychopathology, and associated policies that strive to bridge the inequality gap are crucial to maintaining community resilience.
3.5 IMPACTS OF COVID-19 IN BRAZIL
Brazil recorded the first case in Latin America in February 2020, after laboratory confirmation of COVID-19, the patient received standardized care by epidemiological surveillance, remaining in home isolation, while family members who had contact with the subject, at the hospital where he was treated and on the return flight from Italy, were investigated. Since then, the epidemic has spread throughout the country. It is important to note that as Brazil has not adopted comprehensive testing strategies in the population, there is a high possibility of underreporting in the number of cases and deaths (AQUINO et al., 2020).
Since technological advances occur as a result of advances in human and social policies and practices, it is understood that mental health is essential for maintaining human creativity and productivity capacities. In this way, the study is justified by the need to better target and guide campaigns and proposals to control the spread of COVID-19, since the levels of mental health of the population are reflected in the behavior of citizens, who can comply more or less to distancing policies.
Although Law nº 13.979/2020, which deals with measures to combat COVID-19 in Brazil, has been in force since February 7, that is, since the moment before the official start of the epidemic, the president of the republic has underestimated its relevance, while remaining one of the few world leaders who deny the threat it poses. There are several journalistic articles communicating their opposition to the measures adopted in states and municipalities and encouraging their supporters on social media to fail to comply with the recommendations of social distance. A clear political impasse was established between the president and the then Minister of Health, who defended the measures guided by the WHO and supported the stricter local and regional initiatives of COVID-19 control measures (AQUINO et al., 2020).
Inserted in this political scenario, in addition to the health crisis, an important political crisis, the implementation of control measures, which include social distancing, has been guaranteed by governors and mayors, especially in the most affected states. The administrative autonomy of states and municipalities in the areas of health, education and commerce, provided for in the Federal Constitution, reduces the occurrence of direct interference by the federal government in local government decisions. Therefore, the subject of discussion by the Federal Supreme Court. However, until then, the recognition of the autonomy of states and municipalities regarding the adoption of emergency measures related to public health has prevailed.
Most states and the Federal District have adopted practices and measures to minimize the movement and agglomeration of people to a greater or lesser extent. However, the Federal Government, by underestimating the importance of social distancing and opposing the measures adopted by states and municipalities, had a loss in the population’s adherence to them. In this sense, a Brazilian study applied mathematical modeling to estimate the effect of social distancing measures on the Metropolitan Region of São Paulo (AQUINO et al., 2020).
This study showed that, if social distancing measures were not adopted, the capacity of ICUs for the treatment of COVID-19 would be exceeded in the first month by about 130%, while in the second month this would correspond to 14 times. It also suggests that “the set of social distancing measures implemented (and their maintenance at the moment) could avoid overloading the health system (keeping the occupation at 76%) and the death of almost 90,000 people throughout the epidemic” ( AQUINO et al., 2020 p. 2429). In addition, the study indicates the use of SARS (Severe Acute Respiratory Syndromes) hospitalization data for monitoring the impact of social distancing measures (GANEM et al., 2020).
According to the most recent news, the COVID-19 epidemic in Brazil is still in its first phase, and the political crisis, fueled by the replacement of the Minister of Health, adds more insecurities regarding the policies that may be adopted by the Federal Government. Scientific surveys suggest that the combination of case isolation, contact quarantine and expanded social distancing measures, especially those that reduce social contacts by at least 60%, have the potential to minimize the transmission of the disease. Although little explored in the literature on the subject in the Brazilian context, the previous observation of Asian and European countries suggests that social distancing strategies should be stimulated and applied and coordinated between different governmental spheres and regions aiming to reach the end of the epidemic as soon as possible as soon as possible, as well as to prevent further waves of disease contagion.
Its implementation in Brazilian reality is undoubtedly a great challenge. The country’s social inequality, with many people in poverty and the growing share of people living on the streets, added to the large number of individuals deprived of their liberty, can contribute to the transmission and make it difficult to implement social distancing. In addition, the important part of informal workers requires that, in order to guarantee the sustainability and real effectiveness of the COVID-19 control measures, social protection policies and support to individuals in vulnerable situations are applied. Policies such as the minimum income that certify the protection of workers who have formal employment relationships are essential to guarantee people’s survival, not only while restrictions on the development of economic activities persist.
Even though social isolation is considered a source of anxiety and stress for the population, this variable is not significantly identified in the regression model. Such surveys may suggest that social distancing and the restriction of physical contact between people during the pandemic are not intrinsically a risk factor for mental illness; but rather that other factors that permeate this context influence the development of such a disease. Financial losses due to the effects of the disease on the local economic scenario and, also, exposure to negative information about COVID-19 are factors that provide risks to mental health. Thus demanding special attention to economic factors and the loss of family income, in order to reinforce the need for public policies and financial aid benefits during this period.
Thus, as indicated by the World Health Organization, it appears that mental and behavioral disorders represent one of the main causes of absence from work. As a result, it is identified that the provision of good mental health rates helps preventive behavior and the maintenance of the population’s health, enabling these people to be able to return to their activities soon after the pandemic, which is essential to recovery of the country’s economy.
COVID-19 not only causes physical health problems, it also results in a number of psychological disorders. The spread of the new Coronavirus can impact the mental health of people in different communities. Thus, it is essential to preserve the mental health of individuals and develop psychological interventions that can improve the mental health of vulnerable groups during the COVID-19 pandemic. Therefore, it can be concluded that the COVID-19 pandemic can affect the mental health of individuals and different communities.
In the current crisis, it is essential to identify individuals subject to psychological disorders in different groups and in different strata of the population, so that, with adequate psychological strategies, techniques and interventions, the mental health of the population in general is preserved and improved. What most are feeling are the effects of transient losses.
The economic implications of the COVID-19 pandemic are serious. It is important to be aware of the risks of promoting cheap solutions to expand access to mental health care. Low-quality mental health care based on accessibility without quality assessment or monitoring of needs and efficiency will only increase inequalities and worsen mental health.
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 Graduated in Psychology at Universidade Estácio de Sá, and Graduated in Technology in Occupational Safety at Centro Universitário Gama e Souza.
 Graduated in Psychology at Universidade Estácio de Sá, and graduated in Human Resources Management at Universidade Estácio de Sá.
Sent: December, 2020.
Approved: January, 2021.