Executive summary

Background and aim

In March 2020, the World Health Organization declares the COVID-19 outbreak to be a global health crisis. In the more than two years following this declaration, governments over the world take measures to slow down the spread of the virus and to ensure that hospitals can cope with surges of COVID patients. The social distancing regulations and lockdowns have a deep impact on people’s social lives, and many are cut off from in-person contact with family, friends, and some even from their partners, and the wider society.
This report describes the impact of the COVID-19 pandemic on loneliness and social isolation among younger and older adults living in the Nordic countries, with and without disabilities, and in different situations. By means of a literature review of empirical studies on Nordic residents, this report answers the following questions: 1) What was the impact of the pandemic in terms of loneliness and social isolation among various groups in the Nordic countries; 2) Which groups were particularly susceptible to loneliness and social isolation during the COVID-19 measures?; 3) What were the (typical) mechanisms through which COVID-19 measures affected loneliness and social isolation in each group; and 4) Did the findings vary across the Nordic countries, and if so, how?

Methods

A literature review of research on the social impact of COVID-19 was conducted between April 11 and September 22, 2022. We searched the Web of Science, a global citation database giving access to multiple electronic databases, and the WHO Global research database. We selected all articles that (1) focused on the COVID-19 pandemic, (2) reported on experiences of loneliness and/or social isolation as an outcome of the pandemic, and (3) included studies where the study participants came from the Nordic countries. In total, 45 studies provided information that helped us to answer the research questions.

Findings

The social distancing regulations imposed by the government, healthcare institutions, and by people themselves led to a substantial and sudden drop of in-person contact with family, friends, colleagues, neighbours, students, and healthcare professionals in all parts of society. However, while a large proportion of the population were socially isolated during lockdowns, the increase in loneliness was relatively modest in the first wave, at least among healthy people without special support needs, but loneliness increased gradually the longer the pandemic lasted.
For people with underlying health issues and specific needs for support, the negative consequences of the pandemic were more substantial. The loneliest people included severely ill patients in intensive care units (ICUs), hospital patients in general, students, older adults in care homes, and people who self-isolated to mitigate the risk of infecting others or being infected themselves. COVID patients who were hospitalised experienced strong feelings of isolation and loneliness and nightmares, even after being discharged from hospital. Students were disconnected from their peers at a critical time of life marked by complex hormonal, cognitive, behavioural, and social transformations, when support from peers and friends is important. Other people at risk for loneliness were the oldest-old (85+), people with disabilities, those living alone, people with lower education, unemployed people, and those with a psychiatric diagnosis or mental illness. Women had a greater risk of becoming lonely, which may be partly related to other factors that occur more often among women (living alone, unemployment, higher levels of depression).
Another aspect that might have contributed to loneliness was the way in which healthcare institutions and governments communicated regulations on social distancing and adhered to it, especially at the beginning of the pandemic. Some studies mentioned that the communication and instructions were unclear and/or inconsistently followed, especially in the first wave, which lowered trust in institutions and increased concerns. Worrying and low levels of trust are associated with enhanced feelings of loneliness. At the same time, public debate about loneliness raised awareness of who were most at risk of becoming lonely. This encouraged staying in contact with the most vulnerable people by telephone or online and provide practical help. It also raised awareness of a sense that we are all in the same isolated situation together, which may have increased resilience against loneliness even among risk groups. The way in which healthcare professionals coped with the overwhelming number of patients prompted public praise and encouragement for medical staff in hospitals and care homes (e.g., healthcare professionals being publicly applauded).
Our fourth question, about potential differences between the Nordic countries, could not be answered as there were no studies comparing the countries directly. While available data from European and worldwide databases allowed us to compare the statistics about numbers and severity of COVID-19, no direct comparisons could be made on the social impact of the pandemic.

Limitations of the selected studies

Most of the studies included in this review were conducted during the first wave of the pandemic, which means that the findings mainly relate to the first two lockdowns. Most studies were based on one measurement, which does not provide solid information on the impact of the pandemic on loneliness and social isolation. Moreover, healthier, higher educated people and women are often overrepresented, while the loneliest people and oldest-old are often underrepresented. This may have slightly distorted the results.

Advice to policy and practice

Lessons learned so far from the pandemic and its impact on loneliness and social isolation show that it is important to provide a clear and consistent message about the regulations to slow down the spread of the virus. While the impact on loneliness was modest during the first wave, the consequences increased the longer the pandemic lasted. It is essential to focus on groups at risk for loneliness, that is, people in hospital and nursing or care homes, people with disabilities, those with mental diseases, oldest-old and students, and to some extent the lower educated and unemployed people. It is also important to realise that the pandemic-related feelings of loneliness did not disappear immediately for all groups once the social distancing regulations were lifted. This calls for long-term attention to the most vulnerable groups. Interventions seeking to prevent increased loneliness as resulting from social distancing or social isolation should be tailored made, as the one-size-fits-all approach does not do justice to the heterogeneity of the population, especially among the oldest old.
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