The Dose - COVID-19 is Making Us Lonelier: Is There a Way Out?

Episode Date: January 29, 2021

Almost a year into the COVID-19 pandemic, the U.S. faces another health crisis – one of loneliness. Between lockdowns, social distancing, and the fear that contact with others could make us sick, many people are living in isolation. But there are ways to cope. On this episode of The Dose podcast, Matthew Pantell and Laura Shields-Zeeman, researchers at the University of California, San Francisco, talk about how innovative programs from around the world could help mitigate the effects of isolation.

The Dose is a production of the Commonwealth Fund, a foundation dedicated to healthcare for everyone. Hi everyone, welcome to The Dose. We've been talking about COVID-19 for almost a year, but we haven't paid nearly enough attention to another pandemic that people are living through. A pandemic of loneliness. Lockdowns, social distancing, and this constant fear that other humans, even the people we love, could make us sick has meant that many of us are living in isolation. So on today's show, we're talking about what happens to our health when we are deprived of

human contact. My guests are Matt Pantel, a pediatrician and assistant professor at the University of California, San Francisco, and Laura Shields, a researcher at UCSF. Now, Laura is working remotely from her home country, the Netherlands, where she heads the Department of Mental Health at the Dutch Institute for Mental Health and Addiction. Matt, Laura, welcome to the show. Thank you. Thanks so much. So I think everyone who's listening is familiar with what it's like to feel lonely. But to get us on the same page, could you start by explaining what we're talking about when we say social isolation and loneliness.

Absolutely. Yeah, while the concepts are sometimes used interchangeably, what we usually refer to for social isolation is more of an objective term. So the objective lack of social contact with others or limited contact. So if you aren't in a partnered relationship, if you don't speak with friends, if you don't participate in group activities, the lack of those things objectively is what we call social isolation, whereas loneliness is more of a subjective feeling

and it's the perception of social isolation or the subjective feeling of being lonely. And so you could be actually very socially connected. You could have live in a partner relationship and live with someone and participate in groups and talk with friends frequently, but you might still feel lonely. So they're two related but distinct concepts. And I guess when we think about the pandemic, everybody, person before, and that is now cut off because of the pandemic, they might, even though they are now technically more isolated, they might not feel more lonely if they are still keeping up with friends via phone or other communication. So

that's exactly right. Okay, that's really helpful. And so thinking about that time before the pandemic, which is hard to imagine, but anyway, obviously social isolation and loneliness were bad for people's health at that time, even before they were socially distancing. Can you talk a little bit about why? So I think we've seen through quite a substantial body of evidence that weaker social relationships do have a variety or result in a variety of poor

health outcomes. And that goes also for an increased risk of almost all mortality causes of mortality. And we know that also it puts us at risk for symptoms of depression, for instance, which can then have also further effects on our physical health afterwards. It's also been associated with cognitive decline and an increased risk of dementia, as well as with stroke and with heart disease. So we know that there's both a lot of associations with social isolation and loneliness or feelings of loneliness with our physical and our mental health. And studies have shown that that risk is sort of comparable to what traditional clinical risk factors in medicine like obesity and high cholesterol and high blood pressure. And in fact, it's similar to, it's a similar association with mortality as smoking about 15 cigarettes per day. Wow.

If we think about the way that as a society we treat, for example, the ill effects of obesity or the ill effects of smoking, do we have similar approaches to treating isolation and loneliness? I think in the United States right now, we're not treating it like those other risk factors we identify. We're not treating it consistently like that, although there is a growing enthusiasm to address social isolation and loneliness in the context of health settings because they are such strong predictors of mortality and other health outcomes. So that's what both of you do research about, right? Programs both in the US and across the world that have had some success at addressing isolation and loneliness.

Could we talk about some of those programs and your work? Sure, yeah. So we have been working with a group called UCSF's SIREN, which stands for Social Interventions Research and Evaluation Network. And Laura and I are both researchers in that group. And over the last year, what we've been doing is looking at different programs, both in the United States, but also internationally, programs that are designed to address social isolation, loneliness, or both. So we did a big review of all sorts of interventions and programs around the world. And we developed a set of criteria on how to arrive at a set of five key programs or interventions that we thought

would be promising, especially for the US context to delve into further. And those are a combination of group-based interventions that really focus on eliciting positive group dynamics to share experiences of loneliness or social isolation and come up with therapeutic sometimes but also group-based storytelling techniques to really arrive at individual strategies to be taken away from these group settings to reduce feelings of loneliness, or strategies to reduce social isolation. We also looked at several programs which focus on using technological interventions or use of technology, one including a robot that's actually a seal,

which is designed to engage with the user in an interactive way and mimic interactions that you would have socially with other people. And we also focused on a few cases that looked at using simple designed, user-centric designed technology, tablet, a tablet type device to really connect older people much more easily to their family members and friends without having to worry so much about the logistical constraints often encountered with use of technology. So let's get into each of these because they're all interesting and different in their own way. group-based interventions. I imagine that the pandemic has made it particularly difficult to implement these in a way of actually being able

to get a group of people physically together. So how did some of these interventions work before the pandemic and how have they adapted? One of the programs that we interviewed extensively was called Circle of Friends that comes out of Finland. It's been running for quite a few years now all over Finland and its model before the pandemic was based on having a group of older people who identify as lonely come together in a social space. So for instance, a community center, a restaurant, or a public space that they agree upon, and have a group facilitator kind of encourage group dynamics to do a shared activity together and just encourage positive social engagement.

And after time, the group facilitator leaves the group, and the idea is that the group will continue to meet on their own the group facilitator leaves the group and the idea is that the group will continue to meet on their own without the facilitator being there. During the pandemic, there were, of course, lockdown measures in Finland as well to curb the number of cases of COVID-19. And they were exploring at the time of the interviews, possibilities to move some of these group sessions to online using laptops or smartphones. And in some cases, they were also exploring in regions that had identified safe ways to meet in person, for instance, doing a socially distanced walk in a park.

They were also exploring ways to do that. That's really interesting. Let's talk more about socially distanced interactions later. But what are ways in which to make tech more user friendly for older people? One of the cases that we studied really illustrates this, and that was called Comp. And Comp is essentially a user-centered designed tablet, as Laura described it. It's basically the size of a, you know, a, it's the size, I'd say, of a laptop screen, and it stands alone, and it just has one dial on it that's sort of kind of like a radio dial, so you turn it on, and then if it one dial on it that's sort of kind of like a radio dial. So you turn it on, and then if it keeps turning, it's sort of the volume goes up.

And it was developed by a company called No Isolation. And it was developed with older people in mind that weren't as tech savvy or used to using digital products as much as maybe some younger people. And the idea behind it is once you have it installed in someone's home who can then turn it on and off as they please, although many people just keep it on, then other users of the program that are more tech savvy and own iPads and own iPhones. Typically, the model that they talk about is if there's a grandparent who isn't tech savvy, then the grandparents, grandchildren and children can use their iPhones to call into the comp with FaceTime and that video or some face to face mechanism. And then they will appear on that screen without the primary user

having to do anything. There are a number of platforms. In other countries, in New Zealand, you have SeniorNet, I believe. In the Netherlands, you have similar types of programs that offer training to seniors in different formats to bridge that sort of digital divide with using different platforms and different devices. And that's been ramped up during the pandemic to really help move that ahead. You get a phone call on your landline, for instance, which is the case for many seniors, and that you just walk through how to use the device. I've also heard of people sending manuals by mail with pictures on step-by-step instructions on how to use a particular platform. And there's also, at least here in the Netherlands, a very active encouragement publicly to help your neighbors out and help people just around the corner on your streets.

Of course, with a safe distance of one and a half meters and with a mask on, but to also support with this helping your neighbors get set up with, for instance, a laptop over the fence or standing at the door. That's also been shown a lot in our media here. That sounds really helpful. And then the third thing you mentioned was a robot seal. Can you talk about how this is helping people deal with social isolation? It's a robot seal that essentially can be trained sort of by interactions to perform, if you will, for the user actions that it finds sort of more helpful or pleasing. So for example, it is used a lot in people who are experiencing cognitive decline and dementia. And so, for example, if it does something like makes a sound or it makes emotion, you know, and it, you know, it's sort of hit,

it will not do that again. If it makes a sound or emotion and it's pet, you know, it'll do that again. It sort of takes that feedback. And, and, um, you know, during, during the pandemic, we we've spoke with someone who uses it in her, uh, daily practice with, um, with people who are living in nursing homes. And she talked about how, uh, without being able to have visitors come in, she was seeing actually a lot more symptoms of loneliness and of having mental health issues and higher levels of depression and anxiety. She anecdotally said that she thought it was actually more helpful during the pandemic and people were more interested in using it because they were just, in her eyes,

experiencing so much of the sequelae of the social isolation and loneliness. I can imagine. I mean, a lot of the things you've been talking about are programs and interventions for older adults. But I feel like people of all ages have been experiencing increased loneliness right now. Is that the case? Yeah, you bring up a very good point because before the pandemic, a lot of the focus of research and of, you know, a lot of the focus of research and campaigns about social isolation and loneliness

and how harmful they could be were aimed at i'd say adult and even older populations in the united states um you know i've seen much more anecdotally much more interest in talking about this among all populations since the pandemic which i attribute to an increased awareness of loneliness after experiencing all of this social isolation. But, you know, for example, there are studies that have shown that younger adults are actually experiencing increases in loneliness during the pandemic, especially during the first few months after the pandemic started in the United States. Right. Like what about kids who are used to going to school and spending the whole day with their friends? Now they're, they're just stuck at home with maybe a laptop or a tablet or maybe not even. Right. Right. And even one of the people that we were interviewing for our project said that even though the program about which she was talking was focused on adults, you know, she had noticed during the pandemic so many more teenagers and kids this, you know, the effects that social isolation have on, you know, populations of all ages. out as a whole and think about a health system that was really trying to combat loneliness at a

nationwide level before the pandemic hit. Are there any countries that stand out to you? I would say first and foremost is the UK. And it's been widely in the media and reported that there was in 2018, as a result of the Joe Cox Commission report on loneliness, the government decided to take its first steps in addressing loneliness and appointed, I believe, the world's first minister to lead work nationally on tackling loneliness, which they subsequently had a large fund launched in partnership with a number of national foundations. They started to review the evidence base on loneliness, and they, I think, importantly published a strategy for loneliness. And since then, I understand that they've been reviewing about 60 commitments nationally on ways in which they tackle loneliness.

And that's ranged from training frontline workers in the public sector on how to identify loneliness and take action on it. And that includes job center, so employment center staff members. They've expanded substantially their social prescribing strategy, which is essentially thinking about primary care professionals that would instead of prescribe a medication or a treatment, actually prescribe a referral to a community group activity like men's sheds or a community exercise class instead of a treatment or medication and following up on that and training different types of primary care staff to work on social prescribing. They've also done a national campaign on loneliness,

which really brought together a number of businesses and organizations to get involved. And importantly, I think they've also made funding available, not only to collect data at the municipality level on loneliness to be able to understand how trends change over time, but they've also made funding available for research. And as Matt just spoke about, one of the areas that we don't know as much about in terms of interventions and strategies

for loneliness and social isolation is for young people. And funds available in the UK have started to explore possibilities to do projects and intervention development in that. I wonder if from everything, all the programs that you're looking at, are there lessons for the US from other countries that could help us as we return to normal, emerge from the pandemic of loneliness?

I guess some lessons we can learn are that one, we can incorporate programs or essentially practices that do facilitate social connection, even in a socially distanced way. So I'll say, for example, we looked at a lot of programs and we looked at whether they changed their programs during the pandemic to accommodate social distancing. And a lot of them did. And whether that was implementing guidelines such that instead of groups meeting inside, they met outside with masks, socially distance, exercise classes were converted, you know, converted to online classes. You know, there were a lot, there was lots of innovation that occurred to accommodate social distancing. So I think one thing we can learn from programs abroad and in the United States is that there

are ways to set up safe practices to promote social connection, even in the face of social distancing. And we saw that innovation come rapidly. And just to add to what Matt just said is that I think with a lot of the programs that we spoke to and looked into, a key component across them was creating a supportive environment where people felt comfortable and psychologically safe to share their experiences of loneliness and also other factors that might have influenced that trajectory over time. And I think the pandemic has, well, only amplified the need to find alternative ways online,

for instance, to create that safe space, to create that supportive environment where we can share what we're going through on a daily basis, what we are struggling with at different phases of the pandemic, how our experiences are changing. So I think that having that supportive environment and finding ways to create it as our daily lives change is something that we can keep going from the programs we spoke to. And the second is that, you know, feelings of anxiety or depression or stress are pretty normal reactions to an unprecedented situation like this. And I think that we don't fully know what the scale of the adverse mental health impacts of the pandemic are going to be yet. But I do see one relevant thing to do is that during the pandemic,

a lot of mental health services, helplines, digital interventions got a boost and were much more low threshold for people to access in times of need. And I would really encourage that easy access to such services to continue even after the pandemic has subsided in order to make sure that it can address the needs that might emerge or be staggered over time according to what's needed in the population. The Dose is hosted by me, Shanur Sirvai. I produced this show along with Joshua Tallman for the Commonwealth Fund. Special thanks to Barry Scholl for editorial support, Jen Wilson and Rose Wong for our art and design,

and Paul Frame for web support. Our theme music is Arizona Moon by Blue Dot Sessions with additional music from Poddington Bear. Our website is thedose.show. There you'll find show notes and other resources. That's it for The Dose.

Thanks for listening.