Rapid Systematic Review: The Impact of Social Isolation and Loneliness On The Mental Health of Children and Adolescents in The Context of COVID-19 (2020)

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REVIEW
Rapid Systematic Review: The Impact of Social Isolation

and Loneliness on the Mental Health of Children and
Adolescents in the Context of COVID-19
Maria Elizabeth Loades, DClinPsy, Eleanor Chatburn, MA, Nina Higson-Sweeney, BSc,
Shirley Reynolds, PhD, Roz Shafran, PhD, Amberly Brigden, MSc, Catherine Linney, MA,
Megan Niamh McManus, BSc candidate, Catherine Borwick, MSc, Esther Crawley, PhD
Objective: Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how
loneliness and disease containment measures impact on the mental health in children and adolescents.
Method: For this rapid review, we searched MEDLINE, PsycInfo, and Web of Science for articles published between January 1, 1946, and March 29,
2020. Of the articles, 20% were double screened using predefined criteria, and 20% of data was double extracted for quality assurance.
Results: A total of 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the
mental health of previously healthy children and adolescents (n ¼ 51,576; mean age 15.3 years). In all, 61 studies were observational, 18 were lon-
gitudinal, and 43 were cross-sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retro-
spective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias, although longitudinal studies were of better
methodological quality. 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. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness.
Conclusion: Children and adolescents are probably more likely to experience high rates of depression and most likely anxiety during and after
enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventive support and early intervention where
possible and be prepared for an increase in mental health problems.
Key words: loneliness, pandemic, COVID-19, disease containment, mental health
J Am Acad Child Adolesc Psychiatry 2020;59(11):1218–1239.
he COVID-19 pandemic has resulted in gov- experiencing anxiety over a health threat and threats to
T ernments implementing disease containment
measures such as school closures, social
distancing, and home quarantine. Children and adolescents
family employment/income.
Social distancing and school closures are likely to result
in increased loneliness in children and adolescents whose
are experiencing a prolonged state of physical isolation from usual social contacts are curtailed by the disease contain-
their peers, teachers, extended families, and community ment measures. Loneliness is the painful emotional experi-
networks. Quarantine in adults generally has negative psy- ence of a discrepancy between actual and desired social
chological effects including confusion, anger, and post- contact.4 Although social isolation is not necessarily syn-
traumatic distress.1,2 Duration of quarantine, fear of onymous with loneliness, early indications in the COVID-
infection, boredom, frustration, lack of necessary supplies, 19 context indicate that more than one-third of adolescents
lack of information, financial loss, and stigma appear to report high levels of loneliness5,6 and almost half of 18- to
increase the risk of negative psychological outcomes.1 Social 24-year olds are lonely during lockdown.7 There are well
distancing and school closures may therefore increase established links between loneliness and mental health.8
mental health problems in children and adolescents, already The purpose of this review was to establish what is
at higher risk of developing mental health problems known about the relationship between loneliness and
compared to adults3 at a time when they are also mental health problems in healthy children and adolescents,
1218 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry
Volume 59 / Number 11 / November 2020
REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH
and to determine whether disease containment measures A truncated quality assessment was conducted by one
including quarantine and social isolation are predictive of author (SR) using criteria adapted from the National In-
future mental health problems. We included cross-sectional, stitutes of Health (NIH)14 (Table 1).
observational, retrospective, and case control studies if
studies included mainly children and adolescents who had Data Synthesis
experienced loneliness or had used validated measures of We conducted a narrative synthesis within the following
social isolation and mental health problems. To capture the categories: (1) the impact of loneliness on mental health in
possible effects of social isolation and the expected mediator healthy populations (further divided into cross-sectional and
(ie, loneliness) on mental health problems, we included longitudinal evidence); (2) pandemic-specific findings; and
search terms to capture these two areas. (3) intervention studies.
METHOD RESULTS
We conducted a rapid review to provide a timely evidence We located 4,531 articles (Figure 1), of which 83 articles (80
synthesis to inform urgent healthcare policy decision mak- studies) met the inclusion criteria. Of these, 18 articles (17
ing.9 A rapid review adheres to the essential principles of studies) reported on the impact of loneliness in individuals
systematic reviews, including scientific rigor, transparency, with a variety of health conditions, including mental health
and reproducibility. 9,10 It uses “abbreviated” systematic problems (12 studies), physical health problems (one study)
review methodology, including limiting search criteria, and neurodevelopmental conditions (4 studies). The
faster data extraction, and using narrative synthesis remaining 65 articles reported on 63 studies that examined
methods.11,12 the impact of loneliness or disease containment measures on
healthy children and adolescents. For the purposes of this
Search Strategy and Selection Criteria rapid review, we will focus our analyses on these 63 studies.
Table S1, Table S2, and Table S3, available online, Figure 1 provides a PRISMA flow diagram showing
provide the full search strategy. Briefly, we searched search results.15
MEDLINE, PsycInfo, Web of Science, and the Cochrane The 63 studies were mainly from the United States,
Library. Our search terms were informed by recent rapid China, Europe, and Australia. Included studies were also
reviews in the COVID-19 context1 and included defini- conducted in India, Malaysia, Korea, Thailand, Israel, Iran,
tions of loneliness and social isolation to capture the and Russia. A total of 61 studies were observational, and 2
impact of social distancing and school closures. Terms studies reported on interventions. Of the 61 observational
captured “children” or “adolescents” AND “quarantine” studies, 43 studies were cross-sectional only, 6 were longi-
or “social isolation” or “loneliness” AND mental health tudinal only, and 12 reported both cross-sectional and lon-
related terms with a focus on the most common mental gitudinal findings. One study was a retrospective study after a
health problems in this age group, namely, depression pandemic. In cross-sectional studies, likely confounders (eg,
and anxiety. adversity, socioeconomic status [SES]) were rarely controlled
Peer-reviewed studies were selected according to the for, meaning that the association between loneliness and
following inclusion criteria: published between 1946 and mental health outcomes in these studies is very likely to be
March 29, 2020; reported primary research; included pre- inflated.16 Four longitudinal studies used multi-informant
dominantly children/adolescents (mean age <21 years)13; approaches, including self-report and parent and/or teacher
published in English (Web of Science only); participants report to assess mental health outcomes. Importantly, they
had experienced either social isolation or loneliness; and typically assessed and controlled for confounds and could
valid assessment of depression, anxiety, trauma, obsessive- assess the most plausible direction of causality between
compulsive disorder (OCD), mental health, or mental loneliness/social isolation and mental health.
well-being.
Impact of Loneliness on Mental Health
Study Selection and Data Collection Table 217-60 and Table 361-79 describe the 60 studies that
We checked 20% of all study eligibility results (both examined the impact of loneliness on mental health. A total
included and excluded) to ensure adherence to the eligibility of 53 studies stated that they measured the impact of
criteria. Data were extracted into a purpose-designed data- loneliness on mental health. Seven studies stated that they
base. A random 20% of the data was double-entered to measured the impact of social isolation39,45,50,59,69,70,72 on
ensure accuracy. mental health, but the social isolation measures used were
Journal of the American Academy of Child & Adolescent Psychiatry www.jaacap.org 1219
LOADES et al.
TABLE 1 Quality Assessment Tool Adapted From National Institutes of Health14
Were the exposure measures (independent variables) Yes: 1

clearly defined, valid, reliable, and implemented No: 0
consistently across all study participants?
Was the exposure measure objective (ie, not self-report) Yes: 1
No: 0
Were the outcome measures (dependent variables) Yes: 1
clearly defined, valid, reliable, and implemented No: 0
consistently across all study participants?
Was the outcome assessed objectively? Yes or by blinded assessors: 2

By another individual, eg, parent: 1
No, ie, self-report: 0
Were key potential confounding variables measured No or unclear: 0
and adjusted statistically for their impact on the Some attempt, eg, SES,
relationship between exposure(s) and outcome(s)? demographics: 1
Reasonable or comprehensive, eg, baseline
depression for longitudinal studies, other
exposure to stress or adversity, negative
affectivity: 2
Is a longitudinal design with exposure measured Yes: 1
before outcome? No: 0
Longitudinal only
Was loss to follow-up after base line 20% or less? Yes: 1

No: 0
Were the exposure(s) assessed more than once over time? Yes: 1
No: 0
Note: Exposure measures indicate independent variables. SES ¼ socioeconomic status.
either subscales or questions from loneliness scales, or strongly examined symptoms of anxiety. Those that did found small
overlapped with the construct of loneliness. Therefore, we have to moderate associations between anxiety and loneliness/
considered them together with studies that measured loneli- social isolation (0.18 r 0.54). The duration of loneli-
ness. Participants were mainly school or university students or ness was more strongly associated with anxiety than in-
taking part in longitudinal cohort studies. tensity of loneliness.25,41 Social anxiety was moderately to
A total of 45 studies examined the cross-sectional rela- strongly associated with loneliness/social isolation (0.33
tionship between depressive symptoms and loneliness r 0.72) and there were moderate associations between
and/or social isolation.17,19,20-24,28-30,32-38,40-42,44,46-49, generalized anxiety and loneliness/social isolation (r ¼ 0.37,
51-56,58,61,63,66,68,73-79
The majority were conducted in 0.40).45,30 One study found a small association between
adolescent (N ¼ 23) and young adult (N ¼ 16) samples, panic and loneliness (r ¼ 0.13).75,76 In the single study that
although 6 studies included children under the age of 10 reported odds ratios, being lonely was associated with
years. Most reported moderate to large correlations (0.12 increased odds of being anxious by 1.63 to 5.49 times.51
r 0.81), and most included a measure of depressive Positive associations were also reported between social
symptoms. Two studies reported odds ratios, with those isolation/loneliness and suicidal ideation,20,21,34 self-
who were lonely 5.846 to 40 times51 more likely to score harm,34 and eating disorder risk behavior.34 Negative as-
above clinical cut-offs for depression. The associations were sociations were reported between social isolation/loneliness
stronger in older participants35 and in female participants.47 and well-being26,27 and mental health.50
However, the strength and direction of the associations did Eighteen studies followed participants over time
not differ by age of the sample. Fewer studies (N ¼ 23) (Table 3).61,62,64,65,67-72,74-77,79,80 Several of these were
FIGURE 1 PRISMA Flow Diagram Showing Search Results
conducted in childhood (N ¼ 6), or adolescence (N ¼ 8), depression, although this did not hold in a cross-lagged
although three were in university students. Most (N ¼ 12) model,69 suggesting a possible bidirectional relationship
had only one follow up time point, usually between 1 and 3 between the variables. A study of university students found
years. evidence of a sex difference, with loneliness being associated
In all, 12 of the 15 studies found that loneliness is with later depression in female participants but not in male
associated with depression and explained a significant participants.70 In a large longitudinal cohort of vulnerable
amount of the variance in severity of depression symptoms young people, aged 11 to 17 years, after controlling for
several months to several years later.61,62,64,65,67-72,74-77,79,80 caregiver neglect and other relevant covariates, a substantial
Two studies found that loneliness in childhood at age 5 increase in self-reported peer isolation (1 SD) was associated
years was not associated with depression several years with an increase in depression symptoms (0.49 SD).62
later,73,74 although other studies that assessed loneliness Duration of peer loneliness rather than intensity of peer
during childhood found evidence that it is associated with loneliness was associated with depression 8 years later (ie,
subsequent depression.61,64 One large study of adolescents from age 5 to age 13 years); in contrast, family-related
(n ¼ 3,088) found that loneliness was not associated with loneliness was not independently associated with subse-
depression 1 year later.63 There were mixed findings in quent depression.73
another large study of adolescents (n ¼ 541), which found a Three of the four studies that examined the longitudinal
significant association between loneliness and subsequent effect of loneliness on anxiety found that loneliness was
1222
LOADES et al.
TABLE 2 Cross-Sectional Studies Examining Social Isolation/Loneliness
Associations between social isolation/

Child (11 y)/ loneliness and mental health [r (p)] unless
adolescent Social otherwise stated
Total N (% (1218 y)/ Age range isolation/
Authors (year), male Young adult at Mean loneliness Mental health Other mental
country Sample participants) (19 y) baseline y, age (SD) measure measure Depression Anxiety health
www.jaacap.org
Social isolation/loneliness and concurrent mental health symptoms

Alpaslan et al. School 487 (41.7) Adolescent 14e19 16.07 (1.05) UCLA Loneliness CDI, Male
(2016),17 Turkey students Scale SDQ participants:
OR 1.21
Female
participants:
OR 1.05
Arslan (2020),18 School 244 (47.5) Adolescent 14e18 16.27 (1.02) 8-item UCLA Youth Lon - mental
Turkey students Loneliness Internalizing health
Scale- and problems 0.41
Short Form Externalizing (<.001), b [
behavior 0.22 (<.01).
screeners
Baskin et al School 294 (NS) Adolescent NS Estimated 13.11 (0.469) Children’s BDI-Y R2 [ .28 (<.001).
(2010),19 students 13-14 Loneliness Moderated by
USA Scale (CLS) belongingness
Brage et al. School 156 (39.7) Adolescent 11e18 14 (1.56) Loneliness CES-D (child 0.646, (<.001)
(1993),20 Brage students Inventory version)
Journal of the American Academy of Child & Adolescent Psychiatry
et al. Short Form

(1995),21 USA
Chang et al. University 228 (23.7) Young adult 18e28 19.69 (1.38) Revised UCLA BDI, Frequency 0.69 (<.001). Lon - suicidal
(2017),22 students Loneliness of Suicidal Regressions: ideation 0.52
USA scale Ideation 47% shared (<.001).
Inventory variance Lon R2 [
26.9% variance
in suicidal
ideation
Doman and Le University 275 (42.3) Young adult 19e34 20.92 (NS) Le Roux Psychological 0.517 (<.01). Anx: 0.365, (<.01)
Roux (2012),23 students Loneliness General Well- 26.7% shared
South Africa Questionnaire Being Index: variance.
anxiety D
depressed
mood
Erdur-Baker and School 144 (54.2) Adolescent 11e15 12.5 (1.61) LSDQ CDI 0.51 (NS)
Bugay (2011),24 students
Turkey
(continued )
TABLE 2 Continued
Other mental
Authors (year), male Young adult at Mean loneliness Mental health
Depression Anxiety health
country Sample participants) (19 y) baseline y, age (SD) measure measure

Ginter et al. School 144 (45.1) Adolescent 11e16 13.90 (1.5) The Loneliness Revised Not lonely group:
(1996),25 Israel students Rating Scale Children’s Frequency of
(subscales for Manifest Lon-Anx 0.33
Frequency, Anxiety Scale (<.001),
Intensity, (RCMAS) Intensity of Lon-
Duration) D Anx 0.18 (< .05)
additional 2 Lon group >
questions Anx t [
3.81 (<.001),
Heredia et al. School 394 (50.2) Adolescent 12e15 13.52 (0.63) LSDQ Well-being - LonLwell-being
(2017),26 students World Health 0.111, (<.05)
USA Organisation Hierarchical
Well-being linear
Index (WHO-5) regression:
loneliness
accounted for
1.3% of
variance in
well-being
Houghton et al School 1143 (46.3) Adolescent 10.1e16 13.20 (1.2) Perth Aloneness Warwick- Friendship
(2016),27 students Scale (includes Edinburgh related
Australia (friendship- Mental Well LonLwell-
related Being Scale being 0.36

loneliness (WEMWBS) (< .001)
subscale)
Hudson et al. Adolescent 21 (0) Adolescent 16e19 18 (1.14) Revised UCLA CES-D (child 0.53 (<.05)
(2000),28 mothers post- Loneliness version)
USA partum recruited Scale
from primary
www.jaacap.org
health care
practices
Hutcherson and Female school 100 (0) Child 9e12 10.52 (1.04) Loneliness Social Anxiety 0.62 (<.001). Social anx: 0.65
Epkins (2009),29 students (and Scale (LS) Scale for Controlling for (<.001)
USA their mothers) Children- social Anx Controlling for
Revised 0.36 (<.001) Dep
(SASC-R), CDI 0.49 (<001)
Jackson and University 293 (49.8) Young adult 17e26 Median 19 Revised UCLA Symptom 0.54 (<.001). General Anx: Obsessive-
Cochran (1991),30 students Loneliness Checklist-90 Controlling for 0.37 (<.001) compulsive
USA Scale (SCL-90) overall disorder
symptoms 0.40 (<.001)
1223
0.23 (<.01)
(continued )
1224
LOADES et al.
TABLE 2 Continued
Other mental
www.jaacap.org

Johnson et al University 124 (43.5) Young adult 17e21 Male participants UCLA Loneliness Franke and Soc anx: F6,115 [
(2001),31 students 19.41 (NS) Scale (Revised) Hymel Social 4.23 (<.05)
USA Female Anxiety and b [ 0.24 (<.01)
participants Social R2 [
19.69 (NS) Avoidance 0.31 (<.01)
Scale
Kim (2001),32Korea University 452 (44.7) Young adult 18e25 20.9 (2.0) Revised UCLA BDI Male
students Loneliness participants:
Scale b [ 0.49
(<.01). 24%
shared
variance
Koenig et al. School 397 (38.3) Adolescent 14e18 NS Revised UCLA BDI Male
(1994),33USA students Loneliness participants:
Scale 0.55 (<.001)
Female
participants:
0.49 (<.001)
Lasgaard, School 1009 (43) Adolescent NS 17.11 (1.11) SELSAeSF (3 BAI-Y, 23% of the Anx: 14% shared Suicidal ideation
Goosens et al. students subscales: BDI-Y, variance Peer- variance Peer- (SI): 14%
(2011),34Denmark social lon, Social related lon e related Lon shared
family-related Interaction Dep b[ 0.26, b [ .21 r2 [ variance. Peer-
lon, Anxiety Scale r2 [ 0.076; .045. Family- related Lon e
romantic lon) (SIAS), family-related related Lon SI b [ 0.17,
Suicide lon e Dep b [ b [ .21 r2 [ 0.027.
Ideation 0.29, r2 [ .045 Family-related
subscale from r2 [ 0.089 Social Anx: Lon e SI b [

the Suicide 21% shared 0.26, r2 [ .061
Probability variance. Peer- Self-harm: 10%
Scale, related Lon shared
Deliberate b [ .33 r2 [ variance.
self-harm .109. Romantic Family-related
(DSH), Lon Lon b [ 0.31,
Risk Behavior b [ 0.19 r2 [ 0.081.
related to r2 [ 0.040. Eating
Eating disorder (ED):
Disorders risk behavior:
(RiBED-8) 6% shared
variance
Family related
lon e ED b [
.22, r2 [ .041
(continued )
TABLE 2 Continued
Other mental

Lau et al. School 6,356 (NS Child/adolescent 9e14 NS Marcoen and CDI, Primary school
(1999),35Hong students estimated 48) Brumagne’s RCADS students:
Kong Loneliness 0.71 (<.001)
Scale (3 Peer-related
subscales: Lon 0.67
Peer-Related (<.001), parent-
Lon, Parent- related Lon
Related Lon, 0.49 (<.001),
and Aloneness) aloneness e
0.65 (<.001).
46% shared
variance
Secondary
school
students:
0.81 (<.001)
Peer-related
Lon 0.77,
(<.001), parent-
related Lon
0.56 (<.001),
aloneness e
Dep 0.72
(<.001)

65% shared
variance
Majd Ara et al. Female school 301 (0) Adolescent 15e18 16.6 (1.1) Children’s DASS-21 0.66 (NS).
(2017),36 Iran students Loneliness
Scale
www.jaacap.org
Mahon et al. School 127 (43.3) Adolescent 12e14 12.9 (0.63) Revised UCLA Profile of Mood 0.57 (<.001).
(2001),37USA students Loneliness States -
Scale Depression-
Dejection
subscale
Markovic and School 157 (45) Adolescent NS 13.84 (.75) LSDQ YSR 0.39 (<.001) Anx: 0.35 (<.001)
Bowker (2015),38 students
USA
Matthews et al. Twin birth 2066 (49) Young adult 18 18.4 (0.36) Multidimensional Diagnostic 0.21 (<.001)
(2016),39 cohort Scale of Interview
UK Perceived Schedule
1225
Social Support
(MSPSS)
(continued )
1226
LOADES et al.
TABLE 2 Continued
Other mental
www.jaacap.org

McIntyre et al. University 1135 Young adult NS 20.78 (4.35) UCLA Loneliness PHQ-9, 0.58 (<.001) Anx: 0.54 (<.001)
(2018), UK students Scale GAD[-7, b[ b[
Self-harm (4 0.52 (<.001) 0.50 (<.001)
items)
Moore and Schultz School 99 (45) Adolescent 14e19 17 (0.98) UCLA Loneliness SDS, 0.66 (<.001). State anx: 0.48
(1983),41USA students Scale (ULS) D STAI Lon duration (<.001) Lon
frequency, 0.46, (<.001) duration 0.37
duration, Lon frequency (<.001)
characteristics -Dep Lon frequency
and perceived 0.70 (<.001) 0.48 (<.001)
causes of
loneliness
Mounts et al. University 350 (36) Young adult 18e19 NS Revised UCLA BDI, b [ 0.51, (<.001) Anx
(2006),42 students e Loneliness BAI b[
USA ethnically diverse Scale 0.30 (<.001)
sample
Neto and Barros School 487 (39.3) Adolescent NS Cape Verde 17.5 Revised UCLA Social Anxiety Social Anx
(2000),43 Portugal students (estimated (1.2): Portugal Loneliness subscale 0.33L0.35

15e18) 17.8 (1.0). Scale (<.001)
Purwono and Muslim school 453 (45.9) Adolescent 13e16 7th grade: 13.57 10 items from CES-D 0.59 (<.01).
French (2016),44 students (0.44) UCLA
Indonesia 10th grade: Loneliness
16.47 (0.43) Scale -
modified
Richardson et al. Community 528 (51) Child/Adolescent 10L12 11.18 (0.56) 3 Items from SCAS-Ce 0.46 (<.001). Social Anx
(2019),45 School subscales 0.50 (<.001).

Australia Belonging and generalized Generalized
Isolation Scale anx, social Anx Anx 0.42
and separation (<.001)
Anx 3 Separation anx
item SMFQ 0.41 (<.001)
Roberts and Chen School 2614 (n.s) Adolescent 11e14 NS (NS) 8 item UCLA CES-D, OR [ 5.8 (<.001) Suicidal ideation:
(1995),46USA students Loneliness 4 suicide items OR 5.0
Scale from Oregan
Adolescent
Depression
Project
(continued )
TABLE 2 Continued
Other mental

Singhvi et al. School 300 (50) Adolescent 15e17 NS Revised UCLA SDS, Male Male
(2011),47India students Loneliness Cohen’s participants: participants:
Scale Perceived 0.461(<.001) Lon associated
Stress Scale Female with perceived
participants: stress [t[1.50,
0.683 (<.001) p<.01,
Male b[-.108]
participants:
Lon associated
with Dep t [
6.32 (<.005)
b [ 0.461
Female
participants:
Lon associated
with Dep t [
11.38 (<.005)
b [ 0.683
Spithoven et al. NS Sample 1: 417 Adolescent NS Sample 1: 12.47 LACA e peer- Sample 1: CDI. Sample 1: 0.48
(2017),48 Belgium (48.4) (1.89) related Sample 2: Iowa (<.001)
and Netherlands Sample 2: Sample 2: loneliness short form of Sample 2:
1140 (48.7) 12.81 (0.42). subscale CES-D. 0.54 (<.001)
Stednitz and Epkins Community 102 (0) Child 9e12 10.46 (1) LSDQ CDI, 0.63 (<.001) Social anx: self-

(2006),49 sample Social Anxiety rated 0.72
USA Scale for (<.001).
Children e Mother-rated
Revised (child 0.36 (<.001)
and parent
versions)
www.jaacap.org
Stacciarini et al. Church and 31 (42) Adolescent 11e18 13.0 (2.0) Short version of SF-12 Health Mental health
(2015),50 community PROMIS Health survey r [ L0.38
USA (Latina/o Organisation (<.05)
immigrants) Social Isolation
(continued )
1227
1228
LOADES et al.
TABLE 2 Continued
Other mental
www.jaacap.org

Stickley et al. School Sample 1: 2205 Adolescent 13e15 NS Lon item from CES-D (minus ORs: 8.04L40.13 Anx: ORs:
(2016),51 students (NS) CES-D Lon item), 1.63L5.49
Czech, Russia Sample 2: 12 statement
and USA 1995 (NS) anxiety scale
Sample 3:
2050 (NS)
Swami et al. University 172 (41.8) Young adult 18e24 20.3 (1.25) Revised UCLA BDI 0.38 (<0.01).
(2007),52Malaysia students Loneliness
Scale
Thomas and School 103 (51.4) Child/Adolescent NS 13.73 (0.82) LSDQ YSR 0.42 (<0.1)
Bowker students (estimated
(2015),53USA 10-13)
Tu and Zhang University 444 (38.4) Young adult NS 19.02 (1.26) Revised UCLA CES-D (7 item g [ 0.517 (<.001) Stress:
(2014),54 students Loneliness version), b[ g [ 0.381
China Scale Perceived 0.833 (<.001) (<.001)
Stress Scale b[
0.297 (<.001)
Uba et al. (2012),55 School 242 (49.2) Adolescent 13e16 14.67 (1.27) Revised UCLA CDI 0.493 (<.01)
Malaysia students Loneliness
Scale
Vanhalst, Luyckx, University 370 (16.5) Young adult NS 18.22 (1.21) LACA CES-D Peer-related Lon
Raes (2012),56 students 0.58 (.001)
Belgium Parent-related
Lon
0.23 (<.001)
Wang and Yao Schools (left 442 (54) Child/Adolescent 8e16 11.5 (2.098) UCLA Loneliness Social Anxiety Social Anx:
(2020),57 China behind children Scale Subscale 0.332 (<.001)
in rural China)
Xu and Chen School 724 (59.5) Child/Adolescent 6e14 9.15 (1.79) LSDQ CES-D 0.492 (<.01)
(2019),58 students
China
Yadegarfard et al. Transgender 260 (100) Adolescent/ 15e25 20 (NS) SSA DASS-21 (short Transgender:
(2014),59 association and Young adult version), Social
Thailand university (male Positive and supportLDep
transgender and Negative (B [ L0.01)
cis gender) Suicide Lower social
Inventory support
associated with
higher negative
(continued )
TABLE 2 Continued
Other mental

risk factors
related to
suicidal
behavior (B [
0.13)
Cisgender:
Social
supportLDep
(B [ 0.23)
Lower social
support
associated with
higher negative
risk factors
related to
suicidal
behavior
(B [ 0.15)
Social Isolation/Quarantine in the Context of Infectious Disease
Sprang and Silman Parents of 398 (NS) Child NS NS Children PTSD-RI; PCL-C PTSD-RI: Children who experienced isolation/
(2013),60 children (who experienced quarantine were more likely to meet cut-off score for
USA, Canada, experienced pandemic; PTSD (30%) than those who had not been in
and Mexico H1N1/SARS/ 20.9% social isolation or quarantine; 1.1%; c2 [ 49.56 (<.001),
avian flu isolation and Cramer V [ 0.449

pandemics) 3.8% Mean scores in isolated/quarantined group (22.3)
quarantine were 4 times those in general group (5.5); t [ 6.59
(.000)
PCL-CL: Children who experienced isolation/
quarantine were more likely to meet cut-off score for
PTSD (28%); c2 [ 31.44 (<.001)
www.jaacap.org
Note: Anx ¼ Anxiety; BAI ¼ Beck Anxiety Inventory; BAI-Y ¼ Beck Anxiety Inventory for Youth; BDI ¼ Beck Depression Inventory; BDI-Y ¼ Beck Depression Inventory for Youth; CBCL ¼ Child
Behaviour Checklist; CDI ¼ Children’s Depression Inventory; CES-D ¼ Center for Epidemiologic Studies Depression Scale; DASS-21 Depression, Anxiety, and Stress Scale, Dep ¼ depression;
GAD-7 ¼ Generalized Anxiety Disorder – 7; Lon ¼ Loneliness; LSDQ ¼ Loneliness and Social Dissatisfaction Questionnaire; LACA ¼ Loneliness and Aloneness Scale for Children and
Adolescents; OR ¼ Odds Ratio; PCL-C ¼ PTSD Checklist Civilian Version; PHQ-9 ¼ Patient Health Questionnaire; PTSD-RI ¼ UCLA Posttraumatic Stress Disorder Reaction Index; RCADS ¼
Revised Children’s Anxiety and Depression Scale; SAS-A ¼ Social Anxiety Scale for Adolescents; SCAS-C ¼ Spence Children’s Anxiety Scale- Child; SDS ¼ Zung Self-rating Depression Scale;
SDQ ¼ Strengths and Difficulties Questionnaire; SELSA ¼ Social and Emotional Loneliness Scale for Adults; SMFQ ¼ Short Mood and Feelings Questionnaire-Child; SSA ¼ Social Support
Appraisals scale; STAI ¼ State Trait Anxiety Inventory; TRF ¼ Teacher Rating Form; YSR ¼ Youth Self-Report Form.
1229
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LOADES et al.
TABLE 3 Longitudinal Studies Examining Social Isolation/Loneliness and Subsequent Mental Health Outcomes
Child (11 y)/ Is social isolation/loneliness

adolescent Mean Social Cross- associated with later mental health?
Author Sample Total N (% (1218 y)/ age isolation/ Mental Sectional
(year), (selection male young adult Age (SD) loneliness health associations Length of
country criteria) participants) (19 y) range, y at T1 measure measures r (p) follow-up, y Depression Anxiety
Boivin et al. School 774 (51.8) Child 9e12 10.8 LSDQ CDI Lon-Dep 0.53 1 T1 Lon e T2 Dep: r [ 0.36 (p < .01)
www.jaacap.org
(1995),61 students (NS) (p < .001) T1 Lon accounted for 8.3% of

Canada variance in T2 Dep
Christ et al. National Survey 2776 (47) Adolescent 11e17 13.5 LDSQ 7 peer 4 items NS 7 Controlling for caregiver neglect
(2017),62 of Child and (NS) isolation from YSR and covariates, a 1-SD increase in
USA Adolescent items peer isolation was associated
Well-being (child with a 0.49-SD increase in
welfare cohort) depression
Danneel Longitudinal Sample 1: 1116 Adolescent Sample 1: Sample LACA peer- Samples 1 and Lon-Social 1 Not significant Lon /
et al. cohorts (51.1), 11e17 1: 13.79 related 3e anxiety 0.58 Social
(2019),63 Sample 2: 1423 Sample 2: (0.94) loneliness SAS-A; CES-D. r 0.67 anxiety
Belgium (47.6), 11e18 Sample subscale Sample 2 - CDI Lon-Dep 0.48 b [ 0.10
Sample 3: Sample 3: 2: 13.59 r 0.56 (p < .001)
549 (37.33) 12e17 (0.98) (all <.01)
Sample
3:
14.82
(0.79)
Fontaine School NS (52) Child NS NS LSDQ (T2) Internalizing NS 2-3 T2 Lon / Anx/Dep symptoms at T3
et al. students Estimated items from: g2 [ 0.18, z [ 2.60 (p < .01)
(2009),64 (longitudinal 5e9 CBCL (mother

USA cohort) T1 and T3);
TRF (teacher T1
and T2);
YSR (self T2
and T3)
Jones et al. Longitudinal 889 (50) Child 6 NS LSDQ CDI short form NS 9 Indirect effects T1 Lon / T2
(2011),65 cohort Suicidal thoughts through Dep
USA (b [ 0.06, p < .001)

Ladd and School 478 (50) Adolescent 12e18 12.0 LSDQ e Depression Lon-Dep 0.19 7 Changes in Lon associated with
Ettekal students (n.s) revised - 3 items CBCL (p < .01) changes in Dep reported by
(2013),66 (longitudinal items (parent); (parent), 0.38 teachers (r [ 0.63, p < .001) and
USA cohort) TRF (teacher); (p < .001) adolescents
YSR (self) (teacher) (r [ 0.65, p < .001), but not
0.62 (p < parents
.001) (self) (r [ 0.18,p ¼ .13)
Lalayants National Survey 356 (0) Adolescent 11e12 NS LSDQ CDI NS 1.5 T1 Lon / T2 Dep
and Prince of Child and AOR [ 2.93, CI [ 1.74L4.91
(2015),67 Adolescent (p < .001)
multiple Wellbeing (child T1 lonely female participants
countries welfare cohort) were 5.09 times more likely (CI
2.24L11.56 (p < .001) to be
depressed at T2
(continued )
TABLE 3 Continued
Lapierre College 346 (33.6) Young adult 17e20 19.11 UCLA 10-Item CES-D Lon-Dep 0.628 0.25 T1 Lon e T2 Dep (r [ 0.524, p <
et al. Students (0.75) Loneliness (T1), 0.666 (T2) .001)
(2019),68 Scale (p < .001) T1 Lon / T2 Dep b [ 0.21,
USA SE [ .05 (p < .001)
Lasgaard School T1: 1009 (43) Adolescent/ 15e26 17.11 SELSA-short BAI-Y, Lon-Dep 0.61 1 T1 Lon/ T2 Dep (r [ 0.37, p <
et al. students T2: 541 (40) Young adult (1.11) form; MSPSS BDI-Y (p < .0005) Lon- .0005)
(2011b),69 Anx 0.51 (p < Cross-lagged structural equation
Denmark .0005). modeling found T1 Lon did not
Soc supporte predict Dep at T2
Dep r [ L0.12,
L0.18, L0.28
(all p < .0005)
Liu et al. College 741 (28.3) Young adult NS 18.47 6 item index SDS NS 3 Female participants: T1 isolation
(2020),70 students (estimated (0.87) of social associated with increased Dep (b [
China 18L20) isolation 0.22, p < .001)
based on only Lon associated with increased Dep
child status, (b [ 0.23, p < .001)
number of Male participants: T1 isolation
friends, associated with increased Dep (b [
frequency of 0.25, p < .01)
contact with Lon did not predict Dep (b [ 0.14,
friends and p > .05)
family; UCLA
Loneliness
Scale
Mak et al. School 687 (47.7) Adolescent NS 11.27 LSDQ SAS-A Lon-social 1.5 (T2), 3 (T3) T1 Lon / T2

(2018),71 students (estimated (0.49) anxiety Social
USA (randomized 11e14) 0.41L0.45 Anxiety (b [
trial) (p < .01) 0.09, p <
.05).
T2 Lon / T3
Social
www.jaacap.org
Anxiety (b [
0.12, p < .01)
By gender:
T2 Lon / T3
Social Anx:
Boys (b [
0.22, p <
.001)
Girls (b [
0.01 p [ .79)
(continued )
1231
1232
LOADES et al.
TABLE 3 Continued
Matthews Twin birth 2232 (NS) Child 5 NS 6 items from MASC NS 7 T1 social
www.jaacap.org
et al. cohort CBCL isolation

(2015),72 (parent) and failed to
UK TRF (teacher) predict T2
Anx,
controlling
for T1 Anx
Qualter School 296 (49.3) Child 5 NS T1 and T2: T1: T-CARS T1 8 T1 Peer Lon-T2 Dep r [ 0.07
et al. students Peer and T2 and T3: Peer Lon- T1 Peer Lon-T3 Dep r [ 0.06
(2010),73 Parent DDPCA internalizing T2 Peer Lon e T3 Dep r [ 0.12
UK subscales symptoms 0.32 (p < .05)
LACA (p < .01) T1 Parent Lon e T2 Dep r [ 0.19,
Parent Lon- p < .01
Internalizing T1 Parent Lon-T3 Dep r [ 0.13
Symptoms 0.09. (p < .05)
T2 T2 Parent Lon-T3 Dep r [ 0.08
Peer Lon- Dep Structural model: Duration of
0.13 (p < .05) Peer Lon / T3 Dep T1 and T2
Parent Lon-Dep Peer Lon, Parent Lon (T1, T2, and
0.12 (p < .05) duration) did not independently
predict T3 Dep
Schinka Longitudinal 832 (53) Child 9 NS LDSQ T1: CBCL T3 2 (T2), T1 Lon-T3 Dep r [ 0.01
et al. cohort study (mother) Lon-Dep -0.10 6 (T3) T2 Lon-T3 Dep r [ L0.01
(2013),74 T3: (p < .01) T1 Lon-T3 Suicidal ideation r [
USA CDILShort LonL suicidal 0.00
form; Suicide ideation r [ T2 Lon-T3 suicidal ideation r [
items from 0.02 0.03
CBCL and YSR LonL suicide T1 Lon-T3 suicide attempt r [
attempt r [ 0.4 0.02
T2 Lon-T3 suicide attempt

r [ L0.01
Vanhalst, Community 389 (53) Adolescents 15 15.22 LACA Peer- 6 item Lon-Dep 5 T1 Lon / T2 Dep symptoms
Goosens sample via (0.60) related depression 0.34L0.50 (p < (B [ 0.13, p < .001)
et al. municipality loneliness questionnaire; .001)
(2013)75 registers subscale SCARED Lon- Perceived
and generalized stress 0.23 (p <
Vanhalst, anxiety, panic .001).
Klimstra and social Lon-
et al. anxiety Generalized Anx
(2012),76 subscales. 0.40 (p < .001),
Netherlands Lon-Panic 0.13
(p < .05),
LonL Social
phobia 0.47
(p < .001)
(continued )
TABLE 3 Continued
Vanhalst, University Sample 1: 514 Young adults Sample: NS Sample 1: 8- Sample 1: 12- Sample 1: 2 Sample 1:
Luyckx et al. students (10.9) 19.62 (0.62) item revised item CES-D Lon-Dep T1 lon e T2 Dep r [ 0.35 (p <
(2012)77 Sample 2: Sample 2: UCLA Sample 2: 20- 0.49L0.52 (p < .001)
Belgium 437 (17) 18.22 (1.21) Loneliness item CES-D .001) T1 lon e T3 Dep r [ 0.36 (p <
Scale. Sample 2: .001)
Sample 2: Lon-Dep r [ Lon / associated with Dep
LACA Peer- 0.40L0.60 across both time intervals.
related (p < .001) Sample 2: cross-lagged path from
loneliness Lon associated with Dep (b [
subscale 0.12, p < .05)
Wang et al. School 921 (48.3) Adolescents 12e15 12.98 Revised SCARED; T1 1 T1 Lon-T3 Dep 0.36 (p < .001) T1 Lon-T3
(2020),78 students (0.66) UCLA DSRSC (T1 Lon- Anx 0.40 T2 Lon-T3 Dep 0.46 (p < .001) Anx 0.29,
China Loneliness and T3) (p < .001) p<.001. T2
Scale (T1 Lon-Dep 0.57 Lon-T3 Anx
and T2) (p < .001) 0.36
(p < .001)
Zhou et al. School 866 (49) Adolescents 11e15 12.98 UCLA DSRSC (T3) T1 2 T1 Lon-T3 Dep r [ 0.38 (p < .001)
(2020),79 students (0.67) Loneliness Lon-Dep r [ Controlling for age, sex, and SES,
China Scale (T1 0.56 (p < .001) T2 Lon-T3 Dep adjusted b [ 0.34
and T2) (p < .001)
Note: Anx ¼ Anxiety; BAI-Y ¼ Beck Anxiety Inventory for Youth; BDI-Y ¼ Beck Depression Inventory for Youth; CBCL ¼ Child Behaviour Checklist; CDI ¼ Children’s Depression Inventory;
CES-D ¼ Center for Epidemiologic Studies Depression Scale; DDPCA ¼ Depression Profile for Children and Adolescents; Dep ¼ depression; DSRSC ¼ Birleson Depression Self-Rating Scale
for Children; Lon ¼ Loneliness; LSDQ ¼ Loneliness and Social Dissatisfaction Questionnaire; LACA ¼ Loneliness and Aloneness Scale for Children and Adolescents; MASC ¼ Multidi-
mensional Anxiety Scale for Children; MSPSS ¼ Multidimensional Scale of Perceived Social Support; NS ¼ not specified; SAS-A ¼ Social Anxiety Scale for Adolescents; SCARED ¼ Scale for
Child Anxiety Related Emotional Disorders; SES ¼ socioeconomic status; SDS ¼ Zung Self-rating Depression Scale; SELSA ¼ Social and Emotional Loneliness Scale for Adults; T-CARS ¼

Teacher-Classroom Adjustment Rating Scale; T1 ¼ Time 1; T2 ¼ Time 2; T3 ¼ Time 3; TRF ¼ Teacher Rating Form; YSR ¼ Youth Self-Report Form.
www.jaacap.org
1233
LOADES et al.
associated with later anxiety.63,71,78 Two of these studies the general population (peer mentoring81 and classroom
assessed social anxiety, and one measured anxiety as a broad based82 (Table 4). In both instances, the comparator was no
construct. One study did not find that loneliness/social intervention/with follow-up and education as usual. A
isolation at age 5 years was associated with anxiety at age 12 relatively intensive peer mentor program, with an adult
years.72 One study of young adolescents found differences by mentor, 4 to 6 hours per month for 4 months on average,
sex, with loneliness being associated with later social anxiety reduced loneliness and mental health problems (small to
in male participants but not female participants.71 None of medium effects) for victims of bullying and victimization.
these studies measured loneliness during childhood. However, a brief (two-session) universal classroom-based
Other mental health outcomes reported over time program delivered in schools including psychosocial sup-
included internalizing symptoms which were associated port through peer mentors and a staff mental health support
with prior loneliness in primary school age children,64 and team did not reduce loneliness. Neither intervention spe-
suicidal ideation during adolescence, which was not asso- cifically addressed mental health problems that had devel-
ciated with prior loneliness during childhood.74 oped in the context of loneliness; therefore, we are unable to
answer our second review question, which was what in-
Impact of Social Isolation in an Infectious Disease terventions are effective for individuals who have developed
Context mental health problems as a result of social isolation or
One study60 reported on mental health and social isolation loneliness.
in the context of different infections, including H1N1, se-
vere acute respiratory syndrome, and avian flu (Table 2).
This retrospective study included 398 parents of exposed DISCUSSION
children from the United States, Canada, and Mexico, of This rapid systematic review of 63 studies of 51,576 par-
whom 20.9% experienced social isolation and a further ticipants found a clear association between loneliness and
3.8% had been quarantined. Parents of children reported on mental health problems in children and adolescents.
their child’s experience of trauma and on their current Loneliness was associated with future mental health prob-
mental health. One-third of parents whose children had lems up to 9 years later. The strongest association was with
been subjected to disease containment measures said that depression. These findings were consistent across studies of
their child had needed mental health service input because children, adolescents, and young adults. There may also be
of their pandemic-related experiences. The most frequently sex differences, with some research indicating that loneliness
reported diagnoses were acute stress disorder (16.7%), was more strongly associated with elevated depression
adjustment disorder (16.7%), grief (16.7%), and post- symptoms in girls and with elevated social anxiety in
traumatic stress disorder (PTSD) (6.2%). Two different boys.70,71 The length of loneliness appears to be a predictor
parent-reported measures of PTSD symptoms found that of future mental health problems.73 This is of particular
those children exposed to disease containment measures relevance in the COVID-19 context, as politicians in
scored significantly higher for PTSD symptoms post- different countries consider the length of time that schools
pandemic. On the PTSD Checklist Civilian Version, 28% should remain closed, and the implementation of social
of children who had experienced isolation/quarantine scored distancing within schools.
about the cut-off for PTSD, compared to 5.8% of those Furthermore, in the one study that examined mental
who had not experienced isolation/quarantine. Similarly, on health problems after enforced isolation and quarantine in
the UCLA PTSD Reaction Index, 30% of children who previous pandemics, children who had experienced
experienced isolation/quarantine scored above the cut-off enforced isolation or quarantine were five times more
for PTSD, compared to 1.1% of those who had not expe- likely to require mental health service input and experi-
rienced isolation/quarantine (effect size: Cramer V ¼ enced higher levels of posttraumatic stress. This suggests
0.449). Mean scores were four times higher in the isolated/ that the current social distancing measures enforced on
quarantined group than in those who had not been isolated/ children because of COVID-19 could lead to an increase
quarantined. The most common trauma symptoms in the in mental health problems, as well as possible post-
quarantined/isolated group were avoidance/numbing traumatic stress. These results are consistent with pre-
(57.8%), re-experiencing (57.8%), and arousal (62.5%). liminary unpublished data emerging from China during
the COVID-19 pandemic, where children and adolescents
Interventions aged 3 to 18 years are commonly displaying behavioral
Two randomized controlled trials measured loneliness and manifestations of anxiety, including clinginess, distraction,
mental health outcomes following an intervention aimed at fear of asking questions about the pandemic, and
TABLE 4 Study Description and Relevant Findings: Intervention Studies
Age
Author range at
(year), Total N (% male baseline, Mean Loneliness Mental health Comparison
country Sample participants) y age (SD) measure measures Intervention condition Main findings
King et al. Experienced 218 (33. 5) 12e15 13. 50 Revised UCLA Reynolds LET’S CONNECT No treatment At 6 months,
(2018),81 bullying/ (1. 1) Loneliness Adolescent (LC) mentorship loneliness
USA Victimization, Scale Depression program decreased more
recruited via ScaleL2 short; (strengths-based in LC
paediatric Columbia approach) intervention
medical Suicide Severity Mentorship group than in
emergency Rating Scale lasted an control group
services average of (p < . 01)
120.32 days ES [ 0.4
(SD [ 69.69),
4L6 h/mo
Larsen et al. School students 2,254 (NS; 15e19 16. Loneliness Scale Symptom Dream School Education as No significant
(2019), 82 estimate 53). 82 (NS) (modified) Checklist Program; aimed usual. effects on
Norway to change mental health or
psychosocial loneliness for
environment of either
classroom, intervention
including group
through peer
mentors and a
staff mental
health support

team. Two
classes over two
semesters
Note: ES ¼ effect size; NS ¼ not specified.

www.jaacap.org
1235
LOADES et al.
irritability.83 Furthermore, a large survey of young adult duration and the intensity of loneliness, and that separate
students in China has reported that around one in four are peer-related loneliness from parent-related loneliness
experiencing at least mild anxiety symptoms.84 In the could be elucidating.
United Kingdom, early results from the Co-SPACE This rapid systematic review was conducted rapidly, in
(COVID-19 Supporting Parents, Adolescents and Chil- 3 weeks, to inform our response to COVID-19. We double
dren in Epidemics) online survey of more than 1,500 screened 20% of all articles and data extracted. In line with
parents suggest high levels of COVID-19related worries Cochrane rapid review guidance,10 gray literature, and trial
and fears, with younger children (aged 410 years) registry databases were not searched, hand-search strategies
significantly more worried than older children and ado- were not used, and only English-language publications were
lescents (aged 1116 years).85,86 included, meaning that some relevant studies may have
In addition to the more direct effects of enforced been missed. During the rapid data extraction phase, there
isolation and quarantine, loneliness as an unintended was no scope to contact authors to request any missing
consequence of disease containment measures seems to information. The main limitation of this review is the lack
be particularly problematic for young people.5,7 This of high-quality studies investigating mental health problems
may be because of the particular importance of the peer after enforced isolation. All but one study investigated social
group for identity and support during this develop- isolation that was not enforced on young people and was
mental stage.87,88 This propensity to experience loneli- not common across a peer group. The effect of widespread
ness may make young people particularly vulnerable to social distancing could mitigate against the social isolation
loneliness in the COVID-19 context, which, based on described with increased use of Internet-mediated relation-
our findings, may further exacerbate the mental health ships, which can be beneficial to adolescents.92 Most studies
impacts of the disease containment measures. More were cross-sectional, and therefore the direction of the as-
studies have examined the relationship between loneli- sociation cannot be inferred. Few studies used independent
ness and depression than between loneliness and anxiety. (ie, not self-report) measures of mental health or social
Losing links to other people and feeling excluded can isolation/loneliness, thereby increasing the risk of bias.
result in an affective response of depression.89 Social Furthermore, the studies were mainly observational and did
anxiety was more strongly associated with loneliness than not consistently control for potential confounders. The
other anxiety subtypes. This may be because social majority of studies focused on depression and anxiety, and
anxiety is triggered by a perceived threat to social re- other mental health problems are important to measure in
lationships or status.90 future research.
It is difficult to predict the effect that COVID-19 will However, we used all available evidence on social
have on the mental health of children and young people. isolation and loneliness to inform the likely outcome for
The subjective social isolation experienced by study par- healthy children and adolescents subjected to social isola-
ticipants did not mirror the current features of social tion. The results were consistent across all study method-
isolation experienced by many children and adolescents ology for depression (but less so for anxiety), suggesting that
worldwide. Social isolation was not enforced upon the these results are reliable. The results are also consistent with
participants, nor was social isolation almost ubiquitous one study investigating mental health problems in chil-
across their peer groups and across the communities in dren60 after pandemics, improving our confidence in the
which they lived. As loneliness involves social compari- results. However, the postpandemic study has several limi-
son,91 it is possible that the shared experience of social tations in that the sample was self-selecting, and the de-
isolation imposed by disease containment measures may mographics of the children and the time elapsed since the
mitigate the negative effects. The studies were also not in experience were not reported. There is little evidence per-
the context of an uncertain but dangerous threat to taining to interventions. We have focused on healthy pop-
health. These features limit the extent to which we can ulations in this review and will report on those with pre-
extrapolate from existing evidence to the current context. existing conditions including mental health problems
To make evidence-based decisions on how to mitigate the elsewhere.
impact of a second wave, we need further research on the
mental health impacts of social isolation in the disease Implications for Policy and Practice
containment context of a global pandemic. In this The review indicates that loneliness is associated with
context, to more specifically understand the impacts of adverse mental health in children and adolescents. There is
loneliness, measures such as the Loneliness and Aloneness limited evidence that indicates specific interventions to
Scale for Children and Adolescents (LACA) that assess the prevent loneliness or to reduce its effects on mental health
and well-being. However, there are well-established prac- face therapies.101 Importantly, reviews have tended to
tical and psychological strategies that may help to promote conclude that effects are better if there is some therapist
child and adolescent mental health in the context of input97,101 and if parents are involved especially for younger
involuntary social isolation, for example, during the children.96,97
COVID-19 pandemic. Reducing the impact of enforced The rapid review suggests that loneliness that may result
physical distancing by maintaining the structure, quality, from disease containment measures in the COVID-19
and quantity of social networks, and helping children and context could be associated with subsequent mental health
adolescents to experience social rewards, to feel part of a problems in young people. Strategies to prevent the devel-
group, and to know that there are others to whom they can opment of such problems should be an international
look for support is likely to be important.8 Finding ways to priority.
give children and adolescents a sense of belonging within
the family and to feel that they are part of a wider com-
munity should be a priority. Therefore, providing accurate
information about the relative risks and benefits of social Accepted May 28, 2020.
media and networking to parents who overestimate the Dr. Loades, Mss. Chatburn, Higson-Sweeney, and Borwick are with the Uni-
versity of Bath, United Kingdom. Prof. Reynolds is with the University of
dangers of allowing their children too much screen time Reading, UK. Prof. Sharan is with UCL Great Ormond Street Institute of Child
may help young people to access the benefits of virtual social Health, London, United Kingdom. Mss. Brigden and Linney and Prof. Crawley
are with the University of Bristol, United Kingdom. Ms. McManus is with the
contact. University of Edinburgh, United Kingdom.
However, simply increasing the frequency of contact The authors have reported no funding for this work. All research at Great
may not address young people’s subjective experience of Ormond Street Hospital NHS Foundation Trust and UCL Great Ormond Street
Institute of Child Health is made possible by the NIHR Great Ormond Street
loneliness.39 Helping young people to identify valued alter- Hospital Biomedical Research Centre. This report is independent research. The
native activities and build structure and purpose into periods views expressed in this publication are those of the author(s) and not neces-
sarily those of the NHS, the NIHR, or the Department of Health and Social
of involuntary social isolation may help to provide a wider Care.
range of rewards.93 Addressing negative thoughts about social Author Contributions
encounters (eg, self-blame, self-devaluation) may also be Conceptualization: Loades, Chatburn, Reynolds, Shafran, Borwick, Crawley
Data curation: Loades, Chatburn, Higson-Sweeney, Brigden, Linney, McManus
effective.30,94 During periods of prolonged social isolation, Formal analysis: Loades, Chatburn, Reynolds
Methodology: Loades, Chatburn, Reynolds
digital technology that provides evidence-based interventions Project administration: Loades, Chatburn, Higson-Sweeney, Borwick
to help young people to reappraise their thoughts and to Supervision: Reynolds, Shafran, Crawley
Writing e original draft: Loades
change their behavior within the confines of the home setting Writing e review and editing: Loades, Chatburn, Higson-Sweeney, Reynolds,
may be particularly welcome. Shafran, Brigden, Linney, McManus, Borwick, Crawley
Although this review did not provide evidence on in- ORCID
terventions to improve social isolation or loneliness in Maria Elizabeth Loades, DClinPsy: https://orcid.org/0000-0002-0839-3190
Eleanor Chatburn, MA: https://orcid.org/0000-0002-6745-6737
healthy children and adolescents, given social distancing, Nina Higson-Sweeney, BSc: https://orcid.org/0000-0002-6926-0463
Shirley Reynolds, PhD: https://orcid.org/0000-0001-9975-2023
digital interventions may be appropriate. A computerized Roz Shafran, PhD: https://orcid.org/0000-0003-2729-4961
self-help program that is based on cognitivebehavioral Amberly Brigden, MSc: https://orcid.org/0000-0002-7958-7881
Catherine Linney, MA: https://orcid.org/0000-0002-3873-3686
therapy (CBT), BRAVE-TA was shown to be effective for Megan Niamh McManus, BSc candidate: https://orcid.org/0000-0002-72
anxiety following the Christchurch earthquake in New 06-3444
Zealand.95 Furthermore, computerized CBT, such as Catherine Borwick, MSc: https://orcid.org/0000-0002-5423-7279
Esther Crawley, PhD: https://orcid.org/0000-0002-2521-0747
MoodGym, SPARX, and “Think, Feel, Do” generally have Disclosure: Dr. Loades has received funding from the National Institute for
small but positive effects on mental health.96,97 Although Health Research (NIHR Doctoral Research Fellowship, DRF-2016-09-021). Ms.
Brigden has received funding from the National Institute for Health Research
mobile applications for mental health have been found to be (NIHR Doctoral Research Fellowship, DRF-2017-10-169). Profs. Reynolds, Sha-
generally acceptable to children and adolescents, there is a fran, Crawley and Mss. Chatburn, Higson-Sweeney, Linney, McManus, and
Borwick have reported no biomedical financial interests or potential conflicts of
lack of convincing evidence of effectiveness on intended interest.
mental health outcomes98 and few mobile health apps have Correspondence to Maria Loades, Department of Psychology, University of
been thoroughly tested.97 Self-help interventions including Bath, Bath, BA2 7AY, England; e-mail: [email protected]
bibliotherapy99 and computerized therapy100 have shown a 0890-8567/$36.00/ª2020 American Academy of Child and Adolescent
Psychiatry
moderate positive effect size when compared to control
https://doi.org/10.1016/j.jaac.2020.05.009
groups although they are generally less effective than face to
LOADES et al.
REFERENCES
1. Brooks SK, Webster RK, Smith LE, et al. The psychological impact of quarantine and 28. Hudson DB, Elek SM, Campbell-Grossman C. Depression, self-esteem, loneliness, and
how to reduce it: rapid review of the evidence. Lancet. 2020;395:912-920. social support among adolescent mothers participating in the new parents project.
2. Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine Adolescence. 2000;35:445-453.
and isolation for infection prevention: a systematic umbrella review of the global 29. Hutcherson ST, Epkins CC. Differentiating parent- and peer-related interpersonal
evidence. Available at: psyarxiv.com/dz5v2/. Published 2020. Accessed April correlates of depressive symptoms and social anxiety in preadolescent girls. J Soc Pers
10, 2020. Relat. 2009;26:875-897.
3. Deighton J, Lereya ST, Casey P, Patalay P, Humphrey N, Wolpert M. Prevalence of 30. Jackson J, Cochran SD. Loneliness and psychological distress. J Psychol. 1991;125:
mental health problems in schools: poverty and other risk factors among 28 000 257-262.
adolescents in England. Br J Psychiatry. 2019;215:565-567. 31. Johnson HD, Lavoie JC, Mahoney M. Interparental conflict and family cohesion:
4. Perlman D, Peplau LA. Toward a social psychology of loneliness. Pers Relat. 1981; predictors of loneliness, social anxiety, and social avoidance in late adolescence. 2001.
3:31-56. Available at: https://doi.org/10.1177/0743558401163004. Accessed September
5. Oxford ARC Study. Achieving resilience during COVID-19 weekly report 2. 2020. 29, 2020.
Available at: http://mentalhealthresearchmatters.org.uk/achieving-resilience-during- 32. Kim O. Sex differences in social support, loneliness, and depression among Korean
covid-19-psycho-social-risk-protective-factors-amidst-a-pandemic-in-adolescents/. college students. Psychol Rep. 2001;88:521-526.
Accessed May 22, 2020. 33. Koenig LJ, Isaacs AM, Schwartz JA. Sex differences in adolescent depression and
6. Young Minds. Coronavirus report March 2020. 2020. Available at: https:// loneliness: why are boys lonelier if girls are more depressed? J Res Personal. 1994;
youngminds.org.uk/media/3708/coronavirus-report_march2020.pdf. Accessed May 28:27-43.
24, 2020. 34. Lasgaard MG, L, Bramsen RH, Trillingsgaarf T, Elklit A. Different sources of loneliness
7. Mental Health Foundation. Loneliness during Corona-virus. 2020. Available at: https:// are associated with different forms of psychopathology in adolescence. J Res Personal.
www.mentalhealth.org.uk/coronavirus/loneliness-during-coronavirus. Accessed May 2011;45:233-237.
22, 2020. 35. Lau S, Chan DW, Lau PS. Facets of loneliness and depression among Chinese children
8. Wang J, Lloyd-Evans B, Giacco D, et al. Social isolation in mental health: a con- and adolescents. J Soc Psychol. 1999;139:713-729.
ceptual and methodological review. Soc Psychiatry Psychiatr Epidemiol. 2017;52: 36. Majd Ara E, Talepasand S, Rezaei AM. A structural model of depression based on
1451-1461. interpersonal relationships: the mediating role of coping strategies and loneliness. Noro
9. World Health Organization. Rapid reviews to strengthen health policy and systems: a Psikiyatr Ars. 2017;54:125-130.
practical guide. Geneva: World Health Organization; 2017. 37. Mahon NE, Yarcheski A, Yarcheski TJ. Mental health variables and positive health
10. Garritty CG, G, Kamel C, et al. Cochrane Rapid Reviews. Interim guidance from practices in early adolescents. Psychol Rep. 2001;88:1023-1030.
the Cochrane Rapid Review Methods Group. 2020. Available at: https://methods. 38. Markovic A, Bowker JC. Social surrogacy and adjustment: exploring the correlates of
cochrane.org/rapidreviews/sites/methods.cochrane.org.rapidreviews/files/public/ having a "social helper" for shy and non-shy young adolescents. J Genet Psychol. 2015;
uploads/cochrane_rr_-_guidance-23mar2020-v1.pdf. Accessed September 29, 2020. 176:110-129.
11. Ganann R, Ciliska D, Thomas H. Expediting systematic reviews: methods and im- 39. Matthews T, Danese A, Wertz J, et al. Social isolation, loneliness and depression in
plications of rapid reviews. Implement Sci. 2010;5:56. young adulthood: a behavioural genetic analysis. Soc Psychiatry Psychiatr Epidemiol.
12. Tricco AC, Antony J, Zarin W, et al. A scoping review of rapid review methods. BMC 2016;51:339-348.
Med. 2015;13:224. 40. Mclntyre JCW, J, Corcoran R, Harrison Woods P, Bentall RP. Academic and non-
13. Manuell ME, Cukor J. Mother Nature versus human nature: public compliance with academic predictors of student psychological distress: the role of social identity and
evacuation and quarantine. Disasters. 2011;35:417-442. loneliness. J Ment Health. 2018;27:230-239.
14. National Institutes of Health. Study Assessment Tools. 2018. Available at: https:// 41. Moore D, Schultz NR Jr. Loneliness at adolescence: correlates, attributions, and coping.
www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools. Accessed May J Youth Adolesc. 1983;12:95-100.
22, 2020. 42. Mounts NS, Valentiner DP, Anderson KL, Boswell MK. Shyness, sociability, and
15. Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred Reporting parental support for the college transition: relation to adolescents’ adjustment. J Youth
Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. PLoS Med. Adolesc. 2006;35:68-77.
2009;6:e1000097. 43. Neto F, Barros J. Psychosocial concomitants of loneliness among students of Cape
16. Westfall J, Yarkoni T. Statistically controlling for confounding constructs is harder than Verde and Portugal. J Psychol. 2000;134:503-514.
you think. PLoS One. 2016;11:e0152719-e0152719. 44. Purwono U, French DC. Depression and its relation to loneliness and religiosity in
17. Alpaslan AH, Kocak U, Avci K. Gender-related factors for depressive symptoms in Indonesian Muslim adolescents. Mental Health Religion Culture. 2016;19:218-228.
Turkish adolescents. J Child Adolesc Psychiatr Nurs. 2016;29:23-29. 45. Richardson C, Oar E, Fardouly J, et al. The moderating role of sleep in the relationship
18. Arslan G. School belongingness, well-being, and mental health among adolescents: between social isolation and internalising problems in early adolescence. Child Psy-
exploring the role of loneliness, Aust J Psychol. 2020;1-10. chiatry Hum Dev. 2019;50:1011-1020.
19. Baskin TW, Wampold BE, Quintana SM, Enright RD. Belongingness as a protective 46. Roberts RE, Chen YW. Depressive symptoms and suicidal ideation among Mexican-
factor against loneliness and potential depression in a multicultural middle school. origin and Anglo adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:81-90.
Couns Psychol. 2010;38:626-651. 47. Singhvi MK, Sehgal SR, Kumari N. Psychological correlates of loneliness among ad-
20. Brage D, Meredith W, Woodward J. Correlates of loneliness among midwestern adolescents. Indian J Psychol Sci. 2011;2:8.
olescents. Adolescence. 1993;28:685-693. 48. Spithoven AW, Lodder GM, Goossens L, et al. Adolescents’ loneliness and depression
21. Brage D, Campbell-Grossman C, Dunkel J. Psychological correlates of adolescent associated with friendship experiences and well-being: a person-centered approach.
depression. J Child Adolesc Psychiatr Nurs. 1995;8:23-30. J Youth Adolesc. 2017;46:429-441.
22. Chang EC, Wan L, Li P, et al. Loneliness and suicidal risk in young adults: does 49. Stednitz JN, Epkins CC. Girls’ and mothers’ social anxiety, social skills, and loneliness:
believing in a changeable future help minimize suicidal risk among the lonely? associations after accounting for depressive symptoms. J Clin Child Adolesc Psychol.
J Psychol. 2017;151:453-463. 2006;35:148-154.
23. Doman LCH, Le Roux A. The relationship between loneliness and psychological well- 50. Stacciarini JM, Smith R, Garvan CW, Wiens B, Cottler LB. Rural Latinos’ mental
being among third-year students: a cross-cultural investigation. Int J Culture Ment wellbeing: a mixed-methods pilot study of family, environment and social isolation
Health. 2012;5:153-168. factors. Community Ment Health J. 2015;51:404-413.
24. Erdur-Baker O, Bugay A. Mediator and moderator role of loneliness in the relationship 51. Stickley A, Koyanagi A, Koposov R, et al. Loneliness and its association with psycho-
between peer victimization and depressive symptoms. Aust J Guidance Counsel. 2011; logical and somatic health problems among Czech, Russian and U.S. adolescents. BMC
21:175-185. Psychiatry. 2016;16:128.
25. Ginter EJ, Lufi D, Dwinell PL. Loneliness, perceived social support, and anxiety among 52. Swami V, Chamorro-Premuzic T, Sinniah D, et al. General health mediates the rela-
Israeli adolescents. Psychol Rep. 1996;79(1):335-341. tionship between loneliness, life satisfaction and depression. A study with Malaysian
26. Heredia D Jr, Sanchez Gonzalez ML, Rosner CM, et al. The influence of loneliness and medical students. Soc Psychiatry Psychiatr Epidemiol. 2007;42:161-166.
interpersonal relations on Latina/o Middle School Students’ Wellbeing. J Latinos Educ. 53. Thomas KK, Bowker JC. Rejection sensitivity and adjustment during adolescence: do
2017;16:338-348. friendship self-silencing and parent support matter? J Child Family Stud. 2013;24:
27. Houghton SH, Carroll JA, Wood L, Baffour B. It hurts to be lonely! Loneliness and 608-616.
positive mental wellbeing in Australian rural and urban adolescents. Journal Psychol 54. Tu Y, Zhang S. Loneliness and subjective well-being among Chinese undergraduates:
Counsel Sch. 2016;26:52-67. the mediating role of self-efficacy. Soc Indic Res. 2014;124:963-980.
55. Uba I, Yaacob SN, Juhari R, Talib MA. Does self-esteem mediate the relationship 78. Wang YT, L, Guo L, Huebner SE. Family dysfunction and adolescents’ anxiety and
between loneliness and depression among Malaysian teenagers? Pertanika J Soc Sci depression: a multiple mediation model. J Appl Dev Psychol. 2020;66.
Humanit. 2012;20:179-188. 79. Zhou J, Li X, Tian L, Huebner ES. Longitudinal association between low self-esteem
56. Vanhalst J, Luyckx K, Raes F, Goossens L. Loneliness and depressive symptoms: the and depression in early adolescents: the role of rejection sensitivity and loneliness.
mediating and moderating role of uncontrollable ruminative thoughts. J Psychol. 2012; Psychol Psychother. 2020;93:54-71.
146:259-276. 80. Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement
57. Wang L, Yao J. Life satisfaction and social anxiety among left-behind children in rural on children during the COVID-19 outbreak. Lancet. 2020;395:945-947.
China: the mediating role of loneliness. J Community Psychol. 2020;48:258-266. 81. King CA, Gipson PY, Arango A, et al. LET’s CONNECT community mentorship
58. Xu J, Chen P. The rural children’s loneliness and depression in Henan, China: the program for youths with peer social problems: preliminary findings from a randomized
mediation effect of self-concept. Soc Psychiatry Psychiatr Epidemiol. 2019;54: effectiveness trial. J Community Psychol. 2018;46:885-902.
1101-1109. 82. Larsen TB, Urke H, Tobro M, et al. Promoting mental health and preventing loneliness
59. Yadegarfard M, Meinhold-Bergmann ME, Ho R. Family rejection, social isolation, and in upper secondary school in norway: effects of a randomized controlled trial. Scand J
loneliness as predictors of negative health outcomes (depression, suicidal ideation, and Educ Res. 2019;1-14.
sexual risk behaviour) among Thai male-to-female transgender adolescents. J LGBT 83. Jiao WY, Wang LN, Liu J, et al. Behavioral and emotional disorders in children during
Youth. 2014;11:347-363. the COVID-19 epidemic. J Pediatr. 2020;221:264-266.
60. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health- 84. Cao W, Fang Z, Hou G, et al. The psychological impact of the COVID-19 epidemic
related disasters. Disaster Med Public Health Prep. 2013;7:105-110. on college students in China. Psychiatry Res. 2020;287:112934.
61. Boivin MH, S, Bukowski WM. The roles of social withdrawal, peer rejection, and 85. University of Oxford. COVID-19’s impact on youth mental health the focus of new
victimization by peers in predicting loneliness and depressed mood in childhood. Dev research. 2020. Available at: http://www.ox.ac.uk/news/2020-03-30-covid-19s-impact-
Psychopathol. 1995;7:765-785. youth-mental-health-focus-new-research. Accessed April 13, 2020.
62. Christ SL, Kwak YY, Lu T. The joint impact of parental psychological neglect and peer 86. Weale S. Fifth of primary children afraid to leave house over COVID-19, survey finds.
isolation on adolescents’ depression. Child Abuse Negl. 2017;69:151-162. 2020. Available at: https://www.theguardian.com/world/2020/apr/10/fifth-of-primary-
63. Danneel S, Nelemans S, Spithoven A, et al. Internalizing problems in adolescence: children-afraid-to-leave-house-because-of-covid-19-survey-finds. Accessed April
linking loneliness, social anxiety symptoms, and depressive symptoms over time. 13, 2020.
J Abnorm Child Psychol. 2019;47:1691-1705. 87. Brown BB, Eicher SA, Petrie S. The importance of peer group (’crowd’) affiliation in
64. Fontaine RG, Yang C, Burks VS, et al. Loneliness as a partial mediator of the relation adolescence. J Adolescence. 1986;9:73-96.
between low social preference in childhood and anxious/depressed symptoms in 88. Meeus W, Dekoviic M. Identity development, parental and peer support in adoles-
adolescence. Dev Psychopathol. 2009;21:479-491. cence: results of a national Dutch survey. Adolescence. 1995;30(120):931-944.
65. Jones AC, Schinka KC, van Dulmen MH, Bossarte RM, Swahn MH. Changes in 89. Beck ATC, Clark DA. Anxiety and depression: an information processing perspective.
loneliness during middle childhood predict risk for adolescent suicidality indirectly Anxiety Research. 1988;88:23-36.
through mental health problems. J Clin Child Adolesc Psychol. 2011;40:818-824. 90. Leary MR. Responses to social exclusion: social anxiety, jealousy, loneliness, depression
66. Ladd GW, Ettekal I. Peer-related loneliness across early to late adolescence: normative and low self-esteem. J Soc Clin Psychology. 1990;9:8.
trends, intra-individual trajectories, and links with depressive symptoms. J Adolesc. 91. Wiseman H. On failed intersubjectivity: recollections of loneliness experiences in
2013;36:1269-1282. offspring of Holocaust survivors. Am J Orthopsychiatry. 2008;78:350.
67. Lalayants M, Prince JD. Loneliness and depression or depression-related factors among 92. Przybylski AK, Orben A, Weinstein N. How much is too much? Examining the
child welfare-involved adolescent females. Child Adolesc Soc Work J. 2015;32: relationship between digital screen engagement and psychosocial functioning in a
167-176. confirmatory cohort study. Available at: https://jaacap.org/article/S0890-8567(19)
68. Lapierre MA, Zhao P, Custer BE. Short-term longitudinal relationships between 31437-6/fulltext. 2019. Accessed July 1, 2020.
smartphone use/dependency and psychological well-being among late adolescents. 93. Pass L, Lejuez CW, Reynolds S. Brief Behavioural Activation (Brief BA) for adolescent
J Adolesc Health. 2019;65:607-612. depression: a pilot study. Behav Cogn Psychother. 2018;46:182-194.
69. Lasgaard M, Goossens L, Elklit A. Loneliness, depressive symptomatology, and suicide 94. Masi CM, Chen HY, Hawkley LC, Cacioppo JT. A meta-analysis of interventions to
ideation in adolescence: cross-sectional and longitudinal analyses. J Abnorm Child reduce loneliness. 2011. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/
Psychol. 2011;39:137-150. PMC3865701/. Accessed April 9, 2020.
70. Liu H, Zhang M, Yang Q, Yu B. Gender differences in the influence of social isolation 95. Moor S, Williman J, Drummond S, et al. ’E’ therapy in the community: examination of
and loneliness on depressive symptoms in college students: a longitudinal study. Soc the uptake and effectiveness of BRAVE (a self-help computer programme for anxiety in
Psychiatry Psychiatr Epidemiol. 2020;55:251-257. children and adolescents) in primary care. Internet Interv. 2019;18:100249.
71. Mak HW, Fosco GM, Feinberg ME. The role of family for youth friendships: exam- 96. Pennant ME, Loucas CE, Whittington C, et al. Computerised therapies for anxiety and
ining a social anxiety mechanism. J Youth Adolesc. 2018;47:306-320. depression in children and young people: a systematic review and meta-analysis. Behav
72. Matthews T, Danese A, Wertz J, et al. Social isolation and mental health at primary and Res Ther. 2015;67:1-18.
secondary school entry: a longitudinal cohort study. J Am Acad Child Adolesc Psy- 97. Grist R, Croker A, Denne M, Stallard P. Technology delivered interventions for
chiatry. 2015;54:225-232. depression and anxiety in children and adolescents: a systematic review and meta-
73. Qualter P, Brown SL, Munn P, Rotenberg KJ. Childhood loneliness as a predictor of analysis. Clin Child Fam Psychol Rev. 2019;22:147-171.
adolescent depressive symptoms: an 8-year longitudinal study. Eur Child Adolesc 98. Grist R, Porter J, Stallard P. Mental health mobile apps for preadolescents and ado-
Psychiatry. 2010;19:493-501. lescents: a systematic review. J Med Internet Res. 2017;19:e176.
74. Schinka KC, van Dulmen MH, Mata AD, Bossarte R, Swahn M. Psychosocial pre- 99. Creswell C, Violato M, Fairbanks H, et al. Clinical outcomes and cost-effectiveness of
dictors and outcomes of loneliness trajectories from childhood to early adolescence. brief guided parent-delivered cognitive behavioural therapy and solution-focused brief
J Adolesc. 2013;36:1251-1260. therapy for treatment of childhood anxiety disorders: a randomised controlled trial.
75. Vanhalst J, Goossens L, Luyckx K, Scholte RH, Engels RC. The development of Lancet Psychiatry. 2017;4:529-539.
loneliness from mid- to late adolescence: trajectory classes, personality traits, and psy- 100. Lillevoll KR, Vangberg HC, Griffiths KM, Waterloo K, Eisemann MR. Uptake
chosocial functioning. J Adolesc. 2013;36:1305-1312. and adherence of a self-directed internet-based mental health intervention with
76. Vanhalst J, Klimstra TA, Luyckx K, Scholte RH, Engels RC, Goossens L. The interplay tailored e-mail reminders in senior high schools in Norway. BMC Psychiatry.
of loneliness and depressive symptoms across adolescence: exploring the role of per- 2014;14:14.
sonality traits. J Youth Adolesc. 2012;41:776-787. 101. Bennett SD, Cuijpers P, Ebert DD, et al. Practitioner review: Unguided and guided
77. Vanhalst J, Luyckx K, Teppers E, Goossens L. Disentangling the longitudinal relation self-help interventions for common mental health disorders in children and adolescents:
between loneliness and depressive symptoms: prospective effects and the intervening a systematic review and meta-analysis. J Child Psychol Psychiatry Allied Discip. 2019;
role of coping. J Soc Clin Psychol. 2012;31:810-834. 60:828-847.
LOADES et al.
TABLE S1 Database Search: Ovid MEDLINE (R)
1 exp Adolescent/ or exp Child/ or exp Child, Preschool/ or exp Infant/ or exp Minors/ or exp Pediatrics/ 35,33,050
2 (adolesc* or preadolesc* or pre-adolesc* or boy* or girl* or child* or infan* or preschool* or pre-school* or 29,51,684
juvenil* or minor* or pe?diatri* or pubescen* or pre-pubescen* or prepubescen* or puberty or teen* or young* or
youth* or school* or high-school* or highschool* or schoolchild* or school child*).tw,kf.
3 1 or 2 47,48,091
4 quarantine*.tw,kf. 4,350
5 exp Quarantine/ 2,093
6 Quarantine.tw,kf. 3,975
7 exp social isolation/ 17,148
8 (isolation and (infect* or SARS or influenza or flu or MERS or ebola or COVID-19)).tw,kf. 34,141
9 exp Loneliness/ 3,552
10 4 or 5 or 6 or 7 or 8 or 9 56,227
11 anxiet*/ or anxious*/ or “anxiety disorder*".tw,kf. 29,320
12 depress*/ or “internal* disord*"/ or “low mood".tw,kf. 737
13 depressive disorder/ 72,188
14 exp depression/ 1,15,922
15 depress*.tw,kf. 4,45,459
16 exp adjustment disorders/ 4,197
17 adjustment disorder*.tw,kf. 1,642
18 low mood.tw,kf. 737
19 obsessive-compulsive disorder.tw,kf. 12,336
20 stress disorders, traumatic/ 672
21 stress disorders, post-traumatic/ 31,840
22 trauma*.tw,kf. 3,53,295
23 (((post-trauma* or posttrauma*) adj stress) or PTSD).tw,kf. 35,040
24 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 8,53,134
25 3 and 10 and 24 1,277
Note: Search conducted March 29, 2020. Full references saved as Medline 290320 v1.
1239.e1 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry
TABLE S2 Database Search: Ovid PsycINFO
1 (adolescent or child or child, preschool or infant or minor or pediatrics).ti,ab,id. 4,25,212

2 (adolesc* or preadolesc* or pre-adolesc* or boy* or girl* or child* or infan* or preschool* or pre-school* or 12,27,549
juvenil* or minor* or pe?diatri* or pubescen* or pre-pubescen* or prepubescen* or puberty or teen* or youth* or
school* or high-school* or highschool* or schoolchild* or school child*).ti,ab,id.
3 1 or 2 12,27,549
4 quarantine.ti,ab,id. 179
5 exp *Social Isolation/ 5,944
6 (isolation and (infect* or SARS or influenza or flu or MERS or ebola or COVID-19)).ti,ab,id. 437
7 Disease containment*.ti,ab,id. 5
8 Lonel*.ti,ab,id. 10,569
9 exp *loneliness/ 3,642
10 4 or 5 or 6 or 7 or 8 or 9 16,688
11 anxiet*/ or anxious*/ or “anxiety disorder*".ti,ab,id. 33,786
12 depress*/ or “internal* disord*"/ or “low mood".ti,ab,id. 673
13 exp *depression/ 19,678
14 depress*.ti,ab,id. 3,01,583
15 exp adjustment disorders/ 719
16 adjustment disorder*.ti,ab,id. 1,851
17 obsessive-compulsive disorder.ti,ab,id. 15,268
18 post-traumatic stress disorder.ti,ab,id. 10,195
19 trauma*.ti,ab,id. 1,07,899
20 (((post-trauma* or posttrauma*) adj stress) or PTSD).ti,ab,id. 44,403
21 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 4,31,601
22 3 and 10 and 21 1,303
Note: Search conducted March 29, 2020. Full references saved as PsycINFO 290320 v1.
Journal of the American Academy of Child & Adolescent Psychiatry www.jaacap.org 1239.e2
LOADES et al.
TABLE S3 Database Search: Web of Science Core Collection
# 22 3,211 #21 AND #10 AND #3

# 21 1,173,555 #20 OR #19 OR #18 OR #17 OR #16 OR #15 OR #14 OR #13 OR #12 OR #11
# 20 64,185 TS[(((post-trauma* or posttrauma*) NEAR stress) or PTSD)
# 19 387,085 TS[trauma*
# 18 15,994 TS[post traumatic stress disorder
# 17 25,733 TS[obsessive compulsive disorder
# 16 22,119 TS[adjustment disorder*
# 15 22,104 TS[adjustment disorders
# 14 627,349 TS[depress*
# 13 494,240 TS[depression
# 12 628,267 TS[(depress* OR " internal* disord* " OR " low mood ")
# 11 283,559 TS[(anxiet* OR anxious* OR " anxiety disorder* ")
# 10 77,296 #9 OR #8 OR #7 OR #6 OR #5 OR #4
# 9 12,570 TS[loneliness
# 8 15,420 TS[Lonel*
# 7 2,586 TS[Disease containment*
# 6 35,721 TS[(isolation and (infect* or SARS or influenza or flu or MERS or ebola or
COVID-19))
# 5 17,794 TS[social isolation
# 4 8,759 TS[quarantine
# 3 3,591,598 #2 OR #1
# 2 3,581,837 TS[(adolesc* or preadolesc* or pre-adolesc* or boy* or girl* or child* or infan* or
preschool* or pre-school* or juvenil* or minor* or pe?diatri* or pubescen* or pre-
pubescen* or prepubescen* or puberty or teen* or youth* or school* or high-
school* or highschool* or schoolchild* or school child*)
#1 2,450,709 TS[(adolescent OR child OR child, preschool OR infant OR minor OR pediatrics)
Note: Search conducted March 29, 2020. Applied ‘English language’ limit ¼ 3,012
1239.e3 www.jaacap.org Journal of the American Academy of Child & Adolescent Psychiatry

Rapid Systematic Review: The Impact of Social Isolation and Loneliness On The Mental Health of Children and Adolescents in The Context of COVID-19 (2020)

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Since January 2020 Elsevier has created a COVID-19 resource centre with

free information in English and Mandarin on the novel coronavirus COVID-

Elsevier hereby grants permission to make all its COVID-19-related

Rapid Systematic Review: The Impact of Social Isolation

TABLE 1 Quality Assessment Tool Adapted From National Institutes of Health14

Were the exposure measures (independent variables) Yes: 1

Was the outcome assessed objectively? Yes or by blinded assessors: 2

Was loss to follow-up after base line 20% or less? Yes: 1

Note: Exposure measures indicate independent variables. SES ¼ socioeconomic status.

FIGURE 1 PRISMA Flow Diagram Showing Search Results

Associations between social isolation/

Social isolation/loneliness and concurrent mental health symptoms

et al. Short Form

Social isolation/loneliness and concurrent mental health symptoms

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

Social isolation/loneliness and concurrent mental health symptoms

subscale from r2 [ 0.089 Social Anx: Lon e SI b [

Social isolation/loneliness and concurrent mental health symptoms

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

Social isolation/loneliness and concurrent mental health symptoms

(2000),43 Portugal students (estimated (1.2): Portugal Loneliness subscale 0.33L0.35

(2019),45 School subscales 0.50 (<.001).

Social isolation/loneliness and concurrent mental health symptoms

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

Social isolation/loneliness and concurrent mental health symptoms

Social isolation/loneliness and concurrent mental health symptoms

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

Child (11 y)/ Is social isolation/loneliness

(1995),61 students (NS) (p < .001) T1 Lon accounted for 8.3% of

(2009),64 (longitudinal 5e9 CBCL (mother

USA (b [ 0.06, p < .001)

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

et al. cohort CBCL isolation

T2 Lon-T3 suicide attempt

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

TABLE 4 Study Description and Relevant Findings: Intervention Studies

REVIEW: SOCIAL ISOLATION AND MENTAL HEALTH

Note: ES ¼ effect size; NS ¼ not speciﬁed.

TABLE S1 Database Search: Ovid MEDLINE (R)

TABLE S2 Database Search: Ovid PsycINFO

1 (adolescent or child or child, preschool or infant or minor or pediatrics).ti,ab,id. 4,25,212

TABLE S3 Database Search: Web of Science Core Collection

# 22 3,211 #21 AND #10 AND #3

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