The overall aim of this report is to gather new research from the Nordic countries about the social consequences of the COVID-19 pandemic. The knowledge base can serve to support and guide public authorities, experts, organisations, and other Nordic policymakers when dealing with crises and preventing social isolation and loneliness.
Specifically, this report answers four questions; 1) What was the impact of the pandemic on loneliness and social isolation among various groups in 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? Since not enough information was available to answer question 4, our general discussion refers to the first three research questions about the impact, groups at risk, and typical mechanisms through which the pandemic has affected loneliness and social isolation.
The impact of the pandemic on loneliness and social isolation
The social distancing regulations imposed by the government, healthcare institutions, and by people themselves led to a substantial and sudden drop in the number of contacts with family, friends, colleagues, neighbours, students, and healthcare professionals in all parts of society. While a large share of the population were socially isolated during lockdowns, the increase in loneliness was relatively modest during the first wave among the many social groups that did not need special support.
For people with specific needs or diseases and/or who lacked autonomy, the negative consequences of the pandemic were more substantial. The loneliest people were gravely ill patients in intensive care units (ICUs), pregnant women in hospital, students, older people in care homes, and people who self-isolated to protect themselves against infection or were concerned about infecting others. Informal caregivers of demented spouses felt left alone as the formal home care services stopped or significantly reduced. Loneliness did, however, become more severe in all groups the longer the pandemic lasted. Ten months since the beginning of the pandemic, loneliness increased to the point where more people felt lonely than before the pandemic.
In Sweden, there was a remarkable difference in impact between people living in the urbanised area of Stockholm as compared to the general older population. The increase in loneliness was substantial in the urbanised area during the first months of the pandemic (Beridze et al., 2022), but loneliness did not increase in a population-based sample of older adults during the same period (Kivi et al., 2021). This may be due to a higher proportion of people living in less urbanised parts of Sweden, or because the loneliest had dropped out. However, in other studies that considered urbanisation in Norway, there were no remarkable differences between the rural areas and the city (Geirdal et al., 2021a; Hansen et al., 2021b). Perhaps the absence of strict regulations in Sweden during the first wave increased the fear of, and concern about, COVID-19 in urban areas, which according to Hoffart et al. (2021) may have led to the higher prevalence of loneliness in cities, while the less strict regulations compared to the neighbouring countries may have felt as a liberation in the less urbanised parts of Sweden. Further research is needed to substantiate this claim.
Groups at risk
People in hospitals and care homes were hard hit by the social distancing regulations. Family and other people were not allowed to visit them, and they had few opportunities to leave their isolated homes themselves. Voluntary initiatives to help people get out (to nature) were not always successful as some older people did not want to be a burden for others and therefore refused such help (Kulmala et al., 2021). Patients in healthcare institutions as well as pregnant women were suddenly on their own: partners and family were not allowed to visit them, adding additional stress to the already high need for emotional support that remained unfulfilled during lockdown. Students were disconnected from friends and peers at a time of life when many complex hormonal, cognitive, behavioural, and social transformations take place and support from peers and friends is very important. Community-dwelling older people aged 70 and over were advised to self-isolate in Sweden, and many people with underlying illnesses self-isolated for fear of becoming infected.
Fear of infection by the virus was often mentioned by people participating in the studies. Many were even more concerned about their loved ones becoming infected. Worries in turn can easily increase feelings of loneliness. Results from the quantitative studies suggest that the loneliest people during the pandemic were women, young and oldest-old (85+) people, people living alone, people with lower education, unemployed people, and people with a mental illness. These findings are largely in line with studies from before the pandemic on risk factors of loneliness (e.g., Dahlberg et al., 2022), where the most prominent risk factors were not being married/partnered and partner loss; a limited social network; a low level of social activity; poor self-perceived health; and depression/depressed mood and an increase in depressive symptoms.
Typical mechanisms
The social distancing measures isolated people from each other in many if not all social strata of the Nordic societies. Some people also chose to self-isolate, some because of government recommendations (e.g., Swedish people aged 70+) and others out of fear to become infected, which was common among people with COPD or cancer.
Social isolation is an important risk factor of loneliness, but not all socially isolated people became lonely, suggesting that individual or societal factors may have supressed the effect of social isolation on loneliness. The downward comparison with other people in society who are in even worse situations may have contributed to a lower-than-expected level of loneliness. Mechanisms that further helped to reduce the negative impact of social isolation on loneliness may also be attributed to processes in society. People felt that they were not alone in their being alone, and they no longer felt stigmatised for being lonely. Raising the awareness of who was at risk may also have prompted people to stay in contact (online or by telephone) with those most at risk for loneliness or to initiate public action to encourage certain social groups (e.g., public applause for health care professionals).
The consequences of social isolation for loneliness were remarkable for those who most needed the social companionship from their partner, family, or friends. Hence, the loneliest people were severely ill ICU patients, pregnant women in hospitals, people with disabilities, older people in care homes, and people who self-isolated because they were afraid of being infected. Also, the isolation of people with mental illnesses, such as bipolar disorder, anxiety, or depressive symptoms increased the risk of loneliness, apart from some people who felt that reduced social contacts were a relief. Finally, the way in which governments and healthcare institutions communicated rules related to social distancing contributed to loneliness through the overall level of trust that people had in the government or healthcare institution. If people do not trust institutions (government, healthcare institutions, other people), the level of loneliness is high. In some cases, feelings of loneliness have increased as a result of unclear or inconsistent communication and adherence to the general rules.