AMITY INSTITUTE OF BEHAVIORAL AND

ALLIED SCIENCES

B.A. (Hons.) Applied Psychology (2020-2023)

Term paper on

Social isolation and mental

health

Supervised by: Submitted by:

Dr. Ruchi Joshi Zainab Zakir Hussain

Assistant Professor B.A.(Hons) Applied Psychology

Second Semester
 Introduction
Social isolation and loneliness are both terms that show the severity of disconnection from society. While
social isolation is the physical lack of connection with the outside world, loneliness is more subjective and
in often cases the result of social isolation. Humans are said to be social animals, social interactions are
necessary for us to maintain our wellbeing. Risks related to social isolation are getting more talked about
due to the onset of the COVID19 pandemic.

What is social isolation?

Social isolation in simple words would be lack of social interactions and refusal to participate in social
situations. Most of us crave solitude in our lives, some more than others, it is meditative and refreshing.
But the social isolation discussed is the one that has lasting effects. There are some common red flags to
look out for when a person is socially isolating themselves, as discussed below-

 Avoiding any social interactions, even the ones they once enjoyed
 Canceling plans or wishing they would get canceled, feeling relief when they do
 Anxiety and panic surges when thinking about social interactions
 Not feeling happy or satisfied during periods of isolation
 Feeling exhausted and dread related to social activities
 Spending large amounts of time alone and avoiding and extremely limited human interactions

What causes social isolation?

 Abusive relationships- people in abusive environments tend to be socially withdrawn, maybe due to
the fear of the abuser or to avoid revealing their situation.
 Loss of a loved one- Deaths are tragedies that take a long time to heal from, people in mourning
many times want to stay alone and isolated to mourn in peace.
 Mental health issues- Individuals with anxiety, depression, and low self-esteem can be the by
causes of social isolation but many times they also initiate it.
 Remote locations- individuals in remote are, such as military bases, etc can feel isolated staying far
away from family and friends.
 Social media- while the world has become smaller due to social media, so have the number of
social interactions, since it is possible to have conversations without actually meeting
 Unemployment- the shame and guilt related to losing a job can be overwhelming and lead to the
individual wanting to “not face the world”
  Physical distancing- amid a pandemic it has become a necessity to stay away from human contact
for our safety and that of others.

High-risk groups

Some groups are separated and socially isolated more than the general population

 Marginalized groups- LGBTQ+ groups, people of color in a white-dominated country, and others
who are oppressed and constantly marginalized
 Older adults, many elderlies have suffered through the loss of family and friends throughout their
lives and feel socially isolated and alone
 Immigrants and those who are unable to speak the language of the country they’re living in can
limit social interactions very much.
 Individuals and children who are immunocompromised are forced to isolate due to the health risks
associated
 People with chronic illnesses and disabilities who are unable to leave their house without a
caretaker or nurse often have limited social interactions

Pandemic and its Repercussions

The COVID 19 pandemic has bought the world into chaos and on its knees, with the whole world scared
and unsure of how to handle a pandemic of such scales, something not many alive has seen or even thought
of seriously. One of the biggest things that highlighted the pandemic was the long and seemingly unending
lockdown, while some countries have successfully ended theirs, some countries like India are still
struggling to get control over the situation.

When asked most people only have something negative to say about their mental health during the
pandemic. What seemed like a long two-week holiday, in the beginning, has now prolonged to two years
and the end of the tunnel seems far.

The COVID19 pandemic has prompted the execution of extraordinary "socially isolating" techniques
restricting the spread of the infection. Those affected are forced to isolate and isolation systems for the
individuals who have been affected with Coronavirus, social isolation has been upheld among everyone to
decrease the transmission of the virus.

The danger of contamination is more noteworthy for individuals beyond 60 years old who are at an
uplifted danger of serious disease, hospitalization, emergency unit, and passing. the case casualty rate is
about 4% for patients more than 60 years of age, 8% for patients over age 70 years, and roughly 15% for
patients beyond 80 years old. This contrasts and CFR of 0.0026%–0.3% in those under age 45. (Dr. Kluge
Hans, 2020)

People are experiencing irritability, emotional disturbances, insomnia, depression, PTSD symptoms after
the quarantine period, the long-term impact of this is apparent and could range from anger issues to
substance abuse and compulsive disorders.

In general, people suffering from mental health disorders are told to socialize as a part of therapy, but what
happens when socializing becomes too dangerous. with “stay at home”, “physically distanced” etc
becoming a new normal routine, the vulnerability to mental illness such as anxiety and depression is
visible clearer than ever. The key principle of effective mental health care is close engagement and
involvement with the client, which is hard to maintain from a distance or through online mediums.

Another part of worsening mental health would be the discrimination associated with any sort of disease,
during the Ebola outbreak in 2014 individuals of African descent were discriminated against,
discrimination against Hispanics during the H1N1 flu outbreak, and the recent hate crimes against Asians
due to the COVID19 pandemic.

Lockdowns have increased the durations of people staying home, in turn being more exposed to abusive
partners, parental figures, caretakers et, this puts a raise in the possibilities of domestic violence, sexual
abuse, etc with no way out for a very long time, inducing helplessness and hopelessness.

With the older adults being high at-risk individuals, their activities have come to a halt even after some
leniency in the COVID protocols, before the outbreak, they attended community programs, church/
religious gatherings, meeting with even far-away family, with such a sudden stop to all of them, they might
be at high risks of developing, anxiety and depression.

Since isolation and quarantine from loved ones is the norm of the current world situation, it can often
precipitate depression and anxiety and often feel they are being ripped off their purpose of living. Isolation
is known to cause a lot of stress which can exacerbate feelings of anxiety and uncertainty.

Indian perspective

Mental illness is still a taboo in Indian society, while searching for depression, you often see an old man
sitting in front of a computer screen in a dark room, such stock images couldn’t be farther from the reality,
with depression being one of the most common disorders among teens and young adults, the conversations
around it are awfully few.

Ironically enough the generation of the social networks are shown to be more isolated than the rest, many
people in their 20s and 30s are more in contact with their phone than with their friends and family’s youth
is engaging in anything but social interactions, whether it be social media or substance abuse or even the
adrenaline spiking things, they’re all addicted to something. It’s not all negatives, many times the
loneliness can lead to lifestyle modifications such as fitness, outdoor adventures traveling, etc.

The situation in India is even if you want to overcome your need to isolate, the availability of professionals
is very low. With only 3.827 psychiatrists and 898 clinical psychologists, the options are limited and not
easy to reach.

By conservative estimates, nearly 150 million people in India suffer from one or the other sort of mental
disorders, some severe, some not, some severe just not getting treated. There are 4 psychiatric nurses, 2
psychologists, and 2 psychiatric social workers for every 10 million peoples, a shockingly small ratio when
compared to other countries, and this is for the urban settings, the rural areas that are about 70 to 80% of
the population, there are if we are being generous 2 mental health professionals per million people. (WHO,
2005)

When the government of India announced its first lockdown, some were happy for a long vacation, and
most were worried about their livelihood. The long period of lockdown destroyed the routine of citizens
affecting their well-being physically and mentally. The researches that are done in this period all suggests
that while the lockdown could be a boon in controlling the pandemic, it will have lasting effects on the
economy and wellbeing of the Indian population.

Older Adults and Social Isolation

The outbreak of COVID-19 will have a long-term and profound impact on the health and well-being of
adults around the world. Social isolation and loneliness can be major risk factors affecting the health
outcomes of adults. Other strategies to address these issues can be implemented in many countries. These
measures include: raising awareness of the health and medical effects of isolation and loneliness for all
health workers and members of the public; to develop interventions for new technology to gather resources
from family members, community-based networks, and resources that address social isolation and
loneliness in older adults; and involve the health care system to begin the process of building mechanisms
to identify social isolation and loneliness in health care facilities

Increasing evidence suggests that social isolation affects the health and well-being of individuals. Studies
have found that social isolation and loneliness are major risk factors associated with poor physical and
mental health: high blood pressure, heart disease, obesity, decreased physical activity, depression, anxiety,
mental retardation, increased risk. of Alzheimer's disease(In a study showed the risk of AD was doubled in
lonely individuals) and mortality. Social isolation is associated with an almost 50% risk of intellectual
disability, 29% increased risk of a cardiovascular event and 32% increased risk of stroke. We need to
realize that social isolation from efforts to reduce the spread of COVID-19 can simultaneously increase the
risk of these adverse effects, which could have a significant impact on their health and well-being.
(National Academies of Sciences, Engineering, and Medicine. 2020)

While each country has asked its citizens to keep social distance, this message of social distancing can be
misleading. Public messaging, keeping physically away from social media, is even more important than
ever. Studies have shown that social support can mediate social isolation and improve the state of mental
health. It is important to integrate resources from family members, community-based networks, and
resources that address social isolation and loneliness in older adults. There are also great opportunities for
older adults to volunteer to provide much-needed peer support for individuals. In our first project, we
found that many older adults, including the oldest (85+ years old), we're actively contributing to support
their families, friends, and neighbors, such as providing friendliness, comfort, cooking, and shopping for
others. In old age homes, family and staff can play an important role in helping residents connect with the
community through technology, such as video and social media.

A Storm of Risks for Depression related to the Pandemic

The natural pressures that characterize this particular moment in history clearly suggest the dangers of this
new disease, and in this case, there are signs that it may be our mental health; but the national health
system, too, may not be ready to prevent the effects of the epidemic.

As the reality of social isolation continues throughout and outside of crime, loneliness and isolation will
arise, especially for those most at risk in society. Mental fatigue, anxiety, fear and pain, sadness, trauma,
and anger - these feelings change, come together, and intensify into depression, leading to significant
clinical psychological disorders, such as "active depression."

While the COVID-19 problem increases the risk of depression, stress affects a person's ability to solve
problems, set and achieve goals, and work effectively, in the workplace and relationships, making recovery
more difficult. Even if it seems different, based on depression there is always a state of despair. Gradually
people lose any kind of motivation to face life's difficulties: there is an increasing tendency to complain, to
let go of power, and to rely entirely on others for their management, all acts of power transfer, and
therefore to refuse.

Feeling safe and secure is a basic human need so the fact that we could roam around freely without fearing
our lives to now having to be afraid of falling sick brings about a feeling of insecurity and paranoia, often
making us feel powerless or having no control over our lives. When all of this fails, when the belief that
anything we do will not improve matters begins to emerge, the feeling of “learned worthlessness” grips,
hinders any relief or change.

Moreover, the psychological consequences of this brand-new form of isolation called "social or physical
isolation" should not be underestimated. Loneliness, fear and anxiety, and the intense grief of losing a
loved one, the most common fears require care that goes beyond the practices of hand washing and
wearing a mask. All the wandering of the empty streets of the city not only reminds us that the worst
plague of the century is upon us but the best response to social care with us is also with us. Also, if the
virus is contagious, so is hope.

Coping with Social Isolation

It is important that you know when you are fighting against isolation. Awareness is the first step in
building strategies for coping with a healthy lifestyle. To deal with isolation, try to:

 Being outdoors is beneficial for your mental and physical health. Natural light can help boost your
mood and vitamin D in sunlight can reduce symptoms of depression. While the pandemic is
looming upon us, opening the window, going out on a balcony or a garden, etc can also improve
your mood immensely.
 Reconnect with your interests. If you find that you have little time for yourself, think about a
particular hobby that you once enjoyed or wanted to pursue. Pursuing a new hobby can refresh your
mind and give you something good to think about.
 Get used to taking care of yourself. It is important to combat the stress responses that come with
social isolation. Depression can cause problems with your breathing, blood pressure, muscles, and
more. Take time to relax in a way that works for you, whether it’s a warm bath with cool music or a
meditation program.
 Log in with people you know. When you are isolated, it is easy to feel that people are doing well
without you. It is a common fulfillment of loneliness brought about by loneliness, and it is often not
true - unless it causes you to withdraw from others and treat them as if you know they don't care.
 Instead, challenge what you think and achieve. You may find that your friends and acquaintances
need you just as much as you need them.
 It is important for people living in isolation to have self-care strategies. This is especially true when
the factors contributing to segregation present real barriers to accessing external resources. For
example, an outbreak of disease may limit a person's access to health care. People living in remote
areas may not have easy personal access to mental health professionals.
 People can reduce the negative effects of isolation by taking steps to address the challenges posed
by isolation:
 Engage in leisure activities. Exercise and exercise, reading, listening to music, meditating and
praying, writing stories, and hobbies can help reduce the stress that can be associated with isolation.
 Follow the schedule. Daily routines promote a sense of purpose and common sense.
 Maintain healthy habits. Eating well, getting enough sleep, and exercising can promote better
mental health.
  Stay connected. If circumstances limit contact, calls, email, messaging, social media, and
videoconferencing may be used to keep in touch.
 Stay informed. Keeping informed can be very important for those who are separated because of a
serious threat, such as an outbreak. Learning the facts about their dangers can help people to avoid
panic. That being said, controlling the use of the media is also helpful --– excessive exposure to
negative news can alleviate anxiety.

Hikikomori

Hikikomori (“pulling inward, being confined"), is overall withdrawal from society and in search of severe
levels of social isolation and confinement. Hikikomori refers to the phenomenon when an individual
isolates themselves and completely disconnects from society or social situations. Hikikomori was defined
as loners or "modern-day hermits. Estimates recommend that 1/2 of 1,000,000 Japanese youths have grown
to be social recluses, in addition to greater than 1/2 of 1,000,000 middle-elderly people.

The Japanese Ministry of Health, Labour, and Welfare defines hikikomori as a situation wherein the
affected people refuse to leave their parental house, and isolate themselves far from society and their circle
of relatives in a room for a duration exceeding six months. The psychiatrist Tamaki Saitō, who coined this
term defines hikikomori as "a state that has become a problem by the late twenties, that involves cooping
oneself up in one's own home and not participating in society for six months or longer, but that does not
seem to have another psychological problem as its principal source"( Saitō 2012)

While symptoms clash with those of anxiety or other mental health disorders, hikikomori is something
much more severe, during a diagnosis, trained professionals evaluate for,

 Spending most of the day nearly every day staying indoors

 Marked and persistent avoidance of relationships and social situations
 Functional impairment due to social withdrawal symptoms
 No medical or physical explanations for the social withdrawal symptoms
 Persistence of withdrawal for more than 6 months
 No diagnosis of schizophrenia, intellectual disability, and bipolar disorder
 People who can maintain interpersonal relationships are excluded (Teo, Alan ,8 November 2012)

Not only does a hikikomori individual lose a few years in their existence in isolation, the circumstance
additionally influences their family. Typically, Japanese parents of hikikomori patients devote years to
make sure their child’s simple residing wishes are met. This way there are rarely natural triggers to push
them to get help. Mental health, in addition to academic and social care services, is too regularly catered to
responding to greater dramatic or seen problems. This leaves households feeling caught and isolated.
While many humans experience the pressures of the out of doors world, hikikomori reacts with the aid of
using whole social withdrawal. In a few greater intense cases, they isolate themselves from their bedrooms
for months or years at a time. They normally have few or no friends. In interviews with present-day or
recuperating hikikomori, media reviews and documentaries have captured the robust degrees of mental
misery and angst felt by those individuals.

While hikikomori favors indoor activities, a few go outdoors occasionally. The withdrawal from society
normally begins off evolved gradually. Affected humans can also additionally seem unhappy, lose their
friends, emerge as insecure and shy, and communicate less.

The prevalence of hikikomori individuals is high in Japan; the Japanese government released figures
stating that there are 700,000 individuals within japan with an average age of 31.There is the first
generation of hikikomori who are ow in their 40s, their reintegration into society is difficult as they’ve
spent over 20 years in isolation, especially concerns when they turn 60 and their parents are no longer
alive(Hoffman, Michael ,9 October 2011). There are estimates that about 1.55 million people on the verge
of becoming hikikomori. Tamaki Saito who first coined the term says there are over one million
Hikikomori individuals in japan, but there are no factual pieces of evidence to prove this, as the parents of
hikikomori individuals often hide and refuse the fact. (Saitō 1998)

Hikikomori is like the social withdrawal showed by certain individuals with chemical imbalance range
issues, a gathering of formative problems that incorporate, PDD-NOS and mental imbalance. This has
driven a few specialists to recommend that hikikomori might be influenced by chemical imbalance range
problems and different issues that influence social coordination, yet that their issues are changed from their
average Western show due to Japanese sociocultural pressures. Suwa and Hara (2007) found that 5 of 27
instances of hikikomori had high-functioning pervasive developmental disorder (HPDD), and 12 more had
different issues or mental sicknesses,10 out of 27 had essential hikikomori. The analysts utilized a vignette
to outline the distinction between essential hikikomori (with no undeniable mental issue) and hikikomori
with HPDD or other disorders. Alan Teo and partners led itemized symptomatic assessments of 22 people
with hikikomori and found that while most of the cases satisfied rules for different mental conditions,
around 1 of every 5 cases were essential hikikomori. To date, nonetheless, hikikomori is excluded from the
DSM-5, due to deficient data.

Albeit the association between present-day correspondence advances, like the Web, web-based media, and
computer games, and the marvel isn't definitively settled, it is considered in any event a worsening element
that can extend and support withdrawal. Past investigations of hikikomori in South Korea and Spain
tracked down that some of them gave indications of Web compulsion, however, scientists don't believe this
to be the fundamental issue. Computer games and web-based media have diminished the measure of time
that individuals spent outside and in friendly conditions that require direct up close and personal
interaction. The development of cell phones and afterward cell phones may likewise have developed the
issue, given that individuals can proceed with their dependence on gaming and internet surfing anyplace,
even in bed.

The Japanese training framework, similar to those found in China, Singapore, India, and South Korea, puts
extraordinary requests upon youth. A large number of assumptions, high accentuation on rivalry, and the
repetition retention of statistical data points to finish selection tests into the following level of training in
what could be named an unbending pass-or-bomb philosophy, incite an undeniable degree of stress. The
expectations often lead these individuals into isolation, from shame or trauma of not meeting the
unrealistic expectations (Rohlen 1992).
Review research
Global level

The vast majority of people may be affected by loneliness or isolation. In 2018, a national study conducted
by the Henry J. Kaiser Family Foundation, AARP, and Cigna examined an increase in loneliness,
estimated at 22, 35 percent, and 47 percent, respectively. Differences may be the result of differences in
sample design and measurement. Even with the most conservative measures, loneliness affects one in five
adults. Because demographic data are not always collected, it is difficult to determine whether loneliness is
on the rise. However, using the same approach as in its 2018 study, in 2020 Cigna reported that loneliness
among Americans increased to 61 percent in 2019, from the previously reported 47 percent.

More than two in ten report loneliness or social isolation in the U.K. and the U.S., double the share in
Japan. Loneliness appears to occur in parallel with reports of real life problems and circumstances. Across
the three countries, people reporting loneliness are more likely to report being down and out physically,
mentally, and financially. In Japan, majorities say loneliness has had a negative impact on their mental
health (75 percent), physical health (63 percent), and personal relationships (59 percent), and nearly half
say it’s had a negative impact on their ability to do their job (47 percent). In the U.S. and U.K., many say
their loneliness has had a negative impact on their mental health (58 percent and 60 percent, respectively)
and about half say it’s had a negative impact on their personal relationships (49 percent and 55 percent)
and their physical health (55 percent and 49 percent). In terms of their ability to do their job, about a third
in the U.S. and the U.K. say their loneliness has had a negative impact. (DiJulio B, Hamel L. Munana C,
Brodie M, KFF, 2018)

In contrast to loneliness, data on several social classification scores are regularly collected in US censuses,
which allows for reliance on prevalence levels and follow-up over time. For example, more than a quarter
of the U.S. population lives alone, and the average house size decreases. Few Americans will marry, have
children, and participate in social activities such as religion and devotion than they did decades ago. In
addition, nationwide research shows that the median size and diversity of roles on social media have
decreased. While all of these things are signs of social isolation, they may not cause that. In addition, many
older people have more symptoms, making the accuracy of distribution rates difficult to measure.
However, the evidence points to an important segment of the American population as a social exclusion in
some way and shows that other scores are increasing. That reporting loneliness appear to lack meaningful
connections with others

Gen Z (adults ages 18-22) has the highest loneliness score (48.3), and the Greatest Generation (adults ages
72+) are the least lonely (38.6). Americans who live with others are less likely to be lonely (average
loneliness score of 43.5) compared to those who live alone (46.4). Respondents defined as very heavy
users of social media have an average loneliness score (43.5) not markedly different from those who never
use social media (41.7). Those who have daily meaningful in-person interactions have an average
loneliness score that is 20 points lower than those who 20 never have in-person interactions (39.6 versus
59.6). Nearly nine in ten (88%) of those who have daily in-person interactions say their overall health and
mental health is good, very good or excellent, while around half of those who never have in-person
interactions say the same. People who feel good, very good or excellent about their physical health and
mental health have average loneliness scores that are lower (41.6 for both) than those who rate their
physical/mental health as fair or poor (49.6 and 54.5, respectively). Therefore, the inhibitory factors
described earlier may vary between ages. Importantly, apart from these related differences, loneliness was
experienced in all ages and circumstances. (Cigna 2020)

This systematic review of 63 investigations of 51,576 members tracked down a reasonable relationship
between loneliness and emotional well-being issues in kids and youths. Loneliness was related to future
emotional wellness issues as long as after 9 years. The most grounded affiliation was with depression.
These discoveries were predictable across investigations of youngsters, youths, and youthful grown-ups.
There may likewise be sex contrasts, with some examination showing that depression symptoms were
alleviated in girls and with raised social uneasiness in boys. The length of depression seems, by all
accounts, to be an indicator of future psychological wellness problems. This is of specific importance in
the Coronavirus setting, as government officials in various nations consider the time allotment that schools
ought to stay shut and the execution of social separating inside schools.

Besides, in the one investigation that analysed psychological wellness issues after implemented seclusion
and isolation in past pandemics, youngsters who had encountered upheld detachment or isolate were
multiple times bound to require emotional well-being administration input and experienced more
significant levels of posttraumatic stress. This recommends that the current social removing measures
implemented on youngsters as a result of Coronavirus could prompt an expansion in psychological
wellness issues, as well as could be expected posttraumatic stress. These outcomes are steady with primer
unpublished information rising out of China during the Coronavirus pandemic, where kids and teenagers
matured 3 to 18 years are normally showing social indications of anxiety, including clinginess, distraction,
fear of asking questions about the pandemic, and irritability. Moreover, a huge review of youthful grown-
up understudies in China has detailed that around one out of four is encountering, in any event, gentle
tension symptoms.84 In the Assembled Realm, early outcomes from the Co-SPACE (Coronavirus
Supporting Guardians, Young people, and Kids in Pestilences) online overview of over 1,500 guardians
propose undeniable degrees of Coronavirus 19−related concerns and fears, with more youthful kids
(matured 4−10 years) fundamentally more stressed than more established youngsters and young people
(matured 11−16 years). (Jiao W.Y., Wang L.N., Liu J 2020;2021)

Notwithstanding the more straightforward impacts of authorized disengagement and isolation, as an unseen
side-effect of illness control measures is by all accounts especially tricky for youthful people. This might
be a direct result of the specific significance of the friend bunch for character and backing during this
formative stage. This inclination to encounter forlornness may make youngsters especially powerless
against depression in the Coronavirus setting, which, given our discoveries, may additionally compound
the emotional well-being effects of the sickness regulation measures. More examinations have analyzed the
connection between loneliness and depression than between loneliness and anxiety. Losing connections to
others and feeling barred can bring about an emotional reaction of depression. Social uneasiness was more
emphatically connected with forlornness than other nervousness subtypes. This might be because social
uneasiness is set off by an apparent danger to social connections or status.

It is hard to anticipate the impact that Coronavirus will have on the emotional wellness of youngsters and
youngsters. The abstract social disengagement experienced by study members didn't reflect the current
highlights of social confinement experienced by numerous youngsters and youths around the world. Social
segregation was not upheld upon the members, nor was social separation practically universal across their
friend gatherings and across the networks wherein they lived. As depression includes social comparison, it
is conceivable that the common experience of social disengagement forced by infection regulation
measures may moderate the adverse consequences. The investigations were likewise not with regards to an
unsure but rather perilous danger to wellbeing. These highlights limit the degree to which we can
extrapolate from existing proof to the current setting. To settle on proof put together choices concerning
how to alleviate the effect of a subsequent wave, we need further examination on the psychological well-
being effects of social disengagement in the illness control setting of a worldwide pandemic. In this unique
circumstance, to all the more explicitly comprehend the effects of dejection, measures like the Loneliness
and Aloneness Scale for Children and Adolescents (LACA)that evaluate the length and the power of
depression, and that different friend related depression from parent-related depression could be explaining.

Indian Researches

The number of studies reviewed is very few because there were only a few studies done in India between
the years 1991 to 2019, these studies attempted to understand the loneliness along the spectrum of different
age groups. The study done by Bhogle (1991), showed that adolescents scored higher on loneliness as
compared to other adult participants. Another study by Samantha (2012) reported a difference in the self-
reported loneliness among rural and urban adolescents, 17.3% among urban and 9.5% among rural
adolescents. A study done by Nayyar and Singh in 2011 sampled young people with 22 years as average
age, showed 60% higher scores on loneliness. These are clear indications that adolescents and early
adulthood are periods when individuals may get overwhelmed and choose to isolate themselves and thus
increased loneliness.

This is a serious mental health concern for India, which already has a high burden of mental disorders
among children, moreover special subgroups, PLHIV, for example, the loneliness was 66% among them,
associated with educational, marital, residence and opportunistic infection (Mishra et al., 2013). The
elderly population is also one that suffers through loneliness because as important is social support in other
stages of life, during old age it becomes all the more important and crucial. (Singh and Mishra,2009). The
way individuals perceive loneliness depends also on their culture and religions, as both heavily influence
daily life, Hindis scored higher than those practicing Islam and Christianity. While the proportions
remained similar for adolescents, Christan men and women showed an increase (Bhogle, 1991)

Another aspect that has to lead to an increase in loneliness is a decline in stable close relationships and the
overall stress of expectations put on individuals by the society, in a collectivist country like India,
individualism is becoming the new norm, and the stress shifts to independence rather than
interdependence, eventually resulting in loneliness. (Bhogle, 1991)

Other studies have emphasized the roles of social isolation in loneliness, and significant connection to
depression, efforts need to be made to establish and maintain contacts regularly, barriers to participation in
social activities should also be considered when taking measures. Another huge contributor is the increased
and easily available use of the internet, youth who has now become addicted to the web use it excessively
to spend less time in social situations, escapism is on the rise.

Another thing that has changed over time is the belief that having a joint or extended family could be an
assurance against loneliness and social isolation, people living in a joint family have still shown the same
levels of loneliness, as the interactions have decreased and the use of social media has increased.

The studies on the psychological impacts of loneliness and isolation have been increased as the situation
has become prevalent amidst the pandemic. One such study done showed that about two-fifths of the
general public participants, were experiencing anxiety disorders and depression and nearly three fourth had
moderate levels of stress and poor mental well-being within only the first two weeks of the lockdown.
Another national study had shown a 28.4% increase in PTSD and sleep disturbances. (National Academies
of Sciences, Engineering, and Medicine. 2020.)

Fear of disease can give rise to new psychiatric symptoms in those already suffering from a mental illness
and cause distress to their caregivers and others involved. Many who have no exposure can have mental
breakdowns due to experiences of fear and anxiety related to the virus and its associated disease,
helplessness or blaming those who are sick are all triggering points. As discussed earlier the fear and
anxiety that comes with a disease lead to discrimination, for example, people from Wuhan the origin of the
virus were blamed for the worldwide crisis, eventually to it being called the “China virus” and increased
hate crimes against Asians in the US, results of which were heart-breaking and scary, fatalities and injuries
were high and the high Asian population feared to leave their homes.

Another study to explore quarantines psychological impact on individuals due to the pandemic. The study
findings show a high prevalence of depression and anxiety, there is a significant increase as compared to
the pre-pandemic studies done. The most probable cause is the fear instilled in the general population
regarding the pandemic, which was not so intense or deep-rooted in the study as it was still done in the
early stages of the pandemic. (Desai M, Khan A, Kulkarni R, Hegde B, 23Sep.2020)

Considering the other factors, depression was shown to be associated with age, gender, location, and
occupation. Women are shown to be more prone to depression for many reasons, the stress of balancing
professional and personal lives. Males of age 14-25 i.e., Adolescents and young adults are more prone than
older men. The age groups that are interested and addicted to social media are at risk as they're exposed to
the rumours, false pieces of information, and the public chaos that is shown very clearly on social media
platforms, these also tend to show unrealistic lifestyles and induce insecurities and expectations. (Desai M,
Khan A, Kulkarni R, Hegde B, 23Sep.2020)

The study showed a high prevalence of anxiety disorders among the participants within the age group 21-
50 years or the working class, a clear indicator of the economic crisis and its effect on mental health.
Fasquilho concluded that economic recession, unemployment, low income, and debt are raising the rates of
mental disorders, substance abuse, and suicidal behaviors. (Desai M, Khan A, Kulkarni R, Hegde B,
23Sep.2020)

The study noticed significant anxiety and depression in the community as a response to the pandemic,
about 41.5% of Karnataka’s general population has anxiety and 46.8% depression. Anxiety was more
common among 31-40 years and depression among 21-30 years. Depression in females is more prevalent
as compared to the male population of the city, and the association of anxiety and depression with youth
and females shows the population at risk of psychological disorders amidst a global crisis. (Desai M, Khan
A, Kulkarni R, Hegde B, 23Sep.2020)

The lack of studies on rural populations makes it difficult to assess the severity of the situation in a
majority part of the Indian population, other reasons include lack of education and Hindi based tests and
questionnaires made for the specific rural population, to get accurate test results and to figure out how to
move ahead from there.

There is also a need for more conversation on the mental health of the population and the youth socially
isolating themselves more and more every day, need for an increase in the education and interventions
related to the percussions of the pandemic farther than the physical and economic ones, though those are
still pressing matters, the trauma and other psychological distress that will come out of this pandemic will
have lasting and grave effects.

Hikikomori Research

Very limited and reliable data exists on Hikikomori, the strongest comes from a review of three studies that
study 12 cities and approx. 4000 people. It showed 0.9% to 3.8% had a history of hikikomori. Another
survey by Okinawan researchers for over 1600 families in 2002 and found 14 cases, which if we were to
extend this data for the whole country of japan, we get approximately 410,000 cases.

A relatively large three-month study conducted by Japanese child psychiatrists examined 463 cases of
those under 21 years old with an ongoing or past diagnosis of hikikomori. According to the DSM-5
criteria, the top diagnosis with multiple diagnoses possible was Pervasive development disorder,
adjustment disorder, generalized anxiety disorder, OCD, and schizophrenia.

A multicentre study examining older cases found somewhat similar diagnostic and undiagnosable cases.
The criteria for inclusion were, patients had to be 16-35 with the onset of social isolation before reaching
30 and a minimum of 6 months of social withdrawal. 97 cases the patent presented, which was challenging
as the basic symptom of this is the refusal to leave their rooms. The diagnosis was made according to
DSM-5 criteria with the presence of one psychiatrist and three other allied mental health professionals.

Results showed that 8 out of 97 had schizophrenia, 25 had an anxiety disorder, 8 had a mood disorder, 7
had an adjustment disorder, 22 had personality disorders, 4 had OCD. 27 were first diagnosed in infancy,
childhood, or adolescence (including 10 with intellectual disability, 7 with autism, 5 with Asperger
syndrome, 3 with the pervasive developmental disorder) and 6 had other conditions.

the irony of the term hikikomori has achieved such popularity in use and recognition that it may now be
unintentionally overshadowing the diagnosis, its term so widely used in conversation and literature it will
ultimately lead to demise amongst clinicians. In the Japanese society where the term clinical depression is
taboo, leave be schizophrenia, hikikomori is broadly accepted socially. Hikikomori is the sugar coating of
the much more bitter underlying mental disorder.

There are three arguments about hikikomori and its psychiatric diagnosis,

1. The cases are often but not always classifiable according to DSM-5
2. It may be considered a culture-bound syndrome
3. Its merits require further consideration and research into if it should be classified as a psychiatric
disorder

Very simply there is insufficient undefinable evidence for Hikokomori meeting criteria of DSM-5 and
ICD-10, but rejecting it would be a statistical equivalent of a type II error. It is possible to meet the criteria
if further and extensive researches are done globally in the area. Nonetheless, to suggest that the
combination of large-scale hikikomori in Japan, the persistence of such reports across multiple decades,
and recent empirical data supporting undiagnosable cases are good enough evidence for the culturally
bound syndrome of hikikomori and potentially a new psychiatric disorder.
 Conclusion

Isolation is the lack of social contact that leads to loneliness. A person suffering from it is cut off from
normal social networks, which can happen due to factors such as loss of mobility, unemployment, or even
health issues. One may end up staying at home for a long time. This condition brings about loneliness since
it effects an individual's ability to make social connections. Loss of mobility, unemployment, and health
problems can trigger this condition. Those who isolate themselves can remain at home for a long period of
time.

Increasing evidence suggests that social isolation affects the health and well-being of individuals. Studies
have found that social isolation and loneliness are major risk factors associated with poor physical and
mental health: high blood pressure, heart disease, obesity, decreased physical activity, depression, anxiety,
mental retardation, increased risk. of Alzheimer's disease (In a study showed the risk of AD was doubled in
lonely individuals) and mortality.

We need to realize that social isolation from efforts to reduce the spread of COVID-19 can simultaneously
increase the risk of these adverse effects, which could have a significant impact on their health and well-
being. Mental fatigue, anxiety, fear and pain, sadness, trauma, and anger - these feelings change, come
together, and intensify into depression, leading to significant clinical psychological disorders, such as
"active depression." While the COVID-19 problem increases the risk of depression, stress affects a
person's ability to solve problems, set and achieve goals, and work effectively, in the workplace and
relationships, making recovery more difficult. When all of this fails, when the belief that anything we do
will not improve matters begins to emerge, the feeling of “learned worthlessness” grips, hinders any relief
or change.

There is the first generation of hikikomori who are ow in their 40s, their reintegration into society is
difficult as they’ve spent over 20 years in isolation, especially concerns when they turn 60 and their parents
are no longer alive. This has driven a few specialists to recommend that hikikomori might be influenced by
chemical imbalance range problems and different issues that influence social coordination, yet that their
issues are changed from their average Western show due to Japanese sociocultural pressures.
 References
AACN (American Association of Colleges of Nursing). 2006. The essentials of doctoral education for
advanced nursing practice. Washington, DC: American Association of Colleges of Nursing.

AACN. 2008. The essentials of baccalaureate education for professional nursing practice. Washington,
DC: American Association of Colleges of Nursing.

Barger, S. D., N. Messerli-Bürgy, and J. Barth. 2014. Social relationship correlates of major depressive
disorder and depressive symptoms in Switzerland: Nationally representative cross sectional study. BMC
Public Health 14(1):273.

Barrett, A. E., and C. Gumber. 2019. Feeling older and driving less: The effect of age identity on older
adults’ transition from driving. Innovation in Aging 3(1):1–8.

Bhogle, S. (1991). Perception of loneliness as an index of culture and age. Psychological Studies.

Barth, J. S., Schneider, S., and von Känel, R. (2010). Lack of social support in the etiology and the
prognosis of coronary heart disease: a systematic review and meta-analysis. Psychosom. Med. 72, 229–
238. doi: 10.1097/PSY.0b013e3181d01611

Cao W., Fang Z., Hou G. The psychological impact of the COVID-19 epidemic on college students in
China. Psychiatry Res. 2020;287:112934.

Curtin, A., D. C. Martins, C. Gillsjö, and D. Schwartz-Barcott. 2017. Ageing out of place: The meaning of
home among Hispanic older persons living in the United States. International Journal of Older People
Nursing 12(3):e12150.

Czaja, S. J., W. R. Boot, N. Charness, W. A. Rogers, and J. Sharit. 2018. Improving social support for
older adults through technology: Findings from the PRISM randomized controlled trial. Gerontologist
58(3):467–477.

Dagenais, C., M. C. Laurendeau, and M. Briand-Lamarche. 2015. Knowledge brokering in public health:
A critical analysis of the results of a qualitative evaluation. Evaluation and Program Planning
53(2015):10–17.

Danese, A., T. E. Moffitt, H. Harrington, B. J. Milne, G. Polanczyk, C. M. Pariante, R. Poulton, and A.

Caspi. 2009. Adverse childhood experiences and adult risk factors for age-related disease: Depression,
inflammation, and clustering of metabolic risk markers. Archives of Pediatric & Adolescent Medicine
163(12):1135–1143.

Desai M, Khan A, Kulkarni R, Hegde B. The psychological impact of COVID-19 and the subsequent
social isolation on the general population of Karnataka, India. jidhealth [Internet]. 23Sep.2020 [cited
5Jun.2021];3(Special1):190-5. Available from: https://jidhealth.com/index.php/jidhealth/article/view/51
Garritty C.G., G, Kamel C. Cochrane Rapid Reviews. Interim guidance from the Cochrane Rapid Review
Methods Group. 2020.

Hossain, Md & Purohit, Neetu & Khan, Nusrat & Ma, Ping & Bhattacharya, Sudip & Pawar, Priyanka &
Mckyer, Ellisa Lisako. (2020). Prevalence and correlates of loneliness in India: A systematic review.
10.31235/osf.io/x4ctz.

Hughes, M. E., Waite, L. J., Hawkley, L. C., and Cacioppo, J. T. (2004). A short scale for measuring
loneliness in large surveys: results from two population-based studies. Res. Aging 26, 655–672. doi:
10.1177/0164027504268574
Jiao W.Y., Wang L.N., Liu J. Behavioral and emotional disorders in children during the COVID-19
epidemic. J Pediatr. 2020;221:264–266. [

Liu H., Zhang M., Yang Q., Yu B. Gender differences in the influence of social isolation and loneliness on
depressive symptoms in college students: a longitudinal study. Soc Psychiatry Psychiatr Epidemiol.
2020;55:251–257.

Mak H.W., Fosco G.M., Feinberg M.E. The role of family for youth friendships: examining a social
anxiety mechanism. J Youth Adolesc. 2018;47:306–320.

Miller, G. (2011). Social neuroscience. Why loneliness is hazardous to your health. Science 331, 138–140.
doi: 10.1126/science.331.6014.138
National Academies of Sciences, Engineering, and Medicine. 2020. Public–Private Partnerships for Global
Health at the National, Municipal, and Community Levels: Proceedings of a Workshop—in Brief.
Washington, DC: The National Academies Press. https://doi.org/10.17226/25904.

Nayyar, S. & Singh, B.. (2011). Personality correlates of loneliness. Journal of the Indian Academy of
Applied Psychology. 37. 163-168.

Przybylski A.K., Orben A., Weinstein N. How much is too much? Examining the relationship between
digital screen engagement and psychosocial functioning in a confirmatory cohort study. 2019.

Przybylski A.K., Orben A., Weinstein N. How much is too much? Examining the relationship between
digital screen engagement and psychosocial functioning in a confirmatory cohort study. 2019.

Qualter P., Brown S.L., Munn P., Rotenberg K.J. Childhood loneliness as a predictor of adolescent
depressive symptoms: an 8-year longitudinal study. Eur Child Adolesc Psychiatry. 2010;19:493–501.

Shankar, A., McMunn, A., Banks, J., and Steptoe, A. (2011). Loneliness, social isolation, and behavioral
and biological health indicators in older adults. Health Psychol. 30, 377–385. doi: 10.1037/a0022826

Sprang G., Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters.
Disaster Med Public Health Prep. 2013;7:105–110.

University of Oxford COVID-19’s impact on youth mental health the focus of new research. 2020.
Weale S. Fifth of primary children afraid to leave house over COVID-19, survey finds. 2020.