Psychological Trauma:

Theory, Research, Practice, and Policy

© 2020 American Psychological Association 2020, Vol. 12, No. S1, S55–S57
ISSN: 1942-9681 http://dx.doi.org/10.1037/tra0000703

Loneliness, Isolation, and Social Support Factors in Post-COVID-19

Mental Health
Leia Y. Saltzman, Tonya Cross Hansel, and Patrick S. Bordnick
Tulane University

Social support plays a key role in well-being, yet one of the major preventative efforts for reducing the
spread of COVID-19 involves social distancing. During times of crisis, social support is emphasized as
a coping mechanism. This requires many people to change their typical ways of connectedness and
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

assumes that people have existing healthy relationships or access to technology. The purpose of this
This document is copyrighted by the American Psychological Association or one of its allied publishers.

article was to explore the potential impact of COVID-19 on loneliness and well-being. Social support is
an important consideration for understanding the impact of COVID-19 Psychological First Aid and Skills
for Psychological Recovery, which are tools used to inform response methods to help people connect
during isolation and are interventions that could be adapted to COVID-specific needs for what may be
a prolonged isolation and postisolation. Given the many unknowns of COVID-19, studies are needed to
understand the larger behavioral health impact to ensure resources are available, current, and evidence
informed. Future studies are also needed to understand how access to technology may help buffer
loneliness and isolation and thus improve the social outcomes of the current pandemic.

Keywords: COVID-19, loneliness, social isolation, mental health

Aside from hand washing, the primary preventative efforts for
the COVID-19 disease pandemic are physical restrictions includ-
ing distancing (reduces unknown spread), quarantine (reduces
potential spread), or isolation (reduces spread; Centers for Disease
Control & Prevention, 2020). The economic consequences of these
physical restrictions are most evident (International Monetary
Fund, 2020), but the cultural ramifications are largely unknown—
specifically, how the isolation and loneliness resulting from phys-
ical restrictions will affect the larger population and their mental
well-being. In a systematic review of general social isolation and
loneliness, Leigh-Hunt and colleagues (2017) found associations
with both poorer mental and physical health. The authors noted
that it is difficult to understand causal effects and whether isolation
and loneliness may be outcomes of poorer mental and psychical
health (Leigh-Hunt et al., 2017). During this pandemic, the mes-
saging has also had a negative impact in reinforcing the “you’re
alone or isolated” theme. For example, the term “social distancing”
has been a constant call-to-action on TV, radio, and social media
versus the more appropriate term “physical distancing,” adding to
the perception of isolating oneself socially. Further, this research
Editor’s Note. This commentary received rapid review due to the time-
sensitive nature of the content. It was reviewed by the special section Guest
Editors and the Journal Editor.—KKT
This article was published Online First June 18, 2020.
X Leia Y. Saltzman, X Tonya Cross Hansel, and Patrick S. Bordnick,
School of Social Work, Tulane University.
Correspondence concerning this article should be addressed to Tonya
Cross Hansel, School of Social Work, Tulane University, 127 Elk Place,
New Orleans, LA 70112. E-mail: tcross1@tulane.edu
was compiled from perceived isolation rather than imposed lone-
liness due to disaster response.
Following Hurricane Katrina, social support and community ties
played a crucial protective role in mental health recovery (Chan,
Lowe, Weber, & Rhodes, 2015; Hansel, Osofsky, Osofsky, &
Friedrich, 2013; Weems et al., 2007). In one of the first disaster
studies, on a 1972 mining disaster, bereaved widows reported high
levels of personal, but not community, loneliness (Bahr & Harvey,
1979). Bereavement and grief continue to be relevant regarding
perceived loneliness (Cattan, White, Bond, & Learmouth, 2005;
Valtorta, Kanaan, Gilbody, Ronzi, & Hanratty, 2016), and with the
loss of life associated with COVID-19, this is likely to be ampli-
fied. Symptoms of depression and other serious mental illnesses—
common following disasters (Kessler, Galea, Jones, Parker, & the
Hurricane Katrina Community Advisory Group, 2006) and other
pandemics (Lau et al., 2005; Mak, Chu, Pan, Yiu, & Chan,
2009)—are exacerbated by loneliness and lack of social support
(Wang, Mann, Lloyd-Evans, Ma, & Johnson, 2018). Social sup-
port is also a strong predictor of resilience following disasters and
posttraumatic growth following exposure to trauma and disasters
(Hall et al., 2010; Saltzman et al., 2018; Xu & Ou, 2014). This
literature suggests that social support will not only be important for
reducing negative symptomology but also for promoting positive
adaptation following COVID-19.
Associations among loneliness and neighborhood perception
(Matthews et al., 2019) may also influence postpandemic mental
health, yet we may also see improved social cohesion, similar to
studies following the SARS epidemic in 2003 (Lau et al., 2005).
We can also look to terror management and existential theories
that when confronted by fear of death and increased mortality
rates, individuals may attach more within their primary support
systems. Following the World Trade Center attacks, county-level
data revealed a significant 4-year reduction in divorce rates across

S55
 S56 SALTZMAN, HANSEL, AND BORDNICK
the state of New York, which suggests that individuals postponed
or abdicated planned divorces (Hansel, Nakonezny, & Rodgers,
2011). The sudden tragedy of the attacks led individuals to con-
sider their own mortality and, in order to manage this unexpected
fear, revert to their known support systems. Further, the shared
experience of social distancing may be a protective factor toward
more experiential types of loneliness, but individuals with preex-
isting traumatic experiences or unresolved grief may be particu-
larly vulnerable (Stein & Tuval-Mashiach, 2015). However, these
findings do not take into account preexisting traumas or mental
health concerns, nor do they address the financial, household, and
family strain that may affect social support systems, connected-
ness, and post-bio-disaster mental health (Lau et al., 2005).
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Unique to COVID-19 is the wide access to technology that may
This document is copyrighted by the American Psychological Association or one of its allied publishers.
help buffer loneliness and isolation that lead to exacerbated mental
health problems (Smith, Smith, & Knighton, 2018). Similarly,
Sippel, Pietrzak, Charney, Mayes, and Southwick (2015) noted the
importance of social networks promoting resilience to stress and
trauma. Using technology to socialize may also offer an important
opportunity to meet the unique needs of children and adolescents
(Saltzman, Solomyak, & Pat-Horenczyk, 2017). First-line disaster
interventions, such as Psychological First Aid (PFA) and Skills for
Psychological Recovery (SPR; Ruzek et al., 2007; Wade et al.,
2014), have in their core components social support as a coping
mechanism. Both PFA and SPR have extensive evidence from
providers, trainees, and experts as initial interventions in postdi-
saster settings (Allen et al., 2010; Berkowitz et al., 2010; Forbes et
al., 2010; Fox et al., 2012). Studies on effectiveness for survivors
have noted decreased stress, increased hope (Despeaux, Lating,
Everly, Sherman, & Kirkhart, 2019), and improved perceptions of
social support (Brown, 2019).
Technology needs to be leveraged to raise awareness of self-
care and the use of techniques to promote well-being. The impor-
tance of self-care has been identified as a key practice for behav-
ioral health professionals (e.g., social workers, psychologists) to
support well-being (Miller, Lee, Niu Grise-Owens, & Bode, 2019;
Richards, Campenni, & Muse-Burke, 2010). The negative effects
of the COVID-19 pandemic reach beyond heath and behavioral
health care professionals. Raising awareness on the importance of
self-care to reduce feelings of isolation and anxiety is paramount to
promote well-being for everyone (Butler, Carello, & Maguin,
2017; Kuhn & Flanagan, 2017). In support of this effort, the
Tulane School of Social Work in New Orleans, Louisiana devel-
oped an extensive website dedicated to self-care tools and re-
sources (https://selfcaretips.tulane.edu/). The goal was to develop
a website that provides easy access to tools across the main
self-care areas of meditation/mindfulness, physical activity, social
connectedness, and indulging/fun activities. A key feature was the
development of five meditation videos that are 9 –15 min in length,
to promote use during critical times (e.g., front-line health care
professional could use between patients) and during hectic sched-
ules. Self-care tools can offer an accessible resource to promote
individual coping as a first step in the recovery process.
The American Psychological Association has noted the contin-
ued importance of social support as a COVID-19 response (Amer-
ican Psychological Association, 2020), but this may require others
to branch out from their coping methods. This requires many
people to change their typical ways of connection and assumes that
people have existing health relationships with others. New meth-
ods or outlets of connecting, specific to technology, also bring
about concerns, such as knowledge, access, and safety. It also
disregards existing barriers that may exacerbate loneliness, such as
poor mental health. Future research should assess the effectiveness
of social media as a disaster response tool (Taylor, Wells, Howell,
& Raphael, 2012) and the potential negative aspects, such as
unattainable or picture-perfect standards (Gil-Or, Levi-Belz, &
Turel, 2015). As researchers, we also need to understand the larger
mental health impact to ensure resources are available and that
these survey methodologies include questions on isolation, mental
health symptoms, previous trauma, and social support. As provid-
ers, we need to develop methods to help people connect during
isolation. Consistent with PFA, this begins with targeted commu-
nication and outreach (Reynolds, Deitch, & Schieber, 2007) that
can help normalize mental health response postdisaster and pro-
vides psychoeducation. Existing websites compiled from nonprofit
sources such as the Tulane University School of Social Work
self-care activities and the Centers for Disease Control and Pre-
vention coping activities can help supplement PFA as free and
accessible COVID-specific resources. Next, SPR can help rein-
force or identify positive coping skills and support mental health,
which will need to expand and focus on social media or use of
technology for what may be a prolonged isolation or future need
for periodic social distancing.
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Received April 25, 2020
Revision received May 18, 2020
Accepted May 19, 2020 䡲